AWARENESS AND ACCEPTABILITY OF CERVICAL CANCER SCREENING AMONG FEMALE OF REPRODUCTIVE AGE

1.1 Introduction

Cervical cancer is the most common form of cancer among women in developing countries. Hospital based data in Nepal also showed cervical cancer is most commonly occurring cancer among women in Nepal. Pap smear is the very significant screening test for reduction of incidence and mortality from cervical cancer and many developing countries failed to obtained high coverage of target population (Sherpa et al., 2015). Possible reasons for a low participation in cervical cancer screening include; ignorance of the existence of such test, ignorance of importance of screening or lack of risk awareness and the risk factors to the development of cervical cancer, absence of symptoms and lack of awareness of centers where such services are obtainable, and lack of motivation to get screened (Aniebue & Aniebue 2010).

As a prelude to other parts of this study, this chapter will discuss the background upon which this study was initiated, the statement of problems that led to this study, the Aim and Objectives of the study. Others are Significance of the study, Scope of work, Limitations of the Study and Definition of technical terms.

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1.2 Background of Study

Cervical cancer is the most common malignancies among females worldwide especially in women of 20–39 years of age. Its contribution to cancer burden is significant across all cultures and economies. Cervical cancer also accounts for over 270,000 deaths worldwide, an overwhelming majority of which occur in the less developed regions (Imam, 2008). Globally there are over 500,000 new cases of cervical cancer annually and in excess of 270,000 deaths, accounting for 9% of female cancer deaths. 85% of cases occur in developing countries and in Africa (Campbell, 2008).

Cervical cancer remained the second leading cause of cancer deaths after breast cancer and the fifth most deadly cancer in women, accounting for approximately 10% of cancer deaths (Okonofua, 2007). The developing countries have carried a disproportionate share of the burden and 80 % of the 250,000 cervical cancer deaths in 2005 occurred there (WHO, 2007; Uysal & Birsel, 2009). Cervical cancer is the malignant cancer of cervix uteri or cervical area. This happens when normal cells in the cervix change into cancer cells (Arbyn, 2005). Human Papilloma Virus (HPV) infection is a necessary factor in the development of nearly all cases of cervical cancer. Sexually transmitted human papilloma virus infection leads to the development of cervical intraepithelial neoplasia and cervical cancer (Colgan, 2006).

Thus cervical cancer has been called “a case study in health equity” (WHO, 2008). Mortality rates climb as women enter their forties5. Two million seven hundred (2.7m) age weighted years of life were estimated to be lost to the disease in the year 20006. The biggest impact of high cervical cancer morbidity and mortality in developing countries are on poverty, education and gender equity the first three millennium development goals (Ferlay et al., 2004).

Cervical cancer morbidity and mortality result in huge economic costs over short and long terms. Family members incur overwhelming medical, transportation and other related costs while caring for women with cancer in addition to losing work opportunities (Chang et al., 2004). Reduction in family income due to the financial burden of cervical cancer may affect investment in human capita. As poverty increases, more children especially girls may not only be kept out of school, but also made to contribute to family income through child labour with attendant social, psychological and health consequences7. The teaching profession is dominated by women, cervical cancer can also impact on education when schools lose experienced teachers to the disease (Ferlay et al., 2004).

The differential economic and social impact on women and girls make it more difficult to achieve gender equity. It should be noted that lower levels of female education are linked to decreased maternal and infant health10 – the focus of two other millennium development goals (Ferlay et al., 2007).

The high morbidity and mortality caused by cervical cancer in poor nations of Sub-Saharan Africa and other developing countries if not prevented will greatly affect the attainment of millennium development goals related to poverty, education, gender equity, maternal and infant health, and sustainable development in low resource countries of the world (Ferlay et al., 2007).

Excess morbidity due to cervical cancer also contributes to increasing health care costs. Given the enormous cost of acute and supportive care of chronic conditions such as late-stage cervical cancer (Chang et al., 2004), which frequently presents in Nigeria, effective screening programmes offer a significantly better return on a community and country’s health investment (Chang et al., 2004).

Pap smear is considered the most successful cancer screening tool ever developed (Stoter, 2000). Much like childhood vaccinations, they are thought of as one of the preventive health victories of modern medicine (Stoter, 2000).

Cervical cancer is preventable by instituting cervical cytological screening and treatment of early lesions (UNAIDS et al., 2004). In countries where screening quality and coverage have been high, Papanicolaou screening (Pap test) has reduced invasive cervical cancer by about 70 – 90%14. Unfortunately, only 5% of women in developing countries undergo cervical cancer screening compared to 40 – 50% in the developed world (Gustatsson et al., 1997).

A former World Health Organisation (WHO) Secretary General, Gio Hartem Brundtland submits that all nations should prevent cervical cancer as an investment in humankind, national and global economy. It is an investment into the nations’ and families’ fortunes and future. The importance of the challenge posed by cancer was re-iterated by the World Health Assembly in 2005, in Resolution (Yeo et al., 2000).

Therefore, in University of Benin Female Students where the research was carried out, the activities that was conducted is to know the Knowledge and Acceptability of Cervical Cancer Screening.

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1.3 Statement of Problems

Investigation reveals the problems of the existing research work, which are stated as follows;

1. A lot of female gender has suffered from cervical cancer as a result of poor knowledge or awareness of the cause of cervical cancer contraction;
2. Lack of knowledge of unprotected sexual intercourse, which is a risk factor of Cervical Cancer;
3. Lack of awareness to cervical cancers screening is a major barrier to cervical cancer screening; and
4. The level of awareness of cervical cancer screening is low in Nigeria and other developing countries.

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1.4 Aim and Objectives of Study

The aim of the study is to examine the Awareness and Acceptability of Cervical Cancer Screening Among Female of Reproductive Age. In achieving this aim, the following specific objectives were laid out as follows:

1. To determine the knowledge and acceptability of Cervical Cancer Screening among Female Students in University of Benin;
2. To assess the knowledge, attitude and practice towards cervical cancer and screening among University of Benin Female Students;
3. To carry out health education on cervical cancer and screening for Female Students in University of Benin, which is the intervention group; and
4. To assess the effect of health education on knowledge, attitude and uptake of cervical cancer screening among Female Students in University of Benin.

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1.5 Research Questions

The study came up with research questions so as to be able to ascertain the above stated objectives. The specific research questions for the study are stated below as follows:

• Do you have any knowledge of what cervical cancer entails?
• Does unprotected sexual intercourse is a risk factor of Cervical Cancer?
• Does abnormal vaginal bleeding is a sign of cervical cancer?
• Can cervical cancer be detected by Cervical Cancer screening?
• Is cervical cancer screening is done in hospital?
• Have you had any cervical cancers screening?
• How important is cervical cancer screening?
• Do you have intention of going for Cervical Cancer screening?
• Is lack of awareness to cervical cancers screening is a major barrier to cervical cancer screening?

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1.6 Research Hypothesis

In order to pursue the objective of this study, the following generalized statements have been designed to guide and aids in obtaining the result for the experiment to be conducted. For this work, the null hypothesis will be represented with H0 while the alternative hypothesis will be represented with hypothesis H1.

Hypothesis One

• H0: There is no relationship between knowledge of cervical cancer and acceptability of cervical cancer screening
• H1: There is relationship between knowledge of cervical cancer and acceptability of cervical cancer screening

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1.7 Significance of Study

The following are the relevance of the research work;

1. The teaching profession is dominated by women, when schools lose experienced teachers and bread winners to cancer, it will greatly affect the attainment of millennium development goals related to poverty, education, gender equity, maternal and infant health, and sustainable development in the community, state and the nation (Ferlay et al., 2004).
2. Teachers are stakeholders in health and are means through which the twin goal of health for all and education for all can be achieved. Therefore reducing morbidity and mortality among them through cervical cancer prevention is paramount to the achievement of millennium development goals.

This study will be of immense benefit to other researchers who intend to know more on this study and can also be used by non-researchers to build more on their research work. This study contributes to knowledge and could serve as a guide for other study.

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1.8 Scope of Study

The scope of this research is focused on the Knowledge and Acceptability of Cervical Cancer Screening of Female Students in University of Benin.

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1.9 Limitations of the Study

During the course of this study, many things militated against its completion, some of which are:

1. Time Constraint: The time frame given to accomplish this project was very short due to school academic calendar and it was carried out under pressure which made the researcher not to implement some necessary features.
2. Research material: availability of research material is a major setback to the scope of the study.
3. Frequent power failure: This made the researcher append more money on fuel to ensure sustainable power.
4. Financial Constraint: Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).