|Year : 2023 | Volume
| Issue : 1 | Page : 60-64
Knowledge, attitude, and practice on cervical cancer and its screening among women of Mulugu Mandal: A cross-sectional study
Kasha Ramyatha, Aruna Tubachi, Anusha Doddoju Veera Bhadreshwara, Gopa Raju Anumolu
Department of Community Medicine, RVM Institute of Medical Science and Research Center, Siddipet, Telangana, India
|Date of Submission||01-Jul-2022|
|Date of Decision||13-Jul-2022|
|Date of Acceptance||06-Sep-2022|
|Date of Web Publication||02-Dec-2022|
H.NO: 48-307, Ganesh Nagar, Chintal, HMT Road, Hyderabad - 500 054, Telangana
Source of Support: None, Conflict of Interest: None
Background: Cervical cancer is the fourth-leading cause of death in females among noncommunicable diseases. Hence, knowledge of risk factors, symptoms, and screening in females, especially in rural areas is important to reduce the burden of disease.
Objective: The objective of this study was to estimate the level of knowledge, attitude, and practice (KAP) regarding risk factors, symptoms, and preventive measures of cervical cancer, and screening the females by means of Papanicolaou test (PAP) smear.
Subjects and Methods: A cross-sectional study was conducted among 30–65 years females of Mulugu Mandal from October 2021 to February 2022. After obtaining informed consent, 505 females were interviewed by house-to-house visit using a semistructured questionnaire with questions regarding KAP on risk factors, symptoms, and preventive measures of cervical cancer, and motivated female for PAP smear if willing, was brought to the institution. Data were analyzed using SPSS 22.
Results: The mean age of the study participants was 47.46 ± 9.698. Good knowledge, positive attitude, and regular practice were 11.28%, 43.8%, and 14.1%, respectively, on cervical cancer. PAP smear acceptance rate was 14.059% result and showed 12.6% have atypical squamous cells of undetermined significance and 87.3% have an inflammatory smear.
Conclusion: Knowledge on risk factors, symptoms and screening for cervical cancer is low, and the acceptance rate of PAP smear is very low.
Keywords: Cervical cancer, knowledge, PAP smear, rural area
|How to cite this article:|
Ramyatha K, Tubachi A, Veera Bhadreshwara AD, Anumolu GR. Knowledge, attitude, and practice on cervical cancer and its screening among women of Mulugu Mandal: A cross-sectional study. MRIMS J Health Sci 2023;11:60-4
|How to cite this URL:|
Ramyatha K, Tubachi A, Veera Bhadreshwara AD, Anumolu GR. Knowledge, attitude, and practice on cervical cancer and its screening among women of Mulugu Mandal: A cross-sectional study. MRIMS J Health Sci [serial online] 2023 [cited 2023 Mar 30];11:60-4. Available from: http://www.mrimsjournal.com/text.asp?2023/11/1/60/362530
| Introduction|| |
According to the World Health Organization, 71% of global deaths every year are due to noncommunicable diseases (NCDs). Among NCD deaths, cancers are the second-leading cause of death with 9.3 million deaths every year. Cervical cancer is the fourth most common cause with 5,70,000 diagnosed cases and 311,000 deaths in 2018 worldwide., In India, it is the second-most common cancer with 96,922 new registered cases and 60,078 deaths in 2018.
The most common risk factors associated with cervical cancer are carcinogenic human papillomavirus (HPV) infection, multiple sexual partners, early menarche, low-socioeconomic status, and first sexual intercourse at early age. Symptoms of cervical cancer are bleeding between periods, prolong heavy menstruation, persistent back pain and pelvic pain, and bleeding after intercourse. Preventive measures include HPV vaccination, a physical checkup every year, PAP smear should be done in 30–65 years females once every 3 years. These preventive measures should be followed by every female to reduce the burden of cervical cancer.
Cervical cancer can be prevented if the women are screened at early stages. This can reduce the death due to cancer. It is very important for every woman to know the risk factors, symptoms, and screening methods available. Most of the studies conducted were hospital-based studies on females who attended the outpatient department with some problems. Hence, a community-based study to estimate the level of knowledge, attitude, and practice (KAP) regarding risk factors, symptoms, and preventive measures of cervical cancer, and to screen the females by means of PAP smear is needed because most of the symptoms are ignored by many females due to the lack of knowledge.
| Subjects and Methods|| |
A community-based cross-sectional study was conducted among females of age 30–65 years of Mulugu Mandal, Siddipet district. Mulugu is one of the Mandal with a 21,908 female population with 10 villages. Women permanent residents of Mulugu Mandal were included in the study. Women who were already diagnosed with cervical cancer and on treatment for cervical cancer, pregnant, and lactating women were excluded from the study. The study was conducted from October 2021 to February 2022 (5 months). Ethical approval was obtained from the institutional ethical committee.
The sample size was calculated by taking prevalence from a study conducted by Narayana et al. in south India has the prevalence of knowledge on symptoms of cervical cancer, i.e. bleeding between periods is one of the symptoms of cervical cancer was 48.4% and d is 10% of prevalence at 95% confidence interval. Using n = (1.96)2 P q/d2 and adding nonrespondence rate of 20%, we got a sample size of 490. Stratified random sampling was done to select the female from each village. All selected houses were visited and if the house was locked or female was not willing to participate in survey then the next house was selected for survey.
The study tool was a semistructured questionnaire which include five sections: demographic profile, history of risk factors for cervical cancer, knowledge of women about risk factors, symptoms and screening methods regarding cervical cancer, attitude and practice toward screening methods, and findings of PAP smear (females who underwent PAP smear).
Scoring was given based on female responses; knowledge was scored based on points each question has two options maximum points she can score is 16 and the minimum is 0. If the score was 11–16 than good, 6–10 moderate and 0–5 poor knowledge. Attitude has 8 questions and one has 3 options, maximum points she can score was 24 and the minimum was 8 based on her points if it is ≥12 then she has a positive attitude and <12 is a negative attitude. Practice is categorized as regular if she had PAP smear done within 3 years and irregular practice if PAP smear was done >3 years and no practice if she had never done PAP smear.
Data collection procedure study sample was approached by house-to-house visit and explained about the purpose and procedure of the study and consent was taken. Female was assured confidentiality regarding their identity and that data will be used only for research purpose and face-to-face interview was done by maintaining privacy. Health education was given regarding cervical cancer and the importance of screening. Motivated females for PAP smear by conducting health camps at the end of the survey and 71 females who were willing to undergo PAP smear procedure were brought to the institute. The smear was collected by scraping the squamocolumnar junction with Ayer's spatula and endocervical brushing and sent to the pathology department for reporting.
Data were entered and analyzed using Statistical package for social sciences (SPSS) by IBM (international business machines), Chicago, Illinois, United States of America. Data were presented as percentages, mean, and standard deviation. Data were represented in tables.
| Results|| |
A total of 505 females were interviewed. The mean age of the study participants was 47.46 ± 9.698 years. Most of the females are between 50 and 65 (35.2%). About 90.9% of females were married. Hindus are 83.2%. Illiterates correspond to 65.9% and 55.2% of females are homemakers. According to B. G. Prasad's 2021 socioeconomic scale, the middle class is 40.2% followed by the upper middle and lower middle with 26.5% and 17.8%, respectively, as shown in [Table 1].
The risk factor in females and 52.3% attain their menarche between 14 and 17 years and 59.9% of females had a regular cycle of periods. Thirty-six of the females complained of menorrhagia (heavy menstrual bleeding). Early marriage was common, 39.2% got married between 13 and 15 years followed by 36% married between 9 and 12 years and 18.8% of females complained of repeated pelvic inflammatory disease (PID) in the past (one episode of PID in past). The use of oral contraceptive pills (OCPs) is seen in 32.5% of females among them 13.5% of females used OCPs >5 years. History of use of tobacco-related products >6 months was 9.9%, as shown in [Table 2]. None of them used barrier methods of contraceptive and were even not vaccinated with HPV vaccine. None of them had multiple sexual partners.
The female knowledge regarding risk factors, symptoms and screening methods of cervical cancer. About 36.8% of females answered irregular menstrual bleeding can be a symptom of cervical cancer, weight loss (32.9%), and abnormal vaginal discharge (32.5%). Risk factors such as smoking (43.8%), early start of sexual activity (43.4%), and drug abuse (37%) can cause cervical cancer were the common answers, as shown in [Table 3].
Attitude toward cervical cancer among females showed 37.6% of females agreed that screening causes no harm to the client followed by cervical cancer is highly prevalent and the leading cause of death among all cancers in India and any adult woman can acquire cervical cancer (36.6%). Screening help in preventing cervical cancer was agreed was 22.8% of females, as shown in [Table 4].
Among 505 females, 50.09% of females had poor knowledge. A negative attitude was seen (56.2%) and no practice was seen (52.1%). Good knowledge was 11.28%, positive attitude in 43.8%, and regular practice was followed by 14.1%, as shown in [Table 5]. The correlation was done between demographic data and KAP on cervical cancer but no significant findings were seen.
Even after the motivation acceptance rate of the PAP smear is very low, i.e. 14.059%. Atypical squamous cells of undetermined significance (ASCUS) means ASCUS seen in nine females were referred to the department of obstetrics and gynecology for further investigation and management. Inflammatory smear was seen in 62 females and this was treated by antibiotics and advised proper hygiene practices, as shown in [Table 6].
| Discussion|| |
Abnormal vaginal discharge as a symptom of cervical cancer was reported by 32.5% in this study which was less when compared with the study conducted by Shashank et al. shows 69% it is because this study was conducted in educated females in rural areas. In current study 27.9% females responded that Bleeding after sexual activity can be a symptom of cervical cancer and this finding is less when compared with Khanna et al. (61.7%), and low (8.7%) in Dahiya et al. and Shekhar et al. 20.1%. In the current study, early start of sexual activity was reported by 43.4% but many other studies show different results such as 26.7% and 36.2%, in studies conducted by Ghosh et al., Narayana et al.,, multiple sexual partners can be a risk factor was answered by 31.8%, but in Ghosh et al., only 7.3% answered correctly and in Narayana et al. (38.4%), Dahiya et al. (10.7%), Khanna et al. and (59.2%), chamaraja et al. (20%).,,,, In this study, knowledge about smoking can cause cervical cancer was 43.8%, but in other studies, it was low.,,, The prolonged use of OCP >5 years can cause cervical cancer was answered by 25.9% in this study, but in Narayana et al. was very low (6.9%) and Oswal et al. (28%).,
Among 505 females, 48% (regular 14.1%, irregular 33.9%) of females practiced PAP smear due to some symptoms, but in the study conducted by Dahiya et al. 13.3%, Mahalakshmi et al. 16.7%, it is very low even after the knowledge that PAP smear can detect early lesion females are not accepting. The acceptance rate of PAP smear is low in this study (14.1%) similar findings are seen in the study conducted by Khanna et al. The acceptance rate can be low due to many reasons such as lack of knowledge, not availability, and painful procedure.,
In our study, good knowledge was only 11.28%, positive attitude was (43.8%), and regular practice was only (14.1%) contrary to this finding a study conducted by Narayana et al. shows good knowledge (37.7%), positive attitude (62.5%), and regular practice (5.4%).
The study participants may face recall bias as history was asked regarding symptoms and practice and females can find difficulty in answering few questions (multiple sexual partners and barrier method of contraception) this could give a subjective bias. However, the study was done in a rural setting with 10% of allowable error. Among 505 females, we could screen only 71 with PAP smear this is the major limitation of our study.
| Conclusion|| |
Knowledge on risk factors, symptoms, and screening for cervical cancer is low and the acceptance rate of PAP smear is very low among study participants. Regular practice of PAP smear is very low due to this we need to create awareness among females. Motivate them for regular screening for cervical cancer.
To reduce cervical cancer cases, we need to create awareness regarding various risk factors, symptoms, and even motivating females for regular screening practice. By regular practice, we can detect early lesions and stop the progression of cancer. Similar multicentric studies should be conducted this can help in creating awareness in females.
We would like to thank Dr. R. Yakaiah (chairmen, RVMIMS and RC) and ethical committee members of the institution for their support to research. Special thanks to the entire study participant for their contribution in the research.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Saranath D, Khanna A. Current status of cancer burden: Global and Indian scenario. Biomed Res J 2014;1:1-5. [Full text]
Dahiya N, Aggarwal K, Singh MC, Garg S, Kumar R. Knowledge, attitude, and practice regarding the screening of cervical cancer among women in New Delhi, India. Ci Ji Yi Xue Za Zhi 2019;31:240-3.
Narayana G, Suchitra MJ, Sunanda G, Ramaiah JD, Kumar BP, Veerabhadrappa KV. Knowledge, attitude, and practice toward cervical cancer among women attending Obstetrics and Gynecology Department: A cross-sectional, hospital-based survey in South India. Indian J Cancer 2017;54:481-7.
] [Full text]
Operational guidelines on National Programme for Prevention and Control of Cancer by ministry of health and family welfare. Available from: https://main.mohfw.gov.in
. [Last accessed on 2021 Dec 12].
Shashank S , Sharma C, Thakur S, Raina N. Cervical Cancer Screening: Knowledge, Attitude and Practices among Nursing Staff in a Tertiary Level Teaching Institution of Rural India. Asian Pac J Cancer Prev 2013;14:3641-5.
Khanna D, Khargekar N, Budukh A. Knowledge, attitude, and practice about cervical cancer and its screening among community healthcare workers of Varanasi district, Uttar Pradesh, India. J Family Med Prim Care 2019;8:1715-9.
] [Full text]
Shekhar S, Sharma C, Thakur S, Raina N. Cervical cancer screening: Knowledge, attitude and practices among nursing staff in a tertiary level teaching institution of rural India. Asian Pac J Cancer Prev 2013;14:3641-5.
Ghosh S, Mallya SD, Shetty RS, Pattanshetty SM, Pandey D, Kabekkodu SP, et al
. Knowledge, attitude and practices towards cervical cancer and its screening among women from tribal population: A community-based study from Southern India. J Racial Ethnic Health Disparities 2021;8:88-93.
Thippeveeranna C, Mohan SS, Singh LR, Singh NN. Knowledge, attitude and practice of the pap smear as a screening procedure among nurses in a tertiary hospital in north eastern India. Asian Pac J Cancer Prev 2013;14:849-52.
Romli R, Shahabudin S, Saddki N, Mokhtar N. Cervical cancer and pap smear screening: Knowledge, attitude and practice among working women in northern state of Malaysia. Med J Malaysia 2019;74:8-14.
Singh M, Ranjan R, Das B, Gupta K. Knowledge, attitude and practice of cervical cancer screening in women visiting a tertiary care hospital of Delhi. Indian J Cancer 2014;51:319-23.
] [Full text]
Oswal K, Kanodia R, Pradhan A, Nadkar U, Avhad M, Venkataramanan R, et al
. Assessment of knowledge and screening in oral, breast, and cervical cancer in the population of the Northeast Region of India. JCO Glob Oncol 2020;6:601-9.
Mahalakshmi S, Suresh S. Barriers to cancer screening uptake in women: A qualitative study from Tamil Nadu, India. Asian Pac J Cancer Prev 2020;21:1081-7.
Srivastava AN, Misra JS, Srivastava S, Das BC, Gupta S. Cervical cancer screening in rural India: Status and current concepts. Indian J Med Res 2018;148:687-96.
] [Full text]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]