Comprehensive knowledge on cervical cancer, attitude towards its screening and associated factors among women aged 30–49 years in Finote Selam town, northwest Ethiopia

Screening services for cervical pre-cancerous lesions are currently available for all women aged 30–49 years at public hospitals in Ethiopia. Though women’s knowledge and their attitude are determinants for the uptake the screening service, there is limited information on these. Therefore, this study aimed to assess the comprehensive knowledge of cervical cancer, attitudes towards the screening, and associated factors among women aged 30–49 years at Finote Selam town, northwest Ethiopia.

A total of 1137 women participated in this study. Nearly one third, 30.3% of the women had comprehensive knowledge on cervical cancer, and 58.1% had a favorable attitude towards cervical cancer screening. Having college and above education, knowing someone with cervical cancer, and having a history of sexually transmitted diseases were significantly associated with comprehensive knowledge of cervical cancer. Meanwhile, college and above educational status, knowing someone with cervical cancer, and having comprehensive knowledge of cervical cancer were positively associated with favorable attitude towards cervical cancer screening. Therefore we recommended that provision of information, education, and counseling about the disease and screening service are mandatory to address the knowledge gap and to improve women’s attitude towards screening services.

Despite the fact that cervical cancer is preventable, it is reported that there were 485,000 cervical cancer cases and 236,000 deaths of women due to cervical cancer in 2013 worldwide [1]. Almost 87% of the deaths occurred in less developed regions, it was the second most commonly diagnosed cancer and the third leading cause of cancer death among females in less developed countries [2].

East Africa has the highest sub- regional incidence of cervical cancer in which the age standardised rate is 42.7 per 100,000 women, followed by Southern Africa with 31.5 per 100,000 women [3]. In Ethiopia, an estimated 7095 new cervical cancer cases were diagnosed, and 4732 die annually from it in 2012 [4]. New cases of cancer were diagnosed in the Black Lion specialized Hospital data set between 1997 and 2012, and the result revealed that 31.8% were cervical cancer patients [5].

The large geographic variations in cervical cancer rates reflect the presence of differences in the accessibility of screening service because the presence of screening service detects precancerous lesion and helps early initiation of treatment of the lesion before it progresses to cancer stage [6]. A population survey indicates the average cervical cancer screening in developing countries is 19%while it is 63% in developed countries and ranging from 1% to 73%respectively [7]. A meta-analysis noted that the risk of dying from cervical cancer was 35% lower among women invited to screening with cytology testing than among women who were not offered screening services [8].

Having knowledge on cervical cancer and it’s screening is associated with the uptake of services [9], favourable attitudes towards cervical cancer screening is also associated with the uptake of screening services [10, 11]. Cervical cancer screening helps to detect pre-cancerous lesions before it advances to a cancerous stage which in turn reduces its related mortality rates. In Ethiopia, screening services for cervical pre-cancerous lesion is available for all women aged 30–49 years at public health institutions [12]. Women’s knowledge on cervical cancer and their attitude for screening determine the uptake of service [13]. However, evidence on women’s knowledge of cervical cancer and their attitude towards screening at the community level is very limited in Ethiopia. Therefore, a community based study was conducted to assess knowledge of cervical cancer, attitude towards its screening and associated factors among women aged 30–49 years at Finote Selam town, northwest Ethiopia.

Knowledge of cervical cancer and attitude towards its screening are essential for the prevention of the disease. The current study was conducted to determine women’s comprehensive knowledge on cervical cancer, attitude towards pre-cervical cancer screening and associated factors.

The study revealed that nearly one-third, 30.3% (95%CI: 27.2–32.9), of participants had comprehensive knowledge on cervical cancer. This finding is comparable with that of a community based study conducted in Gondar (31%), Ethiopia, among women aged 15 years and above [15]. This finding is higher than the finding 25% reported from Addis Ababa [18]. The possible reason for difference might be that the researchers used only 13 questions and 7/13 was used as the cutoff point to determine knowledge in the previous study. However, our result is lower than the finding reported by a community-based study in Uganda which noted 55% [19]. The possible reason for the difference from the study done in Uganda could be the variation in educational status between the two study populations. The majority of the participants in the Ugandan study completed primary school unlike ours in which nearly half of participants did not have formal education.

Ours study showed that 58.1% (95% CI: 55, 62.2) of the women had favourable attitude towards cervical cancer screening. This result was better than that of a study done in Dessie, Ethiopia which documented 42.1% [11]. The gap between our study and that of Dessie might be the high proportion of single (unmarried) participants in the Dessie study. There is evidence that single women have less favourable attitude towards screening [16]. However, the result is lower than the finding of a hospital-based study in India which reported 76% [16]. The difference between our and the study in India might be the study setting; hospitalized women might have high health seeking behaviour and better access to information. Our finding was also lower than that of a study conducted among market women in Nigeria noted 80.4% had favourable attitude towards screening [20]. The difference might be that in the Nigeria study the participants were shop owners/attendants aged 15 years and above, most of them with higher educational status.

In this study, educational status was positively associated with women’s comprehensive knowledge on cervical cancer. Women who have primary, secondary and college/university education were more likely to have better knowledge on cervical cancer than those who did not have formal education. Studies in the Democratic Republic of Congo [10], India [16], and Dessie, Ethiopia [11], reported similar findings. Similarly, in this study, it was found that educational status of women had a significant association with attitude towards cervical cancer screening. In the present study, women who had college and above educational status were more than two times more likely to have favorable attitude towards cervical cancer screening. Similar results were found by studies conducted in Eastern Uganda [19], and Addis Ababa [18].

The present study identified that the participants who knew someone with cervical cancer were five times more likely to be knowledgeable on cervical cancer than those who didn’t know someone with cervical cancer. Studies conducted in Gondar [15], and Kenya [21] had similar findings. Our study revealed that women who knew someone who had cancer were 3.24 times more likely to have favorable attitude towards cervical cancer screening (AOR = 3.24, 95%CI: 1.14, 9.15).

Our finding showed that women who had history of STD were nearly three times more likely to be knowledgeable on cervical cancer than those who had not. A similar finding was reported by a study done on Asian Maldives [22]. This might be because of women who had STD might have contact with health professionals to get treatment for the disease during which they might be advised/counselled about the risks of unprotected sex, including the risk of viral infections, such as HIV, and the human papiloma virus plus their consequences and means of prevention. Thus, this communication might help them get information on cervical cancer. A study conducted in rural Kenya identified that family planning service utilization was positively associated with knowledge on cervical cancer [9]. In our study, no significant association was observed between knowledge on cervical cancer and obstetric service related variables such as ANC, family planning and post-natal service utilization. This may suggest that women who utilize maternal health services do not receive information on cervical cancer.

The finding in this study showed that women who had comprehensive knowledge of cervical cancer were three times more likely to have favorable attitude towards cervical cancer screening as compared to their counterparts. Previous studies done in Nepal [23], and a health facility-based study in Dessie Ethiopia [11], reported a similar finding. This shows that women who have adequate knowledge on cervical cancer might understand the nature disease (causes, symptoms, preventions, and treatments), and the benefits of screening which in turn make them have positive attitude towards screening. Since this study was conducted in urban setting that could not generalize for rural women. This might be the potential limitation of this study. Additionally, one of the independent variables we considered was history of sexually transmitted diseases that might be exposed for social desirability bias. However, the authors tried to minimize this potential bias by providing adequate information for the study participants about the importance of telling the truth and confidentiality nature of the research.

In this study, it was identified that women’s knowledge on cervical cancer was low, despite the high incidence of the disease in Ethiopia. Relatively, a large proportion of the study participants in this study had favorable attitude towards cervical cancer screening. Attending primary, secondary school and college, knowing someone who had cervical cancer and history of STD were factors associated to comprehensive knowledge on cervical cancer.

Attended college and above, knowing someone who had cervical cancer, and having comprehensive knowledge on cervical cancer were important factors for having favorable attitude towards cervical cancer screening. There is clear need for information sharing on cervical cancer, including its screening targeting women with less educated. Educational campaign on the disease and screening,involving the mass media in providing information to the women on cervical cancer, including screening service availability when the women visit health facilities for reproductive services are proposed.