CHAPTER ONE
INTRODUCTION
1.1 Background of the Study
Cervical cancer is a malignant neoplasm of the cervix uteri or cervical portion of the uterus. It sometimes present with vaginal bleeding, but symptoms can be cancelled until the cancer is in its advanced stages (Safaeian, Solomon, and Castle, 2015). Treatment consists of surgery (including local excision) in early stages with chemotherapy and radiotherapy in advanced stages of the disease. If pre-malignant disease or cervical cancer is detected early through screening, it can be monitored or treated relatively non-invasively. Central to the success of any screening programme is its ability to identify, reach and screen the defined target population (Safaeian, Solomon, and Castle, 2015).
Ferlay, Parkin, Whelan, Storm, (2009), in some countries with minimal resources (for example, southeast Asia and south America), one of the major public health challenges facing them is cancer and the most prevalent type of cancer among women in these countries is cervical cancer. The high occurrence of Human Papillomavirus (HPV) is one reasons why there high level and prevalence of cervical cancer among in these countries with low resources, another factor responsible for the high problem of cervical is the absent of effective cervical cancer screening. Sankaranarayanan, Budukh, and Rajkumar, (2011), in some instances the availability of an effective cervical cancer screening programs is not properly harnessed by people because of inadequate knowledge about the importance of the program, also negative health seeking behavior has prevented most women from participating in the program.
The population of women around the world that presently have cervical cancer is about one million and majority of this women do not have access to treatment and they have not been diagnosed, because of their ignorance this make it difficult to prolong their lives (World Health Organization, 2006). In most cases the diagnosis of cervical cancer among women in developing countries is usually at the advance stages and at this stage the chance of survival of these women is usually very low. (Sankaranarayanan, Thara, Ngoma, Naud, and Keita, 2010). In addition, the case of cervical cancer is usually found among women between the ages of 20-29 years and reaches the highest level at the age of 55-64 years and the condition of cervical cancer becomes worse at the age of 65 years. Ferlay, Parkin, Whelan, Storm, (2009), during the period 1993-1997 the case of cervical cancer among women in developing countries is usually found in about 20-55 per women.
The prominent factor responsible for cancer motility in Nigeria is cervical cancer, and study as revealed that cervical cancer is the second most common type of cancer across the globe (Adewole, 2008). In Nigeria, the recorded of cases of women who develop cervical cancer annually is about 10,000 while the population of women who are reported dead of cervical cancer annually is about 8,000 women. (Ackerson and Pretson, 2009) assert that one of the most popular cancer that women in Nigeria develops is cervical cancer while, Ogundipe, and Obinna, (2008) documented the incidence rate of cervical cancer as 25/1100,000. The incidence rate recorded is usually low in developed countries like United States because of the availability of an effective cervical cancer screening programs (Adewole, 2008). In Nigeria, some of the challenges responsible for the prevalence of cervical cancer among women are ignorance, cultural beliefs and late reporting (Adewole, 2008).
In health related issue the health workers who are looked upon for health advices and role models are nurses. The populace are often educated by the nurses on the necessity, availability and importance of cervical cancer screening exercises. Because of the involvement of nurses in health related issues, they are seen has individuals who are highly knowledgeable in health related issues and they are expected to model others in these issues but study has shown otherwise.
Cancer has continued to be gradually fatal more so in young women. This results from the thought in women that cancer leads to unavoidable death. Thus Women choose to keep away from screening and remain unconscious of their state of health. Awareness and sensitization regarding cancer affecting the cervix as well as breast continued to reduce and fatality risen as a result of women being ignorant (Patel, 2013).
Cervix cancer results from the Human Papilloma Virus (HPV) passed through sex, commonly the male is a carrier of the virus that is passed to females. Both the females and males do not seem to be alert of the virus and the dangers associated with it (Roland, Bernard, Saraiya, Hawkins, Brandit and Friedman, (2009). Therefore, this study focuses on the determinants of cervical cancer screening uptake among post-natal clients in OOUTH Sagamu.
1.2 Statement of the Problem
In developing countries, one of the things that has play an important role in the rate mortality among women is cervical cancer (Adewole, 2008). Cervical cancer is a disease that can be prevented. The prevalence of cervical cancer can be controlled by the establishment of an effective cervical cancer screening. In developing countries, one of the disease responsible for the increased rate of mortality among women of middle-aged is cervical cancer (Carr and Sellors, 2014), cervical cancer is a type of cancer that is preventable if it diagnose early and treated before it escalated.
The determinants of cervical cancer screening uptake among post-natal clients include exposure to knowledge, age, socioeconomic status, perception, attitude, and cultural beliefs. Each of these determinates influences the level pf uptake of cervical cancer screening among women, poor level of knowledge affects the uptake of cervical cancer screening negatively because most women are not aware of the medical implications of not taking the cervical cancer screening. The low uptake for screening has been observed as a cause for illness and death. Through consistent cervix screening and timely management, mortality and morbidity resulting from the condition can be greatly achieved. Uptake of cervical cancer screening services still remain low despite efforts made by the government to incorporate screening programs in the regular patient care through the nationwide cervical cancer prevention strategy that is focusing on primary avoidance, screening and early detection and treatment (MOPHS and MOMS, 2012-2015).
Lack of knowledge about cancer of the cervix remains a critical barrier to women’s access to the screening services (Terefe and Gaym, 2008). Knowledge level regarding cancer of the cervix screening, perceived behavior about the disease is higher in the city compared to the country side (Eze, Umeora, Obuna, Egwuatu, and Ejikeme, 2012), however, little is known regarding level of knowledge regarding cancer of cervix among women in rural areas.
The perception of women towards the uptake of cervical screening is one of the major factor responsible for the prevalence of cervical cancer among women (Terefe and Gaym, 2008). Cervical cancer is a health issue that can be prevented by effective cervical screening but most women fails to carry out cervical screening. Religious belief and cultural practices are some of the factors influencing the perception of women towards the uptake of cervical screening. These problems make it glaring that there is a need to carry out a study on the determinants of cervical cancer screening uptake among post-natal clients in OOUTH Sagamu.
1.3 Objectives of the Study
The broad objective of this study is to examine the determinants of cervical cancer screening uptake among post-natal clients in OOUTH Sagamu. The specific objectives include the following:
1. To ascertain the knowledge of post-natal clients in OOUTH Sagamu on cervical cancer screening uptake.
2. To examine the perception of post-natal clients in OOUTH Sagamu on cervical cancer screening uptake.
3. To investigate the influence of socioeconomic status on cervical cancer screening uptake among post-natal clients in OOUTH Sagamu.
4. To find out the impact of environmental factors on cervical cancer screening uptake among post-natal clients in OOUTH Sagamu.
5. To assess the factors preventing cervical cancer screening uptake among post-natal clients in OOUTH Sagamu.
1.4 Research Questions
1. What is the knowledge of post-natal clients in OOUTH Sagamu on cervical cancer screening uptake?
2. What is the perception of post-natal clients in OOUTH Sagamu on cervical cancer screening uptake?
3. What is the influence of socioeconomic status on cervical cancer screening uptake among post-natal clients in OOUTH Sagamu?
4. What is the impact of environmental factors on cervical cancer screening uptake among post-natal clients in OOUTH Sagamu?
5. What are the factors preventing cervical cancer screening uptake among post-natal clients in OOUTH Sagamu?
1.5 Research Hypothesis
H0 – There is no significant influence of socioeconomic status on cervical cancer screening uptake among post-natal clients in OOUTH Sagamu.
H1 – There is no significant influence of knowledge of post-natal clients in OOUTH Sagamu on cervical cancer screening uptake.
1.6 Significance of the Study
The findings from this study are relevant to researchers, policy makers and educationist
1. To women, the study could create awareness to women about the need to get vaccinated themselves and their female children early enough .This study could determine various factors that influence cervical cancer screening. The literate women can read and acquire the information on their own while the illiterate ones can be assisted by their husbands or children in acquiring the information.
2. To health workers the study could enable the health workers to give appropriate information to the women who come to receive care from them.
3. To hospitals, could be used in providing structured modules that will be used in various hospitals for improving awareness of cervical cancer among women. The availability of the modules will make cervical cancer information easier.
4. To government, the findings from this study addresses the responsibility of the government in providing the required equipment for carrying out cervical screening. Inadequate equipment might prevent the hospital from carrying out cervical screening for women and this might lead to an increase in the prevalence of cervical cancer.
5. To researchers, this study will enhance the existing body of literature by contemplating the areas of the literature that have not yet been examined or considered and incorporating these factors into the current study. The study will thus form the basis for further studies in the field
1.7 Scope of the Study
The scope of this study is restricted to the determinants of cervical cancer screening uptake among post-natal clients in OOUTH Sagamu. Ogun State. A questionnaire was use for the purpose of this study and the sample population are women attending post-natal clinic at OOUTH Sagamu, Ogun State. The researchers restrict this study to post-natal clients in OOUTH Sagamu because to the limited resources available and the time constraints.
1.8 Limitation of the Study
The study is carrying on an applied research and the major limitation of the kind of research his time frame, resources and adequate information to be drawn from the respondents.
1.9 Definition of Terms
Determinants: it is the factor behind the occurrence of the disease in the woman
Cervix Cancer: This is a malignant condition that occurs when the cells of the cervix proliferate to abnormal cells and can upset layers of cell that are deeper or increase to other parts of the body and cause harm.
Screening; this is the processing a patient is put through to discover the true state of a patient on the disease
Uptake: This is the rate or number of times of which women undertake Pap smear test.
Post-Natal clients; This is the mother and her newborn baby receiving weekly and monthly care immediately after birth