Research Proposal 1. 1Topic Cervical cancer and screening; knowledge and attitude of St. Dominic Hospital Staff in the Eastern egion of Ghana. 1. 2 introduction background Cervical cancer is the most frequently diagnosed cancer among women in Ghana and knowledge about its cause, risk factors, prevention, symptoms and treatment is essential in the fight to reduce cancer morbidity and mortality among women in the country. Cancers are developed, not acquired thus cannot be transmitted to other persons.
It is one or some of the individual’s own body cells that transform, divide rapidly and become hostile to other sorounding tissues, organs and sometimes the entire human system. A research conducted by Ghana Health Service indicate that an estimated 3038 women are diagnosed annually of cervical cancer and 2006 women die from the disease every year. Daily Graphic, 2013. Cervical cancer like all other cancers develops from a single cell that defies the laws of cellular division and begins to abnormally replicate and produce cells that differ in structure and function of the parent cells in the tissue.
It takes many years for an individual to begin to have symptoms suggestive of disease in the affected part. Unlike breast cancer, another leading cancer among women which women can self examine their breasts for abnormal lumps as an early diagnostic measure, it takes the services of special health professionals and an extended procedure to examine woman’s cervix for abnormal growth or cancer. The Human Papilloma Virus(HPV) infection, early sexual debut, multiple exual partners, multiparity, low social economic status, are the major risk factors to the development of cervical cancer. A lot of studies have identified the Human Papilloma Virus infection as the principal cause of Cervical cancer development, a virus which is sexually transmitted. Women who are sexually active or has had sex before are likely to be exposed the HPV. Knowledge of risk factors, early detection of symptoms and undergoing screening is the way forward for the prevention of advanced cervical cancer among Women who are sexually active.
Papanicolaou smear (Pap smear) and visual inspection of the cervix with acetic acid wash (VIA) are the screening options available with the latter being newly introduced, piloted and getting adopted by the Ministry of Health, Ghana because it is simpler and faster and result is readily available after the procedure. Both screening options requires a speculum to be inserted into the vagina for the cervical lining to be visualized and then processed for abnormality. Cervical cancer is curable if detected early.
Cryotherapy, a procedure where an iced carbon dioxide is used to kill the cancer cells has been widely used to treat early cervical cancers and has yielded tremendous results. If cervical cancer is not detected early and becomes advanced, its spreads to affect the other organs in the pelvis including the womb, bladder, urethra, rectum, etc. it is very painful, ‘disgraceful’ and offensive as urine and faeces may be discharging continually through the vagina. Such women are often nursed to peaceful death. Statement of problem
As already pointed out, cervical cancer ranks the highest in the cancer morbidity and mortality among Ghanaian women. The yearly over 2000 deaths recorded in women as a result of Cervical cancer, a preventable and treatable disease is unacceptable in a developing country that needs to build its human resource for development. Knowledge about cervical cancer and screening programs is necessary and needs to be aggressively pursued to arrest and turn-around the high cervical cancer deaths among Ghanaian women.
Health workers are change agents, they belong to Churches, clubs and other organizations. Their knowledge, awareness and attitude towards cervical cancer and screening is crucial and likely to correlate with their uptake of available screening programs and also encourage their friends, families and social organizations to do same to better the health and lives of Ghanaian women. The Ministry of Health, Ghana, is about giving vaccines to about giving HPV vaccines to about 32,000 females aged between the ages of 9 to 11 in the Central and Northern Regions to prevent HPV infection.
But what is the fate of the remaining Ghanaian women who are or getting sexual active and worse of all those who can be found under the other risk factors ? Purpose of the study The purpose of this study is to explore the knowledge and attitude of female clinical health staff of St. Dominic Hospital, Akwatia in the Eastern Region of Ghana concerning Cervical cancer and screening programs as a means of reducing cervical cancer mortality. Objectives of the Study 1.
To explore the Knowledge and beliefs of respondents on cervical cancer as the major cancer morbidity and mortality among Ghanaian women. 2. To find out the level of knowledge of respondents on the risk factors of cervical cancer development and available cervical screening programs 3. To explore their attitude towards susceptibility to cervical cancer, and willingness to undergo screening. 4. To find out factors that hinder the participation of respondents in screening for cervical cancer 1. Literature Review The knowledge and awareness about cervical cancer and its prevention among interns and nursing staff in a Tertiary care hospital in Karachi-Pakistan was assessed by Ali et al in 2010 revealed that, “the majority of working health professionals are not adequately equipped with knowledge concerning cervical cancer”. They concluded that, “Continuing Medical Education program should be started at the hospital level along with conferences to spread knowledge about this disease”. Ali et al 2010.
Results from a study conducted with 171 women in Maroua in Cameroon to assess the knowledge, attitude and assumption of cervical cancer by women indicated that, “The awareness of cervical cancer by women in Cameroon is still inadequate. Thus, to avoid deaths from cervical cancer, a curable and preventable disease, the need of an aggressive campaign to make Cameroonian women aware of cervical cancer and its prevention is needed” Tebeu et al 2007. In another study conducted in Nigeria by GHARORO and IKEANYI in 2006 where structured questionnaire was used to elicit response from 195 female health workers.
They concluded that, “ the majority, 89%, believed that they were not at risk of developing cervical cancer. The self-reported utilization of Pap test among health workers was low. While there was a positive correlation between Pap test awareness and utilization, screening uptake was very poor due to a combination of inappropriate beliefs, misapprehension, and deficient knowledge. There is an urgent need for an aggressive awareness campaign and the provision of a screening program nationally”.
A study conducted by Abotchie and Shoker in 2010 on cervical cancer among female University of Ghana students to explore their knowledge and health beliefs revealed that, “even in these highly educated populations, there is a lack of knowledge about the role of HPV” . they further stated that “Their lack of knowledge on cervical cancer and the need for periodic screening is indicative of a greater lack of awareness among the larger population of less educated women”. Three barriers were identified to negatively ssociated with screening : lack of belief that cervical screening diagnoses cancer, belief that pap test is painful and belief that the test will take away virginity. In another study, 9 clinicians who were trained in VIA and cryotherapy were observed for 18 months to assess the safety, acceptability and feasibility of a single-visit approach to cervical cancer prevention combining visual inspection of the cervix with acetic acid wash (VIA) and cryotherapy of a single-visit approach in Accra, Ghana. A total of 3665 women were screened and 13. 2% tested positive, out of which 70. % received immediate treatment and 21% delayed treatment. It was concluded that, “a single-visit approach using VIA and cryotherapy proved to be safe, acceptable, and feasible in an urban African setting” for that matter Ghana. Blumenthal et al, 2007. 1. 4 Methodoloty St. Dominic Hospital, Akwatia is a A case study approach will be used to make an in-depth exploration on the knowledge and attitude of the clinical health staff of St. Dominic Hospital, Akwatia in the Eastern Region of Ghana. The case study approach will enable a real-life information collection to be done.