Fatalism and its Influence on Uptake of Cervical Cancer Screening among Women Aged 15-54 years in Kiambu Sub-County, Kiambu County, Kenya

Abstract

While cervical cancer screening is key for early diagnosis and treatment, its uptake is often sub-optimal and may be adversely affected by fatalism. The study aimed to establish the factors associated with fatalism and its influence on cervical cancer screening among women aged 15-54 years in Kiambu sub-county. This was because the sub-county is more representative of the larger Kiambu County in terms study population characteristics. A cross-sectional study design, involving a sample size of 400 obtained through simple random sampling was employed. A standard in-person administered structured questionnaire was initially pre-tested (Cronbach’s alpha 0.7) among 10 women and later used for data collection from among selected households across Kiambu sub-county. Before the actual data collection, consent was taken from eligible participants. Data collected involved socio-demographic and socio-economic factors, knowledge, fatalism and cervical cancer screening practices. After data collection, the questionnaires were checked for completeness, and respective data entered into a standard excel data sheet. This was followed by data cleaning, and coding for analysis. Descriptive statistics generated cervical cancer screening, knowledge, and fatalism levels. Binary logistic regression was used for all bivariable, and multivariable analyses to identify factors associated with fatalism, knowledge on cervical cancer and cervical cancer uptake. To establish the influence of fatalism on cervical cancer screening, a univariable and multivariable logistic regression analysis was done adjusting for fatalism. A slightly above a third 134 (34.5%) of the study participants were aged between 25-34 years, with almost half being married 179(45.8%). A majority 267(70.1%) of the participants had no substantial income, with slightly above half 203(52.2%) of them being protestants. The prevalence of cervical cancer screening was 25.8%, whereas that of fatalism was 14.3%. Only age of 35-44 years (AOR 2.1; 95% CI; 1.1-3.9; P=0.02) and being a Muslim (AOR 9.9; 95% CI 1.6-61.7; P=0.02) were significantly associated with fatalism. A majority (80.6%) of the study participants had good knowledge on cervical cancer and screening. Only the age of 45-54 years, (AOR 1.6; 95% CI 0.8-3.3; p=0.02), having attained a tertiary level of education (AOR 0.45; 95% CI 0.3-0.8; p=0.01), and being a Muslim (AOR 0.13; 95% 0.02-0.8; p=0.03) were significantly associated with knowledge of cervical cancer and screening. On adjusting for fatalism, there were no factors that significantly influenced fatalism among the study participants. Conclusively, 25.8% uptake of cervical cancer screening is low at 25.8%. A majority (80.6%) of women aged 15-54 years have good knowledge of cervical cancer and screening in Kiambu Sub-County. While the level of fatalism was low at 14.3%, more public health awareness campaigns should be focused to women aged 35-44 years and the Muslims who constitute the factors significantly associated with fatalism. While fatalism had no significant influence on cervical cancer and screening, there is still the need to dispel any existing related fatalistic beliefs among women aged 15-54 years in Kiambu Sub-County. The study recommends more public health sensitization, and awareness campaigns to reach as many women aged 15-54 years of age as possible with cervical cancer screening and linkage of those infected in care and follow-up.