Last modified: 2019-02-13
Abstract
Impact of Health Information Dissemination and Print Media to Enhance Cervical Cancer Screening in Addis Ababa: Cluster Randomized Controlled trial
Selamawit Hirpa , Berhan Tassew, Estehiwot Tilahun, Abigiya Wondimagegnehu, Mahlet Yigeremu Mitike Molla
Introduction
According to Globocan, in Ethiopia there were 7,095 newly diagnosed cancer cases and 3,235 deaths occurred in 2012 alone. Studies in Ethiopia indicate low prevalence of cervical cancer screening practice. In Black Lion Hospital only 3% of cervical cancer patients were ever screened for cervical cancer before diagnosis.
The aim of this study is to determine the joint effect of one to one health education and educational brochure on the practice of cervical cancer screening among women who visit selected health centers of Addis Ababa.
Methods
This study was conducted in eight selected health centers which provide VIA screening service in Addis Ababa. A cluster randomized controlled trial study was conducted from September, 2017 to December, 2017. Eight health centers were randomized to intervention and control groups with a 1:1 ratio. Two thousand four hundred women in the age range of 30-49 years who visited the selected health centers for immunization, family planning, under 5 clinic services were included in the study. Convince sampling method was employed to select study participants. The intervention was health education framed in health belief model involving a one to one brief heath talk by the health provider followed by issuing educational brochure. Baseline data was collected from mothers who came seeking care both in the intervention and control facilities and a follow up measurement was done after two months. Data analysis was done using STATA version 14.
Result
A total of 2,137 women participated in the study. The median age of participants among the intervention and control group was 32 and 34, respectively. In the study period, 211 (9.9%) women were screened for cervical cancer and majority of these women were in the intervention health centers. Getting health education assisted with educational brochure is significantly associated (X2, 41.3, P-value 0.000) with the uptake for cervical cancer screening.
Table 1. Socio demographic and health related information of study participants at health centers of Addis Ababa
Variable
Intervention Group
Control Group
Frequency
Percent
Frequency
Percent
Age
30- 34 years
670
63.21
774
71.73
35-39 years
282
26.60
250
23.17
40-44 years
70
6.60
42
3.89
45-50 years
38
3.58
13
1.20
Marital status
Single
66
6.22
53
4.92
Married
900
84.83
992
92.11
Divorced/ Separated
80
7.54
23
2.13
Widowed
15
1.41
9
0.84
Educational level
Illiterate
14
14.6
Read and write
10.8
12.7
Primary
26.9
29.9
Secondary
39.17
38.7
Diploma
13.35
11.4
First degree/ above
9.73
7.2
History of STI
No
929
88.39
980
90.74
Yes
122
11.61
100
9.26
Tested for HIV
No
48
4.53
30
2.78
Yes
1,011
95.47
1,050
97.22
HIV status
Negative
984
94.89
1,007
94.20
Positive
52
5.01
58
5.43
Unknown
1
0.10
4
0.37
Table 2. Chi- square test result of cervical cancer screening practice with type of health center (Intervention/Control)
Variable
Screened for Cervical Cancer
x2 value
P- value
Yes
(n=211)
No
(n=1926)
Type of the health center
Intervention
149
911
41.3552
0.000
Control
62
1,015
Discussion and Conclusion
This study revealed that significant number of women who received health education and educational brochure were screened for cervical cancer using VIA. This finding is similar with study done in Zimbabwe, which showed that educational interventional program has a positive effect on the practice of cervical cancer screening (Sylvia C et.al., 2011). We can conclude that the existing low uptake for cervical cancer screening can be improved by providing focused health education on the benefits of cervical cancer screening and risks of delay.
From women in the intervention group, 75% stated that being busy with other things was the reason for not being screened for cervical cancer. So repeated and continuous educational messages may result a better practice of cervical cancer screening.