Annals of Tropical Medicine and Public Health
Home About us Ahead Of Print Instructions Submission Subscribe Advertise Contact e-Alerts Editorial Board Login 
Users Online:1836
  Print this page  Email this page Small font sizeDefault font sizeIncrease font size
 


 
Table of Contents   
ORIGINAL ARTICLE  
Year : 2013  |  Volume : 6  |  Issue : 4  |  Page : 418-421
Prevalence of cervical intraepithelial neoplasia in relation to knowledge, attitudes/beliefs, and practices among university students in North-Eastern Nigeria


1 Department of Medical Laboratory Science, University of Jos, Jos, Nigeria
2 Department of Medical Laboratory Science, University of Maiduguri, Maiduguri, Nigeria
3 Meena Histopathology and Cytology Laboratory, Jos, Nigeria

Click here for correspondence address and email

Date of Web Publication26-Feb-2014
 

   Abstract 

Background: The involvement of communities in control of cervical cancer cannot be overemphasized, but this must take cognizance of their current knowledge, attitudes/beliefs, and practices (KABP) of the people if it will be sustainable. This study assessed the prevalence of cervical intraepithelial neoplasia (CIN) among university students and their level of KABP concerning cervical screening in Maiduguri North-Eastern, Nigeria. Materials and Methods: Two hundred and fifty-two subjects (age range: 18-69 years) were screened using pap smear screening method and acetowhite method. A structured questionnaire was administered on each subject to elicit information on KABP that could predispose them to the disease. Results: CIN was recorded in 12.8% of subjects with low-grade squamous intraepithelial lesion in 10.8% and high-grade squamous intraepithelial lesion 2.0% of the women, respectively. The average general level of knowledge of various aspect of was 43.3% average positive attitudes/beliefs about the disease was recorded in 17.1% of subject, while positive practices that could lead to prevention of the disease was obtained in 30.0%. Conclusion: The level of knowledge of the disease and screening is very low and together with high levels of negative attitudes and practices, will adversely affect control measures and therefore have to be addressed.

Keywords: Cervical cancer, knowledge, attitudes/beliefs, practices

How to cite this article:
Adisa JO, Tukur SB, Bukar M, Egbujo EC. Prevalence of cervical intraepithelial neoplasia in relation to knowledge, attitudes/beliefs, and practices among university students in North-Eastern Nigeria. Ann Trop Med Public Health 2013;6:418-21

How to cite this URL:
Adisa JO, Tukur SB, Bukar M, Egbujo EC. Prevalence of cervical intraepithelial neoplasia in relation to knowledge, attitudes/beliefs, and practices among university students in North-Eastern Nigeria. Ann Trop Med Public Health [serial online] 2013 [cited 2020 Sep 23];6:418-21. Available from: http://www.atmph.org/text.asp?2013/6/4/418/127780

   Introduction Top


Cervical cancer is the second most common cancer in women, with an estimated 500,000 new cases and 231,000 deaths annually worldwide. [1] In most countries with an established national screening program, the incidence of invasive cervical cancer has decreased, [2] but increasing numbers of preinvasive cervical intraepithelial neoplasias (CINs) have been registered in UK [3] and the USA, [4] particularly in young women. It is unlikely that this increase in the number of abnormal cervical smear results can be accounted for either by the increase in number of women participating in the screening program [5] or by changes in diagnostic procedures or terminology. [6]

Cervical cancer is yet to be recognized as an important public health problem in sub-Saharan Africa. Several studies have shown poor knowledge and awareness of the disease in Africa, which even cuts across different literacy levels. [7],[8] Among 500 attendees of a maternal and child health clinic in Lagos, Nigeria only 4.3% were found to be aware of cervical cancer. [9] Similar studies in Kenya and Tanzania also reported very poor knowledge of the disease in patients. [10] Poor knowledge is not limited to patients alone; however; health care workers who are supposed to be better informed do not have knowledge of the disease either. In Lagos, delay by primary health care providers in referring cases of cervical cancer was found to be an important cause of women presenting with late-stage disease. It took a mean of 9.35±12.9 months for primary health care providers to diagnose and refer women with cervical cancer to a tertiary hospital for management. [11]

The study of CIN in Maiduguri, Nigeria showed an overall prevalence rate of 104 per thousand (10.4%), with CIN I, II, and III accounting for 56.9%, 33.4%, and 9.7%, respectively, while carcinoma in situ was found in five women. Cancer of the cervix accounts for 70.5% of the female genital tract in North-Eastern Nigeria. [12] This high incidence could be attributed to early marriage and high number of live birth by women in the region. This study, therefore, seeks to find out the relationship between the prevalence of CIN and knowledge, attitudes/beliefs, and practices (KABP) in North-Eastern Nigeria.


   Materials and Methods Top


Two hundred and fifty-two female students aged between 18 and 69 years comprising one hundred and fifty-three married and ninety-nine unmarried but sexually active subjects from Maiduguri, Nigeria; were recruited for this study. A questionnaire to determine their KABP as regards CIN was designed and administered to the subjects. This was then followed by visual inspection of the cervix with 5% acetic acid and collection of  Pap smear More Details with Ayre's spatula and cytobrush. The smeared slides were then fixed in 95% ethanol and stained by Papanicolaou's method. Each slide was examined carefully for nonspecific, premalignant, and malignant changes.


   Results Top


The cervical smear collected from 252 female students of University of Maiduguri revealed nonspecific inflammatory changes in 176 subjects representing 69.8% [Table 1]; low-grade squamous intraepithelial lesion in 27 subjects representing 10.7% and high-grade squamous intraepithelial lesion in five subjects representing 2% [Table 2]. Peak age for specific squamous intraepithelial lesion prevalence rate of 40.6% was recorded in 20-29 years age group; while the lowest age-specific prevalence rate of 3.1% was recorded in 50-59 years age group.
Table 1: Distribution of benign changes/neoplastic changes in the various age groups

Click here to view
Table 2: Distribution of subjects according to knowledge of CIN

Click here to view


Results from the questionnaire revealed that only 64 subject representing 25.4% claimed knowledge of the cause of CIN, while 188 subjects (74.6%) claimed not to have knowledge of the cause of the disease. The questionnaire further revealed that 24.2% and 80.2% of the women had correct knowledge of the symptoms and treatment respectively as against 75.8% and 9.8% who are not knowledgeable [Table 2].

The study on attitude and belief revealed that 133 (44.8%) had positive attitude on early marriage and 139 (55.2%) had negative attitude on early marriage. A greater number of the women 241 (95.6%) and 247 (98.0) had negative attitude toward participation in organized cervical screening and sex of health personnel collecting the smear respectively as against 11 (4.4%) and 5 (2.0%) with positive attitudes [Table 3].
Table 3: Distribution of subjects according to attitudes/ beliefs that relates to CIN

Click here to view


On practices that may predispose them to CIN 120 (47.6%), 214 (84.9%), and 174 (69.0%) had negative attitude about age at first sexual exposure, number of sexual partners, and practice toward number of children, respectively, while 132 (52.4%), 38 (15.1%), and 78 (31.0%) had positive attitude respectively about the practice. In contrast, 75 (29.8%) of the female students are from polygamous families which is a positive practice that promote development of CIN [Table 4].
Table 4: Distribution of subjects according to practices that predisposes them to CIN

Click here to view


Comparing the results of aceto-white and pap smear diagnosis revealed that 9 (3.6%) out of the study population were positive for acetowhite and pap smear. While 188 (71.2%) were negative for acetowhite and positive for nonspecific inflammatory changes and 44 (16.7%) were negative for acetowhite and negative for pap smear [Table 5].
Table 5: Results of acetowhite and pap smear diagnosis

Click here to view



   Discussion Top


The objective of this study was to find out the level of KABP regarding CIN among female students of University of Maiduguri through the use of systematic sampling and questionnaires administered to 252 students. The general knowledge on the cause and symptoms of CIN was 64 (25.4%) and 61 (24.2%), which explains why the prevalence of CIN is up to 12.8% in the study area. The level of knowledge is comparable to that of Maiduguri, Borno state, where only (44.8%) of the women who responded to similar questionnaire had adequate knowledge of CIN. [13] Among 500 attendees of a maternal and child health clinic in Lagos, Nigeria only 4.3% were found to be aware of cervical cancer. In 2004, also in Lagos, 81.7% of 139 patients with advanced cervical cancer had never heard of cervical cancer before. [9] This result highlights the need for better public education on the cause, symptoms, and treatment of CIN/cervical cancer as an important component of control of the disease. The level of ignorance of the people apparently sustains the current prevalence level of this condition. The 44.8% of the subjects accepting early marriage is abnormal. This is worrisome because it is a major predisposing factor to CIN and other social problems. The response of the subjects to participation in organized cervical screening was quite negative [Table 3] and so was the issue of the sex of health personnel collecting the smear in the same table. This is expected since these have to do with their privacy and the sociocultural and religious factors that are prevalent in the area. Purdah is the way of life and that means that a woman is to be kept away from the view of other men as much as possible, so a healthcare facility that would respond appropriately to reproductive health needs of the women must take these factors into consideration.

A practice that may likely predispose to CIN from this study is age at first sexual exposure and age at which women get married. This is because those who have sex at an early age with more than one partner or have been married to more than one husband have increased risk of exposure to human papillomavirus (HPV) infection. In this culture, very young girls, usually virgins are given out in marriage to much older men, some with several more wives already. [14] This may increase the likelihood of such girls being infected with HPV at intercourse. Polygamy is reported to increase the risk of cervical cancer by twofolds and the risk increases with increasing number of wives. Also from [Table 4], (31.0%) of subjects would like to have as many children as possible. This practice also promotes development of CIN.

 
   References Top

1.World Health Organization. Available from: http://www.who.int/en/. [Last accessed on 2003 Aug 7].  Back to cited text no. 1
    
2.Gustafsson L, Ponten J, Zack M, Adami HO. International incidence of invasive cervical cancer after introduction of cytological screening. Cancer Causes Control 1997;8:755-63.  Back to cited text no. 2
    
3.Macgregor JE, Campbell MK, Mann EM, Swanson KY. Screening for cervical intraepithelial neoplasia in north east Scotland shows fall in incidence and mortality from invasive cancer with concomitant rise in pre-invasive disease. BMJ 1994;308:1407-11.  Back to cited text no. 3
    
4.Mangan SA, Legano LA, Rosen CM, McHugh MT, Fierman AH, Dreyer BP, et al. Increased prevalence of abnormal Papanicolaou smears in urban adolescents. Arch Pediatr Adolesc Med 1997;151:481-4.  Back to cited text no. 4
    
5.Herbert A. Is cervical screening working? A cytopathologist′s view from the United Kingdom. Hum Pathol 1997;28:120-6.  Back to cited text no. 5
    
6.Noller KL. Incident and demographic trends in cervical neoplasia of from the United Kingdom. Hum Pathol 1996;28:120-6.  Back to cited text no. 6
    
7.Walker AR, Michelow PM, Walker BF. Cervix cancer in African women in Durban, South Africa. Int J Gynaecol Obstet 2002;79:45-6.  Back to cited text no. 7
    
8.Wellensiek N, Moodley M, Moodley J, Nkwanyana N. Knowledge of cervical cancer screening and use of cervical screening facilities among women from various socioeconomic backgrounds in Durban, Kwazulu Natal, South Africa. Int J Gynecol Cancer 2002;12:376-82.  Back to cited text no. 8
    
9.Anorlu RI, Banjo AA, Odoemhum C. Cervical cancer screening: Level of awareness in women attending a primary health care facility in Lagos. Niger Postgrad Med J 2000;70:25-8.  Back to cited text no. 9
    
10.Gichangi P, Estamble B, Bwayo J, Rogo K, Ojwang S, Opiyo A, et al. Knowledge and practice about cervical cancer and Pap smear testing among patients at Kenyatta National Hospital, Nairobi, Kenya. Int J Gynecol Cancer 2003;13:827-33.  Back to cited text no. 10
    
11.Anorlu RI, Orakwue CO, Oyeneyin L, Abudu OO. Late presentation of cervical cancer in Lagos: What is responsible? Eur J Gynaecol Oncol 2004;25:729-32.  Back to cited text no. 11
    
12.Kyari O, Nggada H, Mairiga A. Malignant tumours of female genital tract in North Eastern Nigeria. East Afr Med J 2004;81:142-5.  Back to cited text no. 12
    
13.Bukar M. Cervical intraepithelial neoplasia in Maiduguri. A study of prevalence knowledge attitude beliefs and practices that affects it. Undergraduate 2004.  Back to cited text no. 13
    
14.Bayo S, Bosch FX, de Sanjose S, Muñoz N, Combita AL, Coursaget P, et al. Risk factors of invasive cervical cancer in Mali. Int J Epidemiol 2000;31:202-09.  Back to cited text no. 14
    

Top
Correspondence Address:
James O Adisa
Department of Medical Laboratory Science, University of Jos, P. M. B. 2084, Jos
Nigeria
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1755-6783.127780

Rights and Permissions



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

Top
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Email Alert *
    Add to My List *


    Abstract
   Introduction
    Materials and Me...
   Results
   Discussion
    References
    Article Tables

 Article Access Statistics
    Viewed2393    
    Printed60    
    Emailed1    
    PDF Downloaded20    
    Comments [Add]    

Recommend this journal