CHAPTER ONE

INTRODUCTION

Background to the Study

The word cervix is a Latin word meaning “the neck” especially of the uterus (Weller, 2005).

It is the lower narrow portion of the uterus where it joins with the end of the vagina.

Cancer of the cervix is the 2 nd most common cancer in women worldwide and is a leading

cause of cancer of related death in women in under developed countries. Worldwide,

approximately 500,000 cases of cervical cancer are diagnosed each year. In the united state,

routine screening has decreased the incidence of cervical cancer. Approximately 12,900 cases

are diagnosed and 4,100 deaths occur each year. Invasive cervical cancer is more common in

women middle aged and older and in women of poor socio-economic status, who are less

likely to receive regular screening and early treatment. In the United States, there is also a

higher rate of incidence among African American, hispanic, and Native American women

(Stanley, swierzewski, 2015). Cervical cancer usually develops slowly over time. Before

cancer appears in the cervix, the cells of the cervix go through changes, known as dysplasia in

which cells that are not normal begin to appear in the cervical tissues. Cervical dysplasia

occurs more often in women who are in their twenties and thirties. Most of the changes will

not lead to cancer and the cells may go back to normal on their own. However, in some cases,

the abnormal cells need to be treated to prevent them from becoming cancerous. Cervical

cancer is caused by certain types of human papilloma virus (HPV) a very common virus

transmitted by sexual contact. Most HPV infections clear by themselves but some high risk

types such as HPV types 16 and 18 can cause cell changes which can be detected through
1
screening usually by papanicoloau (pap) smear. The best protection against some types of

HPV especially type 16 and 18 that causes about 70% of cervical cancer is papanicoloau

smear (national cancer institute, 2014). Tobacco, smoking, high parity, long term hormonal

contraceptive use, co-infection in Chlamydia trachomatis, herpes simplex virus type 2, HIV,

immunosuppressant, certain dietary deficiencies, genetic and immunological host factors are

contributing factors to cervical cancer. The incidence of cervical cancer is lower in developed

countries than in developing countries. In developing countries about 75% of people present

in advanced stage when cure is not to be expected. Cervical cancer incidence and mortality

have declined substantially by 70-80% in western countries following the introduction of

screening programmers. Screening program in African are however often rudimentary or non-

existent. (Abeyeji, Iyaiya, Jimoh, 2007) there is need for further understanding of the

awareness and knowledge of cervical cancer among women of 40-69 years of age in uruagu

nnewi, nnewi north L. G.A Anambra state.

Statement of the Problem

In developing countries including Nigeria, the rate at which women present with cervical

cancer is very high. In 2014, cervical cancer was the 20 th leading cause of cancer death

among females in Nigeria. It is estimated that it will become the 19 th most common cause of

death from cancer among females in 2017. In 2014, there were 223 deaths from cervical

cancer in Nigeria. It is estimated that this will increase to 258 deaths by 2018.

The number of death from cervical cancer decreased from 378 in 1968 to 223 in 2014. This

death rate dropped significantly with the increased use of the pap test. In nnamdi Azikiwe

University Teaching Hospital Nnewi, the statistics for 2013/2015 are; about 45 new cases of
2
invasive cervical cancer were diagnosed. About 25 women died from cervical cancer. Udigwe

(2016).

Many older women do not realize that the risk of developing cervical cancer is still present as

they are of age. More than 15% of cases of cervical cancer was found in women over 65

years. However, these cancers rarely occur in women who have been getting regular tests to

screen for cervical cancer before they were 65. Observations and enquires made by the

researcher gave insight to the fact that women who attend the health facilities (NAUTH

Nnewi) lack the awareness of cervical cancer and its screening facilities leading to increased

incidence of cervical cancer.

The researcher choose Uruagu Nnewi which is one of the villages in Nnewi, Nnewi North due

to increasing number of women presenting with signs and symptoms of cervical cancer

throughout the researcher’s period of stay and posting during her general nursing programme.

Therefore, the researcher is motivated to conduct a study to ascertain the awareness and

knowledge of cervical cancer among women of age 40-69 years in Uruagu Nnewi, Nnewi

North L.G.A Anambra.

Objective of the Study

The purpose of the study is to determine the awareness and knowledge of cervical cancer

among women of age 40-69 years through the following specific objective:

 To ascertain the awareness of the women on cervical cancer

 To determine the attitude of the women towards the prevalence of cervical cancer

 To determine the awareness of cervical screening among women

3
  To identify the factors affecting participation in cervical screening among women

Significance of the Study

This study will provide information on the awareness and knowledge of cervical cancer and

it’s prevalence by highlighting the benefits associated to the general public. But the study

will be significant to the following group: it will help women of age 40-69 years by creating

awareness on what cancer is and also prevent its prevalence it will also give insight on the

factor affecting cervical screening. This study will also provide information on level of

knowledge of cervical cancer and its screening the health workers have so as to facilitate

early detection and treatment. Also it will help communicate to the government so as to take

appropriate measures to reduce the prevalence of cervical cancer in our society. This

finding will also help inform health policy makers as they will see the reason why cervical

screening should be inculcated into our national health programmers. Finally, it will help

the researcher improve and add to the existing body of knowledge of cervical cancer and its

awareness

Research Questions

 What is the level of awareness of cervical cancer among women?

 What are the attitude of women towards the prevalence of cervical cancer?

 What is the level of awareness of cervical screening among women?

 What are the factors affecting participation in cervical screening among women

4
Scope of the Study

The researcher is delimited to awareness and knowledge of cervical cancer and prevalence,

opinion of women towards the prevalence, awareness and factor affecting the participation

of women of 40-69 years of age in Uruagu Nnewi.

Operational Definition

 Prevalence: this refers to the number of people alive with a prior diagnosis of cancer at

a given time.

 Cervix is the lower part of uterus and connect the uterus to the vagina.

 Cancer is a group of diseases involving abnormal cell growth with the potential to

invade or spread to other parts of the body.

 Cervical cancer is a cancer arising from the cervix.

 Awareness is the knowledge or perception of a situation or fact.

 Knowledge : facts, information and skills acquired through experience or education;

the theoretical and practical understanding of a subject.

 Woman is a female human being.

5
 CHAPTER TWO

LITERATURE REVIEW

This chapter deals with the review of previous relevance literatures related to this study and it

will be discussed under the following headings:

 CONCEPTUAL FRAMEWORK

 THEORETICAL REIVEW

 EMPIRICAL REVIEW

 SUMMARY

Conceptual Framework
Introduction of Cancer of the Cervix
Cervical cancer occurs when abnormal cells on the cervix grow out of control. Cervical

cancer can often be successfully treated when it’s found early. It is usually found at a very

early stage through a pap test. Most cervical cancer is caused by a virus call human

papillomavirus (HPV). Not all types of HPV cause cervical cancer. Some of them cause

genital warts, but other types may not cause any symptoms. One can get HPV by having

sexual contact with someone who has it. Most adults have been infected with HPV at some

time. An infection may go away on its own but sometimes it may cause genital wart or lead to

cervical cancer. That’s why it’s important for women to have regular pap tests. A pap test can

find changes in cervical cells before they turn into cancer. If these cell changes are treated,

cervical cancer my be prevented. (WebMD 2015).

6
KNOWLEDGE ON PREVALENCE OF CERVICAL CANCER

Cervical cancer is a cancer arising from the cervix. It is due to the abnormal growth of cells

that have the ability to invade or spread to other parts of the body (WHO Bulletine, 2014).

Early on, typically no symptoms are seen, later symptoms may include abnormal vaginal

bleeding, pelvic pain or pain during sexual intercourse. While bleeding after sex may not be

serious, it may also indicate the presence of cervical cancer. (NCI, 2014).

Human Papilloma virus (HPV infection causes more than 90% of cases. Most people who

have had HPV infection however do not develop cervical cancer. Many different types of

human papilloma virus (HPV) especially types 16 and 18 can affect the cervix and only some

of them cause abnormal cells changes that may become cancerous while some HPV infections

go away without treatment. Other risk factors include smoking, a weak immune system, brith

control pills, starting sex at a young age and having many sexual partners. Cervical cancer

typically develops from precancerous changes over 10 to 20 years. About 90% of cervical

cancer cases are squamous cell carcinomas, 10% are adenocarcinoma, and a small number are

other types ( Bosch, De Sanjose, 2007).

Low level of awareness and poor knowledge of cervical cancer coupled with unavailability
and
inaccessibility of cervical cancer screening services are responsible for the prevalence of

cervical cancer in African and in other developing countries. In developed countries people

seem to be aware of cervical cancer and screening and treatment are widely available and

utilized. A study done (M. Giles, Garland, 2006) showed that many women has heard of HPV

and attributed a number of different clinical symptoms to infection. Most women do not
7
understand the risk factors for HPV infection, the clinical problems it may cause and the

potential long term complication of infection.

ATTITUDE TOWARDS THE PREVALENCE OF CERVICAL CANCER

The women of poorer communities are mostly affected with cervical cancer. This condition

affects not only the health and lives of the women, but also their children, families and their

communities at large. Cancer of the cervix was the most common form of cancer amongst

south African women in 1998 and second leading cancer after breast cancer in 1999. The

known primary underlying is the human papillomavirus, the most common sexually

transmitted infection worldwide and it is estimated that 50% to 80% of sexually active women

are infected at least once in their lifetime. The risk of sexual behaviours such as sexual contact

without the use of condom or barrier, initiation of coitus before 18 years, multiple sexual

partners, previous history of STD’s and vulval warts, a lack of knowledge and lack of

preventive care such as regular pap test are leading to the high prevalence of HPV infection

among women that lead to cervical cancer later Udigwe (2016). A study done among college-

age Vietnamese students found that more than one third (39.3%) of sexually active

respondents reported never had a pap smear. Also according to the study done, only 16 (9.8%)

participants had had a pap smear test of those 11 (69%) knew their result. Among those who

knew about pap smear test (n=136), 86 respondents did not have the test done mainly because

of personal factors such as fear of the procedure, cultural or religious reasons, and were not ill

(61.1%). (Hogue, Hogue, 2014).

8
 According to the study done shows that the belief that nothing can be done once one is

diagnosed

with cervical cancer was common and might hinder women from seeking screening services

for fear of a positive diagnosis. He also noted that even when the opportunity to screen was

provided to women, they reported other barriers such as screening procedures and vaginal

examinations (Mukama, T. Ndejjo R, Musabyimana A, Abdullah H., Musoke D (2017).

AWARENESS OF CERVICAL SCREENING

Screening is testing of all women at risk of cervical cancer, most of whom will be without

symptoms.

Cervical screening is very important because it can stop cervical cancer from developing.

Regular cervical screening can reduce a woman’s risk of developing cervical cancer by 90%.

The screening is carried out at intervals. The most cervical screening interval is every three

years for individuals between the ages of 20 and 49 years and every five years for people

between the ages of 50 and 65 years (Ezem, 2017)

Low level of awareness and poor knowledge of cervical cancer coupled with unavailability

and inaccessibility of cervical cancer screening services are responsible for the very small

number of women being screening in Africa and in other developing countries. In developed

countries people seem to be aware of cancer and screening services are widely available and

utilized, and this has led to marked fall in incidence and morality of cervical cancer. A study

done in Nnamdi Azikiwe University Teaching Hospital Nnewi among nurses (Udigwe, 2006)

9
showed that nurses have high knowledge of cervical cancer and its screening services but the

practice is very poor.

Awareness has been created through the media, literature and studies educating women on the

benefits of early detection of cervical cancer as early detection proffers better prognosis of

treatment. Quite unfortunately, this awareness seems not to have gotten to the rural areas as

many women in such localities seem not to have heard of cervical cancer and its screening

techniques. Even among the literate women, a good number of them have negative attitude

toward cervical screening.

According to Wellensiek N., Moodley M., Kwanyana N. (2014), a study carried out in South

African showed that in spite of the knowledge of cervical screening and the availability of

such services, majority of women (87%) from higher social and educational backgrounds did

not undergo cervical screening.

In developed countries, majority of the women undergo cervical screening unlike in

developing countries. According to Munoz N.F. X., Boschs, in a cross-sectional survey of 650

women, 15-78 years of age randomly recruited at two hospitals in London, England, 80,5%

have had pap smear at least once and 71.5% reported regular smears every three to five years.

FACTORS HINDERING/PROMOTING WOMEN’S AWARENESS OF CERVICAL

CANCER,
SOLUTION TO THE IDENTIFIED PROBLEMS/FACTORS

Cervical cancer is one of the most preventable of all cancers; still the mortality and morbidity

rate seem to be increasing in Nigeria. Certain factors have been identified as barriers to

10
regular cervical screening in various countries including developing countires. Various studies

have identified reasons for non-participation which include cultural based influences,

embarrassment, fear and hopelessness concerning the diagnosis of cancer, cost and poor

accessibility, lack of physician’s referral, perception of the screening as being unneessary and

discomforting, fear of vaginal exposure, physical and psychological pain and gender of the

practitioner (Adoyeji, Iyaya, Jimoh, 2007). Other factors identified is the general poor attitude

to preventive health measures and the fact that matters relating to sex and sexual organs are

not to be openly discussed especially in some religion (Islam) and culture because they feel

their cultural and religious values are threatened. (Martin and Lebamon, 2007). Lack of

awareness on cervical screening and its guidelines affects the uptake of the screening services

especially amongst the rural dwellers and illiterate women. Poor availability of screening

services are not provided in every hospital. Cultural beliefs also affects cervical screening

greatly as most women believe that cervical cancer could either be as a result as their

husband’s extra marital affairs or affair with their daughters. Family misunderstanding affects

women’s uptake of cervical screening as many husbands are against it. Also, some women

believe cervical cancer to be as a result of bewitchment. The cost of undergoing a cervical

screening is high, as a result of this, most women find it difficult to assess the screening

exercise.

Theoretical Review

Health Belief Model

Health belief theory is one of the first theories of health behavior. It was developed by a group

of
11
public health service social psychologist who wanted to explain why few people were

participating programs to prevent and detect disease.

The health belief model proposes that a person’s perception of four critical areas: the severity

of

a potential illness, the persons susceptibility to illness, the benefits of taking a preventive

action, and the barriers to taking the action (Andrey and Shirlec, 2012). Health belief model is

a framework for motivating people to take positive health actions that uses desire to avoid

negative health consequence as the prime motivation. It addresses the relationship between a

person’s beliefs and behavior. It provides a way to understanding and predicting how clients

will behave in relation to their health and how they will comply with health care therapies.

The six major concepts in health Belief Model are:

 Perceived susceptibility: One’s belief to the chances of getting a disease.

 Perceived severity: One’s belief of how serious a condition and its

consequences are.

 Perceived benefits: One’s belief that a given treatment will cure the illness or

help prevent it.

 Perceived cost: Refers to the complexity, duration and accessibility of the

treatment.

 Motivation (cues to action): Includes the desire to comply with a treatment and

the belief that people should promote awareness and provide information.

12
  Modifying factors: including personality variables, patient’s satisfaction and

soico-demographic factors.

The health belief model is related to the topic “Awareness and knowledge of cervical cancer

among women of age 40-69 years” where the knowledge and attitude towards the prevalence

of cervical cancer, awareness and factors affecting cervical screening among women were

studied. The study considered the widespread and the severity of cervical cancer, the women

at visit, the benefits of uptaking the screening and factors affecting uptake of the screening

exercise, and these are the four major areas which the health belief model proposes that a

person’s health related behavior depend on.

Empirical Review

So many studies have been done on this topic and related topics in different countries

including Nigeria. A study carried out in Mulago Hospital by Mutyaba, Mmiro, Weiderpass

(2006) among the medical workers with 300 participants. 93% considered cervical cancer a

public health problem and knowledge about pap smear was 83%. Less than 40% knew the

risk factors for cervical cancer, eligibility for screening and the screening interval. 65% did

not feel susceptible to cervical cancer, 81% had never been screened. Attitudes and practices

of screening were negative.

A study by Udigwe (2006) in Nnewi, South Eastern Nigeria on the knowledge, attitude and

practice of cervical cancer screening (pap smear) among female nurses, 144 questionnaire

were distributed and collected out of which 122 (87%) were aware of the existence of the

screening services. Although 9.3% has lost relations to cervical cancer, only 5.7% had ever

13
undergone a pap smear, 52 (15%) had not reason for not being screened, 21(15%) were afraid

of the possible outcome and 35(25%) felt they were not likely candidates for cervical cancer.

The study revealed that the nurses have good knowledge of cervical screening but abysmally

poor uptake of it. Similarly, a study carried out by Anya, Oshi and Nwosu (2005) on the

knowledge, attitude and practice of female health professionals regarding cervical cancer and

pap smear, 144 female health professionals were sampled, 132 (91.7%) have knowledge of

cancer of the cervix, 22% could not list the risk factors, only 13(9%) of the respondents had

ever had a pap smear. Perceived non-availability of Pap smear service was the main reason

(51.3%) for not having a pap smear.

However, 30.3% had not thought of it or did not consider themselves at risk of cervical

cancer. In a study carried out by Ezem (2007) on awareness, and up-take of cervical screening

in Owerri, South-Eastern Nigeria, 846 respondents were sampled. The study showed that 447

(52.8%) were aware of cervical cancer screening while 60 (7.1%) had never done the test. The

major sources of information about cancer smear were hospital /health facilities (31.3%) and

friends (30.9%) common reason for not doing the test were lack of awareness, 390 (46.1%),

no need for the screening, 106 (12.5%) and fear of bad result 98 (11.6%).

In a study by Aboyeji, Iyaiya and Jimoh (2007) in Ilorin, Nigeria, various groups of female

professional workers were sampled and study revealed that out of 483 health workers, 337

(69.8%) knew about pap smear as a screening test for cervical cancer while 146 (30.2%) had

not such knowledge of those with knowledge of pap smear, only 10 (0.3%) had pap smear test

at least once previously. The common reasons for not wanting to be screened include the fact

14
that respondents cannot have cervical cancer (52.5%), fear of detection of cancer (19.2%) and

screening against religious beliefs (14.6%).

Similarly, a study carried out by Akuyobi, Ikechebelu, Onuknwo, Onyiorah (2008) in South-

Eastern Nigeria among female students in tertiary institutions revealed that out of the 200

students sampled, 134 (60.9%) had knowledge of cervical cancer, 118(53.6%) were sexually

active. About two third of the students did not know about pap smear and worse still, none of

them had undergone a papa screening test before. This low participation in screening for

cervical cancer was attributed to several reasons including ignorance of the existence of such

test, lack of awareness of centers where such services are obtainable, ignorance of the

importance of screening and risk factors to the development of cervical cancer.

Also in survey carried out in Ibadan, South-East local government area, Oyo state, Nigeria

among women in the primary health care centers by Odetola and Oyatunde (2012), a total of

261 women participated in the study. Results showed that just 28.7% possessed good

knowledge of cervical screening and had it done, some of the women did not perceive

cervical cancer as a serious disease and 7.3% of them did not even see themselves at risk of

contracting the disease despite their being sexually active.

In a study carried out by Adodele, Adoyomoye, Kwasi, Dolapo,(2011) among nurses in Lagos

University Teaching Hospital Lagos Nigeria. 200 nurses sampled, result obtained showed

99% were aware of cervical cancer screening, 91% were aware of pap smear as one of the

screening techniques and 89% had good attitude towards pap smear but most of them had

never done it before. Majority of them do not know coloposcopy as one of the screening

techniques and poor disposition towards cervical screening.

15
Summary

From the review, it was observed that the knowledge about cervical cancer and cervical

screening was good thus affecting the attitude though there is still need to create more

awareness about the existence of cervical cancer and cervical screening and the need to

undergo the screening regularly. One should therefore consider improving awareness of the

programme to further their knowledge by educating students about risk factors for cervical

cancer and practicing preventive behavior. The role of media campaigns should be considered

as these are known to work best in promoting cervical cancer knowledge, its risk factor and

screening when multiple media are used. Health care workers at the clinic and hospitals can

educate healthcare users, targeting the risk population on risk factors for cervical cancer and

motivate them to have a pap smear performed. This can improve women’s knowledge of

cervical cancer and practices on the pap smear test when they seek medical care for optional

cervical health and function.

16
 CHAPTER THREE

RESEARCH METHODOLOGY

This chapter describes and specifies the method with which necessary data relating to

the research problem was collected and analysed. It provides a procedural framework for the

conduct of this study and will be discussed under the following headings:

 Design of study

 Setting

 Target population

 Sample

 Sampling technique

 Instrument for data collection

 Validity of the instruments

 Reliability of the Instrument

 Method of data collection

 Method of Data Analysis

 Ethical Consideration
17
Design of the study

The research design used for this study was non-experimental descriptive survey because the

researcher deals with accurate and factual description, also helps observe the subject matters

as they naturally occur. They also help in the systematic collection of data, analysis or

interpretation and reporting of facts about the subject matter. It is used to determine the

awareness and knowledge of cervical cancer among women of age 40-69 years in Uruagu

Nnewi, Nnewi North Local Government Area Anambra state.

Setting

Nnewi is the second largest city in Anambra state in South Eastern Nigeria. Nnewi as a

metropolitan city encompasses 2 local government areas, Nnewi North and Nnewi South.

Nnewi North is commonly referred to as Nnewi central and comprises of four autonomous

quarters; Otolo, Uruagu, Umudim and Nnewichi. Uruagu being the second quarter among the

four quarters of Nnewi town comprises of eight (8) kindred which are; The setting is Uruagu

Nnewi, Nnewi North Local Government Area Anambra state. ; Ndiojukwu, Akaboedoji,

Akabuokwu, Akaboezem, Edoji, Umumejiaku, Obiagu and Ezenwankwo. The researcher

chose Uruagu Nnewi due to increased promiscuity in the community which could be a

predisposing factor to cervical cancer.

Target Population

The population of study includes 750 women of age 40-69 years residing at Uruagu

community

18
both indigene, non-indigene, lower middle and Upper socio-economic status, working class

group and non working class group, learned and non-learned people, married or not married.

Sample

A sample size of 192 women of 40-69 years of age was used. Uruagu has eight (8) villages,

with a total of about 750 women of age 40-69 years.

Table I: Number of women of age 40-69 years and the various kindreds

Kindreds Number of women aged 40-69 years

Ndijiokwu 100

Akaboedoji 98

Akaboukwu 50

Akaboeze 80

Edoji 110

Umumejiaku 92

Obiagu 100

Ezenwankwo 120

Total 750

Source: National Census (2006)

Sampling Technique

19
 The researcher used convenient sampling technique as not all the members of the population

will

be present at the time of study, thus all women who are not at home during the time of study

are excluded.

The researcher limited her study to five (5) kindreds which are still under Uruagu Nnewi
because

of the closeness. A sample size of 192 women was selected from 750 women using 40

percent of the total population of the women of age 40-69 years in these selected kindred in

Uruagu village of Nnewi town. This convenient sampling method was used to get the number

of respondents to be questionnaire in the selected hundreds. The population was large for the

researcher and due to time constraints, Nwana’s principle (1985) and Ofoegbu (2009) which

states that 40% of the population of study in few hundred should be used.

These kindred’s are;

Table 2: Number of women and choosen kindred

Kindred Population of women (40-69 Sample size

yrs)

Ndiojukwu 100 100 X 40 =40

1 100

Akaboedoji 98
98 X 40 =39
1 100
80 X 40 =32

20
 Akaboezem 80 1 100

110 X 40 = 44
Edoji 110
1 100

92 X 40 = 37
Umumejiakau 92
1 100

Total 480 192

Instrument for Data Collection

The instrument for data collection is structured questionnaire. Questionnaire is a set of

questions

(item) relating to the objective of the study to which the respondents are required to answer by

writing in their responses. It consists of two (2) sections, section A which contains personal

profile of the respondents, and section B which answers the researcher’s questions.

Validity of Instrument

The questionnaire was corrected by the researcher who ensured that questions were related to

the topic and objectives of the study. The questionnaire was submitted to the project

21
supervisor for necessary corrections. The correction were noted and affected by the

researcher.

Reliability of instrument

Reliability refers to consistency of an instrument in collecting the same data that means

appropriateness for use overtime. Chinweuba et al, (2013). The reliability of the instrument

was achieved through a pilot study using ten percent (10%) of the sample size. Nineteen (19)

women of age 40-69 years in Nnewichi Nnewi North L.G.A Anambra state. The responses

were found to correspond and no ambiguity was found.

Method of Data Collection

A total number of 192 questionnaires was shared for the study. 40 copies was allotted to

Ndiojukwu, 39 to Akaboedoji, 32 to Akaboezem, 44to Edoji, and 37 to Umumejiaku. These

questionnaires were distributed to the women using various churches and markets. It took the

researcher five (5) days to administer and collect the questionnaire from the respondents. A

total of 170 questionnaire were collected hence return rate of 88.5%.

170 x 100
192 1

Method of Data Analysis

The results were tallied at the end of the data collection, the data analyzed in frequencies, four

point likert scale and percentages. Also results were represented in tables and pie chart for

clarity.

22
X= F x 100
N 1
Where F = Frequency of responses

N =Number of people studied

P = Percentage (%)

Ethical Consideration

The researcher maintained the following ethical consideration during the course of the study.

Respect: Respect for the respondents was maintained by approaching them politely and

necessary clarification made.

Informed consent: The researcher ensured that full information about the study was given to

the respondents.

Voluntary participation: The respondents were given the right to decide willingly whether to

participate or not without persuasion.

Confidentiality: All information provided by the respondents was kept confidential and was

not revealed by any other person.

Principle of Anonymity: Self identification data such as name of the respondents was not

allotted.

Plagiarism: The names of the authors used in this research work were duly cited.

23
 CHAPTER FOUR
DATA ANALYSIS
The data collected from the questionnaire used for this study were analyzed and presented in
accordance with the research question. Presentation of the results was done with the use of
tables, pie charts and essay.

Section A
Table 3: Demographic characteristics of the respondents
N=170
CHARACTERISTICS FREQUENCY PERCENTAGE

(1) AGE
40-45 26 15.2
46-50 52 31
51-55 60 35.2
56-60 21 12.3

24
 61-69 11 7
Total 170 100
(2)MARITAL STATUS
Single 134 79
Married 10 6
Divorced 22 13
Widowed 4 2.4
Total 170 100

(3)RELIGION
Islam 49 29
Christianity 121 71
Hindu - -
African traditional religion - -
Total 170 100

(4)ETHINICITY
Igbo 105 62
Hausa 14 8.2
Yoruba 51 30
Total 170 100
(5)NUMBER OF CHILDREN
2 13 8
3 24 14.1
4 39 23
5 AND ABBOVE 94 55.2
TOTAL 170 100

Result: the above table shows that respondents 26(15.2%) were age 40-45, 52 (31%) were

46-50, 60 (35.2%) were between 51-55, 21 (12.3%) were 56-60, 11 (7%) were between 61-69

years of age. 134 (79%) were married, 10 (6%) were single, 22 (13%) were widowed,

whereas 4 (2.4%) were divorced. 49 (29%) of the respondents were Islam, 121 (71%) were

Christians. 105 (62%) of the respondents were Igbo’s, 14(8.2%) were Hausas, 51 (30%) were

Yoruba’s. The table also showed that 13 (8%) of them have 2 children, 24 (14.1%) have 3

children, 39 (23%) have 4 children where as 94 (55.2%) have up to 5 children and above.

25
SECTION B: This section answered the research question.

Research Question 1: What is the level of awareness of cervical cancer among women?

Item 6, 7, 8 and 9 from the questionnaire answered the question.

Table 4: Awareness of cervical cancer among women

N=170

ITEMS/OPTIONS RESPONSES FREQUENCY PERCENTAGE

6.Have you heard of
cervical cancer?
Yes 77 45.3
No 93 55

Total 170 100

7.If yes, where was N=77
the source of information?
Through radio 5 6.4
Through T.V 12 16
programme 10 13
Seminar 5 6.4
Through a friend (s) 45 58.4
Hospital
77 100
Total

26
From the table above, item 6 showed that 77 (45.3%) of the respondents have heard of

cervical cancer while 93 (55%) have not heard of cervical cancer before. Item 7, 5(6.4%)

heard about cervical cancer through the radio, 12 (16%) got the information through

television programme 10 (13%) got the information through seminars, 5 (6.4%) of them heard

it from their friends whereas 45 (58.4%) heard the information at the hospital.

Table 5: Awareness of cervical cancer among women

ITEMS/OPTIONS RESPONSES FREQUENCY PERCENTAGE

8. what are the possible N=77
risk factors?
Early sexual intercourse before the 11 14.

age 1.2
1
of 18 51
39
Increase number of children
Multiple sex partners and frequent
17 22.1
change of sexual partner
- -
Family history of cancer of the cervix
- -
Curse from the gods/enemies 9 11.16
Use of sanitary pads
Recurrent sexually transmitted
infection

Total 77 100
9.What are the possible N77
signs and symptoms?
Intense pain during sexual 22 28.5
intercourse
Heavy menstruation 3 3.8
Frequent and persistent 8 10.3
bloody vaginal discharge
Kidney failure - -
Headache - -
Pelvic pain 15 19.4
Abnormal bleeding 29 35
27
 during sexual intercourse

Total 77 100

Item 8, 11(14.2%) of the respondents ticked early sexual intercourse before the age 18, 1

(1.2%) ticked increase number of children, 39 (51%) ticked multiple sex partner and frequent

change of sexual partner, 17 (22.1%) of them identified family history of cervical cancer as a

possible risk factor, 9 (11.6%) of the respondents ticked recurrent sexually transmitted

infection. Item 9, 22(28.5%) of the respondents ticked intense pain during sexual intercourse,

3 (3.8%) ticked heavy menstruation, 8 (10,3%) of them identified frequency and persistent

bloody vaginal discharge, 15 (19.4%) of them ticked pelvic pain while 29 (38%) ticked

abnormal bleeding during sexual intercourse.

Research Question II: What are the opinion of women towards the prevalence of cervical
cancer?

Items 10, 11 and 12 from the questionnaire were used to answer the research question.

Table 6: Attitude of women towards the prevalence of cervical cancer

ITEMS/OPTIONS RESPONSES FREQUENCY PERCENTAGE

10. At what age did you have

first sexual intercourse?

16-18 81 48
19-25 43 25.2
26-30 46 27

Total 170 100

11. Since then have you been
sexually active?

Yes 170 100

28
 No - -

Total 170 100

From the table above, item 10 showed that 81 (48%) of the respondents indicated they started

sexual intercourse at the age of 16-18 year, 43(25.2%) indicated age at 19-25 years,46(27%)

had their first sexual intercourse at 26-30 years of age. Item 11 showed that 170(100%) of the

respondents have been sexually active since then.

Item 12: Do you use barrier method (condom) during sexual intercourse?

Key

30% 23%

47%

Key

Yes

No

Often

29
Figure 1: Pie chart showing responses on the use of barrier method (condom) during sexual

intercourse.

Above pie chart showed that 51(30%) of respondents use barrier method(condom) during

sexual intercourse, 80(47%) does not use barrier method, 39(23%) of them often use barrier

method during sexual intercourse.

Research Question III: What is the level of awareness of cervical screening among women?

Items 13, 14,15.16 from the questionnaire answered the question.

Table 7: Awareness of cervical screening among women.

N= 17

ITEMS/OPTIONS RESPONSES FREQUENCY PERCENTAGE

13. Have you heard of
cervical screening?
Yes 77 45.3
No 93 55

Total 170 100

14.If yes, what are the techniques

used in cervical screening?
Papillonicoals smear 40 51.7
Visual inspection of the 20 26
acetic acid painted
cervix 10 13
30
 Human papiloma virus
DNA test 7 91
Coloposcopy

77 100
Total

From the table above, item 13 showed that 77 (45.3%) of the respondents have heard above

cervical screening, while 93 (55%) of them indicated that they have not heard about it, item

14, 40 (51.9%) of them identified papilomaviurs smear as one of the techniques used for

cervical screening, 20(26%) of them ticked visual inspection of the acetic acid painted cervix,

10 (13%) ticked human papilomavirus DNA test, 7 (9.1%) of them ticked colosposcopy.

Table 8: Awareness of cervical screening among women

ITEMS/OPTIONS RESPONSES FREQUENCY PERCENTAGE

15.What group of people are N=77
eligible to undergo
cervical screening?
Women who are sexually 23 29.8
active
Women who have never 11 14.2
had
sex 6 8
Women who used to have
sex 37 48.1
but stopped
Women whose husbands 77 100
have
genital warts
Total
16.At what age is one N=77
31
 eligible to undergo
cervical screening?
20-70 45 58.4
10-20 7 9.1
After menopause 25 32.5
Total 77 100

Result: In item 15 above, (29.8%) of the respondents identified women who are sexually

active as group of people who are eligible to undergo cervical screening, 11 (14.2%) of them

ticked women who have never had sex, 6 (8%) identified women who used to have sex but

stopped, 37 (48.1%) ticked women whose husbands have genital warts. Item 16, 45( 58.4%)

chose 20-70 years to be the eligible age for one to undergo cervical screening, 7 (9.1%)ticked

10-30 years of age, while 25(32.5%) chosed after menopause.

Research Question IV: What are the factors affecting participation in cervical screening
among women?

Item 17: Factors affecting participation in cervical screening among women.

Table 9: Responses of the respondents of the factors affecting participation in cervical

screening among women.

Responses Strongly Agree Disagree Strongly Total Average Remark

Agree Disagree mean mean
score score
Religious 36 51 - - 312 4.0 Positive

Belief 38 29 - - 239 3.0 Positive

High cost

32
 screening

Fear of 63 50 - - 402 5.0 Positive

detection of

cancer 3 9 - - 39 0.5 Negative

Lack of 75 53 - - 461 6.0 Positive

interest

Not

susceptible to - 10 - - 20 0.2 Negative

cervical

cancer 11 7 - - 65 0.8 Negative

No particular

reason

Cultural

beliefs

Result: table 8 above shows the acceptable mean value for all the responses in this order. The

respondents behavior towards religious belief was 4.0, 3.0 for high cost of screening, 5.0 for

fear of detection of cancer, 0.5 for lack of interest, 6.0 for not susceptible to cervical cancer,

0.2 for no particular reason, 0.8 for cultural beliefs. From the scores higher number of the

33
respondents have positive behaviours towards factors affecting participation in cervical

screening.

CHAPTER FIVE

DISCUSSION OF FINDINGS

34
This chapter discussed the findings that were gotten form the answer to the research

questions. The findings will be discussed in relation to the literature review. The chapter will

be discussed under the following sub-headings:

Discussion of Findings

Implications of the study

Limitations of the study

Summary

Conclusion

Recommendations

Suggestions for further findings

DISCUSSION OF FINDING

The result of the data collected was discussed in relation to the objectives with respect to the

research questions in the study which aims to ascertain the awareness and knowledge of

cervical cancer among women of age 40-69 years in Uruagu Nnewi, Nnewi North Local

Government Area Anambra state.

Research Question I

What is the level of awareness of cervical cancer among women?

35
The findings revealed that (43.3%) of the respondents had the knowledge of cervical cancer

while (55%) didn’t have the knowledge. More number of them (58.4%) indicated they got the

knowledge from the hospital, (13%) through seminars, (16%) through T.V programme (51%)

of the respondents believed that multiple sexual partners and frequent change of sexual

partners possible risk factor to cervical cancer, (22.1%) identified family history of cervical

cancer to also be a possible risk factor (28.5%) believed that pain during sexual intercourse is

one of the signs and symptoms, (38%) choosed abnormal bleeding, while (10.3%) identified

frequency and persistent bloody vaginal discharge

The findings does not agree with Anya, Oshi and Nwosu (2005) who observed (91.7%)

knowledge about cervical cancer.

Research Question II:

what are the attitude of women towards the prevalence of cervical cancer?

The findings revealed (48%) of the women indicated they started sexual intercourse at the age

of 16-18 years, (25.2%) indicated age at 19-25 years, (27%) had their first sexual intercourse

at 26-30 years of age. Also indicated, (100%) of the women have been active since then. Only

(30%) of them uses barrier method (condom) while (47%) does not use barrier method.

This shows that women have poor attitude towards the prevalence of cervical cancer. This is

in agreement with the study by Udigwe, (2016) which states that 50%-80% of sexually active

women are infected with HPV at least once in their life time, showing risk behaviour such as

sexual contact without the use of barrier and initiation of sexual intercourse before the 18

years.

36
Research Question III

What is the level of awareness of cervical screening among women?

The findings revealed that women did not have good knowledge of cervical cancer screening

with (45.3%) of the respondents showing the knowledge of it (51.9%) were aware that

papnicoloau smear is a cervical screening technique but just few of the women had

knowledge of other techniques such as visual inspection of acetic acid painted cervix, human

papiloma virus DNA test and coloposcopy. The respondents gave their opinion on the

eligibility for undergoing cervical screening with (29.8%) pointing at that it is meant for

women who are sexually active, (14.2%) agreed that women who have never had sex are

eligible, (8%) believed that cervical screening is also for women who used to have sex but

have stopped, and (48.1%) agree that women whose husbands have genital wart are eligible to

undergo cervical screening.

Also most of the respondents (58.4%) identified the age interval for screening to be 30 to 70

years and (32.5%) believed the interval for the screening is after menopause. The findings

does not agree with Mutyaba, Mmiro, Weiderpass (2006) who observed 83% knowledge

about cervical screening. Also a study by Awodele et al (2007) showed 99% were aware of

cervical cancer screening. This does not support the fact that there is no good knowledge

about cervical cancer screening.

Research Question IV:

what are the factors affecting participation in cervical screening among women?

37
Findings revealed that there are factors affecting the uptake of cervical screening even with

the little knowledge of cervical screening among the women.

The findings revealed 4.0 mean value on religious belief, 3.0 mean value on high cost of

screening, 5.0 mean value on fear of detection of cancer 6.0 mean value on not susceptible to

cervical cancer, 0.5 mean value were hindered by lack of interest, 0.8 mean value hindered by

cultural beliefs, 0.2 men value for no particular reason.

This findings correlates with the study by Oshi et al in which 30.3% of the respondents did

not consider themselves at risk of cervical cancer. Also a study done by Aboyeji, Iyaya and

Jimoh (2007) showed that 52.5% of the respondents feels they cannot have cervical cancer.

Conclusions from Findings

Based on the findings, researcher concluded that less number of the respondents 45.3% have a

good knowledge of cervical cancer for which majority of them 100% believed cervical

cancer can be prevented showing good opinion towards the prevalence of cervical cancer but

89% have poor attitude towards its prevalence. Also the study went further to reveal that only

45.3% have a good knowledge of cervical cancer screening techniques, this shows that there

is poor knowledge of the cervical screening and its screening techniques. Factors such as the

belief that one is not susceptible to cervical cancer 6.0, fear for detection of cancer 5.0 and 3.0

cost of the screening affect the uptake of cervical screening among Uruagu women.

Limitation of the Study

38
In the course of study limitations such as time constraints, stress combining academic

engagement and carrying out the research study, poor co-operation of some of the women and

financial constraints were encountered.

Implications of the Study

The findings from the study showed that women in Uriagu Nnewi have low awareness and

poor knowledge of cervical cancer and its screening but there is still room for improvement.

These health workers are expected as patient’s advocates and counselors, to give information

on the knowledge of cervical cancer and the importance of regular cervical screening to

women. They should also be well equipped with details on cervical cancer, available

screening centers and treatment modalities. Nurses should advocate to the government to

make cervical screening a routine test for every woman and most importantly help eliminate

the factors affecting their anticipation in the screening by health educating its usefulness.

Recommendations

Based on the findings, the researcher recommends that institutions should organize seminars

and trainings for nurses and health workers who form a group of professionals that can give

health education to women about cervical cancer. Health education of women on the

prevalence of cervical cancer and its screening techniques should be organized by the health

workers in various primary health centres. Also women should be encouraged to undergo

cervical screening as that is the only way of detecting the precancerous cells early and as such

prevent cervical cancer. Above all government should provide all the necessary resources

39
needed to make screening services readily available and accessible to all females and at an

affordable cost.

Suggestions for Further Studies

The researcher suggests that a study should be carried out to find out the attitude of nurses in

health institutions towards cervical screening in the prevention of cervical cancer. Also

similar study should be carried out to find out the knowledge and attitude of women who visit

the hospital towards cervical screening.

Summary

This research was done to find out the awareness and knowledge of cervical cancer among

women of age 40-69 years in Uruagu Nnewi, Nnewi North Local Government Area Anambra

state. The objectives of this study were to ascertain the awareness of the women on cervical

cancer, to determine the opinion of the women towards the prevalence of cervical cancer, to

determine the awareness of cervical screening among women and to identify the factors

affecting screening among women. The study covered a sample size of 192 women but 170

questionnaire were collected hence return rate of 88.5% from the findings, 45.3% of the

respondents possessed good knowledge of cervical cancer while 55% did not, 58.4%

indicated they got the information from the hospital, with 51% of them who believed that

multiple sexual partner and frequent change of sexual partner to be a possible risk factor to

cervical cancer and 22.1% who identified family history of cervical cancer to also be a risk

factor. 28.5% believed pain during sexual intercourse is one of the signs and symptoms while

38% chosed abnormal bleeding to be one of the signs and symptoms too. 94.7% out of 77

40
(45.3%) respondents who indicated knowledge of cervical cancer agreed that cervical cancer

is treatable if discovered at early stage. 100% of them believed cervical cancer can be

prevented with only 11.2% of them indicated they’ve been immunized with human papiloma

virus vaccine while the majority of them 89% have not. From the findings, only 51.9% of the

respondents possessed good knowledge of pap smear as a cervical screening technique but

poor knowledge of coloposcopy with only 9.1% having knowledge of it. The findings also

revealed some factors affecting the uptake of cervical screening amongst women. The

findings showed 36 strongly agreed while 51 agreed that religious belief was a factor

affecting participation in cervical screening giving a positive mean value of 4.0, 38 strongly

agreed and 29 agreed that high cost of screening was also a factor giving a positive mean

value of 3.0, 75 strongly agreed, 53 agreed and 2 disagreed that not susceptible to cervical

cancer was a factor too giving a positive mean value of 6.0 also 63 strongly agreed and 5.0

agreed that fear of detection of cancer is a factor affecting the participation giving rise to

positive mean value of 5.0

Finally, it has been made known from this study that women have poor knowledge of cervical

cancer and limited understanding of the types of cervical cancer screening techniques and

poor disposition towards undergoing cervical screening.

41
 REFERNCES

Aboyeji, P, Iyaiya M. & Jimoh, A (2007). Knowledge, attitude and practice of cervical smear
as a screening procedure for cervical in Ilorin, Nigeria. Retrieved on 26th September,
2017 from http://www.ncbi.nlm.nil.gov.

Akujobi, Ikechabelu, J, Onunkwo, I. & Onyiorah, I. (2008). Knowledge, attitude and practice
of screening for cervical cancer among female students of tertiary institution in South-
Eastern, Nigeria. Retrieved on 9th October, 2017 from http://www.wikipedia.org.

Andrey, B. & Shirlee, S. (2012) Kozier and Erb’s fundamental of Nursing, concepts process
and practice. (9th edition) pear plc New Jersey.

Anya, S.E, Oshi, Oshi, D.C & Nwosu, S.O (2015). Knowledge, attitude and practice of
female health professionals regarding cervical cancer and pap smear Niger, Jmed 14(3):
283-6.

Awodele, O., Adeyomoye, A.A.A., Awodele D.F., Kwashi, V. & Dolapo D.C. (2011).
study on cervical cancer screening amongst nurses in Lagos University teaching
Hospital, Lagos, Nigeria. Retrieved 3rd November, 2017 from
http://www.nchi.nlm.nih.gov/pubmed/21222/92.

Bosch, F.X & De Sanjose, S. (2007). The epeidemiology of human papilloma virus infection
and cervical cancer. Retrieved 6th October, 2017 from http://www.en.m.wikipedia.org.

Cancer Treatment Centers of America (2013). Anatomy of cancer. Retrieved on 2nd

November 2017from http://www.cancercenter.com.

Ezem, B.U (2007). Awareness and Uptake of Cervical Cancer Screening in Owerri, South-
Eastern Nigeria. Retrieved on 9th October, 2017 from
http://www.ncbi.nlm.gov//pubmed/18240495.

Giles, M & Garland, S. (2006). Women’s knowledge regarding human papiloma virus
infection, cervical cancer and human papillomavirus vaccines. Retrieved on October 6 th
2017 from http://www.onlinelibrary.wiley.com.

Hoque, E. & Hogue, M. (2014). Knowledge and Attitude Towards Cervical Cancer Among
Female University Students In South Africa. Retrieved On 9th October 2017 From
Http://Www.Ncbi.Nlm.Gov.

42
Mutyaba, T. J Mmiro, F & Weiderpass, E. (2006). Knowledge, attitude and practices of
cervical cancer screening among medical worker of Mulago Hospital Uganda.
Retrieved on 9th October 2017 from http://www.wikipedia.org.

National Cancer Institute (2014). Cervical cancer screening. Retrieved on 26 th September,

2017 from http://www.cancer.gov.

Odetola, T. & Oyetunde, M. (2012).Knowledge, attitude and practice of cervical cancer

screening among women in Primary health care center in Ibadan South East local
Government Area, Oyo state, Nigeria. West African Journal of Nursing 23 (34): pg
34-47.

Stanley, J. & Swierzewski, M.D. (2015). Overview of cervical cancer. Retrieved on 26th
September, 2017 from http://www.healthcommuniteis.com.

Udigwe, G.O (2006). Knowledge, attitude and practices of cervical cancer screening (Pap
Smear) among female nurses in Nnewi, South-Eastern Nigeria. Retrieved on th
October, 2017 from http://www.ncbu.nlm.nihi.gov.

Udigwe,G.O (2016).Incidence and prevalence of cervical cancer among women in

Nnewi,South-Eastern Nigeria.Retrieved on 1st February, 2018 from
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Vanputte, C., Rogan, J. & Russo, A. (2011). Seeley’s Anatomy & Physiology (9th edition)
McGraw-Hill Companies, inc.

Wellensick N,, Moodley, M & Nkwanyana N. (2014). Knowledge and attitude towards
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from http://www.wikipedia.org.

43
 QUESTIONNAIRE

School of Midwifery,
Holy Rosary Specialist Hospital
Waterside, Onitsha.
P.M.B 415
Anambra state.
Dear Respondent,

I am a final year student of the above named institution, carrying out a research study on the
Awareness and Knowledge of Cervical Cancer among women of age 40-69 years in Uragu
Nnewi, Nnewi North Local Government Area Anambra state. Your honest response will be
highly appreciated and treated confidentially. Your hones response will be highly appreciated
and treated confidentially.

Yours faithfully,
--------------------
Ezechimpu Maryann O.
SECTION A: BIODATA
Instruction
Please tick (√ ) in the boxes provided.
1. Age (years):
(a) 40-455 (b) 46-50 (c)51-55 (d)56-60
(e)61-69
2. Marital Status:
(a) Married (b) Single (c)Widow (d)Divorced
3. Religion:
(a) Islam (b) Christianity (c) African Traditional Religion

4. Ethnicity:
(a)Igbo (b) Hausa (c) Yoruba

44
5. How many children do you have?
(a) 2 (b) 3 (c) 4
Section B
To ascertain the awareness of the women on cervical cancer
6. Have you heard of cervical cancer?
(a) Yes (b) No
7. If yes, where was the source of information?
a. Through the radio (b) Through T.V Progamme (c) Seminar
(d) Friends (e) Hospital
8. What are the possible risk factor?
a. Early sexual intercourse before the age of 18 (b) Increase number of children
(c) Multiple sex partner and frequent change of sexual partner
(d) Family history of cancer of the cervix (e) curse from the gods/enemy
(f) recurrent sexually transmitted infection.
9. What are the possible signs and symptoms?
a. Intense pain during sexual intercourse (b)Heavy menstruation
(c)Frequent and persistent bloddy vagina discharge (d) Kidney failure
(e) Headache (f) Pelvic pain (g) Abnormal bleeding during sexual
intercourse
To determine the opinion of women towards the prevalence of cervical cancer
10 At what age did you have first sexual intercourse?
(a) 16-18 (b) 19-25 (c) 26-30
11 Since then, have you been sexually active?
(a) Yes (b) No
12 Do you use barrier method (condom) during sexual intercourse?
(a) Yes (b) No (c) Often
To determine the awareness of the cervical screening among women
13 Have you heard of cervical screening?
(a) Yes (b) No

45
14 If yes, what are the techniques used in cervical screening?
(a) Papaniculoau smear (b) Visual inspection of the cervix painted with acetic acid
(c) Human papilomaviurs DNA test (d) Colosposcopy
15 What group of people are eligible to undergo cervical screening?
(a) Women who are sexually active (b) Women who have never had sex
(c)Women who used to have sex but have stopped (d) Women whose husbands
have genital warts
16 At what age is one eligible to undergo cervical screening?
(a) 20-70 (b) 10-30 (c) After menopause
To determine factors affecting cervical screening among women
17 What hinders you from undergoing cervical screening
Reponses Strongly Agree Disagree Strongly
agree disagree
a. Religious belief
b. High cost of screening
c. Fear of detection of cancer
d. Lack of interest
e. Not susceptible to cervical cancer
f. No particular reason
g. Cultural belief

46
47