|Year : 2020 | Volume
| Issue : 2 | Page : 60-66
Knowledges, attitudes, and practices on cervical cancer screening by women in Brazzaville-Congo
Pierre Marie Tebeu1, Jesse Saint Saba Antaon1, Sylvain Honoré Woromogo2, Wilfried L Tatsipie3, Chrismichel Kibimi2, Rostand Njiki4
1 Department of Health Program Management and Epidemiologic, Inter-State Centre for Higher Education in Public Health of Central Africa (CIESPAC), Brazzaville-Congo; Department of Gynecology and Obstetrics; Department of Public Health; Faculty of Medicine and Biomedical Sciences, University of Yaoundé I; League of Initiative and Active Research for Women's Health and Education (LIRASEF), Cameroon
2 Department of Health Program Management and Epidemiologic, Inter-State Centre for Higher Education in Public Health of Central Africa (CIESPAC), Brazzaville-, Congo
3 Department of Gynecology and Obstetrics; Department of Public Health; Faculty of Medicine and Biomedical Sciences, University of Yaound I, Cameroon
4 United Nations Population Fund (UNFPA), Chad
|Date of Submission||31-Dec-2019|
|Date of Decision||25-Feb-2020|
|Date of Acceptance||18-Mar-2020|
|Date of Web Publication||2-Jun-2020|
Prof. Pierre Marie Tebeu
Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon. Inter-States Centre for Higher Education in Public Health of Central Africa
Source of Support: None, Conflict of Interest: None
Background: Cervical cancer is a serious disease, responsible for more than 311,000 deaths worldwide each year. The objective of the study was to assess the knowledge, attitudes, and practices (KAPs) regarding cervical cancer screening of women aged 25–65. Materials and Methods: This was an analytical KAP study conducted from May 2, 2018, to August 10, 2018, including women aged 25–65 years, attending the gyneco-obstetrics departments of six hospitals in Brazzaville. The variables of interest were sociodemographic and reproductive characteristics, KAPs. Frequencies, central tendency parameters, and odds ratios were calculated using Epi Info 188.8.131.52 software. We used Pearson, Fisher, and Wald statistical tests, with a significance level of 0.05. Results: We interviewed 169 women aged 25–65 years (average 35 [±9.05] years). The majority had an unsatisfactory level of knowledge (70.41%), favorable attitudes (56.21%), and bad practices (43.20%). Factors associated with better knowledge were at least secondary school education (adjusted odds ratio [ORa]: 1.76 [1.02–3.34]) and being employed (ORa: 4.24 [2.60–6.93]). Women with the best knowledge had the best attitudes (ORa: 3.86 [2.38–6.26]) and best practices (ORa: 5.28 [3.08–9.05]). Those with better attitudes had better practices (ORa: 2.94 [1.87–4.61]). Conclusion: Women in Brazzaville lack knowledge about cervical cancer. Better knowledge and attitudes were associated with best practices, hence the need to implement awareness – raising strategies to give greater impetus to the participation of Congolese women in cervical cancer screening.
Keywords: Attitudes, cervical cancer, knowledge, practices, screening, women
|How to cite this article:|
Tebeu PM, Antaon JS, Woromogo SH, Tatsipie WL, Kibimi C, Njiki R. Knowledges, attitudes, and practices on cervical cancer screening by women in Brazzaville-Congo. J Cancer Res Pract 2020;7:60-6
|How to cite this URL:|
Tebeu PM, Antaon JS, Woromogo SH, Tatsipie WL, Kibimi C, Njiki R. Knowledges, attitudes, and practices on cervical cancer screening by women in Brazzaville-Congo. J Cancer Res Pract [serial online] 2020 [cited 2020 Jul 7];7:60-6. Available from: http://www.ejcrp.org/text.asp?2020/7/2/60/285682
| Introduction|| |
Precancerous lesion of the cervix is a benign and asymptomatic epithelial abnormality. However, if untreated, they can progress to invasive cancer. Cervical cancer is the second leading cause of cancer deaths among women in resource-limited countries, after breast cancer. It is a sexually transmitted disease that progresses very slowly between during 10–20 years period and therefore offers a great opportunity for screening.
GLOBOCAN 2018 estimated that more than 570,000 new cases and 311,000 deaths are attributed to cervical cancer worldwide, with more than 31,900 new cases and 23,500 deaths in Central Africa. In the CEMAC subregion (Cameroon, Centrafrica Republic, Congo, Gabon, Equatorial Guinea, Chad), the same source estimates more than 3900 new cases and 2700 deaths per year. In sub-Saharan Africa, only 2.6%–8.3% of women are screened for cervical cancer., Few studies are available on the knowledge, attitudes, and practices (KAPs) of women in Brazzaville regarding cervical cancer screening.
The objective of the study was to assess the knowledge, attitudes, and practices of women aged 25–65 years in Brazzaville on cervical cancer screening.
| Materials and Methods|| |
This was an analytical KAP study conducted from May 2, 2018, to August 10, 2018 in Brazzaville. It took place in six public hospitals (Brazzaville University Hospital Centre, Talangaï, Makélékélé, Mfilou, Bacongo, and Pierre Mobengo Hospital). Congolese women aged 25–65 years who were seen in the obstetrics and gynecological departments of the Mentioned hospitals were included in the study. Women who were unable to respond to our questionnaire were excluded from the study.
Data collection was done using a pretested questionnaire that was structured in four sections: the first section on sociodemographic and reproductive data; the second section on knowledge of risk factors, means of cervical cancer prevention, age of screening initiation, and benefits of cervical cancer screening; the third section on women's attitudes toward cervical cancer screening; and the last section on women's practices toward screening.
Data on women's KAPs were rated with maximum scores of 17 points, 4 points, and 6 points, respectively. After each criterion was scored, KAPs were grouped together to obtain the number of points for each of three main variables (KAPs). The points obtained made it possible to classify knowledge into four levels each, namely very insufficient (0–4), insufficient (5–7), good (8–11), and very good (12–17); attitudes as very negative (0–1), negative (2), positive (3), and very positive (4); and practices as very weak (0–1), weak (2–3), good (4–5), and very good (6).
To understand interactions among KAPs, we grouped the levels of KAPs into two modalities each, namely for knowledge: unsatisfactory and satisfactory (0–4 points; 5–17 points); for attitudes: unfavorable and favorable (0–2 points; 3–4 points); and for practices: bad and good (0–1 points; 2–6 points). The rating of the levels of knowledge and attitudes was adapted according to the methods of DeFinetti  and Likert, respectively. Practices were adapted according to previous work on the quantification of levels of practice in studies of KAPs.,
The data were analyzed using Epi-Info software 184.108.40.206. (Produced by Center for Disease Control and Prevention (CDC), USA). With regard to the calculations performed, to establish the levels of KAPs, absolute and relative frequencies as well as central tendency parameters (mean and median) and dispersions (standard deviation and quartiles) were calculated. With respect to the influences among the different variables, simple and multiple logistic regression analyses were performed; odds ratios were calculated with their 95% confidence intervals. Statistical tests of Pearson Chi-square, Fisher, and Wald were used. The significance level was P < 5%. The study was submitted to and approved by the Ethical Committee of the Inter-state Centre for Higher Education in Public Health of Central Africa (CIESPAC), Congo IRB No. 001/CSERC/CIESPAC/2018. Informed consent of the respondents was obtained.
| Results|| |
Sociodemographic characteristics of the participants
A total of 169 women were interviewed, with ages ranging from 25 to 65 years (mean age: 35 [±9.05] years). Most of the participants were single (69.82%; 118/169) [Table 1].
|Table 1: Sociodemographic and reproductive profile of respondents in Brazzaville|
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Respondents' knowledge, attitudes, and practices
Almost all (81.66%; 138/169) of the women surveyed had heard of cervical cancer. Few (3.55%; 6/169) knew that early sexual intercourse is a risk factor for cervical cancer. Overall, 17.75% (30/169) and 5.33% (9/169) of the women knew that the early detection and vaccination against human papillomavirus, respectively, can prevent this disease [Table 2].
|Table 2: Summary of the knowledge of the women interviewed on cervical cancer screening in Brazzaville|
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In addition, 10% of the respondents reported that cervical cancer had a “mysterious nature.” The majority (81.07%; 137/169) of the respondents preferred that their screening was done by a midwife. Modern medicine was the most (91.12%; 154/169) common treatment reported in case of a positive diagnosis of precancerous lesions or cervical cancer.
The frequency of participation in cervical cancer screening was 8.88% (15/169) [Table 3].
|Table 3: Distribution of attitudes and practices of respondents regarding cervical cancer screening, Brazzaville|
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After classifying the KAPs of the 169 respondents into four levels, the level of knowledge was very insufficient (70.41%), insufficient (17.75%), good (9.47%), and very good (2.37%). The level of attitudes was very negative (1.18%), negative (11.83%), positive (30.78%), and very positive (56.21%), and the level of practices was very low (43.20%), low (46.15%), good (4.73%), and very good (5.92%) [Table 4].
|Table 4: Distribution of respondents' levels of knowledge, attitude, and practice regarding cervical cancer screening in Brazzaville|
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Thus, the respondents had unsatisfactory knowledge (70.41%), favorable attitudes (56.21%), and bad practices (43.20%).
Factors associated with best knowledge
The factors associated with the best (satisfactory) knowledge were having a high school education (superior) (11.36% vs. 27.37%; adjusted odds ratio [ORa]: 1.76 [1.02–3.34]; P = 0.040), having a higher level (11.36% vs. 63.33, ORa: 2.96 [1.54–5.68]; P = 0.0008), and being employed (12.24% vs. 75%; ORa: 4.24 [2.60–6.93]; P = 0.0001) [Table 5].
|Table 5: Factors associated with women's increased knowledge of cervical cancer screening in Brazzaville|
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Influence of knowledge on attitudes
Women with the best (satisfactory) knowledge had a higher rating of having better (favorable) attitudes. This score remained significant after adjusting for confounding factors (47.06% vs. 78%; ORa: 3.8 [2.38–6.26]; P = 0.001) [Table 6].
|Table 6: Influence of participating women's knowledge level on attitudes about screening and cervical cancer, 2018|
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Influence of knowledge and attitudes on respondents' practices
Women with the best (satisfactory) knowledge about cervical cancer screening had a higher rating of having better (good) practices. This score remained significant after adjusting for confounding factors (44.54% vs. 86%; ORa: 5.28 [3.08–9.05]; P = 0.0001). Women with better (favorable) attitudes had a higher rating of having better (good) practices. This rating remained significant after adjusting for confounding factors (47.30% vs. 64.21%; ORa: 2.94 [1.87–4.61]; P = 0.001) [Table 7].
|Table 7: Influence of respondents' level of knowledge and attitude on their practice of cervical cancer screening in Brazzaville|
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| Discussion|| |
Sociodemographic characteristics of the participants
With regard to the characteristics of the respondents, they had an average age of 35 (±9.05) years. Previous studies have investigated women's KAPs regarding cervical cancer,,,,,,, some of which had a similar mean age to our study, ranging from 34 to 37 years, while others had higher average ages ranging from 41 to 44 years.,
Knowledge of respondents
With regard to the women's knowledge, 39.64% were aware of the existence of means to prevent cervical cancer. This low level of knowledge about screening methods may be explained by the fact that there is no organized communication strategy on cervical cancer in Brazzaville and the lack of a national program to combat cervical cancer. Previous studies have explored women's KAPs regarding cervical cancer,,,,,,,,,,, some of which reported knowledge rates on prevention means similar to our study, ranging from 35% to 45.8%.,,,, This similarity could be explained by the fact that these studies were conducted in Africa. Other authors have reported higher rates of knowledge of prevention methods than in our study, ranging from 46% to 76.4%.,, The higher knowledge rates in these studies could be explained by the fact that they are all conducted in countries more developed than Congo-Brazzaville. Lower rates ranging from 19% to 24.4% have been reported in Cameroon and Nigeria., By classifying the knowledge of the women surveyed into four levels, we found that 70.41% had a very low level of knowledge about cervical cancer. We found one previous study conducted in Cameroon that reported a similar level of knowledge about cervical cancer screening (73.8%) to our study. The similarly poor level of knowledge could be explained by the fact that Congo and Cameroon are both developing countries, and therefore, both countries have almost the same realities with regard to cervical cancer prevention. The very inadequate level of knowledge (70.41%) of respondents in Brazzaville about cervical cancer justifies the need to implement awareness-raising strategies likely to reach the entire population, so that the population becomes aware of the disease (cervical cancer).
Factors associated with best knowledge
Higher level of education (secondary: ORa: 1.76 [1.02–3.34], superior: ORa: 2.96 [1.54–5.68]) and being employed (ORa: 4.24 [2.60–6.93]) were associated with the best knowledge. With respect to educational attainment, some authors have reported similar results to ours., A similar result to ours could be explained by the fact that women with at least secondary education have greater access to the media than those who do not attend school. With regard to favorable economic status, a Lebanese study on cervical cancer also reported the same findings. This could be explained by the fact that women with favorable income level have greater access to health services than those without favorable income. The factors associated with better knowledge of cervical cancer identified in this study justify the need to intensify communication taking into account all segments of the population. This communication is necessary to raise the level of knowledge, even for those who do not have access to certain health services.
Attitudes of the respondents
Analysis of the respondents' attitudes showed an average level of favorable attitudes (56.21%) about cervical cancer. Some studies have investigated subjects similar to our participants,,, some of which had rates higher than ours ranging from 62.5% to 95.3%.,
Influence of level of knowledge on attitudes
We found that women with better (satisfactory) knowledge also had better (favorable) attitudes about cervical cancer screening (ORa: 3.86 [2.38–6.26]). This finding of better knowledge promoting a better attitude could be explained by the fact that better knowledge of prevention and risk factors can help women to have a good perception of the disease. This is consistent with the theory of planned behavior. The findings from a Cameroonian study are similar to ours. Our results justify the need to increase awareness through strategies to improve the level of knowledge of the population, which is important to help the population to have better (favorable) attitudes.
Practices of the respondents
With regard to the practices of the respondents, 8.87% of them reported having undergone cervical cancer screening. This low rate of the practice of cervical cancer screening by Congolese women could be due to several reasons, including the lack of a national program to combat cervical cancer, the very inadequate level of knowledge (71.41%) about cervical cancer, and the lack of cervical cancer screening units in Brazzaville's Basic (District Hospital) hospitals.
Previous studies have also investigated women's KAPs about cervical cancer screening,,,,,,,,,,, some of which had a screening rate similar to ours ranging from 2.6% to 9.7%.,,, This similarity could be explained by the fact that in these countries, cervical cancer screening is not organized as in the case of Congo-Brazzaville. A few studies have reported higher results than ours, ranging from 39.4% to 62.4%.,, The higher results could be explained by a lack of knowledge of how to prevent cervical cancer and the lack of screening units in Brazzaville's base hospitals. Our results justify the need to raise awareness of cervical cancer screening, involving opinion leaders, health personnel, and the media. There is a need for equipping health services with the materials needed for screening to reduce morbidity and mortality from cervical cancer.
Influence of knowledge and attitudes on respondents' practice
Regarding the link between knowledge and practice, we found that women with better (satisfactory) knowledge had better (good) practices (ORa: 5.28 [3.08–9.05]). In other words, better knowledge promoted better practices. This result could be explained by the fact that women who were informed about the existence of the disease would take steps to avoid it. In addition, women with a better knowledge of cervical cancer would be more likely to avoid it through cervical cancer screening. This observation is consistent with the health belief model theory which suggests that when an individual has knowledge about the benefits or harm of the disease, he/she is able to adopt behavior to avoid the occurrence of the disease. This result is similar to that found in a Cameroonian study.
In terms of the relationship between attitudes and practices, women with the best attitudes had a higher rating of having better (good) practices (ORa: 2.94 [1.87–4.61]). The more women had a better attitude about the disease, the more they would agree to participate in cervical cancer screening. Better attitudes favoring best practices could be explained by beliefs about the effectiveness of available actions to reduce the threat of disease. These are the benefits perceived by respondents as outlined in the health belief model theory.
| Conclusion|| |
Women in Brazzaville lack knowledge about cervical cancer. Best knowledge and attitudes were associated with best practices; hence, there is a need for more awareness and screening campaigns for cervical cancer in the city of Brazzaville.
The authors express their gratitude to all of the CIESPAC staff for supervision in the training of the masters in public health. The same is true for the users and health professionals in Brazzaville, thanks to whom this work was made possible.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]