Knowledge and awareness of cervical cancer in Southwestern Ethiopia is lacking: A descriptive analysis

Unlocking prevention: the role of health literacy in cervical cancer screening: community nursing perspective

INTRODUCTION

Cervical cancer presents a significant global public health challenge, particularly affecting low- and middle-income countries like Egypt. Despite the availability of effective screening methods such as Pap smears and HPV testing, the incidence of cervical cancer remains high in Egypt. Health literacy, which refers to the ability to access, understand, and utilize basic health information and services to make informed decisions, is crucial in influencing individuals' health behaviors, including their participation in cancer screening programs.

OBJECTIVES

To examine the correlation between health literacy levels and cervical cancer screening behaviors among women.

METHODS

This study employed a multi-site cross-sectional research design from September 2023 to January 2024. The research was conducted at four primary health care (PHC) facilities in the Damanhur district of Egypt. Three hundred fifty women participated in the study, completing a comprehensive questionnaire that included a Woman's Social and Health Form, a Cervical Cancer Knowledge Scale, a Cervical Cancer Screening Behaviors Scale, and a Health Literacy Scale (HLS-SF12).

RESULTS

The study revealed significant relationships between the importance of health literacy (HL) in understanding cervical cancer (CC) knowledge and screening behaviors among Egyptian women. A positive correlation was found between Knowledge and HL (r = 0.507, p < 0.001). Conversely, perceived barriers negatively correlated with knowledge and HL (r = -0.172, p < 0.05; r = -0.277, p < 0.01). The regression analysis revealed that higher levels of HL were significantly associated with greater knowledge about CC (B = 0.148, p < 0.001). Conversely, knowledge about CC was also found to be a strong predictor of higher HL levels (B = 1.205, p < 0.001). These results highlight the bidirectional relationship between HL and knowledge, where improvements in one can enhance the other.

CONCLUSION

Addressing misconceptions and increasing knowledge about the importance of regular screenings, mainly through accessible and culturally appropriate channels, could lead to an improved uptake of cervical cancer screening services. Overall, this study lays a foundation for future research to continue exploring ways to improve cervical cancer prevention and control efforts among women.

CLINICAL TRIAL NUMBER

Not applicable.

Knowledge, attitude, and practice towards uterine cervical cancer screening in Egyptian females: a nationwide cross-sectional study

BACKGROUND

Cervical cancer is a major cause of morbidity and mortality among women worldwide; it is ranked the 4th most common cancer among women globally. The current recommendation for cervical cancer (CC) screening involves the use of cytology examination methods like Pap smear. However, there is a lack of data on the practice of Pap smear screening in Egypt. Furthermore, understanding the knowledge, attitudes, and barriers related to cervical cancer screening among potential participants is crucial.

METHODS

In this cross-sectional study, we conducted interviews with female patients aged 21 years or more who visited outpatient clinics in six university hospitals across Egypt. The survey aimed to assess participants' compliance with CC screening guidelines, their knowledge of and attitude toward CC screening, and their perception of potential barriers.

RESULTS

A total of 897 participants from the six study centers completed the survey. Only a small percentage (1.1%) of participants had undergone CC screening, although only (0.8%) of the participants were referred to do CC screening. The referral rate was more likely to be higher in participants who had one of their first-degree relatives or the surrounding people with a history of CC compared to those who have no one with CC (37.5% vs. 0.4%, P < 0.001; 5% vs. 0.6%, P = 0.035 respectively). Moreover, the referral rate was higher among participants who discussed CC and CC screening with their physicians (15.8% vs. 0.5%, P < 0.001; 23.5% vs. 0.3%, P < 0.001 respectively). Knowledge of CC screening was limited, with only 2.7% of respondents demonstrating good actual knowledge. However, after introducing the concept of CC screening to all participants, the majority (74.6%) showed a positive attitude towards undergoing the procedure. Lack of knowledge about the procedure, its tool, the place to do it, and financial burden were cited as the most common barriers to CC screening (79.8%, 65.9%, 64.2%, and 53.2%, respectively).

CONCLUSION

Despite inadequate knowledge about CC screening, there is a positive attitude toward it among eligible participants in Egypt. This lack of knowledge likely contributes to low compliance with current CC screening guidelines and calls for national-level efforts to address this issue.

Histopathologic patterns and factors associated with cervical lesions at Jimma Medical Center, Jimma, Southwest Ethiopia: A two-year cross-sectional study

BACKGROUND

The cervix is the lower portion of the uterus, which connects this organ to the vagina through the endocervical canal.

OBJECTIVE

This study aimed to determine the histopathologic patterns and factors associated with cervical lesions at Jimma Medical Center from September 12, 2017, to September 12, 2019.

METHODS

A 2-year facility-based cross-sectional study was conducted from May 1 to June 30, 2020.

RESULT

In this study, cervical cancer was the most common (71%) cause of cervical lesions. Squamous cell carcinoma was the most frequent cervical cancer diagnosed during the study, accounting for 96.4% of 331 cancerous cases, followed by adenocarcinoma (3.3%). High-grade squamous intraepithelial lesions were the most frequently diagnosed precancerous lesions, accounting for 68.4% of cases. Endocervical polyps were the most commonly diagnosed benign lesions, accounting for 59.3% of cases.

CONCLUSION

The maximum age distribution of cervical lesions was in the 41-50-year age range. Squamous cell carcinoma was the most frequent type of cervical cancer. High-grade squamous intraepithelial lesions were the most frequently diagnosed precancerous cervical lesions. The most common benign cervical lesions were endocervical polyps.

RECOMMENDATION

We recommend educating the community to improve health-seeking behavior and on possible preventive strategies for cervical cancer.

Less known but greatly feared: Cervical cancer in Ethiopia community awareness

To improve a community's awareness and attitude towards cervical cancer, strong evidence is needed to inform contextually appropriate policies. This study aims to explore community awareness about cervical cancer from the perspective of women, men and health extension workers (HEWs). The research was conducted from May to July 2021 in Jimma, Ethiopia. A total of 23 in-depth interviews were conducted. The study included married and unmarried women (15-19 and 25-29 years old), men of similar ages (married and unmarried), and HEWs. Furthermore, eight separate focus group discussions (FGDs) were conducted with both men and women. Thematic analysis was used to draw findings from the interviews and FGDs. Community awareness about cervical cancer was very limited. However, people who knew of it believed that cancer is fatal. A few participants were aware of cervical cancer through its symptoms, but most people did not know it by name and had never heard about HPV as the cause of cervical cancer. There was little understanding of HPV risk, transmission factors, prevention, vaccination, screening, or treatment. Participants considered their participation in this study as their first chance to learn about the disease. HEWs had limited knowledge about HPV and cervical cancer. Study participants demonstrated favorable attitudes towards HPV vaccination, cervical screening, and treatment after they received basic information about cervical cancer from the data collectors. Participants and HEWs strongly suggested awareness creation programs for the wider community members, including active involvement of men and HEWs in cervical cancer interventions. There is a critical information gap regarding cervical cancer, its cause and risk factors, HPV transmission, cervical screening, and treatment programs. Limited community awareness leads to poor uptake of cervical screening in the few settings where it is available. Therefore, community awareness programs about HPV, cervical cancer, and available services should improve the community's awareness of cervical cancer and HPV.

Women's and health professionals' perceptions, beliefs and barriers to cervical cancer screening uptake in Southern Ethiopia: a qualitative study

Cervical cancer remains a public health problem worldwide. Screening for cervical cancer is poorly implemented in resource-limited settings. In Ethiopia, evidence from the community and health professionals regarding implementation of the screening programme is lacking. The objective of this study was to explore women's and health professionals' perceptions, beliefs, and barriers in relation to cervical screening in Southern Ethiopia. Five focus group discussions among women and six key informant interviews with health professionals were conducted from June to July 2022 to gather the required data from a total of 42 participants. The participants were purposively selected from a diverse group to ensure varied viewpoints. Data were collected through group discussions and face-to-face interviews using a semi-structured interview guide. The interview sessions were tape-recorded. The data were analysed using a thematic approach. Women demonstrated a low level of awareness and perceived risk. Also, the perceived benefit of screening for cervical cancer during healthy periods was low. Individual and system-level barriers to screening include low awareness, stigma, poor perceptions towards health screening and causes of cervical cancer, low risk perception and competing domestic priorities, shortage of trained human and other resources, human resource turnover, low implementation and lack of close follow-up of screening programmes. In summary, lack of awareness, misconceptions, and poor perceptions were common. Screening implementation and uptake were low due to individual, psychosocial, and system-related barriers. Therefore, behavioural change communication and system-strengthening efforts need to be in place to effectively tackle the observed gaps.

Cancer signs and risk factors awareness in Addis Ababa, Ethiopia: a population-based survey

BACKGROUND

There is a paucity of data on public awareness of cancer in Ethiopia. This study assessed cancer signs, symptoms, and risk factors awareness among individuals aged 18 and older in Addis Ababa, Ethiopia.

METHOD

A population-based face-to-face interview was conducted applying a validated cancer awareness measure (CAM) tool. A total of 600 adults (315 males and 285 females) were recruited using a multistage sampling technique. One open-ended and ten closed-ended questions were used to assess awareness of cancer signs and symptoms. To assess awareness of cancer risk factors, one open-ended and twelve closed-ended questions were used. Logistic regression analysis was used to test the association between sociodemographic status and awareness of cancer signs, symptoms, and risk factors.

RESULTS

Based on the responses for the open-ended questions, unexplained bleeding (23.16%) and smoking (24.17%) were the most frequently recalled cancer sign and risk factor, respectively. Based on the responses for the closed questions, the majority of respondents identified tiredness all the time (80.7%) as a cancer symptom and alcohol use (82.5%) as a cancer risk factor.  The odds of cancer signs and symptoms awareness was higher in those with primary (AOR = 4.50, 95% CI, 1.72-11.79, p = 0.02), secondary (AOR = 4.62; 95% CI 1.86-11.43; p = 0.001), and tertiary (AOR = 7.51; 95% CI 3.04-18.56; p < 0.001) education than those who were illiterate. The odds of awareness about cancer signs and risk factors was 0.28 (95% CI 0.12-0.65; p = 0.003) and 0.22 (95% CI 0.83-0.58; p = 0.002) times lower, respectively, among individuals aged 60 and older than those aged 18 to 29.

CONCLUSIONS

Young adults who attended formal education of primary or higher level may have a better cancer signs and symptoms awareness. Future education interventions to increase awareness of the society in Addis Ababa may target illiterate and the elderly.

Knowledge and practice for cervical cancer among female primary school teachers in Phnom Penh, Cambodia: A cross-sectional phone-based survey

Cervical cancer is a cancer with evidence-based and cost-effective preventive measures; Human Papilloma Virus (HPV) vaccination for school girls and cancer screening for women. In Cambodia, cervical cancer accounts for an estimated 11.4% and 10.4% of women's cancer and deaths in 2020, respectively. This study aimed to identify the knowledge of cervical cancer, its information sources, and the experiences of cervical cancer screening among female primary school teachers, who are key influencers of HPV vaccination. A cross-sectional study was conducted using telephone interviews with 100 female primary school teachers in Phnom Penh, the capital of Cambodia. All 100 participants had heard of cervical cancer, 94 (94%) had heard of screening, and 49 (49%) had ever undergone a screening. When asked about their knowledge regarding cause(s), symptom(s), detection, and treatment(s) of cervical cancer, 31%, 44%, 35%, and 55% respondents said "Do not know". Those who did not reply "Do not know" were asked open-ended questions. Many of their answers were judged as incorrectby gynecologists. Consequently only 1%, 38%, 63% and 28% of respondents replied with at least one correct answer regarding cause(s), symptom(s), detection and treatment(s) respectively. The most common sources of information were family and friends, followed by doctors, television, and the Internet. Among female primary school teachers with an above-average educational level, their knowledge of cervical cancer was generally low. To promote cervical cancer prevention, it is necessary to provide correct knowledge in a broad and accessible manner through involvement of local medical doctors and healthcare providers.

The Mediating Role of Policy-Related Factors in the Relationship between Practice of Waste Generation and Sustainable Construction Waste Minimisation: PLS-SEM

As the construction industry grows, it produces large volumes of construction waste, which has a tremendous environmental impact and generates public concern in the neighbouring towns. The construction industry generates a significant volume of waste and faces a challenge with poor construction waste minimisation in order to prevent adverse environmental and dumping impacts worldwide. In developing countries, regional waste management systems have increased problems. Environmental pollution (air, water, and soil) and human health issues are caused by waste produced in a country as a result of different cultural, social, and religious activities. Prior studies were reviewed to choose dimensions and items for the data gathering instrument. A pilot test was conducted to identify potential questionnaire adjustments, and hypotheses were tested using structural equation modelling (SEM). A total of 220 Malaysian construction professionals answered the survey, which yielded the results. Five hypotheses have direct correlations based on the findings, three of which have a significant effect. Furthermore, the findings reveal that policy-related factors mediate the relationship between improving factors and sustainable construction waste minimisation. In contrast, they did not mediate the relationship between current practices/generation and sustainable construction waste management. The established framework can help improve construction waste management and help achieve global sustainable development goals. The data reveal that adopting preventive plans to reduce construction waste is one of the most important aspects of enhancing profitability. This study could aid construction industry players in evaluating waste management components during the construction and design stages of a building project.

Low level of knowledge about cervical cancer among Ethiopian women: a systematic review and meta-analysis

Introduction

Cervical cancer is one of the leading causes of malignancies among women in Ethiopia. Knowing the disease could empower women to make an informed decision regarding participation with cervical cancer prevention strategies. There is scarcity of compiled data in the field. Therefore, this systematic review aimed to provide an overview of knowledge about cervical cancer among Ethiopian women.

Methods

We conducted a systematic review of peer-reviewed articles on the knowledge of cervical cancer. Articles were systematically searched using comprehensive search strings from PubMed/Medline, SCOPUS, and grey literature from Google Scholar. Two reviewers assessed study eligibility, extracted data, and the risk of bias independently. Meta-analysis was performed using STATA v 14 to pool the overall knowledge of the women about cervical cancer.

Results

We included 26 articles published between 2013 and 2020 covering a total of 14,549 participants. All the included articles had good methodological quality. The proportion of participants who had heard of cervical cancer varied from 4.6 to 87.7% with the pooled estimate at 56% (95% CI: 47–66). Similarly, the proportion of participants who knew that HPV is the main cause of cervical cancer lied between 0 and 49.7% with the pooled result at 21% (95% CI: 13–30). Likewise, the pooled prevalence to identify at least one risk factor, one symptom of cervical cancer and ever heard of cervical cancer screening was gauged at 52% (95% CI: 39–64), 43% (95% CI: 26–60), and 39% (95% CI: 24–55), respectively. The overall pooled prevalence of good knowledge about cervical cancer was at 43% (95% CI: 33–53). On top of this, the prevalence of previous screening practice among the participants was at 14% (95% CI: 9–20).

Conclusions

Knowledge about cervical cancer among Ethiopian women is quite poor. Therefore, health education to provide sufficient and unbiased information about HPV and cervical cancer in general is required to the public.

Knowledge of Cervical Cancer and Associated Factors Among Women Attending Public Health Facilities in Eastern Ethiopia

Purpose

This study was done to assess women’s knowledge of cervical cancer and associated factors.

Materials and Methods

We conducted a facility-based cross-sectional study in eastern Ethiopia from January 1 to May 30, 2019. A convenient sampling technique was used to include 1181 women in this study. Information on socio-demographic characteristics, sexual history, knowledge and awareness of women was collected using face-to-face interview. The data were cleaned, coded and entered into EPI‑info version 3.5.4 and then exported to Statistical Package for Social Science version 23.0 software for analysis. The associations between independent variables and outcome variables were assessed using bivariate and multivariable logistic regressions. The results of these analyses were reported as odds ratios with 95% confidence intervals. We declared statistically significant variables at a p-value less than 0.05.

Results

Nearly half (574, 48.6%) of the participants have ever heard about cervical cancer. One hundred and thirty-nine (24.2%) of them did not know any of the risk factors. The majority of them mentioned bleeding after intercourse (329, 57.4%) as a symptom of the disease. Overall knowledge assessment revealed that 288 (55.7%) participants had adequate knowledge about cervical cancer. Participants’ age in the range of 40–49 years (AOR: 2.58, 95% CI 1.99–5.57), having educational level above 12th grade (AOR: 12.11, 95% CI 4.57–32.09) and receiving information about the disease from healthcare professionals (AOR: 2.72, 95% CI 1.69–4.37) were independently associated with adequate knowledge of cervical cancer.

Conclusion

The knowledge of women towards cervical cancer in our study area was inadequate. The respondents’ age, educational status and source of information were independently associated with study participants’ knowledge of cervical cancer. Young women with no formal education should get special focus in prevention strategies and we also recommend regular and effective counselling, and education about cervical cancer at health institutions.

Communicative challenges among physicians, patients, and family caregivers in cancer care: An exploratory qualitative study in Ethiopia

Background

Cancer is a growing concern in Ethiopia. Though communication is essential for the treatment process, few studies have looked at communication in Ethiopian cancer care. Due to the large number of patients and scarcity of resources, it is vital to understand how to manage consultations in order to effectively help as many patients as possible in this challenging work environment. Thus, research is needed to analyze and understand the communicative challenges experienced by physicians, patients, and family caregivers, in order to successfully handle patient care in practice.

Objective

We explore communication in Ethiopian cancer care and present the main challenges faced by physicians, patients, and family caregivers.

Methods

This explorative qualitative study was conducted at the Oncology Department of the Tikur Anbessa (Black Lion) Specialized Teaching Hospital (TASH) in Addis Ababa, Ethiopia. A triangulation of data collection methods was used: 91 audio-recorded, semi-structured interviews and 21 video-recordings of authentic interactions during hospital rounds. The aim was to obtain as complete a picture as possible of communication from the perspectives of physicians, patients, and family caregivers. The interviews were analyzed using thematic content analysis and the identified themes were supported by excerpts from the transcribed recordings.

Results

Eight themes emerged from the data. Workload and time pressure, in combination with restricted space for privacy, limited the possibilities for physicians to deliver detailed information and provide emotional support. Furthermore, patient literacy levels, in combination with no or little cancer awareness, financial problems, reliance on traditional and religious treatments, the stigma of cancer, and a fatalistic attitude, resulted in delays in patients seeking care and participating in positive health behaviors, and, subsequently, often resulted in an unwillingness to openly discuss problems with physicians and adhere to treatment. The study also illustrates the paramount role of family in physician-patient communication in Ethiopia. Though family caregivers provide a valuable interpreting support when patients have limited language skills, they can also prevent patients from sharing information with physicians. Another important finding is that family caregivers were often responsible for making decisions about treatment and avoided telling patients about a poor prognosis, believing that conveying bad news may upset them. All of these themes have important implications for the role of ethically acceptable communication in patient-centered care.

Conclusions

This study has identified a number of serious challenges for successful and ethically acceptable health communication in Ethiopian cancer care. The study contributes to our understanding of the complexity around the role of family, combined with patients’ dependency on family members for communication, support, and access to care, which creates particular ethical dilemmas for the medical staff. The questions raised by this study concern how to organize consultations to achieve patient-centered health communication, while maintaining a constructive alliance with the family and not jeopardizing the patient’s continued access to care. The integration of communication training for medical students in Ethiopia, with a focus on ethical guidelines for family-centered patient consultation suitable for these circumstances, would be an essential step.