European Journal of Cardiovascular Medicine

Worldwide, cervical cancer is the second most common cancer among women, after breast cancer. Every year, 500 000 new cases are diagnosed and 270 000 women die of this disease, mostly (85%) in developing countries. ^[1] The world pattern of cervical cancer indicates that this is predominantly a problem of low resource setting countries. The main reason is limited access to screening and treatment facilities. ^[2] Countries that have organized screening programs have substantially reduced cervical cancer incidence and mortality. Screening programs have the potential to be effective because cervical cancer is easily accessible to biopsy, there is a long latent period easily recognizable before development of cancer and there is an effective treatment in precursor disease. ^[3]

Women in their forties have on average 7 children and 21% of them have their first child when they are teenagers. ^[4] Approximately 6% of the population aged 15-49 is infected with HIV. ^[5] There is a national cervical cancer-screening program, but the service is limited to some main cities, and this probably contributes to the high incidence and mortality from cervical cancer in a country where 42% of the population is rural. Based on hospital registry data, women most at risk for cervical cancer are those over 35 years with a median age at diagnosis of 49 years; most of them having an advanced and incurable disease at presentation. ^[6] Awareness and educational campaign in the mass media and distributed information on the availability of cervical cancer screening. The method of screening was not specified but the tests (cytology-based or visual inspection with acetic acid (VIA)) were offered free of charge to the population. ^[7]

Recent years have also seen significant developments in cervical cancer prevention. Previous efforts to implement cytology-based screening in developing countries have been conducted since the early 1980’s.  ^[8] However, to date, they have failed to reduce the mortality rates mainly because of inadequate material resources, absence of a quality control system, lack of trained providers and of follow-up and treatment facilities.

Lack of knowledge about cervical cancer in the population and among healthcare workers is a prime barrier for access to cervical cancer prevention [6-8]. Our aim was to assess the knowledge and awareness of cervical cancer prevention among healthcare workers.

This is a cross-sectional study design was conducted to assess the level of knowledge about cervical cancer screening and its practice among female health care workers at Tertiary Care Teaching Hospital.

All female health workers comprising doctors, nurses, midwives, pharmacy technicians, pharmacists, and medical laboratory technicians and technologists, aged between 15 and 65 years, and employed in our zone were considered as the source population, while those who were employed in the selected health institution were considered as the study population.

A simple random sampling technique was employed to select health centers among public health centers in our zone. All hospitals in our zone administration were purposively included in the study. The total numbers of female health care workers in each group of professions (namely doctors, nurses, midwives, pharmacists and pharmacy technicians, medical laboratory technologists, and technicians) in these health institutions (data obtained from each institution by principal investigator via preliminary survey). Then, the sample was allocated to the selected health institutions proportional to the number of female health workers in the respective health institutions. Finally, a simple random sampling technique was used to select a total of 90 female health care workers.

A pretested and structured self-administered questionnaire was used for data collection. The collected data were checked for completeness and consistency by the investigator and supervisor. Different relevant literature was reviewed to develop the tool that addresses the objective of the study. The instrument was pretested on 40 study participants who were working in other health facilities that were not part of the actual study. Findings from the pretest were used to modify the instrument in terms of clarifying the questions. The questionnaire was designed to obtain information on the sociodemographic, reproductive, and professional characteristics of the respondents, knowledge about cervical cancer, and health workers’ cervical cancer screening history. Knowledge about cervical cancer was measured by using 12 knowledge questions about risk factors, symptoms, treatments, and outcomes of cervical cancer. To produce a more objective assessment of knowledge about cervical cancer, a scoring method was devised and a knowledge score for each participant was obtained by summing up the score for correct responses given to the selected questions in the questionnaire. A score of mean value or above ($6) to these questions was considered as a good level of knowledge, otherwise lower scores were taken as poor level of knowledge. Five BSc nurses facilitated the data collection process. They were given 1 day training before the actual work, about the aim of the study, procedures, and data collection techniques.

Statistical analysis

The collected questionnaire was checked manually for its completeness, coded, and entered into Epi-Info version 3.5.4 statistical package, then exported to SPSS version 20.0 for further analysis. Descriptive and summary statistics were done. Both bivariate and multivariate logistic regression analyses were used to determine the association of each independent variable with the dependent variable. Variables significant in bivariate analysis (P-value #0.2) were entered into a multivariate logistic regression model to adjust the effects of confounders on the outcome variable. Odds ratios with their 95% confidence intervals (CIs) were computed to identify the presence and strength of association, and statistical significance was declared if P, 0.05.

Among 90 female primary healthcare workers who accepted to participate to the study, mean age was 35.84±9.02 years (21-53), mean duration of marriage was 11.48±8.07 years (1-25) and mean number of pregnancies was 4.45±2.24 (0-8). When the occupational distribution of the participant healthcare workers was examined, 11.1% (n=10) were physicians, 33.3% (n=30) were nurses, 44.4% (n=40) were obstetricians and 11.1% (n=10) were other assistant healthcare workers (health officer, emergency medical technician). It was found that 2.2% (n=2) of the participants went through the menopause and, of these, 1.1% (n=1) were still using hormone replacement therapy. When the regularity of the menstruation was questioned in non-menopausal participants, 96.7% (n=87) reported to have regular menstrual cycles. Mean menarche age of the participants was 15.21±2.33 years (10-17). Other sociodemographic characteristics of the participants are seen in Table 1.

Table 1. Sociodemographic Characteristics of the Participants

Table 2. Pap Smear Test Status by the Knowledge of the Women about Pap smear

It was found that only 27.8% (n=25) of the participants regularly had gynecologic examination. It was reported that, of the participants, 11.1% (n=10) had a gynecological examination once every six months, 13.3% (n=12) annually, 3.3% (n=3) every other year and 5.6% (n=5) more rarely. It was found that the participants who had gynecological examination had it for averagely 4.38±2.35 times (1-5) within the last five years. While 94.4% (n=85) of the participants reported that they had already heard about pap smear test, 44.4% (n=40) had underwent this test. It was determined that the participants who had pap smear test had it for averagely 2.70±0.95 times (1-4) within the last five years. It was reported that 55.6% (n=50) of the participants informed about Pap smear test (p<0.001) and 83.3% (n=75) of the participants who regularly had gynecological examinations (p<0.001) had this test.

Of the participants, 91.1% (n=82) gave the right answer to the question of “Which Disease’s Diagnosis Do Pap Smears Test For?” Of the participants, 66.7% (n=60) answered as “I don’t know” the question of “Do you know when you should being to have pap smear test?”. However, when the answers of these people were examined, it was seen that only 24.4% (n=22) gave the right answer. It was found that the people who were informed about the risk factors for the cervical cancer more commonly had Pap smear test, but no statistical significance was found (Table 2).

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