CERVICAL CANCER SCREENING
Kirsten A et al.,2019 showed that out of pocket was a very common reason for not being screened for cervical cancer with (20%;11 of 54 women) and not repeating screening with repeated frequency(Austad et al., 2018). There is an association between cost and the uptake of cervical cancer screening services. A study proved this carried out in Nigeria by TK N et al., 2019 which showed that with an introduction of a fee the utilization of cervical cancer services dropped in the number of patients presenting with a total of 81(48.5%) compared to 86(51.5%) when the fee was introduced (Nyengidiki et al., 2019)
In a study on predictors of cervical cancer screening among Kenyan women, it was evident that there was the difference in the uptake of cervical cancer screening services between women of high-income quintile (25.2%) and those of low-income quintile with (3.6%) (Ng’ ‘ and” an et al., 2018).
2.3.8 Uptake of cervical cancer screening services and knowledge, AttitudeAttitude and perceptions
Knowledge of cervical cancer screening
Bansal et al., (2015) reported that (65%) of the respondents proved to know the clinical presentation of cervical cancer at 64%, about 39% were conversant with risk factors towards cervical cancer and 34.5% representing a third of the study population had heard about cervical cancer screening (Bansal et al., 2015). Ramathuba et al. 2016 report that most of the respondents 62.0% of 958 shows that they had never heard about cervical cancer compared to 38.0% of 588 who had heard about cervical cancer (Ramathuba et al., 2016).
A study was done in Uganda on knowledge, facilitators and barriers to cervical cancer screening among women explored on women’s knowledge and awareness regarding causes, signs, and symptoms, risk factors and screening methods for cervical cancer showed that almost all the participants had heard about cervical cancer from radios and health workers at health facilities and a few from traditional practitioners though the study also revealed that there was poor knowledge about cervical cancer where the respondents reported that it resulted from the use of contraceptives, foods they ate and its preparation, having fewer children, continued use of sanitary towels, abortions, sharing hygiene facilities like bathrooms and improper personal hygiene. On signs and symptoms of cervical cancer, few respondents were conversantly indicating that there is vaginal bleeding, backache, and abdominal pain, the respondents were knowledgeable about the risk factors reporting having many sexual partners, infections like gonorrhea and HIV positive. The participants on knowledge on screening methods were poor, noting that they had never heard of any method justifying that they had never had cervical cancer hence no screening done(Ndejjo, Mukama, Kiguli, & Musoke, 2017).
In Kenya, Elkanah O et al., 2016 showed that on common knowledge of cervical cancer example in the signs and symptoms that a higher proportion of the respondents did not know whether bleeding immediately after sex was not a sign of cervical cancer had higher chances of accepting cervical cancer screening 271(12%) versus 21(8%) (Morema et al., 2014b).
ATTITUDE ON CERVICAL CANCER SCREENING
In a study carried out in China on assessing knowledge and attitudes on cervical cancer screening among rural women, it was reported that 96.0% of women had positive AttitudeAttitude towards cervical cancer screening though on the other hand, only 67.3% of the participants had previously gone for cervical cancer screening services. (Liu et al., 2017)
The researcher did not go deeper to get insight into the participant’s participant’s attitudes towards cervical cancer screening services because his AttitudeAttitude was based on whether they were interested in screening for cervical cancer or not. If yes, they have positive AttitudeAttitude and. If they have negative Attitude but for one to gauge people’speople’s attitudes, one has to have in-depth discussion with the participants.
In another study on determinants of cervical cancer screening uptake among women in Ilorin,North Central Nigeria,45.5% of the respodents had ever been screened for cervical cancer which reflected a positive attitude towards screening in relation to those who had not a negative attitude of 12%(Idowu et al., 2016).According to the researcher ,if the respondents were willing to attend cervical cancer screening exercise were termed as having posisitiive AttitudeAttitude and vice versa.Again this is not the true Picture of AttitudeAttitude and again they did not go further to establish why the women did not want to be screened.
A study carried out in Northern Ethiopia (2015) reflected on perception that the majority of the respondents agreed on the importance of screening of cervical precancerous 1151(97.0%) though only 235(19.8%) had been screened for cervical cancer for the last 3 years as much as 822(69.3%) felt that they were susceptible to cervical cancer. For the respondents who had not been screened for cervical cancer upon being asked why they responded that they felt they were healthy because they did not reflect any signs and symptoms .(Bayu et al., 2016)
Ali W et al(, 2017)showed that as much as cervical cancer screening process was not harmful, only 31.1% had been screened
the reason among others being because the y feared and others thought it was not important(9.7 %)(Waiswa et al., 2017)
A study carried out in Kenya on women’swomen’s knowledge and attitudes related to cervical cancer and cervical cancer screening services in Isiolo and Tharaka Nithi counties showed that nearly two thirds (61.4 %) of the participants had positive AttitudeAttitude towards cervical cancer screening and believed that health care workers performing the examinations are not rude to women(Gatumo et al., 2018) .The researcher used only quantitative research which cannot address fully the insight reflection of AttitudeAttitude on cervical cancer screening only questionnaires were used to collect data.
PERCEPTION AND UPTAKE OF CERVICAL CANCER SCREENING
In a study carried out on perceptions of cervical cancer screening, screening behavior and post migration living difficulties among Bhutanese in United States, it was evidenced that there was high rate of pap testing (53.3% in relation to 11.1 %) for those participants who had positive perception .(Kue et al., 2017)
According to Chinyere M et al,2017,the participant’sparticipant’s perception of screening for cervical cancer following peer health education training intervention with the benefit to screen increased significantly from 50.9% to 68.9% .The study further showed that
there was an increase of uptake of screening for cervical cancer from (Mbachu et al., 2017b)
In a study on knowledge and perception of women towards cervical cancer screening carried carried out in Meru county ,Kenya, deduced that perception of cervical cancer screening is a major hindrance to screening that fears(16.8%) to screening was probably the due to perception that if the respondent is tested positive after screening ,they would be stigmatized by the society.(Kandie et al., 2019)
THE EFFECT OF TRAINING ON COMMUNITY HEALTH VOLUNTEERS AND UPTAKE OF CERVICAL CANCER SCREENING AND MULTIPLE CANCERS
Siriwan S et al 2017 in a study on knowledge ,attitudes and practices regarding cervical cancer screening among village health volunteers in Nakornayok province in Thailand showed that the respondents had high knowledge on cervical cancer screening services of a mean score of 0.70 points ,where113( 88.3%) indicated that women who did not have children needed to be screened for cervical cancer(Srisuwan et al., 2015)
In a study carried out in Kadibo division, Kisumu county by Edwin O et al 2017,On knowledge on cervical cancer screening
services, the community health volunteers exhibited knowledge that ranged from as low as( 37.8%)to high 77(41.0%),it reflected that all 188(100%) of respondents had heard about cervical cancer that it affected women but 128(68.1%) had low knowledge of risk factors associated with cervical cancer. The results also indicated that 60(31.9%) had average knowledge and none having high knowledge (0%).About 95(50.5%) of the respondents had low knowledge on the signs and symptoms of cervical cancer, 15(8.0% ) had average knowledge and 78(41.5%) had high knowledge( Ochomo et al., 2017b)
The studies have only looked at training of community health volunteers on single cancer (cervical cancer) but not looked at the effect of training the community health volunteers on multiple cancers which is usually the area of interest in this study.
This study looks at the multiple cancers which includes the breast, cervical cancer esophageal cancers. From the study carried out by …it is evidenced that these are the first three leading cancers in women in Kiambu County.
In this study the researcher will address the gap on training of community health volunteeres where in a systematic review on the role of community health workers on screening for cervical cancer in low and middle income countries by James O et al 1978 and 2019 reported that that in many studies carried out during period poorly documented training with only four community health workers training was evaluated with pre training and post training of the fifteen reviewed articles and that the was also challenge in the support of community health workers(O’DonovanO’Donovan et al., 2019) This study will test the community health volunteers. Before and after capacity strengthening and will also facilitate the community health workers to motivate them to carry out the desired task with ease.
2.5 Uptake of cervical cancer screening services and intervention
A study on effects of peer health education on perception and practice of screening for cervical cancer among urban residential women in South –East Nigeria showed that the proportion of women who felt screening for cervical cancer would be highly beneficial increased from 145(50.9%) to (195(68.9%) after the intervention.(Mbachu et al., 2017a).The willingness to screen for cervical cancer was relatively high at base line (226(79.3%) but not much change was observed following the intervention 228(80.8%).The study goes further to reveal that the proportion of participants who screened for cervical cancer increased from 30(10.5%) before the intervention to 49(17.3) after the intervention. (Mbachu et al., 2017a).A study carried out in Jamaica reported that there was increase in willingness to screen from 72 % to 77%
after an educational program on awareness in North central Nigeria((Gana et al., 2016)