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Abstract

The awareness of cervical cancer screening procedure (pap smear) was examined amongst 196 health service users of Regina Mundi Health Centre in Mushin Local Government area, a suburban community. Only 26.02% of the respondents were aware of cervical cancer, 29% of these knew that it was possible to detect cervical cancer early. 15.82% of them were aware of pap smear and about half of these got the right definition.

Very few of them “6.63% had ever done a pap smear, nonetheless more than half of them 65.31% indicated a willingness to participate in a screening exercise. The major source of information about the smear test was the hospital/health worker 41.67%. The indication for doing the pap smear was mainly because an health worker asked them to do it 76.9%.

Methodology

This is a descriptive study carried out among female Health users of the Regina Mundi health facility which is located in Mushin Local Government area of Lagos State, Nigeria.

200 questionnaires were administered. The questions were adapted in line with previous works and model questionnaires like:

1. International Union against cancer (UICC) model questionnaire for health survey on cancer control (UICC, 1976).

2. Lazio region (of Italy) Epidemiological units questionnaire for “Screening of women” as used in knowledge, Attitude and practice of female secondary school Teachers of Oshodi/Isolo LGA, Lagos State. With regard to cervical cancer screening, by Ayeke 1991.

The questionnaire was structured, closed ended and self administered with provision however, for self-expression in some areas. The questions were designed to obtain information regarding respondent’s knowledge of cervical cancer, in general, as well as the value and utilization of pap smear as a screening test. It also attempted to find out reasons for their attitude and practices regarding pap smear.

The questionnaire had three sections:

• Section A: personal data
• Section B: knowledge, attitude and practice in relation to cancer generally and cervical cancer in specific.
• Section C: knowledge attitude and practice of pap smear

The draft questionnaire was pre-tested on five female health users prior to the design of the final form. Confidentiality of respondents was assured before administering the questionnaire.

Sampling Procedure And Data Collection

• Total population was 196 female health users
• Random sampling of first set of people to volunteer
• Data collected in 4 days between 10:00 and 13:00
• Field assistants (10 Dental and Medical Students from LUTH) were trained prior to the data collection
• 50 questionnaires administered daily

Data Analysis

• Compilation and coding done by the author and field assistants.
• Analysis of coded response done using the Excel software.

Results

Table I: Socio-Demographic Characteristics of respondents

Variable	Classification	Frequency	(%)
Age (years)	< 20	15	7.65
	20 – 24	53	27.04
	25-29	63	32.14
	30-34	38	19.39
	35-37	6	3.06
	40-44	7	3.57
	45-50	1	0.51
	51-54	4	2.04
	55-60	1	0.51
	> 60	5	2.55
	No response	3	1.53
Educational Qualification	Primary	19	9.69
	Secondary	110	56.12
	Tertiary	55	28.06
	None	5	2.55
	No response	7	3.57

Table 2: Responses to Statements Concerning Prevention and Cure of Cervical Cancer

Statements	True	False	No response
It is not possible to detect cancer of the cervix early by currently available test	57(29%)	53(27%)	86(44%)
Early detection of cervical cancer improves prognosis	118(60%)	26(13%)	52(27%)
Surgical removal of the womb in the only treatment for cervical cancer	64(33%)	76(39%)	56(28%)

Table 3: Responses to statements concerning basic knowledge about predisposing factors for cervical cancer (n = 196)

Stated predisposing factor	True (%)	False (%)
Early age of starting Coitus	54(27.55)	142(72.45)
Multiple sexual partners	75(38.27)	121(61.73)
Sexually transmitted disease	73(37.24)	123(62.76)
First delivery after 30yrs.	25(12.15)	171(87.24)
Old age above 40yrs.	71(36.22)	125(63.78)

Table 4: Response to Statement Concerning Knowledge about Cervical Cancer Symptoms N=196

State symptom	True (%)	False (%)
Irregular menstruation in a teenager	26(13.27)	170(86.73)
Painful menstruation	19(9.69)	177(90.31)
Post coital bleeding	52(27.04)	143(72.96)
Post menopausal bleeding	66(33.67)	130(66.33)

Table 5: Responses Related to Awareness Of cervical cancer and Source of Information

Information	Frequency	(%)
Hospital/health worker	30	35.29
Friend	9	10.58
Newspaper/magazine	10	11.16
Radio/T.V	25	29.4
Special Cancer Enlightening prog.	4	4.71
Others	7	8.25
Total	85	100.00

Table 6: Responses Related to Having Heard of Pap Smear and Their Source of Information

Table 6.1

Statement	Yes	No	No response
Have you heard of pap smear	31(15.82)	146(74.49)	19(9.69)
What do you understand/know as pap smear	15(7.65)	7(3.57)	174(88.76)

Table 6.2

Information	Frequency	%
Radio/T.V	4	8.34
Hospital/health worker	20	41.67
Newspaper/magazine	4	8.34
Special cancer enlightening programme	5	10.41
Personal communication (friends/family)	7	14.58
Handbills/posters	3	6.25
Others	5	10.41
Total	48	100.00

Table 7.1: Practice of Smear test among respondents’ n = 196

Ever had pap smear done	13	6.63
Never had	110	56.12
Not sure/No data	73	37.24

Table 7.2: Indication for undergoing pap smear test

	Frequency	%
Doctor/Nurse consultant	10	76.9
Routine ANC/family planning procedure	4	30.76
Personal initiative	3	23.08

Table 8: Reasons for failure to undergo smear test amongst respondents

Response	Frequency	%
Don’t know where facility exists	7	3.57
Never heard of the test	103	52.55
Did not consider it important	10	5.10
Fear it might be expensive	2	1.02
Wait till I am older	6	3.06
I can never have cancer	8	4.08
Others	2	1.02

Table 9: Willingness to participate in cervical cancer screening exercise

Response	Frequency	%
Yes	128	65.31
No	27	13.78
Not sure	18	9.14
No data	23	11.73

Table 10: Socio-demographic variables as related to knowledge and awareness of cervical cancer

Variables	Classification	Frequency	(%)
Age (years)	< 20	3	5.88
	20 – 24	14	27.45
	25-29	18	35.29
	30-34	10	19.61
	35-39	1	1.96
	40-44	2	3.92
	45-50	0	-
	50-55	1	1.96
	55-60	1	1.96
	> 60	1	1.96
Educational Qualification	Primary Secondary	1 22	1.96 43.14
	Tertiary	25	49.02
	None	1	1.96

Table 11: Socio-demographic variables as related to Awareness of Screening test

Variables	Classification	N = 31	(%)
Age (years)	< 20	-	-
	20 – 24	7	22.59
	25-29	11	35.48
	30-34	4	12.90
	35-39	1	3.23
	40-44	4	12.90
	45-47	-	-
	50-54	2	6.45
	55-60	1	3.23
	> 60	-	-
Educational Qualification	Primary	-	-
	Secondary	14	45.16
	Tertiary	14	45.16
	None	1	3.23

Discussion

Knowledge of cervical cancer is still very poor. We attribute this to insufficient publicity as most people are aware of breast cancer but only 26.02% of the respondents were aware of cervical cancer. This is similar to findings in a study among Native American women in North Carolina^41. 27% of respondents knew that cervical cancer could be detected early by currently available screening test while more than half of them (60%) agreed that early detection improves the prognosis.

Postmenopausal bleeding was the commonest pointer to cervical cancer as indicated by 33.67% of respondents. Postcoital bleeding was the other pointer chosen by 27.04% of respondents. This reflects, in part, the level of ignorance about the symptoms of cervical cancer.

Younger women (20-29years) had better awareness and knowledge of cervical cancer 62.64%, in line with findings in New Delhi²⁶. This could be due to education and more exposure. We observed a low knowledge of risk factors. Only 38.27% of respondents knew that multiple sexual partners was a risk factor for cervical cancer while 27.55% knew that early age of starting coitus was also a risk factor. This is similar to findings reported in other parts of the country⁴¹.

Less than a sixth (15.82%) of the respondents were aware of pap smear compared to 57.3% among rural Thai women³⁸. Only 6.63% had ever had a pap smear test. Majority 52.53% never did the test because of ignorance. 5.10% did not consider it important. Encouragingly, 65.31% of respondents were willing to undertake Pap Smear.

Better education was a common variable among those who knew of pap smear test as 45.16% each had tertiary and secondary education. This is similar to the University College Hospital, Ibadan study⁴².

The source of information of pap smear amongst those who were aware was mostly from hospital/health workers(41.67%). Other common source of information includes friends and relatives(14.58%), special cancer enlightenment campaigns(10.41%) and mass media(16.68%). This is similar to the finding in Singapore⁴⁴. This underscores the need to emphasize use of other sources of information for a wider coverage.

Currently pap smear is still a hospital-based test. This is a problem due to financial inaccessibility, lack of equipment and personnel to carry out the test. Since only the “tip of the ice berg” use the hospitals then the majority of women are unlikely to know about or utilise the test. For example, majority 76.9% of those who had undergone pap smear did it because the health worker asked them to do it.

Conclusion

The awareness of cervical cancer and its screening procedure is currently low but there is a lot of opportunity to increase the awareness of cervical cancer and Pap smear among health users in sub-urban areas. The challenge is to intensify grass root cancer education aimed at community mobilization and participation.

Recommendation

1. Intensive Health Education Program focusing on behavioral lifestyles that facilitate the disease, for example poor personal hygiene, multiple sexual partners and early age of Coitus, should be started in health centers nation-wide.

2. Employ mass media and alternative sources to build appropriate awareness of cervical cancer and pap smear.

3. Make health workers arrow head in the awareness building program

4. Provide more Screening Centers via NGOs and Government Agencies.

5. Free Pap Smear day targeted at women at risk.

6. Develop national Policy/guidelines for screening of cancer in Nigeria.