This study was conducted to determine the utilization of cervical cancer screening services among female health-care workers in Lautech Teaching hospital, in Osogbo, Osun state. A total sample size of 170 female health-care workers were recruited for this study. A descriptive cross-sectional design was utilized to assess utilization of cervical cancer screening services among female health-care workers.
The data was collected through a self-administered questionnaire and consisted of six sections. The collected data were entered using Excel and later analysed using the "Statistical Package for Social Sciences 25". The data were presented using tables, a bar chart, frequency, and percentages. Furthermore, three null hypotheses were tested using chi square at 0.05 level of significance.
Cervical cancer screening is a key to detect the pre-cervical cancer in an early stage, but it is rarely utilized in most developing countries and most cases are only diagnosed at a late stage of cervical cancer. The current screening level will not have any real effect to control cervical cancer unless female health-care workers are addressed since they act as a role model to the public.
INDEX
CHAPTER ONE
CHAPTER TWO
CHAPTER THREE
CHAPTER FOUR
CHAPTER FIVE
REFERENCES
CHAPTER ONE
1.0 introduction
1.1 Background to the Study.
Cervical cancer is the fourth most frequent cancer among women worldwide with an estimated 570,000 new cases in 2018 representing 6.6% of all female cancers and the commonest in the developing counties especially in Central America and Sub-Sahara Africa (World Health Organization, [WHO] 2018) . Cervical cancer is the second commonest cancer in Nigerian women and the leading gynaecological malignancy with high mortality among the afflicted (Oluwole, Mohammed, Akinyinka & Salako, 2017). According to World health organization, (2017) the disease progresses over many years, with an estimated 1.4 million women worldwide living with cervical cancer, and up to 7 million world-wide may have precancerous conditions that need to be identified and treated. Approximately, 90% of deaths from cervical cancer occurred in low- and middle-income countries (WHO, 2019). The high mortality rate from cervical cancer globally could be reduced through a comprehensive approach that includes prevention, early diagnosis, effective screening and treatment programmes (WHO, 2018). The disease, which affects the poorest and most vulnerable women, sends a ripple effect through families and communities that rely heavily on women's roles as providers and caregivers (Oluwaseun, Olusola & opeyemi, 2017). According to Ajibola, Samuel, Olowookere, Tolulope & Olumuyiwa (2016), cervical cancer is one of the most preventable human cancers because of its slow progression, cytological identifiable precursors, and effective treatments if detected early, but unfortunately, most screening activities in developing countries do not reach the vulnerable women and consequently, a high proportion of cervical cancer cases are diagnosed at an advanced stage (Adepiti, Ajenifuja, Okunola, Omoniyi-Esan, Onwudiegwu,2017). The uptake of cervical cancer screening has remained very low in Nigeria while the mortality and morbidity associated with cervical cancer has remained high (Oluwaseun, Olusola & opeyemi, 2017). In spite of efforts from governmental and nongovernmental organizations to improve access to cervical cancer screening services in Nigeria, uptake has been appalling. Several studies have documented factors associated with uptake of cervical screening tests worldwide (Ajibola et. al., 2016). Such factors include age of the women, their marital status, parity, risk perception, financial constraint, and knowing someone who has cancer of the cervix (Butho, Amita, Jeremy, Patricia, and Paulina, 2015). In with the developed countries, where optimal practice of screening services has led to significant reduction in incidence and prevalence of cervical cancer, little improvement has been recorded among female health workers population (Ifemelumma et al., 2019). Health workers are often times looked upon as "role models" in health related issues. Nurses play a major role in enlightening the public on the availability and need for cervical cancer screening services. They are informed individuals who are expected to have more information and knowledge about several health related issues and also act as role models in uptake of preventive services but studies have documented low uptake amongst them. (Ndigwe, 2016). As reported by Oluwaseun, et al., (2017) conducted among female health workers at OAUTHC, the utilization of cervical cancer screening services amongst the studied population was reported low due several factors such as lack of time, fear of results and poor attitudes towards screening.
1.2. Statement of Problem
Cervical cancer affects women yearly with an estimated 570,000 new cases in 2018 representing 6.6% of all female cancers and the commonest in the developing counties especially in Central America and Sub-Saharan Africa (WHO, 2018). Despite the fact that cervical cancer is a potentially preventable disease, most women infected die from this condition Udigwe, 2016). Each year approximately, 10,000 women develop cervical cancer, and about 8,000 women die from cervical cancer in Nigeria WHO (2016), It is worrisome as all sexually active women are at risk for the development of cervical cancer which includes female health care workers (Airede, Onakewhor, Aziken, Ande & Aligbe, 2015).The high burden of cervical cancer in developing countries, like Nigeria, is due to both high prevalence of HPV infection and the lack of effective cervical cancer screening programmes ( Ndikom and Ofi, 2012 as cited in Oluwaseun, et al., 2017). A considerable reduction in cervical cancer incidence and deaths has been achieved in developed countries with effective strategies for cervical cancer screening and treatment programs (Roland, Soman, Benard, Saraiya, 2016). However, this has not been possible in most resource-limited countries, mainly because systematic screening is rarely performed (Gebreegziabher, Asefa & Berhe, 2016) . An important strategy towards the reduction of the incidence and mortality associated with cervical cancer is by increasing the screening rate of women which also include female health workers that have not screened or those that screen infrequently. Previous studies done among female health workers have shown good knowledge of cervical cancer, however, the attendance rates of uptake of cervical cancer screening among health workers are still far from satisfactory in most countries (Udigwe, 2016; Ifemelumma et al., 2019; Bisi-Onyemaechi, Chikani & Nduagubam, 2018; Abiodun et al., 2017). Female health workers (nurses, doctors, pharmacist and laboratory scientist) play a major role in promoting health care services and in enlightening the public on many health-related issues and their knowledge and attitude on health-related issues are crucial in gaining and promoting patients’ uptake of care. They also help to improve women’s confidence but most of them are not making use of cervical screening services (Ifemelumma et. al., 2019). The importance of utilizing cervical cancer screen cannot be overemphasized as lack of screening may cause late detection of cervical cancer and cause havoc to the health of female health workers. This prompted the researcher to carry out a study on perceived factors associated with utilization of cervical cancer screening services among female health care workers in Lautech Teaching Hospital, Osogbo, Osun state.
1.3. Objectives of the Study
Broad objective: is to determine utilization of cervical cancer screening services among female health care workers in general hospital, Lautech Teaching hospital, Osogbo, Osun state.
Specific objectives:
1. To explore female health workers’ knowledge on causes and prevention of cervical cancer.
2. To assess the knowledge of female health workers regarding cervical cancer screening.
3. To determine attitudes of female health workers towards cervical cancer screening.
4. To determine the level of utilization of cervical screening services by female health workers.
5. To identify perceived factors influencing utilization of cervical cancer screening services among female health workers
1.4. Research Questions
1. What is female health workers’ knowledge on causes and prevention of cervical cancer?
2. What is the level of knowledge of female health workers regarding cervical cancer screening?
3. What is the attitude of female health workers towards cervical cancer screening?
4. What is the level of utilization of cervical screening services by female health workers?
5. What are the perceived factors influencing utilization of cervical cancer screening services among female health workers?
1.5. Research Hypothesis
HO1- There is no significant relationship between years of working experience and utilization of cervical cancer screening service among female health workers.
HO2 - There is no significant relationship between attitude of female health workers and utilization of cervical screening services
HO3- There is no significance relationship between their knowledge of cervical cancer screening services and utilization of cervical cancer screening among female health workers
1.6. Significance of the Study
The result of this study will serve as pivot to plan intervention program by the hospital management to solve the problem of underutilization of prevention services and to modify existing policies on reproductive health in aspect of cervical cancer screening and prevention. The study will help to contribute to existing knowledge on cervical cancer and cervical cancer screening.
1.7. Scope of the Study
The study was delimited to utilization of cervical cancer screening services among female health workers in Lautech Teaching hospital, Osogbo, Osun state.
1.8. Operational Definition of Terms
Perceived: what is believed to be true about uptake of cervical cancer screening among female health workers
Factors: circumstances that influence the uptake of cervical cancer screening among the female health worker.
Cancer : A disease in which the cells of a tissue undergoes abnormal proliferation (WHO, 2018).
Cervical Cancer: Abnormal neoplastic changes in the cervix (neck of uterus).
Female Health Workers: Female health care professional who works at Lautech Teaching hospital which include the nurses, doctors, medical laboratory scientists and pharmacists.
Utilization: The act of using cervical screening services by female health workers to check for cancer of the cervix.
Screening: Process of checking for abnormal cellular proliferation of the cervix by means of tests such as Visual acid inspection, Pap smear etc.
CHAPTER TWO
2.0 LITERATURE REVIEW
2.1 Overview of cervical cancer
Globally, cervical cancer is the 4th most frequent cancer among women (WHO, 2018). Low-resource countries account for 85% of the cases, yet very little is spent in preventing and treating cervical cancers (Udigwe, 2016). Similarly, it is the most common and most lethal cancer among the women of sub-Saharan Africa (Iliyasu, Anubakar, Aliyu & Galadananci, 2015). A considerable reduction in cervical cancer incidence and deaths has been achieved in developed countries with effective strategies for cervical cancer screening and treatment programs (Roland, Soman, Benard, Saraiya, 2016). However, this has not been possible in most resource-limited countries, mainly because systematic screening is rarely performed (Gebreegziabher, Asefa & Berhe, 2016)
In Ethiopia, cervical cancer ranks as the most frequent cancer among women and cause for 4,732 deaths annually (Abate, 2015). Among the general population, ~33.6% of women is estimated to harbour cervical human papilloma virus (HPV) infection at a given time (Abate, 2015). Despite this fact, very few health workers receive cervical cancer screening services in Ethiopia ( Duka, Dulla & wakagri,2017). Besides, there is an obvious need among female health care providers for training about cervical cancer etiology, risk factors, and prevention techniques (Duka, 2017). Cervical cancer screening has been consistently shown to be effective in reducing the incidence rate or the occurrence of new cervical cancer cases and mortality from cervical cancer (Duka, 2017).
However, cervical screening attendance rates are still far from satisfactory in many countries (Gebreegziabher et al, 2016). Perhaps, cervical cancer screening facilities are limited because of poor infrastructure, staff, poor knowledge about cervical cancer, and illiteracy; the uptake of cervical cancer screening is poor among women who live in the places where the screening facilities are available (Gebreegziabher et al, 2016).
2.2. Global burden of disease
Approximately 570 000 cases of cervical cancer and 311000 deaths from the disease occurred in 2018 (WHO, 2018). Cervical cancer was the fourth most common cancer in women, ranking after breast cancer (2·1 million cases), colorectal cancer (0·8 million) and lung cancer (0·7 million) (Allemani et al., 2018). The estimated age-standardized incidence of cervical cancer was 13·1 per 100 000 women globally and varied widely among countries, with rates ranging from less than 2 to 75 per 100000 women. Cervical cancer was the leading cause of cancer-related death in women in eastern, western, middle, and southern Africa (Vaccarella, Lortet-Tieulent, Saracci, Conway, Straif &Wild, 2018). The highest incidence was estimated in Eswatini, with approximately 6·5% of women developing cervical cancer before age 75 years (Vaccarella, et al., 2019). China and India together contributed more than a third of the global cervical burden, with 106000 cases in China and 97 000 cases in India, and 48 000 deaths in China and 60 000 deaths in India (United Nations, 2019). Globally, the average age at diagnosis of cervical cancer was 53 years, ranging from 44 years (Vanuatu) to 68 years (Singapore) (Allemani et al., 2018). The global average age at death from cervical cancer was 59 years, ranging from 45 years (Vanuatu) to 76 years (Martinique). Cervical cancer ranked in the top three cancers affecting women younger than 45 years in 146 (79%) of 185 countries assessed (Mendes, Mesher, Pista, Baguelin & Jit, 2018)
2.2. Burden of cervical cancer in Nigeria
Current estimates indicate that every year 14943 women are diagnosed with cervical cancer and 10403 die from the disease (WHO, 2018). Cervical cancer ranks as the 2nd most frequent cancer among women in Nigeria and the 2nd most frequent cancer among women between 15 and 44 years of age (CDC, 2019). As reported by International Agency for Research on Cancer (IARC) 2019) about 3.5% of women in the general population are estimated to harbor cervical HPV-16/18 infection at a given time, and 66.9% of invasive cervical cancers are attributed to HPVs 16 or 18
2.2. Risk Factors of Cervical Cancer
According to American society of clinical oncology [ASCO], (2018 ) a risk factor is anything that increases a person’s chance of developing cancer. The following factors may raise a woman’s risk of developing cervical cancer
2.2.1. Human Papillomavirus (HPV) Infection: the most common risk factor for cervical cancer is infection with HPV. Research shows that infection with this virus is a risk factor for cervical cancer (WHO, 2018). Sexual activity with someone who has HPV is the most common way someone gets HPV. There are over 100 different type of HPV, not all of which are linked to cancer. The HPV types that are most frequently associated with cervical cancer are HPV16 and HPV18 with Two HPV types (16 and 18) cause 70% of cervical cancers and pre-cancerous cervical lesions (Nordgvist, 2019; WHO, 2018).
2.2.3. Immune System Deficiency: women with lowered immune systems have a higher risk of developing cervical cancer. A lowered immune system can be caused by immune suppression from corticosteroid medications, medication, organ transplantation, treatment for other types of viral infections or from the human immunodeficiency virus (HIV), which is the virus that causes acquired immune deficiency syndrome (AIDS). When a woman has HIV, her immune system is less able to fight off early cancer. (Onyenwenyi & Mchunu, 2018).
2.2.2. Herpes: women who have genital herpes have a higher risk of developing cervical cancer. (Onyenwenyi, & Mchunu, 2018).
2.2.3. Smoking: Tobacco use has also been considered as a major risk factor in the process of cervical carcinogenesis. Winkelstein was the first person to set up the hypothesis that cigarette smoking could be one of the causes of cervical carcinogenesis. His hypothesis was prompted by the high correlation in the geographic distribution of cancer of the cervix and the cancer of the lung in the third national cancer survey (Winkelstein 2015). Cigarette associated tumours are predominantly squamous cell tumors like lung or esophagus, cancer of the cervix could therefore be possibly associated with cigarette smoking. An exhaustive review of the literature, examining the relationship of smoking with cervical neoplasia, revealed positive association between the factor and the disease. It was observed that studies which did not reveal positive association had some bias in the selection of the controls. One of the studies tried to explore the effect of smoking cessation on the lesion size (Winkelstein, 2015). The study revealed that women who had completely stopped smoking showed a reduction in size of lesion by at least 20% revealing a high degree of statistical significance. A recent study from Sweden observed smoking to be an important risk indicator. Most of the variables had lost significance after adjusting the role of human papillomavirus but the odds ratios associated with smoking retained their statistical significance. Also, an Indian study conducted by ICMR revealed a high degree of statistical significance with role of smoking for the development of severe dysplasia and malignancy even after adjusting with socio demographic factors and variables associated with sexual behaviour. In this study the comparison was made between ever smoker and non-smoker. There were only 20% of the women who had reported history of smoking as compared to 4% in controls. Role of smoking in husbands was also evaluated for risk of development of cervical cancer. It was observed that an elevated risk of Cervical Intra-epithelial Neoplasia (CIN 3) was reported for the women whose husbands were smokers. Although the risk diminished when adjusted for other confounding factors, it was still present (Udigwe, 2018).
2.2.4. Age: girls younger than 15 years old rarely develop cervical cancer. The risk goes up between the late teens and mid-30s. Women over 40 years of age remain at risk and need to continue having regular cervical cancer screenings, which include both a pap test and HPV test (WHO, 2018).
2.2.5. Male behaviour: The risk of cervical cancer is influenced not only by woman's sexual behaviour but also by male behaviour. This hypothesis is based on the observations that there have been clusters of cervical cancers among women whose husbands reportedly have more than one sexual partners (Das, Murthy & Sharma, 2016). It was observed in India that risk of cervical cancer was about three times higher in women whose husbands reported sexual contacts with more than one woman other than wives during their lifetime (Das, Murthy & Sharma, 2016). Poor penile hygiene of male partners has also been hypothesized as a risk factor for cervical cancer (Das, Murthy & Sharma, 2016).
2.2.6. Socioeconomic Factors: cervical cancer is more common among groups of women who are less likely to have access to screening for cervical cancer. Those populations are more likely to include black women, Hispanic women, and American Indian women. (Onyenwenyi, &Mchunu, 2018).
2.2.7 Oral Contraceptives: some research studies suggest that oral contraceptives, which are birth control pills, may be associated with an increase in the risk of cervical cancer. However, more researches are needed to understand how oral contraceptives use and the development of cervical cancer are related (Onyenwenyi, & Mchunu, 2018).
2.2.8. Exposure to Dihethylstilbestral (DES): Women whose mothers were given this drug during pregnancy to prevent miscarriage have a rare type of cancer of the cervix or vagina. DES was given for this purpose from about 1940 to 1970 (Winkelstein, 2015).
2.2.9. Early child bearing age. Women who were younger than 17 years when they had their first full-term pregnancy are almost 2 times more likely to get cervical cancer later in life than women who waited to get pregnant until they were 25 years or older (Winkelstein 2015).
2.2.10. Multiple pregnancies: Women who have had 3 or more full-term pregnancies have an increased risk of developing cervical cancer. No one really knows why this is so. butstudies have pointed to hormonal changes during pregnancy as possibly making women more susceptible to HPV infection or cancer growth. Another thought is that pregnant women might have weaker immune systems, allowing for HPV infection and cancer growth (Winkelstein 2015).
2.2.11. Diet has also been under consideration of this important research. Vitamin C and Beta-carotene have been considered as the protective agents against cervical cancer. Various studies have been carried out in developed countries on dietary pattern based on diet recall and level of micronutrients in the blood. Study from China had indicated that intake of green vegetables had protective role for cancer cervix (Guo, Hsinng, Li, Chen & Chow, 2017). A study by Ziegler had expressed a weak relation between the risk of both cervical cancer and in situ disease and intake of carotenoids, vitamin C, folate, fruits and vegetables. Vitamin A was not found to be statistically protective factor (Guo, 2017). Lack of these vitamins in food could increase the risk of women having cervical cancer (Go et al., 2017).
2.2.12. Frequency of sexual contact: The role of frequency of sexual contact on the risk of development of cervical is a difficult area of research, yet efforts have been in this direction to explore this sensitive variable (Go et al., 2017). Earlier studies carried out did not reveal any statistical significance of enhanced frequency of sexual intercourse and increase risk of cervical cancer (Devassa & Diamond, 2018). The research on this aspect still continued because of hypothesis of association of sexual behaviour with cervical cancer. As citied by Devassa (2018) in a study conducted by Herrero et al (1990) stated that frequency of coitus was a significant factor only for women reporting multiple exposures before 20 years supporting the hypothesis of vulnerable cervix. The frequency of contact did not emerge as a significant variable through a multiple logistic model after adjusting for possible confounders such as age, age at consummation of marriage, extramarital affairs (Devassa et al 2018).
2.3. Prevention of Cervical Cancer
Cervical cancer is in essence a preventable disease and can be prevented through prevention of HPV (WHO, 2019). Health promotion aimed at sexual behavior changes and treatment of sexually transmitted diseases can help. There are basically three modes of prevention, the primary preventive strategy which involves the use of vaccines against HPV, as the secondary preventive strategy which involves screening programmes directed towards early detection and treatment of the condition and tertiary prevention. (Ajayi, 2014)
2.3.1. Primary prevention
- Human papilloma virus vaccine should be given to girls as early as 13 years of age
- Smoking cessation
- Avoid sexual activity with uncircumcised
- Ensure having stable partner
- Prompt treatment of cervical cancer
- Women exposed to DES should have an annual pelvic examination that includes a cervical pap test as well as a 4 quadrant pap test, in which samples of cells are taken from all sides of the vagina to check for abnormal cells
2.3.2. Secondary prevention: this focus on screening of precancerous and cancerous cervical cancer. Method adopted includes;
- Screen and treat – using a screening test that gives immediate results (like visual methods, VIA) followed by “on the spot” treatment (e.g. using cryotherapy) of detected lesions, without any further tests unless a suspected cancer is found.
- Sequential testing – carrying out a second screening test (triage test) for those who had a positive first screening test result, and if pre-cancer lesion is re-confirmed this is followed by treatment.
- Screening and, for those women who tested positive, carry out colposcopy and biopsy with treatment based on the biopsy result.
2.3.3. Tertiary prevention
- Establishing and maintaining a treatment referral network: The main aim to prevent cervical cancer is to establish and maintain an effective referral network to enable timely access and continuity of care by linking the service facility to the referral facility, laboratory, diagnostic and treatment centres for cervical cancer. A referral protocol and functioning communication system need to be in place to ensure an effective referral system. Referral networks can vary from country to country and depend on the structure of the health system in the country (Devassa, 2018).
- Compliance with treatment: Another important way of tertiary prevention is ensuring completion of treatment which requires a long stay at a treatment centre located at the regional or national level. Geographic, financial, and social barriers often result in non-compliance with treatment, especially for radiotherapy. Providing support for housing, cost of travel and/or disability grants for lost work hours can play an important role in enabling the woman and her family to cope during the treatment period. In countries which do not have the capacity to provide cancer treatment services, it is useful to be aware of intergovernmental arrangements for referral to neighboring countries and avail of this arrangement (WHO, 2017).
- Palliative care: Ensuring that patients with life-threatening cervical cancer are provided with relief from pain and suffering (both physical and psychological) requires resources, special skills, and supervision. Effective palliative care engages a team of doctors, nurses, other specialists, and community members who work together in health facilities, the community, and homes (Ajayi, 2019)
2.4. Cervical cancer screening services
Cervical cancer screening has been consistently shown to be effective in reducing the incidence rate or the occurrence of new cervical cancer cases and mortality from cervical cancer (Gebreegziabher et al., 2016). However, cervical screening attendance rates are still far from satisfactory among females’ health workers in many countries (Duka, 2017). Methods of cervical screening services include;
2.4.1. Pap smear Papanicolaou (Pap) testing has resulted in dramatically lowered cervical cancer rates when the test is repeated every few years Nyomb (2014) but most developing countries lack the resources, infrastructure and trained personnel needed to implement such programs (Duka, 2017). Effective screening programs require high coverage of women at risk, quality screening tests, and effective follow-up and treatment. These often are challenging to achieve with a cytology-based program because Pap tests require a doctor or nurse to collect a cervical cell sample, a cyto technician to process and interpret the sample, and a pathologist to confirm positive results (Nyomb, 2014). And like other screening strategies, Pap programs also need systems for active recruitment of women, monitoring the quality of test results, and ensuring that all women with abnormal results receive appropriate treatment. One of the limitations of Pap is the subjective nature of the test — it is dependent on individual interpretation. Additionally, due to the observed low sensitivity (the ability of the test to correctly identify positive cases) of cytology, frequent rescreening every one, three or five years is key to the effectiveness of Pap programs. This further increases the costs and challenges for developing countries. Cytology can be burdensome for patients. A woman must generally make three or more separate clinic visits, first to be tested; then to learn the results; and where applicable, to receive further testing, diagnosis, or treatment (Chao et al., 2019).
2.4.2. Visual inspection with acetic acid: Visual inspection of the cervix using acetic acid or Lugol’s iodine to highlight precancerous lesions so they can be viewed with the “naked eye”, shifts the identification of precancer from the laboratory to the clinic. Such procedures eliminate the need for laboratories and transport of specimens, require very little equipment and provide women with immediate test results (Nordgvist, 2019).
A range of medical professionals- Nurses and professional midwives can effectively perform the procedure, provided they receive adequate training. As a screening test, VIA performs equal to or better than cervical cytology in accurately identifying precancerous lesions. This has been demonstrated in various studies where trained nurses and professional midwives correctly identified between 45% and 79% of women at high risk of developing cervical cancer (Almonte, 2016). By comparison, the sensitivity of cytology has been shown to be between 47 and 62% It should be noted, however, that cytology provides higher specificity (the ability of the test to correctly identify negative cases) (Sankaranarayanan, 2017)
2.4.3. HPV DNA testing: Current HPV DNA test detects the presence of cancer-causing HPV types in cervical or vaginal cells, indicating whether a woman is currently infected. Most HPV infections clear spontaneously and do not lead to cervical cancer — these are most common among women in their teens and 20s who are sexually active. But when cancer-causing HPV is found in women aged 30 or older, there is a good chance that the virus has persisted in their systems; these women are considered to be at high risk of current or future cervical cancer. In order to focus precious health system resources and provider time where it will have the greatest impact, HPV DNA testing often is recommended for use in women aged 30 years and older (Duka, 2019). Those who test positive subsequently are assessed for precancerous lesions or cancer, and are treated as indicated. For HPV testing, cervical or vaginal samples are collected by a trained provider. In some cases however, the woman herself can collect a vaginal sample. Vaginal self-sampling has been proven acceptable to women in many settings, can be performed at home or in a clinic, and does not require use of a speculum (Sankaranarayanan, 2017). Cervical or vaginal samples can be stored in a preservative solution if necessary, and then transported to a laboratory for processing by trained personnel. HPV DNA testing is the most sensitive screening examination. Most studies have found that HPV DNA tests are between 66 and 95% sensitive in identifying women who have abnormal precancerous lesions (WHO, 2018). Unlike Pap smears and VIA, HPV DNA results are processed by a machine and are not susceptible to differences in human interpretation. Management options vary for women who test positive for HPV. In low-resource settings where colposcopy and biopsy may not be available, performing VIA after a positive HPV test can help determine if precancerous lesions are present on the cervix and if cryotherapy treatment is appropriate. Large studies have found that HPV testing was more effective than either VIA or Pap at reducing women’s long-term risk of cervical cancer and on their overall mortality (Sankaranarayanan, 2017).
2.5. Factors associated cervical cancer screening
According to a study conducted by Dulla, Daka & Wakagri (2017) among Ethiopian female health workers in some selected hospitals factors found to be significantly associated with cervical cancer screening practices among female health workers were marital status, age, profession, experience, level of education, knowledge about cervical cancer outcome, type of health institution, and working in cervical cancer screening centres. However, in multiple logistic regression analysis, type of profession and working in cervical cancer screening centre were significantly associated with cervical cancer screening practices. Those who were physicians were 88% less likely to be screened for cervical cancer than other health care workers. Similarly, those who were working in cervical cancer screening centres were 86% less likely to be screened for cervical cancer than their counterparts.
2.6. Empirical studies
2.6.1. Knowledge of female health workers on causes and prevention of cervical cancer screening
According to a study conducted by Duka, Dulla and Wakagri (2017) Knowledge about cervical cancer screening and its practice among female health care workers in southern Ethiopia: a cross-sectional study three hundred and nineteen (86.9%) health workers were found to have good level of knowledge on cervical cancer. Most of the respondents, 341 (92.9%), had heard about cervical cancer. Regarding the source of information about cervical cancer, 232 (63.2%) had heard from school/college, 107 (29.2%) from news/media, 80 (21.8%) from friends/colleagues, and 40 (10.9%) from brochures/posters, while six (1.6%) of them had heard from a religious institution. Most of the respondents, 353 (96.2%), knew that cervical cancer was not communicable. Similarly, 299 (81.5%) and 140 (38.1%) of them knew that cervical cancer was preventable and were aware of its prevention methods, respectively. More than half, 207 (56.4%), of them knew that avoiding multiple sexual partners prevents cervical cancer. In addition, 223 (60.8%) and 133 (36.2%) of them knew that early screening and vaccination for HPV could prevent cervical cancer, while 291 (79.3%) and 271 (73.8%) of them stated using holy water and praying to god as the prevention methods. A significant number of the respondents, 296 (80.7%), knew that cervical cancer was curable at an early stage. Likewise, a majority of the respondents, 329 (89.6%), 321 (87.5%), and 295 (80.4%), knew about the risk factors, symptoms, and outcomes of cervical cancer, respectively. Among the listed outcomes of untreated cervical cancer, 287 (78.2%) were death, 188 (51.2%) bleeding, and 185 (50.4%) chronic illness, while 210 (57.2%) of the respondents knew about cervical cancer treatments.
According to a study conducted by Sajid et al., 2019 among female health care professionals on knowledge, attitude and practice toward cervical cancer screening, many of the participants were not knowledgeable about cervical cancer. For example, only 8.9% of the sample knew that multiple sexual partners placed a woman at risk for cervical cancer. Women older than 50 years of age are at higher risk, yet only 8.6% of the sample had that knowledge. In advanced stages of cervical cancer, sign and symptoms a woman may experience are vaginal bleeding, foul-smelling vaginal discharge, and contact bleeding. However, a majority of the participants were lacking knowledge (93%, 92%, and 87%), respectively. As for preventing cervical cancer, 90% of the participants were unaware of the major behaviours one could do or avoid to prevent cervical cancer. Lastly, a majority of the participants did not have knowledge about the different ways of screening for cervical cancer.
Knowledge of prevention revealed that 51.7% opined that regular Pap smear can be used to prevent cervical cancer, 30.8% reported early diagnosis, and 13.9% mentioned avoidance of multiple sexual partners and 11.9% early treatment. Other ways of prevention mentioned included avoidance of sexual intercourse (8.0%), health education (6.6%), and reduction in exposure to radiation (3.4%). These levels of knowledge were found not to influence the utilization of cervical screening services.
2.6.2. Knowledge of female health workers on cervical cancer screening
In a study conducted by Jassim, Obeid, & Al Nasheet, Knowledge, attitudes, and practices regarding cervical cancer and screening among female health care workers in Bahrain. 300 Bahraini female health workers consented to participate and complete the questionnaire. The mean ± SD age of the participants was 37.24 ± 11.89 years, with a mean parity of 2.31 ± 2.09 and mean duration of marriage of 14.9 ± 10.99 years. Most of the participants were married (221; 73.7%), with a high school or higher education (261; 87%), and approximately 41% were employed (123 participants) nearly 65% (194 participants) had heard about the Pap smear. Approximately 64% (192 participants) believed that the Pap smear was helpful in detecting pre-cancer and cancer of the cervix, 44.3% (133 participants) believed that they should have a Pap smear at least every 3 years, and 67.7% (203 participants) knew that the purpose of the Pap smear was to detect abnormal cells in the cervix. Nevertheless, 10% (30 participants) believed that the Pap smear is not successful in reducing the incidence and mortality of cervical cancer. Approximately 59% of the respondents (117 participants) believed that the Pap smear is non-invasive. Approximately 33.7% (101 participants) thought that women should have Pap smears from the onset of their sexual activity, and 34.3% (103 participants) thought that Pap smears could not be performed during menstrual periods and agreed that women should not have sex 24 h before having a Pap smear. Only 8.7% (26 participants) believed that a Pap smear should be discontinued after menopause. Finally, 71% (213 participants) agreed to have a Pap smear even if not performed by a doctor. Regarding the HPV vaccine, only 3.7% (11 participants) had heard about the vaccine, and the majority (289; 96.3%) either had not heard or did not know about the HPV vaccine. According to a study conducted by Duka, Dulla and Wakagri (2017) among female health workers on knowledge of female health workers on cervical cancer three hundred and nineteen (86.9%) health workers were found to have good level of knowledge on cervical cancer. Most of the respondents, 341 (92.9%), had heard about cervical cancer. Regarding the source of information about cervical cancer, 232 (63.2%) had heard from school/college, 107 (29.2%) from news/media, 80 (21.8%) from friends/colleagues, and 40 (10.9%) from brochures/posters, while six (1.6%) of them had heard from a religious institution. More than two thirds of the respondents, 283 (77.1%), knew that there was a procedure used to detect premalignant cervical lesions. (37.6%) of them mentioned visual inspection with acetic acid as a screening method. Similarly, 113 (30.8%) of them mentioned Pap smear as a screening method. More than half, 196 (53.4%), of the respondents said that women aged between 36 and 60 years were more likely to be affected by cervical cancer than others. In addition, 63 (17.2%), 17 (4.6%), 16 (4.4%), and 17 (4.6%) of them said that women aged between 26 and 35, 19 and 25, 15 and 18, and .60 years were more likely to be affected by cervical cancer than others. However, 58 (15.8%) of them did not know which age group was more likely to be affected. Regarding the eligibility criteria for cervical cancer screening, 247 (67.3%) of the respondents said that all women aged .21 years should be screened, while 161 (43.9%) of them said that commercial sex workers should be screened. Two hundred twenty-five (61.3%) of them stated that all older women should be screened. A majority of the respondents, 306 (83.4%), knew that the cervical cancer screening test was used to check the health of the cells of the cervix. Regarding the cervical cancer screening services, 158 (43.1%) of the respondents stated that there was no cervical cancer screening test in their institution. As reported by Seyoum, Yesuf, Kejela, Gebremeskel (2017) Utilization of Cervical Cancer Screening and Associated Factors among Female Health Workers in Governmental Health Institution of Arba Minch Town and Zuria District, Gamo Gofa Zone, Arba Minch, Ethiopia Out of the total respondents, 281 were responded to the questionnaire, making the response rate of 95.6%. The age of participant’s ranges from 23 to 58 years with mean of 30.37 and standard deviation of ±5.96. Majority 131 (46.6%) of the respondents were in the age group of 28-30 years. The work experiences of the respondents range from 1 to 37 years with mean of 7.44 and standard deviation of ±5.72. 164 (58.4%) of the study participants were orthodox followers, followed by protestants 114 (40.6%). Majority 183 (65.4%) of the respondents were Gamo, and 77 (24.4%) were Amhara about 248 respondents had known the availability of cervical cancer screening service in their health facility or around their residents. The main sources of information were mass media (36.3%) followed by training (25.6%) and doctors (23.5%). Among respondents 20.6% had mentioned HPV and multiple sexual intercourse was the risks factors respectively. Around half of respondents cited that both women in the reproductive age groups and age above 50 years were vulnerable to cervical cancer. About 72.4% of the respondents had stated one or two symptoms of cervical cancer (vaginal bleeding and foul vaginal discharge), and 25.3% had cited three and above symptoms (vaginal bleeding, foul smelling of vaginal discharge, contact bleeding and post-menopausal bleeding). From all respondents the most mentioned symptom was Vaginal bleeding 108 (38.4%). Around 35.6% of respondents did not know the way of any kind of screening, however, 24.5% had known at least three screening types (Pap smear, Visual inspection with acetic acid (VIA) and Lugol’s solution (VILI). About 66% of the respondents mentioned that one of a prevention method was avoiding multiple- sexual intercourse. Regarding cervical screening, 51.2% of respondents had cited that women whose age is 30 and above were the target
2.6.3. Attitude of female health workers on cervical cancer screening
According to a study conducted by Sajid et al., (2019) among female health care professionals on knowledge, attitude and practice toward cervical cancer screening Of the 420 questionnaires that were distributed, 395 (94%) were returned and included in the analysis. The mean age (SD) of the participants was 34.7 (8.3) years. A total of 261 (66.1%) respondents were nurses, 63 (16.0%) respondents were physicians, and the remaining 71 (18.0%) respondents included pharmacists, dieticians, technicians, health educators, physiotherapists, and therapists. About 60% of the respondents were married. Nine (2.3%) participants reported having history of cervical cancer the majority of participants showed disagreement for all the statements about attitude towards screening. More than three-fourths of the participants (84.8%) disagreed with the statement “screening helps in prevention of carcinoma of the cervix”, more than half (52.5%) disagreed that carcinoma of the cervix is highly prevalent and is a leading cause of deaths amongst all malignancies in Saudi Arabia, (78,2%) disagreed any young woman including you can acquire cervical carcinoma, (67.1%) carcinoma of the cervix cannot be transmitted from one person to another, (67.8%) disagreed screening helps in prevention of carcinoma of the cervix, (78.4%) disagree screening causes no harm to the client. Overall, only 15 (3.8%) respondents agreed that they would have screening done if it was free and caused no harm.
2.6.4. Utilization of cervical screening services by female health workers
A study conducted Frank & Ijeoma (2017) Factors Influencing Uptake of Cervical Cancer Screening among Female Health Workers in University of Port Harcourt Teaching Hospital, Rivers State. Only 174 (34.6%) of the respondents had made use of cervical cancer screening services. Of these 174, 10.3% were Assistant Directors of Nursing, 21.8% were Chief Nursing Officers and 8.0% were staff nurses. Cadre of nurses was found to be significantly associated with utilization. Pattern of utilization showed that 80 (46.0%) had accessed CCSS only once, 48(27.6%) twice, 15(8.6%) thrice and 31(17.8%) four or more times with the University College Hospital being the mostly patronized (85.6%). Logistic regression analysis showed that staff nurses and nursing officers were four and almost five times less likely to utilize cervical cancer screening services than assistant directors of nursing. Main reasons cited by the 329 who had never used cervical cancer screening services included lack of time 153(46.5%), fear of the result 42(12.8%), cumbersome procedure 36(10.9%), lack of awareness of where the test can be done 29(8.8%), cost consideration 27(8.2%), not sexually active 21(6.4%) and not knowing about the test 21(6.4%). Likelihood of going for screening was indicated among 409(81.0%) respondents. Significant others who reportedly can influence respondents’ decision to go for screening in a multiple response question were husbands (58.1%), doctors (49.5%) and colleagues (48.3%). As reported by Seyoum, Yesuf, Kejela, Gebremeskel (2017) Utilization of Cervical Cancer Screening and Associated Factors among Female Health Workers in Governmental Health Institution of Arba Minch Town and Zuria District, Gamo Gofa Zone, Arba Minch, Ethiopia Out of the total respondents, 281 were responded to the questionnaire, making the response rate of 95.6%. The age of participant’s ranges from 23 to 58 years with mean of 30.37 and standard deviation of ±5.96. Majority 131 (46.6%) of the respondents were in the age group of 28-30 years. The work experiences of the respondents range from 1 to 37 years with mean of 7.44 and standard deviation of ±5.72. 164 (58.4%) of the study participants were orthodox followers, followed by protestants 114 (40.6%). Out of the total respondents, 9.6% of them utilized cervical cancer screening service and their main reason for utilization of the service was to maintain healthy (59.8%) and to detect early cervical cancer change (33.3%)
2.6.5. Factors influencing cervical cancer screening among female health workers
As reported by Seyoum, Yesuf, Kejela, Gebremeskel (2017) Utilization of Cervical Cancer Screening and Associated Factors among Female Health Workers in Governmental Health Institution of Arba Minch Town and Zuria District, Gamo Gofa Zone, Arba Minch, Ethiopia Service year of the respondents and knowledge were independently associated with ever screening for cervical cancer. The odds of ever screening for cervical cancer is 5 times higher for those who served more than or equal to 7 years than those who served less than seven years (AOR [95% CI] =4.99 [1.36- 18.10]). Knowledge about cervical cancer is also associated with utilization of cervical cancer. Those respondents who have good knowledge about cervical cancer were 1.78 times more likely to utilize cervical cancer screening compared to those who have poor knowledge about cervical cancer. As reported by Duka, Dulla and Wakagri (2017) Knowledge about cervical cancer screening and its practice among female health care workers in southern Ethiopia: a cross-sectional study it was reported that the factors found to be significantly associated with cervical cancer screening practices were marital status, age, profession, experience, level of education, knowledge about cervical cancer outcome, type of health institution, and working in cervical cancer screening centers. However, in multiple logistic regression analysis, type of profession and working in cervical cancer screening center were significantly associated with cervical cancer screening practices. Those who were physicians were 8 times less likely to be screened for cervical cancer than other health care workers similarly; those who were working in cervical cancer screening centres were 86% less likely to be screened for cervical cancer than their counterparts
2.7. Theoretical framework
Health Belief Model: The health belief model is a psychosocial model proposed by Rosenstock (1966) as cited by Stanhope, and Lancaster, (1996) for studying and promoting the uptake of health services like screening. The model explains preventive behaviour. The model assumes that belief and attitudes of people are critical determinants of their health-related actions. It holds that when cues to actions are present, the variations in uptake behaviour can be accounted for by beliefs concerning four sets of variables. These include:
1. The individual’s view of own vulnerability to illness. If an individual does not see him or herself as being at risk of any problem, he or she will not seek care.
2. Belief about severity of the illness. The associated problem could be seen as little; therefore, little attention will be required.
3. The person’s perception of the benefits associated with action to reduce the level of threat or vulnerability.
4. The individual’s evaluation of the potential barrier associated with the proposed action, this could be physical, psychological, financial and social.
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The health belief model (Rosenstock, 1996).
2.7.1. Framework of the Three Major Components of Health Belief Model
Figure 2.1 below is used to illustrate the framework of the three major components of Health Belief Model as it relates to factors affecting utilization of cervical cancer screening services. The three major components of the health belief model are: individual perception; modifying factors; and variables affecting likelihood of action:
1. Individual perception: perception is the process of becoming aware of objects, qualities or relation by the way of sense organ. The individual’s perception of being at risk of cervical cancer will motivate the person to preventive services.
2. Modifying factors: these are variables that change or improve likelihood of action. They include demographic variables, level of education, location of health facility, mass media etc. They affect perception of threat; increased knowledge will result in correct perception of threat based on scientific knowledge of cervical cancer.
3. Likelihood of action: an individual will take action if he or she understands that there is a need and that the particular action will help in meeting the need. Also if barriers to the utilization of such services are minimized.
Since cervical cancer is not usually noticed until late stage, the call to go for screening seems to be ignored. Some women may not consider it as important because they have other competing needs. While others who may perceive screening as needful preventive health behaviour.
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Figure 2.1 Conceptual model for factors affecting utilization of cervical screening services developed by the researcher
2.8. Application of the theory to this study
The understanding of the concept listed above and the maintenance of balance between them would help in maintaining individuals’ health as any deviation from these causes malfunctioning. The individual perception (perceived susceptibility to cervical cancer, perceived seriousness of cervical cancer, perceived benefits of cervical cancer screening) and modifiable factors such as demographic variables (age, year of experience, time, occupation, marital status) may enhance the uptake or utilization of cervical cancer screening by female health workers.
CHAPTER THREE
RESEARCH METHODOLOGY
3.1. Introduction
This chapter focused on the research design, research setting, target population, , sample size determination, sampling techniques, instrumentation, psychometric properties of the instrument, validity and reliability of the instrument, data collection method, method of data analysis and ethical considerations.
3.2. Research Design
This study utilized a descriptive cross sectional design to assess utilization of cervical cancer screening services among female health workers in Lautech Teaching hospital, Osogbo.
3.3. Research Settings
This study was conducted in Lautech Teaching hospital, Osogbo. Osun state Nigeria. Lautech Teaching Hospital is a tertiary health institution in Nigeria. The hospital covers a large landmass and is located along Idi-seke, Osogbo. The Hospital started as Africa Hospital at Osogbo and was renamed "General Hospital" like other sister institutions throughout the country then. By the late 1960's, specialist medical care was already being carried out by specialist staffs that were already working in the hospital. This specialist status of the hospital has so remained till April, 1998. With the creation of Osun State in 1991, the hospital was upgraded to a State Hospital. In 1993, Osun State Government acquired a private medical facility i.e Mercyland Hospital, located some three kilometres away from the State Hospital, in Egbedore Local Government, to become an annex of the state Hospital, Osogbo.
The State and Mercy land Hospitals were released to LAUTECH for establishing a Teaching Hospital in June 1996. However, it became a Teaching Hospital by an edict promulgated by the Osun State Military Administrator, Lt. Col. Anthony Obi, the visitor to the University. The edict was gazette on the 25th September, 1997 (No. 8, Vol. 2, Osun State Notice No. 24) which was amended by Edict No. 2 of 1999 Osun State dated 25th March, 1999. The Hospital Management Board was inaugurated on 29th July, 1999 by the Executive Governors of Oyo and Osun States, Alhaji Lam Adesina and Chief Adebisi Akande respectively in Osogbo.
The hospital consists of different departments- administration, clinical, medical laboratory, supportive services, training schools.It also consist of different wards, among which are the accident and emergency unit, the obstetrics and gynecology emergency unit, the emergency pediatric unit and the general outpatient department to mention but a few. The total staff list is 1,120 in which 350 works as nurses at the facility and the department of nursing in the hospital is directed by deputy director of nursing services. The facility has about 1,000 beds in both male and female wards. The institution serves as a teaching hospital for medical students, nursing students, and other health related courses and as referral Centre for neighbouring communities. It contain about 350 nurses in which 200 are females, 120 medical doctors in which 50 are females, 50 laboratory scientist in which 15 are females and 25 pharmacist in which 15 are females. The hospital provides both in and out patients services including National Health Insurance Scheme services, public/community health care services and immunization. The hospital has a cervical cancer screening services centre which has been in existence since the creation of the hospital; the centre is headed by a registered midwife and they work on weekdays. The cervical screening centre provides screening services which include; pap smear papinocolaou, visual inspection with acetic acid, HPV DNA testing.
3.4. Target Population
The target population for this study were female health workers in, Lautech Teaching hospital, Osogbo which include nurses, doctors, pharmacist, and laboratory scientist.
3.5. Sample Size Determination
The sample size of the population that was determined using Taro Yamane formula
n= N/1+N (e²)
n=sample size required
N=total population of female health care workers
e=allowable error (0.05)
n=280/1+280(0.05²)
n=280/1+280(0.0025)
n=2800/1.70
n=164.7
n is approximated to be 165 with attrition of 170
The respondents for this study is 170
3.6 Sampling Technique
This research was carried out using one hundred and sixty-five female health workers as respondent’s. The structured questionnaires were administered on some selected female health workers to determine utilization of cervical cancer screening. A proportional stratified simple random was adopted for this study. This method entails recruiting female health workers at Lautech Teaching hospital, Osogbo from each profession as follows.
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Inclusion Criteria
- Must be a female health worker at Lautech Teaching hospital, Osogbo.
- Must be willing to participate in the study
Exclusion Criteria
- Female health workers who are not available as at time of data collection
- Female health workers who doesn’t give her consent to participate in the study
3.7. Instruments for Data Collection
A semi-structured, self-developed questionnaire was used to gather information about the perceived factors associated with utilization of cervical screening among female health workers at Lautech Teaching Hospital, Osogbo from one hundred and sixty-five (165) female health workers. The questionnaires were divided into sections “A, B, C, D, E, F” with sections containing information about the demographic data of the respondents, knowledge of respondents on cervical cancer causes and prevention, Attitude towards knowledge of respondents towards cervical cancer screening, level of utilization of cervical cancer screening, and factors influencing utilization of cervical cancer screening services respectively.
3.8 Psychometric Properties of the Instrument
3.8.1 Validity of Instrument
The questionaire were subjected to face and content validity. The instrument were constructed with the use of literature review as guide; each section of the instrument were matched with the predetermined objectives. Copies of the questionnaire were given to the supervisor to determine its face and content validity. The comments received were used to modify the final draft of the instrument before it was finally administered.
3.8.2 Reliability of Instrument
The self- structured questionnaire was subjected to pilot study at Asubiaro State Hospital, Osogbo and was conducted among 10% of the sample population which is the female health workers in Asubiaro; these respondents were not part of the main study. The data collected were analysed, and the reliability coefficient was computed. A value of 0.712 was yielded.
3.9. Method of Data Collection
The researcher went to the study settings personally to administer the questionnaire which has been pretested. The instruments were given to the respondents to fill on the site and retrieved back after completely filled. The respondents will be properly guided on how to fill the questionnaire. Data collected will be kept in a secured place for proper data management and analysis.
3.10. Method of Data Analysis
The data were analysed using tables, bar charts, percentages and correlation coefficient to test the null hypothesis. Descriptive statistics of mean, frequencies and percentages were used to describe the study population in relation to relevant variables. Beyond descriptive statistics, inferential statistical tools of chi square and univariate and multivariate logistic regression models were used to identify variables related to cervical cancer screening utilization. Predictor variables that showed association with outcome variables in the chi square analysis were included in the multivariable model.
3.11. Ethical Consideration
A letter of permission to collect data for the study was obtained from the Department of Nursing Science, Osun State University Osogbo and was submitted to the ethical committee in Lautech Teaching hospital, Osogbo and the College of Health Science, Osun State University, Osogbo for ethical approval. A formal introduction was done as a written opening statement at the beginning of the questionnaire and also verbally at the point of administration of the questionnaire. The importance of the study were explained verbally to the participants and written informed consent were obtained before the commencement of the study. Every attempt was made to maintain the confidentiality of the participants and they would be reassured of non-maleficence. The questionnaires were administered to the female health workers upon approval by the ethical committee of the hospital facility. Participation was voluntary and information was kept confidential and anonymity was maintained.
CHAPTER FOUR
RESULTS
Table 4.1. Sociodemographic Characteristics
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Table 4.1 above revealed sociodemographic characteristics of the respondent; more than half of the respondents are between age 36-45 2with mean 41±8.2, more than half 115(67.6%) married, half the respondents 85(50.0%) are Christians, there were 102(60.0%) nurses, 49(28.8%) medical doctors, 9(5.3%) pharmacist and 10(5.9%) medical laboratory scientist; more than half 95(55.5%) have 1-10years of experience, 69940.6%) have 11-20 years and 6(3.5%) 21-30years, majority 119(70.0%) are Yoruba, on monthly income54(31.8%) collect less than #100,000, 82(48.2%) collect #100,000-#199,000 and 34(20%) collect #200,000 and above
Table 4.1. Knowledge on causes and prevention of cervical cancer
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As revealed from table 4.2. Above on knowledge on causes and prevention of cervical cancer all of the respondents have heard of cervical cancer before, major source of information 79(46.5%) is from school, on risk factors of disease 162(95.2%) reported early marriage, 153(90%) reported having multiple sexual partners, 105(61.8%) reported daily exercise is not a risk factor. 67(39.4%) reported infection with Hiv/Aids as cause of the disease, 147(86.5%) Infection with Human papilloma virus, 158(92.9%) lack of personal hygiene, 157(92.4%) knew that cancer of the cervix can be prevented, antibiotic use was reported as preventive measure by 99(58.2%), cervical cancer screening was reported by all the respondent 170(100%) as way to prevent the disease, 152(89.4%) reported immunization with HPV vaccine.
Figure 4.1.Bar chart showing source of information on cervical cancer
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From figure 4.1 above on source of information on cervical cancer screening 60(35.3%) knew from Information communication technology (ICT), 8(4.7%) knew from family, 23(13.5%0 from friends and 79(46.5%).
Figure 4.2. Bar chart showing risk factors on cervical cancer
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From figure 4.2. Above on risk factors of cervical cancer 89(49.4%) reported having a relative that had the disease, 56(32.9%) having Hiv/Aids, 160(90%) reported having a multiple partner, 162(95.3%) early marriage, 59(34.7%) poverty, 64(37.6%) and 60(35%)
Figure 4.3. Bar chart showing prevention of cervical cancer
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From figure 4.3 above showing the prevention of cervical cancer 99(58.2%) reported use of antibiotic, 170(100%0 reported cervical cancer screening, 152(89.4%) immunization with HPV vaccine.
Figure 4.4. A Pie chart showing level of knowledge of respondents on causes and risk factors of cervical cancer
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From Figure 4.4 above majority of the respondents 147(86.3%) had good knowledge on causes and prevention of cervical cancer while 24(13.5%) had poor knowledge.
Table 4.3. Attitude of the respondents toward cervical cancer screening
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As revealed from table 4.3 above 124(72.9%) of the respondents Have you ever had a cervical cancer screening done, 103(60.6%) would not feel embarrassed if a male nurse is to perform the test, 106(62.4%) perceived cervical cancer screening as not embarrassing and unpleasant, 87(51.4%) said Cervical cancer screening is unnecessary if there are no signs and symptoms, 152(89.4%) would take HPV vaccine, 130(76.5%) cervical cancer screening helps in prevention of carcinoma of the cervix, 77(45.3%) cervical cancer is expensive
Figure 4.5. Attitude of the respondents toward cervical cancer screening
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Figure 4.5 shows that 122(72%) had good attitude towards cervical cancer screening while 48(28%) had poor attitude towards cervical cancer screening.
4.4. Knowledge about Cervical Cancer Screening
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Table 4.4 above shows knowledge of respondents about cervical cancer screening, majority 152(89.4%) have heard of cervical cancer screening, major source of information was lecture 76(44.7%), 117(68.8%) said women should have their first screening as early as she become sexually active, 87(51.2%) <15 years, 117(68.8%) 30-50years, 119(70.0%) above 50 years, 101(59.4%) said screening should be done once a year, 52(30.6%) every three years, 6(3.5%) every five years and 11(6.5%) did not know.
Figure 4.6. Pie chart showing knowledge on cervical cancer screening
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As shown in figure 4.6 above, 65(38%) had good knowledge on cervical cancer screening while 105(62%) had poor knowledge on cervical cancer screening.
Table 4.5. Cervical Cancer Screening Utilisation
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Table 4.5 above on cervical cancer screening utilization, majority 129(75.9%) have had screening done, 104(61.2%) had it done at government hospital, 25(14.7%) had it done at private hospital, on types of screening done; 74(43.5%) 103(60.6%) had visual inspection with acetic acid done, 40(23.5%) had HPV DNA testing done. On reasons for screening; it was prescribed for 77(45.3%), 49(28.8%) on a voluntary basis, 5(2.9%) suggested by a friend; 61(35.9%) have been screened this year, 28(16.5%) last year, 35(20.6%), 7(4.1%) 3years ago
Figure 4.7. A pie chart showing the level of utilization
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As revealed by figure 4.7 above 150(88%) had high level of utilization of cervical cancer screening while 20(12%).
Table 4.6 Factors affecting utilization of cervical cancer screening
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As revealed by table 4.6 above on factors affecting utilization of cervical cancer screening lack of time was reported by 133(78.8%), fear of results 140(82.4%), religious belief 112(65.9%), cultural belief 106(62.4%), cost of screening 108(63.5%), painful procedure 136(80%), male staff attending to me 105(61.8%) and support from husband 104(61.2%)
Figure 4.8, A bar chart showing factors affecting utilization of cervical cancer screening.
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As revealed by Figure 4.8 above on factors affecting utilization of cervical cancer screening lack of time was reported by 133(78.8%), fear of results 140(82.4%), religious belief 112(65.9%), cultural belief 106(62.4%), cost of screening 108(63.5%), painful procedure 136(80%), male staff attending to me 105(61.8%) and support from husband 104(61.2%)
4.2 Hypothesis testing
Decision rule: If the P-value is less than 0.05 the null hypothesis (HO) will be rejected and the alternative hypothesis (HI) will be accepted otherwise null hypothesis be accepted and the alternative will be rejected.
Hypothesis one
Ho - There is no significant relationship between years of working experience and utilization of cervical cancer screening service among female health workers.
Table 4.2.1 Relationship between years of working experience and utilization of cervical cancer screening service
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X2= Pearsons` Chi square
Df-degree of freedom
Inference: from table 4.2.2 above there is no statistical significant relationship between attitude of female health workers and utilization of cervical screening services (x2 =0.35a, p -value 0.852) tested at p<0.05
Hypothesis three
Ho - There is no significance relationship between knowledge of cervical cancer screening services and utilization of cervical cancer screening among female health workers.
Table 4.2.3 Relationship between Knowledge of Cervical Cancer Screening Services and Utilization of Cervical Cancer Screening Among Female Health Workers.
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X2= Pearsons` Chi square
Df-degree of freedom
Inference: from table 4.2.2 above there is statistical significant relationship between knowledge of cervical cancer screening services and utilization of cervical cancer screening (x2 =4.547a, p -value 0.033) tested at p<0.05
CHAPTER FIVE
5.0 Introduction
This aspect of study deals with the discussion of findings, summary, conclusion, implication for Nursing practice, Limitation of study, conclusion, Recommendations and suggestion for further study.
5.1 Discussion of Findings
This study was carried out to determine utilization of cervical cancer screening services among female health care workers in general hospital, Lautech Teaching hospital, Osogbo, Osun state. The sociodemographic characteristics of the respondent; more than half of the respondents are between age 36-45 with mean and SD OF (41±8.2), more than half 115(67.6%) married, half the respondents 85(50.0%) are Christians, there were 102(60.0%) nurses, 49(28.8%) medical doctors, 9(5.3%) pharmacist and 10(5.9%) medical laboratory scientist; more than half 95(55.5%) have 1-10years of experience, 69940.6%) have 11-20 years and 6(3.5%) 21-30years, majority 119(70.0%) are Yoruba, on monthly income54(31.8%) collect less than #100,000, 82(48.2%) collect #100,000-#199,000 and 34(20%) collect #200,000 and above.
Research question one: What is female health workers’ knowledge on causes and prevention of cervical cancer?
Present study reveals that all of the respondents have heard of cervical cancer before which is majorly due to the fact that they were all health care professionals, major source of information was 79(46.5%) is from school, on risk factors of disease 162(95.2%) reported early marriage, 153(90%) reported having multiple sexual partners, 105(61.8%) reported daily exercise is not a risk factor. 67(39.4%) reported infection with Hiv/Aids as cause of the disease, 147(86.5%) Infection with Human papilloma virus, 158(92.9%) lack of personal hygiene, 157(92.4%) knew that cancer of the cervix can be prevented, antibiotic use was reported as preventive measure by 99(58.2%), cervical cancer screening was reported by all the respondent 170(100%) as way to prevent the disease, 152(89.4%) reported immunization with HPV vaccine these finding were similar to what was reported by (Jassim, Obeid, & Al Nasheet, 2018).
In general, Majority 147(86.3%) had good knowledge on causes and prevention of cervical cancer while 24(13.5%) had poor knowledge this corroborate with what was identified by Duka, Dulla and Wakagri (2017) in tier study.
Research Question Two: To assess the knowledge of female health workers regarding cervical cancer screening.
The present study had majority 152(89.4%) have heard of cervical cancer screening and major source of information was lecture 76(44.7%), 117(68.8%) said women should have their first screening as early as she become sexually active supported by WHO(2018), 87(51.2%) <15 years, 117(68.8%) 30-50years, 119(70.0%) above 50 years, 101(59.4%) said screening should be done once a year, 52(30.6%) every three years, 6(3.5%) every five years and 11(6.5%) did not know these findings were somewhat similar to that of (Seyoum et al., 2017)
Generally, 65(38%) had good knowledge on cervical cancer screening while 105(62%) had poor knowledge on cervical cancer screening. This is somewhat similar to Ogbonna (2017), also similar to findings Duka, Dulla and Wakagri (2017).
Research Question Three: What is the attitude of female health workers towards cervical cancer screening?
Present study reveals that majority 124(72.9%) of the respondents Have had a cervical cancer screening done, 103(60.6%) would not feel embarrassed if a male nurse is to perform the test, 106(62.4%) perceived cervical cancer screening as not embarrassing and unpleasant, 87(51.4%) said Cervical cancer screening is unnecessary if there are no signs and symptoms, 152(89.4%) would take HPV vaccine which shows a good attitude and was supported by Sajid et al., (2019), 130(76.5%) cervical cancer screening helps in prevention of carcinoma of the cervix, 77(45.3%) cervical cancer is expensive. This findings were somewhat similar to that of (Seyoum et al., 2017).
In general, 122(72%) had good attitude towards cervical cancer screening while 48(28%) had poor attitude towards cervical cancer screening.
Research Question Four: What is the level of utilization of cervical screening services by female health workers?
This present study reveals that majority 129(75.9%) have had screening done, 104(61.2%) had it done at government hospital, 25(14.7%) had it done at private hospital, on types of screening done; 74(43.5%) 103(60.6%) had visual inspection with acetic acid done, 40(23.5%) had HPV DNA testing done. On reasons for screening; it was prescribed for 77(45.3%), 49(28.8%) on a voluntary basis, 5(2.9%) suggested by a friend; 61(35.9%) have been screened this year, 28(16.5%) last year, 35(20.6%), 7(4.1%) 3years ago.
Generally, Majority 150(88%) had high level of utilization of cervical cancer screening while 20(12%) had low level of utilization.
Research Question Five: What are the perceived factors influencing utilization of cervical cancer screening services among female health workers?
Present study reveals that lack of time was reported by 133(78.8%), fear of results was reported by 140(82.4%) which is supported by , religious belief 112(65.9%), cultural belief 106(62.4%) supported by Ifemelumma et al., (2019) cost of screening 108(63.5%), painful procedure 136(80%), male staff attending to me 105(61.8%) and support from husband 104(61.2%) as factors influencing utilization of cervical cancer screening. These findings were similar to what was reported by (Udigwe, 2016; Abiodun et al., 2017).
Hypothesis One
Ho - There is no significant relationship between years of working experience and utilization of cervical cancer screening service among female health workers.
H1 - There is significant relationship between years of working experience and utilization of cervical cancer screening service among female health workers.
Inference: There is statistical significant relationship between years of working experience and utilization of cervical cancer screening service. Hence, the null hypothesis is accepted (X2 = 11.281a, p -value 0.004) tested at p<0.05. As year of experience increases, the rate of utilization of cervical cancer decreases
Hypothesis two
Ho - There is no significant relationship between attitude of female health workers and utilization of cervical screening services
H1 - There is significant relationship between attitude of female health workers and utilization of cervical screening services.
Inference: There is no statistical significant relationship between attitude of female health workers and utilization of cervical screening services, hence null hypothesis is rejected (X2 =0 .35a, p -value 0.852) tested at p<0.05
Hypothesis Three
Ho - There is no significance relationship between knowledge of cervical cancer screening services and utilization of cervical cancer screening among female health workers.
H1 - There is significance relationship between their knowledge of cervical cancer screening services and utilization of cervical cancer screening among female health workers.
Inference: Since p-value is less than 0.05, there is statistical significant relationship between knowledge of cervical cancer screening services and utilization of cervical cancer screening (X2 = 4.547a, p -value 0.033) tested at p<0.05
5.2. Summary
This study was aimed to determine utilization of cervical cancer screening services among female health care workers in general hospital, Lautech Teaching hospital, Osogbo, Osun state. A total sample size of 170 was chosen using Taro Yamane formula. The questionnaires were distributed to the selected female health care workers in general hospital, Lautech Teaching hospital, Osogbo, Osun state. Pertinent literatures were reviewed which includes: textbooks, journals, past research works and internet sources. Majority 150(88%) had high level of utilization of cervical cancer screening, 122(72%) had good attitude towards cervical cancer screening, fear of results was reported by 140(82.4%) as a barrier to utilization of cervical cancer screening.
5.3 Conclusion
From the study carried out, utilization of cervical cancer screening services among female health care workers in general hospital, Lautech Teaching hospital, Osogbo, Osun state was determined and some Five (5) research questions were asked and answered and the three hypothesis set were also tested using chi-square at 0.05 level of significance. It was discovered there is significant relationship between year of working experience and utilization of cervical cancer screening. It was also discovered there is significant relationship between knowledge of cervical cancer screening and utilization of cervical cancer screening. From this study, it was discovered that those between 1-10 years of working experience tends to utilized cervical cancer screening and the rate of utilization decreases as the years of working experiences increases.
5.4. Nursing implication
Nurses constitute a major and tangible components of the health team as a whole, therefore,
- Nurses should focus on improving knowledge of females and entire population as a whole in preventing occurrence of cervical cancer through effective screening utilization.
- Nurses are to lead a collaborative efforts by engaging other health care team in increasing the level of awareness of the citizen on importance of cervical cancer screening.
- Nurses should advocate at the local, state and federal level to enhance screening programs in early detection and prevention of cervical cancer
5.5 Limitation of study
This study were subjected to the following limitations;
1. Funds; Financial constraint prevented the researcher to cover large population that could have been used to generalize the findings further.
2. Time factor; the researcher had limited time problem in administering the instrument to the respondents as the researcher took extra time to pass the mind of the study to the students. Also, the researcher had limited time to combine the study with other academic activities work.
3. Respondents’ attitudes: some of the respondents shows negative attitudes towards participating in the study, particularly, in dedicating their time in filling the questionnaires.
5.6 Recommendation
1. More should be done on awareness creation and sensitization of health workers on cervical cancer screening and sustaining national screening programs widely.
2. Health workers need to be marked at first since they have crucial role in any potential screening activities in order to achieve screening coverage in the community.
3. Even though, knowledge is necessary it is usually insufficient to change individual behaviour. So that motivation and sensitization needed for health workers about cervical cancer and the importance of screening to raise the uptake of screening besides to this, strategies should be designed for cervical cancer test to avoid barriers through advocacy
5.7. Suggestion for further study
Further studies could be carried out on this same subject matter using a large number of subjects and a different location. Studies could also be carried out on:
1. Barriers to utilization of cervical screening services
2. Predictors to uptake of cervical cancer screening.
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QUESTIONNAIRE ON UTILIZATION OF CERVICAL SCREENING SERVICES AMONG FEMALE HEALTH WORKERS IN LAUTECH TEACHING HOSPITAL, OSOGBO, OSUN STATE.
Dear Respondent,
I am a 500 level student of the Department of Nursing Osun state university, Osogbo. I am conducting a research on utilization of cervical screening services among female health workers in Lautech Teaching hospital, Osogbo, Osun state. The questionnaire is meant for data collection for my study, your honest and sincere response to these questions will be highly appreciated. The research is for academic purpose and all information provided are strictly confidential and will only be used for academic purpose.
Thank you
Section A
Demographic Data
1. Age
2. Marital status (a) Single (b) Married (c) Divorced (d) Separated (e) Other
3. Religion (a) Islam (b) Christianity (c) Traditional (d) Other
4. Profession
5. Years of experience
6. Tribe (a) Yoruba (b) Igbo (c) Hausa (d) Other
7. Monthly income
Section B:
Knowledge on Causes and Prevention of Cervical Cancer
Instruction: Kindly tick as appropriate or fill the gap where necessary
8. Have you ever heard of cervical cancer? A. Yes ( ) B. No ( )
9. If yes, what is your source(s) of information? A. Information Communication Technology ( ) B. Family C. Friends ( ) D. school ( ) E. Others (specify) _______
Abbildung in dieser Leseprobe nicht enthalten
Section C
Attitude toward cervical cancer screening
Abbildung in dieser Leseprobe nicht enthalten
Section D: Knowledge about Cervical Cancer Screening
Instruction: select all that apply and tick what you think is correct
21. Have you ever heard of cervical cancer screening? (a) Yes (b) No (c) Not sure
22. If yes, what is/are your source(s) of your information (a) lecture (b) media (c) friends (c) school.
23. When should a woman have her first cervical cancer screening ?
Select as appropriate
Abbildung in dieser Leseprobe nicht enthalten
24. How often should it be carried out? A. Once a year ( ) B. Every three years ( ) C. Every five years ( ) D. Don’t know ( ) E. Others specify_______________
Section D: Cervical Cancer Screening Utilisation
Instruction: Tick as appropriate
25. Have you ever had cervical cancer screening done before? A. Yes ( ) B. No ( )
26. If yes, where did you do it? A. Government hospital ( ) B. Private Hospital ( ) C. Others specify _
27. If yes, select the type of screening you have done before and state how many time(s) you have done it
Abbildung in dieser Leseprobe nicht enthalten
28. What was the reason(s) for screening? A. It was prescribed ( ) B. It was voluntary ( )
C. Suggested to me by a friend ( ) D. Others (specify)
29. When last were you screened for cervical cancer?
A. This year ( ) B. Last year ( ) C. 2 years ago ( ) D. 3 years ago ( ) E. Others specify: ________________
Section E: Factors Influencing Utilization of Cervical Screening Services
Instruction: Kindly select as appropriate from the given answers
Abbildung in dieser Leseprobe nicht enthalten
[...]
- Quote paper
- Adebayo Yusuf Kolawole (Author), 2021, Utilization of Cervical Cancer Screening Services among Female Health-Care Workers in General Hospitals, Munich, GRIN Verlag, https://www.grin.com/document/1020700
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