Factors affecting cervical cancer screening uptake, visual inspection with acetic acid positivity and its predictors among women attending cervical cancer screening service in Addis Ababa, Ethiopia

Springer Science and Business Media LLC - Tập 20 Số 1 - 2020
Atalay Mulu Fentie1, Tamir Birhanu Tadesse2, Gebremedhin Beedemariam Gebretekle1
1Social and Administrative Pharmacy Unit, School of Pharmacy, College of Health Sciences, Addis Ababa University, P.O.Box: 1176, Addis Ababa, Ethiopia
2Addis Ababa Health Bureau, Addis Ababa, Ethiopia

Tóm tắt

Abstract Background Cervical cancer is the second most common cancer in Ethiopia next to breast cancer. Despite the high burden of the disease and availability of free screening services in Ethiopia, uptake is still trivial. This study aims to identify factors associated with cervical cancer screening uptake, VIA (visual inspection with acetic acid) positivity and its predictors among women attending cervical cancer screening service in Addis Ababa, Ethiopia. Methods Concurrent mixed study approach of qualitative interview (n = 15) and cross-sectional study among 844 screened women was conducted from February to July 2018. A multistage sampling technique was employed to recruit survey participants from the selected health facilities while the key informants for an in-depth interview were selected purposively. Descriptive statistics were used to summarize the quantitative data and multivariable logistic regression was employed to explore factors associated with VIA positivity of the cervix among screened women. Qualitative data were analyzed using thematic analysis approach. Results The VIA positivity of the cervix was 10.3%. Mean age of study participants was 35.74 ± 7.6 years and women in the age group of ≥45 years were about > 8 times more likely to have VIA test positive result compared to younger women (≤24 years). Being single (AOR = 3.2, 95%CI: 1.4–7.31), widowed (AOR = 18.6, 95%CI: 3.8–91.2), initiating sexual intercourse early (< 16 years) (AOR = 2.72; 95%CI: 1.65–4.49), and having two or more lifetime sexual partners (AOR = 4.9; 95% CI: 1.31–8.75) were also found to be predictors of being VIA positive. Lack of awareness, inaccessibility of the screening service, cultural beliefs and negative perception towards cancer were found to be the major reasons for low uptake of cervical cancer screening. Conclusion The VIA positivity among screened women in Addis Ababa was found to be moderately low compared to reports in other parts of Ethiopia. Having multiple sexual partners, being older age and initiation of sexual intercourse at an early age were associated with VIA positivity of the cervix. Thus, concerted efforts must be taken to increase accessibility of screening services and improve awareness regarding cervical cancer screening.

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Tài liệu tham khảo

Torre LA, Islami F, Siegel RL, Ward EM, Jemal A. Global cancer in women: burden and trends. Cancer Epidemiol Biomarkers Prev. 2017;26(4):444–57.

Bray F, Ferlay J, Soerjomataram I, Siegel R, Torre L, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394–424.

Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136(5):E359–86.

Bruni L, Albero G, Serrano B, Mena M, Gómez D, Muñoz J, et al. ICO/IARC information Centre on HPV and cancer (HPV information Centre). Human papillomavirus and related diseases in EthiopiaSummary Report 17 June; 2019.

World Health Organization. International Agency for Research on Cancer and World Health Organization: GLOBOCAN 2018: estimated cervical cancer incidence and mortality; 2018. Available from: http://gco.iarc.fr.

EFMoH. National Cancer Control Plan 2016–2020. Dis Prev Control Dir. 2015:1–83 Available from: http://bmg.bund.de/en.html.

WHO. Guidelines for screening and treatment of precancerous lesions for cervical cancer prevention. WHO Libr Cat Data. 2013;22–7. Available at: https://www.who.int/reproductivehealth/publications/cancers/screening_and_treatment_of_precancerous_lesions/en/. Accessed 14 July 2020.

Shiferaw N, Salvador-Davila G, Kassahun K, Brooks MI, Weldegebreal T, Tilahun Y, et al. The single-visit approach as a cervical cancer prevention strategy among women with HIV in Ethiopia: successes and lessons learned. Glob Heal Sci Pract. 2016;4(1):87–98.

Kasa AS, Tesfaye TD, Temesgen WA. Knowledge, attitude and practice towards cervical cancer among women in Finote Selam city administration, west Gojjam zone, Amhara region, north West Ethiopia, 2017. Afr Health Sci. 2018;18(3):623–36. https://doi.org/10.4314/ahs.v18i3.20.

Aweke YH, Ayanto SY, Ersado TL. 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. https://doi.org/10.1371/journal.pone.0181415.

Nega AD, Woldetsadik MA, Gelagay AA. Low uptake of cervical cancer screening among HIV positive women in Gondar University referral hospital, Northwest Ethiopia: cross-sectional study design. BMC Womens Health. 2018;18(1):87Published 2018 Jun 7. https://doi.org/10.1186/s12905-018-0579-z.

Tefera F, Mitiku I. Uptake of cervical cancer screening and associated factors among 15–49-year-old women in Dessie town, Northeast Ethiopia. J Cancer Educ. 2017;32(4):901–7.

Bayu H, Berhe Y, Mulat A, Alemu A. Cervical cancer screening service uptake and associated factors among age eligible women in Mekelle zone, northern Ethiopia, 2015: a community based study using health belief model. PLoS One. 2016;11(3):1–13.

Erku DA, Netere AK, Mersha AG, Abebe SA, Mekuria AB, Belachew SA. Comprehensive knowledge and uptake of cervical cancer screening is low among women living with HIV/AIDS in Northwest Ethiopia. Gynecol Oncol Res Pract. 2017;4:20. https://doi.org/10.1186/s40661-017-0057-6 eCollection 2017.

Nigussie T, Admassu B, Nigussie A. Cervical cancer screening service utilization and associated factors among age-eligible women in Jimma town using health belief model, south West Ethiopia. BMC Womens Health. 2019;19(1):127. https://doi.org/10.1186/s12905-019-0826-y.

Belete N, Tsige Y, Mellie H. Willingness and acceptability of cervical cancer screening among women living with HIV/AIDS in Addis Ababa, Ethiopia: a cross sectional study. Gynecol Oncol Res Pract. 2015;2(1):6.

Bezabih M, Tessema F, Sengi H, Deribew A. Risk factors associated with invasive cervical carcinoma among women attending Jimma University specialized hospital, Southwest Ethiopia: a case control study. Ethiop J Health Sci. 2015;25(4):345–52.

Getahun F, Mazengia F, Mulunesh Abuhay Zelalem B. Comprehensive knowledge about cervical cancer is low among women in northwest comprehensive knowledge about cervical cancer is low among women in Northwest Ethiopia. BMC Cancer. 2013;13(2):1–7.

Mitiku I, Tefera F. Knowledge about cervical cancer and associated factors among 15-49 year old women in Dessie town, Northeast Ethiopia. PLoS One. 2016;11(9):1–10.

Dulla D, Daka D, Wakgari N. Knowledge about cervical cancer screening and its practice among female health care workers in southern Ethiopia: a cross-sectional study. Int J Womens Health. 2017;9:365–72.

Pourhoseingholi MA, Vahedi M, Rahimzadeh M. Sample size calculation in medical studies. Gastroenterol Hepatol Bed Bench. 2013;6(1):14.

Raykov T, Marcoulides GA. Intra-class correlation coefficients in hierarchical design studies with discrete response variables: a note on a direct interval estimation procedure. Educ Psychol Meas. 2015;75(6):1063–70. https://doi.org/10.1177/0013164414564052 Epub 2015 Jan 7.

Deksissa ZM, Tesfamichael FA, Ferede HA. Prevalence and factors associated with VIA positive result among clients screened at Family Guidance Association of Ethiopia, south west area office, Jimma model clinic, Jimma, Ethiopia 2013: a cross-sectional study. BMC Res Notes 2015;8:618. https://doi.org/10.1186/s13104-015-1594-x.

Ibrahim A, Aro AR, Rask, Pukkala E. Cervical cancer screening in primary health care setting in Sudan: a comparative study of visual inspection with acetic acid and Pap smear. Int J Womens Health. 2012;4:67–73.

Gedefaw A, Astatkie A, Tessema GA. The prevalence of precancerous cervical cancer lesion among HIV-infected women in southern Ethiopia: a cross-sectional study. PLoS One. 2013;8(12):e84519.

Obure J, Olola O, Swai B, Mlay P, Masenga G, Walmer D. Prevalence and severity of cervical squamous intraepithelial lesion in a tertiary hospital in northern Tanzania. Tanzan J Health Res. 2009;11(4):163–9.

Kassa RT. Risk factors associated with precancerous cervical lesion among women screened at Marie stops Ethiopia, Adama town, Ethiopia 2017: a case control study. BMC Res Notes. 2018;11:1–5.

Teame H, Addissie A, Ayele W, Hirpa S, Gebremariam A, Gebreheat G, et al. Factors associated with cervical precancerous lesions among women screened for cervical cancer in Addis Ababa, Ethiopia: a case control study. PLoS One. 2018;13(1):e0191506.

Abate SM. Cervical cancer : open access trends of cervical cancer in Ethiopia. Cerv Cancer. 2015;1(1):1–4.

Ghim S, Basu PS, Jenson AB. Cervical cancer : etiology , pathogenesis , treatment , and future vaccines. Asian Pac J Cancer Prev. 2002;3(July 2017):207–14.

Plummer M, Peto J, S F. Time since first sexual intercourse and the risk of cervical cancer. Int J Cancer. 2014;130(11):2638–44.

Schiffman M, Wentzensen N, Wacholder S, Kinney W, Gage JC, Castle PE. Human papillomavirus testing in the prevention of cervical cancer. J Natl Cancer Inst. 2011;103(5):368–83.

Biswas LN, Manna B, Maiti PK, Sengupta S. Sexual risk factors for cervical cancer among rural Indian women: a case-control study. Int J Epidemiol. 1997;26(3):491–5.

Ncube B, Bey A, Knight J, Bessler P, Jolly PE. Factors associated with the uptake of cervical cancer screening among women in Portland, Jamaica. N Am J Med Sci. 2015;7(3):104–13.

Morema EN, Atieli HE, Onyango RO, Omondi JHOC. Determinats of cervical cancer screening services uptake among 18-49 years old women seeking services at Jaramogi Oginga Odinga teaching and referral hospital. BMC Health Serv Res. 2014;6(14):1–5.

Gakidou E, Nordhagen S, Obermeyer Z. Coverage of cervical cancer screening in 57 countries: low average levels and large inequalities. PLoS Med. 2008;5(6):0863–8.

Lyimo FS, Beran TN. Demographic, knowledge, attitudinal, and accessibility factors associated with uptake of cervical cancer screening among women in a rural district of Tanzania: three public policy implications. BMC Public Health. 2012;12(1):22.

Teame H, Gebremariam L, Kahsay T, Berhe K, Gebreheat G, Gebremariam G. Factors affecting utilization of cervical cancer screening services among women attending public hospitals in Tigray region, Ethiopia, 2018; case control study. PLoS One. 2019;14(3):e0213546Published 2019 Mar 14. https://doi.org/10.1371/journal.pone.0213546.

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