Factors influencing cervical cancer screening in a Kenyan Health Facility: a mixed qualitative and quantitative study
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20171381Keywords:
Cervical cancer, HIV, WomenAbstract
Background: Cervical cancer is the commonest cause of cancer-related morbidity and mortality among women in developing countries in sub-Saharan Africa. Screening for cervical cancer among HIV infected women is crucial as they are more at risk of developing the disease and progressing faster once infected with Human Papilloma Virus (HPV).
Methods: We aimed to determine the factors affecting the utilization of cervical cancer screening among HIV infected women above 18 years of age at Kenyatta National Hospital by conducting a cross-sectional mixed quantitative and qualitative methods study. Descriptive and inferential analysis was carried out on quantitative data to determine significant associations with cervical cancer utilization. Qualitative data were analyzed after coding for significant clauses and transcribing to determine themes arising.
Results: Three hundred and twenty eight of the total 387 women enrolled reported they had been advised by their health providers to go for screening. However, only 179 (46%) reported cervical cancer screening. Women were more likely to report cervical cancer screening if recommendation by a staff was made (p <0.001), and prior to joining KNH CCC (p <0.001). Qualitatively the main barrier to screening included fear of screening due to concerns about excessive pain or bleeding, lack of proper communication on screening procedures and long waiting time
Conclusions: The utilization of cervical cancer screening services was low despite high rates of health care recommendation. The women were more likely to utilize the service if recommendation from the health care worker was made, and if they had ever screened before.References
Parkin P, Pisani J, Ferlay DM. Global cancer statistics. Cancer J Clin. 1999;49(1):33-64.
Wright TC, Ellerbrock TV, Chiasson MA. Cervical intraepithelial neoplasia in women infected with human immunodeficiency virus: prevalence, risk factors, and validity of papanicolaou smears. Obstet Gynecol. 1994;8:99-106.
Ellerbrock TV, Chiasson MA, Bush TJ. Incidence of cervical squamous intraepithelial lesions in HIV-infected women. JAMA. 2000;283:1031.
Moscicki AB, Ellenberg JH, Nowick P. Risk of high-grade squamous intraepithelial lesion in HIV-infected adolescents. J Infect Dis. 2004;190:1413.
Austrickler HD, Burk RD, Fazzari M, Anastos K. Natural history and possible reactivation of human papillomavirus in human immunodeficiency virus-positive women. J Natl Cancer Inst. 2005;97(8):577.
Clifford GM, Gonçalves MA, Franceschi S. Human papillomavirus types among women infected with HIV: a meta-analysis. HPV and HIV study group. AIDS. 2006;20(18):2337.
Frisch M, Biggar RJ, Goedert JJ. Human papillomavirus-associated cancers in patients with human immunodeficiency virus infection and acquired immunodeficiency syndrome. J Natl Cancer Inst. 2000;92(18):1500.
NASCOP. Guidelines for Antiretroviral treatment in Kenya. 2011.
International AIDS vaccine initiative HPV vaccine adoption in developing countries: cost and financing. Available at http://www.iavi.org/, http:// www.path. org/publications/. Accessed on 8 April 2012.
Megan J, Huchko, Elizabeth A, Bukusi, Craig R. Cohen successful integration of a cervical cancer screening and prevention. Int J Gynecol Obst. 2011;114(2):106-10.
Sandelowski M. Sample size in qualitative research. Research Nursing Health. 1995;5:89-95.
Machoki JM, Rogo KO. Knowledge and attitudinal study of Kenyan women in relation to cervical carcinoma. Int J Gynecol Obst. 1991;34:55-9.
Ajayi IO, Adewole IF. Knowledge and attitude of general outpatient attendants in Nigeria to cervical cancer. Cent Afr J Med. 1998;44:41-3.
Adanu RM. Cervical cancer knowledge and screening in Accra, Ghana. J Womens Health Gend Based Med. 2002;11:487-8.
Arevian M, Noureddine S, Kabakian T. A survey of knowledge, attitude, and practice of cervical screening among Lebanese/Armenian women. Nurs Outlook. 1997;45:16-22.
Ezechi OC, Chidinma V, Okafor G. Ostergren and karen odberg pettersson willingness and acceptability of cervical cancer screening among HIV positive Nigerian women. BMC Public Health. 2013;13:46.
McKenzie K, Rogers R, Pamnani R, Warui D, Sakr S, Ngumo R, et al. Free cervical cancer screening among HIV-positive women receiving antiretroviral treatment in Kenya: acceptance and findings. IAS. 2014;11:54-68.
Grangé G. Factors associated with regular cervical cancer screening. Int J Gynecol Obstet. 2008;11:48-55.
