Abstract:
Cancer has become a major source of morbidity and mortality globally. About 86%
of the cases of cervical cancer occur in developing countries. Kenya has a population
of 10.32 million women 15 years and older who are at risk of developing cervical
cancer. In Kenya, cervical cancer represents 21% of all cancers in women. Cervical
cancer has a long development period taking as long as 10 years making it possible
to control through screening and treatment. With the overall burden of cervical
cancer projected to continue rising over the next 10 years, several projects in
reproductive health and Human Immunodeficiency Virus (HIV) offer cervical cancer
screening using visual inspection with acetic acid or visual inspection with Lugol’s
iodine (VIA/VILI). Naivasha County Referral Hospital is located in a cosmopolitan
area. The hospital offers VIA/VILI services in the family planning clinic. Family
planning counselling programs are a good opportunity to discuss the benefits of
cervical cancer screening with gynaecological examination more easily accepted
during a reproductive health consultation. The objective of this study was to
determine the factors that influence uptake of cervical cancer screening among
women attending the family planning clinic at Naivasha County Referral Hospital.
The study took place from June to July 2014. This study was a concurrent
triangulation mixed method study with descriptive cross sectional design, key
informant interviews and focus group discussions. A total of 384 women aged 18 –
49 years were enrolled through systematic sampling for the cross sectional study.
Data were collected through semi-structured questionnaires. After purposive
sampling seven key informant interviews and two focus group discussions were
conducted using interview guides among women treated at the family planning
clinic. Descriptive cross sectional data were analysed for descriptive statistics,
bivariate and multivariate analysis. Qualitative data were analysed manually using
themes. Participants who had been screened for cervical cancer were 15.4%. Some
factors were found to be associated with cervical cancer screening uptake. These
were employment status (p=0.023), usual treatment centre (p=0.041), risk of cervical
cancer (p=0.028), having heard of cervical cancer (p=0.006) and knowing someone
who had been screened (p<0.001). Common barriers that were identified were large
xiv
number of clients, inadequate screening rooms, inadequate information and
misconception of facts on cervical cancer screening. Hospital talks were the most
preferred source to get information related to cervical cancer. Of those who reported
having been screened, 2.3% were screened during the study period and 44.4% of
them had positive VIA/VILI results. In conclusion, the availability of screening
services at clinics that clients normally attend and where gynaecological examination
is expected to be easily accepted did not translate into high proportions in cervical
cancer screening uptake due to the various barriers. However, targeted screening
resulted in more positive cases being reported. A comprehensive strategy by policy
makers which includes programs in health facilities and outreaches should be
considered to ensure those reached are well informed. Healthcare providers should
generate a systematic sensitization program on cervical cancer that includes details
on causes and need for screening. There is also need to increase the number of
healthcare workers trained and provision of more resources for screening to make it
more accessible. This will lead to an increase in cervical cancer screening uptake.