Perceived Barriers Of Cervical Cancer Screening Among .
iMedPub JournalsThis article is available from: http://www.acmicrob.comARCHIVES OF CLINICAL MICROBIOLOGY2011Vol. 2 No. 1:4doi: 10:3823/222Perceived barriers of cervical cancerscreening among women attendingMahalapye district hospital, BotswanaC M Ibekwe, MBBS, MPH1, M E Hoque MSc2,B Ntuli-Ngcobo, MSW, MPH3, M E Hoque, MSc4AbstractTitle: Perceived barriers of cervical cancer screening among women attending Mahalapye district hospital, BotswanaBackground: Cervical cancer is a serious cause of mortality and morbidity amongwomen in less developed countries including Botswana. The objectives of the studywere to describe the women’s perceived barriers to cervical cancer and their association with socio-demographic characteristics.Methods and findings: A cross-sectional hospital based study was conducted bya questionnaire survey with a total of 300 participants selected by convenience sampling techniques. The results of participants’ demographics and outcome variableswere summarized using descriptive summary measures: expressed as mean (SD) forcontinuous variables and percent for categorical variables. The chi-square test wasused to find an association between categorical variables. Participants’ mean age was37years (SD 11). Cervical cancer screening rate was 39%. More than two-thirds (68%)of the participants believed that cervical cancer screening was not embarrassing.Less than half (48%) mentioned that doing cervical cancer screening did not suggest someone was having sex. More than half (55.5%) of the participants who neverscreened either strongly disagreed or disagreed that cervical cancer screening waspainful. Among those never screened 66.3% either strongly agreed or agreed thatlack of information was a barrier to cervical cancer screening as opposed to 51.7% ofthose that had screened. Forty four percent of the ever screened had high perceivedbarriers and 60% of the never screened had low perceived barriers. No significantassociation was found between perceived barriers for cervical cancer screening andscreening for cervical cancer (c2 0.153; p 0.696).Running head: Perceived barriers of cervicalcancer screening1 S enior Medical OfficerMahalapye District Hospital,Box 49, Mahalapye,Central District, Botswana.Email: maquincy@yahoo.com2 Lecturer, Department of Public HealthFaculty of Health Care SciencesUniversity of Limpopo (Medunsa Campus),South AfricaTelephone: 27 012 5213093E-mail: Muhammad Hoque@embanet.com3 Lecturer, Department of Public HealthFaculty of Health Care SciencesUniversity of Limpopo (Medunsa Campus),South AfricaE-mail: Busi Ntuli-Ngcobo@embanet.com4 Corresponding Author:Lecturer, Department of Public HealthFaculty of Health Care SciencesUniversity of Limpopo (Medunsa Campus),South AfricaTelephone: 27 012 5213093E-mail: Muhammad Hoque@embanet.comLimitations of the study: This study was limited by its cross-sectional design,use of self-report, and convenience sampling.Conclusion: The screening rate is still far too low compared to the National targetof greater than 75%. Most women do not especially point out perceived barrierssuch as embarrassment, pain, lack of convenient clinic time, lack of information, etc,as barriers to seeking cervical cancer screening. Therefore, more work needs to bedone aimed at decreasing perceived barriers to cervical cancer screening throughprovision of education/information, addressing misconception and beliefs.Keywords: Perceived barrier, cervical cancer, screening, Botswana. Under License of Creative Commons Attribution 3.0 License1
iMedPub JournalsThis article is available from: http://www.acmicrob.comARCHIVES OF CLINICAL MICROBIOLOGYIntroductionCancer of the cervix is a major burden on women’s healthworldwide. It is the second most common cause of cancerrelated death among women globally as well as in Botswana[1,2]. It is estimated that 493,000 new cases and 274,000 deathsoccur every year due to this preventable disease [2]. Cervicalcancer is a major cause of mortality and morbidity amongwomen in less developed countries including Botswana. Astudy found that cervical cancer is one of the most preventablehuman cancers, because of its slow progression, cytologicalidentifiable precursors, and effective treatments [3]. Therefore,Papanicolaou (Pap) cervical cytology screening has helped toreduce cervical cancer rates dramatically through early detection of premalignant lesions [4,5].In Botswana, the crude incidence rate of cervical cancer per100,000 women is 19.8, and the annual number of new cervical cancer cases is 156 per 100,000 women. It is the secondhighest rate of cancer in Botswana after breast cancer (crudeincidence rate of 21.4 per 100,000 women) [2]. Despite beingthe second highest occurring type of cancer in Botswana, thecrude mortality rate from cervical cancer remains the highestwhen compared to other types of cancers with a crude mortality rate of 15.9 per 100,000 women, followed by the crudemortality rate from breast cancer of 15.7 per 100,000 women[2]. Furthermore, despite effective preventive and screeningprograms that are available in the country’s health care systemfor free cervical cancer screening, the annual number of deathsfrom cervical cancer in Botswana has remained high at 126 per100,000 women [2].Worldwide, high incidence of cervical cancer is associated withlack of cervical cancer screening or lack of regular cervical cancer screening and follow-ups of abnormalities. A recent studyfrom Botswana reported that lack of cervical cancer screeningis noted for different reasons like lack of knowledge, access, financial constraints, etc [6]. These perceived barriers to cervicalcancer are major factors that determine a woman’s likelihoodto participate cervical cancer screening although attitudes ofhealth providers, availability and cost are other important determinants [7].Many studies have identified fear of report of having a cancer,embarrassment, pain, financial constraints, attitudes of healthworkers, lack of convenient clinic times and lack of femalescreeners, etc as the major barriers to cervical cancer screening. A study from Jamaica reported that 42% of the studypopulation feared that their health provider would find cervical cancer if they do Pap smear test, 46% reported that theirmajor concern was pain associated with the procedure and24% reported that not receiving the result back was the mainreason why they were not interested in doing cervical cancerscreening [8]. Another study compared women who had a Papsmear and those who never had a Pap smear test done. Thefindings showed that 82.4% of those who had a Pap smear testfelt very sure or completely sure that they could discuss issues22011Vol. 2 No. 1:4doi: 10:3823/222regarding Pap smear test with their healthcare provider. However, 78% of those who had never been screened felt that theycould get a Pap test done even if they were worried that it willbe painful (74% vs. 57%), and that they could get a Pap testdone even if they were worried that it would be embarrassing(49.6% vs. 22%) [9].A study on Cervical cancer and Pap smear screening in Botswana found that only 40.0% of study participants had everhad Pap smear tests and the major barriers to obtaining Papsmear tests included inadequate knowledge about Pap smearscreening, provider attitudes, and limited access to physicians.Reasons for limited knowledge included cultural norms of secrecy, providers not informing the public, and policy makers’limited attention to cervical cancer. Providers’ major barriers toproviding Pap smear tests was found to include clients’ inadequate knowledge of Pap smear screening, providers’ inabilityto see the importance of Pap smear tests, and workload andstaff shortages) [6]. If these barriers of doing cervical cancerscreening are addressed, the uptake of cervical cancer screening can improve given that these barriers deter most womenfrom doing cervical cancer screenings especially misconceptions and cultural beliefs. Therefore, determining ways of overcoming these problems is a pre-requisite for improving the uptake in cervical cancer screening program. Thus, the objectivesof this study were to describe the women’s perceived barrierto cervical cancer and the association between socio-demographic characteristics and perceived barrier to cervical cancer.MethodsThe study was a cross sectional study. The study was conducted in Mahalapye District Hospital which is a 250 bed hospital.The hospital offers outpatients and inpatients services to theMahalapye sub-district community. It is one of the 6 districthospitals managed by the Ministry of Health in Botswana. Itserves as a referral facility to 44 health facilities in the subdistrict comprising one primary hospital, 15 clinics, 28 healthpost and mobile clinics [10]. Mahalapye sub-district has a totalpopulation of 109,811 people, comprising 53,318 males and56,493 females [11]. The hospital is located in the central partof Botswana about 200km from Gaborone, along the A1 roadthat runs across the country from North to South.Mahalapye district Hospital was chosen because it runs bothoutpatients and inpatients services to both males and females.On average, approximately 180 to 240 patients are seen in outpatients daily, approximately 80 patients in Infectious DiseaseControl Centre (IDCC), and the hospital has an average bed occupancy rate of 102 patients for inpatients cases [12]. It has agood information management system in place that enablesthe capturing and retrieval of relevant information with somedegree of accuracy and reliability.The target population for the study comprised all womenserved by Mahalapye District Hospital who were above the Under License of Creative Commons Attribution 3.0 License
iMedPub JournalsThis article is available from: http://www.acmicrob.comARCHIVES OF CLINICAL MICROBIOLOGY2011Vol. 2 No. 1:4doi: 10:3823/222age of 18 years. From the census report, Mahalapye sub-districthas a total population of 109,811 people, comprising 53,318males and 56,493 females [11]. The target population of thestudy included 37,662 of the 56,493 female population servedby Mahalapye District Hospital. Since outpatients departmentforms the entry point of all patients to the hospital, the sampled populations were interviewed mainly at the outpatientsdepartment.questionnaire. Each question was scored ranging from strongly agree (5) to strongly disagree (1). The scale was revised fornegatively worded questions. The total scores for perceivedbarrier subscale had a possible range from 12 to 60. The categorical dependent variable rated yes or no whether a womanhad ever had cervical cancer screening. If the answer was yes,she was asked if the cervical cancer screening was done withinthe past 3 years.A minimum sample size was calculated using a standard formula for known population size for a cross sectional study. Theformula is given below [13]:The questionnaire was translated to the local Setswana language and was pre-tested using 30 patients in another healthfacility outside Mahalapye by the researcher to identify gapsand modify the questionnaire appropriately. The questionnaire was then pilot tested and modified to ensure it answeredthe research questions. Piloting of the questionnaire was donein Palapye Primary Hospital. Palapye is another town about 70kilometers from Mahalapye.Where n sample size of adjusted population, N populationsize and e accepted level of error taking alpha as 0.05.The estimated number of women seen in Mahalapye DistrictHospital monthly was estimated from Hospital records to beabout 800. Substituting this figure into the formula below, asample size of 267 was obtained.The questionnaire was administered by the researcher and atrained assistant who speaks the local language to excludepersonal prejudice. The questionnaire was also translated tothe local Setswana language and administered to participantsto eliminate bias due to non-response because the participantcould not read or write.Ethical Considerationsn 267.However, since convenience sampling was used to interviewthe participants, the sample size was increased to 300 participants.Convenience sampling was performed by approaching all eligible women who presented to outpatients department during the month of sample collection for interview (June, 2009).The purpose of the research and procedure was explainedto them and those who consented to participate were interviewed. The researcher and the assistant ensured that nowoman was interviewed more than once by asking if they hadpreviously been interviewed.All adult women age above the age of 21 years attending Mahalapye District Hospital who consented to participate wereincluded in the study. We excluded all women attending Mahalapye District Hospital who were below the age of 21 yearssince they cannot give consent to participate according to Botswana law as well as women above 21 years who refused toconsent for participate in the study.A structured self-administered questionnaire was used to collect data for those who could read and write. For those whocould not read or write, the research assistant administeredthe questionnaire. The perceived barrier of cervical cancerwas assessed using 5 point LIkert-type scale questions in the Under License of Creative Commons Attribution 3.0 LicenseEthical clearance for the study was obtained from MedunsaCampus Research and Ethics Committee (MCREC) of the University of Limpopo, South Africa. Permission to conduct thestudy was obtained from the National Health Research Unit(HRU) of the Ministry of Health, Botswana, and the Management of Mahalapye District Hospital before commencement ofthe study. Informed consent of participants was obtained. Confidentiality of participants was maintained at all times. To further maintain confidentiality, no form of identifiers was in thequestionnaires. Participation was voluntary, and participantswere informed that they could withdraw from the study at anystage of the interview if they so desired without any penalty.Data analysisData were entered into a Microsoft Excel 2003 spreadsheetand imported to SPSS 17.0 for Microsoft Window version foranalysis. The analysis results of participants’ demographics andoutcome variables were summarized using descriptive summary measures, expressed as mean (SD) for continuous variables and percent for categorical variables. The chi-square testwas used to find an association between categorical variables.Binary logistical regression was carried out to find the significant predictor for doing a Pap smear test. All statistical testswere performed using two-sided tests at the 0.05 level of significance. For all regression models, the results were expressedas effect (or odds ratios for binary outcomes), correspondingtwo-sided 95% confidence intervals and associated p-values.3
iMedPub JournalsARCHIVES OF CLINICAL MICROBIOLOGYThis article is available from: http://www.acmicrob.comP-values were reported to three decimal places with values lessthan 0.001 reported as 0.001. A high score was considered75% or more and a low score was considered as less than 75%.ResultsTable 1 summarized socio-demographic characteristics of thestudy participants. A total of 300 participants were recruitedwith mean of 36.9 years (SD 11.04). More than one third of thewomen were between the age of 21 and 29 years (36%). Majority of them were (71%) were single, and 21% were married. Only8% had no form of education and 69% had attained at leastsecondary education. Almost all participants were of black African race (98%). Less than half (44%) were unemployed. Theresidential status was almost equally distributed with rural(51%) and urban plus peri-urban (49%).TABLE 1: Socio-demographic characteristics of respondents (n 300)VariablesAge (years)Marital StatusEducational levelEmployment StatusMonthly IncomePercentage4Table 2 showed the distribution of cervical cancer screeningstatus of the participants. Most of those that had ever screenedfor cervical cancer (64%) actually did the screening within thepast 3 years. Most (72%) of the ever screened had attained atleast secondary school education. Regarding age, the highesttesting rates were among the age group 40 – 49yrs.TABLE 2: The cervical cancer screening status socio-demographiccharacteristics.Cervical cancerscreen everCervical cancerscreen in the past3 yearsYesNoYesNo%%%%39.360.764.421 - 2928.840.730 - 3927.140 - 4950 - 59Group abiting2.53.32.62.493.0Group TotalAge 8729.0Marital statusEducational ed44.0Employed48.361.040.861.916856.0Employed56.0 P500016.3 500024.611.031.611.94916.3P3000-P499910.03000 - 499914.47.117.19.53010.0P1000-P299917.01000 - 299916.117.615.816.75117.0 P99912.3 100010.213.79.211.93712.3No income44.3No 934.247.615551.7UrbanResidential Area2011Vol. 2 No. 1:4doi: 10:3823/22218.00Peri-urban30.3Rural51.7Monthly incomeResidence Under License of Creative Commons Attribution 3.0 License
iMedPub Journals2011Vol. 2 No. 1:4doi: 10:3823/222ARCHIVES OF CLINICAL MICROBIOLOGYThis article is available from: http://www.acmicrob.comTABLE 3: Response to statements of perceived barriers to cancerRating (%)Perceived rvical cancer is painful15.133.126.815.1102.721.19Doing cervical cancer screening suggest theperson is having sex14.34612.322.74.72.571.13Doing cervical cancer screening makes oneworry1644.310.326.332.561.13Cervical cancer screening takes away virginityin virgins163029.317.37.32.701.15Not knowing where to go is the reason for notscreening7.737.710.332.3123.031.22Only those with babies need to do cervicalcancer screening25.354.27.710.822.100.97Partner resisting cervical cancer screening26.8568.771.32.00.87Lack of female screeners in health facilitiescontributes for not doing cervical cancer17.140.66.427.28.72.701.28Attitudes of health workers discouragescervical cancer screening1146.27.422.712.72.81.27Lack of convenient clinic time is a barrier toroutine cervical cancer7.429.8839.515.43.261.24Lack of information is also a barrier to cervicalcancer screening6.728.44.335.525.13.441.31Embarrassing to do cervical cancer screeningTable 3 summarized the responses to perceived barriers tocervical cancer screening. In general, most of the ratings werebelow 3.0. That is, most participants disagreed or stronglydisagreed about the statements on perceived barriers. Thisshowed that most participants believed that: cervical cancerscreening was not embarrassing (68%) and doing cervical cancer screening did not suggest someone was having sex (48%).When the ever screened and never screened were compared(Table 4), 44.4% of the ever screened had high perceived barriers and 60% of the never screened has low perceived barriers. There were no significant association between perceivedbarriers for cervical cancer screening and screening for cervicalcancer (c2 0.153; p 0.696).TABLE 4: Association between cervical cancer screening and perceivedbarriers to cervical cancer 9TABLE 5: Screening status and response to statements of perceivedbarriers to seeking cervical cancer screeningPerceived BarriersCervical cancer screen everNo (%)Yes (%)Total7.726.34515.1Disagree23.847.59933.1172Not sure42.03.48026.8287Agree14.416.14515.1Strongly agree12.26.83010.015.911.94314.3Odd Ratio 1.211 (95% CI: 0.463 – 3.167) (
University of Limpopo (Medunsa Campus), South Africa Telephone: 27 012 5213093 E-mail: Muhammad_Hoque@embanet.com C M Ibekwe, MBBS, MPH1, M E Hoque MSc2, B Ntuli-Ngcobo, MSW, MPH3, M E Hoque, MSc4 Title: Perceived barriers of cervical cancer screening among women attending Ma-halapye district hospital, Botswana Background: Cervical cancer is a serious cause of mortality and morbidity among .
– and prevents over 7 in 10 diagnoses. However, like any screening test, cervical screening is not perfect and there are some risks. Benefits of cervical screening Cervical screening aims to identify whether you are at higher risk of developing cervical cell changes or cervical cancer. This mean
cervical cancer as the seventh most common cancer among females [3]. Although the incidence rate of cervical cancer shows a gradually decreasing trend, the incidence increased from 1993 through 2002 in women in their 20s and in those who were 70 years or older. As the incidence of cervical cancer decreased, an increase in the incidence of
Conclusions: The study revealed utilization of cervical cancer screening service was low among HIV positive women. Educational status, duration of HIV diagnosis, partner support, knowledge status about risk factor, CD4 count and attitude towards cervical cancer and its screening were associated with cervical cancer screening utilization.
that ANSM can achieve an accuracy of 93.33% with a false negative rate of zero in classifying cancer and healthy cervical tissues using nucleus texture features. This provides evidence that nucleus-level analysis is valuable in cervical histology image analysis. 1. INTRODUCTION Quantitative analysis in cervical cancer using pathological
As the Chair and Co-Chair of the Kansas Cancer Partnership (KCP), we are pleased to provide . you with the 2017-2021 Kansas Cancer Prevention and Control Plan. This plan is the result of . Breast Biopsies Breast Cancer Cervical Cancer Colorectal Cancer Lung Cancer Prostate Cancer. Post-Diagnosis & Quality of Life throughout the Cancer Journey.
Drainage from the head and neck: All the lymphatic drainage of the head (the ring) will go into the upper deep cervical lymph nodes The upper deep cervical drains into the lower deep cervical. Superficial cervical drain directly into the lower deep cervical. Then two lymphatic trunks will be formed, right and left jugular lymphatic trunks.
The top part of the spine (your neck) is known as the cervical spine. What is cervical spine (neck) surgery? 1. An anterior cervical discectomy (ACD) An anterior cervical discectomy is an operation to remove a damaged disc. Sometimes the space left after removing the disc will be filled with a metal
Consider the task of buying a copy of AI: A Modern Approach from an online bookseller. Suppose there is one buying action for each 10-digit ISBN number, for a total of 10 billion actions. The search algorithm would have to examine the outcome states of all 10 billion actions to find one that satisfies the goal, which is to own a copy of ISBN 0137903952. A sensible planning agent, on the .
