Abstract:
Purpose
Cervical cancer screening has been successful in reducing the rates of cervical cancer in
developed countries, but this disease remains the leading cause of cancer deaths among
women in sub-Saharan Africa. We sought to understand factors associated with limited
uptake of screening services in our cervical cancer-screening program in Western Kenya.
Participants and Methods
Using items from a previously validated cancer awareness questionnaire repurposed for
use in cervical cancer and culturally adapted for use in Kenya, we interviewed 2,505 women
aged 18
–
55 years receiving care in gynecology clinics or seeking other services in 4 health
facilities in Western Kenya between April 2014 and September 2014. We used logistic
regression modeling to assess factors associated with uptake (or non-uptake), associated
odds ratios (ORs) and the 95% confidence intervals (95% CI).
Results
Only two hundred and seventy-three women out of 2505 (11%) accepted VIA cervical can-
cer screening. Knowledge of just how women are screened for cervical cancer was signifi-
cantly associated with reduced uptake of cervical cancer screening (OR: 0.53; CI 0.38
–
0.73) as was fear that screening would reveal a cancer (OR 0.70; CI 0.63
–
0.77), and reli-
ance on prayer with the onset of illness (OR 0.43; CI 0.26
–
0.71). Participants who thought
that one should get cervical cancer screening even if there were no symptoms were more
than twice as likely to accept cervical cancer screening (OR 2.21; 95% CI 1.24
–
3.93). Older
patients, patients living with HIV and women who do not know if bleeding immediately aftersex might be a sign of cervical cancer were also more likely to accept screening (OR 1.03,
CI 1.02
–
1.04; OR 1.78, CI 1.01
–
3.14; OR 2.39, CI 1.31
–
4.39, respectively).
Conclusions
In our population, a high percent of women knew that it is appropriate for all women to get
cervical cancer screening, but only a small proportion of women actually got screening.
There may be an opportunity to design educational materials for this population that will not
only encourage participation in cervical cancer screening but also remediate misconcep-
tions. The discussion illustrates how our findings could be used in such an effort.