Cervical Cancer and Pap Smear Awareness and

Utilization of Pap Smear Test among Federal Civil

Servants in North Central Nigeria
Hyacinth I. Hyacinth1,4*, Oluwatoyosi A. Adekeye2, Joy N. Ibeh3, Tolulope Osoba4
1 Department of Microbiology Biochemistry and Immunology, Morehouse School of Medicine, Atlanta, Georgia, United States of America, 2 National Center for Primary
Care, Morehouse School of Medicine, Atlanta, Georgia, United States of America, 3 Department of Pediatrics, University College Hospital Ibadan, Ibadan, Nigeria, 4 Faculty
of Medicine, Department of Public Health, University of Liverpool, Liverpool, England, United Kingdom

Abstract
Cervical cancer is a leading cause of cancer death in women in developing countries. A key factor linked to the relatively
high levels of cervical cancer in these populations is the lack of awareness and access to preventive methods. This study
aimed to determine the level of awareness of cervical cancer and Papanicolaou test (Pap smear test) and factors associated
with the utilization of Pap test among female civil servants in Jos. Data was obtained from female workers (n = 388) aged
18–65 years in a Nigerian Federal establishment. Participants were randomly approached and instructed to complete
validated questionnaires. Data was analyzed using Chi-square, t-tests and logistic regression analysis to determine if there
was an association between variables and identify any predictors of awareness and utilization of the Pap test. Cervical
cancer and Pap smear test awareness was 50.9% and 38.6% respectively, with the media as the major source of information.
Pap smear test utilization rate was 10.2%, with routine antenatal care (ANC) as the major reason for getting screened.
Personal barriers to screening include the lack of awareness, and belief that cervical cancer is not preventable. Opportunistic
screening, mass media campaigns and ANC education were suggested as ways of improving awareness and utilization of
cervical cancer screening services.

Citation: Hyacinth HI, Adekeye OA, Ibeh JN, Osoba T (2012) Cervical Cancer and Pap Smear Awareness and Utilization of Pap Smear Test among Federal Civil
Servants in North Central Nigeria. PLoS ONE 7(10): e46583. doi:10.1371/journal.pone.0046583
Editor: Rui Medeiros, IPO, Inst Port Oncology, Portugal
Received July 13, 2012; Accepted August 31, 2012; Published October 1, 2012
Copyright: ß 2012 Hyacinth et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding: The authors have no funding or support to report.
Competing Interests: The authors have declared that no competing interests exist.
* E-mail: hhyacinth@msm.edu

Introduction these countries are reported to have the lowest incidence and
prevalence of cervical cancer and related morbidity and mortality
Cervical cancer is a female genital cancer that results from in the world [11,12]. The high incidence and prevalence of
infection with the human papilloma virus, commonly serotypes 16 cervical cancer in developing countries such as Nigeria is highly
and 18 [1,2]. This infection results in transformation of the suggestive of health care access issues. For example, a pilot study in
cervical epithelial cells, first to precancerous lesions and then to Jos, Nigeria reported an estimated annual incidence rate of
frank cancer [3,4,5]. Cervical cancer is the fourth leading cause of cervical cancer in 77/1,000 women [13] and mortality of 3000–
female genital cancers and sixth cause of female cancer death in 8000 [14,15]. These estimates are much higher than those of the
the United States [6]. Globally, it is the most common cause of United States [6], or Europe [12] where there is regular cervical
female genital cancer and female cancer deaths [7]. Over 75% of cancer screening.
the annual cases of cervical cancer and cervical cancer related Uptake of Pap smear test in Nigeria is very low [16,17,18] even
morbidity and mortality occur in developing countries [7] usually when compared with other developing countries [19,20] further
with less comprehensive cervical cancer prevention programs. In contributing to the reported [8] levels of cervical cancer and its
Nigeria, the most recent government estimates put the number of attendant morbidity. It has been reported that almost two thirds of
new cases at 25,000 per year [8], while there are no official figures cervical cancer cases in Nigeria present at stage III or later, and
for North Central Nigeria where this study was carried out. that a single one time screen could potentially save more than
Despite the high mortality from this disease in developing 6,000 women annually [21]. Various reasons have been suggested
countries, it is preventable and it morbidity and mortality could be for the low utilization of Pap smear test screening in Nigeria. The
greatly reduced using preventative health methods such as safe two main reasons are lack of awareness and poverty
sexual practice and most importantly the Pap test. The Pap smear [16,18,21,22,23]. Adewole et al [21] reported a strong relationship
test is currently the most widely used approach for preventing between poverty and incidence or prevalence of cervical cancer in
cervical cancer, via a 1–3 yearly screening depending on the low income countries in Africa. Such countries, including Nigeria
environment [9,10]. The benefits of Pap smear test in preventing with high incidence of cervical cancer, were reported to have
cervical cancer has been demonstrated by in countries like lower rates of screening for the condition compared with other
Finland, Sweden with National screening programs. As a result, populations reporting higher levels of awareness. Some investiga-

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 Cervical Cancer and Pap Smear Test and Utilization

tors concluded that increased awareness may not translate into Table 1. Socio-demographic characteristics of respondents
increased utilization, because studies among healthcare workers, and their practice of Pap smear test screening.
medical students and physicians, who have a high level of
awareness demonstrated a lower level of utilization than non-
healthcare workers or students [17,24,25]. Variables Frequency Percentage
Anecdotal evidence suggests that Federal civil servants in
Age
Nigeria are likely to be more educated and posses higher levels of
socioeconomic status compared with the general Nigerian 20–35 120 32.3
population. Thus we hypothesized that the level of awareness of 36–55 243 65.3
the Pap smear test and cervical cancer is directly related to the .55 9 2.4
level of utilization. Furthermore, that both awareness and Marital status
utilization would be higher among civil servants than reported
Single 55 15.0
for the general population.
Married 284 77.6

Materials and Methods Widowed 17 4.6

Divorced 10 2.7
The study was approved by the Plateau state Ministry of Health
Educational level
and the University of Liverpool Research Ethics Committee. Due
Primary 33 9.4
to security concerns, the prisons and police stations were excluded.
After estimating the required sample size [17], women ages 18 to Secondary 73 20.9
65, who working at a Federal non-healthcare establishment were Tertiary 244 69.7
randomly approached to complete a validated questionnaire Religion
[17,25]. Consenting participants were allowed 1–2 days to Muslim 4 1.0
complete and return the questionnaire. Of the 450 questionnaires
Christianity 380 99.0
given out, 388 were completed and returned resulting in an 86.2%
response rate. The data from the questionnaires were entered into Number of children
a spreadsheet, categorical data were re-coded into numerical 1–3 92 30.6
variables and data analysis done using SPSS version 10 for 4–6 193 64.1
Windows. 7+ 16 5.3
Univariate analyses using frequency distribution and means
Number of sexual partners
were carried out to describe the characteristics of respondents. Bi-
Only one 281 98.6
variate analysis was conducted using Chi-square and t-test to
investigate associations. Finally, multivariate logistic regression was Two or more 4 1.4
done to investigate factors that independently predict cervical How did you hear about cervical cancer?
cancer and Pap smear test awareness and/or utilization of Pap Media 110 57.6
smear test. Hospital 43 22.5
Friends 26 13.6
Results
Relatives 4 2.1
Socio-demographic characteristics of respondents Others 8 4.2
A total of 388 questionnaires out of the 450 given out were How did you hear about Pap smear test?
completed and returned (response rate of 86.2%). The mean age Media 69 49.6
was 38.867.3 years (20–61 years), with 65.3% in the 36–55 year
Hospital 36 22.5
old range, 99.0% were Christians and 77.6% are married.
Majority (69.7%) of respondents had some form of tertiary Friends 15 13.6
education with the mean number of children reported as 4.161.6 Relatives 7 2.1
and ranging from 1–10. More than two-thirds of respondents had Others 12 4.2
4–6 children, while only 1.0% of reported having more than one When was your last Pap smear test?
sexual partner in the last ten years (table 1), with the mean being 1–3 years ago 21 80.8
1.0160.12 partners per respondent.
.3 years ago 5 19.2
How regular is your Pap smear test
Cervical cancer and Pap smear test awareness screening?
Approximately 50.9% of respondents reported having heard
Regular 26 76.5
about cervical cancer. Twelve and half percent believed the
disease to be treatable, while 45.6% felt it could be prevented. Irregular 8 23.5
Slightly over 38% reported having heard about the Pap smear test doi:10.1371/journal.pone.0046583.t001
and 27.0% said that regular screening with Pap smear test can
prevent cervical cancer (Table 2). A little less than 50% of
relatives (22.5%). When asked about the risk factors for cervical
respondents who had heard about Pap smear test got their
cancer, 27.6% of respondents identified having multiple sexual
information from the media, followed by the hospital setting with
partners (MSP) as a risk factor. Early coitarche (20.3%), cigarette
25.9% (table 1). Out of the 50.9% (Table 2) of respondents who
reported having an awareness of cervical cancer, majority (57.6%) smoking (17.2%), having a sexually transmitted disease/infection
reported obtaining their information from the media, while the (14.7%), oral contraceptive use (9.9%), high parity i.e. .3 children
second most common source of information was friends and (5.7%), and HIV/AIDS (1.7%) were among other factors

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 Cervical Cancer and Pap Smear Test and Utilization

Table 2. Showing the level of awareness of cervical cancer, perception of its treatability or preventability, awareness of Pap smear
test and its role in preventing cervical cancer among respondents.

Variables No. of Respondents (%)

Yes No

Have you heard of cervical cancer? 191(50.9) 184(49.1)

Cancer of the cervix can be treated? 45(12.5) 315(87.5)
Can cancer of the cervix be prevented? 160(45.6) 191(54.4)
Have you ever heard of Pap smear test? 136(38.6) 216(61.4)
Can regular screenings with Pap smear test prevent cancer of the cervix? 89(27.0) 241(73.0)
Have you ever had a Pap smear test done? 34(10.2) 300(89.8)

doi:10.1371/journal.pone.0046583.t002

identified by respondents as risk factors for cervical cancer. Less status, educational level, number of children, number of sexual
than four percent had no idea about the risk factors for the disease. partners, belief that cervical cancer is treatable or preventable, and
belief that regular screening with Pap smear test can prevent
Utilization of Pap smear test among respondents cancer. It indicates that cervical cancer awareness was associated
Utilization of Pap smear test at least once among this population with marital status (with singles having the highest level of
was 10.2% (table 2), 89.8% reported never having tested. Of the awareness), educational status (with respondents who possess
10.2% that had tested at least once, 65.7% reported testing as part tertiary education having the highest level of awareness) and
of routine antenatal clinic (ANC) test, 11.4% reported that it was perception about cervical cancer,(with individuals who believe that
based on a doctor’s recommendation, while 22.9% reported that it cervical cancer is treatable or preventable by having regular Pap
was their personal initiative. All the respondents who had ever had smear test, having the highest level of awareness), p,0.01.
a Pap smear test did so at a secondary or tertiary health center. Similarly, table 4 shows that there is a relationship between
76.5% of respondents, who have ever had a Pap smear test, awareness about Pap smear test and respondent’s age (with women
reported a regular screening pattern i.e. at least once every 1–3 older than 55 years tend to be more aware about the Pap smear
years. About 80% of respondents who have ever had a Pap smear test). Also, Proportionally more married women, women with
test reported testing within the last 1–3 years, which parallels the tertiary education, those with 4–6 children, those who believe it is
result on screening regularity (table 1). Of the 89.8% that had a preventable disease, and those who believe that regular Pap
never tested, 14.3% reported inability to locate the facility, 57.1% smear test is the way to prevent cervical cancer, had heard about
reported that they had never heard of the test, 6.7% reported Pap smear test. In addition, table 5 shows that respondent’s
being anxious about a positive test result, 4.3% reported that they perception of the disease was associated with utilization of Pap
never thought about having cancer, 9.1% reported that they do smear test. Those respondents who believed that cervical cancer is
not consider it important, 1.9% said they feel the procedure is not treatable, but preventable via regular screening were more
embarrassing, while 6.7% reported that will rather wait until a likely to have had a Pap smear test. Similarly, there was a
later date. relationship between utilization of Pap smear test and respondent’s
Respondents agreed that the level of awareness can be educational level (respondents with tertiary education were more
improved, with 37.0% reporting that this can be done through likely to have had a Pap smear test) and their awareness about Pap
the provision of information about cervical cancer and Pap smear smear test (p,0.01). Other factors significantly associated with
test during ANC visits. Another 11.0% reported that this can be utilization of Pap smear test includes; age (with older women (.55
done using government policies, probably legislations that years) more likely to have had a Pap smear test, p,0.01),
mandates some form of cervical cancer education in schools, etc. awareness about Pap smear test (p,0.01) and general perception
About 37.0% reported that radio and television advertisement can of Pap smear test as a preventative procedure for cervical cancer.
help in improving the level of awareness, while another 15.0%
reported that special cancer education program can be used for Multi-variate statistical analysis
this purpose. Multi-variate analysis was done using multiple logistic regression
models to investigate the predictors of awareness of cervical
Bi-variate analysis cancer, Pap smear test, and utilization of Pap smear test in the
A t-test showed that there was no statistically significant study population. The result of the analysis showed that none of
difference in the mean age of respondents who had knowledge the variables (age category, marital status, educational level,
of cervical cancer compared with those who did not (39.067.8 vs. number of children, source of cervical cancer information, belief in
38.766.3, p = 0.607). The same was true for those who had heard the treatability of cervical can or preventability of cervical cancer
of the Pap smear test compared with those who had not (39.267.7 using regular Pap smear test) significantly predict level of
vs. 38.267.3, p = 0.267). On the other hand, there was statistically awareness of cervical cancer. A similar analysis was done with
significant difference in the mean age (44.267.8 vs. 38.167.2 the dependent variable being awareness about Pap smear test and
years) of respondents who had a Pap smear test done compared it showed that the only significant predictor of awareness was a
with those who had not, p = 0.02. belief that cervical cancer is a preventable disease (p = 0.04,
Table 3 is a Chi-square test indicating the proportional CI = 0.02–0.98, p = 0.04). On the other hand, a similar analysis
distribution of respondents and thus the association between with utilization of Pap smear test as the dependent variable did not
awareness about cervical cancer and respondent’s age, marital reveal any significant predictor.

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 Cervical Cancer and Pap Smear Test and Utilization

Table 3. Indicates the proportional distribution of respondents that have or have not heard about cervical cancer by certain socio-
demographic variables and perception of cervical cancer.

Variables Response n(%) Chi-Square Value P-value

Yes No

Age category (years) 0.13 0.93

20–35 58(50) 58(50)
36–55 114(49) 120(51)
.55 4(44) 5(56)
Marital status 16.41 ,0.01
Single 29(57) 22(43)
Married 149(52) 135(48)
Widowed 4(24) 113(76)
Divorced 0(0) 10(100)
Educational level 46.36 ,0.01
Primary 0(0) 33(100)
Secondary 34(47) 39(53)
Tertiary 149(62) 91(38)
Number of children 2.11 0.34
1–3 53(58) 39(42)
4–6 91(48) 97(52)
$7 8(50) 8(50)
Number of sexual partners 5.34 0.02
Only one sexual partner 162(58) 119(42)
Two or more sexual partners 0(0) 4(100)
Believe that cervical cancer is treatable 28.02 ,0.01
Yes 41(91) 4(9)
No 150(49) 156(51)
Awareness of cervical cancer preventability 81.45 ,0.01
Yes 128(81) 30(219)
No 59(32) 128(68)
Regular Pap smear test can prevent cervical cancer 41.75 ,0.01
Yes 73(82) 16(18)
No 97(42) 135(58)

doi:10.1371/journal.pone.0046583.t003

Discussion information about cervical cancer or Pap smear test. Thus the
media plays an important role in disseminating health educational
This study, done among female federal civil servants showed information with the next most common source being the
that cervical cancer awareness was 50.9%, (table 2) a value that is hospitals. Other authors have shown that the role of the media
slightly less than what was reported among women in South in disseminating health maintenance information cannot and
Eastern Nigeria [18]. And significantly lower than was reported should not be discounted when health education is being carried
(71% awareness) among female undergraduates in South Western out [28,29]. A health education program about cervical cancer
Nigeria [17]. The significant difference with the study among that incorporates the media could be very impactful in our
female undergraduates might be because this study involved a environment. The National Health Service (NHS) stated that the
large portion of the ‘‘lay public’’ as opposed to study by Ayinde et involvement of prominent public figures like movie stars or music
al which was done among female undergraduates, a good portion artists can go a long way. For instance, they reported an increase
of whom were medical student. As seen in table 2, 38.6% of in uptake of cervical cancer screening when a prominent movie
respondents were aware of Pap smear test, which is a much higher star was brought in to tell her story about how cervical cancer has
level of awareness when compared with what was reported impacted her life negatively [30]. Thus a well funded media
university undergraduates [17] or sexually active women non-civil campaign could change the current picture in Nigeria. Since this
service women [22]. But it is noted that this level of awareness was study did not attempt to make a distinction between the type of
lower than had been reported among Kuwaiti, Jordanian, Indian media vehicle, inference cannot be made as to which will be more
and Saudi Arabian (developing countries like Nigeria) female effective. But anecdotal evidence suggests that most public offices
outpatient population [19,20,26,27]. About half of the respondents in Nigeria have a radio and as such it could be inferred that
still cited the media followed by hospitals as their source of campaigns done via radio might have a wider reach. About 40%

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 Cervical Cancer and Pap Smear Test and Utilization

Table 4. Association between respondent’s level of awareness about Pap smear test there socio-demographic characteristic and
perception of cervical cancer.

Variables Response n(%) Chi-Square Value P-value

Yes No

Age category (years) 5.42 0.06

20–35 31(28) 80(72)
36–55 84(39) 132(61)
.55 5(56) 4(44)
Marital status 18.71 ,0.01
Single 13(26) 37(74)
Married 109(42) 152(58)
Widowed 0(0) 13(100)
Divorced 0(0) 10(100)
Educational level 10.60 0.01
Primary 4(16) 21(84)
Secondary 21(30) 48(70)
Tertiary 102(44) 127(56)
Number of children 18.67 ,0.01
1–3 29(33) 59(67)
4–6 89(49) 91(51)
$7 0(0) 16(100)
Number of sexual partners 2.76 0.09
Only one sexual partner 110(41) 158(59)
Two or more sexual partners 0(0) 4(100)
Awareness of cervical cancer preventability 67.74 ,0.01
Yes 95(61) 61(39)
No 32(17) 151(83)
Regular Pap smear test can prevent cervical cancer 71.65 ,0.01
Yes 68(80) 17(20)
No 63(27) 169(73)

doi:10.1371/journal.pone.0046583.t004

of respondents in this study were aware of the risk factor for smear test, but this was not the case in our study, which support
cervical cancer. This is slightly higher than was reported among earlier report from a study among commercial sex workers in
sexually active women from South Eastern Nigeria [22]. Nigeria [23].
Knowledge of whether cancer of the cervix is preventable was
higher among this study population than reported among Utilization of Pap smear test
commercial sex workers in a part of Nigeria [23]. The percentage The level of utilization of Pap test smear test among respondents
of respondents who believed that cervical cancer was preventable in this study was 10.2% (table 2), slightly higher than was reported
seems to be closely related to the level of awareness about cervical among female state civil servants from a similar population [31],
cancer and Pap smear test (Table 2). The number of children that and much higher than the 4.4% that was reported in Northern
respondents had as at the time of this study yielded a mixed picture Nigeria among female healthcare workers [16], and female
when measured with the level of awareness about cervical cancer undergraduates [17]. The level of utilization of Pap smear test in
(not statistically significant) and Pap smear test (statistically this study population was also higher than was reported among
significant). One conclusion could be that, since Pap smear test health care workers in Jos [32], although lower than was reported
is done routinely as part of ANC care, it is possible that the among female healthcare workers from South Eastern Nigeria
knowledge of Pap smear test was gotten from there. Although it is [32]. Older to middle aged women were more likely to have had a
not clear why none of the women with $7 children were aware of Pap smear test (table 4). Lack of awareness about Pap smear test
Pap smear test as seen in table 3, if the prior explanation were to was the most commonly cited reason for not having had a Pap
be the case. The relationship between level of awareness about smear test. This result is similar to that obtained among Hispanic
Pap smear test and cervical cancer was statistically significant. A American females and inner city girls, who also cited lack of
similar result was documented among lay women in Nigeria [22], awareness as the their major reason for not having had a Pap
possibly because information about both is usually provided at the smear test [33,34]. A similar factor also surfaces in studies done
same time. The investigators expected respondents with multiple among Middle Eastern [19,20,26] and Nigerian women
sexual partners to be more aware about cervical cancer and Pap [17,18,22]. Contrary to a prior study [24], table 4 shows that in

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 Cervical Cancer and Pap Smear Test and Utilization

Table 5. Shows the proportional difference among respondents based on utilization and practice of Pap smear test.

Variables Response n(%) Chi-Square Value P-value

Yes No

Age category (years) 29.02 ,0.01

20–35 0(0) 100(100)
36–55 22(12) 188(88)
.55 4(50) 4(50)
Marital status 1.73 0.63
Single 4(8) 43(92)
Married 21(9) 230(91)
Widowed 0(0) 9(100)
Divorced 0(0) 10(100)
Educational level 12.19 0.01
Primary 0(0) 29(100)
Secondary 0(0) 65(100)
Tertiary 25(12) 185(88)
Number of children 2.54 0.28
1–3 8(10) 72(90)
4–6 22(13) 151(87)
$7 0(0) 16(100)
Number of sexual partners - -
Only one sexual partner 25(10) 253(90)
Two or more sexual partners 0(0) 0(0)
Believe that cervical cancer is treatable 5.35 0.02
Yes 0(0) 45(100)
No 29(11) 240(89)
Awareness of cervical cancer preventability 18.05 ,0.01
Yes 24(17) 121(83)
No 5(3) 170(97)
Regular Pap smear test can prevent cervical cancer 8.67 0.01
Yes 16(19) 69(81)
No 18(7) 223(93)
Ever heard about the Pap smear test 52.39 ,0.01
Yes 34(25) 101(75)
No 0(0) 186(100)

doi:10.1371/journal.pone.0046583.t005

this study, there was a significant association between awareness needed to make a difference. This is in support of findings among
about the test and its utilization (p,0.01). Similarly, there was also Hispanic women and other minority female populations in the
a significant relationship between respondent’s level of education United States, where one of the reasons given for not having done
and utilization of Pap smear test, with utilization being higher the Pap smear test was because the doctor/healthcare provider did
among women with tertiary education compared with those who not recommend it [33,34].
have secondary or primary education, which is in contrast to a A bright side from this study is the fact that about 76% of those
previous report [22]. who reported that they have done a Pap smear test said that they
Majority of those who had done the test reported doing it as do so regularly (which is every 1–3 years), which means that if the
part of their antenatal care. This is an important finding because importance of initiating screening is properly communicated and
many women go through the antenatal clinic. A report indicates healthcare workers can get the women to start screening, they are
that a onetime screening will result in the identification of 8000 likely to keep it up. Another good news from this study is the fact
new cases of invasive cancer per annum [21] and ANC visit that about 81% of respondent said that their last Pap smear test
provides a perfect opportunity for such onetime screening. Only was within the last three years. This implies that the majority of
11.9% of respondents mentioned that a doctor or nurse’s respondents who engage in Pap smear test tend to abide by the
recommendation was the reason they had a test. This number is recommended protocol.
not encouraging because it could mean that healthcare practi- Finally, the regression model showed a statistically significant
tioners are not recommending the test, at least not as much as relationship between awareness about Pap smear test and belief or

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 Cervical Cancer and Pap Smear Test and Utilization

knowledge that cervical cancer is preventable. Thus it is possible organizations and schools alone or in conjunction with the
that women who have come to understanding that cervical cancer government. Policies that encourage doctors to recommend the
is a preventable disease are more likely to actively seek information procedure to their female patients who meet the necessary
about the means of doing so. This also has health education requirements for commencing Pap smear test screening should
implications because it means that it is not just enough to provide be instituted. Policies should also be put in place that encourage or
information about cervical cancer, but to also let women know as appropriate mandate that all women coming for antenatal
that it is preventable and tell them how, where and when to obtain services are provided with the options of a Pap smear test. Cervical
such preventable services. cancer education needs to be properly packaged so that the
message delivered is complete. Finally facilities capable of carrying
Conclusions out Pap smear test be established, and more opportunistic
screenings be done so that as many eligible women as possible
This study shows a lower level of awareness of cervical cancer
can get at least one Pap smear test.
(50.9%), and Pap smear test (38.6%) compared with reports from
other parts of Nigeria. The major source of information about
cervical cancer and Pap smear test was the media. There was no Limitations
statistically significant relationship between educational level and This study represents an improvement on the results reported
level of awareness. Although awareness about cancer of the cervix from an earlier study. But there are some limitations that could
was higher among single women, there was no statistically affect the overall conclusion that has been drawn from the results.
significant relationship between marital status and Pap smear test A good portion of the study sample had a higher literacy level
awareness, perception or utilization. (tertiary education) than the general population and this might
Educational level, awareness about Pap smear test, treatability have biased the outcome of this study. Some information about
of cervical cancer and preventability of cervical cancer, are among cervical cancer and Pap smear test was provided in the
factors that showed a statistically significant relationship with information section of the questionnaire, there is no way to
utilization of Pap smear test. The level of awareness and utilization ascertain if the reported level of awareness was prior to their
from this study was higher than seen among female state civil getting the questionnaire or not, although attempt was made to
servants. This may have something to do with a higher word the questions to refer to prior knowledge. This also could
socioeconomic status (not tested in this study) among Federal civil have favorably biased the result of the study. This study did not
servants who tend earn more in terms of salary than state civil measure socioeconomic status, however it may have been a
servants. Finally, it is the opinion of the authors that there is need reasonable variable to explore as it might have been the reason for
for intense, well focused cervical cancer education in order to the lower levels of awareness and/or utilization obtained in other
increase awareness because we have seen from this study that populations compared with this one. There is no way of validating
improved awareness can translate into improved utilization. the accuracy of the information provided by the respondents. Thus
larger population studies need to be conducted.
Recommendations
Based on our findings, we recommend that an intense public Author Contributions
health campaign be conducted on a recurring basis; providing
Conceived and designed the experiments: HIH JI TO. Performed the
cervical cancer education with emphasis on its etiology, risk factors experiments: HIH JI. Analyzed the data: HIH TO. Contributed reagents/
and methods of prevention. Public service announcements materials/analysis tools: HIH OA TO. Wrote the paper: HIH OA. Critical
promoting Pap smear test utilization and its benefits should be review of manuscript: HIH OA JI TO.
carried out by the government and other non-governmental

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