Cervical cancer is a malignant disease that affects the cervix with the attributed causes being the Human Papilloma Virus (HPV) and Herpes Simplex virus whose risk factors are associated with having increased sexual activity from multiple partners [1]. The disease is the easiest gynecologic cancer to prevent, with regular screening tests and follow up. Women below 25 years are at risk of developing cervical cancer. Early screening is essential as it aids in reducing cervical cancer incidences since it allows early diagnosis and treatment. Studies conducted in African countries such as Kenya, Botswana, and Nigeria have shown that women have limited knowledge towards screening of cervical cancer. This contributes to their non-participation in screening programs, and even though some get tested, they do not present themselves up for follow up care [2] [3].

Cervical cancer is the most prevalent type of neoplasm among women globally, and more so, the disease has been rampant in the developing countries with Kenya not being an exemption. Worldwide an estimated 529,828 cases of the disease are reported every year with 275,125 women succumbing to the ailment. According to surveillance and epidemiology, it has been determined that the average life years lost due to cancer of the cervix is approximately 25.3 years [4] [5]. Of the new occurring cases of cervical cancer each year, about 86 percent occur in the developing countries where 85 percent of the mortality occurs. Sub Saharan Africa is the region with the highest incidence of cervical in the world that is; 22 percent of all cases of cervical cancer (CV) with a concomitant high mortality rate from the disease that usually affects women during the prime years of their life’s [6]. According to Herweijer et al., this is attributable to the low screening uptake in the region for early detection of precancerous lesions and the onset of the HIV/AIDS epidemic that magnifies the issue [7].

The heavy burden of cervical cancer in the developing nations is as a result of the inadequate prevention approaches that hinder the early detection and subsequent treatment. Very few women from these countries hardly go for cervical cancer screening which is essential for the early detection of the condition [8]. If they ever go for screening it is because they have had issues with their reproductive system and it was recommended by the physician. In fact, most of the women in the developing countries do not have adequate knowledge about the disease. Thus, it becomes difficult to prevent and treat it [9]. The Cancer Research UK (2014) states that health outcomes from cervical cancer in these countries are poor due to late diagnosis and treatment. The burden of cervical cancer is increased by inadequate health literacy concerning the disease’s pathology, cost of screening, treatment challenges and barriers to seeking health care.

Kenya has a population of 12.92 million women aged 15 years, and above who are at risk of developing cervical cancer thus urgent preventive measures are paramount [9]. Currently, the estimated annual number of cervical cancer cases is 2454 while the annual number of deaths due to cervical cancer is 1676 in Kenya. It is projected that by the year 2025, the number of new cervical cancer cases annually in Kenya will reach 4261. More so about 39.6 percent of the women in the general population are estimated to harbor the Human Papilloma Virus at a given time that causes the disease [9].

Screening methods available in Kenya that are part of the Ministry of Health (MOH) national cervical cancer prevention strategic plan include the use of Pap smear, visual inspection with acetic acid (VIA) and visual inspection with Lugol's iodine (VILI). Despite the call from the government to adopt these strategies in the fight against cervical cancer, their uptake is very low. Cervical cancer screening coverage in Kenya is currently at 3.2 percent which is very low [9]. This further complicates the situation at hand. Factors that have been associated with the low uptake include lack of awareness, lack of funds, women’s worry about the examination discomfort, fear of being diagnosed with cancer and the inability to establish effective follow-up treatment [10].

Objectives of the Study

Broad Objective

To determine the factors affecting cervical cancer screening among women aged below 25 years in Kithare area Tharaka Nithi County

Specific Objectives

1) To assess the level of knowledge on cervical cancer screening among women aged 25 years and below in Kithare area

2) To determine the individual perspectives and attitude about cervical cancer screening

3) To identify the barriers to cervical cancer screening among women aged 25 years and below in Kithare area

Women have a poor perception and limited knowledge about the need and importance of cervical cancer screening leading to reduced uptake of screening services. Some believe that an abnormal screening result means that the woman already has cancer. Thus, due to the limited knowledge, they opt not to get tested [11]. More so, in most of the communities in the developing countries, women are bound by the cultural norms of secrecy not to discuss reproductive health issues with their families as well as healthcare practitioners hindering the women from gaining knowledge on the importance of cancer screening [12].

According to Alfaro et al., having the correct knowledge on the importance of cervical cancer screening is a key determinant for a woman to seek screening services. To increase the screening rate, more efficient educative strategies need to be employed [4]. The use of health educators may be useful in recruiting and scheduling HPV screening appointments. Rasul, Cheraghi, & Moghdam in a study done to assess the influencing factors on cervical cancer screening among the Kurdish women, beliefs and knowledge on cervical cancer and screening played a significant role in the women’s decision making to get screened. Women were more likely to get screened if there were prevailing beliefs about the risk of getting cervical cancer and if they presented with the symptoms [13].

Despite the fact that cervical cancer has a very high mortality rate in the developing countries only a few women will go for screening due to their negative attitude towards the service. Beliefs and perceptions influence the decision on cervical cancer screening [13]. Understanding the factors associated with the women’s attitude of cervical cancer could guide future educational planning and clinical interventions to improve cervical cancer screening as this will help in influencing the women positively and increase the uptake rate of screening [14].

A number of women associate cancer with lots of treatment and the final outcome being death. Others view cancer as a death sentence without a cure and therefore; women will evade the cervical cancer test to avoid a positive result. Women who have had at least one cervical cancer test are less likely to express fear and anxiety compared to those who are new. Since the conflicts mentioned above exert a significant effect on the women’s tendency to participate in cervical cancer screening, providing precise information about cervical cancer testing is crucial in increasing the willingness of getting tested [15].

Other influences to cervical cancer screening include the social, cultural factors regarding the beliefs and traditions, the perception of testing and religion. Some cultures believe that screening is evil and unclean; therefore, women from these communities will hardly consider going for cervical screening. Some husbands also have a negative attitude towards the practice of cervical screening because they do not want their women and wives to be examined on their reproductive parts. Some tell and assume that their wives go to have some private affairs with other men and consider the practice unclean. Because of the fear of being chased away from their marriages and homes women married from such men do not find cervical cancer screening necessary [9].

Economic constraints are also a factor that influences cervical cancer screening. The woman has to pay for the services offered by the healthcare provider and for those lacking the funds; they will end up missing the screening opportunity. This is one of the contributing reasons why quite a number of women in the developing countries do not go for the screening or for follow up care. For those already diagnosed with cervical cancer treatment is expensive for them to afford and most of the times they end up missing it and will succumb to the disease at the long run [16]. Therefore, it is essential for the government and private organizations to provide help programs to such individuals in an effort of promoting cervical cancer screening and reducing the mortality rate of the disease.

Kithare Sub-location is in Chogoria ward or location which has a population of approximately 32,000 residents. The sub-location is in Mwimbi Division, Maara Sub-County in Tharaka Nithi County, Kenya. The population of Kithare sub-location is 3685 residents with more than half of these being women of the reproductive age.

Research Design

This is a descriptive cross sectional study aimed at determining the factors affecting cervical cancer screening among women aged below 25 years in Kithare area Tharaka Nithi County conducted between August and September 2018.

Study Population and Selection Criteria

The study population comprised of women of the reproductive age, 15 - 25 years who were residents of Kithare sub-location located in Maara Sub County, Tharaka Nithi County. Why women aged 15 to 25 years because they are sexually active and very prone to get the disease. Only those women who gave a free voluntary informed consent to take part in the study were involved with the sample size being 80 respondents.

Sampling Procedures and Sample Size

Convenience sampling method was used in the study. The eligible participants who meet the inclusion criteria and give an informed consent to participate in the research study were involved. The sample size was estimated using Cochrane’s formula [17] and Fisher’s formula [18] with the study participants included in the study being 80. Kithare Sub-location has nearly 2000 women with nearly 1/4 aged 25 years and below (KDHS, 2016).

Sample Size Calculation

The sample size was determined using Cochrane’s formula.

Where;

n = z 2 p q d 2

n = sample size if the target population is less than 10,000

z = standard normal deviate corresponding to 95% confidence level (1.96)

p = proportion of the target population. Since information on the screening prevalence in rural areas is not available, 50% (0.5) is assumed to get the possible maximum sample size.

q = 1 − p (Proportion without characteristics): q = 1 − p = (1 − 0.5) = 0.5

d = the level of statistical significance at 95% confidence level = (0.05)

n = 1.96 2 × 0.5 × 0.5 0.05 2 = 384

nf is the desired sample size and represents the estimate population size which is less than 10000 and thus sample size was determined by Fisher’s formula

n f = n 1 + n / N = 384 1 + 384 / 100 = 384 1 + 3.84 = 384 4.84 = 79.332

Thus, the study participants included in the study were 80 in number.

Validity and Reliability

Validity refers to how well a test measures what is purported to measure. Validity was ensured by; Expert review of the instruments (questionnaires) before commencement of the study for content validity. The researcher ensured that all the questions in the instrument were clear, properly grouped and easy to understand. Training of research assistants was done to ensure a proper understanding of the operational definitions of the study and uniformity in the questioning skills.

Reliability is the degree to which an instrument produces conSsistent results if repeated. A pretest of 10% of sample size was done prior to actual data collection which aided in establishing the reliability by finding out if sufficient questions were included to meet the study objectives and whether the meaning of the questions was similar to all the respondents. After which necessary adjustments were made.

Data Management

Information from the research participants was collected using interviewer administered questionnaires. Data entry using unique identifiers was done in duplicate for validation (double entry) and the data was crosschecked for entry error. Data Analysis was done using SPSS version 25.0 for windows. Interpretation and presentation was done using line graphs, tables, pie charts and bar graphs.

From the study, the researcher made the following conclusions: The age at first sexual intercourse ranged from 12 to 23 years with a significant number of the women reporting that they had two or more sexual partners thus were at risk of cervical cancer. The knowledge and practice of cervical cancer screening were inadequate. In relation to the individual’s perspectives about screening some women believed that it was important for early detection and management of the disease, to know the health status, it is important in preventing infertility and death. On the contrary, others were afraid of the procedure, some citied the procedure to be uncomfortable and painful, it leads to a low self-esteem as well as the fear of wrong results and the diagnosis of cancer. Inadequate knowledge, lack of screening services, negative attitude towards screening and limited funds were cited as major barriers towards screening. Other barriers citied include cultural and religious beliefs towards screening, male spouse disapproval and lack of support.

Language barrier was a significant challenge when administering the questionnaire as most of the participants conversed in their local native language.

More education on screening should be provided to reduce the misconceptions involved. Provision of free services and more participation in education and sensitization from the healthcare providers should also be done.

The authors declare no conflicts of interest regarding the publication of this paper.

Ngari, D.M., Nyamiaka, M.S. and Mukami, F.M. (2021) Factors Affecting Cervical Cancer Screening among Women Below 25 Years in Kithare Area, Tharaka Nithi County, Kenya. Open Journal of Obstetrics and Gynecology, 11, 485-503. https://doi.org/10.4236/ojog.2021.115046

Instructions Serial No………….

1) Do not write your name.

2) Fill all the relevant sections

3) Use a tick (√) where applicable

Part A

1) Age:

a) 15 - 18 years [ ]

b) 19 - 22 years [ ]

c) 23 - 25 years [ ]

2) Gender:

a) Male [ ] b) Female [ ]

3) Level of Education:

a) Primary [ ]

b) Secondary [ ]

c) College [ ]

4) Occupation:

a) Student [ ]

b) Farmer [ ]

c) Business [ ]

d) Employed [ ]

5) Age at menarche:____________________________________________

6) Marital status

a) Single [ ]

b) Married [ ]

c) Divorced [ ]

d) Widowed [ ]

7) Age at first sexual intercourse:_____________________________________

8) Number of sexual partners:_______________________________________

SECTION B: KNOWLEDGE ON CERVICAL CANCER SCREENING

9) Have you ever heard of cervical cancer?

a) Yes [ ]

b) No [ ]

10) If Yes, Briefly explain what you understand about cervical cancer

………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

11) Where did you get the information about cervical cancer screening?

a) Friends [ ]

b) Family member [ ]

c) Media channels e.g TV, newspaper [ ]

d) Healthcare providers/Hospital [ ]

e) Other (Please specify)

………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

12) When should a woman go for cervical cancer screening?

a) When starting menstruation [ ]

b) When married [ ]

c) When sexually active [ ]

13) How often should a woman go for cervical cancer screening?

a) Monthly [ ]

b) Annually [ ]

c) Every 2 years [ ]

d) As per HCP instructions [ ]

e) Do not know [ ]

14) Have you ever been screened for cervical cancer before?

a) Yes [ ] b) No [ ]

15) If Yes, Explain what happens?

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16) What made you seek screening services?

………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

17) What are the benefits associated with cervical cancer screening

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SECTION C: BELIEFS ABOUT CERVICAL CANCER SCREENING

18) Do you agree/concur that cervical cancer screening is helpful?

a) I agree [ ]

b) I disagree [ ]

19) If Yes in 18 above, explain your reasons

………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

20) If No in18 above, explain your reasons

………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

SECTION D: BARRIERS THAT HINDER CERVICAL CANCER SCREENING

21) What are some of the barriers that hinder women aged 25 years and below from seeking cervical cancer screening services? Please tick appropriately, you can tick more than one time

Lack of services for screening [ ]

Inadequate knowledge by women [ ]

Lack of money to go for screening [ ]

Negative attitude towards screening [ ]

Cultural beliefs against screening [ ]

Religious beliefs against screening [ ]

Lack of male/family support [ ]

Male spouse disapproval [ ]

Other (Specify)……………………………………………………………………

……………………………………………………………………………………….

22) What are some of the things you propose that can be done to improve the practice of cervical cancer screening?

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