Cervical Cancer Screening as Correlates for Tackling Maternal Morbidity and Mortality in Ondo North Senatorial District, Ondo State, Nigeria

Background of the Study

Cervical cancer is a disease that is peculiar to women, and has adverse effect on their sexual and reproductive health as well as their general condition and family life. In Nigeria, current estimates indicate that in early year of 2015, about 9922 women were diagnosed with cervical cancer and 8030 died from the disease¹⁷. Cervical cancer ranks the 2^nd most frequent cancer in women in Nigeria, and the 2^nd most frequent cancer among women between 15 and 45 years of age. About 24.8% of women in the general population are estimated to harbour cervical HPV infection at a given time, and 10.0% of invasive cervical cancers in Nigeria are attributed to HPVs 16 or 18 HPV⁵.

Issues relating to women’s health were the focus of the International Conference on Population and Development (ICPD) in 1994 which gave rise to the need for strategies to improve reproductive health globally¹⁴,¹⁵. The primary underlying cause for cervical cancer is Human Papilloma Virus (HPV). Early sexual debut, multiple sexual debut, multiple sexual partners, family types especially polygamy, HPV infection, smoking, genetic predisposition and compromised immunity are associated with development of cervical cancer. Cervical cancer contributes to mortality among women especially those in developing countries¹²,^15,16. Risk factors for cervical cancer emanate from the risk for contacting Human Papilloma Virus (HPV) such as early onset of sexual activity, multiple lifetime sexual partners (of a woman or her partners), and history of other STIs-generally reflect sexual activity. Therefore, primary prevention efforts have focused on reducing infection by reducing the number of sexual partners and encouraging the use of barrier contraceptives, especially condoms⁷,^8,11. Individuals can harbour HPV infection for long durations without knowing they are infected; therefore, even mutually monogamous couples may transmit infection obtained in a previous relationship to a current partner.

Participation in screening programme for disease such as hypertension and cancer is part of the health promotion activities in the Nigeria National Health Policy, to be carried out by individuals and families in Nigeria⁵. To ensure that the purpose of screening is achieved, women should be counseled before and after screening so they can make informed choice. To increase informed uptake, the tailored intervention should include information on the likely harms and risks, as well as the benefits of screening⁷. Providing information on cervical cancer in the community and in Health services is vital to raising awareness and reducing illness and death¹⁰. The content of information about cervical cancer varies according to client’s problem or concern or circumstances. It covers prevention, screening, follow-up, referral, diagnosis, treatment of precancerous conditions and treatment of invasive cancer².

In a study conducted by Winnie, et al. (2016)¹⁸ on factors associated with uptake of cervical cancer screening among women aged 18-49 years in Njiru sub country, Nairobi, Kenya revealed that those with higher educational degrees uses cervical cancer screening services more than those with primary education while those with intermediate educational background uses cervical cancer screening services less than those with higher degrees. In a similar study conducted by Alfaro, Gage, et al. (2015)⁸ was consistent with a study conducted by Nisreen-Arif Al-bizrah and Farzana Rizwan Arain (2015)¹³ and both of them revealed that the more the respondents were educated the more preventive measures adopted for early detection of cervical cancer among women of child bearing age.

Statement of Problem

Cervical cancer is a preventable disease if detected early but if otherwise it kills faster than any other diseases of reproductive health. Within a national cancer control programme, there are four basic components of cervical cancer control: Primary prevention; early detection through increased awareness and organized screening programmes; diagnosis and treatment; and palliative care for advanced disease. Screening involves testing a target group (in this context, women) who are at risk for a given disease (in this context, cervical precancer). The aim of screening is to detect and treat those people identified as having early signs of the disease, usually by means of an inexpensive, accurate, and reliable test that can be applied widely.

Health promotion activities are very important in the prevention various ailments that will have negative impact on the health of women. Cervical cancer is one of the conditions that can be prevented through vaccination and health promotion activities in reproductive health. Health promotion encouraging consumer behaviours most likely optimize health potentials (physical and psychosocial) through health information, preventive programs, and access to medical care. The introduction of screening programme in developing countries has been associated with a decline in incidence of invasive cervical cancer Screening is usually taken to refer to the process of sifting to discriminate objects which have predetermined set of characteristics from those who do not. Screening is the procedure where a test is applied to healthy volunteers from the population in order to identify those individuals at high risk of developing otherwise unrecognized disease. Screening for cervical cancer is aimed at reducing the incidence of disease, reduce the duration of disease and consequently the risk of transmission, and reduce the effects of infection, including both the physical and psychosocial complications and the financial burden to the immediate family and total lost to the community. Early detection and screening for cervical cancer will promote health, preserve health, to restore health when it is impaired and to minimize suffering and distress. Cervical cancer screening as a correlate in tackling maternal morbidity and mortality helps in early detection, early diagnosis and treatment of cancer of cervix which is preventable.

Research Hypotheses

The researcher formulated four research hypotheses and tested at 0.05 level of significance to guide the study:

1. There is no significant correlation between maternal mortality and cervical cancer screening in Ondo North Senatorial District of Ondo State, Nigeria.

2. There is no significant correlation between parity and cervical cancer screening in tackling maternal mortality in Ondo North Senatorial District of Ondo State, Nigeria.

3. There is no significant correlation between sexually transmitted diseases and cervical cancer screening in tackling maternal mortality in Ondo North Senatorial District of Ondo State, Nigeria.

4. There is no significant correlation between educational background and cervical cancer screening in tackling maternal mortality in Ondo North Senatorial District of Ondo State, Nigeria.

Significance of the Study

The study could benefit health care providers, students in various places of learning, cervical cancer patients, survivors, health educators in hospitals, State and Federal Government. The findings of the study could provide useful information on the various types of cervical cancer screening that are available for health care providers to enable them to take appropriate action to assist all women for early detection of cervical cancer.

Methods

A descriptive research of the survey type was used for this study .Survey design will be considered appropriate and adopted because it will describe psychosocial factors and breast cancer screening among women in Ondo North Senatorial District, Ondo State, Nigeria the population for the study were all women of child bearing age in Ondo North Senatorial District, Ondo State, Nigeria. The sample for the study consisted of 1800 women between 18- 50 years attended antenatal clinics in all health facilities in the entire six Local Government Areas of the study area. Simple random sampling technique was used to select 300 respondents in each of the six local government area of Ondo North Senatorial District, Ondo State, Nigeria. A self-designed questionnaire was used to elicit information from respondents. The questionnaire consists of two sections identified as A and B. Section A contains information on demographic characteristics of the respondents while section B was used to elicit information on how to use screening practices to tackle maternal mortality in the study area while putting into consideration other variables like parity, influence of educational background and sexually transmitted diseases on cervical cancer.

The instrument was subjected to face content and construct validities and confirmed by experts that were fit and good for the study. A correlation coefficient of 0.76 was obtained using Spearman Correlation Formular. Reliability was established using test – retest method. A reliability coefficient of 0.79 was obtained using Pearson Product Moment Correlation Analysis. This result was considered reliable for the study and this is in accordance with the documentation of Kothari and Gaurav (2015)⁹ who affirmed that any reliability coefficient that is above 0.6 should be considered reliable for the study. Research assistants were trained and saddled with responsible to establish good rapport with the respondents before the administration of the instrument and this enable them to gain their support and willingness to participate in the study. The data generated were analyzed using descriptive and inferential statistics to analyze the four null hypotheses and tested at 0.05 level of significance.

Results

Discussion of Findings

The study investigated cervical cancer screening as a correlates for tackling maternal morbidity and mortality in Ondo, North Senatorial District, Ondo State, Nigeria. The finding of this study is in agreement with the finding of Ayinde and Omigbodun (2003)⁴ which affirmed the relationship between cervical cancer screening for early detection to prevent poor prognosis of the said disease. According to FMOH (2005)⁵, early diagnosis of cervical cancer and prompt management will have a positive influence in prevention of increase maternal mortality among women of child bearing age. Early detection of cervical cancer through adequate screening is a key factor in Nigeria national health promotion policy as entrenched in the nation national health policy. Alliance for Cancer Prevention (2003)² confirmed the relationship between maternal mortality and late detection of cervical cancer which is also in conformity with this present study.

Parity signify the number of times a woman get pregnant and deliver a baby which reduces the elasticity of the uterine muscles with consequent prone and susceptibility to infection. The present study confirmed the correlation between parity and maternal mortality which is in conformity with Ayinde and Omigbodun, 2003⁴; WHO (2001)¹⁵; WHO (2004)¹⁶ and UNPF (2007)¹⁴. Therefore, there is need to create more awareness on the need for adequate family planning programme in the study area and nation at large.

The study is in agreement with other studies conducted earlier in other region of the country by scholars like Ayinde and Omigbodun (2003)⁴ on knowledge, attitude and practices related to prevention of cancer of the cervix among female health workers in Ibadan. In the same vein the study is in conformity with the study conducted by Mutyaba, Mirembe and Weiderpass (2007)¹² on influence on uptake of reproductive health services on Nsangi Community of Uganda and their implications for cervical cancer screening.

The study conducted by Nisreen-Arif Al-bizrah and Farzana Rizwan Arain (2015)¹³ and Winnie Mungai, et al. (2016)¹⁸ confirmed that respondents with higher educational background subjected themselves for cervical cancer screening more often than those respondents without basic and formal education. This singular reason can be linked to increase prevalence of late detection of cervical cancer among people living in rural low resource in underdeveloped and developing nations around the world. The findings of this present study are in agreement and conformity with the findings of the researchers mentioned above.

Conclusion

Based on the findings of this study, it is concluded that:

• There is significant correlation between maternal mortality and cervical cancer screening in Ondo North Senatorial District of Ondo State, Nigeria.

• There is significant correlation between parity and cervical cancer screening in tackling maternal mortality in Ondo North Senatorial District of Ondo State, Nigeria.

• There is significant correlation between sexually transmitted diseases and cervical cancer screening in tackling maternal mortality in Ondo North Senatorial District of Ondo State, Nigeria.

• There is significant correlation between educational background and cervical cancer screening in tackling maternal mortality in Ondo North Senatorial District of Ondo State, Nigeria.

Recommendations

The following recommendations were made among other things:

1. there should be regular screening for cervical cancer among women of reproductive age,

2. the number of times a woman should carry pregnancy should be reduced to lowest minimal and family planning services should be promoted,

3. any patient infected with sexually transmitted diseases should be thoroughly treated and investigated to enhance quality reproductive health care services,

4. The government of Nigeria at all levels should ensure that the entire populace are well informed, educated and made versatile with those information that will promote and sustain their healthful living.