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      Factors affecting utilization of cervical cancer screening services among women attending public hospitals in Tigray region, Ethiopia, 2018; Case control study

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          Abstract

          Background

          Incidence and mortality of cervical cancer is the leading cancer among women in Ethiopia. Absence of effective detection methods and treatment strategies is a major reason for the sharply rising cervical cancer rates in developing countries.

          Objective

          To determine factors affecting utilization of cervical cancer screening services among women attending public hospitals in Tigray region in 2018.

          Methods

          Hospital based unmatched case control study was applied with sample size of 312 cases and 312 controls. Data was entered to Epi data version 3.1 and exported to SPSS version 20. The odds ratio with their 95% confidence interval, two-tailed P value was calculated. Variables with P value ≤ 0.05 in the bivariate analysis were included in the multivariate logistic regression model.

          Results

          Being in the age group of 30–39 and 40–49 years were two and four times more likely to utilize cervical cancer screening than those who were 21–29 years (AOR = 2.15 95%CI:1.11, 4.17 and AOR = 3.86 95%CI:1.48, 10.06) respectively. Current occupation with governmental and private employee were four and three times more likely to utilize the screening service than those housewife respectively (AOR = 3.85 95%CI: 1.87, 7.92 and AOR = 3.17 95%CI: 1.31, 7.66). Having ever given birth and history of multiple sexual partners were more likely to utilize the screening service (AOR = 2.57 95%CI: 1.02, 6.50) and (AOR = 2.65 95%CI: 1.10, 6.40) respectively.

          Conclusions

          There is a need to strengthen policy and guidelines on cervical cancer screening among women particularly with regarding age group of 21–29, current occupation with housewife, single sexual partner and null parity. All stakeholders should give priority on the promotion and initiation of women to acquired good knowledge and attitude on cervical cancer screening.

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          Most cited references19

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          Effectiveness of cervical screening with age: population based case-control study of prospectively recorded data

          Objective To study the effect of cervical screening on incidence of cervical cancer as a function of age with particular focus on women screened under the age of 25. Design Population based case-control study with prospectively recorded data on cervical screening. Setting Selected centres in the United Kingdom. Participants 4012 women aged 20-69 with invasive cancer diagnosed in participating centres and two controls per case individually matched on age and area of residence. Main outcome measures Odds ratios for strength of association between cervical cancer and screening at particular ages. Results There is no evidence that screening women aged 22-24 reduced the incidence of cervical cancer at ages 25-29 (odds ratio 1.11, 95% confidence interval 0.83 to 1.50). Similar results were seen for cancers restricted to squamous carcinoma or FIGO (International Federation of Gynaecology and Obstetrics) stage IB or worse, but the numbers are insufficient to provide narrow confidence intervals. Screening was associated with a 60% reduction of cancers in women aged 40, increasing to 80% at age 64. Screening was particularly effective in preventing advanced stage cancers. Conclusions Cervical screening in women aged 20-24 has little or no impact on rates of invasive cervical cancer up to age 30. Some uncertainly still exists regarding its impact on advanced stage tumours in women under age 30. By contrast, screening older women leads to a substantial reduction in incidence of and mortality from cervical cancer. These data should help policy makers balance the impact of screening on cancer rates against its harms, such as overtreatment of lesions with little invasive potential.
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            Cervical cancer screening and HPV vaccine acceptability among rural and urban women in Kilimanjaro Region, Tanzania

            Objective To determine cervical cancer screening coverage and the knowledge, attitudes and barriers toward screening tests among women in rural and urban areas of Tanzania, as well as explore how they view the acceptability of the HPV vaccine and potential barriers to vaccination. Setting A cross-sectional study using interview-administered questionnaires was conducted using multistage random sampling within urban and rural areas in Kilimanjaro Region, Tanzania. Participants Women aged 18–55 were asked to participate in the survey. The overall response rate was 97.5%, with a final sample of 303 rural and 272 urban dwelling women. Primary and secondary outcome measures Descriptive and simple test statistics were used to compare across rural and urban strata. Multivariate logistic regression models were used to estimate ORs and 95% CIs. Results Most women (82%) reported they had heard of cervical cancer, while self-reported cervical cancer screening among women was very low (6%). In urban areas, factors associated with screening were: older age (OR=4.14, 95% CI 1.86 to 9.24 for ages 40–49, and OR=8.38, 95% CI 2.10 to 33.4 for >50 years), having health insurance (OR=4.15, 95% CI 1.52 to 11.4), and having knowledge about cervical cancer (OR=5.81, 95% CI 1.58 to 21.4). In contrast, among women residing in rural areas, only condom use (OR=6.44, 95% CI 1.12 to 37.1) was associated with screening. Women from both rural and urban areas had low vaccine-related knowledge; however, most indicated they would be highly accepting if it were readily available (93%). Conclusions The current proportion of women screened for cervical cancer is very low in Kilimanjaro Region, and our study has identified several modifiable factors that could be addressed to increase screening rates. Although best implemented concurrently, the availability of prophylactic vaccination for girls may provide an effective means of prevention if they are unable to access screening in the future.
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              Knowledge about cervical cancer and barriers toward cervical cancer screening among HIV ‐positive women attending public health centers in Addis Ababa city, Ethiopia

              Abstract Screening rate for cervical cancer among HIV‐infected women and among women overall is low in Ethiopia despite the high burden of the disease and HIV infection, which increases cervical cancer risk. In this paper, we assessed knowledge about cervical cancer symptoms, prevention, early detection, and treatment and barriers to screening among HIV‐positive women attending community health centers for HIV‐infection management in Addis Ababa. A cross‐sectional survey of 581 HIV‐positive women aged 21–64 years old attending 14 randomly selected community health centers without cervical cancer screening service in Addis Ababa. We used univariate analysis to calculate summary statistics for each variable considered in the analysis, binary logistic regression analysis to measure the degree of association between dependent and independent variables, and multiple regressions for covariate adjusted associations. Statistical significance for all tests was set at P < 0.05. We used thematic analysis to describe the qualitative data. Of the 581 women enrolled in the study with mean age 34.9 ± 7.7 years, 57.8% of participants had heard of cervical cancer and 23.4% were knowledgeable about the symptoms, prevention, early detection, and treatment of the disease. In multivariate analysis, higher educational attainment and employment were significantly associated with good knowledge about cervical cancer. In addition, only 10.8% of the participants ever had screening and 17% ever received recommendation for it. However, 86.2% of them were willing to be screened if free of cost. Knowledge about cervical cancer is poor and cervical cancer screening rate and provider recommendation are low among HIV‐positive women attending community health centers for management and follow‐up of their disease in Addis Ababa. These findings underscore the need to scale up health education about cervical cancer prevention and early detection among HIV‐positive women as well as among primary healthcare providers in the city.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: MethodologyRole: SoftwareRole: SupervisionRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Formal analysisRole: MethodologyRole: SupervisionRole: Writing – review & editing
                Role: ConceptualizationRole: MethodologyRole: Writing – review & editing
                Role: ConceptualizationRole: MethodologyRole: SupervisionRole: Writing – review & editing
                Role: ConceptualizationRole: Formal analysisRole: MethodologyRole: SupervisionRole: Writing – review & editing
                Role: MethodologyRole: SupervisionRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                14 March 2019
                2019
                : 14
                : 3
                : e0213546
                Affiliations
                [1 ] Department of Public Health, College of Medicine and Health Science, Adigrat University, Adigrat, Ethiopia
                [2 ] Department of Medical Laboratory Technology, College of Medicine and Health Science, Adigrat University, Adigrat, Ethiopia
                [3 ] Department of Nursing, College of Medicine and Health Science, Adigrat University, Adigrat, Ethiopia
                Ordu University, TURKEY
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0002-7519-8133
                http://orcid.org/0000-0003-1775-8216
                Article
                PONE-D-18-31546
                10.1371/journal.pone.0213546
                6417770
                30870497
                3a81e1ab-0819-48e2-80bb-baf11eae7f43
                © 2019 Teame et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 1 November 2018
                : 23 February 2019
                Page count
                Figures: 0, Tables: 4, Pages: 11
                Funding
                Funded by: Adigrat university
                Award ID: AGU/CMHS/036/09
                Award Recipient :
                This research was funded by Adigrat univesity (AGU/CMHS/036/09 to HT). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Medicine and Health Sciences
                Oncology
                Cancers and Neoplasms
                Gynecological Tumors
                Cervical Cancer
                Medicine and Health Sciences
                Diagnostic Medicine
                Cancer Detection and Diagnosis
                Cancer Screening
                Medicine and Health Sciences
                Oncology
                Cancer Detection and Diagnosis
                Cancer Screening
                People and Places
                Population Groupings
                Age Groups
                People and Places
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                Medicine and Health Sciences
                Public and Occupational Health
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                Biology and Life Sciences
                Microbiology
                Medical Microbiology
                Microbial Pathogens
                Viral Pathogens
                Immunodeficiency Viruses
                HIV
                Medicine and Health Sciences
                Pathology and Laboratory Medicine
                Pathogens
                Microbial Pathogens
                Viral Pathogens
                Immunodeficiency Viruses
                HIV
                Biology and Life Sciences
                Organisms
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                Organisms
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                RNA viruses
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                Biology and Life Sciences
                Microbiology
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                Medicine and Health Sciences
                Pathology and Laboratory Medicine
                Pathogens
                Microbial Pathogens
                Viral Pathogens
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                Biology and Life Sciences
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