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      Utilization of cervical cancer screening and associated factors among women in Debremarkos town, Amhara region, Northwest Ethiopia: Community based cross-sectional study

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          Abstract

          Introduction

          Cervical cancer is the most common type of malignancy among all malignancies for women worldwide with 266 000 deaths every year. Even though there is a proven importance of cervical cancer screening, the death of women due to cervical cancer in Ethiopia is high. We, therefore, did this study to investigate the utilization of cancer screening and its associated factors among women in Debremarkos town, Amhara region, Ethiopia.

          Methods

          A community-based cross-sectional study was conducted among women from 30–49 years in Debremarkos town, from July 1 to August 30, 2018. A multistage sampling procedure was used to select 822 women in the study. We used EPI info version 7 for data entry and SPSS version 24 software for cleaning and analysis. Bivariable and multivariable logistic regression analyses were performed to identify factors associated with the utilization of cervical cancer screening. Variables with a p-value of less than 0.05 were taken as significant variables.

          Result

          The study revealed that 44 (5.4%) of women have been screened for cervical cancer. Women’s age [AOR:3.126(1.246,7.845)], marital status (AOR:3.41(1.299,8.972)], educational status(secondary education level [AOR: 4.578(95% CI: 1.19, 17.65)] and College and above education level [AOR:7.27,95%CI: 2.07,25.513)]), started sexual intercourse for the first time below 16 years[AOR:3.021(1.84,4.97)], history of multiple sexual partners [AOR:2.51(1.040, 6.06)], history of sexually transmitted disease [AOR:4.04(1.68, 9.72),], knowledge on cervical cancer screening [AOR:4.02(2.07,7.77)] and attitude towards cervical cancer screening [AOR:3.23(2.52,4.12)] were significant factors for utilization of cervical cancer screening

          Conclusion

          This study showed the magnitude of the utilization of cervical cancer screening is very low. Women’s age, marital status, educational status, age at first sex history of multiple sexual partners and sexually transmitted disease, knowledge and attitude were important factors of screening. Therefore, intervention programs that are aimed at improving cervical cancer screening practice among women should focus on the identified factors.

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          Cervical cancer screening in developing countries at a crossroad: Emerging technologies and policy choices.

          Cervical cancer (CC) represents the fourth most common malignancy affecting women all over the world and is the second most common in developing areas. In these areas, the burden from disease remains important because of the difficulty in implementing cytology-based screening programmes. The main obstacles inherent to these countries are poverty and a lack of healthcare infrastructures and trained practitioners. With the availability of new technologies, researchers have attempted to find new strategies that are adapted to low- and middle-income countries (LMIC) to promote early diagnosis of cervical pathology. Current evidence suggests that human papillomavirus (HPV) testing is more effective than cytology for CC screening. Therefore, highly sensitive tests have now been developed for primary screening. Rapid molecular methods for detecting HPV DNA have only recently been commercially available. This constitutes a milestone in CC screening in low-resource settings because it may help overcome the great majority of obstacles inherent to previous screening programmes. Despite several advantages, HPV-based screening has a low positive predictive value for CC, so that HPV-positive women need to be triaged with further testing to determine optimal management. Visual inspection tests, cytology and novel biomarkers are some options. In this review, we provide an overview of current and emerging screening approaches for CC. In particular, we discuss the challenge of implementing an efficient cervical screening adapted to LMIC and the opportunity to introduce primary HPV-based screening with the availability of point-of-care (POC) HPV testing. The most adapted screening strategy to LMIC is still a work in progress, but we have reasons to believe that POC HPV testing makes part of the future strategies in association with a triage test that still needs to be defined.
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            Demographic, knowledge, attitudinal, and accessibility factors associated with uptake of cervical cancer screening among women in a rural district of Tanzania: Three public policy implications

            Background Cervical cancer is an important public health problem worldwide, which comprises approximately 12% of all cancers in women. In Tanzania, the estimated incidence rate is 30 to 40 per 100,000 women, indicating a high disease burden. Cervical cancer screening is acknowledged as currently the most effective approach for cervical cancer control, and it is associated with reduced incidence and mortality from the disease. The aim of the study was to identify the most important factors related to the uptake of cervical cancer screening among women in a rural district of Tanzania. Methods A cross sectional study was conducted with a sample of 354 women aged 18 to 69 years residing in Moshi Rural District. A multistage sampling technique was used to randomly select eligible women. A one-hour interview was conducted with each woman in her home. The 17 questions were modified from similar questions used in previous research. Results Less than one quarter (22.6%) of the participants had obtained cervical cancer screening. The following characteristics, when examined separately in relation to the uptake of cervical cancer screening service, were significant: husband approval of cervical cancer screening, women's level of education, women's knowledge of cervical cancer and its prevention, women's concerns about embarrassment and pain of screening, women's preference for the sex of health provider, and women's awareness of and distance to cervical cancer screening services. When examined simultaneously in a logistic regression, we found that only knowledge of cervical cancer and its prevention (OR = 8.90, 95%CI = 2.14-16.03) and distance to the facility which provides cervical cancer screening (OR = 3.98, 95%CI = 0.18-5.10) were significantly associated with screening uptake. Conclusions Based on the study findings, three recommendations are made. First, information about cervical cancer must be presented to women. Second, public education of the disease must include specific information on how to prevent it as well as screening services available. Third, it is important to provide cervical cancer screening services within 5 km of where women reside.
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              Knowledge, attitude and practice for cervical cancer prevention and control among women of childbearing age in Hossana Town, Hadiya zone, Southern Ethiopia: Community-based cross-sectional study

              Background Cervical cancer is the second most common female cancer which Ethiopia put a strategic goal to reduce its incidence and mortality by 2020. Lack of knowledge and poor attitude towards the disease and risk factors can affect screening practice and development of preventive behavior for cervical cancer. The aim of this study was to assess knowledge, attitude, practices and factors for each domain for cervical cancer among women of child bearing age in Hossana town, Southern, Ethiopia. Methods Community based cross sectional study was carried out in June 2015. A total of 583 participants were selected using systematic random sampling technique. Pretested structured interviewer administered questionnaire was used to gather the data. Data were entered in to Epi Info software version 3.5.4 and exported to SPSS version 16 for descriptive and logistic regression analysis. Results Two hundred seventy (46.3%) of the respondents had poor comprehensive knowledge. Only 58 (9.9%) of participants had been screed for the cervical cancer before the survey. Two hundred three (34.8%) of participants had negative attitude towards selected proxy variables. Not having health seeking behavior for cervical cancer [AOR: 5.45, 95% CI: (1.18, 30.58), P <0.031], had not ever received information about cervical cancer and its prevention [AOR: 2.63, 95%CI: (1.78,8.84), P < 0.018] and not actively seeking health information about cervical cancer [AOR: 6.25, (95%CI: (1.26, 31.06) P < 0.025] were significantly associated factors with poor knowledge. Poor knowledge score was associated with poor attitude [AOR: 56.51, 95%CI: (23.76, 134.37), P <0.001]. Had not ever received information about the disease from any source [AOR: 45.24, (95%CI: (11.47, 178.54), P <0.001] was significantly associated factor with not to be screened for the disease. Conclusion This study highlighted the importance of awareness creation, increasing knowledge, promoting active searching for health information and experiences of receiving information from any information sources regarding cervical cancer. Therefore, it will be essential to integrate cervical cancer prevention strategies with other reproductive health services at all level of health care delivery system.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: MethodologyRole: Writing – original draft
                Role: MethodologyRole: SupervisionRole: Writing – review & editing
                Role: Formal analysisRole: SupervisionRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                7 April 2020
                2020
                : 15
                : 4
                : e0231307
                Affiliations
                [1 ] Department of Midwifery, Debremarkos University, Debremarkos, Ethiopia
                [2 ] Department of Midwifery, University of Gondar, Gondar, Ethiopia
                Ordu University, TURKEY
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0003-2847-4841
                Article
                PONE-D-19-16524
                10.1371/journal.pone.0231307
                7138328
                32255807
                0a9a5727-00b1-428b-81ec-fc52c3c3a1ca
                © 2020 Aynalem et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 11 June 2019
                : 20 March 2020
                Page count
                Figures: 0, Tables: 6, Pages: 13
                Funding
                The author(s) received no specific funding for this work.
                Categories
                Research Article
                Medicine and Health Sciences
                Oncology
                Cancers and Neoplasms
                Gynecological Tumors
                Cervical Cancer
                Medicine and Health Sciences
                Diagnostic Medicine
                Cancer Detection and Diagnosis
                Cancer Screening
                Medicine and Health Sciences
                Oncology
                Cancer Detection and Diagnosis
                Cancer Screening
                Medicine and Health Sciences
                Infectious Diseases
                Sexually Transmitted Diseases
                Biology and Life Sciences
                Physiology
                Reproductive Physiology
                Copulation
                Medicine and Health Sciences
                Physiology
                Reproductive Physiology
                Copulation
                People and Places
                Geographical Locations
                Africa
                Ethiopia
                People and Places
                Population Groupings
                Ethnicities
                Amhara People
                Medicine and Health Sciences
                Public and Occupational Health
                Health Screening
                Medicine and Health Sciences
                Women's Health
                Custom metadata
                All relevant data are within the paper and its Supporting Information files.

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