Factors Associated with Utilization of Pap test for Cervical Cancer Screening among Pregnant Women in Embu County

Abstract

Cervical cancer is the second most common cancer and the leading cause of cancer-related death among women in developing countries. In Kenya, women’s knowledge of cervical cancer and Pap smears screening is very limited and this is a major challenge in efforts aimed at reducing the incidence, morbidity, and mortality associated with cervical cancer. Although the success of the Pap smear in the reduction of cervical cancer has been reported in several parts of the world especially in the developed countries, uptake of cervical cancer screening services have remained low among women in Kenya. The objective of this study was to determine the knowledge about Cervical Cancer, awareness of risk factors and utilization of cervical cancer screening among pregnant women attending ANC in Embu County. Also, the study determined the prevalence of precancerous cervical lesions among the women in the study group. A descriptive cross-sectional study that adopted a quantitative approach through interviewer-administered questionnaires and laboratory procedure using Pap smear test was used. The study population was pregnant women attending the antenatal clinic at Embu Level Five Hospital. Systematic random sampling was used to obtain the required sample size of 346 participants. Data analysis was conducted using SPSS and ACCESS programs. Of the 346 women interviewed only 30% (106) had ever had a Pap test done. Knowledge about cervical cancer was high 84% (292) among the women; however, the knowledge of Pap smear test and cervical cancer risk factors were low (42% and 23%) respectively. More than half of the women 58.7% (203) considered themselves at risk for cervical cancer and a majority showed a willingness to screen in the future 71.4% (247). There was a strong correlation between awareness of cervical cancer and practice of Pap smear test with 3.44 increasing odds. This association was statistically significant (P=0.001). This study also identified that there was a correlation between awareness of cervical cancer risk factors and practice of Pap test screening. The factors associated with uptake of the Pap test were age, the level of education, health insurance. Others included, aware of HPV, Immunosuppression, smoking, STDs and Multiple sexual partners risk factors. Barriers identified for not screening included, not knowing about the test (41%), thinks it’s too expensive (24%) and other didn’t know where to go for the test (23%). A majority of the women obtained information about cervical cancer and Pap test from health care personnel 43.3% (125). Among the women, 6.0% (21) had precancerous cervical lesions. The women were advised to undertake a Colposcopy test. The uptake of Pap smear is abysmally poor according to the findings suggesting that majority of the women had never screened for cervical cancer among the target population. The result established a low correlation between the awareness of risk factors that cause cervical cancer and the practice of Pap smear screening. The implication of the results demonstrates the importance of instituting strategies that involves, aggressive awareness campaigns and education programs that focus on increasing women knowledge on risk factors, to inform them on the link between screening and early detection and the mode of prevention, and this will ensure a decline in incidence and mortality from cervical cancer.