TABLE OF CONTENTS
Title page – – – – – – – i
Approval page – – – – – – ii
Certification page – – – – – – – iii
Dedication – – — – – iv
Acknowledgement – – – – – – v
List of table – – – – – – vi
List of appendix – – – – – – vii
Abstract – – – – – – – viii
CHAPTER ONE: INTRODUCTION
Background
to the Study – — – — – – – 1
Statement of Problem – – – – – – 4
Purpose
– – – – – – – – – – 6
Objectives
– – – – – – – – – – 6
Research
questions – – – – – – – – 6
Significance of the Study — – – — – – 7
Scope
of the Study – – – – – – – – 9
Operational
definition – – – – — – – – 9
CHAPTER TWO: LITERATURE
REVIEW
Conceptual
Review – – — – – – – – 11
Development
of Cancer – – – – – – – – 12
Cervical Cancer Development – – – – – 13
Cervical
Cancer Staging – – – – – – – – 15
Incidence of Cervical cancer – – – – – – 16
Types of Screening, strengths and Weakness – – – 18
Theory
Underlying the Study – – – – – – – 20
Application
of the Model to the Study – – – – – – 21
Empirical
Review – – – – – – – – – 25
Attitude
and Practice of Health Care workers – – – – – 26
Summary
of Literature Review — – – – – –
– 29
CHAPTER THREE: RESEARCH
METHOD
Research
Design – – – – – – – – – 30
Area
of Study – – – – – – – – – 30
Population
of Study – – – – – — – – 31
Sample
– – – – – – – – — 32
Sampling
Techniques – – – – – – – – 32
Inclusion Criteria – – – – – – – 33
Instrument for Data Collection – – – – – 33
Validity of Instrument – – – – – – 34
Reliability of Instrument – – – – – – 34
Ethical
Consideration – – – – – – – – 35
Procedure
for Data Collection – – – – – – – 35
Method
of Data Analysis – – – – – – – – 35
CHAPTER FOUR:
PRESENTATION OF RESULTS
Introduction
Presentation
Results – – – — – 34
Presentation of socio demographic data – – – 34
Summary
Findings – – – – – — – 41
CHAPTER FIVE
Discussion,
Conclusion and Recommendation
Discussion
of major findings – – – – 42
Implications
of findings – – – – – – – 49
Limitation of the Study – – – – – 50
Summary – – – – – – – – – 51
Conclusion – – – – – – – – 52
Recommendations — – – – – – – – 53
Suggestions for further Research – – – – 54
References
– – – – – – – – – – 55
Appendices – – – – – – – 58
LIST OF TABLES
- Composition of sample for the study
through proportionate
Stratified random sampling technique
- Distribution
of respondents based on age
- Distribution
of respondents based on duration of service
- Distribution
of respondents based on qualification
- Mean,
standard deviation and percentage responses on the attitude of female
health workers towards the uptake of
cervical cancer screening
- Frequency
and percentage responses on female heath workers practices of
cervical cancer screening
- Mean,
standard deviation and ANOVA on the attitude of female health workers
towards the uptake of cervical
cancer screening based on profession
- Frequency
percentage and chi-square statistics on the relationship between
profession and practices of cervical
cancer screening among female health workers.
LIST
OF APPENDICES
- Sample
questionnaire on the attitude and practice of cervical cancer screening among
female heath workers in the hospital studied and factors that influence uptake
of screening.
- Letter
of introduction from head of department of nursing UNEC.
- Letter
of introduction from the director of clinical services and training of
Braithwaite memorial specialist hospital (BMSH), rivers state.
- Calculation
of reliability co-efficient.
- Calculation
of sample size.
- Calculation
of sample size from each stratum using proportional stratified random sampling
technique.
- Staff
description of female staff (January 2013).
- Approval
letter from hospital (UPTH) ethical committee
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 product-moment 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
