Targeting women with free cervical cancer screening: challenges and lessons learnt from Osun state, southwest Nigeria

Targeting women with free cervical cancer screening: challenges and lessons learnt from Osun state, southwest Nigeria

Ebenezer Gbenga Adepoju¹, Temitope Ilori², Samuel Anu Olowookere^3,&, Ajibola Idowu⁴

 

¹Department of Preventive Medicine, State Specialist Hospital, Osogbo, Osun state, Nigeria, ²Department of Preventive Medicine and Primary Care, College of Medicine, University of Ibadan, Ibadan, Oyo state, Nigeria, ³Department of Community Health, Faculty of Clinical Sciences, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Osun state, Nigeria, ⁴Department of Community Medicine, Faculty of Clinical Sciences, Bowen University Teaching Hospital, Ogbomoso, Oyo State, Nigeria

 

 

^&Corresponding author
Samuel Anu Olowookere, Department of Community Health, Faculty of Clinical Sciences, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Osun state, Nigeria

 

 

 

 

Cervical cancer is a malignant neoplasm of the cervix uteri which is a female reproductive organ that forms the lower portion of the uterus or womb [1-3] The cervix forms the part of the birth canal that opens to the vagina [1, 2]. It is a major public health problem throughout the world [3]. It is the commonest gynaecological cancer and the second leading cause of cancer death after breast cancer worldwide [3]. The World Health organization (WHO) estimates that cancer of cervix is responsible for up to 35% of adult female death [4]. Cervical cancer remains the commonest malignancy in Nigeria. About 370-500,000 cases are newly diagnosed annually with most cases occurring in developing countries [3]. In Nigeria, most cervical cancer cases is diagnosed in the advanced stages where only palliative care can be given to the affected patient [3]. Various studies on cervical cancer screening uptake among university students, market women and female health workers reported that though awareness about this deadly disease was high, uptake of screening had been abysmally low [5-7]. The management of the Osun State Ministry of Health with the support of the State government organized free cervical cancer screening for all women at the State Specialist Hospital, Osogbo. This study documents findings among recipients who were screened during the programme.

 

 

Osun state located in Southwest Nigeria; consist predominantly of the Yoruba ethnic group. Its population by 2006 census was 3,416,959 with women constituting half of this estimate. This prospective study of women resident in the state that attended the cervical cancer screening programme sponsored by the State government and other non governmental organisations with the aim of increasing awareness about the deadly cancer and ensuring its early screening and detection. Awareness was created among women through various women groups and the State mass media about the free cervical cancer screening. These women were attended to by physicians, gynaecologists and other health workers after their written consent was taken. Each participant's sociodemographic characteristics, clinical and gynaecological history, awareness and uptake of HPV vaccine were documented. They were examined and had papanicolaou smear with colposcopy. Clients with positive papanicolaou smear or suspected cervical cancer were referred for definitive management. Information obtained was entered into SPSS version 16. Data analyzed with frequency for categorical variables, mean and standard deviation for continuous variables. Chi-square statistics was used to measure associations with p value <0.05 accepted as significant. Ethical consideration included taking written consent from participants and taking permission from the State Ministry of Health. Confidentiality was maintained with data collected kept in a passworded computer. Ethical approval was obtained from the State Ministry of Health Ethics and Research Committee.

 

 

A total of 287 women were screened. Mean (SD) age was 51.6 (14.3) years with majority (48.1%) in the 45-64 age group. Most participants were urban based (87.1%), married (63.1%), and had secondary education (39%). The majority of the participants were traders (79.1%) and farmers (19.9 %). Most were in monogamous relationship (71.1%) (Table 1). None of the women were aware of the preventive HPV vaccine or had been vaccinated against HPV. Only 3% have had previous cervical cancer screening. Table 2 reported the prevalence of cervical cancer among participants. Seventeen (6%) were diagnosed with pre-invasive cervical cancer while 2 (0.7%) participants had invasive cervical cancer. Table 3 reported the relationship between sociodemographic variables and cervical cancer screening result among participants. The highest proportions of respondents affected were young, had lower education and were married. Challenges identified included poor attendance, low risk perception and logistic issues.

 

 

This study reported the outcome of a free cervical cancer screening among Nigerian women. It showed that uptake of cervical cancer screening was low since most women did not come for the programme despite the public sensitization. Various studies had reported such attitude among women [8-10]. Possible reasons for staying away could be ineffective awareness creation, socioeconomic as well as not realizing the importance of this programme.

 

Most women that attended were urban based. Public transport could have been provided at strategic places especially for women resident in rural areas to convey these women from their place of abode to the hospital. Moreover the screening could be decentralized and community based to encourage these women to attend. Also mobile screening could be done. In addition, incentive such as food could be provided to encourage attendance. Also some women may not be aware of the programme hence there might be need to do more neighbour to neighbour sensitization for such programme in future. Also, it is necessary to target religious leaders, other opinion leaders, their spouses and other decision makers in future programmes.

 

This study showed that all age group above 18 years were affected. This agreed with findings in previous studies [3,5,6]. This had been shown to be due to exposure to prevalent risk factors to developing cervical cancer. Also, none of the women were aware of the preventive HPV vaccine. This showed that awareness should be created in females before onset of sexual intercourse to take the HPV vaccine to prevent development of cervical cancer. Studies had proven that some strains of HPV causes cervical cancer and that the vaccine protects if given to young girls before sexual debut [2,10]. Emphasis should be placed on availability and affordability of this vaccine to all girls before sexual maturity. About 6% of the participants had pre-invasive cervical cancer while 0.7% had invasive cervical cancer. Although this is low compared with previous studies [1,2]. It nevertheless confirmed that cervical cancer is a health problem among the study population that must be curbed.

 

A limitation of this study is that the study population is a convenience sample of women residents who attended the cervical cancer screening programme hence it will be difficult to generalize its findings to all women in the state. Hence a state wide screening programme is encouraged to determine the true prevalence of this deadly condition. A cervical cancer registry should be established in the state to document the burden of the disease.

 

 

In conclusion, cervical cancer is a problem that must be curbed. Most participants that attended were urban based hence need to decentralize cervical cancer screening through mobile clinics and establishment of screening centres in the rural areas. Neighbour to neighbour sensitization on cervical cancer screening is essential. Also, HPV vaccine should be available and affordable to all girls before sexual maturity.

 

 

The author(s) declared no potential conflicts of interests with respect to the research, authorship, and/or publication of this article.

 

 

AEG and OSA made substantial contributions to conception and design of the study while all the authors were involved in data collection, analysis and interpretation. All authors were involved in writing the manuscript and approved the final copy.

 

 

The authors thank the women who participated in this study and the entire staff of Department of Preventive Medicine, State Specialist Hospital, Osogbo for their support and cooperation during the study period.

 

 

Table 1: sociodemographic characteristics of participants

Table 2: result of cervical screening among participants

Table 3: relationship between sociodemographic variables and cervical screening result among participants

 

 

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