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Annals of African Medicine
Annals of African Medicine Society
ISSN: 1596-3519
Vol. 4, Num. 4, 2005, pp. 160-163

Annals of African Medicine, Vol. 4, No. 4, 2005, pp. 160-163

AWARENESS OF CERVICAL CANCER AND SCREENING IN A NIGERIAN FEMALE MARKET POPULATION

O. O. Ogunbode and O. A. Ayinde

Department of Obstetrics and Gynaecology, UniversityCollegeHospital, Ibadan, Nigeria
Reprint requests to: Dr. O. A. Ayinde, Department of Obstetrics and Gynaecology, UniversityCollegeHospital, P. M. B. 5116, Ibadan, Nigeria. E-mail: sola_ayinde@yahoo.com

Code Number: am05040

Abstract

Background: Cervical cancer, although largely preventable, remains a leading cause of cancer death among females in the developing world. The study was aimed at providing useful information on awareness of market women, who are from diverse social backgrounds, about cervical cancer and evaluate the extent of utilisation of Papanicolaou’s smear by them. It was also aimed at determining the prevalence of risk factors for development of cervical cancer among the population.
Methods: This cross-sectional descriptive survey was carried out among market women at Aleshinloye market in November 2003, among 483 randomly selected respondents. A questionnaire probing into their sexual history, awareness about cervical cancer and the extent of utilisation of Pap smear was the survey instrument.
Results: The majority (79.5%) of the women were sexually active. One hundred and eighty-six (38.5%) had early sexual debut and 163 (33.7%) had multiple sexual partners. Only 197 respondents (40.8%) were aware of cervical cancer. Of these, 95 (19.7%) were aware of Pap smear as a screening test. The common media of awareness were radio and television (46.6%), public lecture (27.8%) and friends/ relatives (19.9%). However, only 25 respondents (5.2%) have had previous Pap smear done.
Conclusion: Though the market women are at considerable risk of developing cancer of the cervix, they are poorly informed about the disease and its prevention. Therefore, there is need for continuous awareness campaign and well-organized screening programmes among this unique category of women.

Key words: Cervical cancer, screening, awareness

Résumé

Contexte: Le cancer du col, bien qu’évitable, demeure la principale cause de décès par cancer chez la femme dans les pays en développement. Le but de cette étude était de donner des informations utiles sur la connaissance du cancer du col et l’évaluation de l’utilisation du test de Papanicolaou,  par des vendeuses au marché, de couches sociales diverses. Il s’agissait également de déterminer la prévalence des facteurs de risque de développer le cancer de la prostate dans cette population.
Méthodes : Cette étude descriptive sur un échantillon représentatif a été réalisée au sein de femmes au marché Aleshinloye en Novembre 2003, auprès de 483 femmes sélectionnées au hasard. L’enquête reposait sur un questionnaire s’intéressant à la sexualité, la connaissance du cancer du col et l’utilisation du test de Papanicolaou.
Résultats : La majorité des femmes (79,5) étaient sexuellement actives. Cent quatre six (38,5%) avaient précocement démarré leur activité sexuelle et 163 (33,7%) avaient des partenaires sexuels multiples. Seuls 197 (40,8%) avaient connaissance du cancer du col. Parmi elle, 95 (19,7%) connaissaient le dépistage par le test de Papanicolaou. Les moyens habituels d’information étaient   constitués  par  la  radio  et  le  télévision  (46,6%),  les   conférences publiques (27,8%) et les amis/parents (19,9%). Cependant, seuls 25 femmes (5,2%) avaient déjà bénéficiés de test de Papanicolaou.
Conclusion:Quoique, à risque considérable de développer le cancer du col, ces femmes sont peu informées à propos de cette maladie et sa prévention. A cet effet, il est nécessaire de continuer les campagnes d’information et de mener des campagnes de dépistage bien organisées au sein de cette catégorie de femmes.

Mots clés: Cancer du col, dépistage, conscience

Introduction

Worldwide, cervical cancer is a major cause of cancer related morbidity and mortality in women. It continues to be the second commonest female cancer worldwide after breast carcinoma.1 However it remains the most common malignancy amongst women in Nigeria. 2 - 4 Each year an estimated half million new cases are diagnosed with 80% of then from developing countries. 1, 5

Known predisposing factors to future development of cervical cancer include sexual debut before the age of 20 years, sexual promiscuity, high parity and low socioeconomic status. 6, 7 Some of the factors are thought to facilitate infection by certain high-risk HPV types during the period of active cervical epithelial metaplasia, especially during adolescence.

It is however preventable provided its preinvasive precursors are detected early and promptly treated, as is widely done in developed countries. The absence of organized screening programmes in Nigeria and other developing countries explains why presentation in late stages with resultant poor prognosis is common. 8, 9

Since the establishment of the association between cervical cancer  and the Human Papilloma Virus (HPV) infection, a lot has been done (especially in developed countries) to create awareness concerning sexual behaviours that are known to predispose to the condition as well as encourage early detection through the use of widely acceptable screening programmes. 9 Not much has been done in Nigeria.10

Cervical cancer has a prolonged phase of premalignancy called cervical intraepithelial neoplasia (CIN). This, coupled with the accessibility of the cervix is responsible for the success of screening in reducing the prevalence of the tumour. Cervical cytology using Papanicolaou (Pap) smear is one of the most effective screening techniques currently being used.11, 12

The Nigerian female market population is one of the main economic driving forces in this nation. They comprise of people from different educational, cultural and religious backgrounds. They are mostly women in the reproductive age group and are prone to gender bias as well as sexual exploitation. There is paucity of reports on the risk of cervical cancer and its prevention among this population. This informed the conduct of this study. This study was designed to provide useful information on awareness of the study population about cervical cancer and screening practices. It was also aimed at determining the prevalence of sexual risk factors known to predispose to the development of cervical cancer and the extent of utilization of Pap smear among the market women.

Materials and Methods

The study was a population-based descriptive cross-sectional study. Multi-staged sampling technique was used. Aleshinloye market was chosen for the study from the three major markets in Ibadan by simple random technique. It is a major multipurpose market located in Ibadan South-West Local Government Area. The market is made up of lock-up shops arranged in rows numbered from letters A-Z, with each row containing an average of forty shops. These were numbered serially for the purpose of this study. The total number of shops was 1046. The calculated minimum sample size using the formula by Kish, 1965 13,14 was 386, based on 95% confidence interval and prevalence of awareness of 50 percent from a similar study among rural and urban women in South Africa.

Deliberate over-sampling was done to the tune of 30% to make up for incomplete response. Therefore, a sample size of 499 was used. Working on the assumption that there would be an average of one female of 15 years and above per shop, 500 random numbers were generated using the `epitable’ of EPI INFO 2002 statistical package (Centre for Disease Control, Atlanta, Georgia, USA). Only consenting females shop owners and attendants of ages 15 years and above in the randomly selected shops were included in the study. Customers and visitors were excluded.

The survey instrument was a structured questionnaire created from similar studies. Pre-testing of the questionnaire was done among 20 respondents before the final version was developed. It contained a mixture of 26 closed and open-ended questions. The questionnaire consisted of questions on basic demographic and risk factors for development of cervical cancer. Level of knowledge of a respondent was assessed based on the correct answers provided to fifteen relevant but basic closed ended questions on aetiology, predisposing factors, and prevention of the tumour. Each answer attracts a score of one (if correct) or zero (if wrong) and the total score ranged between 0 and 15. There were also items on previous Pap smear and attitude towards the procedure.

Data collection was by self-administration (in literate respondents) and interview (in non- literate respondents). A preliminary visit was made to the market head to intimate the market population thereby aiming to increase co-operation and reliability. The data was entered into a computer running EPI INFO 2002 software. Analysis was by generation of frequency tables.

Results

Four hundred and ninety-nine questionnaires were administered but only four hundred and eighty-three (96.8%) were analysable.

Table 1 shows the various socio-demographic characteristics of respondents. Their ages of the respondents ranged between 15 and 66 years with the modal age group being 20 to 29 years. The commonest item being sold by 203 respondents (42.0%), followed by clothing and textile materials being sold by 92 respondents (19.0%).  Others sell kitchenwares (6.4%), provisions (6.2%), cosmetics (4.6%), electrical appliances (0.6%) and a host of other items (21.1%).   Many of the respondents (44.1%) have an average daily profit estimate of less than one thousand Naira while 28.4% made 1000-2000 Naira profit per day and 15.7% were making profit of 2000-5000 Naira per day. Only 11.8% were making above five-thousand naira gain per day. One United States Dollar exchanged for one hundred and thirty-five naira at the time of the survey. Majority of respondents (56.3%) had secondary education. Only twenty-one (4.4%) had postgraduate education while forty-seven (9.7%) had no formal education. Three hundred and thirty-eight (70.0%) practiced Christianity; one hundred and forty-one are Muslims while one (0.2%) and three (0.6%) practiced traditional religion and other faiths respectively.  Three hundred and seventy one respondents (76.8%) were Yoruba while Igbo, Hausas and other ethnic groups account for eighty (5.6%), twelve (2.5%) and twenty (4.1%) respectively. Majority (55.5%) of the women were married while 38.9% were single. The others were divorced, widowed or separated. Two hundred and forty-nine (59.3%) were parous. Out of these, one hundred and fifty-nine (32.9%) were multiparas while seventy-three (15.1%) were grandmultiparas.

Tables 2 highlighted the presence of some of the sexual risk factors for cervical cancer among the respondents. The majority (79.5%) of the women were sexually active. One hundred and eighty-six (38.5%) had early sexual debut before the age of twenty years and one hundred and sixty-three (33.7%) had had at least two sexual partners.

Table 3 shows the knowledge of cervical cancer among the respondents. Only one hundred and ninety seven respondents (40.8%) were aware of cervical cancer. Of these, ninety-five (19.7%) were aware of Pap smear as a screening test. The common media of awareness were radio and television (46.4%), Public lecture (27.8%) and friends/relatives (19.9%) while the others became aware through sources such as religious institutions and the Internet. Only one hundred and thirteen (23.4%) had an above average knowledge score of at least 8. However, only twenty-five respondents (5.2%) have had previous Pap smear done. The reasons given for not having the test among the remaining 458 respondents varied. Three hundred and thirty-four (73.0%) were not aware of the test while twenty-four (5.2%) lacked awareness of where it could be carried out. Other reasons cited include reluctance attributed to fear of invasion of privacy (11.6%), lack of conviction about its usefulness (6.5%), cost consideration (2.0%) and lack of husband’s approval (1.7%). Though, a majority (66.7%) of this category of women indicated their willingness to have the test in future, the remaining 33.3% would not have pap smear screening even if made free. 

Table 1: Some demographic characteristics of 483 respondents

Demography

No. (%)

Age (years)

 

<20

43 (8.9)

20 – 29

204 (42.2

30 – 39

108 (22.4)

40 – 49

75 (15.5)

50 – 59

37 (7.7)

≥60

16 (3.3)

Parity

 

0

207 (41.7)

1

50 (10.4)

2-4

159 (32.9)

>4

73 (15.1)

Table 2: Sexual practices among 483 respondents

Sexual practice

No. (%)

Age at sexual debut (years)

 

Not yet sexually exposed

99 (20.5)

<20

186 (38.5)

≥20

198 (41.0)

Total No. of sexual partners ever

 

0

99 (20.5)

1

221 (45.8)

≥2

163 (33.7)

Table 3: Knowledge of cervical cancer among 483 respondents

Knowledge

No. (%)

Awareness

 

Aware

197 (40.8)

Not aware

286 (59.2)

Knowledge score (our of maximum of 15)

 

<8

370 (76.6)

≥8

113 (23.4)

Discussion

A market woman typifies an average Nigerian woman and is expected to exhibit attributes, which conform to those of the majority of the citizenry. Nevertheless, the women interact with people in virtually all spheres of the society and often become aware of popular things. Previous studies suggested that the risk of developing cervical cancer is high for women in the third world due to peculiar trends in socioeconomic characteristics and behaviours.10, 15 This was also confirmed by this study. Most of the women are in their third and fourth decades of life, the age group in which neoplastic lesions of the cervix are common. Majority of them are also in the low socio-economic class. Apart from these, vast majorities (79.5%) were sexually active, 38.5% had early sexual debut and 33.7% have had multiple sexual partners. In addition to these, 48% of them were either multiparous or grandmultuiparous.

Despite the high prevalence of risk factors for the cervical cancer, only 40.8% of the market women were aware of the disease while a much lower proportion (19.7%) had ever heard about Pap smear, the commonest cervical screening technique in use today. It is however worthy of note that the awareness of the tumour was better than 15% reported amongst attendants at the General Outpatient Department (GOPD) of the University College Hospital Ibadan in 1998. 16 This can be possibly attributed to an ongoing awareness campaign and free cervical screening programme organized by the Oyo State Government. This underscores the importance of health education and government intervention in the prevention of this public health problem. An observation that is common to most of the previous similar studies is that of wide disparity between the prevalence of awareness of cervical cancer and utilization of Pap smear. 10, 16 This study also showed that only 5.2% of the women have ever had the screening test done.

In conclusion, the market women are at considerable risk of developing cancer of the cervix but are poorly informed about the disease and its prevention, just like most women in the developing countries. Therefore, there is need for continuous awareness campaign and well-organized screening programmes among this unique category of women. Cervical screening programmes could be established at the markets to give easy access to the market women who are usually restricted from accessing health services by their work. They could also be useful in spreading the information to their customers. The government has a role to play in ensuring affordable cervical screening through subsidisation, as most women are low-income earners.

References 

  1. Schoell WM, Janicek MF, Mirhacheni R. Epidemiology and biology of cervical cancer. Sem Surg Oncol 1999; 16: 203-211
  2. Asuen MI, Ahmanimugan S. Review of cervical cancer at the University of Benin Teaching Hospital, Benin city. In: Obstetrics and gynaecology in developing countries. Proceedings of an International Conference. Society of Obstetricians and Gynaecologists of Nigeria. 1997
  3. Edozien LC, Adewole IF. Cervical cancer in Nigeria- a need for early detection. Afr J Med med Sci 1993: 22; 87-92
  4. Babarinsa I A, Akang EEU, Adewole IF. Pattern of gynaecological malignancies at the Ibadan cancer registry (1976-1995). Nigerian Quarterly Journal of Medicine 1998; 8: 103-106
  5. Bosch FX, Munoz N, de Sanjose S. Human papilloma virus and other risk factors for cervical cancer. Biomed Pharmacother 1997; 51: 268-275
  6. Ekanem E, Abidoye R. Some epidemiologic and clinical features of cervical cancer in Lagos, Nigeria. Public Health 1987; 101: 123-128
  7. Emembolu JO, Ekwempu CC. Carcinoma of the cervix uteri in Zaria: epidemiological factors. Int J Obstet Gynecol 1998; 26: 265-269
  8. Nnatu SN, Durosinmi-Etti FA. The problems with the management of carcinoma of the cervix in Nigeria-Lagos experience. East Afr Med J 1985; 62: 347-354
  9. Omigbodun AO, Akanmu TI.  Clinicopathologic correlates of disease stages in Nigerian cervical cancer patients. J Obstet Gynaecol East Cent  Afr 1991; 9: 79-81
  10. Ayinde OA, Omigbodun AO. Knowledge, attitude and practices related to prevention of cancer of the cervix among female health workers in Ibadan. J Obstet Gynecol 2003. 23: 55-58
  11. Dubois G.  Cytological screening for cervix cancer: each year or three years? Eur J Obstet Gynecol Reprod Biol 1996; 65: 57-59
  12. Sawayua GF, Brown AD, Washington AE, Garber AM. Current approaches to cervical cancer screening. N Engl J Med 2001; 344 : 1603-1607
  13. Kish L. Survey sampling. John Wiley and Sons, New York. 1965; 20
  14. Kirkwood BR. Calculation of required sample size. In: Essentials of medical statistics. Blackwell, Edinburgh. 1988: 191-200
  15. Bosch FX, Munoz N, Desarjose S. Human papilloma virus and other risk factors for cervical cancer. Biomed Pharmacother  1997; 51: 268-275
  16. Ajayi IO, Adewole IF. Knowledge and attitude of GOPD attendants in Nigeria to cervical screening.

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