Cervical cancer screening and HPV vaccine acceptability among rural and urban women in Kilimanjaro Region, Tanzania

Towards 90-70-90 targets: Individual and community level factors associated with cervical cancer screening among women of reproductive age in Tanzania: A multi-level analysis based on 2022 Tanzania demographic and health survey

INTRODUCTION

Cervical cancer is a major public health problem worldwide, and is mainly caused by human papillomaviruses. More than 90% of cervical cancer cases can be prevented by using a human papilloma vaccine and screening. Despite the ongoing global cervical cancer screening target, uptake remains unacceptably low in sub-Saharan Africa such as Tanzania. Although cervical cancer is the leading cause of mortality in Tanzania, evidence on the individual- and community-level factors associated with cervical cancer screening among women of reproductive age is scarce. Therefore, this study aimed to determine the individual- and community-level factors associated with cervical cancer screening among women of reproductive age in Tanzania.

METHODS

This study used data from the 2022 Tanzania Demographic and Health Survey (TDHS). A weighted sample of 15,140 women of reproductive age was included in this study. Given the effect of clustering and binary nature of the outcome variable, we used a multilevel binary logistic regression model. The adjusted odds ratio (AOR) with 95% Confidence Interval (CI) was statistically significant. Moreover, the model with the lowest deviance best suited the data.

RESULTS

The overall uptake of cervical cancer screening among Tanzanian women was 7.28% (95% confidence interval [CI]: 6.87%, 7.70%). Women's age (25-34, 35-49), women with primary, secondary, and higher educational levels, being employed, a high household wealth index, visiting health facilities in the last 12 months, owning mobile phones, urban residence, and southern highlands, Southern, and Zanzibar administrative zones, were significantly associated with cervical cancer screening.

CONCLUSION

Cervical cancer screening among women in Tanzania was low. Low uptake underscores the need for increased focus on addressing the coverage of the 2030 Sustainable Development Goals (SDGs). The study would help policymakers create programs that consider education, employment, visiting health facilities, mobile phones, wealth, residence, and administrative zones, which would make women undergo cervical cancer screening. Pointing to women living with low cervical cancer screening could help increase their uptake and achieve the targets of the national and World Health Organization.

Willingness of caregivers to have their daughters vaccinated against human papilloma virus and associated factors in Jimma Town, Southwest Ethiopia

Introduction

Human Papillomavirus (HPV) is a widespread sexually transmitted infection and a leading cause of cervical cancer. Although there is a significant HPV prevalence in Ethiopia, yet the uptake of the HPV vaccine remains low. This study aimed to assess the level of caregivers' willingness to vaccinate their daughters against the human papilloma virus and associated factors in Jimma town.

Methods

A community-based cross-sectional study was conducted from June 1-30, 2023. A total of 471 study participants were selected using multi-stage sampling techniques. Data was collected using an interviewer-administered questionnaire. Binary and multiple logistic regression analyses were done to identify associated factors, and the adjusted odds ratio and 95% confidence interval were computed. A value p of <0.05 was used to determine statistical significance.

Results

About 82.4% (95% CI: 79.0-86.0) of caregivers indicated a willingness to have their daughters vaccinated. Having college education or above (AOR:3.31, 95%CI:1.02-10.8), good knowledge of the HPV vaccine (AOR:2.25, 95%CI:1.05-4.85), good knowledge of sexually transmitted infections (STIs) (AOR:2.04, 95%CI: 1.09-3.82), good knowledge of cervical cancer (AOR:2.50, 95%CI:1.31-4.77) and a positive attitude towards the vaccine (AOR:4.03, 95%CI: 2.26-7.22), were associated with willingness.

Discussion

The majority of caregivers were willing to vaccinate their daughters against HPV. Caregivers who had higher education, good knowledge about the HPV vaccine, cervical cancer, and STIs, as well as positive attitudes towards the vaccine, were more likely to be willing to vaccinate. Efforts should be made to educate caregivers about the vaccine, cervical cancer, and STIs while promoting positive attitudes.

Socioeconomic inequality in cervical cancer screening uptake among women in sub-Saharan Africa: a decomposition analysis of Demographic and Health Survey data

OBJECTIVE

To examine socioeconomic inequalities in the use of cervical cancer screening among women in sub-Saharan Africa.

DESIGN

Secondary data from the Demographic and Health Survey data in sub-Saharan Africa.

SETTING

Sub-Saharan Africa.

PARTICIPANTS

Women aged 15-64 years.

OUTCOME MEASURES

Socioeconomic inequalities in cervical cancer screening uptake and the pooled prevalence of cervical cancer screening.

RESULTS

The pooled prevalence of cervical cancer screening among women in sub-Saharan African countries was 10.51% (95% CI: 7.54% to 13.48%). Cervical cancer screening uptake showed a significant pro-rich distribution of wealth-related inequalities, with a weighted Erreygers normalised concentration index of 0.084 and an SE of 0.003 (p value <0.0001). This finding suggests that disparities in cervical cancer screening uptake among women are related to wealth. Decomposition analysis revealed that the wealth index, educational status, place of residence and media exposure were the most important factors contributing to this pro-rich socioeconomic inequality in cervical cancer screening.

CONCLUSION

This study emphasises the importance of addressing modifiable factors such as improving educational opportunities, increasing media exposure accessibility in households and improving the country's economy to reduce wealth disparities and improve cervical cancer screening uptake among women.

Preparing patient navigators and assessing the impact of patient navigation in promoting cervical cancer screening uptake, knowledge, awareness, intention, and health beliefs: a protocol for a randomized controlled trial

Aim

There are limited studies in Tanzania concerning the modality of preparing patient navigators and the influence of patient navigation strategies on cervical cancer screening. This protocol describes the preparation of patient navigators and assesses the impact of a patient navigation strategy on promoting cervical cancer screening uptake, knowledge, awareness, intention, and health beliefs.

Design

This is a protocol for a community-based randomized controlled trial.

Methods

The method is categorized into two phases. (1) Preparing patient navigators, which will involve the training of five patient navigators guided by a validated training manual. The training will be conducted over three consecutive days, covering the basic concepts of cervical cancer screening and guiding navigators on how to implement a patient navigation strategy in the communities. (2) Delivering a patient navigation intervention to community women (COMW) which will involve health education, screening appointments, navigation services, and counseling. The study will recruit 202 COMW who will be randomized 1:1 by computer-based blocks to either the patient navigation intervention group or the control group.

Public contribution

The study will prove that the trained patient navigators are easily accessible and offer timely and culturally acceptable services to promote cervical cancer screening uptake in communities.

Knowledge and awareness of cervical cancer and human papillomavirus vaccination among female university students

BACKGROUND

Prevention strategies for reducing cervical cancer incidence rely on informed populations, particularly those most at risk. This study assesses the knowledge and awareness of female university students towards cervical cancer, human papillomavirus (HPV) and its vaccination.

METHODS

A validated self-administered questionnaire was used in a descriptive cross-sectional study among female university students. The data were analysed with Statistical Package for Social Sciences version 26, and p  0.05 was considered significant.

RESULTS

The total participants were 190 with a mean age of 22.6 ± 4.35 years. The majority (90%) were aware of cervical cancer, and 78.9% agreed it is a terminal illness, but fewer participants knew it was associated with infection (63.7%), and that it had effective risk-reducing methods (70.5%). Only 32.6% were aware of the Pap smear test, less than half (43.2%) were aware of the cervical cancer vaccine and only 43.7% knew it was available locally. Although fewer (39.5%) considered themselves susceptible to cervical cancer, many (62.1%) would like a Pap smear test. Overall, 88.9% of the participants possessed adequate knowledge of cervical cancer, 67.9% of the HPV vaccine and only 33.7% of HPV. Ethnicity (p = 0.03), year of study (p = 0.001) and institution (p = 0.002) were all significantly associated with knowledge levels, vaccine awareness and Pap smear test awareness.

CONCLUSION

Participants showed low HPV knowledge and varying awareness levels regarding cervical cancer, HPV and HPV vaccine.Contribution: This study provides insights into female university students' knowledge and awareness gaps, highlighting the need for targeted interventions.

Parental willingness to vaccinate their daughters against human papilloma virus and its associated factors in Woldia town, Northeast Ethiopia

Background

The cells of the cervical epithelial wall are the source of the malignant tumor caused by the human papilloma virus (HPV) known as cervical cancer. In 2018, Ethiopia implemented the HPV vaccine specifically targeting girls aged 9-14 years. This vaccination initiative serves as an effective preventive measure against cervical cancer, provided that parents express a positive inclination to have their daughters vaccinated as part of the program.

Objective

The aim of the study was to assess parental willingness to vaccinate their daughters against human papillomavirus and its associated factors in Woldia town, Northeast Ethiopia.

Methods

A community-based cross-sectional study was conducted among 414 parents of daughters aged 9-14 years between 10 and 25 January 2023. Respondents were selected by a systematic sampling method and a face-to-face interview was conducted to collect data. Data were entered into Epi Data version 4.6 and exported to SPSS version 25 for analysis. Multivariable analyses were used to examine the association between dependent and independent variables. The adjusted odds ratio (AOR), 95% confidence interval (CI), and p-value <0.05 were used to determine statistical significance.

Results

A total of 410 study participants with a response rate of 99% were included in the study, and approximately 72.9% (95% CI: 68.3-77.2) of them were willing to vaccinate their daughters. This study found that parents with a family history of cervical cancer screening (AOR = 3.27, 95%; CI = 1.38-7.74), secondary and above educational status (AOR = 2.72, 95% CI = 1.29-5.73), good knowledge of the human papilloma virus vaccination (AOR = 3.00, 95% CI = 1.70-5.28), and favorable attitude toward the human papilloma virus vaccine (AOR = 4.40, 95% CI = 2.45-7.88) were significantly associated with parental willingness to vaccinate their daughters against human papilloma virus.

Recommendation

In this study, most parents were willing to vaccinate their daughters against human papilloma virus. The significant determinants of parental willingness to their daughter's human papilloma virus vaccination were family history of cervical cancer screening, level of education, and knowledge and attitude toward the human papilloma virus vaccine. Therefore, health information regarding the human papillomavirus vaccination with an emphasis on raising community awareness should be designed.

An Implementation Evaluation of the Smartphone-Enhanced Visual Inspection with Acetic Acid (SEVIA) Program for Cervical Cancer Prevention in Urban and Rural Tanzania

INTRODUCTION

The World Health Organization (WHO) recommends visual inspection with acetic acid (VIA) for cervical cancer screening (CCS) in lower-resource settings; however, quality varies widely, and it is difficult to maintain a well-trained cadre of providers. The Smartphone-Enhanced Visual Inspection with Acetic acid (SEVIA) program was designed to offer secure sharing of cervical images and real-time supportive supervision to health care workers, in order to improve the quality and accuracy of visual assessment of the cervix for treatment. The purpose of this evaluation was to document early learnings from patients, providers, and higher-level program stakeholders, on barriers and enablers to program implementation.

METHODS

From 9 September to 8 December 2016, observational activities and open-ended interviews were conducted with image reviewers (n = 5), providers (n = 17), community mobilizers (n = 14), patients (n = 21), supervisors (n = 4) and implementation partners (n = 5) involved with SEVIA. Sixty-six interviews were conducted at 14 facilities, in all five of the program regions Results SEVIA was found to be a highly regarded tool for the enhancement of CCS services in Northern Tanzania. Acceptability, adoption, appropriateness, feasibility, and coverage of the intervention were highly recognized. It appeared to be an effective means of improving good clinical practice among providers and fit seamlessly into existing roles and processes. Barriers to implementation included network connectivity issues, and community misconceptions and the adoption of CCS more generally.

CONCLUSIONS

SEVIA is a practical and feasible mobile health intervention and tool that is easily integrated into the National CCS program to enhance the quality of care.

The Role of Health Information Sources on Cervical Cancer Literacy, Knowledge, Attitudes and Screening Practices in Sub-Saharan African Women: A Systematic Review

Cervical cancer is the leading cause of cancer deaths among Sub-Saharan African women. This systematic review aimed to identify information sources and their relation to cervical cancer knowledge, literacy, screening, and attitudes. Peer-reviewed literature was searched on 2 March 2022, and updated on 24 January 2023, in four databases-CINAHL Plus, Embase, PubMed, and Web of Science. Eligible studies included those that were empirical, published after 2002, included rural women, and reported on information sources and preferences. The quality of the selected articles was assessed using the Mixed Methods Appraisal Tool. Data extraction was conducted on an Excel spreadsheet, and a narrative synthesis was used to summarize findings from 33 studies. Healthcare workers were the most cited information sources, followed by mass media, social networks, print media, churches, community leaders, the Internet, and teachers. Community leaders were preferred, while healthcare workers were the most credible sources among rural women. There was generally low cervical cancer knowledge, literacy, and screening uptake, yet high prevalence of negative attitudes toward cervical cancer and its screening; these outcomes were worse in rural areas. A content analysis revealed a positive association of health information sources with cervical cancer literacy, knowledge, screening, and positive screening attitudes. Disparities in cervical cancer prevention exist between rural and urban Sub-Saharan African women.

Cervical cancer screening among women with comorbidities: evidence from the 2022 Tanzania demographic and health survey

BACKGROUND

The aim of this study is to examine cervical cancer screening (CCS) uptake among women living with hypertension and HIV in Tanzania.

METHODS

We used the recently released 2022 Tanzania Demographic and Health Survey. The outcome variable assessed in the study was CCS, whereas chronic morbidities constituted the main explanatory variable. Data analysis was based on observations from 6,298 women aged 30-49 years. Multivariable logistic regression models were used to determine the association between hypertension and HIV status, and CCS uptake. The analyses were computed in STATA 18.

RESULTS

Out of the 6,298 respondents, only 805 (12.8%) had undergone CCS with higher screening uptake among those living with either one of the disease (28.5%) than among those living with neither hypertension or HIV. The highest proportion was found among those who had ever been diagnosed with hypertension (24.1%) and among women with positive HIV test results (36.7%). There was a significantly higher likelihood of undergoing screening for cervical cancer among women living with at least one of the diseases [AOR = 2.4; 95% CI: 1.4-2.8], compared to those without these conditions. Women diagnosed with hypertension showed increased likelihood of undergoing CCS [AOR = 1.4; 95%CI: 1.1-1.7]. Similarly, women with a positive HIV test result demonstrated higher odds of screening uptake [AOR = 5.2; 95%CI: 4.0-6.7].

CONCLUSION

The study found a positive association between comorbidities and CCS uptake in Tanzanian women. Our findings emphasize the critical importance of ensuring accessibility and adherence to essential screenings for individuals with chronic morbid conditions. Future efforts should focus on strengthening existing integrated services and identifying potential barriers to accessing CCS within these healthcare settings to optimize cervical cancer prevention efforts for individuals with chronic morbidities.

Cervical cancer screening knowledge and associated factors among Eswatini women: A cross-sectional study

BACKGROUND

Over recent years, cervical cancer incidence and related mortality have steadily increased in Eswatini. Low cervical cancer screening uptake partly explains the situation. Cervical cancer screening-related knowledge is positively associated with screening uptake. Little is known about women's cervical cancer screening-related knowledge in Eswatini.

OBJECTIVE

This study aimed to assess cervical cancer screening knowledge and associated factors among Eswatini women eligible for screening.

METHODS

A cross-sectional study involving three hundred and seventy-seven women aged 25 to 59 selected from four primary healthcare clinics in Eswatini was conducted. A paper and pen survey assessed knowledge about cervical cancer risk factors, benefits of screening, the meaning of screening results, recommended screening intervals, and socio-demographics. Descriptive analyses were performed to assess participants' sociodemographic characteristics. Linear regression was applied to examine associations between cervical cancer screening-related knowledge and participants' sociodemographic characteristics.

RESULTS

Two hundred and twenty-nine (61%) participants answered 80% or more knowledge questions correctly. Compared to HIV-positive participants, HIV-negative participants had 0.61 times lower cervical cancer screening knowledge scores (β = -0.39, 95% CI: -0.56, -0.19, p = 0.03). Participants who travelled more than 30 minutes to the clinic had 0.3 times lower cervical cancer screening knowledge scores (β = -0.70, 95% CI: -1.15, -0.25, p < 0.01) compared to participants who travelled less than 30 minutes to the clinic.

CONCLUSIONS

Relatively high overall cervical cancer screening knowledge levels were observed among the study participants. Findings from the current study may inform future educational programs to create and sustain an accurate understanding of cervical cancer screening in Eswatini communities.

Early age at menarche and history of sexually transmitted infections significantly predict cervical cancer screening uptake among women aged 25-49 years: evidence from the 2021 Côte d'Ivoire demographic and health survey

INTRODUCTION

Cervical cancer is the second dominant type of cancer among Ivorian women with an estimated age-standardised incidence and mortality rate of 31.2 cases and 22.8 deaths per 100,000 women in 2020, respectively. The Ivorian government through its Ministry of Health implemented the National Cancer Control Programme (NCCP) in 2003 with the aim of improving the prevention, early detection and treatment of cancers in Côte d'Ivoire. Yet, there is a low uptake of CCS (1.2%). Thus, making CCS uptake an important public health concern in the country. Understanding of the extent to which reproductive factors predict CCS uptake is limited in literature. This study aimed to investigate reproductive factors as a predictor of women's uptake of CCS in Côte d'Ivoire.

METHODS

Data from the 2021 Côte d'Ivoire Demographic and Health Survey. A sample of 9,078 women aged 25-49 years were analyzed. The outcome variable was CCS uptake while other variables considered included age at menarche, history of STI, sexual debut, parity, age, educational level, wealth index, health insurance, place of residence, and media exposure. A multivariable logistic regression model was fitted to examine the association between the outcome of interest and predictors at 95% confidence interval.

RESULTS

Approximately, 7.52% of women aged 25-49 years had ever undergone testing for cervical cancer by a healthcare provider. Early menarche was associated with lower odds of CCS uptake [AOR = 0.78; CI = 0.65-0.95]. Compared to those who had no STI, women with a history of STI were more likely to screen for cervical cancer [AOR = 2.63; CI = 2.02-3.42]. Increasing age, higher educational attainment, having health insurance, and being exposed to media were significantly associated with CCS uptake.

CONCLUSION

In Cote d'Ivoire, age at menarche and STI history constitute reproductive factors that were significantly associated with women's uptake of CCS. It is imperative for public policy to focus on increasing CCS in these higher-risk women (i.e., women who experienced early menarche, women with early sexual debut and higher parity) through increased sensitization on cervical cancer risk factors.

Cervical cancer screening and its associated factors among women of reproductive age in Kenya: further analysis of Kenyan demographic and health survey 2022

INTRODUCTION

Although cervical cancer screening is one of the most effective strategies to reduce the incidence and mortality of cervical cancer, the percentage of cervical cancer screening in low- and middle-income counties is low. In Kenya, the current nationwide prevalence and associated factors for the detection of cervical cancer is unknown. Therefore, this study aimed to assess the prevalence and associated factors for the detection of cervical cancer screening among women of reproductive age in Kenya using the Kenyan Demographic and Health Survey 2022.

METHODS

This study used the most recent Kenyan Demographic and Health Survey data (2022) with a total weighted sample of 16,901 women. A mixed effects logistic regression analysis was performed and in the multivariable analysis, variables with a p-value below 0.05 were considered statistically significant. The strength of the association was evaluated using adjusted odds ratios along with their corresponding 95% confidence intervals.

RESULTS

The prevalence of cervical cancer screening in Kenya was 16.81%(95% CI: 16.24, 17.38%). Having a history of abortion (AOR = 1.33, 95% CI: 1.171.50, 1.43), using modern contraceptive methods (AOR = 1.57, 95% CI: 1.25, 1.95), media exposure (AOR = 1.31, 95%CI: 1.03, 1.65), primary education (AOR = 1.56, 95%CI: 1.09, 2.22), secondary education (AOR = 21.99, 95% CI: 1.1.38, 2.87), higher education (AOR = 2..50, 95% CI: 1.71, 3.65), visiting health facility within the past 12 months (AOR = 1.61, 95%CI: 1.46, 1.79), positive HIV status (AOR: 3.50, 95% CI: 2.69, 4.57), being from a community with a higher proportion of educated individuals (AOR = 1.37, 95%CI: 1.13, 1.65) and being from a community with high proportion of poor individuals (AOR = 0.72, 9 5%CI: 0.60-0.87)) were significantly associated with cervical cancer screening.

CONCLUSION

In Kenya, the prevalence of cervical cancer screening was found to be low. A history of abortion, use of modern contraceptives, exposure to the media, visits to health facilities in the past 12 months, HIV status, level of education, community educational level, and community wealth were identified as significant associated factors for cervical cancer screening. Therefore, it is recommended to implement targeted public health interventions that focus on these identified factors to improve the adoption of cervical cancer screening in Kenya.

Factors associated with utilization of cervical cancer screening services among HIV-positive women aged 18 to 49 years at Lira regional referral hospital, Northern Uganda

BACKGROUND

Women with HIV have a higher risk of getting cervical cancer due to induced immunosuppression. Though this burden could be avoided through early identification and appropriate management, there is a paucity of information about the utilization of cervical cancer screening (CCS) services in Lira City, Uganda. This study investigated the level and factors associated with the utilization of cervical cancer screening services among HIV-positive women aged 18 to 49 years at Lira Regional Referral Hospital, Lira City, Uganda.

METHODS

We conducted a facility-based cross-sectional study employing quantitative techniques. We used consecutive sampling to recruit 297 HIV-positive women at the ART clinic of Lira Regional Referral Hospital. A structured researcher-administered questionnaire was used to collect data. Descriptive statistics were performed to summarize the data. A modified Poisson regression using robust standard errors was performed to ascertain the factors associated with the utilization of cervical cancer screening. Prevalence ratios at 95% confidence intervals were reported.

RESULTS

Out of 297 respondents, 175(58.9%) utilized cervical cancer screening in this study. The factors found to be associated with CCS were; having ever heard of CCS (Adjusted Prevalence Ratio [PR] 1.80, 95% CI 1.31-2.49, p < 0.001), knowing where CCS is done (Adjusted PR 1.99, 95% CI 1.42-2.81, p < 0.001), fear of CCS outcomes (Adjusted PR 0.67, 95% CI 0.54-0.84,p < 0.001), not knowing whether CCS is beneficial or not (Adjusted PR 0.39, 95% CI 0.20-0.75,p = 0.005) and having friends/relatives who screened for cervical cancer (Adjusted PR 1.31, 95% CI 1.09-1.59, p = 0.005).

CONCLUSION

The level of utilization of cervical cancer screening services among HIV-positive women was suboptimal. Implementation of structured interventions aimed at improving cervical cancer screening awareness among HIV-positive women is crucial. Additionally, to increase opportunities for screening and knowledge on cervical cancer prevention, screening programs can target HIV-positive women during their routine clinic visits.

Drivers of cervical cancer prevention and management in sub-Saharan Africa: a qualitative synthesis of mixed studies

BACKGROUND

Cervical cancer is a public health concern in the sub-Saharan Africa region. Cervical cancer screening is one of the strategies for detecting early precancerous lesions. However, many women have poor access to and utilization of screening services in the region. This review aimed to synthesize evidence on the challenges and opportunities of screening, early detection and  management of cervical cancer in sub-Saharan Africa.

METHODS

We conducted a structured narrative review of studies published in English. We included studies published from 1 January 2013 to mid-2022. Studies were selected following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Key search terms (detractors and enablers, cervical cancer screening, sub-Saharan Africa) were employed to identify studies from three electronic databases (HINARI, Science Direct, and PubMed). We also conducted searches on Google Scholar to identify relevant grey literatures. A thematic analysis was conducted and themes were identified, then explained using a socio-ecological framework (intrapersonal, interpersonal, organizational, community, policy levels).

RESULTS

We identified 60 studies in the final review. Cervical cancer screening and early detection and management programmes are influenced by drivers at multiple levels. Individual-level drivers included a lack of knowledge about cervical cancer and screening literacy, and a low risk in perception, attitude, susceptibility and perceived fear of test results, as well as sociodemographic characteristics of women. Interpersonal drivers were community embarrassment, women's relationships with health workers, support and encouragement, the presence of peers or relatives to model preventive behaviour, and the mothers' networks with others. At the organizational level, influencing factors were related to providers (cervical cancer screening practice, training, providers' profession type, skill of counselling and sex, expert recommendation and work commitments). At the community level, drivers of cervical cancer screening included stigma, social-cultural norms, social networks and beliefs. System- and policy-level drivers were lack of nearby facilities and geographic remoteness, resource allocation and logistics management, cost of screening, promotion policy, ownership and management, lack of decentralized cancer policy and lack of friendly infrastructure.

CONCLUSIONS

There were several drivers in the implementation of cervical cancer screening programmes at multiple levels. Prevention and management of cervical cancer programmes requires multilevel strategies to be implemented  across the individual level (users), community and organizational levels (providers and community users), and system and policy levels. The design and implementation of policies and programmes need to address the multilevel challenges.

HPV DNA Testing and Mobile Colposcopy for Cervical Precancer Screening in HIV Positive Women: A Comparison Between Two Settings in Ghana and Recommendation for Screening

INTRODUCTION

Women living with HIV (WLHIV) have higher prevalence and persistence rates of high-risk human papillomavirus (hr-HPV) infection with a six-fold increased risk of cervical cancer. Thus, more frequent screening is recommended for WLHIV.

OBJECTIVES

This retrospective descriptive cross-sectional study was conducted to investigate and compare the prevalence of hr-HPV infection and abnormal findings on mobile colposcopy in two cohorts of WLHIV following cervical screening in rural and urban settings in Ghana.

METHODS

Through the mPharma 10 000 Women Initiative, WLHIV were screened via concurrent hr-HPV DNA testing (MA-6000; Sansure Biotech Inc., Hunan, China) and visual inspection (Enhanced Visual Assessment [EVA] mobile colposcope; MobileODT, Tel Aviv, Israel) by trained nurses. The women were screened while undergoing routine outpatient reviews at HIV clinics held at the Catholic Hospital, Battor (rural setting) and Tema General Hospital (urban setting), both in Ghana.

RESULTS

Two-hundred and fifty-eight WLHIV were included in the analysis (rural, n = 132; urban, n = 126). The two groups were comparable in terms of age, time since HIV diagnosis, and duration of treatment for HIV. The hr-HPV prevalence rates were 53.7% (95% CI, 45.3-62.3) and 48.4% (95% CI, 39.7-57.1) among WLHIV screened in the rural vs urban settings (p-value = .388). Abnormal colposcopy findings were found in 8.5% (95% CI, 5.1-11.9) of the WLHIV, with no significant difference in detection rates between the two settings (p-value = .221). Three (13.6%) of 22 women who showed abnormal colposcopic findings underwent loop electrosurgical excision procedure (LEEP), leaving 19/22 women from both rural and urban areas with pending treatment/follow-up results, which demonstrates the difficulty faced in reaching early diagnosis and treatment, regardless of their area of residence. Histopathology following LEEP revealed CIN III in 2 WLHIV (urban setting, both hr-HPV negative) and CIN I in 1 woman in the rural setting (hr-HPV positive).

CONCLUSIONS

There is a high prevalence of hr-HPV among WLHIV in both rural and urban settings in this study in Ghana. Concurrent HPV DNA testing with a visual inspection method (colposcopy/VIA) reduces loss to follow-up compared to performing HPV DNA testing as a standalone test and recalling hr-HPV positive women for follow up with a visual inspection method. Concurrent HPV DNA testing and a visual inspection method may also pick up precancerous cervical lesions that are hr-HPV negative and may be missed if HPV DNA testing is performed alone.

Willingness to accept human papilloma virus vaccination and its associated factors among parents with eligible daughters in Addis Zemen town, Northwest Ethiopia

BACKGROUND

Cervical cancer is one of the most common cancers in women. Evidences show that, routine immunization of girls at age 14 year and immunization of girls at age 9 year through a 5 years extended interval between doses are the most efficient to control the disease. Despite this, there is very little information on parents' willingness to accept the human papilloma virus vaccine. Therefore, assessing willingness to accept human papilloma virus vaccination and its associated factors among parents with eligible daughter will help to designing, implementing and monitoring effectiveness of HPV vaccine immunization program.

METHODS

A community-based cross-sectional study was conducted among 386 parents with eligible daughters from 8July-6August, 2022. The multistage sampling technique was used. Data was collected using an interviewer-administered questionnaire. Responses were coded and entered into the computer using EPI data version 4.606 statistical packages, and SPSS version 23 was used for data analysis. Frequencies, percentages and means were as to describe the study variables in relation to the participants. Bivariable and multivariable logistic regression were employed. The statistical significance was set at a p-value of < 0.05 with its respected odds ratio.

RESULTS

A total of 386 study participants were included in the study. Among participants, 80.3% (95% CI: 76.3, 84) were willing to vaccinate their daughters for HPV vaccination. The parents' willingness was affected by the male parents ([AOR = 3.5; 95% CI (1.673-7.371)], fear of side effects [AOR = 0.385; 95% CI (0.206-0.718)], and with poor awareness on the HPV vaccine [AOR = 0.483; 95% CI (0.259- 0.900)].

CONCLUSION

The study has shown that willingness to accept the HPV vaccine is about 80% and significantly affected with parental sex, information on the HPV vaccine, and fear of side effects. As such, it may be helpful for the health care providers and the health care policy makers to emphasize on providing easily understandable information using mass media and social campaign. In addition giving trainings more targeted to female parents might be important.

[Faible niveau de dépistage du cancer du col de l'utérus, disparités géographiques et déterminants sociodémographiques du dépistage chez les femmes adultes au Burkina Faso : résultats de la première enquête nationale en population générale]

OBJECTIVE

To explore the level, geographical disparities and sociodemographic determinants of cervical cancer screening uptake among adult women in Burkina Faso by using data from the first national population-based survey.

METHODS

This was a cross-sectional secondary analysis of primary data obtained by the 2013 World Health Organization (WHO) Stepwise Approach to Surveillance survey conducted in Burkina Faso. All 13 Burkinabè regions, with their different rates of urbanization, were surveyed. Lifetime cervical cancer screening uptake was explored. We included 2293 adult women for analyses and performed Student's t, chi-square and Fisher's exact tests, and logistic regression.

RESULTS

Only 6.2% (95% CI: 5.3-7.3) of women had ever been screened for cervical cancer. For two regions ("Centre" and "Hauts-Bassins"), the pooled frequency was 16.6% (95% CI: 13.5-20.1) while in the other eleven regions it was significantly lower, 3.3% (95% CI: 2.5-4.2). In urban and rural areas, the respective frequencies for the screening uptake were 18.5% and 2.8% (p < 0.001), and in educated and un-educated women, frequencies were 27.7% and 3.3% (p < 0.001) respectively. The sociodemographic factors associated with screening uptake were being educated (adjusted odd-ratio [aOR] = 4.3; 95% CI: 2.8-6.7), urban residence (aOR = 3.8, 95% CI: 2.5-5.8) and having an occupation providing income (aOR = 3.1, 95% CI: 1.8-5.4).

CONCLUSION

There was a significantly wide range in screening uptake between Burkina Faso regions, and the overall national as well as the region-specific levels were far below the WHO's target for cervical cancer elimination. Cervical cancer interventions should be tailored specifically for Burkinabè women with different educational levels, and prevention strategies based on community engagement integrating psychosocial considerations could be helpful.

Does Intervening in the Level of Knowledge About Cervical Cancer Increase Screening and Vaccination in Zambia?

Cancer of the cervix can be prevented by primary and secondary prevention methods. In order for these prevention methods to be practiced it is imperative that women are made aware of cervical cancer and the existing vaccination and cervical screening services available to them. A small intervention study to inquire on the effect of showing a short video about cervical cancer and its prevention proved to be an effective means of increasing awareness and knowledge among Zambian women residing in Lusaka. This brief report follows up on the 2017 intervention study in order to determine to what extent the increased knowledge has led to increased screening and vaccination practices among Zambian women and their daughters after a 3-year period. It is concluded that awareness of prevention services increases women's likeliness to seek screening services when given enough time. Unfortunately, we found no evidence of in an increase of the number of daughters vaccinated in this study.

Screening for cervical cancer among women in five countries in sub-saharan Africa: analysis of the role played by distance to health facility and socio-demographic factors

BACKGROUND

Cervical cancer significantly affects women in Sub-Saharan Africa (SSA). However, limited studies have concentrated on cervical screening behaviour among women in SSA. This study aimed to assess the interplay of distance to health facilities and socio-demographic factors with cervical screening behaviour among women in five SSA countries.

METHODS

The study was based on pooled data of 40,555 women included in Demographic and Health Surveys (DHS) conducted between 2013 to 2021. Proportions and logistic regression models were used in assessing the interplay of distance to health facilities and socio-demographic factors with cervical screening behaviour.

RESULTS

Approximately, 7.9% of women that saw the distance to a health facility as a big problem, tested for cervical cancer compared to 13.5% who indicated that distance to a health facility is not a big problem. More women in urban areas, with a higher level of education, of richest wealth index, aged 40-44 years and using contraceptives who also indicated that distance to a health facility was a big problem tested for cervical cancer compared to those in rural areas with no education, of poorest wealth index, aged 15-19 years and not using contraceptives. Education, age, contraceptive use, frequent exposure to mass media and Sexual Transmitted Infections (STI) had a significant relationship with testing for cervical cancer.

CONCLUSION

The prevalence of cervical cancer screening was low in the five SSA countries largely due to distance barriers and was also significantly influenced by education, age, contraceptive use, frequent exposure to mass media, and STI status. To improve the screening for cervical cancer and its associated benefits in the five SSA countries, there is a need for policymakers, clinicians and public health workers to channel more commitment and efforts to addressing the barriers identified in this study.

Awareness, Acceptance, and Associated Factors of Human Papillomavirus Vaccine among Parents of Daughters in Hadiya Zone, Southern Ethiopia: A Cross-Sectional Study

INTRODUCTION

Human papillomavirus infections are the most prevalent sexually transmitted disease among women worldwide. Cervical cancer is the second-most frequent disease worldwide in terms of incidence and mortality, and it is primarily responsible for fatalities in low- to middle-income nations, including Ethiopia.

OBJECTIVE

To assess awareness, acceptance, and associated factors of the human papillomavirus vaccine among parents of daughters in the Hadiya zone, southern Ethiopia.

METHODS

From November to December 2021, a community-based cross-sectional study was conducted in the Hadiya zone among parents with daughters in the zone. The study respondents were chosen using a two-stage sampling technique from parents with a 9-14-year-old daughter. An interviewer-administered questionnaire was used to collect data. For analysis, the data were entered into Epidata version 3.1 and exported to SPSS version 25. Variables with a p-value less than 0.25 in the bivariate analysis were transferred to multivariable analysis. A logistic regression model was applied to forecast the association between the predictor and outcome variables. Statistical significance was considered at a 0.05 p-value.

RESULTS

The study showed that the overall acceptance of parents to vaccinate their daughters with HPV vaccination was 450 (84.9%). Parents of daughters of male sex (AOR: 0.407; 95%CI: 0.221, 0.748), who had only one daughter (AOR: 2.122; 95%CI: 1.221, 3.685), whose daughter(s) attended a government school (AOR: 0.476; 95%CI: 0.263, 0.861), who had poor knowledge (AOR: 0.532; 95%CI: 0.293, 0.969) and who had a negative attitude (AOR: 0.540; 95%CI: 0.299, 0.977) were discovered to have a strong correlation.

CONCLUSION

This study found that there was a high level of parental acceptance; attitudes and knowledge about the HPV vaccine are significant in determining their intentions to vaccinate their daughter. Authorities in high-risk areas for cervical cancer incidence should plan and implement strategies by providing health information regarding human papillomavirus vaccination with an emphasis on raising community awareness.

Barriers and facilitators to cervical cancer screening for women from culturally and linguistically diverse backgrounds; a qualitative study of GPs

OBJECTIVE

To explore general practitioners' (GPs) perspectives on the barriers and facilitators to cervical cancer screening (CCS) for women from culturally and linguistically diverse (CALD) backgrounds.

DESIGN

Qualitative descriptive study involving semi-structured interviews, with interview guide informed by the Theoretical Domains Framework.

SETTING

Adelaide, South Australia.

PARTICIPANTS

Twelve GPs with experience in providing CCS to women from CALD backgrounds participated.

RESULTS

Four main themes emerged: 'importance of clinician-patient relationship', 'patients' cultural understanding regarding health care and CCS', 'communication and language' and 'health system related'. Each theme had several subthemes. GPs' professional relationship with their patients and repeated advice from other clinicians, together with the provision of opportunistic CCS, were described as facilitators, and encompassed the theme of 'importance of clinician-patient relationship'. This theme also raised the possibility of self-collection human papilloma virus tests. Lack of awareness and knowledge, lower priority for cancer screening and patients' individual circumstances contributed to the theme of 'patients' cultural understanding regarding health care and CCS', and often acted as barriers to CCS. 'Communication and language' consisted of language difficulties, interpreter use and use of appropriate resources. Language difficulties were a barrier to the provision of CCS, and GPs used interpreters and written handouts to help overcome this. The theme of 'health system related' involved the increased time needed for CCS consults for CALD women, access to appointments, funding, health promotion and effective use of practice management software.

CONCLUSIONS

This study highlights that multiple, inter-related barriers and facilitators influence CALD women's engagement with CCS, and that GPs needed to manage all of these factors in order to encourage CCS participation. More efforts are needed to address the barriers to ensure that GPs have access to appropriate resources, and CALD patients have access to GPs they trust.

Acceptability of text messages and knowledge change for cervical cancer screening: a Tanzanian mixed methods study

OBJECTIVES

To investigate the acceptability of a text message intervention and evaluate if text messages could increase knowledge of cervical cancer and screening.

DESIGN

This study was a substudy of a randomised controlled trial that used a mixed methods research design combining a quantitative questionnaire dataset and qualitative interview data. A before and after assessment was made of questionnaire responses. Acceptability was measured on a 6-point Likert scale and knowledge was measured through 16 binary true/false knowledge questions concerning cervical cancer and screening. Qualitative data were coded using a combined inductive-deductive approach.

SETTING

Ocean Road Cancer Institute in Dar es Salaam as well as Kilimanjaro Christian Medical Center and Mawenzi Regional hospital in the Kilimanjaro Region in Tanzania.

PARTICIPANTS

Human papillomavirus (HPV) positive women who had been randomised to the intervention group and received educative and reminder messages. Qualitative interviews were conducted with a subgroup of women in the intervention group.

INTERVENTIONS

15 one-way educative and reminder text messages.

RESULTS

A total of 115 women in the intervention group responded to both the baseline and follow-up questionnaire. Overall, women found it highly acceptable to receive text messages, and there was a trend towards acceptability rising between baseline and follow-up (mean: 0.22; 95% CI 0.00 to 0.44; p=0.05; t-statics=1.96). A significant increase in acceptability was found among the lowest educated and those who had not previously been screened. The qualitative interviews showed that the underlying reasons for the high acceptability rate were that the women felt someone cared for them and that the text messages were for their own benefits. The text messages did not improve the women's knowledge on cervical cancer and screening.

CONCLUSIONS

Educative and reminder text messages are highly acceptable among HPV-positive Tanzanian women; however, they do not increase the women's knowledge of cervical cancer and screening.

TRIAL REGISTRATION NUMBER

clingov (NCT02509702).

Determinants of cervical cancer screening utilization among women in Southern Ethiopia

Cervical cancer has been an important public health problem. Despite the availability of screening services, its utilization in Ethiopia is low. This study therefore, aimed to identify contextual predictors of cervical cancer screening utilization among eligible women. This study employed facility-based unmatched case–control study design. Data were collected from 410 participants using interviewer-administered techniques. The collected data were entered using EpiInfo version 7 and transported to SPSS version 20 for statistical analysis. We performed descriptive analysis and logistic regression to identify predictors of screening utilization. This study demonstrated that urban residence, being in marital union, membership in women development army, knowledge of cervical cancer screening location, use of maternal health care in the previous year and knowledge on cervical cancer and its screening were predictors of screening utilization. Therefore, it is important to improve women’s knowledge on cervical cancer, promote maternal health care use, disseminate health information through women’s groups and consider all positive effects of urban residence among rural women to improve screening utilization.

Willingness to utilize cervical cancer screening among Ethiopian women aged 30–65 years

Background

Cervical cancer screening is a means of detecting cervical cancer early, before it develops, in order to reduce disease mortality and morbidity. When women are screened for cervical cancer between the ages of 30 and 40 years at least one time in their life, their risk of cancer could be decreased by 25–36%. Despite this advantage, cervical cancer screening coverage in Ethiopia is still &lt;2%. As a result, we wanted to see how ready women in the Girar Jarso district, Ethiopia, were to get a cervical cancer test.

Methodology

Community-based cross-sectional study was done using a stratified cluster sampling technique among 855 women aged 30–65 years in the Girar Jarso district, Ethiopia, from 1 June 2021 to 1 September 2021. A pretested and semi-structured interviewer-administered questionnaire was used to collect the data. EpiData management version 4.6 was used to enter data, which was then exported to SPSS version 23 for analysis. Logistic regression analysis was performed, and variables with a p-value of &lt;0.05 were taken as statistically significant predictors of the willingness to utilize cervical cancer screening.

Results

Of the 855 women, only 315 (46.7%, CI = 43–50.3) women were willing to be checked for cervical cancer, with 181 (21.2%) women having been screened at least one time in their life. Age of 30–39 years [AOR = 2.80 (95% CI: 1.05, 7.48)], urban resident [AOR = 2.12 (95% CI: 1.06, 4.48)], positive attitude [AOR = 1.68 (95% CI: 1.11, 2.53)], wealth status, awareness of cervical cancer, and low perceived barriers were independent predictors of the willingness to utilize cervical cancer screening.

Conclusion and recommendation

The willingness to utilize cervical cancer screening services is low in the Girar Jarso district. To improve community awareness and attitude, continued and sustainable advocacy on the value of cervical cancer screening should be offered through mass media and health extension workers.

Cervical cancer screening utilization, and associated factors, in Nepal: a systematic review and meta-analysis

OBJECTIVE

To systematically appraise the existing published literature on cervical cancer screening utilization, and associated barriers and facilitators, in Nepal.

STUDY DESIGN

Systematic literature review and meta-analysis.

METHODS

PubMed/MEDLINE, CINAHL, Scopus, Embase, and, Google Scholar were systematically searched using Preferred Reporting Items for Systematic Review and Meta-Analysis guideline. All quantitative and qualitative studies reporting cervical cancer screening (using the Pap smear test or visual inspection with acetic acid or human papillomavirus test) utilization, barriers, and facilitators for screening were identified. A meta-analysis was performed to estimate Nepal's pooled cervical cancer screening utilization proportion.

RESULTS

The search yielded 97 records, of which 17 studies were included. Fifteen studies were quantitative and two were qualitative. Of the 17 studies, six were hospital-based and six were community-based. The pooled cervical cancer screening utilization proportion (using Pap smear test) among Nepalese women was 17% from the studies in the hospital settings, and 16% in the community. Six studies reported barriers to cervical cancer screening, of which four reported embarrassments related to the gynecological examination and a low level of knowledge on cervical cancer. Three (of four) studies reported health personnel, and two studies reported screening services-related facilitators for cervical cancer screening.

CONCLUSION

Our review reported that cervical cancer screening utilization (16%) is more than four times lower than the national target (70%) in Nepal. Multiple barriers such as low levels of knowledge and embarrassment are associated with cervical cancer screening utilization. Health personnel's gender, counseling, and privacy of screening services were commonly reported facilitators. These findings could help to inform future research, and policy efforts to increase cervical cancer screening utilization in Nepal.

Knowledge and willingness of parents towards child girl HPV vaccination in Debre Tabor Town, Ethiopia: a community-based cross-sectional study

Background

Cervical cancer is currently the second-leading cause of cancer death among women in Ethiopia. Vaccination against the human papillomavirus (HPV) is an effective primary prevention strategy for HPV-related illnesses. The knowledge and willingness of parents toward the HPV vaccine are crucial to increasing the uptake of the vaccine. The vaccine's acceptance by children and young adolescents is dependent on parental consent. Therefore, this study aimed to assess knowledge, willingness, and associated factors of the human papillomavirus vaccine among parents of girls aged 9–14 years at Debre Tabor Town.

Method

A community-based cross-sectional study was conducted among participants from December 10, 2020, to January 15, 2021. A simple random sample technique was used to include 638 participants. A structured face-to-face interviewer-administered questionnaire was used to collect data. The data were entered and analyzed using Epi-Data and SPSS software, respectively. Bivariate and multivariable analyses were used to examine the association. The Odds Ratio (OR), 95% CI, and p-values less than 0.05 were used to determine the statistical association.

Results

Thirty-five percent (35.4%, 95% CI = 31.4%, 38.8%) and 44.8% (95% CI = 40.40%, 48.67%) of participants were knowledgeable about HPV vaccination and willing to get it, respectively. Being government employees (AOR = 5.46, 95% CI = 2.42, 9.34), and having a family history of sexually transmitted diseases (STD) (AOR = 1.76, 95% CI = 1.14, 2.72) were significantly associated with knowledge of the human papilloma virus (HPV) vaccine. Participants’ age (AOR = 1.43, 95% CI = 1.16, 2.87), secondary education and above (AOR = 1.70, 95% CI = 1.05, 2.74), fear of HPV infection (AOR = 2.29, 95% CI = 1.21, 4.32), and having good knowledge of the HPV vaccine (AOR = 3.30, 95% CI = 2.21, 4.93) were significantly associated with willingness to receive the HPV vaccine.

Conclusion and recommendation

The knowledge and willingness of parents toward the HPV vaccine were low. Then, health officials should boost HPV vaccination promotion through public media. In schools, churches, mosques, and health facilities, health extension workers and health professionals provide information about the HPV vaccine for the parents. Mixed quantitative and qualitative studies are preferable for future research to address “why” issues.

Infection with the Human Papillomavirus (HPV) causes nearly 99% of cervical cancer cases and more than 20% of breast, neck, and anogenital cancers. The HPV vaccines protect against high-risk types of HPV (types 16 and 18), which account for approximately 70% of cervical cancers. Global coverage of the HPV vaccine was 39.7%, with high-income countries (68%), middle-income countries (28%), and lower-middle-income countries (2.7%). For different reasons, cervical cancer screening is very poor in Ethiopia (below 2%). Cervical cancer is mostly asymptomatic more than 20 years after infection. Primary prevention (enhancing the HPV vaccine) is the best way to protect women from cervical cancer. Adolescents’ uptake and acceptance of the vaccine depend on parental consent. Assessing parental knowledge and willingness at a community level is very crucial.

A simple random sample technique was used to include 638 participants. A structured and pre-tested face-to-face interviewer-administered questionnaire was used to collect the data. The data were entered and analyzed using Epi-Data, and SPSS software, respectively. Bivariate and multivariable analyses were used to examine the association.

Nearly one-third (35.4%) and less than half (44.8%) of participants were knowledgeable and willing to receive the HPV vaccination. The knowledge and willingness of the parents are significantly lower. Being government employees and having a family history of sexually transmitted diseases (STD) were factors affecting the knowledge of parents about the human papillomavirus vaccine. Participants’ age, secondary education and above, fear of HPV infection, and having good knowledge of the HPV vaccine were significantly associated with their willingness to use the HPV vaccine. The knowledge and willingness of the parents are significantly lower. Health officials and stakeholders should scale up HPV vaccine promotion through public media.

Factors associated with late-stage presentation of cervical cancer in Ghana

Objective

To explore factors associated with late clinical presentation among Ghanaian women with cervical cancer.

Design

This is a cross-sectional survey using a paper questionnaire.

Setting

Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana.

Participants

Participants were women presenting for cervical cancer care at KATH. Inclusion criteria were histologically diagnosed cervical cancer and age ≥18 years. The exclusion criteria was age <18. All women presenting from August 2018-August 2019 were recruited.

Main outcome measures

The primary outcome was the proportion of participants presenting with late-stage cervical cancer, defined as stage II or higher.

Results

Of 351 total participants, 33.6% were unemployed, 35.3% had no formal education, and 96.6% had an average monthly income of less than five hundred Ghana cedis ($86 USD). Time from symptoms to seeing a doctor ranged from fewer than two weeks (16.0%) to more than twelve months (8.6%). Participants' most common barrier in seeking healthcare was financial constraints (50.0%). Most participants presented at late-stage cervical cancer (95.2%, n=334), with only 4.8% (n=17) presenting at stage I. Of participants presenting with late-stage cervical cancer, the vast majority had never had a Papanicolaou (Pap) smear (99.1%) nor a recent gynecologic exam (99.3%). After adjusting for age, parity, and distance to a healthcare facility, a late-stage presentation was associated with lower income and living in a rural area.

Conclusions

In Ghana, 95% of women with cervical cancer seek care at a late clinical stage, defined as stage II or greater, when the cancer is inoperable.

Funding

None declared.

Cervical cancer knowledge and barriers and facilitators to screening among women in two rural communities in Guatemala: a qualitative study

Background

Approximately 80% of deaths due to cervical cancer occur in low- and middle-income countries. In Guatemala, limited access to effective screening and treatment has resulted in alarmingly high cervical cancer incidence and mortality rates. Despite access to free-of-cost screening, women continue to face significant barriers in obtaining screening for cervical cancer.

Methods

In-depth interviews (N = 21) were conducted among women in two rural communities in Guatemala. Interviews followed a semi-structured guide to explore knowledge related to cervical cancer and barriers and facilitators to cervical cancer screening.

Results

Cervical cancer knowledge was variable across sites and across women. Women reported barriers to screening including ancillary costs, control by male partners, poor provider communication and systems-level resource constraints. Facilitators to screening included a desire to know one’s own health status, conversations with other women, including community health workers, and extra-governmental health campaigns.

Conclusions

Findings speak to the many challenges women face in obtaining screening for cervical cancer in their communities as well as existing facilitators. Future interventions must focus on improving cervical cancer-related knowledge as well as mitigating barriers and leveraging facilitators to promote screening.

Patient perspectives on delays in cervical cancer screening and follow-up care in Botswana: a mixed methods study

Background

Delays in screening and timely diagnosis contribute significantly to global disparities in cervical cancer mortality in Botswana and other low- and middle-income countries, particularly those with high rates of HIV. Little is known about the modifiable factors shaping these delays from the perspectives of women themselves and how these perspectives may differ between those living with and without HIV.

Methods

From March–May 2019, we conducted a concurrent, mixed methods study of women receiving treatment for cervical cancer at a multidisciplinary oncology clinic in Botswana. Enrolled participants completed a one-time, concurrent semi-structured interview and structured questionnaire assessing patient characteristics, screening and HIV-related beliefs and knowledge, and barriers and facilitators to screening and follow-up care. Qualitative data were analyzed using directed content analysis guided by the Model of Pathways to Treatment and triangulated with quantitative questionnaire data to identify areas of convergence and divergence. Fisher’s exact tests were used to explore associations between questionnaire data (e.g., screening knowledge) and HIV status.

Results

Forty-two women enrolled in the study, 64% of whom were living with HIV and 26% were diagnosed with stage III cervical cancer. Median age was 45 years (IQR 54–67) in those living with HIV and 64 years (IQR 42–53) in those living without. Overall screening rates before symptomatic disease were low (24%). Median time from most proximal screen to diagnosis was 52 median days (IQR 15–176), with no significant differences by HIV status. General screening knowledge was higher among those living with HIV versus those without (100% vs 73%; p < 0.05), but knowledge about HPV and other risk factors was low in both groups. Similar to questionnaire results, qualitative results indicate limited awareness of the need to be screened prior to symptoms as a central barrier to timely screening. Some participants also noted that delays in the receipt of screening results and fear also contributed to treatment delays. However, many participants also described myriad sources of social and tangible support that helped them to overcome some of these challenges.

Conclusion

Interventions focused on increasing routine screening and supporting timely awareness and access to care are needed to reduce global disparities in cervical cancer.

Patients' pathways to cancer care in Tanzania: documenting and addressing social inequalities in reaching a cancer diagnosis

BACKGROUND

This article investigates the extent and sources of late diagnosis of cancer in Tanzania, demonstrating how delayed diagnosis was patterned by inequities rooted in patients' socio-economic background and by health system responses. It provides evidence to guide equity-focused policies to accelerate cancer diagnosis.

METHODS

Tanzanian cancer patients (62) were interviewed in 2019. Using a structured questionnaire, respondents were encouraged to recount their pathways from first symptoms to diagnosis, treatment, and in some cases check-ups as survivors. Patients described their recalled sequence of events and actions, including dates, experiences and expenditures at each event. Socio-demographic data were also collected, alongside patients' perspectives on their experience. Analysis employed descriptive statistics and qualitative thematic analysis.

RESULTS

Median delay, between first symptoms that were later identified as indicating cancer and a cancer diagnosis, was almost 1 year (358 days). Delays were strongly patterned by socio-economic disadvantage: those with low education, low income and non-professional occupations experienced longer delays before diagnosis. Health system experiences contributed to these socially inequitable delays. Many patients had moved around the health system extensively, mainly through self-referral as symptoms worsened. This "churning" required out-of-pocket payments that imposed a severely regressive burden on these largely low-income patients. Causes of delay identified in patients' narratives included slow recognition of symptoms by facilities, delays in diagnostic testing, delays while raising funds, and recourse to traditional healing often in response to health system barriers. Patients with higher incomes and holding health insurance that facilitated access to the private sector had moved more rapidly to diagnosis at lower out-of-pocket cost.

CONCLUSIONS

Late diagnosis is a root cause, in Tanzania as in many low- and middle-income countries, of cancer treatment starting at advanced stages, undermining treatment efficacy and survival rates. While Tanzania's policy of free public sector cancer treatment has made it accessible to patients on low incomes and without insurance, reaching a diagnosis is shown to have been for these respondents slower and more expensive the greater their socio-economic disadvantage. Policy implications are drawn for moving towards greater social justice in access to cancer care.

Expression analysis of p16 and TOP2A protein biomarkers in cervical cancer lesions and their correlation with clinico-histopathological characteristics in a referral hospital, Tanzania

Introduction

Biomarkers yield important information for early diagnosis of cervical cancer. However, they are rarely applied for prognosis of cervical cancer in Tanzania, where visual inspection assay with acetic acid or Lugol’s iodine and Pap test are being used as the standard screening/ diagnostic methods.

Methods

This was a retrospective hospital-based cross-sectional study that was conducted to assess cyclin-dependent kinase inhibitor (p16) and topoisomerase II-alpha (TOP2A) proteins expression among women seeking cervical cancer care at Kilimanjaro Christian Medical Centre, Tanzania between May 1, 2017 and May 10, 2018. Immunohistochemistry technique was used to detect the expressions of p16 and TOP2A proteins from the retrieved formalin-fixed and paraffin-embedded (FFPE) cervical biopsies.

Results

A total of 145 patients, with a mean age of 52.1 ± 12.9 years, were included in this study. Upon immunohistochemistry staining, 103 (71.0%) and 90 (62.1%) were p16 and TOP2A positive respectively. There was a strong association between histopathological class and p16/TOP2A expression levels (Fisher’s exact test, p<0.001). Moreover, there was a strong positive correlation between p16/TOP2A and cancerous cervical lesions (Spearman’s rank correlation coefficients = 0.833 and 0.687, p = 0.006 and 0.005, respectively). The age-adjusted odds ratio for predicting cervical cancer lesions were independently significant for p16/TOP2A biomarkers in FFPE cervical tissues [p16: OR = 1.142 (95% CI: 1.059–1.232, p<0.001) and TOP2A: OR = 1.046 (95% CI: 1.008–1.085, p = 0.015)]. Importantly, the diagnostic performance of p16 was higher than that of TOP2A in the diagnosis of cancerous lesions from non-cancerous cervical lesions (sensitivity: 97.2% versus 77.6%, accuracy: 92.8% versus 87.8%, respectively).

Conclusion

Our study has highlighted that over-expression of TOP2A is related to the grade of cervical intraepithelial neoplasia but does not predict prognosis in cervical cancer. Similarly, expression of p16 is related to degree of histological dysplasia and malignancy, suggesting its prognostic and predictive value in the management of cervical cancers. Further bigger studies are needed to validate their applications in the early diagnosis of cervical cancer.

Students' Knowledge about Cervical Cancer Prevention in Poland

Background and Objectives: In Poland, the rates of morbidity and mortality due to cervical cancer are amongst the highest in Europe. A significant percentage of newly diagnosed cases of cervical cancer are at an advanced stage. Unfortunately, only about 20% of Polish women take part in cervical cancer screening. The aim of the study was to assess students’ knowledge of cervical cancer risk factors and prevention. Materials and Methods: The study was provided to Polish students from various universities and faculties between May 2020 and November 2020. The questionnaire was designed specifically for this study and was validated. The chi-square test was used to compare the responses between subgroups. Results: The study was carried out on a group of 995 students (80.6% women, 19% men, 0.4% no data), (average age 21.9 years). Most students knew that the main risk factor for cervical cancer is human papillomavirus (HPV) infection (82% of all responders; 86% of medical students; 73% of non-medical students; p < 0.001). Only 40% of students knew that in Poland the Population Prevention and Early Diagnosis Program is carried out on women aged 25–59 years every three years. Most students correctly indicated that cervical cancer screening in Poland is performed using cervical cytology and were familiar with the basis of cytology. Only 57% of students knew that there are no specific early symptoms of cervical cancer. A total of 78% of all respondents knew that HPV vaccination reduces the risk of cervical cancer. Medical students and students who are sexually active demonstrated a better knowledge of cervical cancer. Conclusions: The Polish students had some knowledge of cervical cancer risk factors and primary and secondary prevention. Significantly better knowledge was demonstrated by medical students. Some efforts should be made to ensure that young people, who are not associated with medicine are better educated about cervical cancer in order to reduce the overall incidence and improve early detection rates.

Knowledge, Attitude and Practice of Main Stakeholders towards Human Papilloma Virus Infection and Vaccination in Mombasa and Tana-River Counties in Kenya: A Qualitative Study

Following a successful Human Papilloma Virus (HPV) vaccination pilot in 2013-2015 in Kitui county, Kenya introduced the HPV vaccine in October 2019 with a goal to immunize approximately 800,000 girls annually against HPV. Our study assessed the knowledge, attitudes, and practice of affected groups towards HPV infection and vaccination in two counties of Kenya. Semi-structured interviews from children aged between nine and thirteen years and key informants comprising of parents, head teachers, community leaders and health workers involved in HPV vaccination in health facilities from Mombasa and Tana-River counties were conducted. Content was analyzed thematically and coded for emerging themes using the QRS Nvivo 12 Plus (QRS International, Doncaster, Australia) software package. From our findings, a significant proportion of participants, especially children, have limited knowledge of the subject. Vaccination of boys was opposed by most participants. Parents and the community members are not in favor of HPV vaccination, as compared to the other groups. A similar pattern of inadequate knowledge and strongly opposed attitudes was observed in Tana-River and Mombasa. Active community involvement in primary prevention strategies may promote the uptake of the vaccine which can be achieved by robust awareness, modifying the negative beliefs about HPV vaccine and encouraging the perceptibility of HPV vaccination.

Knowledge and acceptance of HPV vaccination and its associated factors among parents of daughters in Addis Ababa, Ethiopia: a community-based cross-sectional study

Background

Cervical cancer is one of the most diagnosed and deadly cancers in women globally. Though vaccination is an effective way to reduce cervical cancer, people’s knowledge and acceptance of the vaccination remains a challenge in low and middle-income countries. Therefore, the aim of this study was to assess the level of knowledge and acceptance of Human Papilloma Virus (HPV) vaccination and its associated factors among parents of daughters in Addis Ababa, Ethiopia.

Methods

A community-based cross-sectional study was conducted among parents or guardians whose daughters are in the age group of 9–17 years and residing in Akaki-Kalty sub-city in Addis Ababa. A multistage sampling technique was used to select the study participants (n = 430). Face-to-face interview was conducted by using a structured questionnaire. Factors associated with the acceptance of HPV vaccination was identified by multivariable binary logistic regression and expressed by adjusted odds ratio (aOR), and respective 95% confidence interval.

Results

Complete response was obtained from 422 (98.1%) of the participants and their mean age was 39.0 years (SD ± 9.9). Out of the study participants, 41.7% and 72.0% had poor knowledge on cervical cancer and HPV, respectively. More than a quarter (27.0%) of the participants has never heard about HPV vaccine. One-third (36.5%) of the participants had negative attitude towards the HPV vaccine. Overall, 94.3% of the study participants were willing to vaccinate their daughters for HPV. Vaccine acceptability was associated with higher monthly income (aOR = 2.48, 95% CI 1.08–6.34), good knowledge on HPV (aOR = 2.32, 95% CI 1.56–4.87) and the vaccine (aOR = 2.24, 95% CI 1.12–8.60), and positive attitude towards the vaccine (aOR = 5.03, 95% CI 1.63—9.56).

Conclusions

The overall HPV vaccine acceptance was high. However, two out of five and one-thirds of the parents had poor knowledge on cervical cancer and negative attitude towards the HPV vaccine, respectively. Higher monthly income, good knowledge on HPV and the vaccine, and positive attitude towards the vaccine were associated with acceptance of HPV vaccination. To ensure sustainable acceptance of HPV vaccination, it is crucial to increase the community awareness in a sustainable manner.

Connaissances, utilisation et obstacles liés au dépistage du cancer du col utérin dans des hôpitaux de district de Kigali, au Rwanda

Contexte

Dans le monde, le cancer du col utérin arrive au troisième rang des cancers les plus fréquents chez les femmes, mais il passe au deuxième rang en Afrique orientale, où se trouve le Rwanda. Le dépistage périodique est un moyen de prévention efficace. Malgré cela, en Afrique, on estime que le taux de dépistage de ce cancer se situe entre 10 et 70 %. Plusieurs facteurs entravent le dépistage, surtout en Afrique subsaharienne. Au Rwanda, on recense peu d'écrits sur l'utilisation des services de dépistage et les facteurs nuisant au dépistage du cancer du col utérin.

Objectif

Évaluer les connaissances sur le dépistage du cancer du col utérin qu'ont les femmes fréquentant les hôpitaux de district de Kigali (au Rwanda), recenser l'utilisation de ce service et déterminer les obstacles qui empêchent d'y recourir.

Méthodologie

Une étude transversale descriptive a été menée, et les données ont été collectées au moyen d'un questionnaire structuré. Des questions nominales de type « oui ou non » ont mis en lumière les connaissances des femmes sur le cancer du col utérin et l'utilisation des services de dépistage. Pour cerner les obstacles au dépistage, nous avons utilisé des questions de type « échelle de Likert ». Ces données ont ensuite fait l'objet d'une analyse statistique descriptive et déductive. La sélection des répondantes s'est faite par échantillonnage aléatoire systématique depuis la base de données des patientes fréquentant les services gynécologiques de trois hôpitaux de district de Kigali (Rwanda).

Résultats

Au total, 329 femmes ont répondu au sondage. La moitié d'entre elles (n = 165) connaissaient bien le dépistage du cancer du col utérin. Le pourcentage de dépistage se situe à 28,3 %. Nous avons décelé un lien entre l'utilisation du dépistage et une bonne connaissance du sujet (P = 0,000, r = -0,392) ainsi que certains facteurs démographiques (P = 0,000). Parmi les obstacles qui concourent à restreindre l'accès au dépistage, nous avons relevé des obstacles individuels (méconnaissance de l'existence des services de dépistage), géographiques (milieu rural) et liés au système de santé et aux prestataires de soins (campagnes de sensibilisation déficientes, attitudes négatives des prestataires de soins envers les patientes et longs délais d'attente).

Conclusion

Dans les hôpitaux de district étudiés de Kigali (Rwanda), on constate un faible pourcentage de dépistage du cancer du col utérin causé par plusieurs obstacles. Il est donc fortement recommandé d'engager une campagne d'information permanente sur ce cancer et son dépistage. Enfin, il est crucial que les prestataires de soins qualifiés encouragent les femmes à se soumettre au dépistage, et qu'ils s'efforcent de réduire les obstacles qui s'y rattachent.

Knowledge, utilization and barriers of cervical cancer screening among women attending selected district hospitals in Kigali - Rwanda

Background

Cervical cancer is the third most common cancer attacking women globally, and the second in Eastern Africa where Rwanda is located. Regular screening is an effective prevention approach for cervical cancer. Despite that, the screening rate for cervical cancer in Africa is estimated between 10% and 70%, with a number of barriers. This is especially the case in sub-Saharan Africa. In Rwanda, there is limited literature on the rate of use of screening services or the barriers to cervical screening.

Objective

To assess knowledge, utilization, and barriers of cervical cancer screening among women attending selected district hospitals in Kigali, Rwanda.

Methods

A descriptive cross-sectional study with a structured questionnaire was used to collect data. Nominal 'yes' or 'no' questions were used to gather data on knowledge and utilisation of cervical cancer and its screening. Likert-type scale questions were used to identify different barriers to screening services. Data were analysed using descriptive and inferential statistics. Respondents were selected by systematic random sampling from the database of women attending gynaecology services at three district hospitals in Kigali, Rwanda.

Results

Three hundred and twenty-nine women responded to the survey. Half of the respondents (n = 165) had high knowledge level scores on cervical cancer screening. The cervical cancer screening rate was 28.3%. Utilization of screening was associated with knowledge (P = 0.000, r = -0.392) and selected demographic factors (P = 0.000). Individual barriers included poor knowledge on availability of screening services, community barriers included living in a rural area, and health provider and systems barriers included lack of awareness campaigns, negative attitudes of healthcare providers toward clients, and long waiting times; all barriers limit the access to screening services.

Conclusion

A low rate of cervical cancer screening was identified for women attending selected district hospitals in Kigali-Rwanda due to various barriers. On-going education on cervical cancer and its screening is highly recommended. It is important that trained health providers encourage their clients to have cervical cancer screening and work to reduce related barriers.

Tanzanian women´s knowledge about Cervical Cancer and HPV and their prevalence of positive VIA cervical screening results. Data from a Prevention and Awareness Campaign in Northern Tanzania, 2017 - 2019

Background: 14.9 million women (≥15 years) in Tanzania are at risk of developing cervical cancer.

Limited cancer care facilities, prevention programs and sparse knowledge among community members and healthcare workers contribute to late-stage presentation leading to a high mortality rate.

Objective: This study aims to scientifically accompany prevention and awareness campaigns (PrevACamp) in northern Tanzania in its real-world settings to obtain (1) a better understanding about cervical cancer and HPV knowledge amongst female PrevACamp participants and (2) to determine the prevalence of pre-cancerous lesions among women undergoing cervical cancer VIA screening.

Method: Cross-sectional survey among PrevACamp attendees in two regions in Northern Tanzania. Two data collections tools were used: Questionnaires and clinical data from VIA screening. Data were collected from October 2017 to March 2019.

Results: 2,192 PrevACamp attendees were interviewed and 2,224 received VIA screening. There was significant nescience on cervical cancer regardless of education level, resident status, or number of children as well as nescience on HPV in all age groups, especially in urban areas and misconceptions about cancer. Screening revealed VIA positivity rate of 3.1%.

Conclusion: There is an alarming lack of knowledge about cervical cancer and, to a lesser Extent, about HPV among the study participants. Having health insurance influenced the level of knowledge significantly. Outreach programs in rural areas appear to target the population in need of health education. Low positive VIA screening results are paralleled with lower HIV rates among the women. We assume that the high density of primary health care coverage in northern Tanzania contributes to these findings..

Cervical cancer screening uptake in Sub-Saharan Africa: a systematic review and meta-analysis

OBJECTIVES

The objective of this study is to estimate the pooled uptake of cervical cancer screening and identify its predictors in Sub-Saharan Africa.

STUDY DESIGN

Systematic review and meta-analysis.

METHODS

We searched PubMed, EMBASE, CINAHL, African Journals OnLine, Web of Science and Scopus electronic databases from January 2000 to 2019. All observational studies published in the English language that reported cervical cancer uptake and/or predictors in Sub-Saharan Africa were initially screened. We assessed methodological quality using the Newcastle-Ottawa Scale. An inverse variance-weighted random-effects model meta-analysis was performed to estimate the pooled uptake and odds ratio (OR) of predictors with a 95% confidence interval (CI). The I² test statistic was used to check between-study heterogeneity, and the Egger's regression statistical test was used to check publication bias.

RESULTS

We initially screened 3537 citations and subsequently 29 studies were selected for this review, which included a total of 36,374 women. The uptake of cervical cancer screening in Sub-Saharan Africa was 12.87% (95% CI: 10.20, 15.54; I² = 98.5%). A meta-analysis of seven studies showed that knowledge about cervical cancer increased screening uptake by nearly five times (OR: 4.81; 95% CI: 3.06, 7.54). Other predictors of cervical screening uptake include educational level, age, Human Immune deficiency Virus (HIV) status, contraceptive use, perceived susceptibility and awareness about screening locations.

CONCLUSIONS

Cervical screening uptake is low in Sub-Saharan Africa as a result of several factors. Health outreach and promotion programmes to target these identified predictors are required.

Men's willingness to support HPV vaccination and cervical cancer screening in Nigeria

Cervical cancer is the second most common female cancer in Nigeria, even though it can be prevented by vaccination and screening. The uptake of these preventive services is extremely low due to lack of spousal support and cost. Human papilloma virus (HPV) vaccines and cervical screening require finance as health services are mostly paid out of pocket. This study explored Nigerian men's willingness to encourage and pay for family member to obtain HPV vaccine and cervical screening. This is a cross-sectional study of 352 men aged 18-65 years living in 12 communities in the 6-geopolitical region. We found poor perception of HPV risk, and believed their family was not susceptible to cervical cancer. However, the majority (>80%) believed HPV vaccine and cervical screenings are important. Additionally, a good number (>58%) would encourage and pay for their family member to receive HPV vaccine and cervical screening. Residency, educational level and monthly income were significantly associated with willingness to encourage their family to receive HPV vaccine and cervical screening. Also, age group, marital status, residency, educational level and monthly income were significantly associated with the willingness to pay for HPV vaccine and cervical cancer screening. Majority were willing to encourage and pay for their family member to get vaccinated and receive cervical screening. This supports the findings that lack of male involvement may be an overlooked obstacle to cervical cancer prevention in developing countries.

Elimination of cervical cancer in Tanzania: Modelled analysis of elimination in the context of endemic HIV infection and active HIV control

The World Health Organisation (WHO) has launched a strategic initiative for cervical cancer (CC) elimination which involves scaling up three interventions: human papillomavirus (HPV) vaccination, twice-lifetime HPV-screening screening and pre-cancer/cancer treatment by 2030. CC is challenging to control in countries with endemic human immunodeficiency virus (HIV), as women living with HIV (WLHIV) are at elevated risk of HPV infection, persistence and progression. This analysis estimated the impact of the elimination interventions on CC incidence and mortality but additionally considered more intensive screening for WLHIV, using Tanzania as an example. A dynamic HIV/HPV model was used to simulate the elimination strategy for vaccination, screening and pre-cancer/cancer treatment, with 3-yearly HPV-screening in WLHIV starting at age 25 years, in the context of sustained HIV control in Tanzania from 2020 to 2119. Without vaccination or HPV screening, CC incidence rates per 100 000 women are predicted to fall from 58.0 in 2020 to 41.6 (range: 39.1-44.7) in 2119, due to existing HIV control. HPV vaccination and twice-lifetime HPV-screening for the general population and 3-yearly screening for WLHIV, would reduce CC incidence to 1.3 (range: 1.3-2.5) by 2119, with elimination (<4/100 000) in 2076 (range: 2076-2092). CC mortality rates per 100 000 women are predicted to reach 1.1 (range: 1.1-2.1) with further reductions contingent on increased CC treatment access. Vaccination and 3-yearly HPV-screening for WLHIV is predicted to achieve elimination in the subgroup of WLHIV potentially as early as 2061 (range: 2061-2078), with a 2119 CC incidence rate of 1.7 (range: 1.7-3.3). Scaling-up vaccination and HPV-screening will substantially reduce CC incidence in Tanzania, with elimination predicted within a century. Three-yearly HPV-screening and HPV vaccination, at high coverage rates, would facilitate CC elimination among WLHIV, and thus accelerate elimination in the overall population.

Prevalence and determinants of cervical cancer screening in five sub-Saharan African countries: A population-based study

BACKGROUND

Cervical cancer is the fourth most common cancer among women worldwide, with an estimate of 570,000 new cases and about 311,000 deaths annually. Low-resource countries, including those in sub-Saharan Africa, have the highest-burden with an estimate of 84 % of all cervical cancers. This study examines the prevalence and socio-demographic-economic factors associated with cervical cancer screening in sub-Saharan Africa.

METHODS

A weighted population-based cross-sectional study using Demographic and Health Surveys data. We used available data on cervical cancer screening between 2011 and 2018 from the Demographic and Health Surveys for five sub-Saharan African countries (Benin, Ivory Coast, Kenya, Namibia, and Zimbabwe). The study population included women of childbearing age, 21-49 years (n = 28,976). We fit a multivariable Poisson regression model to identify independent factors associated with cervical cancer screening.

RESULTS

The overall weighted prevalence of cervical cancer screening was 19.0 % (95 % CI: 18.5 %-19.5 %) ranging from 0.7 % in Benin to 45.9 % in Namibia. Independent determinants of cervical cancer screening were: older age (40-49 years) adjusted prevalence ratio (aPR) = 1.77 (95 % CI: 1.64, 1.90) compared with younger age (21-29 years), secondary/higher education (aPR = 1.51, 95 CI: 1.28-1.79) compared with no education, health insurance (aPR = 1.53, 95 % CI: 1.44-1.61) compared with no insurance, and highest socioeconomic status (aPR = 1.39, 95 % CI: 1.26-1.52) compared with lowest.

CONCLUSION

The prevalence of cervical cancer screening is substantially low in sub-Saharan Africa countries and shows a high degree of between-country variation. Interventions aimed at increasing the uptake of cervical cancer screening in sub-Saharan Africa are critically needed.

Acceptability and feasibility of self-sampling and follow-up attendance after text message delivery of human papillomavirus results: A cross-sectional study nested in a cohort in rural Tanzania

INTRODUCTION

The objective was to determine if self-collection of vaginal samples for human papillomavirus (HPV) testing was acceptable and feasible in rural Tanzania and to assess the extent of attendance at a follow-up appointment among women who tested HPV-positive after delivery of HPV results via text messages.

MATERIAL AND METHODS

A combined cross-sectional and cohort study was conducted among women aged 25-60 years from rural Kilimanjaro, Tanzania. Women were offered HPV self-sampling or traditional visual inspection of the cervix with acetic acid. If HPV self-sampling was preferred, participants received instructions on self-collection with an Evalyn Brush. A questionnaire was used to assess the acceptability and feasibility of the self-sampling procedure for the participants and delivery of HPV results via text messages. A mobile text message platform was used to send private text messages with the screening results to the participants.

RESULTS

A total of 1108 women were enrolled and self-collected an HPV sample; 11.8% tested positive for high-risk HPV. The majority (98.9%) agreed that they had no trouble in understanding the instructions on how to perform the self-collection and that they would recommend it to a friend (94.5%) or as a standard screening method in Tanzania (95.5%). A minority of women experienced bleeding (2.4%) or pain (6%) while collecting the sample, while some were worried that they would get hurt (12.7%) or felt embarrassed (3.5%). The majority (98.4%) of women would like to receive the screening test results via text messages. Eighty-two per cent of those who tested positive for high-risk HPV attended the follow-up appointment after receiving a text message reminder and an additional 16% attended after receiving both a text message and a phone call reminder whereas 2% did not attend follow up at all. Attendance was not influenced by age, marital status, education level, parity, or HIV status.

CONCLUSIONS

Human papillomavirus self-sampling and text-message feedback delivery are generally well-perceived and accepted among rural Tanzanian women, and the majority of HPV-positive women attended a follow-up appointment after receiving their HPV results and follow-up appointment via text messages. This screening method may have potential to be transferrable to other low-income countries with a high incidence of cervical cancer and so improve cervical cancer screening attendances.

Human Papillomavirus (HPV) Health Savings as an Alternative Solution: HPV Vaccination Behavior in Adolescents

OBJECTIVE

This study aimed to measure the effects of reproductive health savings (tabungan kesehatan reproduksi, Takespro) on human papillomavirus (HPV) vaccine initiation program and the quality of the decision making to get vaccinated, as measured by knowledge, attitudes, beliefs, and self-efficacy toward HPV vaccination.

METHODS

This quasi-experimental study was conducted on 128 students randomly allocated to intervention and control groups. This research was conducted in junior high schools. The intervention group received the health education "Takespro HPV" intervention through videos and booklets for 6 months at school. Participants in the control group received usual care from the school. Data were collected using a questionnaire of knowledge, attitudes, beliefs, and self-efficacy about HPV vaccination modified by researchers based on previous research and tested for validity and reliability. Data were analyzed using Mann-Whitney test and independent t-test.

RESULTS

A total of 40 participants were actively enrolled in the intervention group, and 88 were passively enrolled in the control group. The health education that was part of the Takespro HPV intervention improved the knowledge (p < 0.05) and self-efficacy (p < 0.05) of the intervention group compared with the control group. The attitude and belief variables showed no significant difference (p > 0.05). Forty students exhibited the health reproduction savings behavior at schools. However, the savings amount was insufficient to get HPV vaccination at the initiation phase.

CONCLUSION

"Takespro" HPV intervention can be considered an alternative to increasing the coverage of HPV vaccination in adolescents in Yogyakarta.
.

Acceptance of Human Papillomavirus Vaccination and Associated Factors Among Parents of Daughters in Gondar Town, Northwest Ethiopia

Background

Cervical cancer is one of the profound threats to women’s lives and the fourth most common cancer among women. Ethiopia launched the human papilloma vaccination for the first time, with the support of the Global Alliance for Vaccine and Immunization (GAVI) in 2018. Therefore, the aim of this study was to assess the acceptability of the human papillomavirus vaccine and associated factors among parents of daughters in Gondar town, Northwest Ethiopia.

Methods

A community-based cross-sectional study with a total sample of 946 study participants was conducted in Gondar town from April to May 2019. The study participants were selected using a multistage sampling technique from parents having a daughter of 9−17 years age. Data were collected using an interviewer-administered questionnaire. The data were entered into EpiData version 4.2 and exported to STATA version 14 for analysis. Variables having a p-value of <0.2 and <0.05 in the bivariable and multivariable logistic regression were considered as a statistically significant factor for the acceptance of HPV vaccination.

Results

A total of 899 study participants with a response rate of 95% were included in the study. Among participants in this study, 81.3% with 95% CI (78.6, 83.7) accepted to vaccinate their daughters for HPV vaccination. The acceptance to vaccinate daughters for HPV vaccination was affected by being from the richest household [AOR= 3.44, 95% CI = (1.97, 6.01)], good knowledge about cervical cancer [AOR=5.49, 95% CI= (2.62, 11.52)], and positive attitude towards HPV vaccination [AOR=21.53, 95% CI= (11.60, 39.96)].

Conclusion

The study revealed that the acceptance to human papillomavirus vaccination is high and was significantly associated with the level of knowledge about cervical cancer, the attitude towards HPV vaccination, and the wealth status of the households. Therefore, community education on cervical cancer and its prevention is crucial to increase awareness and acceptance as well.

Awareness of Cervical Cancer and Attitude Toward Human Papillomavirus and Its Vaccine Among Ghanaians

Background: Cervical cancer (CC) is the fourth most commonly diagnosed cancer among women. Ghana is a low-middle- income country with annual diagnosed cases of 3,151 and 2,119 deaths. The high prevalence rate of cervical cancer in Ghana is mainly due to ineffective preventive measures and insufficient knowledge about the disease. Therefore, our objective was to evaluate the level of knowledge and awareness of cervical cancer and attitude toward human papillomavirus and its vaccine among Ghanaians.

Methods: This descriptive cross-sectional survey on the awareness of cervical cancer and attitude toward human papillomavirus and its vaccine was carried out from March 2019 to February 2020. SPSS v. 23.0 was used in the data analysis. The participants' demographic characteristics, knowledge of cervical carcinoma, human papillomavirus vaccine and HPV, and the likelihood to be vaccinated were represented as percentages and frequencies. The difference between males and females was assessed using the chi-square test. The logistic regression analysis was used to evaluate the relationship of possible related indicators with the willingness to receive the HPV vaccine. A p < 0.05 was considered statistically significant.

Results: A total of 1,376 participants were involved in the final analysis. Among the 1,376 participants involved in this survey, 1,240 participants (90.1%) representing 456 males (33.1%) and 784 females (57.0%) were aware of the terminology “cervical cancer” with a significant p = 0.001. When stratified by gender, women had significantly greater knowledge, compared to men in terms of “cervical cancer being common in middle age (35–50) females” (75.5 vs. 67.5%, respectively, p ≤ 0.001). When stratified by gender, women had significantly greater knowledge of human papillomavirus (54.5 vs. 43.6%, respectively, p < 0.001) and the human papillomavirus vaccine (39.3 vs. 33.1%, respectively, p = 0.019) compared to men.

Conclusion: Majority of the respondents had poor knowledge regarding cervical cancer risk factors, symptoms, HPV, and its vaccine. Hence, this indicates a wakeup call for government to increase the awareness and knowledge level via the media and health professionals.

Acceptability of the human papillomavirus vaccine in schools in Lusaka in Zambia: Role of community and formal health system factors

Zambia has one of the highest cervical cancer rates in the world. This paper explores the acceptability of the Human Papillomavirus vaccine administered in girls (9-13 years) in Zambia. A qualitative case study was conducted in two schools in Lusaka district, which participated in the pilot for the Human Papillomavirus vaccine rollout. The study revealed that community level health systems factors such as knowledge levels about the vaccine, sexual morality concerns, conflicting views from parents on the vaccine, rumours that the vaccine contained cervical cancer and that it causes infertility in girls, previous bad experience with other vaccines, religious beliefs such as belief that God protects against illness, the nature of the school environment as well as faith in doctors shaped the uptake of the vaccine. Furthermore, formal health system factors such as availability of health workers and nature of collaboration between the Ministries of Health and Education influenced acceptability of the vaccine among the girls. Strengthening collaboration between community and formal health systems can play a vital role in supporting uptake of vaccines at community level as factors that hinder uptake of the vaccines emanate from both the community and health sector.

Lay knowledge of cervical cancer in Manhiça district, Mozambique: a qualitative study

Background

Mozambique has one of the highest cervical cancer incidence rates in the world. Health interventions are still being conceived solely from a non-communicable disease standpoint despite that it is also a sexual and reproductive health problem. The objective of this study was to assess the extent to which lay perceptions of cervical cancer align with biomedical knowledge from the standpoint of sexual and reproductive health.

Methods

10 focus group discussions were carried out with 10 target groups in Manhiça. The target groups were diverse in terms of age, sex, educational level and occupation. There were a total of 116 participants. The focus groups discussions were applied to obtain verbal information and trigger debates around beliefs and attitudes about cervical cancer as well as to explore notions of transmission and aetiology of the disease. The discussions were recorded for later transcription and analysis, following a combination of content and thematic analysis.

Results

Participants were familiar with the biomedical term ‘cervical cancer’ but knowledge of its aetiology and transmission was limited. Cervical cancer was readily associated to sexual transmission and sexually transmitted infections, and conceived as a ‘wound that does not heal’. The term ‘cancer’ caused confusion, as it was perceived to happen only in limbs, understood as hereditary, not transmissible and as an illness of the West.

Conclusions

Lay perceptions of cervical cancer do, to a large extent, align with biomedical ones, thus, there is common ground to frame future health interventions from a sexual and reproductive health standpoint. Some misperceptions were identified which could be reduced through social behaviour change communication initiatives.

Barriers and facilitators to cervical cancer screening uptake among women in Nepal - a qualitative study

The global incidence of cervical cancer is approximately 570,000 cases and 311,000 deaths annually. Almost 90% of cervical cancer deaths occur in low and middle income countries. Screening is the most effective tool in prevention, early diagnosis, and treatment of cervical cancer. Nepal has no national cervical cancer screening programme, and data from 2003 showed that only 2.8% of Nepalese women had ever been screened. We conducted a qualitative study to obtain better insight into barriers and facilitators to cervical cancer screening among women in Nepal to generate data to inform interventions. In February 2019, four focus group discussions with previously screened and non-screened women, and Female Community Health Volunteers and four in-depth interviews with health workers were conducted in Pokhara Metropolitan City. Semi-structured interview guides were used, interviews were audio-recorded, transcribed verbatim, and analyzed using grounded theory approach with open coding. This resulted in five main themes: 1) lack of husband's support for screening, 2) prevalent stigma and discrimination, 3) lack of awareness about screening options, 4) getting screened, and 5) health care providers. We encourage policymakers and stakeholders apply these findings to improve awareness, access to information, and better screening services in Nepal.

Cervical Cancer Screening among Women Receiving Antiretroviral Therapy in a Resource-Limited Environment

Background:

Cervical cancer is among the most prevalent cancer among women worldwide and women living with HIV are at increased risk, especially in a resource-limited environment.

Objective:

This study aimed to determine levels of awareness, knowledge, uptake, and willingness to screen for cervical cancer among women receiving care in an HIV clinic at Dodoma Regional Referral Hospital (DRRH), Tanzania.

Methods:

Data were collected for a period of three weeks from July 21 to August 11, 2017 using a mobile phone data collection App. A total of 421 Women aged 18-50 years old were included in the study.

Results:

Majority of the women interviewed (n=306, 73%) were aware of cervical cancer. Among those who were aware, 84% (n=257) did not recall ever being screened for cervical cancer, and majority had a poor knowledge of cervical cancer. Educational level completed (p=0.01), income per month (p=0.02), age group (p<0.0001), and area of residence (p<0.0001) were all significantly associated to awareness of cervical cancer. Most of the women who have never screened (n=231, 91%) expressed willingness to be screened. Prior uptake of cervical cancer screening was associated with number of live births (p=0.001) and area of residence (p=0.04). And Willingness to screen was significantly associated with age groups (p=0.03) and the number of live births (p=0.03). Moreover, we found that younger age and urban residence was positively associated with awareness and uptake of cervical cancer screening. Willingness was found to decrease as age increased.

Conclusion:

The study found that despite older women’s higher risk of cervical cancer, those who indicated willingness to screen were younger. Additional education, health promotion, and integration of cervical cancer screening services is needed to improve cervical cancer awareness and screening uptake at the HIV clinic.