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Table of Contents
ORIGINAL ARTICLE
Year : 2021  |  Volume : 8  |  Issue : 3  |  Page : 93-97

Impact of an intrahospital awareness strategy on attendance to the cervical cancer screening unit of the Yaoundé university teaching hospital cameroon


1 Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaounde I; League for Initiative and Active Research for Women's Health and Education, Yaoundé, Cameroon
2 League for Initiative and Active Research for Women's Health and Education, Yaoundé, Cameroon
3 Inter-State Centre for Higher Education in Public Health of Central Africa, Brazzaville, Congo
4 Department of Gynecology Obstetrics, University Teaching Hospital, Yaoundé, Cameroon
5 Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaounde I; Department of Gynecology Obstetrics, University Teaching Hospital, Yaoundé, Cameroon

Date of Submission01-Dec-2020
Date of Decision12-Mar-2021
Date of Acceptance15-Mar-2021
Date of Web Publication26-Jul-2021

Correspondence Address:
Jesse Saint Saba Antaon
Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde
Cameroon
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JCRP.JCRP_8_21

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  Abstract 


Background: Approximately 1500 women in Cameroon die annually from cervical cancer, but only 8% of women at risk have undergone cervical cancer screening. The objective of this study was to analyze the impact of an intrahospital awareness strategy on the frequency of cervical cancer screening at Yaoundé University Teaching Hospital(YUTH). Materials and Methods: This quasi-experimental study (before/after) was conducted at the Yaoundé UTH. It involved women who received an awareness of cervical cancer intervention at the Yaoundé CHU (intervention group) and those who did not (without intervention group) for 4 months (March to June) of 2 consecutive years (2016 and 2017). Proportions, central tendency parameters (mean or median), odds ratios (ORs), and 95% confidence intervals (CIs) were calculated. Results: A total of 1,313 women participated in screening for cervical cancer, of whom 40.60% were in the without intervention group and 59.40% were in the intervention group. The level of education and marital status were heterogeneously distributed in the two groups (P < 0.05). Women with a higher education level and who were married were more likely to participate in cervical cancer screening after intrahospital sensitization (OR [95% CI] = 5.64 [4.41–7.20] and OR [95% CI] = 1.48 [1.19–1.85], respectively). Conclusion: An intrahospital awareness intervention increased the number of participants in screening for cervical cancer. There is a need to implement this strategy in other hospitals and place particular emphasis on sensitizing less educated and single women.

Keywords: Cervical cancer, impact, intrahospital awareness, screening


How to cite this article:
Antaon JS, Eli LD, Mamche R, Mawamba YN, Tebeu PM. Impact of an intrahospital awareness strategy on attendance to the cervical cancer screening unit of the Yaoundé university teaching hospital cameroon. J Cancer Res Pract 2021;8:93-7

How to cite this URL:
Antaon JS, Eli LD, Mamche R, Mawamba YN, Tebeu PM. Impact of an intrahospital awareness strategy on attendance to the cervical cancer screening unit of the Yaoundé university teaching hospital cameroon. J Cancer Res Pract [serial online] 2021 [cited 2021 Dec 5];8:93-7. Available from: https://www.ejcrp.org/text.asp?2021/8/3/93/322192




  Introduction Top


Cervical cancer is a malignant neoformation that develops on the uterine cervix and most often on the exocervical mucosa.[1] It begins with a precancerous lesion of the cervix, named cervical intraepithelial neoplasia, which is a benign and asymptomatic epithelial abnormality. Proper management of cervical intraepithelial neoplasia can prevent the development of invasive cancer.[1] Known as a sexually transmitted disease caused by an oncogenic human papillomavirus, cervical intraepithelial neoplasia develops very slowly between 10 and 20 years.[1]

In 2018, GLOBOCAN estimated that there were more than 570,000 new cases of cervical cancer, resulting in 311,000 deaths worldwide, including more than 31,955 new cases and 23,529 deaths in Central Africa.[2] According to the same source, there were more than 3908 new cases of cervical cancer, resulting in more than 2754 deaths per year in the CEMAC zone (Cameroon, Central African Republic, Congo, Gabon, Equatorial Guinea, and Chad).[2] Of these six CEMAC State members, more than 2356 new cases of cervical cancer including 1546 deaths per year (60.28% and 56.13%, respectively) occurred in Cameroon.[2]

In Cameroon, <8% of women at risk have already undergone cervical cancer screening.[3],[4] Moreover, less than half of all nurses/midwives in Cameroon consider acetic acid and Lugol-based visual tests (VIA/VILI) or human papillomavirus test as screening methods (38% and 47%, respectively).[5]

Treatment strategies for cervical cancer include primary prevention (adolescent immunization and health education), secondary prevention (screening and treatment of premalignant lesions), and tertiary prevention (management of invasive cervical cancer).[1] Hence, cervical cancer is largely preventable through screening, detection, and treatment of precancerous abnormalities; however, few women at risk have undergone screening.

Strategies to increase access to cervical cancer services include education for users and health workers.[6],[7],[8] Targeting health workers, a Norwegian intervention consisted of three elements: an educational session for general practitioners, describing the importance of cervical cancer among immigrants and giving advice about how to invite them to participate, and a poster placed in waiting rooms. After implementing the intervention, the proportion of immigrant women screened significantly increased in the intervention group compared to the control group (2.6% vs. 0.6%, respectively).[6] With regard to interventions focusing on users, the effect of cervical cancer education in the intervention group compared to the control group on cervical cancer screening was recently highlighted in a systematic review. In the review, the use of theory-based educational interventions significantly increased cervical cancer screening rates by 2.46-fold.[6] In addition, a recent report from Ghana revealed that health education interventions are critical in improving knowledge and perceptions and increasing self-efficacy for women about cervical cancer screening.[8] A Nigerian study reported that multimedia health education based on a movie was effective in creating awareness and improving the knowledge and perception of adult women about cervical cancer and screening.[9] A study from Pakistan reported consistent findings, in that education had a highly significant impact on the knowledge level of the subjects.[10]

In Cameroon, there are approximately 1500 deaths from cervical cancer per year. A previous study failed to demonstrate the efficacy of an educational intervention on improving women's confidence in cervical cancer screening using the self-HPV method.[11] Therefore, the aim of this study was to analyze the effect of an intrahospital awareness-raising strategy on increasing cervical cancer screening attendance at the Yaoundé University Teaching Hospital, Cameroon.


  Methods Top


Type–place–period

This was a quasi-experimental study (before/after) conducted at the Yaoundé University Teaching Hospital (YUTH). Two groups of participants were compared: one group that did not receive the intrahospital awareness of cervical cancer intervention and another group that did.

The study was conducted in two subperiods of 4 months each: March to June of 2 consecutive years (2016 and 2017). The study was conducted after approval by the Ethical Committee of the Faculty of Medicine and Biomedical Sciences of the University of Yaoundé I, Cameroon.

Study population

The target population consisted of women aged atleast 25 years. The study population was split into two groups. The first group were screened but did not receive the intervention (no sensitization). The second group (sensitized group) included women who were screened during the intervention and received an awareness leaflet from the health staff of the Hospital and University Center and/or women who were sensitized by their entourage within UTH during the study period. The awareness leaflet contained the definition of cervical cancer, the mode of transmission of the papilloma virus, the clinical signs of cervical cancer, the risk factors, and the means of prevention of cervical cancer.

Intervention process and variables

The sensitization tool was developed by a student, principal investigator and validated by the supervisor. This tool provided information on cervical cancer, including clinical pattern, management, prognosis, and prevention. Moreover, information was given on the availability of the service at the YUTH. This tool was used to train the health workers to use it to sensitize the hospital visitors, both targets and people accompanying the targets. After communicating with the target population, the sensitization tool was distributed. The data were collected on sociodemographic characteristics (age, occupation, marital status, and educational level), source of information on cervical cancer, and the period during which information was collected.

Statistical analysis

Data analysis was performed using Epi Info 7.2.2.6 software (Produced by Center for Disease Control and Prevention (CDC), USA). Absolute and relative frequencies as well as central tendency parameters were calculated. To calculate the cervical cancer screening frequency, the number of women who received screening at the YUTH during the two study periods was divided by the number of women who received a consultation during each of the two periods. Logistic regression analysis was done to understand the influence of the sociodemographic characteristics of the participants on attending cervical cancer screening. Proportions, central tendency parameters (mean or median), and odds ratios (ORs) with their 95% confidence intervals (CIs) were calculated. The level of significance was set at P < 0.05.

Ethics statement

The study protocol was approved by the YUTH according to decision No. 593/AR/CHUY/DG/DGA/DMT. The objectives of the study were explained to the participants, and they chose to participate in the study voluntarily, after providing informed consent. Data confidentiality was maintained during all phases of the survey, and the results were reported in aggregate rather than being associated with individuals. All collected information was kept confidential and was only used for research purposes.


  Results Top


A total of 1313 women participated in screening for cervical cancer, of whom 40.60% (533/1313) did not receive the intervention (intrahospital awareness on cervical cancer intervention) and 59.40% (780/1313) did.

The age of the participants ranged from 25 to 72 years (mean: 42.52, standard deviation [SD]: 4.18 years) and 42.91 (SD: 3.46) for before and after groups, respectively. Education and marital status were heterogeneously distributed in the two groups (P < 0.05) [Table 1]. Women with a higher education level and who were married were more likely to participate in cervical cancer screening after intrahospital sensitization (74.31% vs. 25.69%; OR [95% CI] = 5.64 [4.41–7.20]; P < 0.001; and 63.65% vs. 36.35%; OR [95% CI] = 1.48 [1.19–1.85]) [Table 2].
Table 1: Comparative description of sociodemographic and reproductive characteristics

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Table 2: Factors associated with participation in screening at the time of strategy

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  Discussion Top


This quasi-experimental study was conducted to understand the influence of an intrahospital sensitization campaign on screening attendance. We found that most participants in the intervention group were married (59.48 vs. 49.71). This may be due to the fact that, contrary to unmarried women, married women would be granted moral and even financial support by their husbands. In a Korean study, marital status, monthly income, and annual checkups were significantly correlated with receiving Pap tests.[12]

The results of this study are similar to a study by Harder et al. in 2018, in which unmarried women were less likely to participate in cervical cancer screening than married women (1.67 [1.64–1.70]),[13] but different to those reported in a study from Ghana.[14] These results showed that there is a need to revitalize awareness campaigns among unmarried women (single, divorced, and widowed women).

We also found that most participants in the intervention group were more likely to have attended university (78.97% vs. 39.97%). This result is similar to a study conducted in Senegal in 2017, in which a university level of education was associated with a 2.56-fold higher odds of participating in cervical cancer screening.[15] Similarly, a study conducted in Denmark in 2018 reported that Danish women with a secondary education level or below were less likely to participate in cervical cancer screening than those who attended university (1.35 [1.32–1.38]).[13] Greater participation in cervical cancer screening by highly educated women may be due to better access to information on the illness than those with a lower education level. This finding was reported in a study conducted in Senegal in 2017, in which participation in cervical cancer screening was associated with awareness of the symptoms of the disease (2.64 [1.16–6.01]) and knowledge of diagnostic methods (7.70 [3.63–16.35]),[15] among others. Consistent with these findings, a study conducted in Ghana also showed that unemployed women and those with no formal education were less likely to participate in cervical cancer screening.[14]

The report about economic status is inconsistent with the Ghanaian report as unemployed women and those without formal education were less likely to participate in cervical cancer screening.[14]

Even though there were no significant differences between the two study groups in marital status and level of education, more women in the nonintervention group were employed than in the intervention group (42.3% vs. 39.62%). Low economic status as a factor for nonattendance to cervical cancer screening has been reported in Denmark.[13] Related fees should therefore be taken into consideration, as screening using common visual methods requires about 10 USD per case. In Ethiopia, marital status and secondary education level and above have been associated with cervical cancer screening attendance.[16]

We also found that 31.64% of those who attended cervical cancer screening could be attributed to the intrahospital awareness intervention of cervical cancer. This observation is not consistent with a previous Cameroonian report, because no significant difference was observed between the intervention group and the nonintervention group.[11]


  Conclusion Top


The intrahospital awareness intervention increased the number of participants in screening for cervical cancer. Level of education and marital status were heterogeneously distributed in the two study populations (P < 0.05). There is a need to perpetuate this strategy in other hospitals and place particular emphasis on sensitizing less educated and single women.

Acknowledgments

The authors are grateful to YUTH users and health workers, who made possible the implementation of this study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
WHO. Guidelines for Screening and Treatment of Precancerous Lesions for Cervical Cancer Prevention, Disponible. Available from: https://apps.who.int/iris/bitstream/handle/10665/112555/9789242548693_fre.pdf2014. [Last accessed 2020 Dec 12].  Back to cited text no. 1
    
2.
Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018;68:394-424.  Back to cited text no. 2
    
3.
Tebeu PM, Major AL, Rapiti E, Petignat P, Bouchardy C, Sando Z, et al. The attitude and knowledge of cervical cancer by Cameroonian women; a clinical survey conducted in Maroua, the capital of Far North Province of Cameroon. Int J Gynecol Cancer 2008;18:761-5.  Back to cited text no. 3
    
4.
Dohbit J, Domkao N, Meka N, Belinga E, Joel NT. Knowledge, attitudes and practices of postpartum women regarding cervical cancer in Maroua, Northern Cameroon. J Gynecol Womens Health 2018;11:1-6.  Back to cited text no. 4
    
5.
McCarey C, Pirek D, Tebeu PM, Boulvain M, Doh AS, Petignat P. Awareness of HPV and cervical cancer prevention among Cameroonian healthcare workers. BMC Womens Health 2011;11:45.  Back to cited text no. 5
    
6.
Musa J, Achenbach CJ, O'Dwyer LC, Evans CT, McHugh M, Hou L, et al. Effect of cervical cancer education and provider recommendation for screening on screening rates: A systematic review and meta-analysis. PLoS One 2017;12:e0183924.  Back to cited text no. 6
    
7.
Møen KA, Kumar B, Igland J, Diaz E. Effect of an intervention in general practice to increase the participation of immigrants in cervical cancer screening: A cluster randomized clinical trial. JAMA Netw Open 2020;3:e201903.  Back to cited text no. 7
    
8.
Ebu NI, Amissah-Essel S, Asiedu C, Akaba S, Pereko KA. Impact of health education intervention on knowledge and perception of cervical cancer and screening for women in Ghana. BMC Public Health 2019;19:1505.  Back to cited text no. 8
    
9.
Abiodun OA, Olu-Abiodun OO, Sotunsa JO, Oluwole FA. Impact of health education intervention on knowledge and perception of cervical cancer and cervical screening uptake among adult women in rural communities in Nigeria. BMC Public Health 2014;14:814.  Back to cited text no. 9
    
10.
Hafeez R, Perveen F, Zafar SN, Hafeez A. Educational effect on knowledge, attitude and practice among registered nurses regarding cervical cancer, its prevention and screening in Karachi, Pakistan. J Pak Med Assoc 2020;70:674-78.  Back to cited text no. 10
    
11.
Sossauer G, Zbinden M, Tebeu PM, Fosso GK, Untiet S, Vassilakos P, et al. Impact of an educational intervention on women's knowledge and acceptability of human papillomavirus self-sampling: A randomized controlled trial in Cameroon. PLoS One 2014;9:e109788.  Back to cited text no. 11
    
12.
Lee HY, Choi YJ, Shin J, Yoon YJ, An S. Adherence to cervical cancer screening in Korean American immigrant women: Identifying malleable variables for intervention development. J Transcult Nurs 2020;32:230-8.  Back to cited text no. 12
    
13.
Harder E, Juul KE, Jensen SM, Thomsen LT, Frederiksen K, Kjaer SK. Factors associated with non-participation in cervical cancer screening – A nationwide study of nearly half a million women in Denmark. Prev Med 2018;111:94-100.  Back to cited text no. 13
    
14.
Ampofo AG, Adumatta AD, Owusu E, Awuviry-Newton K. A cross-sectional study of barriers to cervical cancer screening uptake in Ghana: An application of the health belief model. PLoS One 2020;15:e0231459.  Back to cited text no. 14
    
15.
Faye A, Mbengue ET, Tal-Tal A. Factors associated with screening for cervical cancer in rural Senegal. Rev Epidemiol Health 2017;65:S77.  Back to cited text no. 15
    
16.
Aynalem BY, Anteneh KT, Enyew MM. Utilization of cervical cancer screening and associated factors among women in Debremarkos town, Amhara region, Northwest Ethiopia: Community based cross-sectional study. PLoS One 2020;15:e0231307.  Back to cited text no. 16
    



 
 
    Tables

  [Table 1], [Table 2]



 

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