Knowledge of cervical cancer screening and use of cervical screening facilities among women from various socioeconomic backgrounds in Durban, Kwazulu Natal, South Africa

Abstract

The value of screening for cervical cancer has been proven. Such screening in developed countries has achieved a decrease in incidence and mortality by about 80%. Although screening facilities are available in certain parts of developing countries, the incidence of cervical cancer remains very high and many patients present with late stage disease. The study was performed among women from different socioeconomic circumstances (low, middle, and upper social/financial backgrounds). The assessment was performed by means of a questionnaire. The majority of patients from lower socio-economic circumstances with multiple risk factors were not aware of cervical screening or facilities available for this purpose. However, in spite of knowledge of cervical screening and the availability of such services, the majority of women (87%) from higher social and educational backgrounds did not undergo cervical screening. Most patients resided within a 12-kilometer radius of a facility that either provided or could potentially provide screening. Although some patients (36.7%) had had a screening test performed at some time in the past, only 27.3% of patients reported having had a Pap test. This was due to failure on the part of the healthcare giver to disseminate information to the patient regarding the reason and value of cervical screening. Among women from higher socioeconomic groups, the level of education was better and knowledge of the Pap test was not age-dependent. We conclude that the mere provision of a cervical cancer screening service is not sufficient to ensure successful uptake since screening is a multifaceted entity. Improvement of socioeconomic and educational circumstances should improve the uptake of a screening program only if the healthcare giver provides appropriate information to the patient and the patient takes the initiative to avail themselves of such screening.

Cervical cancer: the sub-Saharan African perspective

“…18,[20][21][22] Socio-economic factors Worldwide women of low socio-economic status have a greater risk of cervical cancer. Cervical cancer is often referred to as a disease of poverty 23 RI Anorlu / Reproductive Health Matters 2008;16(32): [41][42][43][44][45][46][47][48][49] and of poor women. 24 Poverty is endemic in sub-Saharan Africa.…”

“…Several studies have shown poor knowledge of the disease in Africa, which even cuts across different literacy levels. 5,[40][41][42][43] Among 500 attendees of a maternal and child health clinic in Lagos-Nigeria only 4.3% were found to be aware of cervical cancer. 43 In 2004, also in Lagos, 81.7% of 139 patients with advanced cervical cancer had never heard of cervical cancer before, and 20%, 30% and 10% respectively thought the symptoms they had were due to resumption of menses, lower genital infection and irregular menses (unpublished report).…”

“…44,45 Poor knowledge is not limited to patients alone, however; health care workers who are supposed to be better informed do not have good knowledge of the disease either. [45][46][47][48] In Lagos, delay by primary health care providers RI Anorlu / Reproductive Health Matters 2008;16(32): [41][42][43][44][45][46][47][48][49] in referring cases of cervical cancer was found to be an important cause of women presenting with late-stage disease. 11 It took a mean of 9.35 ± 12.9 months for primary health care providers to diagnose and refer women with cervical cancer to a tertiary hospital for management.…”

“…55 The default rate among those with cytological abnormalities reaches 60-80% due to the absence of effective mechanisms for recall of women with abnormal smears. 15 The effectiveness of direct visual inspection (visual inspection with acetic acid and visual inspection with Lugol's iodine) as a form of population-based screening is currently being studied in some ongoing projects across the RI Anorlu / Reproductive Health Matters 2008;16(32): [41][42][43][44][45][46][47][48][49] continent, mainly sponsored by international agencies. 6,24 Results from these studies are quite promising and support its use as an alternative to cervical cytology.…”

“…In a survey of terminally ill patients in five countries in Africa -Uganda, Ethiopia, Tanzania, Zimbabwe and Botswana -the greatest need expressed by the patients was pain relief. 62 In another study 63 comparing the concerns of terminally ill patients in a developed country RI [41][42][43][44][45][46][47][48][49] (Scotland) and an African country (Kenya), it was found that the main concern of the Scottish patients was the emotional pain of facing death, while for their counterparts in Kenya it was physical pain and financial worries. Unfortunately, there is inadequate availability of pain-relieving medications, especially opioids.…”