COMPLETE SCHOOL PROJECT TOPICS & MATERIALS :
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ABSTRACT
The purpose of the study was to examine the attitude and practice of female
health workers towards cervical cancer screening (CCS) in the university of
Port Harcourt teaching hospital (UPTH), Rivers state. The descriptive survey
design was adopted for the study. A sample size of 352 was used for the
study. This sample size was approximately 40% of the target population. This
sample was considered representative of the population with an accurate level
of more than 97%. A self-structured questionnaire was the instrument used for
data collection. The validity of the instrument was ascertained by the project
supervisor and two (2) other senior lecturers one being a specialist in
measurement and evaluation.The reliability indices were established using
Test-retest. The scores obtained were correlated using Pearson’s productmoment
coefficient of correlation to obtain the reliability co-efficient (r) of 0.94
which was consideredadequate. Data analysis was done using statistical
software package, for Social Sciences (SPSS) version 20.0. Descriptive
statistics of percentages, mean, standard deviation and mean cut-off criterion
of 2.5 as well as inferential statistics (chi-square and Analysis of variance
(ANOVA)) were used to analyse the data. Findings showed that the female
health workers have negative attitude and poor practice of CCS. Profession
has no influence on their attitude and practice.

CHAPTER ONE
INTRODUCTION
Background to the study
Cervical cancer remains the commonest genital tract cancer yet it is
largely preventable by effective screening programmes. Considerable
reduction in cervical cancer incidence and deaths has been achieved in
developed nations with systematic cytological smear screening
programmes.(Babatunde&Ikimalo,2010; Mutyaha,Mmiro&
Weiderpass,2006).
One woman dies of cervical cancer in every two minutes worldwide,
80% of these deaths occur in developing nations.(Okunnu 2010 ).
For every two women who die of breast cancer, one dies from cervical
cancer worldwide. It is 2nd most common cancer in women worldwide
and most common in African women thus the most leading cause of
cancer deaths in women in sub-Saharan Africa including Nigeria with a
very poor 6-year survival rate.(Okunnu,2010; Obi,Ozumba&
Onyebuchi,2008; Oguntayo Samaila,2008;Papadopoulos,Devaja,Cason
&Raji,2000).
Most cervical cancers are caused by HPV infection with two prominent
types, (16 and 18) which are responsible for about 70% of all cases.
[National cancer institute, 2007]. They can both be prevented and
detected early. Prevention can be achieved by immunizing young girls
between the ages of 9-16 [before the age of sexual debut] while cervical
screening is used for early detection. (Qiao, 2008, WHO, 2006).
Studies conducted in some parts of Africa, Nigeria inclusive reported
that in Benin Nigeria, Carcinoma of the cervix constitute 74.6% of all
malignant gynaecological tumors with stage IIb and above constituting
67.6%of all cases; in Zaria it accounted for 66.2% with advanced
carcinoma of the cervix stage IIb and above making up 58.7% of the
cases. In Kenya, 55% of patients presented with stage III diseases and
beyond (stage iv-v).
Otolorin&sule (2008) also reported that in Nigeria, cervical cancer affects
29women per 100,000 women. Some factors have been implicated in
this tragic and unnecessary loss of lives. WHO (2006), observed that
many women do not attend screening programmes because of
ignorance of the risk for cervical cancer and/or the benefit of screening
in its early detection and cure.
Qiao (2008) from his clinical study reported that well organized cervical
cancer prevention programmes based on primary screening with cervical
cytology lead to impressive reductions in cervical cancer rates in
developed Countries. Screening in the UK saves up to 5000 lives per
year (Olaitan, 2008).
Consequently in industrialized world, effective screening programme
has helped identify precancerous lesions at a stage when they can be
easily treated thereby leading to impressive reduction in cervical cancer
death rates while lack of screening programmes in poorest countries
means that the disease is not identified until it is too late resulting in high
mortality (Ojiyi&Dike, 2010 ; Qiao, 2008).This is similar to what is
prevalent in Nigeria where most cervical cancer cases seen in health
facilities are in stages II and above.
Cervical screening is a health intervention used on population of woman
at risk of developing cervical cancer [WHO, 2008]. It is not undertaken to
diagnose the disease but to identify individuals with a high probability of
having or developing the disease at the precancerous stage. The
individual may actually feel perfectly healthy and may see no reason to
visit a health facility. Preventing the incidence of cancer causing Human
papilloma virus infection, significantly reduces the incidence of cervical
cancer and the burden of the sickness on women, family and the nation
at large.
There are different screening programmes that can be used to detect the
precancerous changes so as to prevent the development of the diseases
and curb its serious consequences. Some of these programmes include;
visual method such as Pap smear or visual inspection with acetic acid
(VIA), visual inspection with Lugol’s iodine (VLI), care Human papilloma
virus [care-HPV], HPV-DNA based screening among others.
The screening programmes are performed by qualified health
professionals and they serve as models to the public. They are generally
believed to be well informed on health issues better than the public.
Their attitude and practice transcends to society health behaviors.
Female Health workers are expected to have a better understanding of
the benefits of cervical screening than women in other spheres of life,
thus be effective agents in creating and disseminating information about
the importance of the screening programmes for the sexually active,
post menopausal women as well as immunization for the girl child
between the ages of 9- 16 years by example. Thus their attitude and
practice towards screening for cervical cancer have a far reaching
implications to its acceptance consequently contributing to the reduction
in death of women from cervical cancer.
Statement of problem
Cervical cancer screening (CCS) has been identified as an effective
instrument in early detection as well as cure for cervical cancer. Yet
women are still dying of cervical cancer, which could have been
prevented given the new technologies available. It has been observed
that the commitment of health workers towards exclusive breastfeeding
has served as a good motivator to the mothers, this has resulted in
a significant reduction of infant mortality. Ana, Mercedes, Jeremy, Jose,(
2001) observed that exclusive breast feeding of infants aged 0-3 months
and partial breast feeding for the remainder of the first year would
prevent about 52 000 infant deaths a year in Latin America. They further
observed that, promotion of breast feeding has an important role in
increasing survival of infants. In the same vein if the female health
workers are committed to cervical cancer screening, this will motivate the
women to participate in the screening, thus helping in reduction of the
incidence and mortality as has been observed with that of exclusive
breastfeeding.
Women in other spheres of life without much knowledge about health
issues look up to female health workers for positive health behaviours
such as participating in the uptake of CCS, thus female health workers
have strong influence on women and as such are role models in health
issues. Reviewed literature revealed that there seem to be a problem of
uptake of CCS among the womenfolk resulting in high incidence,
mortality and poor treatment outcome of cervical cancer. It is in the light
of these that the following pertinent questions are seeking for answers;
What is the attitude of female health workers towards the uptake of
cervical cancer screening; how do the female health workers in the
studied institution practice CCS; how does profession influence the
attitude of female health workers towards the uptake of cervical cancer
screening; and how does profession influence the practice of cervical
cancer screening by female health workers?
Purpose
The purpose of the study is to examine the attitude and practice of
female health workers towards cervical cancer screening at university of
Port Harcourt Teaching Hospital (UPTH), Rivers state.
Objectives
The objectives of this study are to;
1. determine the attitude of female health workers towards cervical
cancer screening in the hospital studied.
2. determine how the female health workers in the studied institution
practice CCS.
3. determine how profession influences attitude of cervical cancer
screening among female health workers in the studied hospital
4. determine how profession influences the practice of cervical
cancer screening by female health workers in the studied hospital
Research Questions
1 What is the attitude of female health workers towards the uptake
of cervical cancer screening?
2 How did the female health workers in the studied institution
practice CCS.
3 How does profession influence the attitude of female health
workers
towards the uptake of cervical cancer screening?
4 How does profession influence the practice of cervical cancer
screening by female health workers?
Significance of the study
Early detection is the key to better treatment outcome of cervical cancer.
However in the developing countries, Nigeria inclusive, this effective tool
of early detection still seems to be a mirage.
Health care professionals are important predictors of the use of cervical
cancer screening (Nwobodo & Malami, 2005). Being knowledgeable
about cervical screening for cancer serves as an advantage thus they
serve as effective agents in creating awareness about screening, its
usefulness in prevention and better treatment outcome of cervical
cancer.
This study will help in identifying the level of health workers commitment
to utilization of cytology services which in turn will motivate uptake of
screening among women folk and as such reduce deaths from cervical
cancer.
The findings of this study will also identify the attitude of female health
workers towards screening and in turn inform the hospital administration
on policies that will promote uptake among female health workers,
thereby ensuring their commitment to the uptake.
A positive attitude involves personally participating in the uptake and
being fully committed to it. By so doing, the health worker will be in a
better position to encourage the women to participate; she calms their
fear and disabuses the misconception and erroneous belief about
screening, thus helping to reduce mortality and poor treatment
prognosis.
A negative attitude indicates lack of interest in the uptake and in creating
awareness among women. Thus lacks the required instrument to
empower the women against the disease and save them from the
preventable and curable disease.
The findings of the study will help determine the practice of female
health workers towards the uptake of cervical screening. When the
female health workers participate in the uptake, creating awareness
through health education and health counseling about the disease and
its prevention (immunization); refer patients for screening, conduct the
screening test and interpret the result for the patients, they are actively
working with the formidable health care team in the fight against cervical
cancer. These healthy practices improve their effectiveness in
encouraging the women to utilize the service.
The findings will also inform the policy makers especially in the health
sector to accord high priority to cervical screening, make policies, create
programmes and allocate sufficient funds to encourage procurement of
vaccines, screening equipment, promote follow-up of results of
screening, early diagnosis and treatment of identified cases. These
programmes of activities will also form part of the health care service of
health institution and thus reduce mortality from cervical cancer. Also,
training institutions for health workers should incorporate practical skills
on cervical screening in their training centre.
Scope of study
The study is delimited to attitude and practice of female health workers
in UPTH towards cervical cancer screening. Variables under studied
include attitude, practice and influence of profession on attitude and
pratice of female health workers towards cervical cancer screening and
also factors that influence the uptake of cervical cancer screening.
Operational Definitions.
Practice of CCS refers to being screened, participating in pre and posttest
counseling, conducting the screening test and interpreting the result.
Attitude of CCS refers to various reasons for not screening patients, not
referring patients for screening and not getting screened. Health professionals The female health workers in the study include
Nurses, Doctors, Medical laboratory Scientist, Radiographers and
Pharmacists.