Knowledge and health system factors influencing utilization of cervical screening services among sex workers in Kiambu County Hotspots, Kenya

Introduction: sex workers are more prone to acquisition and transmission of sexually transmitted diseases that incorporate Human Papillomavirus (HPV) and Human Immunodeficiency Virus (HIV). Less than 10% of sex workers in developing countries are screened for cancer of the cervix annually. In Kenya, majority of sex workers present with advanced/invasive disease. Methods: the study adopted a multistage sampling technique and 418 sexual workers were interviewed and data analyzed using Statistic Package of Social Science (SPSS) version 23. Bivariate analysis was conducted to examine possible associations between predictor variables and cervical cancer screening uptake. This was done using Pearson ́s Chi Square. Association was considered significant when p-value is equal to 0.05. Qualitative data was analyzed by thematic content analysis. Results: the results indicated that awareness of cancer of cervix (CaCX) (p=0.0001) and HCW attitude (p=0.040) were significant association with Cervical Cancer Screening (CCS) uptake. Conclusion: healthcare providers should generate a systematic sensitization program on what is involved in the screening process and the number of times to be screened so as to address some fears by clients who find the whole process a mystery. This may increase screening uptake especially with the preference for hospital healthcare talks. Research | Volume 2, Article 2, 05 May 2020 | 10.11604/pamj-oh.2020.2.2.21200 Available online at: https://www.one-health.panafrican-med-journal.com/content/article/2/2/full © Faith Mugai et al. PAMJ One Health (ISSN: 2707-2800). This is an Open Access article distributed under the terms of the Creative Commons Attribution International 4.0 License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Research PAMJ One Health ISSN: 2707-2800 (/www.one-health.panafrican-med-journal.com) The Manuscript Hut is a product of the PAMJ Center for Public health Research and Information.


Introduction
Sex work is regarded as a public health concern worldwide. The nature of the industry of "selling sex" to multiple sexual partners has a ripple effect on the health of people involved in the sex work cycle [1]. For instance, if one sex worker becomes infected with a sexually transmitted infection (STI), the whole pool of clients and their sexual partners are susceptible to being infected. Sex workers are a diverse group of women, who are from different social backgrounds [2]. Studies have shown that sex workers were likely to be less educated [3,4], however, it is difficult to generalize this to all sex workers as Vafaei [5] found no significant difference on the level of education between nonsex workers and sex workers in Melbourne. According to UNFPA/UNAIDS/Government of Brazil, sex workers start, on average, at 18 years of age and the majority are in their early twenties. The average age of first sexual intercourse globally was 16 years, especially in Asia, and some parents, because of poverty sent their underage daughters into sex work [6,7].
Cancer of the cervix represents nearly 12% of every single female malignancy around the world. High-hazard locales, with assessed age institutionalized rates more than 30 for each 100,000 female sex workers, this incorporates Central Africa (30.6%), Southern (31.5%), Melanesia (33.3%) and Eastern Africa (42.7%). Western Asia (4.4%) and Australia/New Zealand (5.5%) had the lowest rates.
According to GLOBOCAN, cervical cancer still remains the most well-known regenerative tumor among sex workers in Eastern and Middle Africa. Cancer occurrence and mortality estimated globally and locally and distributed by the World Health Organization in the GLOBOCAN reports affirm that there will be constantly rise in numbers of cervical cancer, all the more so in developing nations.
The mortality rate of more than 250,000 and incidences of more than 450,000 annually in least developed nations. It is anticipated that, 98% of cervical cancer mortalities will be from the developing nations by the year 2030, mainly because of underutilization of cancer of cervix screening tests [8]. In Kenya, Cervical disease remains the second most basic type of cancer among females between 15-69 years after breast malignancy. Millions of women are at risk of developing the cancer which is preventable and easily controlled through screening and treatment of pre-cancer and more recently by vaccination [9]. The general weight of cancer of cervix is anticipated to keep ascending throughout the following ten years in Kenya [10]. The purposes behind this incorporate an absence of cervical growth mindfulness among the populace in danger, low take-up of CCS, restricted access to human services administrations, absence of commonality with the idea of preventive facilities, dread of agony amid the screening or of the test outcomes and HIV contaminations [11]. Kenya started CCS programs after realized its burden and yet majority of women present with an advanced or invasive disease [9]. Including level 4 hospitals, but the proportion of cervical cancer screening

Methods
The research was carried out at selected hotspots in Kiambu A study done by Rweyemamu in their paper on ''situation of maternal health care in Tanzania'' also revealed that physical distance to the nearest health facility influences health seeking behavior among women [18]. Long distances to the CCS services lessen the probability of females getting to screening [19]. A community-based, cross-sectional survey uncovered that poor transportation is an extra issue [2]. A community perceptions study among 220 children, males and females in Bangladesh on CCS and cervical cancer found that low need for looking for help for indications, constrained accessibility of wellbeing administrations was among the most widely recognized obstructions to screening [20]. According to Kumakech and Kiguli-Malwadde [21,22], a big number of women in Uganda are too poor to afford transport costs to the regional referral hospitals which provide cervical cancer screening services.
However, many of the women in this study cited that they lived in the hospital area and therefore these were not barriers. However, the long waiting times and time taken off work increases the opportunity costs of seeking cervical cancer screening services making women weary of going for any follow-up appointments [23]. The study participants reported that female health workers were often very rude to them and this impacted on their interest to seek care. This has also been reported in Mbatia [24] in rural Kenya that when health workers showed insensitivity to women´s needs and did not communicate well, women preferred not be What is known about this topic  There is a low reported uptake of health services and in particular cervical cancer screening among the respondents already with cancer of cervix;  The fact that sex work is illegal in Kenya makes the utilisation of screening skewed.

What this study adds
 Gives an idea of the magnitude of the health systems that affect the sex workers. Which proves that availability of services is a key component;  A relationship between sociodemographic and utilisation of screening services.

Competing interests
The authors declare no competing interests.

Authors' contributions
All the authors have read and agreed to the final manuscript.

Acknowledgments
The authors would send special gratitude to former sex workers who played key role in finding the respondents from the hot spots. Sincere gratitude to all Kiambu county director of health and respondents who took part to make this study successful. Table 1: awareness of cancer of cervix