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Proposal on Knowledge and Acceptability of Cervical Cancer Screening Among Female Students of Federal Polytechnic Ado

LITERATURE REVIEW

Conceptual Framework

The concept of screening cervical cancer

Cervical cancer screening is a way of preventing cancer by finding and treating early changes in the neck of the womb (cervix) (Bosch et al, 2002). These changes could lead to cancer if left untreated. The screening uses a test called cytology, which many people know as the Pap smear test (Gustafsson et al 2007). A Pap test is a procedure to collect cells from the surface of the cervix and vagina. A piece of cotton, a brush, or a small wooden stick is used to gently scrape cells from the cervix and vagina. The cells are viewed under a microscope to find out if they are abnormal (National Cancer Institute, 2015).There are several methods available for detection of several forms of pre cancers and these include direct visual inspection of the cervix aided by chemicals like 5 percent acetic acid and iodine (visual inspection with acetic acid [VIA] and visual inspection with Lugol‘s iodine [VILI]), which cause recognizable color changes (Bosch et al., 2002; Smeltzer& Bare, 2004).

A new method of collecting and viewing cells has been developed, in which the cells are placed into a liquid before being placed on a slide. In some cases, samples are also tested for a virus called human papilloma virus (HPV) that increases the risk of cervical cancer. A nurse or doctor takes a sample of cells from the cervix with a small brush. Testing cervical specimens for DNA of oncogenic (high-risk) types of human papillomavirus (HPV), the causal agents of cervical cancer, has entered clinical practice, but this test is used mainly to triage for colposcopy those women with Pap smears labeled as ―at ypical  squamous  cells  of  undetermined  significance‖  They  send  the  sample  to  a  laboratory  to  be checked for abnormalities (Marie-Helene et al, 2007).

 

Accessibility to health facilities and acceptability of cervical cancer screening

In Nigeria, Cervical cancer screening occurs, but only in a few selected sites and in disjointed projects rather than a full-fledged national-level program. This explains why screening coverage is still negligible. Furthermore, there is lack of additional diagnostic and treatment options at the secondary levels of care. Additionally, the link between screening and treatment has been dysfunctional (NCCPP, 2006). The main challenges to increasing access to cervical cancer screening services include inadequate equipment and supplies; lack of treatment facilities when there is pre-cancer or cancer diagnosis; inadequate monitoring and evaluation – especially data collection and management. The HPV vaccine that could be used in primary prevention is also not provided as part of the national vaccine and immunization program (Morema et al, 2014).

National Reproductive Health policy (2006) recommends that, the government to avail cervical cancer screening services at the primary health care level where the majority (80%) live. This primary health care to include: district hospitals, health centers, dispensaries and faith based facilities also to provide the services. Inadequate equipment and supplies (despite the fact that these are inexpensive for visual screening methods), the government should provide in all the institutions to increase the screening of cervical cancer. Were (2011) argues that Strengthen referral system for cervical cancer program (linkages); Improve facility and community Health information system (general records and referral forms); Improve/strengthen communication system between the different levels; Establish a referral directory will enable access to acceptability of screening cervical cancer.

According to Nyaberi (2007), Availability of trained health personnel at all levels to provide cervical cancer screening and treatment services; Provision of facilitative supervision, refresher training and on job certification by the Reproductive Health Training and Supervisory Teams to enable them to maintain or enhance their skills. Retain and schedule trained staff to ensure service availability will enhance the acceptability of screening cervical cancer. The is need to strengthen patient advocacy in international settings to build a global grassroots movement [that portrays] accurate perceptions of cancer; prevent stigma from inhibiting people in their cancer control efforts; help people affected by cancer receive the support, services, and information they need, all of which will help in decreasing the global cancer burden, (Ngau, 2014). A call/recall system based on personal invitations is considered to be a key element of an organized programme in Europe. For this purpose, an accurate list of the target population with names and addresses is needed. Sources of such lists vary between countries and include population registries, health service registers, general practitioners‘ (GPs) medical files, electoral registers and others.

 

Knowledge and acceptability of cervical cancer screening

Several qualitative studies have revealed that, women‘s perceptions and limited knowledge about the importance of cervical screening influence acceptability of cervical cancer screening (Fylan, 1998; Neilson, 1998; Nicky et al., 2005; Merchant, 2007). Women do not have a clear understanding of the interpretation of the screening outcome results. Many believe that an abnormal screening result means that a woman already has cancer, so they have fear and distress in case they screen and end up with an abnormal result. These studies also showed that, cultural norms of secrecy that bar women from discussing issues of reproductive health has made women not gain knowledge about the importance of cervical cancer screening (Nakalevu, 2009).

The main challenges to increasing access to and improving the quality of cervical cancer screening services include: lack of updated National guidelines on cervical cancer prevention and control, low level of community awareness on the importance of screening coupled with low knowledge of common symptoms of cervical cancer and inadequate skills among service providers (NCCP, 2012). Reasons for women not screening include perception of not being at risk and fear that abnormal test results mean existing cancer. Women with low educational achievement, low awareness of the risk factors for cervical cancer, and who do not have support from their husbands may also have poor acceptability of screening services (Were et al, 2011).

Cervical cancer is yet to be recognized as an important public health problem in sub-Saharan Africa. Several studies have shown poor knowledge of the disease in Africa, which even cuts across different literally levels (Wellensiek et al, 2002). Among 500 attendees of maternal and child health clinic in Logos Nigeria only 4.3% were found to be aware of screening cervical cancer, (Anorlu et al, 2000). Similar studies in Nigeria and Tanzania also reported very poor knowledge of the disease in patients (Anya et al, 2005). Lack of knowledge about screening of cervical cancer in the population and among health care workers is a prime for access to cervical cancer prevention (Tebua and Major, 2008). Other reports from the region show that women with HIV develop cervical cancer at an earlier age than women who are HIV negative (Gichangi et al, 2003).

An assessment of women‘s knowledge of cervical screening showed 92% of those dying from this form of cancer have never been tested (Neilson and Jones, 1998). It has been noted also that some women lack the knowledge about Pap smear and its indications. Many women do not have a clear understanding of the meaning of an abnormal smear or the concept of pre-cancerous changes and many believe that the purpose of Pap smear test is to detect cancer (Fylan, 2008). It has been seen that 10% of women in Queensland and 13% in victoria with cervical cancer had a previous abnormality which was not treated. Women need full information about treatment if they are to be fully protected.

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