Background
Objective
Methods
Study design
Setting
District Name | Number of HC level III | Number of HC level IV |
---|---|---|
Agago | 11 | 0 |
Amuru | 10 | 1 |
Gulu (Aswa county) | 6 | 1 |
Kitgum | 8 | 1 |
Lamwo | 8 | 2 |
Nwoya | 3 | 0 |
Omoro | 7 | 1 |
Pader | 11 | 2 |
Organization of health facilities in Uganda
Health facilities and participants selections criteria
Sample size and sampling procedure
Operational definitions and measurements
Attitudes
Data sources and measurements
Quality control
Data management and analysis
Results
Study population
Demographic characteristics of respondents
Variables | Frequency | Percent |
---|---|---|
Health workers qualifications (n = 286) | ||
Nurses | 153 | 54 |
Midwife | 81 | 28 |
Clinical Officer | 52 | 18 |
Gender of health workers (n = 286) | ||
Male | 98 | 34 |
Female | 188 | 66 |
Health centre level of health workers (n = 286) | ||
Health centre level IV | 64 | 22 |
Health centre level III | 222 | 78 |
Number of years employed as a health worker (n = 281) | ||
1–4 years | 54 | 19 |
5–9 years | 113 | 40 |
10–14 years | 53 | 19 |
15 + years | 61 | 22 |
Age group of health workers (n = 280) | ||
21–25 years | 19 | 7 |
26–30 years | 76 | 27 |
31–35 years | 72 | 26 |
36–40 years | 52 | 18 |
41+ years | 61 | 22 |
Health worker trained to conduct cervical cancer screening (n = 283) | ||
Yes | 93 | 33 |
No | 190 | 67 |
HC has education material about cervical cancer (n = 284) | ||
No | 200 | 70 |
Yes | 84 | 30 |
Health worker conducts outreach health education in the community (n = 283) | ||
Yes | 128 | 45 |
No | 155 | 55 |
HC receives fund for cervical cancer activities (n = 282) | ||
No | 273 | 97 |
Yes | 9 | 3 |
HC has guideline for cervical cancer screening (n = 281) | ||
Yes | 58 | 21 |
No | 223 | 79 |
HC has HPV vaccination guideline (n = 276) | ||
Yes | 205 | 74 |
No | 71 | 26 |
Participant knew period covered by strategic plan for cervical cancer prevention and control in Uganda | ||
Yes | 5 | 2 |
No | 281 | 98 |
Practice of cervical cancer prevention
Knowledge about cervical cancer
Variables | Total, N = 285 (%) | Nurses, N = 153 (53%) | Midwives, N = 80 (28%) | CO, N = 52 (18%) | χ2 | p-value |
---|---|---|---|---|---|---|
Adequate knowledge score ≥ mean (18 marks) | 171 (60) | 93 (61) | 48 (60) | 30 (58) | 0.16 | 0.93 |
Risk factors for cervical cancer | ||||||
Infection with HPV | 244 (85) | 130 (85) | 66 (82.5) | 48 (92) | 2.57 | 0.28 |
Smoking cigarette | 120 (42) | 54 (35) | 36 (45) | 30 (58) | 8.37 | 0.02 |
Infection with HIV | 235 (82) | 124 (81) | 66 (82.5) | 45 (87) | 0.81 | 0.69 |
Having multiple deliveries | 189 (66) | 110 (72) | 50 (62.5) | 29 (56) | 5.24 | 0.07 |
Early age at first delivery | 177 (62) | 92 (60) | 55 (69) | 30 (58) | 2.18 | 0.35 |
Early age at sexual debut | 264 (92) | 139 (91) | 74 (93 | 51 (98) | 2.97 | 0.22 |
Long-term use of oral contraceptives pills | 65 (23) | 35 (23) | 21 (26) | 9 (17) | 1.43 | 0.49 |
Infection with Chlamydia trachomatis | 142 (50) | 83 (54) | 35 (44) | 24 (46) | 2.66 | 0.26 |
Having multiple sexual partners | 283 (99) | 153 (100) | 78 (98) | 52 (100) | 5.16 | 0.08 |
Signs and symptoms of cervical cancer | ||||||
Foul-smelling vaginal discharge | 237 (83) | 124 (81) | 69 (86) | 44 (85) | 1.11 | 0.58 |
Bleeding after menopause | 260 (91) | 138 (90) | 73 (91) | 49 (94) | 0.79 | 0.70 |
Bleeding after sexual intercourse | 266 (93) | 143 (93) | 73 (91) | 50 (96) | 1.22 | 0.54 |
Abnormal vaginal bleeding between period | 237 (83) | 126 (82) | 67 (84) | 44 (85) | 0.17 | 0.92 |
Unexplained weight loss | 174 (61) | 95 (62) | 41 (51) | 38 (73) | 6.46 | 0.04 |
Prevention and control of cervical cancer | ||||||
Vaccination against HPV | 282 (99) | 152 (99) | 78 (97.5) | 52 (100) | 2.40 | 0.30 |
Correct age group for HPV vaccination according to Uganda Ministry of Health | 250 (87) | 138 (90) | 68 (84) | 44 (85) | 2.33 | 0.31 |
Using condom during sexual encounter | 234 (82) | 126 (82) | 66 (82.5) | 42 (81) | 0.08 | 0.96 |
Avoiding multiple sexual partners | 280 (98) | 149 (97) | 79 (98) | 52 (100) | 1.37 | 0.74 |
Delaying initiation of sex after 18 years | 220 (77) | 114 (75) | 62 (77.5) | 44 (85) | 2.26 | 0.32 |
Male circumcision | 249 (87) | 134 (88) | 68 (85) | 47 (90) | 0.84 | 0.66 |
Avoiding prolong use of oral contraceptive pills | 81 (28) | 41 (27) | 28 (35) | 12 (23) | 2.63 | 0.27 |
Avoiding smoking cigarette | 133 (47) | 64 (42) | 40 (50) | 29 (56) | 3.53 | 0.17 |
Avoiding multiple deliveries/births | 193 (68) | 113 (74) | 54 (67.5) | 26 (50) | 10.11 | 0.01 |
Early screening | 277 (97) | 148 (97) | 78 (97.5) | 51 (98) | 0.30 | 0.86 |
Correct age group for screening using VIA according to Uganda Ministry of Health | 46 (16) | 19 (12) | 20 (25) | 7 (13) | 6.23 | 0.04 |
Misconceptions about cervical cancer risk factors, signs, and symptoms
Variables | Total N = 285 (%) | Nurses, N = 153 (53%) | Midwives, N = 80 (28%) | CO, N = 52 (18%) | χ2 | P-value |
---|---|---|---|---|---|---|
Misconception about cervical cancer risk factors | ||||||
Infection with herpes simplex virus-2 (HSV-2) | 144 (51) | 75 (49) | 40 (50) | 29 (56) | 0.72 | 0.70 |
Over consumption of Alcohol | 48 (17) | 23 (15) | 14 (17.5) | 11 (21) | 1.07 | 0.59 |
Having a family history of cervical cancer | 209 (73) | 120 (78) | 56 (70) | 33 (63) | 5.08 | 0.08 |
Misconception about cervical cancer signs and symptoms | ||||||
Abdominal pain | 192 (67) | 101 (66) | 52 (65) | 39 (75) | 1.71 | 0.43 |
Having headache | 35 (12) | 24 (16) | 6 (7.5) | 5 (10) | 3.69 | 0.16 |
Having a lot of night sweat | 18 (6) | 7 (5) | 7 (9) | 4 (8) | 1.75 | 0.42 |
Attitudes towards participation in cervical cancer training, and prevention activities
Statements | N | Strongly Disagree (1) | Disagree (2) | Neutral (3) | Agree (4) | Strongly Agree (5) |
---|---|---|---|---|---|---|
I always advise my patients to screen for cervical cancer | 283 | 10 (4) | 2 (1) | 21 (7) | 97 (34) | 153 (54) |
I discuss cervical cancer in our staff meeting | 279 | 39 (14) | 73 (26) | 49 (18) | 87 (31) | 31 (11) |
I will be happy to see that my children/sister are immunised against HPV | 284 | 8 (3) | 0 (0) | 2 (1) | 24 (8) | 250 (88) |
Cervical cancer is not a serious health problem, so screening is just a burden | 285 | 256 (90) | 18 (6) | 2 (1) | 3 (1) | 6 (2) |
Even if we screen and find a woman with precancerous lesion, there is nothing we can do | 280 | 198 (71) | 61 (22) | 10 (3) | 3 (1) | 8 (3) |
I do not think it is necessary to screen for cervical cancer in our health facility | 285 | 236 (83) | 30 (10) | 0 (0) | 3 (1) | 16 (6) |
Government has not shown commitment about cervical cancer so why bother us | 284 | 159 (56) | 69 (24) | 23 (8) | 17 (6) | 16 (6) |
I am not interested in cervical cancer prevention because partners/NGOs do their work without developing our capacity to implement cervical cancer control program on our own | 284 | 131 (46) | 81 (28) | 28 (10) | 28 (10) | 16 (6) |
I will participate in cervical cancer prevention program if I am going to be paid money cash | 282 | 90 (32) | 102 (36) | 49 (17) | 19 (7) | 22 (8) |
I am willing to participate in a training for cervical cancer prevention if organised by Gulu University & University of New South Wales – Australia | 283 | 8 (3) | 8 (3) | 15 (5) | 61 (22) | 191 (67) |
I am willing to participate in a training for cervical cancer prevention if organised by Ministry of Health Uganda | 283 | 4 (1) | 3 (1) | 11 (4) | 66 (23) | 199 (70) |
I am willing to participate in a training for cervical cancer prevention if organised by NGOs | 282 | 5 (2) | 6 (2) | 20 (7) | 77 (27) | 174 (62) |
I am more likely to screen women for cervical cancer if I am trained and given equipment & consumables | 284 | 8 (3) | 1 (0) | 2 (1) | 59 (21) | 214 (75) |
Factors associated with adequate knowledge about cervical cancer among health workers
Demographic and HC characteristics | n (%) | Knowledge | COR | 95% CI | P-value | AOR | 95% CI | P-value | |
---|---|---|---|---|---|---|---|---|---|
Inadequate n = 114 (40) | Adequate n = 171 (60) | ||||||||
Health workers qualifications (n = 285) | |||||||||
Nurses | 153 (54) | 60 (39) | 93 (61) | 1 | 1 | ||||
Midwife | 80 (28) | 32 (40) | 48 (60) | 0.97 | 0.56–1.68 | 0.91 | 1.15 | 0.57–2.30 | 0.70 |
Clinical Officer | 52 (18) | 22 (42) | 30 (58) | 0.88 | 0.46–1.67 | 0.69 | 0.98 | 0.45–2.15 | 0.97 |
Gender of health workers (n = 286) | |||||||||
Male | 98 (34) | 42 (43) | 56 (57) | 1 | 1 | ||||
Female | 187 (66) | 72 (39) | 115 (61) | 1.20 | 0.73–1.97 | 0.48 | 1.43 | 0.74–2.76 | 0.28 |
Health centre level of health workers (n = 286) | |||||||||
Health centre level IV | 64 (22) | 26 (41) | 38 (59) | 1 | 1 | ||||
Health centre level III | 221 (78) | 88 (40) | 133 (60) | 1.03 | 0.59–1.82 | 0.91 | 1.10 | 0.56–2.16 | 0.78 |
Numbers of years employed as a health worker (n = 281) | |||||||||
1–4 years | 54 (19) | 27 (50) | 27 (50) | 1 | 1 | ||||
5–9 years | 112 (40) | 42 (37.5) | 70 (62.5) | 1.67 | 0.86–3.21 | 0.13 | 2.07 | 0 .84–5.11 | 0.11 |
10–14 years | 53 (19) | 20 (38) | 33 (62) | 1.65 | 0.76–3.56 | 0.20 | 1.17 | 0.38–3.62 | 0.79 |
15 + years | 61 (22) | 24 (39) | 37 (61) | 1.54 | 0.74–3.23 | 0.25 | 0.91 | 0.22–3.65 | 0.89 |
Age group of health workers (n = 280 | |||||||||
21–25 years | 19 (7) | 9 (47) | 10 (53) | 1 | 1 | ||||
26–30 years | 76 (27) | 35 (46) | 41 (54) | 1.05 | 0.39–2.89 | 0.92 | 0.83 | 0.24–2.88 | 0.77 |
31–35 years | 71 (25) | 27 (38) | 44 (62) | 1.47 | 0.53–4.07 | 0.46 | 0.87 | 0.21–3.57 | 0.85 |
36–40 years | 52 (19) | 20 (38) | 32 (62) | 1.44 | 0.50–4.16 | 0.50 | 1.32 | 0.30–5.72 | 0.71 |
41+ years | 61 (22) | 23 (38) | 38 (62) | 1.49 | 0.53–4.20 | 0.45 | 1.64 | 0.29–9.31 | 0.58 |
Healthcare worker trained to conduct cervical cancer screening (n = 282) | |||||||||
Yes | 93 (33) | 26 (28) | 67 (72) | 1 | 1 | ||||
No | 189 (67) | 85 (45) | 104 (55) | 0.47 | 0.28–0.81 | 0.01 | 0.39 | 0.21–0.72 | < 0.001 |
HC has education material about cervical cancer (n = 283) | |||||||||
Yes | 84 (30) | 33 (39) | 51 (61) | 1 | 1 | ||||
No | 199 (70) | 80 (40) | 119 (60) | 0.96 | 0.57–1.62 | 0.89 | 1.17 | 0.62–2.23 | 0.63 |
Health worker conduct outreach health education in the community (n = 283) | |||||||||
Yes | 128 (45) | 45 (35) | 83 (65) | 1 | 1 | ||||
No | 154 (55) | 69 (45) | 85 (55) | 0.67 | 0.41–1.08 | 0.10 | 0.73 | 0.41–1.30 | 0.28 |
HC has guideline for cervical cancer screening (n = 281) | |||||||||
Yes | 58 (21) | 18 (31) | 40 (69) | 1 | 1 | ||||
No | 222 (79) | 94 (42) | 128 (58) | 0.61 | 0.33–1.13 | 0.12 | 0.53 | 0.25–1.12 | 0.10 |
HC has HPV vaccination guideline (n = 275) | |||||||||
Yes | 204 (74) | 76 (37) | 128 (63) | 1 | 1 | ||||
No | 71 (26) | 33 (46) | 38 (54) | 0.68 | 0.40–1.18 | 0.17 | 0.68 | 0.38–1.25 | 0.21 |
Factors associated with positive attitudes towards participation in cervical cancer training, and prevention activities
Demographic characteristics | n (%) | Attitudes | COR | 95% CI | p-values | AOR | 95% CI | p-value | |
---|---|---|---|---|---|---|---|---|---|
Negative n = 98 (34%) | Positive n = 187 (66%) | ||||||||
Health workers qualifications (n = 285) | |||||||||
Nurses | 153 (54) | 47 (31) | 106 (69) | 1 | 1 | ||||
Midwife | 80 (28) | 28 (35) | 52 (65) | 0.82 | 0.46–1.46 | 0.51 | 0.56 | 0.28–1.16 | 0.12 |
Clinical Officer | 52 (18) | 23 (44) | 29 (56) | 0.56 | 0.29–1.07 | 0.08 | 0.55 | 0.25–1.22 | 0.14 |
Gender of health workers (n = 285) | |||||||||
Male | 98 (34) | 37 (38) | 61 (68) | 1 | 1 | ||||
Female | 187 (66) | 61 (33) | 126 (67) | 1.25 | 0.75–2.09 | 0.39 | 1.17 | 0.60–2.30 | 0.64 |
Health centre level of health workers (n = 285) | |||||||||
Health centre level IV | 64 (22) | 24 (37.5) | 40 (62.5) | 1 | 1 | ||||
Health centre level III | 221 (78) | 74 (33) | 147 (67) | 1.19 | 0.67–2.12 | 0.55 | 1.25 | 0.65–2.43 | 0.51 |
Numbers of years employed as a health worker (n = 280) | |||||||||
1–4 years | 54 (19) | 19 (35) | 35 (65) | 1 | 1 | ||||
5–9 years | 112 (40) | 43 (38) | 69 (62) | 0.87 | 0.44–1.71 | 0.69 | 1.1 | 0.44–2.72 | 0.84 |
10–14 years | 53 (19) | 13 (25) | 40 (75) | 1.67 | 0.72–3.86 | 0.23 | 3.17 | 0.96–10.54 | 0.06 |
15 + years | 61 (22) | 22 (36) | 39 (64) | 0.96 | 0.45–2.07 | 0.92 | 2.91 | 0.68–12.47 | 0.15 |
Age group of health workers (n = 279) | |||||||||
21–25 years | 19 (7) | 6 (32) | 13 (68) | 1 | 1 | ||||
26–30 years | 76 (27) | 26 (34) | 50 (66) | 0.89 | 0.30–2.61 | 0.83 | 1.02 | 0.28–3.67 | 0.98 |
31–35 years | 71 (25) | 26 (37) | 45 (63) | 0.8 | 0.27–2.35 | 0.68 | 0.65 | 0.15–2.76 | 0.56 |
36–40 years | 52 (19) | 12 (23) | 40 (77) | 1.54 | 0.48–4.92 | 0.47 | 0.92 | 0.20–4.14 | 0.91 |
41+ years | 61 (22) | 25 (41) | 36 (59) | 0.66 | 0.22–1.98 | 0.46 | 0.27 | 0.05–1.58 | 0.15 |
Healthcare worker trained to conduct cervical cancer screening (n = 283) | |||||||||
Yes | 93 (33) | 25 (27) | 68 (73) | 1 | 1 | ||||
No | 190 (67) | 72 (38) | 117 (62) | 0.6 | 0.35–1.03 | 0.06 | 0.52 | 0.28–0.97 | 0.04 |
HC has education material about cervical cancer (n = 283) | |||||||||
Yes | 84 (30) | 24 (29) | 60 (79) | 1 | 1 | ||||
No | 200 (70) | 74 (37) | 125 (63) | 0.68 | 0.39–1.18 | 0.17 | 0.7 | 0.36–1.34 | 0.28 |
HC has guideline for cervical cancer screening (n = 280) | |||||||||
Yes | 58 (21) | 21 (36) | 37 (64) | 1 | 1 | ||||
No | 222 (79) | 75 (34) | 147 (66) | 1.11 | 0.61–2.03 | 0.73 | 1.34 | 0.64–2.77 | 0.44 |
HC has HPV vaccination guideline (n = 275) | |||||||||
Yes | 204 (74) | 67 (33) | 137 (67) | 1 | 1 | ||||
No | 71 (26) | 29 (41) | 42 (59) | 0.71 | 0.41–1.24 | 0.22 | 0.68 | 0.37–1.26 | 0.22 |