Background
Methods
Study area
Study design and population
Participants’ recruitment
Data collection procedures and instruments
Data analysis
Results
Results of quantitative survey
Socio-demographic and behavioral characteristics of survey participants
Variables, n = 844 | n(%) | Name of health center | ||||
---|---|---|---|---|---|---|
AH | W1H | SH | FMH | LH | ||
Age (in years), p = 0.008 | ||||||
15–24 | 54 (6.4) | 19 (12.7) | 9 (5.3) | 6 (3.1) | 9 (6.9) | 11 (5.5) |
25–34 | 343 (40.7) | 48 (32.0) | 70 (41.2) | 94 (48.2) | 55 (42.3) | 76 (38.2) |
35–45 | 359 (42.5) | 61 (40.7) | 69 (40.6) | 76 (39.0) | 61 (46.9) | 92 (46.2) |
46–55 | 77 (9.1) | 20 (13.3) | 19 (11.2) | 18 (9.2) | 3 (2.3) | 17 (8.6) |
> 55 | 11 (1.3) | 2 (1.3) | 3 (1.7) | 1 (0.5) | 2 (1.6) | 3 (1.5) |
Residence, p = 0.410 | ||||||
Addis Ababa (AA) | 841 (99.4) | 149 (99.3) | 170 (100.0) | 194 (99.5) | 130 (100.0) | 198 (99.5) |
Outside AA | 3 (0.6) | 1 (0.7) | 0 (0) | 1 (0.5) | 0 (0) | 1 (0.5) |
Marital status, p = 0.02 | ||||||
Single | 87 (10.3) | 30 (20.0) | 21 (12.4) | 12 (6.2) | 5 (3.8) | 19 (9.5) |
Married | 696 (82.5) | 112 (74.7) | 141 (82.9) | 169 (86.6) | 111 (85.4) | 163 (81.9) |
Divorced | 53 (6.3) | 8 (5.3) | 7 (4.1) | 12 (6.2) | 12 (9.2) | 14 (7.0) |
Widowed | 8 (0.9) | 0 (0) | 1 (0.6) | 2 (1.0) | 2 (1.6) | 3 (1.6) |
Ever habit of smoking, p = 0.653 | ||||||
Yes | 11 (1.3) | 3 (2.0) | 2 (1.2) | 3 (1.5) | 0 (0) | 3 (1.5) |
No | 833 (98.7) | 147 (98.0) | 168 (98.8) | 192 (98.5) | 130 (100.0) | 196 (98.5) |
Age at first sexual intercourse, p < 0.0001 | ||||||
≤ 15 | 174 (20.6) | 22 (14.7) | 21 (12.4) | 40 (20.5) | 17 (13.1) | 49 (24.6) |
16–24 | 584 (69.2) | 103 (68.7) | 97 (57.1) | 118 (60.5) | 68 (52.3) | 126 (63.3) |
25–34 | 81 (9.6) | 25 (16.6) | 51 (30.0) | 35 (17.9) | 45 (34.6) | 23 (11.6) |
35–44 | 5 (0.6) | 0 (0) | 1 (0.5) | 2 (1.1) | 0 (0) | 1 (0.5) |
Life time sexual partners, p < 0.0001 | ||||||
1 | 287 (34.0) | 56 (37.3) | 74 (43.5) | 57 (29.2) | 52 (40.0) | 48 (24.1) |
≥ 2 | 557 (66.0) | 94 (62.7) | 96 (56.5) | 138 (70.8) | 78 (60.0) | 151 (75.9) |
Previously screened for cervical cancer | ||||||
Yes | 0 (0.0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) |
No | 844 (100) | 150 (100) | 170 (100) | 195 (100) | 130 (100) | 199 (100) |
Sexual and reproductive history
Variable, n = 844 | n(%) | Name of health center | ||||
---|---|---|---|---|---|---|
AH | W1H | SH | FMH | LH | ||
Menstrual History, p = 0.011 | ||||||
Regularly | 382 (45.3) | 74 (49.3) | 77 (45.3) | 92 (47.2) | 57 (43.8) | 82 (41.2) |
Irregular | 290 (34.4) | 49 (32.7) | 64 (37.6) | 63 (32.3) | 55 (42.3) | 59 (29.6) |
Post coital spotting | 7 (0.8) | 0 (0) | 4 (2.4) | 1 (0.5) | 1 (0.8) | 1 (0.5) |
Menopause | 165 (19.5) | 27 (18.0) | 25 (14.7) | 39 (20.0) | 17 (13.1) | 57 (28.6) |
Pregnancy status, p = 0.896 | ||||||
Pregnant | 1 (0.1) | 0 (0) | 0 (0) | 1 (0.5) | 0 (0) | 0 (0) |
Non-pregnant | 843 (99.9) | 150 (100) | 170 (100) | 194 (99.5) | 130 (100) | 199 (100) |
Parity, p = 0.004 | ||||||
No | 119 (14.1) | 31 (20.7) | 28 (16.5) | 25 (12.8) | 6 (4.6) | 29 (14.6) |
1–3 | 575 (68.1) | 89 (59.3) | 99 (58.2) | 136 (69.7) | 115 (88.5) | 136 (68.3) |
4–5 | 107 (12.7) | 24 (16.0) | 32 (18.8) | 21 (10.8) | 4 (3.1) | 26 (13.1) |
> 5 | 43 (5.1) | 6 (4.0) | 11 (6.5) | 13 (6.7) | 5 (3.8) | 8 (4.0) |
Ever use of contraceptive methods, p = 0.009 | ||||||
No | 561 (66.5) | 107 (71.3) | 117 (68.8) | 129 (66.2) | 69 (53.1) | 139 (69.8) |
Yes | 283 (33.5) | 43 (28.7) | 53 (31.2) | 66 (33.8) | 61 (46.9) | 60 (30.2) |
Type of contraceptive method, p = 0.317 | ||||||
Injectable | 86 (30.4) | 12 (27.9) | 14 (26.9) | 22 (33.3) | 20 (33.3) | 18 (30.0) |
OCP | 42 (14.8) | 10 (23.4) | 8 (15.4) | 11 (16.7) | 5 (8.4) | 6 (10.0) |
IUCD | 45 (15.9) | 8 (18.6) | 10 (19.2) | 11 (16.7) | 3 (5.0) | 13 (21.7) |
Implant | 102 (36.0) | 11 (25.6) | 19 (36.5) | 19 (28.8) | 30 (50.0) | 23 (38.3) |
Tubaligation | 1 (0.4) | 0 (0) | 0 (0) | 1 (1.5) | 0 (0) | 0 (0) |
Condom | 7 (2.5) | 2 (4.5) | 1 (1.9) | 2 (3.0) | 2 (3.3) | 0 (0) |
Other corticosteroid use history, p = 0.556 | ||||||
Yes | 2 (0.2) | 1 (0.7) | 0 (0) | 0 (0) | 1 (0.8) | 0 (0) |
No | 842 (99.8) | 149 (99.3) | 170 (100) | 195 (100) | 129 (99.2) | 199 (100) |
Family hx of cervical cancer, p = 0.687 | ||||||
Yes | 5 (0.6) | 2 (1.3) | 1 (0.6) | 1 (0.5) | 0 (0) | 1 (0.5) |
No | 839 (99.4) | 148 (98.7) | 169 (99.4) | 194 (99.5) | 130 (100) | 198 (99.5) |
HIV status, p < 0.0001 | ||||||
HIV positive | 252 (29.9) | 64 (42.7) | 56 (32.9) | 35 (26.9) | 53 (27.2) | 46 (23.1) |
HIV negative | 447 (53.0) | 47 (31.3) | 81 (47.6) | 48 (36.9) | 124 (63.6) | 146 (73.4) |
Unknown | 145 (17.1) | 39 (26) | 33 (19.4) | 47 (36.2) | 18 (9.2) | 7 (3.5) |
STI history | ||||||
Yes | 247 (29.3) | 16 (10.7) | 44 (25.9) | 55 (28.2) | 65 (50.0) | 67 (33.7) |
No | 597 (70.7) | 134 (89.3) | 126 (74.1) | 140 (71.8) | 65 (50.0) | 132 (66.3) |
VIA test result, p < 0.0001 | ||||||
Positive | 87 (10.3) | 8 (5.3)) | 8 (4.7) | 30 (25.4) | 11 (8.5)) | 30 (25.1) |
Negative | 757 (89.7) | 142 (94.7 | 162 (95.3) | 165 (84.6) | 119 (91.5 | 169 (84.9) |
Factors associated VIA positivity among women’s screened for cervical cancer
Variable | Screening result, n (%) | COR (95%CI) | AOR (95%CI) | |
---|---|---|---|---|
Positive | Negative | |||
Age (in years) | ||||
≤ 24 | 2 (2.3) | 52 (6.9) | 1.00 | 1.00 |
25–34 | 27 (31.0) | 316 (36.9) | 2.2 (0.5–9.6) | 2.4 (0.51–11.5) |
35–44 | 40 (46.0) | 319 (42.1) | 3.26 (0.77–13.9) | 3.8 (0.81–18.2) |
45–54 | 15 (17.2) | 62 (8.1) | 6.3 (1.4–28.8) | 8.1 (1.53–42.3) |
≥ 55 | 3 (3.5) | 8 (3.0) | 9.8 (1.4–67.7) | 8.4 (1.1–72.3) |
Marital status | ||||
Married | 62 (71.3) | 634 (83.8) | 1.00 | 1.00 |
Single | 12 (13.8) | 75 (9.9) | 1.6 (0.8–3.2) | 3.2 (1.4–7.31) |
Divorced | 8 (9.2) | 45 (5.9) | 1.8 (0.8–4.1) | 1.8 (0.76–4.27) |
Widowed | 5 (5.7) | 3 (0.4) | 17.1 (4.1–72.9) | 18.6 (3.8–91.2) |
Parity | ||||
Null Para | 11 (12.6) | 108 (14.3) | 1.00 | 1.00 |
Multi Para | 64 (73.6) | 568 (75.0) | 1.1 (0.56–2.2) | 1.7 (0.72–4.0) |
Grand multi Para | 12 (13.8) | 81 (10.7) | 1.46 (0.61–3.5) | 1.9 (0.63–5.52) |
Age at first sexual intercourse | ||||
≥ 16 years | 52 (59.8) | 617 (81.5) | 1.00 | 1.00 |
< 16 years | 35 (40.2) | 140 (18.5) | 3.1 (1.86–4.73) | 2.72 (1.65–4.49) |
Ever use of contraceptive | ||||
No | 59 (67.8) | 502 (66.3) | 1.00 | 1.00 |
Yes | 28 (32.2) | 255 (33.7) | 0.93 (0.58–1.51) | 0.64 (0.37–1.11) |
Smoking habit history | ||||
No | 86 (98.8) | 747 (98.7) | 1.00 | 1.00 |
Yes | 1 (1.2) | 10 (11.3) | 0.88 (0.11–6.87) | 1.25 (0.13–11.8) |
Lifetime number of sexual partners | ||||
1 | 15 (17.2) | 272 (35.9) | 1.00 | 1.00 |
≥ 2 | 72 (82.8) | 485 (64.1) | 5.6 (1.9–9.82) | 4.9 (1.31–8.75) |
HIV status | ||||
HIV negative | 34 (39.1) | 413 (54.6) | 1.00 | 1.00 |
HIV positive | 44 (50.6) | 208 (27.5) | 2.57 (1.59–4.14) | 2.59 (1.56–4.25) |
Unknown | 9 (10.3) | 136 (17.9) | 0.80 (0.38–1.72) | 0.88 (0.41–1.93) |
STI history | ||||
No | 65 (74.7) | 532 (70.3) | 1.00 | 1.00 |
Yes | 22 (25.3) | 225 (29.7) | 0.8 (0.48–1.33) | 1.46 (0.84–2.53) |
Between group variance | 0.245 (95%CI: 0.0446–1.247, p < 0.0001) | |||
ICC | 0.069 |
Findings of qualitative interview
Lack of awareness
On the other hand, majority of the respondents lacked adequate information about the cause of cervical cancer and only two participants responded correctly that having multiple sexual partners as the cause of cervical cancer and they heard it from their neighborhoods. Many respondents perceived cancer and by extension cervical cancer as a deadly disease with no cure. They related the experiences of their friends and/or family members who died of cervical or other cancers. All stated cervical cancer; and cancer in general as a horrible disease and one that often incurred huge stress, emotions and physical suffering on both the patient and their family members.“I heard the word cervical cancer in television advertising and in some radio programs but I don’t have full information because the programs are too short and they didn’t transmit the full information. It is a simple advertisement and what I heard is simply a promotion to be screened for cervical cancer.”
Most participants mentioned that there is lack of adequate information about the existence of cervical screening, eligibility for screening, screening sites and time schedule for screening. Most women heard of cervical cancer screening but they did not know where it is provided. A study participant who did not visit a health center for screening stated that:“I think the reason why most women are not screened for cervical cancer is mainly attributed to the nature of the disease. I mean, at that stage they are apparently healthy and had no symptom. We are more concerned if there are noticeable and/or visible signs and symptoms, which is not true for screening programs like this.”
Another in-depth participant added:“I think all women in my community don’t have information about cervical cancer screening but had they known the detailed information about it, I am sure they would have been screened. Sometimes I heard radio/TV advertainments but they don’t convey detailed information about the disease, benefits and risks of screening, where and when to screen, etc.”
A prevailing notion among the participant of the study was cervical cancer screening is only used for the detection of cancer that is already present. Some women refused to be screened as they thought that having cervical cancer screening is not beneficial while others believed that it is a service to be given for sick women only. A study participant who refused for screening stressed that:“Ethiopia has a good record of community health workers but their role in cervical cancer screening is very limited. They are teaching us about hygiene, diabetes mellitus, family planning and hypertension. It would be more cost-effective if cervical cancer screening is considered as one of the packages in community training or teaching.”
“I don’t think the screening for cervical cancer is important for healthy women of my age. I think it is better to screen those women who are sick or in menopausal age […] because in most cases cervical cancer is very common in those women in my community.”
Cultural and religious beliefs
Bad perception about cancer as a whole also prevented them to be screened. They tried to associate it with religious beliefs and believed that it is their GOD’s seek to prevent such types of bad things. Accordingly, some of them preferred to pray for God instead of screened and treated. They also heard and believed that the cancer treatment outcome is poor even if treated; so, it’s better not to be screen rather than screened and told having cancer. One participant said:“Before one year, I was examined for cervical cancer by a male health care provider and I was so ashamed when he asked me to undress. It was very difficult to accept and I think this might be because of our culture which is so sensitive to such things.”
“I preferred to die immediately rather than do the screening and being told having cervical cancer”.