Topic: Examining the Association between Education and the Willingness to be Screened for Cervical Cancer among Women in Southwestern Ethiopia�

Etornam Amesimeku

Introduction and Significance

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• leading cause of cancer-related deaths among Ethiopian women after breast cancer. (Tarekegn, Mengistu & Mirach, 2019).

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• Screening rate for cervical cancer is low among Ethiopian women. (Santesso et al., 2012)

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Introduction and Significance

• Factors affecting cervical cancer screening.
• geographic location
• lack of access to screening facilities
• socioeconomic and demographic features
• Negative attitude toward the disease and screening
• lack of information
• educational attainment. ( Aweke, Ayanto & Ersado, 2017, Saleem et al.,2019  )

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• Previous studies by Aweke, Ayanto & Ersado, 2017, Saleem et al.,2019 used descriptive analysis.

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Research Question

• Research Question

What is the association between women's education and their willingness to be screened for cervical cancer in southwestern  Ethiopia?

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• Hypothesis

There is a positive association between education and willingness to be screened for cervical cancer among southwestern Ethiopian women.

Methods

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• Data Source and Study design
• Cross-sectional survey 2008-2010: cervical cancer patients at Jimma University Teaching Hospital in southwestern Ethiopia. (Saleem et al.,2019  )

Measures

• Dependent variable = Willingness to be screened for cervical cancer which was treated as a dichotomous variable and was measured on a nominal scale.
• Independent variable = education which was dichotomous and was measured on a nominal scale
• Other covariates are; Age, location of the participant, heard of cervical cancer, religion, marital status, and parity.
• Statistical Analysis
• R version 4.2.2
• Descriptive statistics: socio-demographic characteristics of participants.
• Bivariate analysis was used to determine the association between the outcome variable and each covariate
• Multiple logistic regressions: identify factors associated with willingness to be screened for cervical cancer. Odds ratio,95% confidence interval, and a p-value < 0.05 statistical significance level.

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Result

The initial data included 154 women who visited the outpatient clinic between January 2008 and December 2010 with a variety of gynecological symptoms. 53 samples from the sample had missing values and were not included in the analysis. This left 101 instances for further analysis

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From this finding, 89.0% of the respondents had no education while 11% had an education. Findings from this study revealed that 77.23% of the respondents were not willing to be screened for cervical cancer unless they were sick.

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The results have shown that there were no statistically significant associations between willingness to be screened and education (p = 0.997), age (p = 0.131), location (p = 0.464), religion (p = 0.525), marital status (p = 0.259), or heard of cervical cancer (p = 0.798).

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However, a significant association was found between willingness to be screened and parity (p = 0.031), with those having higher parity being more willing to be screened.

Conclusion

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• The respondent's educational status was not statistically associated with the participant's willingness to be screened for cervical cancer. This finding is inconsistent with studies conducted in Addis Ababa((Shiferaw, et. al,2018), Tanzania (Mabelele, et. al,2018), and Bhopal(Bansal.et.al,2015). This may be because of the small sample size.

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• Furthermore, this study found an association between parity and willingness to be screened for cervical cancer. The findings of the respondents who were in the parity group of 6-10 and 11-14 were 3.8 and 11.9 times more likely to be willing to be screened for cervical cancer than those who are in the parity group of 0-5.

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• This is consistent with a study carried out in Tanzania(Kileo,et al,2015). This may be because women who have had more children have more experience with gynecological issues and may be more aware of the importance of cervical cancer screening.

Conclusion

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• Findings from this study revealed that 77.23% of the respondents were not willing to be screened for cervical cancer unless they were sick. This is inconsistent with the study conducted in Addis Ababa(Shiferaw, et. al,2018), where 86% of respondents were willing to undergo free screenings.

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• These disparities may be caused by the extent to which cervical cancer screening information is disseminated, which is critical to increasing participant health-seeking behavior.

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• From this finding, 89.1% of the respondents had no education and this shows why the awareness level is low among the study population.

Conclusion

• Limitation
• Since this study relied on a secondary dataset from one Ethiopian hospital, the findings may not be generalizable to other settings or populations.
• Response and Recall bias
• The study only included women seeking healthcare services at the hospital, which may lead to sampling bias that does not reflect the general population and limits the external validity of the study.
• Implication
• The lack of knowledge about cervical cancer screening is one of the biggest setbacks, so education and information dissemination should be used to increase awareness.
• further research in diverse settings and with a larger sample size would be helpful to understand the barriers and factors influencing cervical cancer screening in Southwestern Ethiopia.

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References

1. Aweke Y, Ayanto S, Ersado T. Knowledge, attitude and practice for cervical cancer prevention and control among women of childbearing age in Hossana Town, Hadiya zone, Southern Ethiopia: Community-based cross-sectional study. PLoS One. 2017;12(7):e0181415. doi:10.1371/journal.pone.0181415
2. Santesso N, Schünemann H, Blumenthal P, et al. World Health Organization Guidelines: Use of cryotherapy for cervical intraepithelial neoplasia. Int J Gynecol Obstet. 2012;118(2): 97-102.
3. Saleem A, Bekele A, Fitzpatrick MB, et al. Knowledge and awareness of cervical cancer in southwestern Ethiopia is lacking: A descriptive analysis. PLOS ONE. 2019;14(11). doi:10.1371/journal.pone.0215117
4. Bansal AB, Pakhare AP, Kapoor N, Mehrotra R, Kokane AM. Knowledge, attitude, and practices related to cervical cancer among adult women: A hospital-based cross-sectional study. J Nat Sci Biol Med. 2015;6(2):324.
5. Kileo NM, Michael D, Neke N, et al. Utilization of cervical cancer screening services and its associated factors among primary school teachers in Ilala Municipality, Dar es Salaam, Tanzania. BMC Health Serv Res 2015; 15: 552.
6. Shiferaw S, Addissie A, Gizaw M, et al. Knowledge about cervical cancer and barriers toward cervical cancer screening among HIV-positive women attending public health centers in Addis Ababa city, Ethiopia. Cancer medicine. 2018;7(3): 903-912.
7. Mabelele MM, Materu J, Ng’ida FD, Mahande MJ. Knowledge towards cervical cancer prevention and screening practices among women who attended reproductive and child health clinic at Magu district hospital, Lake Zone Tanzania: A cross-sectional study. BMC Cancer. 2018;18(1):565.

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References

• Acknowledgments
• Advisor: Don Des Jarlais
• Professor: Mayela Arana
• Vivian Wang

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Thank you!