Cervical cancer screening knowledge and associated factors among Eswatini women: A cross-sectional study.

BACKGROUND: Over recent years, cervical cancer incidence and related mortality have steadily increased in Eswatini. Low cervical cancer screening uptake partly explains the situation. Cervical cancer screening-related knowledge is positively associated with screening uptake. Little is known about women's cervical cancer screening-related knowledge in Eswatini. OBJECTIVE: This study aimed to assess cervical cancer screening knowledge and associated factors among Eswatini women eligible for screening. METHODS: A cross-sectional study involving three hundred and seventy-seven women aged 25 to 59 selected from four primary healthcare clinics in Eswatini was conducted. A paper and pen survey assessed knowledge about cervical cancer risk factors, benefits of screening, the meaning of screening results, recommended screening intervals, and socio-demographics. Descriptive analyses were performed to assess participants' sociodemographic characteristics. Linear regression was applied to examine associations between cervical cancer screening-related knowledge and participants' sociodemographic characteristics. RESULTS: Two hundred and twenty-nine (61%) participants answered 80% or more knowledge questions correctly. Compared to HIV-positive participants, HIV-negative participants had 0.61 times lower cervical cancer screening knowledge scores (ß = -0.39, 95% CI: -0.56, -0.19, p = 0.03). Participants who travelled more than 30 minutes to the clinic had 0.3 times lower cervical cancer screening knowledge scores (ß = -0.70, 95% CI: -1.15, -0.25, p < 0.01) compared to participants who travelled less than 30 minutes to the clinic. CONCLUSIONS: Relatively high overall cervical cancer screening knowledge levels were observed among the study participants. Findings from the current study may inform future educational programs to create and sustain an accurate understanding of cervical cancer screening in Eswatini communities.

Non-adherence to cervical cancer screening recommendations among women in Eswatini: a cross-sectional study.

BACKGROUND: In 2018, Eswatini had the world's highest age-standardised cervical cancer incidence rate. Cervical cancer screening reduces women's risk of invasive cervical cancer. Data on adherence to cervical cancer screening recommendations in Eswatini are scarce. The purpose of the current study was to determine Eswatini women's self-reported adherence to cervical cancer screening recommendations, attitudes toward screening, and factors associated with non-adherence. METHODS: A cross-sectional survey of women (n = 377) aged 25 to 59 accessing primary healthcare clinics (n = 4) in Eswatini assessed screening participation, attitudes and knowledge regarding cervical cancer screening, and socio-demographic variables. Adjusted logistic regression was used to assess factors associated with non-adherence to Eswatini cervical cancer screening recommendations. RESULTS: One hundred and sixty-six (44%) women were classified as adherent to cervical cancer screening recommendations. Attitudinal barriers endorsed by over one-third of participants included a perceived low risk of cervical cancer (n = 161, 43%) and a view that screening is likely to be painful (n = 146, 38%). Participants had higher odds of being classified as non-adherent if they: were single compared with married (OR = 1.78, 95% CI: 1.05, 3.01, p = 0.03), perceived screening as likely painful (OR = 4.43, 95% CI: 2.62, 7.46, p < 0.001); and had not been advised by a doctor/ nurse to screen (OR = 2.82, 95% CI: 1.71, 4.64, p < 0.001). Also, a 1-year increase in age was associated with an increase in the odds of being classified as non-adherent (OR = 1.42, 95% CI: 1.39, 1.45, p = 0.01). CONCLUSIONS: Self-reported adherence was moderate among this group of women. Tailored interventions are needed to increase participation in cervical cancer screening, especially for those women with characteristics associated with being classified as non-adherent. Primary healthcare clinic nurses (and other health providers) may contribute toward improving participation in cervical cancer screening by advising eligible women to screen and providing health education addressing negative attitudes toward screening.

Cervical Cancer Screening Promotion in Eswatini: A Cross-Sectional Survey of Community Health Workers' Perceived Barriers.

BACKGROUND: This study examined community health workers' perceived barriers to discussing cervical cancer screening with women eligible for screening and explored factors associated with endorsing a greater number of barriers. Additional exploratory analyses assessed factors associated with endorsing a specific barrier. METHODS: A telephone survey of 172 community health workers was conducted between July and August 2021. Descriptive analyses were performed to assess participants' socio-demographic and service-related characteristics. Regression analyses were used to assess: the association between socio-demographic characteristics and 1) endorsing a greater number of barriers and 2) endorsing a specific barrier or combination of barriers. RESULTS: Commonly endorsed barriers included: perceived inability to convince women to undertake screening, inadequate time to discuss screening, lack of confidence to talk to older women about screening, and women's lack of interest in screening advice. Community health workers with at least some secondary school level education endorsed 40% more barriers than those without secondary school level education. Community health workers in Lubombo and Shiselweni endorsed 47% and 35% fewer barriers than community health workers in Hhohho. Community health workers in Lubombo were less likely to endorse:  1) barrier combination consisting of 'inability to talk to women in a way that will convince them to undertake cervical cancer screening' and 'lack of confidence to talk to older women about screening', and 2) barrier combination consisting of 'thinking that cervical cancer screening is not important' and 'thinking that health education is not effective in promoting cervical cancer screening'. CONCLUSION: Improvements to the training of community health workers with respect to screening-related health promotion may be useful in addressing most of the identified barriers.

Cervical cancer screening-related knowledge among community health workers in Eswatini: a cross-sectional survey.

Eswatini has the highest age-standardized incidence and second highest mortality rate related to cervical cancer globally. In Eswatini, community health workers educate communities about cervical cancer screening. They need to have accurate knowledge about cervical cancer and screening to do this effectively. Therefore, the current study aimed to assess knowledge regarding cervical cancer screening among community health workers in Eswatini. A telephone survey of 172 community health workers from eight selected constituencies was conducted. Descriptive analyses were performed to assess participants' socio-demographic and service-related characteristics. Linear regression was applied to investigate factors associated with cervical cancer screening-related knowledge. One hundred and seven (62%) participants answered at least 80% of the questions correctly. However, knowledge regarding cervical cancer risk factors, the meaning of screening results and Eswatini cervical cancer screening guidelines was suboptimal. Community health workers aged 46-55 were more likely (ß = 1.27, 95% confidence interval [CI]: 0.39-2.15, p < 0.01) to have a higher cervical cancer screening knowledge score than those aged 30-45 years. Community health workers from Lubombo were marginally less likely (ß = -0.83, 95% CI: -1.80 to -0.04, p = 0.05) to have a higher knowledge score than those from Hhohho. This study suggests knowledge deficits amongst community health workers in Eswatini. Knowledge deficits may result in inaccurate information being communicated to clients. While increasing knowledge of these vital health workers may not be sufficient to increase cervical cancer screening rates in Eswatini, it is an essential first step that should be the focus of future educational efforts.

Community health workers in Eswatini have a role in educating women about cervical cancer screening. However, no previous study has investigated knowledge of cervical screening among community health workers in Eswatini. Therefore, we conducted a survey to assess community health workers' knowledge about cervical cancer screening. One hundred and seventy-two community health workers from eight selected constituencies were interviewed by telephone. Community health workers' knowledge about cervical cancer screening was relatively high. However, community health workers had limited knowledge about things that increase the chance of developing cervical cancer, the meaning of screening results, and Eswatini cervical cancer screening guidelines. Community health workers aged 46­55 years were more likely to be knowledgeable about cervical cancer screening than those aged 30­45 years. Furthermore, community health workers from Lubombo were marginally less likely to be knowledgeable about cervical cancer screening than those from Hhohho. This study suggests concerning knowledge gaps amongst community health workers in Eswatini. While increasing knowledge of these essential health workers may not be enough to increase the number of women getting screened in Eswatini, it is an essential first step that should be the focus of future educational efforts.

Trends in cervical cancer screening research in sub-Saharan Africa: A bibliometric analysis of publications from 2001 to 2020.

Sub-Saharan Africa has the highest incidence of cervical cancer globally. However, compared to developed countries, the region has lower uptake of cervical cancer screening. Research contribution and progress in the field of cervical cancer in the region has not been well investigated. This bibliometric review aimed to address this information gap by examining changes in research volume and type over a 20 year time frame. Medline, Embase, PsycINFO, CINAHL, and Cochrane Library were searched to identify peer-reviewed publications about cervical cancer screening in sub-Saharan Africa. Changes (from 2001 to 2020) in the (i) total publications, (ii) number and proportion of data-based publications relative to non-data-based publications, and descriptive relative to intervention publications, and (iii) the number and proportion of publications meeting the EPOC design criteria relative to those not meeting the EPOC design criteria were assessed using a generalised linear Poisson model, a generalised binomial model and the Pearson Chi-squared test respectively. A two-year increase in time was associated with an estimated 32 % increase in the total number of publications. While no measurement studies were recorded, the bulk of data-based publications (89 %) were descriptive studies. Relative to descriptive publications, a 1 % increase in the proportion of intervention publications was observed over time. Only a small proportion (28 %) of intervention studies met the EPOC design criteria. Our findings suggest that researchers and funders in the region should invest more effort and money in measurement and rigorous intervention research to inform outcome measures and cervical cancer screening policy and practice, respectively.

Improving knowledge, attitudes, and uptake of cervical cancer prevention among female students: A systematic review and meta-analysis of school-based health education.

OBJECTIVE: Schools are an ideal environment for promoting cervical cancer prevention among young women. This systematic review and meta-analysis aimed to examine: 1) the effectiveness of school-based education for improving i) knowledge and perceptions of cervical cancer, HPV infection and vaccination, and cervical cancer screening; ii) attitudes and intentions toward, and uptake of HPV vaccination and cervical cancer screening among female students; and 2) the methodological quality of studies testing school-based cervical cancer education. METHODS: Medline, EMBASE, CENTRAL, PsycINFO, CINAHL, Web of Science, and ERIC literature databases were searched from inception to November 2020. English language publications describing RCTs of any form of cervical cancer education delivered to female students in a school setting were eligible for inclusion. Included studies were assessed for methodological quality using the revised Cochrane risk of bias tool for randomized trials and the GRADE approach. Standardized Mean Differences and Odds Ratios were calculated and meta-analytically pooled using random-effects models. Subgroup analysis explored heterogeneity. RESULTS: Of the 13 included studies, only one study was judged overall as having a low risk of bias. School-based education improved knowledge about cervical cancer and HPV infection. It also improved knowledge of and intentions toward HPV vaccination. Although education was ineffective in improving cervical cancer and HPV infection risk perceptions, and attitudes about HPV vaccination, a subgroup analysis found printed education materials focused on HPV-related content may have significant positive effects on risk perceptions. School-based education did not significantly increase HPV vaccination uptake; however, a face-to-face active approach seemed beneficial in a subgroup analysis. Heterogeneity (I2) ranged between 0% to 93%, and the quality of evidence was rated from low to moderate. CONCLUSIONS: High-quality evidence from methodologically rigorous studies is needed to provide stronger guidance regarding the benefits of school-based education in improving knowledge and behaviours toward cervical cancer prevention.

Knowledge about epilepsy and factors associated with attitudes toward marrying, employing, and driving people with epilepsy: A cross-sectional survey of Asokore Mampong community dwellers in Ghana.

BACKGROUND: Due to lack of information and illiteracy, epilepsy remains a stigmatized disease in sub-Saharan Africa. OBJECTIVES: The main aim of the study was to determine, among community dwellers in Asokore Mampong Municipality (Ghana): (i) the knowledge on risk factors, signs and symptoms, management of epilepsy, and (ii) factors associated with attitudes toward marrying, employing, or driving people with epilepsy (PWE). METHODS: A cross-sectional study of 100 randomly selected individuals aged 18 years and older in Asokore Mampong Municipality was conducted in February 2019. A self-administered questionnaire was used to assess the knowledge about epilepsy and attitudes toward marrying, employing, and driving people with epilepsy. Frequencies and corresponding percentages were used to describe the study participants, their knowledge regarding epilepsy and attitudes toward marrying, employing, or driving people with epilepsy. Univariate and multivariate logistic regression analyses were used to determine the factors associated with attitudes toward marrying, employing, or driving people with epilepsy. RESULTS: Majority (33%) of the respondents indicated that epilepsy is caused by possession of evil spirits or witchcraft. More than 60% of the respondents correctly identified all signs and symptoms presented in the survey. Almost half (45%) of the respondents selected orthodox/medical treatment as the treatment for epilepsy. The odds of marrying PWE among Akans and Ewe/Ga Adangbe were 90% [adjusted Odds ratio (aOR) = 0.10, 95% CI: 0.01-0.67] and 84% lower [aOR = 0.16, 95% CI: 0.04-0.62] compared to odds of marrying PWE among Northerners, respectively. Compared to respondents with no formal education, the odds of employing PWE were 88% lower [aOR = 0.12, 95% CI: 0.03-0.40] among those with tertiary education. In addition, the odds of driving a person with an epileptic attack among Muslims/Traditionalists were 81% lower [aOR = 0.19, 95% CI: 0.05-0.68] than Christians. Respondents between 18 and 30 years old had more than 5 times higher odds of driving a person with an epileptic attack [aOR 5.28, 95% CI: 1.15-24.84] compared to respondents above 30 years. CONCLUSIONS: Individuals in Asokore Mampong have less knowledge about the risk factors and treatment of epilepsy. Generally, they have negative attitudes toward marrying, employing, and driving PWE. Findings from this study highlight the need to increase education to reduce the stigma associated with epilepsy. We recommend that a massive educational campaign should be organized by the Ghana Health Service to address deficiencies in knowledge as well as the negative attitudes toward PWE.