CHAPTER ONE
INTRODUCTION
1.1 Background to the Study
Women’s Reproductive health needs are very important to the health of the family as women have important roles to play in their families. They need to be healthy in order to function optimally. Thus, women’s health must be seen as a holistic concept that includes all biopsychosocial aspects of the women’s being (Pinn, 2008). A woman is healthy when she is free from organic disorders, diseases and deficiencies that interfere with sexual and reproductive functions (Baileff, 2000). Cervical cancer is a disease that is peculiar to women, and has adverse effect on their sexual and reproductive health as well as their general condition and family life. Family type may be monogamy, polygamy or polyandry. In each case, the researchers wish to identify the possible risk factors that can emanate from a woman whose husband has unprotected multiple sexual partners or a woman with many husbands as in polyandry family type. This seems to be capable of causing recurrent sexually transmitted diseases and other genital warts which may predisposes an individual to cervical cancer.
Parity implies various pregnancies and deliveries, abortion or even premature birth experienced by a woman in her life time, which are responsible for debilitating her immune system and increasing the chances of Human Papilloma Virus (HPV) which are the essential cause of cervical cancer (Adewole, 2008). These and other hazard factors are regular in low rural resource of a developing nation like Nigeria.
As indicated by Carr and Sellors (2004) the hazard factors for cervical cancer incorporate smoking, infection with HIV, absence of past screening and various partners. Issues identifying with women’s health were the focal point of the International Conference on Population and Development (ICPD) in 1994 which gave rise to the requirement for systems to improve reproductive health throughout the entire world (Mutyaba, Faxelid, Mirembe, & Weiderpass, 2007).
In Nigeria, cervical cancer is a main source of cancer mortality, and it is the second most frequent pandemic among women (Adewole, 2008). Every year roughly, 10,000 women create cervical cancer, and around 8,000 women die from cervical cancer in Nigeria. Ayinde, Omigbadun and Ilesanmi (2004) attest that cervical cancer is one of the commonest cancer affecting women in Nigeria while Ogundipe, and Obinna, (2008) report the frequency rate of cervical cancer as 25/1100000. Proof of decrease in the occurrence has been seen from nations like the United States where there are available screening protocols (Adewole, 2008). The issue of late documentation and reporting, ignorance and cultural issues identifying with cervical cancer screening are major issue affecting the disease control in Nigeria (Adewole, 2008).The present study was done in low resource rural setting of Delta State, Nigeria. The common rates are high in the low resource rural setting provincial setting of the nation dependent on the available statistics in the nation (Curado et al, 2007).
Cervical cancer adds to mortality among women particularly those in developing nations (Adewole, 2008). It is a preventable illness. Right now cervical screening is recognized to be the best way to deal with controlling this sort of cancer. As indicated by Carr and Sellors (2004) "Cervical cancer is one of the main sources of death for moderately aged women in the developing world", yet it is totally preventable, if precancerous lesions are identify and give adequate attention as early as possible (Baileff, 2000). There are different measures for reducing the danger of developing cervical cancer, which include changes in lifestyle, Human Papilloma Virus (HPV) inoculation and screening for precancerous changes. Changes in lifestyle like decreasing number of partners, maintaining a strategic distance from early initiation sexual intercourse will help to reduce the contact with the Human Papilloma Virus (HPV) which is the known causative operator for cervical cancer (Ogundipe and Obinna, 2008). Also, this prevents HIV which increases the risk for malignant changes if there is contact with the HPV. The new drive of vaccinating girls with Human Papilloma Virus vaccine is the latest measure for the prevention of cervical cancer in adults. Presently the vaccination is yet to take off fully and even if it takes off fully many female adults have missed the opportunity, thus screening for early changes still remains an important preventive measure. Literate respondents in this study are those who had completed and exposed to formal learning and teaching practices in school environment while Illiterate are those who were not exposed to any formal education.
Screening that is being carried out in Nigeria is not a planned programme. It is done using opportunist method for those who visit certain clinics thus, counselling is not carried out appropriately. A screening programme should be an integrated system for all women utilizing reproductive health facility with sufficient coverage and satisfactory access to services. Where the services are available, many women seem not to be aware of the services since they are mainly available in some secondary and tertiary health facilities and cost is also attached to the services, thus they are not accessible and affordable to many women.
1.2 Statement of the Problem
It was observed by the researcher that in spite of a decent number of health awareness, promotion, specialist's recommendation and advice and pleadings, a few women despite everything appear to dismiss the experimental evidence of threats of cervical cancer. The geographical location of women is by all accounts influencing their knowledge of cervical cancer screening for early detection. It appears that they despite everything overlook the event and the probability of cervical cancer prevalence among women. The women living in the remote areas appear not to have enough comprehension about cervical cancer screening centres and what they entail. Noteworthy number of women, however mindful of health dangers of cervical cancer, despite everything seems to disregard the preventive activities of cervical cancer screening (Mutyaba et al, 2007).
Failure of the early detection appears to have caused death on numerous occasions which is more than deaths from different diseases. From all signs, the burden of cervical cancer is rising however with the early detection through screening, the disease needs not guarantee such huge numbers of deaths once more (Ogundipe and Obinna, 2008). Religion of women appears not to permit them undergo the cervical cancer screening due to their beliefs. Some Nigerian women appear to introduce instances of cervical cancer at a phase of the disease at which next to zero treatment can be received.
The twenty nations mainly affected globally by cervical cancer are Africa nations led by Nigeria, follow by Ethiopia, Democratic Republic of Congo, South Africa, Tanzania Mozambique and Kenya. India, China, Indonesia and Brazil make up the top 5 with Nigeria as fifth globally (Africa Health, WHO/ICO, 2010). Women in developing nations appear to use reproductive health services more during pregnancy.
They likewise utilize reproductive health services for post-natal check-up and family planning or when confronted with different gynaecological issues. Along these lines, a significant number of women with intrusive cervical cancer are in the reproductive age group, pregnancy becomes a good avenue for screening, particularly for women who do not undergo gynaecologic assessment regularly. It is imperative to guarantee high coverage of cervical cancer screening within the target group as several investigations bolster the perception that the decrease in rate is increasingly obvious in nations with organised screening programs (Nygard, et al., 2006). Researchers had seen numerous instances of women of child bearing age that were diagnosed as having cervical cancer and have died from the condition in this study area. Statistics show that consistently 9922 women are diagnosed to have cervical cancer and 8030 die from the disease, about 24.8% of women in the rural area are assessed to habour cervical Human papilloma virus infection at a given time in a population (Adewole, 2008).
While it might be conceivable that a few studies may have addressed some related issues of cervical cancer and survival in different parts of the world, no research had carried out on cervical cancer in Igbudu, Okere and main markets in Warri South, Delta State. Based on the above background there is need for this study in Igbudu, Okere and main markets in Warri South, Delta State.
1.3 Objectives of the Study
The objective of this study is to examine knowledge, attitude and practice concerning cervical cancer screening among market women by using Igbudu, Okere and main markets in Warri South, Delta State as a case study.
i) To highlight the sources of getting information about cervical cancer screening among women of Igbudu, Okere and main markets in Warri South, Delta State
ii) To find out the factors influencing women in subjecting themselves to cervical cancer screening
iii) To understand how often the women conduct self and routine examination and cervical cancer screening examination
1.4 Research Questions
The following research questions were generated to guide the study
i) What are the sources of getting information about cervical cancer screening among women of Igbudu, Okere and main markets in Warri South, Delta State?
ii) What are the factors influencing women in subjecting themselves to cervical cancer screening?
iii) How often do the women conduct self and routine examination and cervical cancer screening examination?
1.5 Research Hypotheses
The following research hypotheses were formulated to guide the study and were tested at 0.05 level of significance.
i) There is no significant difference in family type of the respondents and their knowledge of cervical cancer screening
ii) There is no significant difference in the influence of knowledge of cervical cancer screening on parity
iii) There is a significant relationship between educational status and the knowledge of cervical screening among the respondents
1.6 Significance of the Study
The findings from the study could be used in providing structured modules that will be used in various hospitals for improving awareness of cervical cancer among women. The availability of the modules will make cervical cancer information easier.
The literate women can read and acquire the information on their own while the illiterate ones can be assisted by their husbands or children in acquiring the information. Also written information can reach more people. The module could enable the health workers to give appropriate information to the women who come to receive care from them.
The findings from the study could create awareness to women about the need to get vaccinated themselves and their female children early enough. This study could determine various factors that influence cervical cancer screening.
Awareness of the factors will help in removing barriers to screening services. It will also provide information on the areas of difficulties encountered by women. It will help to enhance ways of providing antenatal information to women.
1.7 Scope of the Study
The study was restricted to women using maternal health services in selected health facilities in Igbudu, Okere and main markets in Warri South, Delta State. The population for the study was rural resource setting of Delta State.
