Barriers to cervical cancer screening among women in an urban informal settlement in kibera, Nairobi County, Kenya

Abstract

Background: The global target towards elimination of cervical cancer by 2030 includes screening 70% of women with a high performance test at 35 and 45 years. In Kenya, in 2014, among women with lower social economic status, only 4% had been screened for cervical cancer. In Nairobi, in 2018, Kibera had the highest proportion of cervical cancer disease among women screened. Identification of the barriers to screening will inform interventions to promote early cervical cancer screening and treatment. Objectives: The objectives were to determine the proportion of women who have been screened for cervical cancer, to determine barriers and factors associated with screening among the women in Kibera, Nairobi County and to determine their knowledge on HPV. Methodology: A community based cross sectional study was conducted in Soweto West and Gatwekera villages within Kibera. The study population was women aged 18‒49 years residing in the two villages for four months consecutively in 2019. Stratified sampling was used by obtaining a list of the women in the study population with their respective ages, and grouping them into three age categories. The proportion of women in each age category in the study population was used to calculate a sample size of 222 study participants. Interviews were conducted with each participant using structured questionnaires and data collected on demographics, screening, and barriers to screening. Descriptive statistics were used to describe participant demographics, screening history and barriers to screening. Multivariate logistic regression was used to calculate factors associated with screening. Associations were reported using odds ratios (OR) and 95% CI. Statistical significance was considered for p < 0.05. Results: History of cervical cancer screening was reported in 77 (35%) study participants. The median age among study participants was 28 years (IQR= 24─33). Those who had completed only the primary level education were 107 (48%) and those who were married were 149 (67%). The barriers to cervical cancer screening reported among 145 women not screened were lack of information on the benefit of screening in 43 (29.7%) participants, fear of painful procedure in 30 (20.7%), and lack of time to go to hospitals for screening in 26 (17.9%) participants. Those who reported not feeling at risk of cervical cancer were 18 (12.4%) and 14 (9.7%) reported that they did not know where to go for screening. Independent factors associated with increased odds of cervical cancer screening were living with HIV (AOR 4.4, 95% CI, 1.5─12.7) and having parity of 1 ̶ 3 children compared to having no children (AOR 4.7, 95% CI, 1.1─19.9). Women who had never heard of HOV were 51 (23%). Conclusion: Two-thirds of women reported to have never been screened. The main barriers to screening among the women was lack of information and fear of painful procedure. Women living with HIV were more likely to be screened for cervical cancer. Recommendation: Community health campaigns for women residing in Kibera on the importance of early cervical cancer screening and to counter fear on screening.