Journal of the Medical Women’s Association of Nigeria

ORAL PRESENTATIONS
Year
: 2021  |  Volume : 6  |  Issue : 1  |  Page : 64--72

Factors influencing the acceptance of cervical cancer screening and uptake of human papilloma virus vaccination among female civil servants in Asaba, Delta State


 

Correspondence Address:




How to cite this article:
. Factors influencing the acceptance of cervical cancer screening and uptake of human papilloma virus vaccination among female civil servants in Asaba, Delta State.J Med Womens Assoc Niger 2021;6:64-72


How to cite this URL:
. Factors influencing the acceptance of cervical cancer screening and uptake of human papilloma virus vaccination among female civil servants in Asaba, Delta State. J Med Womens Assoc Niger [serial online] 2021 [cited 2021 Sep 27 ];6:64-72
Available from: http://www.jmwan.org/text.asp?2021/6/1/64/319853


Full Text

BY

Okwe , Uchechukwuka Nnemdi MBBS, PGDip, MPA, MPH

Presented On 13Th September 2019

on The Biennium Of Medical Women's Association Nigeria.

 Outline



IntroductionBackground of the study with literature reviewMethodologySampling techniqueResearch questions and HypothesisPost field results

Evaluation of Demographic factors and knowledge of cervical cancer among female civil servants in Delta State.Evaluation of psychosocial factors that affect the acceptance and uptake of cervical screening among female civil servants in Delta State.Evaluation of psychosocial factors that affects the uptake of HPV vaccination among the female civil servants in Delta State.

ConclusionRecommendationReferences

 Introduction



The cervix is the lower part of the uterus (womb). It is sometimes called the uterine cervix. The body of the uterus (the upper part) is where a baby grows. The cervix connects the body of the uterus to the vagina (birth canal). The part of the cervix closest to the body of the uterus is called the endocervix. The part next to the vagina is the exocervix (or ectocervix). The 2 main types of cells covering the cervix are squamous cells (on the ectocervix) and glandular cells (on the endocervix). The place where these 2 cell types meet is called the transformation zone. Most cervical cancers start in the transformation zone.

There are 2 main types of cervical cancers: squamous cell carcinoma and adenocarcinoma. About 80% to 90% of cervical cancers are squamous cell carcinomas. (A. Sreedevi, 2015) and (O. Adegoke, 2012).

Cancerous changes can be detected by the Pap test and treated to prevent the development of cancer.

 Background/Literature of Study



In Nigeria, uptake of cervical cancer screening and especially HPV vaccination has been demonstrated in different studies to be very low. Out of 13 studies, nine show cervical cancer screening uptake of less than 5.3% (Ndikom et al., 2012; Aniebune and Aniebune, 2012). This calls for concern on how to identify the barriers to cervical cancer screening uptake and ways to proffer solutions.

Psychosocial factors have been implicated in Literature as contributory to the low uptake of cervical cancer screening and HPV Vaccine services. Factors such as anxiety, fear of death, fear of being diagnosed, procrastination, poor health seeking behavior, cost of screening and vaccination, lack of social support, belief values, attitudes, cultural practices and constraints, lack of time, recession, misconception, stigmatization, economic status, religion of the woman, fear of the screening becoming positive, sources of reproductive health knowledge, access to health care, social influence of family members and women has been identified (Teng et al., 2012; Ajah, 2015).

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These Psychosocial factors identified by some scholars in different environment, social settings, different communities, States and countries have not been proven by any literature or scholarly write up to be barriers of not accepting cervical cancer screening and the HPV vaccination in Delta State (Ahmed et al., 2013). This research tends to bridge the gap in knowledge and hopes to identify these factors.

The ignorance of the benefit of cervical cancer screening and HPV vaccination was further emphasized when a Nigerian woman was credited as saying “I rather recharge my phone than test for cervical cancer (Nwobodo and Break, 2016). This underpinned the fact that there is a constant need to emphasize the benefit of cervical screening and HPV vaccination for Nigerian women. Cervical Cancer screening helps to detect early stage of the disease and in most cases early treatment is offered and the chances of survival are better. It is important to know that women who are not screened have a higher risk of developing cervical cancer (Ajah).

In Nigerian communities, gainfully employed women complain of no time due to exigencies of their job against the background of their culturally imposed duties, such as household chores and children up keep could hinder them from up- taking cervical cancer screening. This has implications in Nigerian communities where women have the attitude of procrastinating hospital visits and screening services due to many activities competing for limited time and their belief that hospital services is for the sick only.

Delta is an oil producing State and with relative better economy and with the availability of cervical screening and HPV vaccines in some hospitals and notably in the Delta State Secretariat clinic where most civil servants access treatment on an outpatient basis, many cases of advanced cervical cancer are still seen with few numbers of people presenting for cervical screening and HPV vaccination despite easy access within the State Secretariat. Hence, this study to address this gap would be a welcome development (Delta State Secretariat Clinic records, 2016) 2015).

 Statement of Problem



The future burden of Cervical cancer in Sub-Saharan Africa will rise to about 118,000 new cases in 2025, representing a massive 67% increase from the figures of kitchener et al, 2006; Pallacio et al 2009.xs

In Nigeria 10,000 women develop the cancer and about 8,000 deaths have been recorded annually. The burden of cervical cancer in developing countries including Nigeria is high (Akanbi et al, 2015). More worrisome is that less than 7.1% of Nigerian women have done cervical cancer screening and only 8% of women between 2010 and 2011 had HPV vaccination (Ugwu et al, 2013).

The attitudes of our women towards these preventive measures may encourage the development of precancerous lesions into cervical cancer. HPV Vaccination which offers protection against HPV infection should therefore be encouraged as a primary preventive measure and the barriers to cervical cancer screening uptake should be identified and dealt with (Nwobodo and Break, 2016).

 Aetiology and Symptoms of Cervical Cancer



Cervical cancer is caused by the Human Papilloma Virus that is sexually transmitted and symptoms include,

Vaginal bleedingFoul smelling vaginal dischargePost-coital bleedingLoss of weightPelvic painVessico and rectovaginal fistula (VVF and RVF)Metastases to other organs of the body and death

Prevention is by screening for cervical cancer to detect it early and curb its spread and with HPV vaccination.

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Schematic illustration of cervical screening and psychosocial barriers by AJ Chorley (2016)

 Broad Objective Of The Study



To Evaluate Demographic factors and knowledge of cervical cancer among female civil servants in Delta StateTo Evaluate psychosocial factors influencing cervical screening among female civil servants in Delta State.To Evaluate psychosocial factors influencing of Human papilloma virus vaccination among female civil servants in Delta State.

Specific Objectives

Assess knowledge of cervical cancer among female civil servants in Delta State.Examine uptake of cervical cancer screening among female civil servants in Delta StateExamine participant's acceptance of HPV vaccination for their daughters.

Significance of Study

It will be valuable to the medical profession, other health professionals and various stakeholders in Nigeria, to identify context specific interventions, that if implemented, will improve cervical cancer screening, and reduce new cases of cervical cancer in Nigeria.

Useful to policy makers in shaping cervical cancer screening programs' in Nigeria and the need for HPV vaccination for the girl child.

It will serve as a reference to reproductive health experts and policy makers when implementing cultural sensitive health promotions and intervention strategies.

 Methodology



Study Design: The study was designed to be a cross sectional, descriptive survey method.

Study Setting: This was the Delta State Secretariat located in Asaba the State capital.

Study population: was estimated to comprise 20000 female civil servants from eight Governmental Ministries.

Quantitative questionnaire survey was used to collect data on eight demographic factors including age, educational level, ethnicity, income, marital status, number of children, religion and Ministry. Besides the demographic variables in section A, the structured questionnaire consisted of section B, which elicited information on knowledge of cervical cancer; as well as section C used to examine perceived susceptibility to cervical Cancer and section D some psychosocial factors identified as barriers to cervical screening., Section E and F elicited information on barriers and psychosopcial factors affecting HPV vaccination.

Statistics: Percentage proportions of respondents were assessed for the eight demographic variables. Absolute frequencies of affirmative responses to the questions on knowledge were evaluated. Hypothesis 1 to 5 was tested by Chi square method at a significance of level of 'p < 0.05.

Sample Size Technique and Determination

Delta State Secretariat was selected based on the fact that there is a concentration of civil servants and Ministries in the Secretariat and the easy access to study population.

Simple random sampling (balloting) was used to select the eight (8) ministries that will participate. Ethical approval was gotten from the Ministry of Health research and ethics committee.

At the Secretariat there are females from different religion, cultural background, ethnicity, different beliefs, values opinions and views, attitudes, with diverse social economic status which a good number of women within the study group would be easily assessed for information.

The Raosoft sample size determination and

calculator was used. margin of error accepted 5 %

confidence needed 95%

population size 20,000

response distribution 50%

recommended sample size is 377

Among the 377 questionnaires distributed only 285 questionnaires were filled and returned. Others did not return the questionnaires.

Research Question

Do the Female civil servants in Delta State have the knowledge of uterine cervical cancer?

Are the female civil servants in Delta State ready to uptake cervical cancer screening?

Are the female civil servants in Delta State ready to accept HPV vaccination for their children?

What are the psychosocial factors influencing female civil servants in Delta State towards the acceptance of cervical cancer screening and uptake of HPV vaccination among participants.

Research Hypothesis

Hypotheses one: There is no significant association between demographic variables and knowledge of cervical cancer among female civil servants in Asaba, Delta State.

Hypotheses two: There is no significant association between economic status and acceptability of HPV vaccination among female civil servants in Delta State, Asaba.

Hypotheses three: There is no significant association between knowledge and uptake of cervical cancer screening among female civil servants in Delta State, Asaba.

Hypotheses four: There is no significant association between selected psychosocial factors and uptake of cervical screening.

Hypotheses five: There is no significant association between selected psychosocial factors and uptake of HPV vaccines.

Instrument of Data Collection (Questionnaire with 6 Sections)

Section A- which elicits the social demographic variables

Section B- questions covers objective 1 on knowledge of cervical cancer

Section C- cover Objective 2 and objective 3 and is used to examine perceived susceptibility to cervical cancer

Section D - will be used to assess their uptake of cervical cancer screening

Section E- will be used to assess the acceptance of HPV vaccination for their daughters

Section F- used to access possible psychosocial factors influencing cervical cancer screening acceptability and HPV vaccination.{Figure 1}{Table 1}{Table 2}{Figure 2}{Table 3}{Table 4}[INLINE:3]{Table 5}

 Objective 1



Evaluation of Demographic factors and knowledge of cervical cancer among female civil servants in Delta State.

 Knowledge on Cervical Cancer



 Objective 2



Evaluation of uptake an psychosocial factors of Cervical cancer screening among female civil servants in Delta State

This was reviewed with Hypothesis 3 and 4{Table 6}

 Hypothesis 2



There is no significant association between the economic status and acceptability of HPV Vaccination among female civil servants in Delta State.

Monthly Income * Screened for Cervical Cancer * Been Vaccinated with HPV Cross tabulation [Table 6].

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Hypothesis 2 was rejected from the results below. There was a positive association

OBJECTIVE 2: Evaluation of uptake an psychosocial factors of Cervical cancer screening among female civil servants in Delta State

This was reviewed with Hypothesis 3 and 4{Table 7}{Table 8}{Table 9}{Table 10}

iv Responses to Psychosocial Factors Influencing Uterine Cervical Cancer Screening{Figure 3}{Figure 4}

Responses to Psychosocial Factors

HYPOTHESIS 3: There's no significant association between knowledge and uptake of cervical cancer screening among female civil servants in Delta State, Asaba.

HPOTHESIS 4: There is no significant association between selected psychosocial factors , schedule of work, religion, beliefs, values, cultural practices/differences, taboos, discouraged by spouses, discouraged by friends , attitude of health workers, cost, fear of stigmatization, inaccessibility of screen site and acceptability of cervical screening among female civil servants in Delta State.

 Objective 3



Evaluation of acceptance and psychosocial factors of HPV vaccinations among female civil servants in Delta{Table 11}{Figure 5}{Figure 6}

HYPOTHESIS 2: There is no significanThe search highlighted the fact that gainsst association between the economic status and acceptability of HPV vaccination among female civil servants in Delta State{Table 12}

HYPOTHESIS 5 IS REJECTED

[Table 4]: Chi square output psychosocial factors vs. being vaccinated (N = 285). There is some positive association of psychosocial factors with HPV Vaccination

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 Conclusion



A total of 285 questionnaires were analyzed. The age range of the female civil servants was 20 to 60 years in the 8 ministries randomly selected. The age group of 25 to 29 years responded well and had more participants who have been screened than the older age group. Most screened for cervical cancer worked in the Ministry of Health. Religion was not a barrier to screening or vaccine uptake. The Ibo ethnic group responded more(52%). Most respondents were married (72%).

Most of the respondents in this study heard about Cervical Cancer from the mass media(87%).

A review of the results indicate that the female civil servants in Delta State are knowledgeable on cervical cancer(97.5%), its causes, screening measures, lifestyle risks and its prevention(95.1%).

The intention to screen and encourage friends and their daughters to screen was observed (97.5%).

Almost all respondents agreed that the nature and schedule at work was a major factor in the inability to take the vaccines (100%) and not the affordability.

Most of the respondents in this study were in the middle social class, had University education and were all employed but complained their work schedule was very busy and there was no time to go for screening even though the services of cervical screening and HPV vaccines were within their reach in the Secretariat.

The nature and schedule of work being tasking was a major factor in reduction of acceptance and uptake of cervical screening and HPV Vaccination

Hypothesis 1, 3, 4 and 5 were rejected as there was a positive association between

Demographic variables and knowledge of cervical cancer, knowledge of cervical cancer and uptake of cervical screening and psychosocial reactions to the uptake of cervical screening and HPV uptake.

Initial stratification of respondents in [Figure 8] into income groups and subsequent evaluation of cervical screening plus HPV screening show that acceptance was not different between income groups(hypothesis 2), whereas 'No' responders linearly increased with monthly income . This agrees with cost in hypothesis 5 which showed that affordability of the vaccine and its cost did not show any significance in the uptake of the vaccine. This is contrary to the expectation.{Figure 7}

It was good to know that even if the women had not had the screening and vaccination they are prepared to encourage their daughters and friends to have it done (97.5%).

Another factor was the inaccessibility of the vaccines in most hospitals (80.7%). Some had lost confidence in taking the vaccines due to lack of privacy (80.7%) and hostility of the medical staff (60.4%). It was worthy to note that even though the State secretariat clinic had HPV vaccines some civil servants were not aware and even though some knew they did not utilize the opportunity to have the HPV vaccine taken.

 Recommendation



Health Education: In ensuring cervical screening or pap smear test and HPV Vaccine acceptance and uptake , there is a need for continuous sensitization and awareness of cervical cancer and its prevention.

Improvement in the accessibility and affordability of screening services by Policy makers. There can be a mandatory measure for women to have cervical screening 6 weeks after delivery(post-natal). There must be an intervention or strategy to ensure cancer screening is accepted as this will reduce the morbidity and mortality associated with cervical cancer HPV Vaccination: Adolescents must be encouraged to have HPV vaccines to reduce cervical cancer mortality and morbidity via sensitization in schools.

Maintenance of a good lifestyle free from sexually transmitted infections, multiple sex partners, early exposure to sex, alcoholism, overweight, were some of the preventive measures stated by the women could ensure a reduction in the susceptibility and incidence of cervical cancer.

A better collaboration and advocacy with service providers and participation in screening programs will ensure a better attitude to women's health in issues concerning cancer. Flexible work hours sis also recommended to enable women take the vaccines.

 References



Aboyeji , P.A.(2004).Knowledge, attitude and practice of cervical smear as a s c r e e n i n g procedure for cervical cancer in Ilorin, Nigeria: Tropical Journal of obstetrics and Gynaecology;21: 114-117Adewole, I.F. (1997).Invasive and in situ carcinoma of the cervix in young Nigerians. A clinico-pathologic study of 27 cases. Afri J Med Sci;26:191-193Aggarwal , A. (2013). Disparities in breast and cervical cancer screening in women with mental illness: A systematic literature review: Am J Prev Med 20; 44 (4):392-398.Ahmed Saad Aliyu(2013).Knowledge , attitude and practice of cervical cancer screening. Nigerian Medical Journal;5(54):316-319Akanbi, O.A.(2015).Perceptions of Women about Human Papilloma Virus, Cervical Cancer and HPV Vaccine. Scientifica ;285702(2015).Aldrich, T., & Hackley, B. (2010). The impact of obesity on gynecologic cancer screening: an integrative literature review. J Midwifery Womens' Health ; 55(4):344-356.Assoumou ,O. (2015). Awareness and knowledge regarding cervical cancer, p a p s m e a r screening and HPV infection in Gabonese women.:BMC Women's Health; 37(15)Austin, L. T.(2002). Breast and cervical cancer screening in Hispanic women : a literature review using the health belief model. Womens Health Issues; 12(3):122-128.