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.