26Background 27 Cervical cancer is the second most common cancer in women aged 44 years and above in Ethiopia. Lack of 28 awareness about the disease, lack of screening programs and inadequacy of vaccination in most regions of Ethiopia 29 alarmingly increasing Human papillomavirus (HPV) infections and incidence of the disease. Educational 30 intervention is a fast and effective primary preventive step to reduce the cervical cancer burden. 31 Objective 53 Conclusion 54The present study suggests that educational intervention as the primary preventive method is effective and young 55 trained women volunteers belong both rural and urban areas will be important stakeholder to increase positive 56 attitude to reduce the cervical cancer burden in Ethiopia.
57
Introduction
58According to GLOBOCAN 2018 [1], most of the African countries have no official registry to cover the cancer 59 statistics and it reflects unseen burden including cervical cancer. Cervical cancer is a fourth leading cause for 60 cancer death is the most common cancer in Sub-Saharan Africa, second leading health problem in Northern Africa 61 including Ethiopia among women 44 years and above [2][3][4][5][6][7][8][9][10]. In developing countries, high-risk HPV infections 62 cause cervical cancer and other serious public health problems [11] due to bare minimal resources to cope with 63 the situation [12][13][14].
64Women are at risk of HPV infections in some point in their life [4, 15]. A variety of clinic-epidemiological risk 65 factors such as early age of marriage, multiple sexual partners, multiple pregnancies, poor genital hygiene and 66 smoking and so are often associated with the development of cervical cancer [4, 11, 16, 17]. Most of the women 67 in developing and under-developed countries do not have access to Pap (Papanicolaou) smear screening [12, 18] 68 for early detection of HPV infections. Low or absence of any nationwide cervical screening program [19], very 69 few women receive screening [20] and cancer of cervix remains a major public health problem for Ethiopia [21, 70 22]. According to Tsegaye et al., 2018 [2], only 0.6% of women in Ethiopia, aged 18-69 years includes, 1.6% 71 from urban and 0.4% from rural screened every three years. In Ethiopia, every year around 7095 women are 72 diagnosed with cervical cancer and 4732 dies from this disease [23].
73Several factors like education, economic status, health facilities influence early detection and treatment of cervical 74 precancerous lesions [5, 15,[24][25][26] and reduce cervical cancer morbidity and mortality [27]. The absence of 75 screening facilities coupled with poor literacy and low level of awareness, less attention to women health further 76 aggravate the cervical cancer burden [5,[28][29][30]. Ethiopia has a low level of awareness about cervical cancer and 77 HPV infections [27]. Various studies [31][32][33] have been undertaken to assess women's awareness and knowledge 78 level about cervical cancer. Cervical cancer awareness studies are few in Ethiopia and mostly confined...