Cervical cancer screening uptake among women attending Naivasha District Hospital.

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.