ABSTRACT
Cervical cancer is the second
most common cancer prevalence among women worldwide with half a million cases
each year. Cervical cancer incidence rate in Ghana is among the highest in the
world.Low knowledge level, poor attitude and health beliefs are known to
account for thelow level of cervical cancer screening in the Ghana.The study
set out to explore the knowledge, attitude and health beliefs of cervical
cancer and its screening among women in Ajumako-Enyan-Essiam district. A
questionnaire was used to collect data from 240 women aged 18 to 60 from eight
selected towns in the district. The study found a significant association
between women’s level of knowledge on cervical cancer and practice of cervical
cancer screening. There was also a significant association between women’s
knowledge, health beliefs (34.2%) and practice of cervical cancer screening. In
terms of attitude, the study found the respondents have positive
attitude(44.3%) towards cervical cancer screening. Most of the respondents were
of the view that they will be satisfied after having a pap smear. Majority
(88.8%) of the respondents reported that regular Pap smear gave them a sense of
control. Most respondents (79.6%) believed that cervical cancer test should be
done on regularly basis. It is recommended that women should be educated on cervical
cancer and screening because the formal education of women influence screening
uptake.
CHAPTER ONE
INTRODUCTION
Background to the study
Cervical cancer is the second most common cancer among women
worldwide. About half a million new cases are recorded worldwide each year.
Most of the cases occur in developing countries where victimsreport late when
only palliative treatment can be given. Cancer is responsible for about 51
million deaths annually. About 83% of the cases occur in developing countries,
representing 15% of all female-related cancers. Cervical cancer accounts for
8.5% of the death most in developing countries (Adanu, Seffah, Duda, Darko,
Hill, & Anarfi,2010).
Cervical cancer is the leading cause of cancer-related death
among women in Ghana and West Africa (Williams & Amoateng, 2012,). The
World Health Organization (WHO) predicts that by the year 2025, 5000 new cases
of cervical cancer and 3,361 cervical cancer deaths will occur annually in
Ghana. Althoughthere is no formal cancer registry in Ghana, the International
Agency for Research on Cancer has estimated that in 2008, 30,038 Ghanaian women
developed cervical cancer and more than 2,006 Ghanaian women died because of
cervical cancer (Williams & Amoateng, 2012). Despite the staggering
statistics, cervical cancer prevention is not commonly promoted in Ghana.
An estimated 95% of women in developing countries have never
been screened for cervical cancer (WHO, 2007) and only 2.1% of Ghanaian women
have ever had a pap smear (Adanu etal., 2010). Diseases such as malaria,
tuberculosis, HIV/AIDS, and most recently, breast cancer receive majority of
health promotion resources. Cervical cancer has several unique characteristics that make prevention through screening and the treatment of
pre-cancerous stages relatively less complex. The cause of virtually all
cervical cancer cases is known to be the persistent infection with a restricted
set of human papilloma viruses (HPVs).
Cervical cancer also exhibits an identifiable pre-cancerous
condition and the time window from dysplasia to carcinoma is long
(approximately 10 years on average). Several screening methods to detect
pre-cancer and cancer are available, and can be performed safely and
inexpensively in an outpatient setting. These methods include, but are not
limited to, visual inspection with acetic acid (VIA) and careHPV. In addition
to being used throughout many resource-limited countries around the world,
these methods are also effective at treating pre-cancerous findings, thus,
further decreasing the burden of disease.
Cervical cancer is therefore largely preventable by effective
screening programs. A considerable reduction in cervical cancer incidence and
deaths has been achieved in developed nations with systematic cytological smear
screening programs. These tools (Pap Test and Visual Inspection with Acetic
acid (VIA)) are available in both public and private hospitals throughout the
country.
In Ghana, some public hospitals offer free cervical cancer
screening. Additionally, the bivalent HPVvaccines have licensed for use in
Ghana and are available in a few public hospitals in the country. Despite this,
world health survey indicates that cervical cancer screening rates in urban and
rural areas in Ghana are extremely low (3.2% and 2.2% respectively). The
results of previous studies indicate that lack of knowledge among Ghanaian
women as well as their attitude and beliefs may be a barrier to
cervical cancer screening(Ebu,Siakwa&Sampselle,
2014). Pap smears are available only at a few locations, and most women
lack knowledge of their availability or purpose. Studies conducted in African
countries like Uganda, Botswana and Nigeria as well as Thailand and India by
Wilson (2002) showed that women have limited knowledge and a negative attitude
towards cervical cancer and pap smear screening which contributed to their
non-participation in screening programs and for some, even though they were
screened, they donot present themselves for follow-up for further healthcare
once an abnormality isdetected in their smear results. Fortunately, measures
that offer unprecedented opportunities for preventing cervical cancer are now
given much attention: efficient, low-cost screening approaches suitable for
low-resource areas and vaccines that are efficacious in preventing the
infections and pre-cancerous changes that can lead to cervical cancer.However,
the absence of organized screening programs in Ghana and other developing
countries explain why presentation in late stages with resultant poor prognosis
is common.
For the screening methods to be fully utilized, women need to
be aware of the availability of the methods, to have knowledge of the disease
and screening methods. These will enhance uptake of the screening for
pre-malignant lesions and hence reduction of morbidities and mortalities
resulting from cervical cancer especially in Sub-Saharan Africa. Demographic
factors such as age, education, ethnicity, and socio-psychological factors such
as social class, personality, embarrassment, fear and lack of health insurance
have been recognised to influence screening uptake. Additionally, structural
factors such as beliefs, attitude and knowledge about cervical cancer and the smear test have been documented as determinants of an
individual’s participation in cancer screening (Maait, 2002). Another reason
for poor uptake in the cervical screening programme is attributed to the lack
of communication between healthcare workers and patients regarding availability
and benefits of the screening (Maait, 2002).
Problem Statement
Globally, cervical cancer is the third most common cancer
among women.In 2008 there were an estimated 529,000 new cases and 275,000
deaths occur (Zahedi etal., 2014). WHO also pointed out that, cervical cancer
is the second most frequent cancer among women; however, eighty five percent of
cervical cancer deaths occur in low and middle-incomecountries and this has
been a global burden experienced by these countries (WHO, 2013). In the WHO
African region, 75,000 new cases were recorded in the same year and 50,000 women
died of the disease.
It was also recorded that cervical cancer is the most common
cancer in women accounting for 13% of all female cancers with global mortality
incidence ratio at 52%. Globally, 270,000 women die of cervical cancer each
year and nearly 90% of these women live in the developing world(WHO, 2013). The
majority of cervical cancer deaths occur in women who were never screened or
treated, as well as those who had an early sexual debut, and a history of
multiple sexual partners. If detected early cervical cancer is usually curable.
This is becausethe cause of virtually all cervical cancer cases is known to be
the persistent infection with a restricted set of human papilloma viruses
(HPVs). Cervical cancer also exhibits an identifiable pre-cancerous condition
and the time window from dysplasia to carcinoma is long (approximately 10 years on average). In addition, several
screening methods being used throughout many resource-limited countries around
the worldare also effective at treating pre-cancerous findings, thus further
decreasing the burden of disease. However, despite these, cervical cancer still
remains a problem and a public health concern.
This is attributed to the poor knowledge, attitude and health
beliefs of women on cervical cancer as indicated by espoused by Nakalevu
(2009). This is a view held by Ebu,Siakwa and
Sampselle
(2014) that the health belief of women as well as their knowledge and
attitude may be a barrier to cervical cancer screening. In developed countries,
screening has proved to reduce the incidence of this malignancy effectively but
screening coverage is still low in developing countries like Ghana, ranging
from 2.0% to 20.2% in the urban areas and 0.4% to 14.0% in rural areas.
Cervical cancer remains a major public health problem in
developing countries, especially in Africa of which Ghana forms part where
women continue to be diagnosed with and die from this preventable disease
despitethe time window from dysplasia to carcinoma being long (approximately 10
years on average).This plausibly indicates that Ghanaian women have little or
no knowledgeabout cervical cancer and this has been confirmed by previous
studies indicating that lack of knowledge among Ghanaian women as well as their
attitude and beliefs may be a barrier to cervical cancer screening(Ebu,Siakwa&Sampselle,
2014). Again, Ebu,Siakwa and
Sampselle
(2014) observed that, the inhabitants of the municipality (Elmina) firmly
believe that cervical cancer is a curse by the gods and as such they did not
believe it can be prevented or cured when noticed early. Their knowledge base on cervical cancer was very low hence their poor attitude
towards screening uptake. In this regard, delving more into cervical cancer
will broaden their understanding and clear some of the health beliefs that
societies or communities firmly hold on to thereby preventing them from
utilizing screening programs. Furthermore, it has been reported that
understanding health behaviors in the cultural context is paramount if the
health status of high risk group is to be improved (Wilson, 2002).
It is for this reason that the study sets out to explore the
knowledge base as well as attitude and health beliefs of cervical cancer among
women in the Ajumako-Enyan-Essiam District of the central region of Ghana.
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