Assessment of Cervical Cancer Services and Cervical Cancer Related Knowledge of Health Service Providers in Public Health Facilities in Addis Ababa

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Addis Abeba Universty


Background: Human papiloma virus (HPV), which is mostly acquired by sexual intercourse, is a necessary cause of cervical cancer. Every year more than over quarter of a million women die from cervical cancer and because of poor access to screening and treatment services, large majority of these deaths occur in women living in low- and middle-income countries. In Ethiopia, cervical cancer ranks as the most frequent cancer among women and every year nearly three and half thousands women die with cervical cancer.Majorty of the women had poor knowledge about cervical cancer and cervical cancer screening practice. Objective: To assess cervical cancer services and cervical cancer related knowledge of health service providers in public health facilities in Addis Ababa. Method: A facility-based cross sectional study accompanied by observational assessment was conducted from September 2013-September 2014 in public health facilities in Addis Ababa. A pre-tested, structured and semi-structured questionnaire and a checklist were used to collect data. The data was collected from 5 randomly selected health centers and 3 purposively selected hospitals. A total of 309 health service providers were included in the assessment of their knowledge related to cervical cancer. Data was analyzed using SPSS version 21. The chi-square test was used to look for an association between cervical cancer knowledge and socio-demographic variables. Result: Two of the three hospitals included in the study had cervical cancer screening services Visual inspection with acetic acid (VIA), and precancerous treatment cryotherapy and Loop electrosurgical excision procedure (LEEP).One third of the hospital had cervical cancer diagnosis service punch biopsy and cancer treatment. All the hospitals had trained health professionals and basic facilities, materials, and equipments for the available cervical cancer services. Of all the respondents who consider cervical cancer had biological cause, 192 (62.2%) said virus and 79 (25.6 %) said bacteria. Regarding mode of transmission, they said that it could be transmitted through sexual intercourse 274 (88.7%) and blood contact 45(21%). Majority, 289 (93.5. %) of the respondents said cervical cancer was a preventable disease. Out of those who considered cervical cancer preventable by vaccination, only 121(39.2%) identified correctly the recommended age for HPV vaccine. Having multiple sexual partners 257 (83.2%) and post coital bleeding 251(81.2%), were the most mentioned risk factor and clinical manifestation of cervical cancer respectively. Majority of the respondents were aware of the correct time to start screening viii | P a g e 291(70.5%) and only small percents 95(25.9%) knew screening intervals. Knowledge about cervical cancer was higher in general practitioner and above (X2 = 20.93, P=0.000) and health officers and degree nurses (X2 = 5.90, P=0.015) than diploma nurses. Female had better knowledge about cervical cancer than male (X2 = 8.4, P=0.003). But overall, 165 (53.4%) of health providers scored below the mean knowledge level score about cervical cancer. All the facilities had internal and external referral slips for communicating of referred patients and also kept their records. Absence of trained man power and necessary facilities were the major reasons for referral Conclusion and Recommendation: All the hospitals had trained health providers and screening, diagnosis and treatment infrastructures for the available cervical cancer services but the services were not available at one point. Majority of health professionals in service providing facilities knew the biological cause, mode of transmission, risk factors, clinical presentations, screening methods and time to start and prevention methods of cervical cancer. But most did not know HPV vaccine, the recommended age group and the recommended number of doses and over all time taken, screening intervals and the precancerous treatment methods. The government should expand the full cervical cancer services to be available at least in these hospitals (at one point).Training should be considered for health providers who had no previous training to gain more knowledge about this area.



Assessment of Cervical Cancer Services