ATTITUDE AND PRACTICE OF CERVICAL CANCER SCREENING AMONG FEMALE HEALTH WORKERS IN UNIVERSITY OF PORT HARCOURT TEACHING HOSPITAL

ABSTRACT
 
The purpose of the study was to examine the attitude and practice of female health workers towards cervical cancer screening (CCS) in the university of Port Harcourt teaching hospital (UPTH), Rivers state. The descriptive survey design was adopted for the study. A sample size of 352 was used for the study. This sample size was approximately 40% of the target population. This sample was considered representative of the population with an accurate level of more than 97%. A self-structured questionnaire was the instrument used for data collection. The validity of the instrument was ascertained by the project supervisor and two (2) other senior lecturers one being a specialist in measurement and evaluation.The reliability indices were established using Test-retest. The scores obtained were correlated using Pearson’s product-moment coefficient of correlation to obtain the reliability co-efficient (r) of 0.94 which was consideredadequate. Data analysis was done using statistical software package, for Social Sciences (SPSS) version 20.0. Descriptive statistics of percentages, mean, standard deviation and mean cut-off criterion of 2.5 as well as inferential statistics (chi-square and Analysis of variance (ANOVA)) were used to analyse the data. Findings showed that the female health workers have negative attitude and poor practice of CCS. Profession has no influence on their attitude and practice.
CHAPTER ONE
INTRODUCTION
Background to the study
Cervical cancer remains the commonest genital tract cancer yet it is largely preventable by effective screening programmes. Considerable reduction in cervical cancer incidence and deaths has been achieved in developed nations with systematic cytological smear screening programmes.(Babatunde&Ikimalo,2010; Mutyaha,Mmiro& Weiderpass,2006).
 
One woman dies of cervical cancer in every two minutes worldwide, 80% of these deaths occur in developing nations.(Okunnu 2010 ).
For every two women who die of breast cancer, one dies from cervical cancer worldwide. It is 2^nd most common cancer in women worldwide and most common in African women thus the most leading cause of cancer deaths in women in sub-Saharan Africa including Nigeria with a very poor 6-year survival rate.(Okunnu,2010; Obi,Ozumba& Onyebuchi,2008; Oguntayo Samaila,2008;Papadopoulos,Devaja,Cason &Raji,2000).
 
Most cervical cancers are caused by HPV infection with two prominent types, (16 and 18) which are responsible for about 70% of all cases. [National cancer institute, 2007]. They can both be prevented and detected early. Prevention can be achieved by immunizing young girls between the ages of 9-16 [before the age of sexual debut] while cervical screening is used for early detection. (Qiao, 2008, WHO, 2006).
 
Studies conducted in some parts of Africa, Nigeria inclusive reported that in Benin Nigeria, Carcinoma of the cervix constitute 74.6% of all malignant gynaecological tumors with stage IIb and above constituting 67.6%of all cases; in Zaria it accounted for 66.2% with advanced carcinoma of the cervix stage IIb and above making up 58.7% of the cases. In Kenya, 55% of patients presented with stage III diseases and beyond (stage iv-v).
 
Otolorin&sule (2008) also reported that in Nigeria, cervical cancer affects 29women per 100,000 women. Some factors have been implicated in this tragic and unnecessary loss of lives. WHO (2006), observed that many women do not attend screening programmes because of ignorance of the risk for cervical cancer and/or the benefit of screening in its early detection and cure.
 
Qiao (2008) from his clinical study reported that well organized cervical cancer prevention programmes based on primary screening with cervical cytology lead to impressive reductions in  cervical cancer rates in developed Countries. Screening in the UK saves up to 5000 lives per year (Olaitan, 2008).
 
Consequently in industrialized world, effective screening programme has helped identify precancerous lesions at a stage when they can be easily treated thereby leading to impressive reduction in cervical cancer death rates while lack of screening programmes in poorest countries means that the disease is not identified until it is too late resulting in high mortality (Ojiyi&Dike, 2010 ; Qiao, 2008).This is similar to what is prevalent in Nigeria where most cervical cancer cases seen in health facilities are in stages II and above.
 
Cervical screening is a health intervention used on population of woman at risk of developing cervical cancer [WHO, 2008]. It is not undertaken to diagnose the disease but to identify individuals with a high probability of having or developing the disease at the precancerous stage. The individual may actually feel perfectly healthy and may see no reason to visit a health facility. Preventing the incidence of cancer causing Human papilloma virus infection, significantly reduces the incidence of cervical cancer and the burden of the sickness on women, family and the nation at large.
 
There are different screening programmes that can be used to detect the precancerous changes so as to prevent the development of the diseases and curb its serious consequences. Some of these programmes include; visual method such as Pap smear or visual inspection with acetic acid (VIA), visual inspection with Lugol’s iodine (VLI), care Human papilloma virus [care-HPV], HPV-DNA based screening among others.
 
The screening programmes are performed by qualified health professionals and they serve as models to the public. They are generally believed to be well informed on health issues better than the public. Their attitude and practice transcends to society health behaviors. Female Health workers are expected to have a better understanding of the benefits of cervical screening than women in other spheres of life, thus be effective agents in creating and disseminating information about the importance of the screening programmes for the sexually active, post menopausal women as well as immunization for the girl child between the ages of 9- 16 years by example. Thus their attitude and practice towards screening for cervical cancer have a far reaching implications to its acceptance consequently contributing to the reduction in death of women from cervical cancer.
 
Statement of problem
Cervical cancer screening (CCS) has been identified as an effective instrument in early detection as well as cure for cervical cancer. Yet women are still dying of cervical cancer, which could have been prevented given the new technologies available. It has been observed that the commitment of health workers towards exclusive breastfeeding has served as a good motivator to the mothers, this has resulted in  asignificant reduction of infant mortality. Ana, Mercedes, Jeremy,Jose,( 2001) observed thatexclusive breast feeding of infants aged 0-3 months and partial breast feeding for the remainder of the first year would prevent about 52 000 infant deaths a year in Latin America. They further observed that, promotion of breast feeding has an important role in increasing survival of infants. In the same vein if the female health workers are committed to cervical cancer screening, thiswill motivate the women to participate in the screening,thushelping in reduction of the incidence and mortality as has been observed with that of exclusive breastfeeding.
 
Women in other spheres of life without much knowledge about health issues look up to female health workers for positive health behaviours such as participating in the uptake of CCS, thus female health workers have strong influence on women and as such are role models in health issues. Reviewed literature revealed that there seem to be a problem of uptake of CCS among the womenfolk resulting in high incidence, mortality and poor treatment outcome of cervical cancer. It is in the light of these that the following pertinent questions are seeking for answers; What is the attitude of female health workers towards the uptake of cervical cancer screening; how do the female health workers in the studied institution practice CCS;  how does profession influence the attitude of female health workers towards the uptake of cervical cancer screening; and how does profession influence the practice of cervical cancer screening by female health workers?
 
Purpose
The   purpose of   the study is to examine the attitude   and practice   of   female health workers towards cervical cancer screening at university of Port Harcourt Teaching Hospital (UPTH), Rivers state.
 
Objectives
The objectives of this study are to;

1. determine the attitude of female health workers towards cervical cancer screening in the hospital studied.
2. determine how the female health workers in the studied institution practice CCS.
3. determine how profession influences attitude of cervical cancer screening among female health workers in the studied hospital
4. determine how profession influences the practice of cervical cancer screening by female health workers in the studied hospital

 
Research Questions

• What is the attitude of female health workers towards the uptake of cervical cancer screening?
• How did the female health workers in the studied institution practice CCS.
• How does profession influence the attitude of female health workers towards the uptake of cervical cancer screening?
• How does profession influence the practice of cervical cancer screening by female health workers?

 
Significance of the study
Early detection is the key to better treatment outcome of cervical cancer. However in the developing countries, Nigeria inclusive, this effective tool of early detection still seems to be a mirage.
 
Health care professionals are important predictors of the use of cervical cancer screening (Nwobodo&Malami, 2005). Being knowledgeable about cervical screening for cancer serves as an advantage thus they serve as effective agents in creating awareness about screening, its usefulness in prevention and better treatment outcome of cervical cancer.
 
This study will help in identifying the level of health workers commitment to utilization of cytology services which in turn will motivate uptake of screening among women folk and as such reduce deaths from cervical cancer.
 
The findings of this study will also identify the attitude of female health workers towards screening and in turn inform the hospital administration on policies that will promote uptake among female health workers, thereby ensuring their commitment to the uptake.
A positive attitude involves personally participating in the uptake and being fully committed to it. By so doing, the health worker will be in a better position to encourage the women to participate; she calms their fear and disabuses the misconception and erroneous belief about screening, thus helping to reduce mortality and poor treatment prognosis.
 
A negative attitude indicates lack of interest in the uptake and in creating awareness among women. Thus lacks the required instrument to empower the women against the disease and save them from the preventable and curable disease.
 
The findings of the study will help determine the practice of female health workers towards the uptake of cervical screening. When the female health workers participate in the uptake, creating awareness through health education and health counseling about the disease and its prevention (immunization); refer patients for screening, conduct the screening test and interpret the result  for the patients, they are actively working with the formidable health care team in the fight against cervical cancer. These healthy practices improve their effectiveness in encouraging the women to utilize the service.
 
The findings will also inform the policy makers especially in the health sector to accord high priority to cervical screening, make policies, create programmes and allocate sufficient funds to encourage procurement of vaccines, screening equipment, promote follow-up of results of screening, early diagnosis and treatment of identified cases. These programmes of activities will also form part of the health care service of health institution and thus reduce mortality from cervical cancer. Also, training institutions for health workers should incorporate practical skills on cervical screening in their training centre.
 
Scope of study
The study is delimited to attitude and practice of female health workers in UPTH towards cervical cancer screening. Variables under studied include attitude, practice and influence of profession on attitude and pratice of female health workers towards cervical cancer screening and also factors that influence the uptake of cervical cancer screening.
 
Operational Definitions.
Practice of CCS refers to being screened, participating in pre and post-test counseling, conducting the screening test and interpreting the result.
Attitude of CCS refers to various reasons for not screening patients, not referring patients for screening and not getting screened.
Health professionalsThe female health workers in the study include Nurses, Doctors, Medical laboratory Scientist, Radiographers and Pharmacists