Knowledge, practice of cervical cancer screening and associated factors among women police members of Addis Ababa police commission Ethiopia

Cervical cancer is a cancer of the lower-most part of the uterus [1]. Cervical cancer is the second most common cancer which accounts for 22% of all female cancers and 12% of all newly diagnosed cancers every year, and the leading cause of cancer death in African women [1].

Cervix cancer is a progressive disease originating from abnormal cervical dysplasia, which gradually progresses to cervical cancer. It is a major public health issue and a leading cause of death among women worldwide. As the fourth most frequent cancer in women, it had an estimated 570,000 cases in 2018 [2‐4]. Cervical cancer is a leading cause of death in women and the second-leading cause of female cancer-related deaths. Globally, over 2.7 million women, 85% of whom live in low- and middle-income countries, are at risk of acquiring cervical cancer [3]. Human papilloma virus (HPV), a sexually transmitted infection, can lead to cervical intraepithelial neoplasia and cervical cancer. Women with multiple sexual partners, those with multiple sexual consorts, or those who have been previously exposed to the virus are at higher risk for cervical cancer [5]. Cervix cancer is the second most common cancer among women globally, with 500,000 new cases diagnosed and over 250,000 deaths annually. Cervical cancer is a global health concern, with 80,000 women aged 15 and older at risk each year of being diagnosed with it. In low- and middle-income countries (LMICs), including Ethiopia, cervical cancer is the most common cancer affecting reproductive organs and the leading cause of death among women. In Ethiopia, cervical cancer ranks as the most frequent cancer among women, causing 4732 deaths annually. Ethiopia has a 35.9 incidence and mortality rate, with 7,600 cases and 6,000 deaths annually [6‐9]). Early diagnosis and treatment are crucial to reducing the disease's incidence and mortality [8].

Cervical cancer screening detects abnormal cervical cells, including precancerous lesions, and early-stage cervical cancer, reducing incidence and mortality. Worldwide cervical cancer screening programs and the introduction of the Papanicolaou (Pap) test have significantly reduced mortality and morbidity in developed countries. In Ethiopia, screening is mostly conducted when a woman presents with symptoms. However, limited studies exist on knowledge and practice of cervical cancer screening in Ethiopia [1, 8, 10].

The Federal Ministry of Health Ethiopia (FMOH) Guideline recommends screening for cervical cancer in women aged 25–65, who have never had a Pap smear, had abnormal bleeding, or had cervix abnormalities. Over 80% of cervical cancers in sub-Saharan Africa are detected late, due to lack of information and lack of prevention services. This late stage is associated with low survival rates and limited treatment options in low-resource countries like Ethiopia [6].

Cervical cancer is prevalent in sub-Saharan Africa, with low survival rates and limited information. Low awareness, ineffective screening programs, and insufficient women's health attention contribute to the higher incidence rate [11].

Knowledge about cancer of the cervix and its screening is important in screening uptake. Women with low levels of knowledge about cervical cancer and its prevention are less likely to access screening services [5]. Early diagnosis and treatment are crucial to reducing the disease's incidence and mortality [8]. This study aimed to assess cervical cancer screening knowledge and practice among women police commissioners in Addis Ababa, Ethiopia. focusing on the impact of low awareness on screening uptake. The research aims to improve access to screening services and identify associated factors.

Cervical cancer screening enables the detection of abnormal cervical cells, including precancerous cervical lesions, as well as early-stage cervical cancer. Routine cervical screening has been shown to reduce both the incidence and mortality of the disease. This study showed all participants heard about cervical cancer, 49.5% had good knowledge about cervical cancer screening, and 18.4% had good screening practices. Associated factors that affected knowledge were participants' monthly income, attitude, practice of sexual intercourse, and screening practices. Participants' age, educational status, marital status, monthly income, religion, and knowledge were associated factors for cervical cancer screening practice; the main reason they did not get screened was that they felt healthy. When compared to previous studies conducted globally, the knowledge of the participants in this study is higher; 42.22% were aware of the screening [14]. Further, the study conducted in Nepal 12.6% and Tanzania17.3% discovered adequate knowledge [15, 16].

A study conducted in Saudi Arabia 4.0% had good of knowledge of cervical cancer [16] and a systematic review conducted Ethiopia reported that 47.16% had knowledge about the screening [17] and Previous studies conducted in various parts of Ethiopia among reproductive age women with different background has shown revealed in Adigrat town, Northern Ethiopia in 2019,46.4%, of participants had a knowledge on cervical cancer [7] besides in the rural Butajira and Batu36% and 19.7% of women participants had good knowledge level on cervical cancer respectively [18, 19]. In Addis Ababa’s studies taken on reproductive health service, 43.8% of women had knowledge of cervical cancer [8]. Further, in 2015 with in Addis Ababa, 27.7% women had adequate knowledge of cervical cancer screening [8]. On the other hand, on urban health extension workers studied, 48.4% had good knowledge about cervical cancer screening [12]. The difference may be due to access for health facilities and availability of technology, time gap of the study, and different in educational statue of participants.

on other hand this study lower than the study at University of Gondar,more than half of the respondents 59.3% had a good knowledge [18]. The difference might be due to study area difference, time of study, educational status and participants’ difference. Participants with a positive attitude were 2.03 times more likely to have good knowledge about cervical cancer screening than those with a negative attitude. Those who had been screened for cervical cancer were more likely than those who had not. Regarding the practice of cervical cancer the study showed 18.4% participants screened for cervical cancer this is greater the previous studies done among women globally 13.26% [12], in Nepal and Tanzania 13.6% and 14.3% respectively [15, 16], Ethiopia 2.9% [8] and study in Addis Ababa 3.5% [8]. The difference is due to time, location difference, availability of health facility and availability of screening service near to participant and knowledge of participants. This study is less cervical screening with the study systematic review and meta-analysis in Ethiopia which was 26.15% [17], Aribaminch 27.7% [2] and other study done in Addis Ababa 25% [8]. This is the gap in knowledge, study setting time and study area difference. And the finding near similar with the studies done in Nigeria 20.6% [5] and Sidama 17.8% [20]. The age group > 40 years was 3.2 times more likely to be screened for cervical cancer than the age group 18–29 years. Religion Muslims were 8.65 times more likely than orthodox to be screened. Marital status was 3.884 times more likely for married women, monthly earnings greater than 5251 billion were 4.820 times more likely, and those who were well-informed were 2.345 times more likely, these supported with previous study done [21]. This study aimed to assess the knowledge and Practice of cervical cancer screening and associated factors among women police members in Addis Ababa. police commission. Appropriate sampling techniques were used, but the main limitation of the study was that it was conducted among Police and used self-report instruments. The methodology of relying on respondents self-reporting also has challenges of data bias and inconsistency.

According to the findings of this study, all participants had heard of cervical cancer, and half of the participants had good knowledge of cervical cancer screening but little experience with screening for cervical cancer. Health professionals were the main source of information. Monthly income, attitude, and practice of cervical cancer screening were associated with good knowledge. Participants' age, marital status, religion, monthly income, and knowledge are associated with practice screening. Participants' feelings that they were healthy were the perceived reasons for the low screening practice.

The findings suggest that further awareness is necessary to improve the knowledge and practice of cervical cancer screening. To do this, awareness-creation activities should be undertaken by the Addis Ababa Police Commission health department with a corporate federal police hospital. Health professionals should educate women about the benefits and risk factors for cervical cancer, recommend awareness campaigns to encourage eligible women to get screened, inform women of the availability of the service when they go to a health facility for other services. Reproductive health specialists should pay attention to screening women who came to get other reproductive health services, train health professionals to give screening services, and prepare cervical cancer screening campaigns for vulnerable women. Health extension workers should focus on educating the community and advocating for eligible women to be screened.

Policymakers and programmers should strengthen the existing screening program, and an NGO working in this field should assist with fund-raising for health professional training and screening facilities. To alleviate this problem, health authorities at different levels of the health system should undertake massive awareness-creation and provide screening services.