ABSTRACT
The study examined the knowledge and acceptability of cervical cancer screening among female undergraduate students in Penothniel College, Ogun State. Specifically, assess the level of knowledge of cervical cancer screening among female undergraduate students in Penothniel College, Ogun State, and determine the level of acceptability of cervical cancer screening among female undergraduate students in Penothniel College, Ogun State. The research design adopted for this study is a descriptive research design. The population for this study comprises all undergraduate students enrolled at Penothniel College of Science and Business Management Studies, located in Obada, Abeokuta, Ogun State, Nigeria.The sample size of this study is made up 345 female students who made themselves available to participate in the study during the time of questionnaire administration of the within the study area. Data entry was done using Microsoft Excel version 16 and subsequently exported to SPSS version 25. Findings were presented using descriptive statistics such as mean, frequencies and percentages.From this study, it can be concluded that the respondents are knowledgeable about CC screening. Similarly, they demonstrated a high level of acceptability of CC screening. However, a significant proportion was yet to be screened. Therefore, it is important to make screening facilities available for students. Also, more educational interventions are warranted as over one-third of our respondents reported not having the right information on CC screening.
Keywords: Knowledge, Acceptability, Cervical Cancer, Female, Undergraduate Students, Penothniel College, Ogun State
TABLE OF CONTENTS
Title Page i
Declaration Page
ii
Certification
iii
Dedication iv
Acknowledgement
vi
Table of Contents vii
List of Tables ix
Abstract x
CHAPTER ONE: INTRODUCTION
1.1 Background to
the Study
1
1.2 Statement of
the Problem
3
1.3 Objectives of
the Study 4
1.4 Research
Questions 6
1.5 Research
Hypothesis 6
1.6 Significance
of the Study
6
1.7 Scope of
Study
7
1.8 Operational
Definition of Terms
7
CHAPTER TWO: LITERATURE REVIEW
2.0 Introduction 8
2.1 Conceptual
Review 8
2.1.1 Cervical
Cancer 8
2.1.2 History of
Cervical Cancer 9
2.1.3 Pathology 10
2.1.4 Epidemiology
of Cervical Cancer 10
2.1.5 Treatment and
Management 11
2.1.6 Knowledge of
Cervical Cancer Screening 12
2.1.7 Acceptability
of Cervical Cancer Screening 14
2.2 Theoretical Review 15
2.2.1 Health Believe
Model 15
2.2.2 Application of the Theory 16
2.3 Empirical Review 17
2.4 Summary of
Literature Review 21
CHAPTER THREE: RESEARCH METHODOLOGY
3.1 Research Design
22
3.2 Research
Setting 22
3.3 Research
Population 22
3.4 Sampling Size 23
3.5 Sampling
Techniques 23
3.6 Instrument
for Data Collection 23
3.7 Validity of
the Research Instrument 24
3.8 Method of
Data Collection 24
3.9 Method of
Data Analysis 24
3.10 Ethical
Consideration 24
CHAPTER FOUR: RESULT AND INTERPRETATION OF FINDINGS
4.1 Presentation of Data 25
CHAPTER FIVE: SUMMARY, CONCLUSION AND RECOMMENDATIONS
5.1 Discussion of
Findings 31
5.2 Implication
of findings to the study 32
5.3 Limitation of
the study 33
5.4 Summary of
Findings 33
5.5 Conclusion 33
5.6 Recommendation 34
5.7 Suggestion
for Further Research 35
REFERENCES 36
APPENDIX
38
CHAPTER ONE
INTRODUCTION
1.1 Background of the
study
Cervical
cancer is cancer that affects the uterine cervix in women. It is a health
condition of major public health concern as it is a major cause of morbidity
and mortality among women in the world. It is the fourth most common cancer
among women (Brisson et al., 2019). In 2020, about 604,127 women had cervical
cancer globally resulting in the death of about 341,831 women, and about 90% of
these cases and deaths occurred in low-and middle-income countries (LMIC)
(Farghaly et al., 2022). It is the second most common cancer among women in
Nigeria and other LMICs (3) and causes the most frequent cancer death among
women between the ages of 15 to 44 in Nigeria
In
2020, the incidence of cervical was about 12,000 cases resulting in about 8,000
deaths (8). The main agent implicated in the development of cervical cancer is
the Human Papilloma Virus (HPV), an extremely common virus that is transmitted
through sexual contact. It accounts for more than 95% of cervical cancers. More
than 150 different HPV types have been identified. However, HPV types 16, 18,
31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 68 have been identified and
classified as “high-risk HPV” as a result of their relatively high carcinogenic
potential leading to the development of cancer of the cervix. HPV types 16 and
18 are responsible for about 70% of all cervical cancer cases worldwide (Foran
et al., 2022). Other risk factors for cervical cancer include early onset
sexual activities, having multiple sexual partners, prolonged use of oral
contraceptives, and smoking of cigarettes (2).
Effective
primary prevention measures using the HPV vaccination and secondary prevention approaches
involving screening for, and treating precancerous lesions will lead to the
prevention of most cases of cervical cancer. Effective management following
early detection of cervical cancer can result in successful treatment of the
disease. When detected at late stages, appropriate treatment and palliative
care can also be used to control the disease. With a comprehensive approach to
preventing, screening, and treating, cervical cancer can be eliminated as a
public health problem (Pierre-Victor D et al., 2020). About 74 million new
cases of cervical cancer can be avoided and 62 million deaths prevented if the
preventive strategies are effectively implemented.
Regular
Pap screening reduces the incidence and mortality of cervical cancer by at
least 80% (Fleiss JL 2022).Some of the features of cervical cancer include
pelvic pain, abnormal vaginal bleeding during menstrual periods, pain and
vaginal bleeds during or after sexual intercourse and abnormal vaginal
discharge (Pimple et al., 2019).
In
high-income countries, programmes are in place which enables girls to be
vaccinated against HPV and women to get screened regularly, for pre-cancerous
lesions identified at stages when they can easily be treated. However, in
LMICs, there is limited access to these preventative measures and cervical
cancer is often not identified until it has further advanced and symptoms
develop. In addition, access to treatment of cancerous lesions using surgery,
radiotherapy and chemotherapy is limited, with a resultant higher rate of death
from cervical cancer in these countries (Thyagarajan et al., 2021).
Some
studies have been done among female undergraduate students on cervical cancer
prevention and the findings varied in the various studies. In Debre Berhan,
Ethiopia 40.5% of the students was aware of cervical cancer, 35.6% had good
knowledge, and 0.9% had ever screened for cervical cancer. The reason for not
screening was a lack of information on cervical cancer and screening. Only
33.2% perceived that they were susceptible to cervical cancer (Berrino et al.,
2022). Another study in Gondar, Northwest Ethiopia showed that 50.6%of the
students knew about HPV, and 19.5% knew HPV as the main cause of cervical
cancer. 1.5%was vaccinated against HPV, and 3.0% screened for cervical cancer,
(Berrino F. et al., 1972) while in Brazil. 90.9% of study participants knew
about Pap smear tests, 94.5% had heard about HPV and 52.2% knew that HPV can
cause cervical cancer (Herrero et al., 2007). Also, in Karachi. 74.5% knew
about Pap smear, only 1.2%had been screened for cervical cancer, and the
reasons for not screening were lack of awareness of the procedure and no
recommendation for screening by healthcare provider (La Vecchia et al.,
2022).Furthermore, in Nigeria, one study showed that79.5% of the respondents
have not heard about cervical cancer screening, 78.5% do not know about the HPV
vaccine, and just 4% have had pap smear screening, and the reasons for not
screening were no awareness of a centre where service is available, and fear of
getting a positive result, (Sankaranarayanan et al., 2021) while a second study
reported that72.1% of the respondents were aware of cervical cancer, and 16.1%
had pap smear screening.
Reasons
for not screening were not knowing centers where services were available and
fear of positive results (Herbert A et al., 2022). These studies revealed that
there is a gap in knowledge of cervical cancer and uptake of cervical cancer
screening was poor. Despite the high burden of cervical cancer in Nigeria,
there is limited access to preventive measures and the country has yet to
commence vaccination programmes for HPV at a national level(Sanjay et al.
2022). Based on these lapses and poor knowledge and acceptability of cervical
cancer screening practice, the researcher was prompted to investigate the
knowledge and acceptability of cervical cancer screening among undergraduate
students in Nigeria.
1.2
Statement of the Problem
Over
the years, cervical cancer (CC), an extant lethal disease, has negatively
impacted several women, yet not all women are informed of the possible dangers
of not getting screened. Globally, CC is the fourth most common malignancy
among women (Pontén J et al., 2005). Annually, Africa records20% of the new CC
cases worldwide, and CC is the leading cause of cancer deaths among females in
sub-Saharan Africa (Kumar et al. 2022) In Nigeria, CC is the second commonest
cancer among women of reproductive age and the leading gynecological malignancy
with high mortality among the afflicted (McCredie et al., 2021) CC accounts for the deaths of
over 250,000 women worldwide each year, with an estimated number of 570,000 new
cases in 2020, and 80% of these deaths occur in developing and underdeveloped
countries (Coates . C.2001)
Early
screening often detects abnormalities and can be treated before advancing into
cancer. Evidence suggests that CC can be cured if diagnosed at an early state
and promptly treated (Pierre-Victor D et al. 2020).
When cancer of the cervix is found early before progressing to the invasive
level, the probability of treating it is high (Manini I. et al., 2020]. In a
study conducted in England, Landy et al (Ghosh, et al 2019)] revealed that the
mortality rate of CC would be 5.3 times higher in the absence of screening,
while regular screening will make the mortality rate 65% lower. Similarly,
various other studies showed that CC screening resulted in a decline in the
incidence and mortality rate of CC by up to 90% (Kuhn L et al., 2017)
Despite
the proven benefits of CC screening, Nigeria only has accidental and unevenly
distributed CC screening services, reaching less than 9% of women needing the
services (Der Simonian R et al., 2022). In addition to Nigeria’s weak health
system and lack of cervical cancer control policy, previous studies have also recognized
that lack of awareness, trivialization of CC, poverty, a low number of female
providers, concern for positive screening results and socio-cultural norms
contribute significantly to poor uptake of CCS services, HPV test and pap smear
in Nigeria (Higgins JP et al., 2020).Women between the age bracket of 30 and 45
are prone to this disease and in some cases, even teenagers, particularly at
the age of 18, are likely to be at the mercy of this malignant disease (Deeks
JJ. et al., 2021) CC may develop at any age; while it is a lot in women over
40, younger women are also at risk. The risk associated with CC will depend on
previous behaviours regarding sex, individual immune system, health status and
way of life (Aristizabal N et al., 2022). Sex debut at an age earlier than 18,
having multiple partners or being in relation with persons with various
partners increase the possibility of contracting Human Papilloma Virus (HPV)
(Gatta G et al., 2022).
Furthermore,
a study reports that between 50% and 90% of women who die or are diagnosed with
CC have not been screened for CC (Aristizabal N et al., 2022).The most common
risk factor for CC is the HPV, which is thought to produce proteins that cause
the proliferation of cervical lining cells leading to cancer (Anderson TW et
al., 2022). However, organized and top-quality cytology-based screening
programmes have substantially reduced the burden and risk of CC in various
developed countries, even though there were shortcomings in most developing
countries like Nigeria (Brenes MM, et al., 2020).Although Abiodun et al.,(2019)
noted that the awareness and knowledge of CC and screening were very low,
recent data on these variables are limited in this State. Additionally, it is
essential to understand the knowledge and acceptability of CC screening and its
associated factors among this population, as they are at a high risk of
contracting HPV infection (Shastri SS et al., 2021). Having this understanding
will help develop tailored interventions to address the gaps that might be
identified in the knowledge and acceptability among female undergraduate
students in Penothniel College, Ogun State, Nigeria.
1.3
Objectives of the Study
The study is aimed at determining the
knowledge and acceptability of cervical cancer screening among female
undergraduate students in Penothniel College, Ogun State.
The
objectives of the study were:
1.
To assess the level of knowledge of cervical cancer screening
among female undergraduate students in Penothniel College, Ogun State.
2.
To determine the level
of acceptability of cervical cancer screening among female undergraduate
students in Penothniel College, Ogun State.
1.4 Research Questions
1.
What is the level of
knowledge of cervical cancer screening among female undergraduate students in
Penothniel College, Ogun State?
2.
What is the level of
acceptability of cervical cancer screening among female undergraduate students
in Penothniel College, Ogun State?
1.5
Research Hypothesis
H₀: There is no
significant knowledge of cervical cancer screening among female undergraduate
students at Penothniel College.
H₁: There is significant
knowledge of cervical cancer screening among female undergraduate students at
Penothniel College.
1.6Significance of
Study
Cervical
cancer is the most common form of cancer among women developing countries. Pap
smear is a very significant screening test for reduction of incidence and
mortality from cervical cancer. The Pap smear test detects precancerous
cell change on the cervix that might become cervical cancer if they are not
treated appropriately. The objective of this research is to find out the
knowledge and acceptability of cervical cancer screening among female undergraduate
students. The researcher will also warn the public to be cautious about the
health hazards of cervical cancer and the benefits of early screening for
prevention and treatment. The findings may also help inform policy maker to put
the necessary measures in place to address the problem of cervical cancer. The
research may also be useful to future researchers on the topic and serve as
reference materials in the libraries.
1.7
Scope of Study
This
study covers all the knowledge and acceptability of cervical cancer screening
among female undergraduate students in Penothniel College, Ogun State.
1.8 Operational
Definitions of Term
·
Cervical
cancer: Cervical
cancer is a growth of cells that starts in the cervix. The cervix is the lower
part of the uterus that connects to the vagina. Various strains of the human
papillomavirus, also called HPV, play a role in causing most cervical cancers.
HPV is a common infection that's passed through sexual contact.
·
Knowledge:
This is the understanding of concept of cervical cancer and its damages to
female health.
· Acceptability:
This is the attitude of accepting screening for cervical cancer.
· Undergraduate
Students: Female students enrolled in an
undergraduate program at Penothniel College, who are within the age range
typically recommended for cervical cancer screening. They represent the study's
target population, focusing on their knowledge and acceptability of cervical
cancer screening.
·
Penothniel
College: An educational institution where this
study is conducted, focusing on the knowledge and attitudes of its female
undergraduate students regarding cervical cancer screening. The college setting
provides insight into the awareness and perspectives of young women in this
demographic group.
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