Transcript JUNK - The 5th AFENET Scientific Conference | Addis Ababa

FACTORS AFFECTING UPTAKE OF CERVICAL
CANCER SCREENING AMONG WOMEN IN
NAKASONGOLA DISTRICT, UGANDA
AFENET Scientific Conference
Authors: John Kamulegeya,
J Bukenya, F Makumbi
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Background
• Cervical cancer is leading cancer among women in
Uganda
• Incidence rate 40.7/100,000
• 80% of patients at Mulago National Hospital, present
with advanced disease
• Screening significantly reduce morbidity and mortality
• Free cervical screening using VIA at static/ outreach
• Only 52%of program target realized in 2012
• Reasons for low uptake not known
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Study Objectives
1. To determine the uptake of cervical
cancer screening among women aged
25-49 years, district-wide
2. To establish factors associated with
uptake of cervical cancer screening
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Methodology 1
• A cross-sectional community survey, March-May
2012
• Interviewed 526 women, 4 focus group
discussions, 8 key informant interviews
Inclusion criteria
• Women aged 25- 49 years
• Resident in Nakasongola district for 6+ months
Exclusion criteria
• Very ill and unable to participate in the interview.
• History of total hysterectomy at least 3 years
prior to the study
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Methodology 2
• Multistage cluster sampling, randomly selecting
participants from sampled household
• Uptake ascertained as proportion of screened
between Feb. 2009 - Feb. 2012
• Associated factors obtained by logistic
regression
• Odds ratios (OR) , 95%CI used as measure of
association
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Results 1- Uptake
• Only 14.6% (77/526) of the women reported
ever screening for cervical cancer.
• Majority of screening, 79.2% ( 61/77)
conducted within the district
• Only 6.5%(5 /77) of ever screened, had two or
more screenings
• Willingness to adhere to next screening
appointment was almost universal, 97.4%
(75 /77)
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Results-2 Social Demographic Factors
Characteristics
Age group
25-29
35-39
40-44
45-49
Education Level
Secondary
Tertiary
Marital status
Single
Divorced
Widow
Married
Ever
Screened %
Adjusted
OR ( 95% CI)
8.5 (18/211)
21.7 (15/69)
21.2 (11/52)
17.4 (8/56)
1.0
3.17 (1.30 -7.75)*
2.81 (1.01-7.87)*
1.82 (0.61-5.36)
19.7 (26/132)
36.4 (8/22)
1.96 (0.56 - 6.87)
4.75 (0.99 - 22.81)
10.5 (6/57)
18.3 (13/22)
20.0 (7/35)
14.0 (51/363)
1.0
5.05 (1.18 - 21.57)*
5.76 (1.15 - 28.76)*
2.48 (0.72 – 8.55)7
Results-3 Factors associated with Uptake
Characteristics
Proportion Ever
Screened %
Knowledge about
CxCaS
Good
63.2 (12/19)
Fair
36.4 (32/88)
Poor
7.9 (33/419)
How likely is it to get
cervical cancer in your
life time?
Likely
28.1 (27/96)
Not Likely
11.6 (50/430)
Having CxCa related
signs and symptoms
No
8.3 (34/408)
Yes
37.4 (43/112)
Screening is embarrassing
Yes
11.63 (52/447)
No
31.65 (25/79)
Adjusted
OR( 95% CI)
1.0
0.30 (0.09-1.06)
0.06 (0.02-0.19)*
1.0
0.37 (0.15-0.6)*
1.0
7.45 (3.93-14.16)*
1.0
3.45 (1.68-7.1)*
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Study Limitation
• Response bias
Conclusion
• Uptake of Cervical cancer screening in
Nakasongola district is very low, 14.6%
• Factors associated with poor uptake:
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– Low knowledge of CaCX screening
– Embarrassment about screening
– Low risk perceptions
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Recommendations
• Improve women's knowledge about
cervical cancer screening
• Sensitize women on importance of
screening even when free of signs
• Expand screening services
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Acknowledgements
• Makerere University School of Public
Health(MakSPH)
• Nakasongola District Local Government
• FETP, Uganda
• Family Health Research and Development
Center (FHRDC)- MakSPH
• Ndejje University
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Thank you for your attention!
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