Journal of Cervical Cancer

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Research Article Open Access
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  • One Out of Five Women Practiced Cervical Cancer Screening in Felege Hiwot Referral Hospital, Amhara, North West Ethiopia

    Tenagnework Antefe Abebe 1   Berhanu Elfu 2   Abel Lule Tessema 2   Mulusew Alemneh Sinishaw 3  

    1Amhara Public Health Institute, Bahir Dar, Ethiopia

    2School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia

    3Clinical Chemistry department, School of Health Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia

    Abstract

    Background

    Eighty five percent of cervical cancer occurrence in resource-poor countries. Contributing factors for these are inadequate knowledge about the disease, early initiation of sexual intercourse and multiple sexual partners. Early screening is an intervention in reduction of maternal deaths due to cervical cancer. Consequently this study was conducted aiming to find out about the practice of cervical cancer screening and its associated factors.

    Methods

    A facility based cross sectional study was conducted using a pretested structured questionnaire among women attended Maternal and Child Health (MCH) department of Felege Hiwot Referral Hospital (FHRH) from March15 to April 15, 2019. The study participants were selected systematically. The collected data were entered and analyzed using SPSS version 20. Logistic regression analysis was employed to examine factors association with cervical cancer screening that was confirmed using AOR with its 95% CI.

    Results

    A total of 400 study participants were included with a response rate of 99.5%. Of the total study participants only 78 (19.5%; 95% CI: 15.6, 23.4) practiced screening for cervical cancer. The cervical cancer screening practice was affected by age (AOR=2.025; 95% CI: 1.118, 3.668). Of those women who had ever heard of about cervical cancer were seven fold more likely to practice cervical screening (AOR=6.924; 95% CI: 1.602, 29.928) compared to those who did not have any information before. Moreover, knowing genital tract discharge as a problem of female organ implement fourfold more likely compared to that of knowing nothing about problem of genital tract (AOR=3.766; 95% CI: 1.761,8.055).

    Conclusion and Recommendation

    The study depicted there was low utilization of cervical cancer screening. Awareness creation about cervical cancer and knowledge of genital tract problems had positive influence for screening practice.

    Author Contributions
    Received 26 Sep 2021; Accepted 13 Nov 2021; Published 17 Nov 2021;

    Academic Editor: Hong Zhang, China.

    Checked for plagiarism: Yes

    Review by: Single-blind

    Copyright ©  2021 Tenagnework Antefe Abebe, et al.

    License
    Creative Commons License     This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    Competing interests

    The authors have declared that no competing interests exist.

    Citation:

    Tenagnework Antefe Abebe, Berhanu Elfu, Abel Lule Tessema, Mulusew Alemneh Sinishaw (2021) One Out of Five Women Practiced Cervical Cancer Screening in Felege Hiwot Referral Hospital, Amhara, North West Ethiopia. Journal of Cervical Cancer - 1(1):23-41.

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    Introduction

    Majority (85%) of cervical cancer occurs as global burden in less developed regions with an estimate of 528,000 cases every year worldwide. It ranks the fourth most cancer affecting women 1.

    Low and middle income countries approximately contributed 90% the total deaths occurred from cervical cancer in 20152. Nearly half a million women will die of cervical cancer by 2030.From these, low and middle-income countries will have more than 98% deaths 3.

    Cervical cancer is also common in Eastern Africa region and in Ethiopia, which is estimated as, 45,707 new cases and 28,197 deaths, and 7,095 new cases and 4,732 deaths every year respectively 4.

    The first top cancer in adults above age of 14 years old is cervical cancer which was the second most common of all cancers (15.2%) based on a study handled at Gondar referral hospital in 20165.

    Cervical cancer, malignant neoplasm arising from cells originating in cervix uteri, may be completely asymptomatic in early stages 6. It can be presented as persistent pelvic pain, unexplained weight loss, bleeding between periods, unusual vaginal discharge, bleeding, and pain after sexual intercourse 7. Globally, 75% of cervical cancer is initiated by human papilloma virus (HPV) types 16 and 18 infection while other risk factors like tobacco consumption, multiple sexual partners, early age of sexual intercourse, increasing parity, prolonged use of oral contraceptive pills, and sexually transmitted diseases also subsidized the rest 8, 9.

    Ethiopia lost around 4,732 women per year, cancer related highest mortality rate, due to cervical cancer with an adjusted incidence of 18.9 per 100, 000 women. These may be also underestimated by way of low level of awareness, screening and diagnostic limited access and national cancer registry unavailability10, 11, 12, 13.

    Screen and treat cervical cancer with a single-visit approach is suggested by many studies in low-resource settings as the most successful and cost-effective way since Papanicolaou (pap) smear is used in a limited scope and no national screening program in Ethiopia14.

    Studies which assess the current knowledge of women about cervical cancer and their preventive practice in Ethiopia are rare particularly in the study area. Identifying practice and its associated factors related to cervical cancer screening among women of age ≥21 will enable to reverse the increasing trend of cervical cancer in Ethiopia particularly  in  FHRH, and there by its immediate and long term consequences through design of effective preventive strategies Figure 1.

    Figure 1. Conceptual framework for factors influencing cervical cancer screening practice taken from review literature and adapted contextually
    Figure 1.

    Methods and Materials

    Study Periods and Setting

    An institutional based quantitative cross-sectional study was conducted in Maternal and child health department Felege Hiwot Referral Hospital from March 15 -April 15, 2019.

    Target Population

    All women aged ≥21 years who were attending in Felege Hiwot Referral Hospital at MCH department to obtain different health services. Women unable to communicate due to their sick condition were excluded from the study.

    Sample Size Determination and Sampling Technique

    The sample size was determined using single population proportion formula using the following assumptions: 95% level of confidence, proportion of women have been screened for cervical cancer, 19.8% community based cross-sectional study conducted in Mekellezone15, 5% margin of error (desired precision between sample and population parameter), design effect 1.5, and contingency of 10% for possibilities of non–response rate and incomplete data. The calculated sample size was = 402.

    Sample size was allocated to each MCH departments based on the proportion of eligible women (Figure 2). Selected study subjects at each MCH department using systematic random sampling every 5th entry at each department during study period, and interviewed to collect information until the proportion of the sample size reached. The first participant was drawn using lottery method random sampling technique.

    Figure 2. Sampling technique for cervical cancer screening practice among women aged ≥21 years who have attended MCH Department at Felege Hiwo Referral Hospital, Amhara Region, Ethiopia, 2019.
    Figure 2.

    Data Collection Instrument and Procedure

    A Semi-structured and pretested questionnaire was used to collect data on demographic, knowledge, and practice assessing questions. The data collection tool (questionnaire) was adapted by reviewing literature16. Face-to face interview was used.

    The questionnaire was initially prepared in English and translated into the local language (Amharic) by fluent speakers of both languages to maintain its consistency. Training was given for data collectors and about the objectives, methods, tool and ethics (confidentiality and privacy) of the study to be conducting; and pre-test was conducted on 5% of the sample in an area where the study was not be undertaken; with similar set up in order to assess the quality of the data collection tool, and time consuming. Based on the pre-test finding modification was made on the questionnaire. Data was collected only by trained data collectors and supervised by trained supervisor. Regular meetings were held between the data collectors, supervisor, and principal investigator to solve problematic issues faced during data collection period. Each questionnaire was checked for completeness and consistency daily.

    Data were coded and entered, cleaned, analyzed using statistical package for social science (SPSS) version 20. Frequency and cross tab was performed to clean the data. Descriptive statistics (Frequency distribution, percentages, graphs and proportion) was computed. A binary logistic regression was used to identify associated factors. Adjusted Odds ratios at 95% confidence interval were used to see the significance of the study and the strength of association between study variables.

    Ethical Consideration and Permission

    Ethical approval was obtained from Institutional Review Board of GAMBY medical & Business College. An official letter of co-operation was written from GAMBY medical & Business College of science by department of public health to Amhara public Health institute and then to Felege Hiwot Referral Hospital. Respondents were informed about the objectives and purpose of the study to obtain verbal consent from each respondent before interview. A one page cover information sheet that explained the purpose, procedure and significance of the study was attached with each questionnaire. The data were maintained confidential and used only the purpose of this study.

    Operational Definitions

    1. Knowledgeable: refers those who respond ‘Yes’ for Yes/No knowledge measuring questions and minimum one of the alternatives except the alternative ‘I don’t know’ for multiple questions.

    2. Attitude: refer those who answer attitude questions scored above the mean have positive attitude while, those who answered below the mean said to be negative attitude.

    3. Ever been diagnosed for cervical cancer (Practice) woman that has been diagnosed for cervical cancer in the past pelvic examination Pap or VIA test.

    4. multiple sexual partners is to identify those who have had sexual intercourse with more than one partner

    5. Smoking - questions are responded yes or no for active smoking practices and those who respond yes are analyzed as below 10 years and above.

    6. Substance abuse is any response other than never to any of the substance questions chat, alcohol, marijuana, narcotic &drugs.

    Results

    Socio-Demographic Status Factors of Respondents

    A total of 400 women were included with a response rate of 99.5%. Of these, 53.8%, 92.8%, 95.0%, 80.5%, 36.5%, 78.5%, 42.8% and 27.2% were at the age group of 21-29 years, Orthodox Christian, Amhara ethnic group, married, at college and above educational status, rural dweller, housewife and earned less than 1001 Ethiopian Birr per month correspondingly as stated on table 1.

    Table 1. Socio demographic status of study participants at maternal and child health department in FHRH from March 15- April 15, 2019 (n=400)
    Variable Category Frequency Percent
    Age of women 21-29 Years 215 53.8
    30-65 Years 185 46.2
    Religion Orthodox 371 92.8
    Protestant 8 2.0
    Muslim 21 5.2
    Ethnic group Amhara 380 95.0
    Oromo 10 2.5
    Tigirie 4 1.0
    Agew 6 1.5
    Marital status Single 53 13.2
    Married 322 80.5
    Separated 11 2.8
    Widowed 7 1.8
    Divorced 7 1.8
    Educational status  Unable to read and write 90 22.5
    Able to read and write 35 8.8
    Primary 48 12.0
    Secondary 81 20.2
    College and above 146 36.5
    Residence Urban 314 78.5
    Rural 86 21.5
    Occupation Student 26 6.5
    Self 55 13.8
    Government employee 111 27.8
    Private employee 22 5.5
    Housewife 171 42.8
    No work 15 3.8
    Monthly income (Ethiopian birr) up to 1000 109 27.2
    1001-2000 107 26.8
    2001-2500 25 6.2
    2501-4500 84 21.0
    > 4501 75 18.8

    Behavioral, Health Facility and Family History Factors of Respondents

    Six (1.5%) individuals smoke cigarette from two to five years. On other hand, 29 (7.2%) of the participants were addicted to different substance use (khat, alcohol and stimulant drugs) that ranges from one to fifteen years and 353 (88.2%) experienced sexual intercourse; of them 278 (78.8%) have been experienced with one sexual partner (Table 2).

    Table 2. Family history of women cervical cancer of study participants at maternal and child Health Department in FHRH from March 15- April 15, 2019 (n=400).
    Variable Category Frequency Percent
    Family history for Cervical CA Yes 50 12.2
    No 350 87.8
    Relationship of family history Mother 15 30.0
    Sister 15 30.0
    Grandmother 2 4.0
    Aunt 8 16.0
    Other 10 20.0
    Experienced sexual intercourse Yes 353 88.2
    No 47 11.8
    Number of sexual partner (s) (n=353) One person 278 78.8
    Two person 53 15.0
    Three person 14 4.0
    Five and more 8 2.3
    Addicted with substance abuse Yes 29 7.2
    No 371 92.8

    Knowledge of Study Participants about Cervical Cancer

    A quarter of study participants did not hear about cervical cancer (Table 3). Many of the participants also did not know about cause of cervical cancer (48.0%), symptom of cervical cancer (30.8%) and treatment of cervical cancer (39.0%).

    Table 3. Knowledge of study participants about cervical cancer screening at maternal and child Health Department in FHRH from March 15- April 15, 2019 (n=400).
    Variable Category Frequency Percent
    Problems of genital tract I don't know 180 45
    Discharge 97 24.2
    Sexual transmitted disease 38 9.5
    Cervical cancer 59 14.8
    Uterine tumor 26 6.5
    Ever heard about cervical cancer Yes 306 76.5
    No 94 23.5
    Causes of cervical cancer I don't know 192 48
    Any sexual partner 24 6
    Early initiation of sexual intercourse 39 9.8
    Havening multiple sexual partner 67 16.8
    Sexual transmitted disease 19 4.8
    HIV 11 2.8
    Papiloma virus 18 4.5
    Long years use of Combined oral contraceptives 16 4
    Other 14 3.5
    symptoms of cervical cancer I Don’t know 123 30.8
    Bleeding 94 23.5
    Post coital bleeding 25 6.2
    Vaginal foul smelling discharges 100 25
    Painful coitus 29 7.2
    Post-menopausal bleeding 29 7.2
    Treatment of cervical cancer I don’t know 156 39
    Surgery 95 23.8
    Chemotherapy 70 17.5
    Radiotherapy 72 18
    Others 7 1.8
    The outcomes early undetected of cervical cancer I don’t know 84 21
    Metastasis 82 20.5
    Chronic illness 19 4.8
    Bleeding 8 2
    Death 202 50.5
    Other 5 1.2
    Ever heard of cervical cancer screening method Yes 304 76
    No 96 24
    Methods of cervical cancer screening VIP 145 36.2
    Pap smear 159 39.8
    Who should be screened I don't know 99 24.8
    Age greater than 21 114 28.5
    Commercial sex workers 71 17.8
    Elderly women 104 26
    Other 12 3
    Frequency of screening Every year 185 46.2
    Every two year 54 13.5
    Every three year 74 18.5
    Every five year 43 10.8
    Other 44 11
    Expense of cervical cancer screening I don’t know 135 33.8
    Free 105 26.2
    It is reasonably priced 47 11.8
    moderately expensive 54 13.5
    very expensive 59 14.8
    Reason of cervical cancer screening I do not know 117 29.2
    To check cervix 218 54.5
    To check infections passed through sex 24 6
    To check infections transmitted through blood transfusion 18 4.5
    Others 23 5.8
    Cervical cancer preventable Yes 344 86
    No 56 14
    Prevention method cervicalcancer I do not know 60 17.4
    No multiple partner 151 43.9
    Treat papiloma virus 52 15.1
    Use condom 36 10.5
    Vaccine 30 8.7
    Other 15 4.4

    Among the study participants who had ever heard about cervical cancer (306), majority got the information from media (41.8%) while the least numbers heard from religious leaders (figure 3).

    Figure 3. Source of information about cervical cancer among study participants at maternal and child Health Department in FHRH from March 15- April 15, 2019.
    Figure 3.

    Attitude Assessment of Cervical Screenings

    Out of total (400) participants 56.2% had good attitude about cervical cancer screening and 43.8 % were by the side of poor attitude with mean score of 31.725+4.71559 for the eight questionnaires (figure 4).

    Figure 4. Attitude of study participants about cervical cancer screening at maternal and child Health Department in FHRH from March 15- April 15, 2019
    Figure 4.

    Practice of Cervical Cancer Screenings

    Recent study showed that, out of total 78(19.5%) had practiced cervical cancer screening, 77 ̸ 78 (98.7) did it at once in their life (Table 4). Of these, three (3.9%), 32 (41.0%) and 43 (55.1%) explained it should be practiced with a frequency of every year, two years and three years respectively.

    Table 4. Cervical cancer screening practice of study participants at maternal and child Health Department in FHRH from March 15- April 15, 2019 (n=400).
    Variable Category Frequency Percent
    Have you ever screened for cervical cancer Yes 78 19.5
    No 322 80.5
    Time of last cervical cancer screening less than two years 50 64.1
    Two to three years 19 24.4
    Greater than three years 9 11.5
    Method of screening PAP smear 50 64.1
    VIA 17 21.8
    Both method 11 14.1
    Reason of not to get screening Screening is painful 44 11.0
    Healthy 129 32.2
    Her husband would not agree 9 2.2
    No information about screening 58 14.5
    Not informed health professional 69 17.2
    Workload 11 2.8
    Other 2 0.5

    Note: PAP –Papanicolaou, VIA-Visual inspection with Acetic Acid

    Association of Socio-Demographic Characteristics

    Participants whose age belong to the range of 30-65years were two times more likely to have a good level of performance (AOR=2.025; 95% CI: 1.118, 3.668) than those age were fallen in the range of 21-29 years (Table 5). Of the total study participants family history about cervical cancer were two fold more likely to practice cervical cancer screening than who do not have (AOR =2.441; 95% CI: 1.278, 4.661) while, who had ever heard about cervical cancer were seven fold more likely to practice cervical screening (AOR=6.924; 95% CI: 1.602, 29.928) compared to those who did not have any information before. Moreover, knowing genital tract discharge as a problem of female genital organ implement fourfold more likely compared to that of knowing nothing about problem of genital tract (AOR=3.766; 95% CI: 1.761,8.055) (Table 6).

    Table 5. Association of socio demographic status of study participants to the practice of cervical cancer screening at maternal and child health department in FHRH from March 15-April15, 2019
    Variable Category Have you ever screened for cervical cancer X2 test /Fisher exact test/ COR ( 95%CI) AOR at 95%CI
    Yes No
    Age group 21-29 Years 34 181 0.045 1 1
    30-65 Years 44 141 1.661(1.009,2.736) 2.025(1.118,3.668)
    Religion Orthodox 71 300 0.000*
    Protestant 6 2
    Muslim 1 20
    Ethnic group Amhara 75 305 0.371*
    Oromo 3 7
    Tigirie 0 4
    Agew 0 6
    Marital status of women Single 6 47 0.210*
    Married 70 252
    Separated 1 10
    Widowed 1 6
    Divorced 0 7
    Educational status of women Unable to read and write 15 75 0.834
    Able read and write 6 29
    Primary 10 38
    Secondary 19 62
    College and above 28 118
    Address of women Urban 65 249 0.247
    Rural 13 73
    Occupation of women Student 3 23 0.215
    Self 11 44
    Government employee 30 81
    Private employee 5 17
    Housewife 27 144
    No work 2 13
    Monthly income (Ethiopian birr) up to 1000 14 95 0.192
    1001-2000 20 87
    2001-2500 7 18
    2501-4500 18 66
    greater than 4501 19 56

    Table 6. Association of knowledge and attitude of study participants to the practice of cervical cancer screening at maternal and child health department in FHRH from March 15-April 15, 2019
    Category Have you ever screened for cervical cancer X2 test COR at 95% CI AOR at 95% CI
    Yes No
    Family history of cervical cancer Yes 17 32 0.006 2.441(1.278, 4.661)
    No 61 290 1
    Experience of sexual intercourse Yes 71 282 0.396
    No 7 40
    Problem of genital tract of women I don't know 22 158 0.018 1 1
    Discharge 27 70 2.770(1.476, 5.198) 3.766(1.761,8.055)
    Sexual transmitted disease 9 29 2.229(0.933, 5.324) 1.872(0.664,5.281)
    Cervical cancer 13 46 2.030(0.949, 4.341) 2.091(0.864,5.059)
    Uterine tumor 7 19 2.646(0.998, 7.012) 2.709(0.871,8.425)
    Ever heard of cervical cancer Yes 74 232 0 7.177(2.549, 20.206) 6.924(1.602,29.928)
    No 4 90 1 1
    Source of information about Cervical Cancer Media 36 130 0.032*
    Brusher poster other printed material 2 1
    Health professional 24 63
    Family 4 14
    Religious leader 2 0
    Teachers 3 12
    Other 2 11
    Causes of cervical cancer I don't know 27 165 0.026*
    Any sexual partner 8 16
    Early initiation of sexual intercourse 12 27
    Havening multiple sexual partner 11 56
    Sexual transmitted disease 3 16
    HIV 5 6
    Papiolma virus 5 13
    Long years use of Combined oral contraceptives 5 11
    Other 2 12
    Symptom of cervical cancer of women I Don’t know 10 113 0.002 1
    Bleeding 21 73 3.251(1.448,7.296)
    Post coital bleeding 4 21 2.152(0.617,7.509)
    Vaginal foul smelling discharges 27 73 4.179(1.910,9.144)
    Painful coitus 6 23 2.948(0.974,8.918)
    Post-menopausal bleeding 10 19 5.947(2.183,16.203)
    Treatment of cervical cancer I don’t know 22 134 0.125
    Surgery 23 72
    Chemotherapy 16 54
    Radiotherapy 17 55
    Others 0 7
    Outcome of untreated cervical cancer I don’t know 2 82 0.000*
    Metastasis 19 63
    Chronic illness 6 13
    Bleeding 3 5
    Death 48 154
    Other 0 5
    Ever heard of cervical cancer screening method Yes 68 236 0.01 2.478(1.220,5.031)
    No 10 86 1
    Who should be screened I don't know 8 91 0.005 1
    agegreaterthan21 20 94 2.420(1.015,5.772)
    Commercial sex workers 20 51 4.461(1.834,10.849)
    Elderly women 27 77 3.989(1.713,9.288)
    Other 3 9 3.792(0.852,16.878)
    Expense of screening I don’t know 9 126 1
    Free 26 79 0 4.608(2.053,10.342)
    It is reasonably priced 14 33 5.939(2.365,14.918)
    moderately expensive 14 40 4.900(1.973,12.171)
    very expensive 15 44 4.773(1.951,11.678)
    Expense of screening I don’t know 9 126 1
    Free 26 79 0 4.608(2.053,10.342)
    It is reasonably priced 14 33 5.939(2.365,14.918)
    moderately expensive 14 40 4.900(1.973,12.171)
    very expensive 15 44 4.773(1.951,11.678)
    Reason of screening Do not know 14 103 0.152*
    To check cervix 50 168
    To check infections passed through sex 4 20
    To check infections passed through blood transfusion 4 14
    Others 6 17
    Is cervical cancer preventable Yes 70 274 0.288
    No 8 48
    Prevention method of cervical cancer I do not know 2 58 0.017 1
    No multiple partner 38 113 9.752(2.272,41.855)
    Treat papilomavirus 11 41 7.780(1.637,36.982)
    Use condom 9 27 9.667(1.954,47.820)
    Vaccine 6 24 7.250(1.365,38.494)
    Other 4 11 10.545(1.716,64.802)
    Know age of cervical cancer manifestation Yes 69 294 0.437
    No 9 28
    Know the right sex starting age group Yes 69 242 0.009 5.560(1.309,23.607)
    No 2 39 1
    Had good attitude towards cervical cancer screening Yes 40 185 0.324
    No 38 137

    Note:* The association was performed using fisher exact test since 20% or more cells had expected count less than five.

    Factors of Cervical Cancer Screening Practice

    Of the total study participants who had ever heard about cervical cancer were seven fold more likely to practice cervical screening (AOR=6.924; 95% CI: 1.602, 29.928) as compared to those who did not have any information before. Moreover, knowing genital tract discharge as a problem of female genital organ implement fourfold more likely compared to that who have nothing knowledge about genital tract problems (AOR=3.766; 95% CI: 1.761,8.055) (Table 7)

    Table 7. Association of knowledge and attitude of study participants to the practice of cervical cancer screening at maternal and child health department in FHRH from March 15-April 15, 2019.
    Variable Have you ever screened for cervical cancer COR at 95% CI AOR at 95% CI
    Yes No
    Age group
    21-29 Years 34 181 1 1
    30-65 Years 44 141 1.661(1.009, 2.736) 2.025(1.118,3.668)
    Family history of cervical cancer
    Yes 17 33 2.441(1.278, 4.661) 1.572(0.673,3.670)
    No 61 289 1
    Experience of sexual intercourse
    Yes 71 282 1.439(0.619,3.346)
    No 7 40 1
    Problem of genital tract of women
    Discharge 27 70 2.770(1.476, 5.198) 3.766(1.761,8.055)
    STD 9 29 2.229(0.933, 5.324) 1.872(0.664,5.281)
    Cervical cancer 13 46 2.030(0.949, 4.341) 2.091(0.864,5.059)
    Uterine tumor 7 19 2.646(0.998, 7.012) 2.709(0.871,8.425)
    I don't know 22 158 1 1
    Ever heard of cervical cancer
    Yes 74 232 7.177(2.549, 20.206) 6.924(1.602,29.928)
    No 4 90 1 1
    Symptom of cervical cancer of women
    Bleeding 21 73 3.251(1.448,7.296) 1.022(0.299,3.494)
    Post coital bleeding 4 21 2.152(0.617,7.509) 0.804(0.156,4.154)
    Vaginal foul smelling discharges 27 73 4.179(1.910,9.144) 1.460(0.436,4.889)
    Painful coitus 6 23 2.948(0.974,8.918) 2.001(0.416,9.624)
    Post-menopausal bleeding 10 19 5.947(2.183,16.203) 2.844(0.591,13.679)
    I Don’t know 10 113 1 1
    Ever heard of cervical cancer screening method
    Yes 68 236 2.478(1.220,5.031) 0.642(0.231,1.786)
    No 10 86 1 1
    Who should be screened
    Age greater than 21 20 94 2.420(1.015,5.772) 0.747(0.182,3.069)
    Commercial sex workers 20 51 4.461(1.834,10.849) 1.214(0.280,5.260)
    Elderly women 27 77 3.989(1.713,9.288) 0.900(0.221,3.657)
    Other 3 9 3.792(0.852,16.878) 5.868(0.711,48.418)
    I don't know 8 91 1 1
    Expense of screening
    Free 26 79 4.608(2.053,10.342) 1.575(0.592,4.187)
    It is reasonably priced 14 33 5.939(2.365,14.918) 3.547(1.111,11.320)
    moderately expensive 14 40 4.900(1.973,12.171) 2.814(0.942,8.406)
    very expensive 15 44 4.773(1.951,11.678) 2.225(0.757,6.546)
    I don’t know 9 126 1 1
    Is cervical cancer preventable
    Yes 70 274 1.533(0.693,3.388)
    No 8 48 1
    Prevention method of cervical cancer
    No multiple partner 38 113 9.752(2.272,41.855) 6.806(1.405,32.967)
    Treat papilomavirus 11 41 7.780(1.637,36.982) 6.978(1.279,38.070)
    Use condom 9 27 9.667(1.954,47.820) 5.214(0.868,31.327)
    Vaccine 6 24 7.250(1.365,38.494) 8.597(1.401,52.744)
    Other 4 11 10.545(1.716,64.802) 16.989(2.328,123.982)
    I do not know 2 58 1 1
    Know age of cervical cancer manifestation
    Yes 69 294 0.730(0.330,1.618)
    No 9 28 1
    Know the right sex starting age group
    Yes 69 242 5.560(1.309,23.607) 3.996(0.880,18.149)
    No 2 39 1 1
    Knowledgeable about cervical cancer
    Yes 62 191 2.658(1.469,4.808) 0.624(0.182,2.142)
    No 16 131 1
    Presence of substance abuse
    Yes 4 25 0.642(0.217,1.902)
    No 74 297 1
    Had good attitude towards cervical cancer screening
    Yes 40 185 0.780(0.475,1.280)
    No 38 137 1

    Note STD-sexual transmitted disease

    Discussion

    The result of our study revealed that, out of total 400 participants enrolled in this study, 78 (19.5%) were subjected for cervical cancer screening. Of these, 17/78 (21.8%) were screened by Visual Inspection Acetic Acid(VIA) method. This may contribute for the low screening of cervical cancer screening though low resource settings should implement evidence-based and affordable alternative approach for cervical cancer screening science VIA reduce the deaths of women in developing countries because it is the simplest method for screening with relative ease of use and lowest cost17.

    The current study illustrated as it is fallen in the practice of developing countries; screening coverage is still low, ranging from 0.4% to 14.0% in rural areas and from 2.0% to 20.2% in urban areas18. Cross sectional studies conducted in Nigeria, India, Ghana, Mekele town and Ethiopia exhibited 10%, 8%, 11.6%, 10.7% and 0.6% of cervical cancer screening practice respectively 15, 18, 19, 20, 21. It is far from developed countries carry out; the proportions of women who are screened by Pap test vary from 68 to 84%22. A good example for this utilization reported in study conducted in Brazil gave a picture of 94.7% service consumption 23.

    It was founded that out of total screened, 78 (19.5%), study participants 77 (98.7%) did it at once. This also depicted the low utilization of cervical screening service in the study area though women aged 18–69 who are or have ever been sexually active recommended to have two-yearly Pap tests with the current screening program 24.

    In the current study 94 (23.5%) and 180 (45%) of study participants did not hear about cervical cancer and problems of genital tract. Many of the participants also did not know about cause of cervical cancer 192(48.0%), symptom of cervical cancer 123(30.8%) and treatment of cervical cancer 156(39.0%). Forty two percent of participants got information about cervical cancer from media.

    Very small number of women being screened in sub-Saharan Africa and other developing countries was evidenced by reasons of low levels of awareness and poor knowledge of cervical cancer coupled with unavailability and inaccessibility of cervical cancer screening services23.

    The result 94 (23.5%) was found less than carried out in Finote Selam town, Amhara region in 2017 that the awareness of women on cervical cancer was 34.3%21..

    Regarding participants who know about prevention methods ((Avoid multiple partner (AOR=6.806; 95%CI: 1.405, 32.967) and treatment of Papilloma virus (AOR=6.978; 95% CI: 1.279, 38.070) of cervical cancer had seven times more likely to get cervical cancer screening service compared to individuals that did not be familiar about methods of prevention. Moreover, the recent study revealed that patients who have knowledge on vaccination against Papilloma virus were nine times more likely to practice screening (AOR= 8.597; 95%: 1.401, 52.744).

    Mass campaign early screening and focus from the government and other stake holders to control having multiple sexual partners, human immune deficiency virus positive, history of sexually transmitted infection and early age at initiation of sexual intercourse will reduce cervical cancer by strengthening both cancer prevention and control program and implementation strategies through due attention on the associated risk factors of the study25. Multiple sexual partners’ increases the risk of cervical cancer has been previously documented in studies conducted in Ethiopia and Tanzania 26, 27.

    On other hand, the present study showed that the reasonably priced had four times more likely for screening practice for cervical cancer (AOR=3.547; 95% CI: 1.111, 11.320). This is in agreement with Hadiya, Southern Ethiopia16.

    Conclusion and Recommendation

    The study depicted that there was low utilization of cervical cancer screening that is 19.5% got screened. Awareness about cervical cancer, knowledge of genital tract problems, increased age group, knowledge about prevention method of cervical cancer, and reasonably priced expense had positive influence for screening practice. Therefore, awareness creation about cervical cancer and prevention method is expected from different stakeholder.

    Authors’ Contributions

    Tenagnework Antefe Abebe, Berhanu Elfu, Abel Lule Tessema, Mulusew Alemneh Sinishaw designed the study, collected data, performed analysis and wrote the manuscript. All authors read and agreed on the final manuscript submitted.

    Acknowledgments

    The authors gratefully acknowledge GAMBY Medical & Business College of Sciences, Amhara Public Health Institute and Felege Hiwot Referral Hospital for giving the opportunity to study this title.

    They would also like to extend their gratitude to the study participants for their volunteer participation. Finally they are confessing data collectors and supervisors for their devotion to the successful completion of the project.

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