Assessment of the knowledge, attitude and practice of rural women of northeast Nigeria on risk factors associated with cancer of the Cervix ()
1. INTRODUCTION
Cervical cancer is the most common cancer and the leading cancer-related cause of death among women in sub Saharan Africa. An estimated 70,700 new cases occur each year, representing one quarter of all female cancers in sub Saharan Africa. The magnitude of the problem has been under recognized and under prioritized compared with the competing health priorities of infectious diseases such as HIV/AIDS, tuberculosis and malaria. Studies in the United States and Nigeria have indicated that the disease has the highest incidence among the lowest socio-economic groups [1].
Munoz and Bosch [2] reported that cervical cancer accounts for 15 percent of all cancers in women worldwide; about 2.5 million women suffer from cervical cancer, over 80 percent of all cases occur in developing countries where cancer of the cervix is the most common cancer among women. Annual deaths from cervical cancer worldwide are approximately 270,000 with nearly 85% of those deaths from resource poor nations [3].
High mortality of the disease recorded in most developing countries has been attributed mostly to late presentation consequent to poor level of awareness.
Cervical cancer incidence is low in young women but increases with age. The peak age of the incidence in some countries has been shown to be in the 50 - 59 year age group. However, Babatunde [4] reported that in Nigeria, the peak incidence has been found to be fifteen years earlier, that is, in the 35 - 45 year age group.
Cancer of the cervix aetiology is not well known. However, early sexual exposure, multiple sexual partners, multiparity, sexually transmitted diseases, cigarette smoking and use of combined oral contraceptives (barrier contraceptive is protective) play important roles in the development of cervical cancer.
Studies have identified the total number of sexual partners and age at first sexual intercourse as the two main risk factors irrespective of marital status. This is probably because of the high chances of infection with human Papilloma virus (HPV), most especially the high risk subtypes 16 and 18 [5]. Significant epidemiological observations related to cancer of the cervix have shown that it is rare in virgins and Nuns compared to married women and women who are sexually active [6].
In northern Nigeria, it is the commonest cancer while in southern Nigeria it is second to breast cancer.
The good news is that cervical cancer is largely, a potentially preventable disease if detected early. In the developed world, the incidence of the disease has decreased over the years due to the availability of well-organized cervical cancer screening programmes. Screening allows for the detection of the curable premalignant lesions. Therefore, creating and increasing awareness about the disease among women at risk will lead to desired increase in the response to screening with consequent early detection of the disease.
The objective of this study was to assess the knowledge, attitude and practice of rural women with cancer of the cervix.
2. METHODOLOGY
The study was carried out in 4 local government areas (LGAs) of north-eastern area of Nigeria; Konduga, Bama, Gwoza and Madagali over a period of eight weeks (April to June, 2010) to assess the knowledge, attitude and practice of rural women aged 15 - 55 years regarding risk factors of cancer of the cervix. A cross sectional descriptive study involving 1600 rural women aged 15 - 55 years randomly selected from 28 village units was carried out using a structured validated questionnaire by four groups of final year medical students during their eight week community based medical posting [7]. In each LGA a total of 400 questionnaires were administered to eligible from an average of seven village units from each.
A multi-stage sampling method was used to select respondents from each LGA, each having an average of four districts. In the first stage, one district was chosen randomly for the study. In the second stage, two village units were chosen from each district. And in the third stage, of the village units selected, two wards were selected from which households were selected using systematic sampling. In each household an eligible female was interviewed. However, in households where there were more than one eligible female, balloting was used to select the respondent. A total of 56 wards were selected from which the 1600 respondents were obtained.
The questionnaire comprised of four sections which sought information on the demographic background of the respondent, knowledge on ca cervix and position of the cervix in the body, attitude towards risk factors associated with ca cervix; and knowledge and practice of Pap smear test. The data was analyzed statistically using Epi Info software version 3.4.1.
3. RESULTS
Table 1 shows that the majority of the respondents are in the age group 15 to 34 (79.8%) while 85% are married. The majority (44%) are housewives while the rest are farmers, students, traders or work for the government (civil servants). Slightly over one quarter have no education, about 20% have Quranic education and the rest (56.5%) have some level of western education.