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

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TABLE OF CONTENTS

Title page –                          –              –          –                –              –          –            i

 Approval page     –        –          –                –              –          –            ii

Certification page –              –               –        –                –             –           –            iii 

Dedication                –        –                —            –           –           iv

Acknowledgement               –               –           –               –            –            –          v

List of table                            –               –           –               –            –            –          vi

List of appendix                    –               –           –               –            –            –          vii

Abstract       –                          –               –           –               –            –            –          viii

CHAPTER ONE:  INTRODUCTION

Background to the Study – —          –                       —          –           –           –           1

Statement of Problem –      –           –           –           –           –           4

Purpose –       –           –           –           –           –           –           –           –           –           6

Objectives –   –           –           –           –           –           –           –           –           –           6

Research questions –          –           –           –           –           –           –           –           6

Significance of the Study —       –           –           —          –           –           7

Scope of the Study –            –           –           –           –           –           –           –           9

Operational definition –       –           –           –           —          –           –           –           9

CHAPTER TWO: LITERATURE REVIEW

Conceptual Review –          –           —          –           –           –           –           –           11

Development of Cancer –   –           –           –           –           –           –           –           12

Cervical Cancer Development –    –           –           –           –           13

Cervical Cancer Staging –  –           –           –           –           –           –           –           15

 Incidence of Cervical cancer        –          –             –           –            –          –         16

Types of Screening, strengths and Weakness –              –           –           18

Theory Underlying the Study –      –           –           –           –           –           –           20

Application of the Model to the Study –    –           –           –           –           –           21

Empirical Review –   –           –           –           –           –           –           –           –           25

Attitude and Practice of Health Care workers –  –           –           –           –           26

Summary of Literature Review —  –           –           –           –           –           –           29

CHAPTER THREE: RESEARCH METHOD

Research Design –  –           –           –           –           –           –           –           –           30

Area of Study –         –           –           –           –           –           –           –           –           30

Population of Study –          –           –           –           –           —          –           –           31

Sample          –           –           –           –           –           –           –           –           —          32

Sampling Techniques –      –           –           –           –           –           –           –           32

Inclusion Criteria –   –             –           –           –           –           –           33

Instrument for Data Collection –    –          –           –           –           33

Validity of Instrument –        –           –           –           –           –           34

Reliability of Instrument –   –       –           –           –           –           34

Ethical Consideration –       –           –           –           –           –           –           –           35

Procedure for Data Collection –     –           –           –           –           –           –           35

Method of Data Analysis –  –           –           –           –           –           –           –           35

CHAPTER FOUR: PRESENTATION OF RESULTS

Introduction

Presentation Results                      –           –           –                       —          –           34

 Presentation of socio demographic data            –             –         –         34

Summary Findings –           –           –           –                       –           —          –           41

CHAPTER FIVE

Discussion, Conclusion and Recommendation

Discussion of major findings         –           –                       –                       –           42

Implications of findings      –           –           –           –           –           –           –           49

Limitation of the Study      –           –           –           –           –           50

Summary       –           –           –           –           –           –           –           –           –           51

Conclusion   –           –           –           –           –                       –           –           –           52

Recommendations  —          –           –           –           –           –           –           –           53

Suggestions for further Research         –           –           –           –           54

References – –           –           –           –           –           –           –           –           –           55

Appendices –              –           –            –          –           –          –           58

LIST OF TABLES

  1. Composition of sample for the study through proportionate

Stratified random sampling technique

  • Distribution of respondents based on age
  • Distribution of respondents based on duration of service
  • Distribution of respondents based on qualification
  • Mean, standard deviation and percentage responses on the attitude of  female

            health workers towards the uptake of cervical cancer screening

  • Frequency and percentage responses on female heath workers practices of

            cervical cancer screening

  • Mean, standard deviation and ANOVA on the attitude of female health workers

            towards the uptake of cervical cancer screening based on profession

  • Frequency percentage and chi-square statistics on the relationship between

            profession and practices of cervical cancer screening among female health workers.

LIST OF APPENDICES

  1. Sample questionnaire on the attitude and practice of cervical cancer screening among female heath workers in the hospital studied and factors that influence uptake of screening.
  2. Letter of introduction from head of department of nursing UNEC.
  3. Letter of introduction from the director of clinical services and training of Braithwaite memorial specialist hospital (BMSH), rivers state.
  4. Calculation of reliability co-efficient.
  5. Calculation of sample size.
  6. Calculation of sample size from each stratum using proportional stratified random sampling technique.
  7. Staff description of female staff (January 2013).
  8. Approval letter from hospital (UPTH) ethical committee

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 2nd 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

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