Table of Contents
Title page i
Approval page ii
Certification iii
Dedication iv
Acknowledgements v
Table of Contents vi
List of Tables viii
List of Figures ix
Abstract x
CHAPTER ONE: Introduction
Background to the Study 1
Statement of the Problem 9
Purpose of the Study 10
Research Questions 10
Hypotheses 11
Significance of the Study 11
Scope of the Study 12
CHAPTER TWO: Review of Related Literature 13
1. Conceptual Framework Concept of cervical cancer, incidence, prevalence, screening, pattern, and woman Socio-demographic factors associated with the incidence, prevalence, screening and pattern of cervical cancer 2.Theoretical Framework 26
Health Belief Model (HBM)
The Protection Motivation Theory (PMT)
3.Empirical studies on the incidence, prevalence, screening and patterns of cervical cancer 30
4.Summary of Literature Review 35
CHAPTER THREE: Methods
Research Design 37
Area of the Study 37
Population for the Study 38
Sample and Sampling Technique 38
Instrument for Data Collection 38
Validity of the Instrument
Reliability of the Instrument
Method of Data Collection 39
Method of Data Analysis 39
CHAPTER FOUR: Results and Discussion
Results 40
Summary of Major Findings 56
Discussion of Findings 57
CHAPTER FIVE: Summary, Conclussions, and Recommendations
Summary 61
Conclusion 62
Recommendation 63
Limitations of the Study 63
Suggestion for Further Study 64
References 65
Appendices
Appendix A: Cervical Cancer Inventory Proforma 70
Appendix B: Letter of Introduction 72
Appendix C: Research question/hypotheses analysis 73
List of Tables
- Incidence of cervical cancer from 2000-2005 40
- Incidence rate of cervical cancer from 2000-2005 42
- Patterns of cervical cancer according to age 43
- Patterns of cervical cancer according to marital status 45
- Spatial patterns of cervical cancer 47
- Temporal patterns of cervical cancer 49
- Prevalence of cervical cancer 50
- Level of uptake of cervical cancer 51
- Chi-square analysis testing the relationship between the incidence of cervical cancer and age 53
- Chi-square analysis testing the relationship between the incidence of cervical cancer and marital status 54
- Chi-square analysis testing the relationship between the incidence of cervical cancer and location 55
- Chi-square analysis testing the relationship between the incidence of cervical cancer and uptake of cervical screening. 56
List of Figures
Fig 1: Bar Graph Showing the Incidence of Cervical Cancer from 2000-2005 41
Fig 2: Bar Graph Showing the Incidence Rate Of Cervical Cancer from 2000-2005 42
Fig 3: Bar Graph Showing the Incidence of Cervical Cancer according to Age 44
Fig 4: Bar Graph Showing the Incidence of Cervical Cancer According To
Marital Status 46
Fig 5: Bar Graph Showing the Incidence of Cervical Cancer According To Location 47
Fig 6: Bar Graph Showing the Incidence of Cervical Cancer According To Uptake of Cervical Screening. 52
Abstract
This study examined the incidence, prevalence, screening and patterns of cervical cancer among women attending University of Nigeria Teaching Hospital from 2000-2005. To achieve the purpose of the study, seven objectives with corresponding research questions were posed and three hypotheses were postulated. The descriptive research design utilizing the expost-facto type was used for the study. The instrument for data collection was a researcher designed Cervical Cancer Inventory Proforma (CCIP). Five experts in the Department of Health and Physical Education and Department of Science Education validated the proforma. The population for the study consisted of all the records of cervical cancer cases in University of Nigeria Teaching Hospital, Enugu from 2000-2005 which were 82 cases. No sampling was done as the population was not too large to handle. Data collected from the cancer registry of the health facility were used for analysis. Frequencies and percentages were used to answer the research questions while the chi-square statistic was used to test all the null hypotheses at 0.5 level of significance. The result of the study showed that the highest percentage of cervical cancer was recorded in 2004 (30.5%) while the lowest percentage was recorded in 2001 and 2002 (8.5%) respectively. The highest incidence of cervical cancer occurred among age group 61-100 years and above (35.4%), while the lowest occurred among age group 21 -30 years (1.2%). Incidence of cervical cancer was recorded more among married women (75.6%), than widowed/separated women (17.1%) and lowest incidence was found among single women (7.3%). Rural dwellers recorded a higher incidence of cervical cancer (56.1%) than urban dweller (43.9%). Highest prevalence rate (25 cases per 1000 women) was recorded in 2004 while the lowest occurred in 2000 (12 cases per 1000 women). Majority of the women (75.6%) had never gone for cervical cancer screening. There was no statistically significant difference in the incidence of cervical cancer according to age. There was statistically significant difference in the incidence of cervical cancer according to marital status and location. There was no statistically significant difference between the incidence of cervical cancer and uptake of cervical screening. In conclusion, cervical cancer was recorded highest in 2004, and lowest in 2001 and 2002.The highest number of cervical cancer occurred among age group 61- 100 years, among married and rural women. The highest prevalence rate of cervical cancer occurred in 2004, the number of women who had never undertaken cervical screening were higher (62) than those who had undertaken cervical screening (20).From the findings of the study, it is recommended that the government should provide screening facilities in the hospitals, provide drugs for the treatment of sexually transmitted infections and also mount regular monitoring exercises for cervical cancer through effective registration of cases. It is also recommended that cervical cancer screening should be made mandatory for all women and should also be integrated into existing medical services.
CHAPTER ONE
Introduction
Background to the Study
Globally, women are being afflicted by different organ cancers. Such organs in women are the breasts, uterus, ovaries among others. Cancer is a disease characterized by the abnormal growth of cells of the tissue of the organs affected. These abnormal growths affect such organs like, the breasts, cervix and uterus. The abnormal growth that affects the cervix is called cervical cancer. Cervical cancer has a negative impact on the lives of women worldwide, particularly those in developing countries. According to Ferlay (2002) cervical cancer threatens the lives of women, creates long-term problems for families and challenges health care system. He further stated that globally, 493,000 new cases of cervical cancer occur each year among women and 274,000 women die of the disease annually. He also stated that 83 per cent of new cases are in developing countries where screening programmes are not well established or effective. In most of these countries, cervical cancer is the leading cause of cancer deaths among women. In Nigeria, the national incidence of cervical cancer is 250/100,000(Adesokan, 2009).
According to Obinna and Ogundipe (2010), the World Health Organization (WHO) estimates that Nigeria has a population of 40.43 million women aged 15 years and older who are at risk of developing cervical cancer. WHO indicates that every year 14,550 women are diagnosed with cervical cancer and 9,659 die from the disease.
Adesokan (2009) defined cervical cancer as the malignant growth or immortalization of the cervix. According to her, it is the commonest form of female genital cancer in developing countries and the second commonest type of cancer in women. Within the context of this study, cervical cancer means a disease in which cells of the cervix become abnormal and start to grow uncontrollably, forming tumours. Usually, the disease affects the cervix which is part of the internal reproductive organs. Park (2009) stated that cervical cancer is a disease characterized by an abnormal growth of cells, ability to invade adjacent tissues and even distant organs and the eventual death of the affected patient if the tumour has progressed beyond that stage when it can be successfully removed. He further stated that cancer of the cervix follow a progressive course, from epithelial dysplasia to carcinoma in situ then to invasive carcinoma. Carcinoma in situ persists for a long time, more than 8 years on an average.
The cervix is the lower part of the uterus (womb). It connects the body of the uterus to the vagina (birth canal). It is made up of two types of cells, the squamous and the columnar cells. Approximately, 90 per cent of cervical cancer are made up of squamous cell carcinoma. This type of cancer originates in the thin, flat, squamous cells on the surface of the ectocervix, the part of the cervix that is next to the vagina. Another 10 per cent are of the adenocarcinoma type (Ezigbo, 2010). This originates in the mucus-producing cells of the inner cevix or endocervix near the body of the uterus. Occasionally, cervical cancer may have characteristics of both types and is called adenosquamous carcinoma or mixed carcinoma, (Benneth & Brown, 1999). The statistics for incidence of cervical cancer has been estimated for different countries as follows: Canada, 1,553; Mexico, 5,016; Brazil, 8,798; Britain, 2,880; Germany, 3,989; Italy, 2774. (U.S. Census Bureau, International Data Base, 2004). Usually, the cause of cervical cancer is not actually known but risk factors are attributed to infection by Human Papillomavirus and other factors.
Infection with the common Human Papillomavirus (HPV) is a cause of approximately 90 per cent of all cervical cancers. here are more than 80 types of HPV, about 30 of these can be transmitted sexually, including those that can cause genital warts. About half of the “high-risk” HPVs are associated with cervical cancer, they produce a protein that can cause cervical epithelial cells to grow uncontrollably. The virus makes a second protein that interferes with tumour suppressor that are produced by the human immune system. The HPV – 16 strain is thought to be a cause of about 50 per cent of cervical cancers (America Cancer Society 2011). Other risk factors to cervical cancer are as follows: lack of regular Pap test,
Smoking,sexual history,use of birth control pills,and exposure to Diethystibestrol.
Lack of regular Pap test (Papanicolaou test): Cervical cancer is more common among women who do not have regular test. The Pap test helps the doctor to identify abnormal cells which may eventually become cancerous, at this stage prompt treatment can be instituted. In women who are infected with HPV, smoking cigarette increases the risk of cervical cancer because nicotine suppresses the body immune system (American Cancer Society,2001). Nicotine concentrates on the cervical mucus with resultant reduction in the immunity of the Langerhan’s cells. Infection with Human immunodeficiency virus or taking drugs that suppress the immune system also increase the risk of cervical cancer. Women who have had many sexual partners have a higher risk of developing cervical cancer, (American cancer society, 2001). Also, a woman who had sexual intercourse with a man who has had many sexual partners may be at higher risk of developing cervical cancer. In both cases, the risk of developing cervical cancer is higher because these women have a higher risk of contracting HPV infection.
