research article cervical cancer: community perception and...

Research ArticleCervical Cancer Community Perception and PreventivePractices in an Urban Neighborhood of Lagos (Nigeria)

K O Wright O Aiyedehin M R Akinyinka and O Ilozumba

Department of Community Health and Primary Health Care Lagos State University Teaching Hospital (LASUTH)Ikeja Lagos Nigeria

Correspondence should be addressed to K O Wright loladewrightyahoocom

Received 21 November 2013 Accepted 22 December 2013 Published 4 February 2014

Academic Editors V Coupe and S T Hedau

Copyright copy 2014 K O Wright et al This is an open access article distributed under the Creative Commons Attribution Licensewhich permits unrestricted use distribution and reproduction in any medium provided the original work is properly cited

Background Cervical cancer prevention in developing countries is suboptimal compared with the developed world where thereare fewer deaths and improved survival rates This study describes the perception and preventive practices on cervical cancerby residents of an urban neighborhood of Lagos Nigeria Methods A descriptive cross-sectional study was conducted on 317consecutively recruited consenting participants at a medical outreach using a pretested interviewer-administered semistructuredquestionnaire Data analysis was done using statistical package for social sciences version 19 Tests of significance were performedusing 95 confidence interval with level of significance set at 119875 lt 005 Results The majority of respondents were within 30ndash49years of age (467) and female (621) and 703 had secondary level education and above About 372 of respondents hadheard about cervical cancer with 845 of the participants willing to attend a cervical cancer health education program Amongthe female respondents 41 had received the HPV vaccine while 51 had undergone a Pap test Awareness about cervical cancerwas significantly higher with increasing age in the total population (119875 lt 005) Conclusion There is a need to improve awarenessof at-risk groups and the menfolk about cervical cancer based on the immense benefit of male involvement in reproductive healthmatters

1 Introduction

Invasive cervical cancer (ICC) is the leading cause of cancer-related deaths among women in developing countries [1] It isthe second most common cancer among women worldwidewith an estimate of over 500000 new cases and about 275000deaths in 2008 About 86 of these cases occur in developingcountries representing approximately 15 of female cancers[2 3]

The incidence of cervical carcinoma in Africa is on therise However the true incidence inmanyAfrican countries isunknown as there is gross underreporting [1] Few countrieshave functioning cancer registries but record keeping is sub-optimal Many of the figures in literature are hospital-basedand these represent a small fraction of women dying fromcervical cancer as most women cannot access hospital careand oftentimes die at home [4] Mortality rates in developedcountries with successful screening programs hardly exceed 5per 100000 women In sub-Saharan Africa in 2002 survival

rate was 21 compared with 70 and 66 in USA andWestern Europe respectively [2] In Nigeria 80 of the10000womenwho develop cervical cancer annually die fromit [5]

The known primary underlying cause is the humanpa-pillomavirus (HPV) which is the most common sexuallytransmitted infection worldwide and it is estimated that 50to 80 of sexually active women are infected at least oncein their lifetime [6] Prevention of cancer of the cervix isachievable by preventing HPV infection and ensuring earlydetection and treatment which significantly reduces its mor-bidity andmortality Pap smear test is one of themost reliableand effective cancer screening tests available About 75 ofwomen in industrialized countries have been screened forcervical cancer in the previous five years compared to lessthan 5 in developing countries [7] In sub-Saharan Africafew women are ever screened for cervical cancer Screeningcoverage in developing countries is low ranging from 20 to202 in urban areas and 04 to 140 in rural areas [8] Low

Hindawi Publishing CorporationISRN Preventive MedicineVolume 2014 Article ID 950534 9 pageshttpdxdoiorg1011552014950534

2 ISRN Preventive Medicine

levels of awareness and poor knowledge of cervical cancercoupled with unavailability and inaccessibility of cervicalcancer screening services are responsible for the very smallnumber of women being screened in developing countries[9]

Lagos State has two tertiary and about 22 governmentowned secondary health care facilities where follow-up andtreatment may be accessed for cases of positive Pap smearresultsThis survey was undertaken to assess community per-ception and preventive practices on cervical cancer amongstresidents of an urban neighborhood of Lagos Nigeria

2 Materials and Methods

21 Location of the Study Lagos State is located in southwest-ernNigeria and lies on longitude 3∘ 241015840 E and latitude 6∘ 271015840NLagos State has an estimated population of 15 million people[10] It is made up of 20 local government areas and 37 localcouncil development areas (LCDA) Olusosun is located inOnigbongbo LCDA of Lagos and is an area known widely onaccount of the presence of the largest landfill in Lagos State[11] The area is presently a commercial and residential area

22 Study Design A descriptive cross-sectional study designwas used and the study population was selected among theresidents of Olusosun area

23 Sample Size Determination Sample size was establishedsuch that an accuracy of 5 could be reached around anobserved probability of 25

The required sample sizewas calculated using the formula1198852

1199011199021198892 [12]

Therefore minimum sample size calculated was 288 Anonresponse rate of 10 (+29) was anticipated therefore atotal sample size of 317 was obtained

24 SamplingMethod Amedical outreach (consisting of freemedical consultation and basic services) was conducted inJune 2013 at Olusosun community by resident doctors under-going medical specialist (postgraduate) training at a tertiaryhealth institution in Lagos as part of the activities forthe annual general week of the resident doctors involvingelections medical mission and other programs Residents ofthe community had been sensitized about the program priorto the Outreach to promote community participation in theevent Consecutive recruitment was done for consenting res-idents until the sample size was obtained The inclusion cri-terion is the condition that the respondents must be 18 yearsof age or above

25 Survey Instruments A structured interviewer-adminis-tered questionnaire developed by the researchers (based onliterature search) was used for data collection This instru-ment was pretested in a different community close to thetertiary health institution to exclude ambiguities and admin-istered by research assistants who had a day training to ensurelexical coherence as well as efficient and effective discharge ofduties

The questionnaire sought information on sociodemo-graphic details perception and preventive practices on cer-vical cancer

26 Data Analysis Analysis was done using Statistical Pack-age for social sciences (SPSS) version 19 Tests of significancewere performedusing a 95 confidence interval and the levelof significance was set at 119875 lt 005 Bivariate analysis wasdone to determine associations between variables Outcomemeasures include perception of cervical cancer knowledge ofpreventive practices and proportion of respondents who hadengaged in preventive practices

Ethical clearance was obtained from the research andethics committee and informed consent was obtained fromeach participant at the point of data collection

27 Study Limitation Lagos State is divided into 20 localgovernment areas (LGAs) with a breakdown of 16 urban and4 rural LGAs The study was conducted in one of the LGAsThe findings might not be representative of the entire state(rural and urban combined) but it is fairly representative ofthe urban communities of Lagos

3 Results

See Tables 1 2 3 4 5 6 7 and 8

4 Discussion

The results from this study show that just over a third ofrespondents (372) had heard about cervical cancer withtelevision (39) being the commonest source of the infor-mationThis is quite low when compared to a cross-sectionalsurvey of 650 women conducted in London which showedthat 762 of the participants perceived cervical cancer to bea common disease and were also aware of the risk factors forthe disease [13] Similarly a Yemeni study revealed that mostrespondents (806) had heard about cervical cancer with aquarter of the respondents (264) accessing this informationfrom television [14] In Africa a study in Kenya to assessknowledge and practices about cervical cancer and Pap smeartesting among cervical cancer and noncancer patients foundthat 51 of the respondents were aware of cervical cancerwhich is also higher than that obtained in the present study[15]

Sub-Saharan Africa which appears to be one of the mostaffected regions also has the lowest awareness rates about cer-vical cancer as even lower rates were reported in Cameroonwhere a study to assess the knowledge of cervical cancershowed that only 28 had prior knowledge of cervical cancerand another study in Ibadan among women aged 20 to 65years attending the general outpatient unit of a departmentin a tertiary hospital found that only 15 of the respondentshad heard of cervical cancer [4 16] Among rural women in astudy conducted in Osun State of Nigeria about 392 of thewomen had heard about cervical cancer which is also verysimilar to the findings in the present study [17]

ISRN Preventive Medicine 3

Table 1 Demographic details

Variable Frequency () (119899 = 317)Age (years) Mean 411 Std dev 154lt30 79 (249)30ndash49 148 (467)50ndash69 68 (215)70ndash89 19 (60)No response 3 (09)

GenderMale 120 (379)Female 197 (621)

Marital statusSingle 80 (252)Married 199 (628)Divorced 3 (09)Widowed 29 (91)Separated 4 (13)No response 2 (06)

Educational statusNo formal 28 (88)Primary 66 (208)Secondary 163 (514)Tertiary 58 (183)No response 2 (06)

Employment statusStudent 28 (88)Employed 56 (177)Self-employed 194 (612)Home maker 13 (41)Retired 16 (50)Applicant 10 (32)

Almost half (467) of respondents were aged 30ndash49 years The majority ofrespondents were female (621) andmarried (628) and over half of themhad secondary school education (514) andwere self-employed (612)Themean age was 411 plusmn 154

Suboptimal awareness of cervical cancer is further dem-onstrated in the present study by the fact that only 51 ofrespondents who had heard of cervical cancer understoodthat HPV infection has been strongly implicated in its causal-ity Correspondingly none of the respondents in a studyconducted in Malaysia had heard of the HPV [18] The lowawareness in these countries that have a greater share of cer-vical cancer deaths than high income countries is worrisome

In the midst of this however a favorable finding is that845 of respondents are willing to attend a cervical cancerheath education program This gives an indication that thepopulation is willing to learn about cervical cancer and itsprevention in at-risk groups

Based on the minimal proportion of cervical cancerinformed respondents it is not surprising that over 90of thestudy participants were uninformed on ways of preventingcervical cancer with only 6 of all respondents having heardof the HPV vaccine These are similar to the finding in across-sectional survey among college women in a university

Table 2 Knowledge of cervical cancer

Variable Frequency ()Heard of cervical cancer (119899 = 317)

Yes 118 (372)No 199 (628)

Risk factor for cervical cancer (119899 = 118)HIV 10 (85)HPV 6 (51)Bacteria 17 (144)Do not know 85 (720)

1st source of information about cervical cancer (119899 = 118)TV 46 (390)Radio 36 (305)Magazine 6 (51)News 7 (59)Health talk 22 (186)Others 1 (08)

Knowledge of anyone with cervical cancer (119899 = 118)Yes 22 (186)No 96 (814)

Have been recommended for screening (119899 = 118)Yes 25 (212)No 93 (788)

Early detection of cervical cancer is helpful (119899 = 317)Yes 196 (618)No 13 (41)Do not know 108 (341)

About a third of respondents (372) had heard about cervical cancer priorto the survey Among these only 51 of the respondents identified humanpapilloma virus (HPV) as the major risk factor for cervical cancer Thecommonest source of information about cervical cancer was via television(390) while 181 of respondents knew someone who had had the diseaseDespite the fact that only 372 had heard of cervical cancer over half of therespondents (618) were aware of the importance of early detection

in Ghana which showed that only 79 were aware of thelink between humanpapillomavirus and cervical cancer [19]Findings from the present study are also similar to thosereported from an intervention study conducted among mar-ket women in Lagos to evaluate the effect of health educationon awareness and uptake of cervical cancer screening whereonly 69 and 120 of respondents in the study and controlgroups had heard about Pap smears at baseline [20] Thesefigures are quite low when compared with findings from thestudy conducted in Yemen where a great majority (70) ofrespondents were correctly informed that cervical cancer ispreventable Proportions of 59 and 18 of participants inthat study knew that routine screening by Pap smear andvaccination against HPV infection are some methods for theprevention and control of cervical cancer [14]

Knowledge generally does not necessarily translate topractice in numerous cases as has been observed on certainoccasions For instance despite the better awareness observedabout cervical cancer prevention in the Yemen study preven-tive practices were low with only 19 (7) of all those knowl-edgeable about cervical cancer reported having received


Table 3 Attitude to a cancer educational program

Variable Frequency ()Willingness to attend a cancer health educationprogram (119899 = 317)

Yes 268 (845)No 29 (91)Do not know 20 (63)

Reasons for willingness (119899 = 268)More knowledge 227 (847)Better support to partner 29 (108)Others 12 (45)

Reason(s) for unwillingness or uncertainty (119899 = 49)Embarrassing 4 (82)Women affair 21 (429)Do not know 24 (489)

Willingness to allow a male health worker toscreen wife (male respondents only) (119899 = 120)

Yes 94 (783)No 16 (133)Do not know 10 (83)

The majority of respondents (845) were willing to attend a cervical cancerhealth education program for the main reason of acquiring more knowledge(847) while 429 of those unwilling to attend felt it was a womenrsquos affairOver three-quarters (783) of the male respondents expressed willingnessto allow a male health worker screen their wives

cervical cytology testing (Pap smear test) [14] This is com-parable to findings in the present study where among therespondents who had heard of cervical cancer only 85 hadundergone a Pap smear test and 68 had received the HPVvaccine Some limiting factors may include cost availabilityof vaccines and screening services as well as accessibilityContrarily findings in developed countries such as UKshowed that 805 of women in a study in London hadundergone at least one Pap smear test with 715 reportingregular smear tests (every 3ndash5 years) [13]

Furthermore screening practices were reported to bepoor in a South African survey where in spite of good knowl-edge on cervical screening and readily accessible facilitieswith available screening services the majority of women(87) from higher social and educational backgrounds didnot undergo cervical screening [21] In Nnewi Nigeria itis interesting to observe that among female health careworkers who are expected to uptake innovative promotiveand preventive health practices only 5 had ever had a Papsmear done [22]

5 Conclusion

The findings in the present study indicate that althoughawareness of cervical cancer and its prevention appear poorthere was a willingness to learn about this preventable cancerby all respondents This can form the basis for improvingawareness of at-risk groups and other stakeholders including

the menfolk particularly in the light of the immense benefitof male involvement in reproductive health matters in LagosNigeria and Africa as a whole It is therefore very importantto develop ways of ensuring that the message about cervicalcancer and its prevention spreads to the grassroots acrossNigeria and sub-Saharan Africa to reduce the avoidablemorbidity andmortality In addition primary and secondaryprevention need to be emphasized in terms of health educa-tion HPV vaccination and cervical screening services whichshould also be made readily available and accessible in bothrural and urban areas

Appendix

A Cervical Cancer CommunityPerception and Preventive Practices in anUrban Neighborhood of Lagos (Nigeria)

Dear RespondentCervical cancer is a common female condition through-

out the world This questionnaire is aimed at assessing yourunderstanding and preventive practices regarding cervicalcancer Please be assured that all your responses will be keptstrictly confidential

This is an anonymous questionnaire which does notrequire your name or identity

Participation in this study is voluntary and a refusal toparticipate will not attract any sanctions

Please answer the entire questions to the best of yourability and as truthfully as possible

Your responses will assist the researchers in the preven-tion and control of this condition

A research assistant is available to help you in filling thequestionnaire◻ By checking this box I agree that I have read the above

and agree to participate in this studyThank you for participating

A1 Sociodemographic Details

(1) Age (in years)(2) Marital status

Single ◻Married ◻Divorced ◻Widowed ◻Separated ◻Others (please specify)

(3) Educational status

No formal ◻Primary ◻Secondary ◻Tertiary ◻


Table 4 Cervical cancer preventive practices

Variable Frequency ()Heard of ways to prevent cervical cancer (119899 = 317)

Yes 26 (82)No 172 (543)Do not know 119 (376)

Preventive measures known (multiple responses) (119899 = 26)Pap smear 17 (654)Vaccination 7 (269)HPV testing 2 (77)

Heard of HPV vaccine (119899 = 317)Yes 19 (60)No 196 (618)Do not know 102 (321)

Recipients for the vaccine (119899 = 317)10ndash25 yrs 8 (25)gt25 yrs 7 (22)Do not know 302 (953)

Consider vaccination of daughter with HPV vaccine (119899 = 317)Yes 199 (628)No 17 (54)Do not know 101 (318)

Amongst those aware of cervical cancer receiving HPV (119899 = 118)Yes 8 (68)No 110 (932)

If female received HPV vaccination (119899 = 197)Yes 8 (41)No 129 (655)Do not know 60 (304)

Amongst those aware of cervical cancer doing Pap smear (119899 = 118)Yes 10 (85)No 108 (915)

Had a Pap smear done before (119899 = 197)Yes 10 (51)No 127 (645)Do not know 60 (304)

Reasons for not having a Pap smear done (multiple responses) (119899 = 127)Not at risk 13 (102)Partner will not allow 2 (16)Never heard of it 94 (740)No time 4 (31)Afraid 1 (08)Not sexually active 1 (08)

About 82 of all respondents had heard of preventive methods for cervical cancer and among these about a quarter (269) were aware of vaccinations Sixpercent of all respondents had heard of the HPV vaccine while 25 identified the 10ndash25 year age group as the appropriate recipients for the vaccine Over halfof all respondents (628) would consider vaccination of their daughters with the HPV vaccine Among the female respondents 41 had received the HPVvaccine while 51 had had a Pap smear before In about three-quarters (740) of those who had never had Pap smears done this is because they had neverheard of it before


Table 5 Awareness of cervical cancer by gender and age

Heard of cervical cancer Test of sig 119875 valueYes No Total

GenderMalelt30 7 (292) 17 (708) 24 (100)

1205942

= 55 013830ndash49 20 (370) 34 (630) 54 (100)50ndash69 20 (571) 15 (429) 35 (100)70ndash89 2 (333) 4 (667) 6 (100)

Total 49 (412) 70 (588) 119 (100)Femalelt30 11 (200) 44 (800) 55 (100)

1205942


Total 67 (344) 128 (656) 195 (100)Totallt30 18 (228) 61 (772) 79 (100)

1205942


Total 116 (369) 198 (631) 314 (100)lowastlowastRespondents who did not disclose their ages (3)Awareness about cervical cancer was significantly higher with increasing age (119875 lt 005) in female and total population

Table 6 Willingness to attend a cervical cancer educational pro-gram by gender

Attend program TotalYes No Do not know

GenderMale 91 (758) 21 (175) 8 (67) 120 (100)Female 177 (898) 8 (41) 12 (61) 197 (100)

Total 268 (845) 29 (91) 20 (63) 317 (100)Pearson Chi-Square = 18105a Dof = 3 and 119875 value = 0000In comparison with the male respondents female respondents were signif-icantly more willing to attend a cervical cancer educational program (119875 lt005)

(4) Gender

Male ◻Female ◻

(5) Employment status

Student ◻Employed ◻Self-employed ◻Home maker ◻Retired ◻Applicant ◻

A2 Perception and Preventive Practices on Cervical Cancer

(6) Have you ever heard of cervical cancer

Yes ◻No ◻I do not know ◻If yes

(7) Cervical cancer is caused by

Human immunodeficiency virus (HIV) ◻Humanpapillomavirus (HPV) ◻Bacteria ◻Do not know ◻

(8)Where did you learn about cervical cancer (tick allthat apply)

TV ◻Radio ◻Magazine ◻News ◻Health talk ◻Others (pls specify)

(9) Do you know anyone with a history of cervicalcancer

Yes ◻


Table 7 Willingness to attend a cervical cancer educational program by educational status

Attend educational program Total Test of significance 119875 valueYes No Do not know

GenderMale

Educational statusNo formal 3 (600) 1 (200) 1 (200) 5 (100)

Fishers exact = 6056 0868Primary 21 (808) 4 (154) 1 (38) 26 (100)Secondary 46 (767) 10 (167) 4 (67) 60 (100)Tertiary 21 (750) 6 (214) 1 (36) 28 (100)

Total 91 (765) 21 (176) 7 (59) 119 (100)Female


Fishers exact = 8969 0312Primary 36 (900) 0 (00) 4 (100) 40 (100)Secondary 93 (912) 3 (29) 6 (59) 102 (100)Tertiary 27 (900) 2 (67) 1 (33) 30 (100)No resp 2 (100) 0 (00) 0 (00) 2 (100)

Total 177 (898) 8 (41) 12 (61) 197 (100)Total

No formal 22 (786) 4 (143) 2 (71) 28 (100)


Total 1268 (848) 29 (92) 19 (60) 316 (100)Educational status was not significantly associated with the willingness to attend a cervical cancer educational program (119875 gt 005)

Table 8 Permission for wife of male respondents to be screened by male health worker(s)

Permission to be screened Total Test of significance 119875 valueYes No Do not know

GenderMale

Age in four categories17ndash29 17 (708) 7 (292) 0 (00) 24 (100)

Fishers exact = 17460 006330ndash49 41 (804) 8 (157) 2 (39) 51 (100)50ndash69 30 (909) 0 (00) 3 (91) 33 (100)70ndash89 5 (833) 1 (167) 0 (00) 6 (100)

Total 93 (816) 16 (140) 5 (44) 114 (100)There was no statistically significant difference among the various age groups of male respondents with respect to permitting their wives to be screened by amale health worker

No ◻Dnt know ◻

(10) Do you think it is helpful to detect CervicalCancer early

Yes ◻No ◻Do not know ◻

(11) Has anyone ever recommended that you shouldget tested or screened for cervical cancer

Yes ◻No ◻I do not know ◻

(12) Will you be willing to attend a cancer healtheducation program on womenrsquos health

Yes ◻


No ◻I do not know ◻

(13) If yes why

More knowledge ◻Better support to partner ◻Others (Please specify)

(14) If No why

Embarrassing ◻Women affair ◻Do not know ◻

(15) If you are male would you allow your partner tobe screenedtested by a male health care provider


(16) Have you heard of ways to prevent cervicalcancer


(17) Which preventive measures do you know forcervical cancer (check all that apply)

Pap smear ◻Vaccination ◻HPV testing ◻Drugs ◻Others (please specify)

(18) Have you heard of the humanpapillomavirus(HPV) vaccine


(19) If yes who are those who should receive thisvaccine

lt10 years ◻10ndash25 years ◻gt25 years ◻

(20) If you have a daughter would you considervaccinating her with the HPV vaccine


(21) If you are female have you been vaccinated withthe HPV vaccine


(22) Have you had a Pap smear done before


(23) If no why

Not at risk ◻Cost ◻Partner will not allow ◻Never heard of it ◻No time ◻Afraid ◻Not sexually active ◻Poor health worker attitude ◻

Conflict of Interests

The authors declare that there is no conflict of interestsregarding the publication of this paper

References

[1] M S Mankin and C I Kamann Prevention and Treatmentof Cancer of the Cervix in Africa 1 Surgery in Africa-MonthlyReview 2010

[2] WHOICO Information Centre on HPV and Cervical CancerHuman Papillomavirus and Related Cancers in Nigeria Sum-mary Report 3rd edition 2010

[3] D M Parkin F Bray J Ferlay and P Pisani ldquoGlobal cancerstatistics 2002rdquo CA A Cancer Journal for Clinicians vol 55 no2 pp 74ndash108 2005

[4] R I Anorlu ldquoCervical cancer the sub-Saharan African per-spectiverdquo Reproductive Health Matters vol 16 no 32 pp 41ndash492008

[5] L R Airede J U E Onakewhor M E Aziken A B A Andeand J U Aligbe ldquoCarcinoma of the uterine cervix in Nigerianwomen the need to adopt aNational Prevention Strategyrdquo SahelMedical Journal vol 11 no 1 pp 1ndash11 2008

[6] E Hoque and M Hoque ldquoKnowledge of and attitude towardscervical cancer among female university students in SouthAfricardquo Southern African Journal of Epidemiology and Infectionvol 24 pp 21ndash24 2009

[7] B U Uzem ldquoAwareness and uptake of cervical cancer screeningin Owerri south-eastern Nigeriardquo Annals of African Medicinevol 6 no 3 pp 94ndash98 2007

[8] K S Louie S De Sanjose and P Mayaud ldquoEpidemiology andprevention of humanpapillomavirus and cervical cancer in sub-Saharan Africa a comprehensive reviewrdquoTropicalMedicine andInternational Health vol 14 no 10 pp 1287ndash1302 2009


[9] D M McFarland ldquoCervical cancer and Pap smear screening inBotswana knowledge and perceptionsrdquo International NursingReview vol 50 no 3 pp 167ndash175 2003

[10] A S Mohammed B Odugbemi A Adebayo and O OOdusanya ldquoHelmet use by motorcyclists in urban Lagos fol-lowing enforcement of motorcycle helmet legislationrdquo Journalof Community Medicine and Primary Health Care vol 21 no 1pp 21ndash27 2009

[11] O O Oladapo E A Oni A A Olawoyin O O Akerele and SA Tijani ldquoAssessment of natural radionuclides level in waste-land soils around Olusosun Dumpsite Lagos Nigeriardquo IOSRJournal of Applied Physics vol 2 no 3 pp 38ndash43 2012

[12] T Ibrahim Research Methodology and Dissertation Writing forHealth and Allied Health Professionals Cress Global LinkAbuja Nigeria 2009

[13] C K H Yu and J Rymer ldquoWomenrsquos attitudes to and awarenessof smear testing and cervical cancerrdquo Journal of Family Planningand Reproductive Health Care vol 23 no 4 pp 127ndash133 1998

[14] M Abdul-Aziz ldquoKnowledge attitude and practice towards cer-vical cancer among reproductive health clients at the Universityof Science amp Technology Hospital-Sanarsquoa in Yemenrdquo YemeniJournal for Medical Sciences vol 6 pp 21ndash27 2012

[15] P Gichangi B Estambale J Bwayo et al ldquoKnowledge and prac-tice about cervical cancer and Pap smear testing among patientsat Kenyatta National Hospital Nairobi Kenyardquo InternationalJournal of Gynecological Cancer vol 13 no 6 pp 827ndash833 2003

[16] P-M Tebeu A L Major E Rapiti et al ldquoThe attitude andknowledge of cervical cancer by Cameroonian women a clin-ical survey conducted in Maroua the capital of Far NorthProvince of Cameroonrdquo International Journal of GynecologicalCancer vol 18 no 4 pp 761ndash765 2008

[17] A M Amosu A M Degun A O Babalola andM AThomasldquoLevel of specific knowledge awareness perception andscreening behavior regarding carcinoma of the cervix amongruralwomen in Iwo local government areaOsun StateNigeriardquoAnnals of Biological Research vol 2 no 2 pp 206ndash221 2011

[18] L P Wong Y L Wong W Y Low E M Khoo and R ShuibldquoKnowledge and awareness of cervical cancer and screeningamong Malaysian women who have never had a Pap smear AQualitative Studyrdquo Singapore Medical Journal vol 50 no 1 pp49ndash53 2009

[19] P N Abotchie and N K Shokar ldquoCervical cancer screeningamong college students inGhana knowledge and health beliefsrdquoInternational Journal of Gynecological Cancer vol 19 no 3 pp412ndash416 2009

[20] K O Wright B Faseru Y A Kuyinu and F A FaduyileldquoAwareness and uptake of the pap smear among market womeninLagosNigeriardquo Journal of PublicHeath inAfrica vol 2 articlee14 2011

[21] N Wellensiek M Moodley J Moodley and N NkwanyanaldquoKnowledge of cervical cancer screening and use of cervicalscreening facilities among women from various socioeconomicbackgrounds in Durban Kwazulu Natal South africardquo Interna-tional Journal of Gynecological Cancer vol 12 no 4 pp 376ndash382 2002

[22] G O Udigwe ldquoKnowledge attitude and practice of cervicalcancer screening (pap smear) among female nurses in NnewiSouth EasternNigeriardquoNigerian Journal of Clinical Practice vol9 no 1 pp 40ndash43 2006

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Volume 2014Hindawi Publishing Corporationhttpwwwhindawicom


levels of awareness and poor knowledge of cervical cancercoupled with unavailability and inaccessibility of cervicalcancer screening services are responsible for the very smallnumber of women being screened in developing countries[9]

Lagos State has two tertiary and about 22 governmentowned secondary health care facilities where follow-up andtreatment may be accessed for cases of positive Pap smearresultsThis survey was undertaken to assess community per-ception and preventive practices on cervical cancer amongstresidents of an urban neighborhood of Lagos Nigeria

2 Materials and Methods

21 Location of the Study Lagos State is located in southwest-ernNigeria and lies on longitude 3∘ 241015840 E and latitude 6∘ 271015840NLagos State has an estimated population of 15 million people[10] It is made up of 20 local government areas and 37 localcouncil development areas (LCDA) Olusosun is located inOnigbongbo LCDA of Lagos and is an area known widely onaccount of the presence of the largest landfill in Lagos State[11] The area is presently a commercial and residential area

22 Study Design A descriptive cross-sectional study designwas used and the study population was selected among theresidents of Olusosun area

23 Sample Size Determination Sample size was establishedsuch that an accuracy of 5 could be reached around anobserved probability of 25

The required sample sizewas calculated using the formula1198852

1199011199021198892 [12]

Therefore minimum sample size calculated was 288 Anonresponse rate of 10 (+29) was anticipated therefore atotal sample size of 317 was obtained

24 SamplingMethod Amedical outreach (consisting of freemedical consultation and basic services) was conducted inJune 2013 at Olusosun community by resident doctors under-going medical specialist (postgraduate) training at a tertiaryhealth institution in Lagos as part of the activities forthe annual general week of the resident doctors involvingelections medical mission and other programs Residents ofthe community had been sensitized about the program priorto the Outreach to promote community participation in theevent Consecutive recruitment was done for consenting res-idents until the sample size was obtained The inclusion cri-terion is the condition that the respondents must be 18 yearsof age or above

25 Survey Instruments A structured interviewer-adminis-tered questionnaire developed by the researchers (based onliterature search) was used for data collection This instru-ment was pretested in a different community close to thetertiary health institution to exclude ambiguities and admin-istered by research assistants who had a day training to ensurelexical coherence as well as efficient and effective discharge ofduties

The questionnaire sought information on sociodemo-graphic details perception and preventive practices on cer-vical cancer

26 Data Analysis Analysis was done using Statistical Pack-age for social sciences (SPSS) version 19 Tests of significancewere performedusing a 95 confidence interval and the levelof significance was set at 119875 lt 005 Bivariate analysis wasdone to determine associations between variables Outcomemeasures include perception of cervical cancer knowledge ofpreventive practices and proportion of respondents who hadengaged in preventive practices

Ethical clearance was obtained from the research andethics committee and informed consent was obtained fromeach participant at the point of data collection

27 Study Limitation Lagos State is divided into 20 localgovernment areas (LGAs) with a breakdown of 16 urban and4 rural LGAs The study was conducted in one of the LGAsThe findings might not be representative of the entire state(rural and urban combined) but it is fairly representative ofthe urban communities of Lagos

3 Results

See Tables 1 2 3 4 5 6 7 and 8

4 Discussion

The results from this study show that just over a third ofrespondents (372) had heard about cervical cancer withtelevision (39) being the commonest source of the infor-mationThis is quite low when compared to a cross-sectionalsurvey of 650 women conducted in London which showedthat 762 of the participants perceived cervical cancer to bea common disease and were also aware of the risk factors forthe disease [13] Similarly a Yemeni study revealed that mostrespondents (806) had heard about cervical cancer with aquarter of the respondents (264) accessing this informationfrom television [14] In Africa a study in Kenya to assessknowledge and practices about cervical cancer and Pap smeartesting among cervical cancer and noncancer patients foundthat 51 of the respondents were aware of cervical cancerwhich is also higher than that obtained in the present study[15]

Sub-Saharan Africa which appears to be one of the mostaffected regions also has the lowest awareness rates about cer-vical cancer as even lower rates were reported in Cameroonwhere a study to assess the knowledge of cervical cancershowed that only 28 had prior knowledge of cervical cancerand another study in Ibadan among women aged 20 to 65years attending the general outpatient unit of a departmentin a tertiary hospital found that only 15 of the respondentshad heard of cervical cancer [4 16] Among rural women in astudy conducted in Osun State of Nigeria about 392 of thewomen had heard about cervical cancer which is also verysimilar to the findings in the present study [17]














Yes 118 (372)No 199 (628)












Yes 268 (845)No 29 (91)Do not know 20 (63)




Yes 94 (783)No 16 (133)Do not know 10 (83)




5 Conclusion



Appendix


















Yes 26 (82)No 172 (543)Do not know 119 (376)














GenderMalelt30 7 (292) 17 (708) 24 (100)

1205942


Total 49 (412) 70 (588) 119 (100)Femalelt30 11 (200) 44 (800) 55 (100)

1205942


Total 67 (344) 128 (656) 195 (100)Totallt30 18 (228) 61 (772) 79 (100)

1205942







(4) Gender

Male ◻Female ◻











Yes ◻




GenderMale



Total 91 (765) 21 (176) 7 (59) 119 (100)Female



Total 177 (898) 8 (41) 12 (61) 197 (100)Total

No formal 22 (786) 4 (143) 2 (71) 28 (100)





GenderMale




No ◻Dnt know ◻






Yes ◻



(13) If yes why


(14) If No why


















(23) If no why




References





























of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of





























Yes 118 (372)No 199 (628)












Yes 268 (845)No 29 (91)Do not know 20 (63)




Yes 94 (783)No 16 (133)Do not know 10 (83)




5 Conclusion



Appendix


















Yes 26 (82)No 172 (543)Do not know 119 (376)














GenderMalelt30 7 (292) 17 (708) 24 (100)

1205942


Total 49 (412) 70 (588) 119 (100)Femalelt30 11 (200) 44 (800) 55 (100)

1205942


Total 67 (344) 128 (656) 195 (100)Totallt30 18 (228) 61 (772) 79 (100)

1205942







(4) Gender

Male ◻Female ◻











Yes ◻




GenderMale



Total 91 (765) 21 (176) 7 (59) 119 (100)Female



Total 177 (898) 8 (41) 12 (61) 197 (100)Total

No formal 22 (786) 4 (143) 2 (71) 28 (100)





GenderMale




No ◻Dnt know ◻






Yes ◻



(13) If yes why


(14) If No why


















(23) If no why




References





























of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of



















Yes 268 (845)No 29 (91)Do not know 20 (63)




Yes 94 (783)No 16 (133)Do not know 10 (83)




5 Conclusion



Appendix


















Yes 26 (82)No 172 (543)Do not know 119 (376)














GenderMalelt30 7 (292) 17 (708) 24 (100)

1205942


Total 49 (412) 70 (588) 119 (100)Femalelt30 11 (200) 44 (800) 55 (100)

1205942


Total 67 (344) 128 (656) 195 (100)Totallt30 18 (228) 61 (772) 79 (100)

1205942







(4) Gender

Male ◻Female ◻











Yes ◻




GenderMale



Total 91 (765) 21 (176) 7 (59) 119 (100)Female



Total 177 (898) 8 (41) 12 (61) 197 (100)Total

No formal 22 (786) 4 (143) 2 (71) 28 (100)





GenderMale




No ◻Dnt know ◻






Yes ◻



(13) If yes why


(14) If No why


















(23) If no why




References





























of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of



















Yes 26 (82)No 172 (543)Do not know 119 (376)














GenderMalelt30 7 (292) 17 (708) 24 (100)

1205942


Total 49 (412) 70 (588) 119 (100)Femalelt30 11 (200) 44 (800) 55 (100)

1205942


Total 67 (344) 128 (656) 195 (100)Totallt30 18 (228) 61 (772) 79 (100)

1205942







(4) Gender

Male ◻Female ◻











Yes ◻




GenderMale



Total 91 (765) 21 (176) 7 (59) 119 (100)Female



Total 177 (898) 8 (41) 12 (61) 197 (100)Total

No formal 22 (786) 4 (143) 2 (71) 28 (100)





GenderMale




No ◻Dnt know ◻






Yes ◻



(13) If yes why


(14) If No why


















(23) If no why




References





























of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of



















GenderMalelt30 7 (292) 17 (708) 24 (100)

1205942


Total 49 (412) 70 (588) 119 (100)Femalelt30 11 (200) 44 (800) 55 (100)

1205942


Total 67 (344) 128 (656) 195 (100)Totallt30 18 (228) 61 (772) 79 (100)

1205942







(4) Gender

Male ◻Female ◻











Yes ◻




GenderMale



Total 91 (765) 21 (176) 7 (59) 119 (100)Female



Total 177 (898) 8 (41) 12 (61) 197 (100)Total

No formal 22 (786) 4 (143) 2 (71) 28 (100)





GenderMale




No ◻Dnt know ◻






Yes ◻



(13) If yes why


(14) If No why


















(23) If no why




References





























of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of



















GenderMale



Total 91 (765) 21 (176) 7 (59) 119 (100)Female



Total 177 (898) 8 (41) 12 (61) 197 (100)Total

No formal 22 (786) 4 (143) 2 (71) 28 (100)





GenderMale




No ◻Dnt know ◻






Yes ◻



(13) If yes why


(14) If No why


















(23) If no why




References





























of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of


















(13) If yes why


(14) If No why


















(23) If no why




References





























of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of




































of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of
















research article cervical cancer: community perception and...

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