Cervical cancer is one of the gravest threats to women’s lives. Worldwide, currently, it is estimated that over a million women have cervical cancer. Most of these women have not been diagnosed, nor they have access to treatment that could cure them or prolong their lives [
Cervical cancer is the fourth most common cancer in women, and seventh overall, with an estimated 528,000 new cases worldwide. A majority (around 85%) of the global burden occurs in the less developed regions. There are about 266,000 deaths from cervical cancer worldwide that accounts for 7.5% of all female cancer deaths. Almost nine out of ten (87%) cervical cancer deaths occur in less developed regions [
In sub-Saharan Africa, 34.8 new cases of cervical cancer are diagnosed and 22.5 die per 100,000 women annually [
According to the American Cancer Society Report, risk factors for cervical cancer include sexual intercourse at an early age, multiple sexual partners, tobacco smoking, long-term oral contraceptive use, low socioeconomic status, immunosuppressive therapy, and micronutrient deficiency [
The main strategies of cervical cancer prevention are immunization of human papilloma virus (HPV) vaccine and screening for cervical cancer to detect and remove cancerous lesions. Regular screening and early treatment highly decrease the incidence of cervical cancer. To reduce the incidence and mortality associated with the disease, early screening and treatment as part of targeted interventions is mandatory. So, concrete evidence is crucial for the development of strategies, policy, and planning. But there are very limited studies conducted in the country to assess the utilization of cervical cancer screening. Therefore, this study is aimed at assessing cervical cancer screening service utilization and associated factors among women of 30-49 aged in the Shabadino district, Ethiopia.
This study was conducted in the Shabadino district, Sidama zone, Southern Ethiopia. The district comprises 35 rural kebeles. It is 27 kilometers way from Hawassa, the capital city of the southern region. As shown from the estimated projection of 2007 Central Statistical Agency [
The study population included women whose age ranged from 30 to 49 years in the Shabadino district in the past one year, whereas women with a history of cervical and/or uterus removal and who are positive for cervical cancer were excluded.
The sample size was determined using a single population proportion formula based on assumptions of 95% confidence interval, utilization of cervical cancer screening from a previous similar population study, which was 19.8 [
The sample size was 244, and due to the multistage sampling technique, the design effect applied by multiplying with 2 and 10% of nonresponse rate was added to get the final sample size of 536.
Among the total 35 kebeles found in the Shabadino district, 11 kebeles were selected by a simple random sampling technique. Then, 536 households were selected using a systematic random sampling technique and the total sample size was allocated proportionate selected kebele to the size of their households.
Based on the national plan of 2007, the projected estimate of the district comprised 10,568 households in eleven selected kebeles. Therefore, the sampling interval of households in each kebele was determined by dividing the number of households to the allocated sample size of the respective kebeles. The initial household was selected randomly by a lottery method. The subsequent households included in the study were identified by systematic random sampling through house-to-house visit after nominating and adding the sample interval to each household with the pervious number till the total number of sample size was achieved. If there was a household with more than one eligible woman, one woman was randomly selected using the lottery method. Then, the objective of the study was explained by the data collector and consent was asked to participate in the study.
The questionnaire was prepared in English and translated to “SidamuAfoo” and retranslated to check its consistency. All were trained for three days on the objective of the study, the contents of the questionnaire, the issues related to the confidentiality of the response, and the right of the respondents. Close supervision was conducted during the process of data collection, and questionnaires were checked for consistency and completeness.
After data collection was completed and questionnaires were edited and coded, the data were entered into a computer and processed by using the Statistical Package for the Social Sciences (SPSS) version 22.0 for further analysis. Descriptive statistics like frequency, percentage, and mean with standard deviation were used to describe the study population in relation to relevant variables. Binary logistic regression analysis with a 95% confidence interval was used to assess the eligible variable for the multivariable analysis model. And variables that had a significant association with the outcome variable at
Cervical cancer screening utilization was assessed by asking the respondent’s action towards screening for cervical cancer within one year. Those who screened within the past one year were categorized as having
The scores of the knowledge base item questions were computed, and a score greater than the mean score was considered
From a total of 536 selected eligible women, 506 have participated in the study with the response rate of 94%. The mean age of participants was 37 (± 5.3 SD) years (Table
Sociodemographic characteristics of respondents in the Shabadino district, Sidama Zone, Ethiopia, 2018 (
Variables | Frequency | Percentage (%) |
---|---|---|
Age group | ||
30-34 | 178 | 35.2 |
35-39 | 193 | 38.1 |
40-44 | 85 | 16.8 |
45-49 | 50 | 9.9 |
Religion | ||
Orthodox | 45 | 8.9 |
Protestant | 403 | 79.6 |
Muslim | 54 | 10.7 |
Catholic | 4 | 0.8 |
Ethnicity | ||
Sidama | 447 | 88.3 |
Amara | 42 | 8.3 |
Silite | 7 | 1.4 |
Wolayita | 10 | 2 |
Marital status | ||
Single | 5 | 1 |
Married | 468 | 92.5 |
Divorced | 15 | 3 |
Widowed | 18 | 3.5 |
Educational status | ||
Non-formal education | 185 | 36.6 |
Primary education | 239 | 47.2 |
Secondary school | 64 | 12.6 |
College and above | 18 | 3.6 |
Occupation | ||
Housewife | 421 | 83.2 |
Self-employed | 70 | 13.8 |
Government employee | 15 | 3 |
Household monthly income | ||
<900 | 146 | 28.9 |
901-1600 | 258 | 51 |
1601-2700 | 83 | 16.4 |
>2700 | 19 | 3.7 |
Almost all (503, 99.4%) of the participants had sexual intercourse, and among them, 430 (85%) had their first sexual intercourse at the age of 18 and above (Table
Sexual and reproductive characteristics of respondents in the Shabadino district, Sidama Zone, Ethiopia, 2018 (
Variables | Frequency | Percentage (%) |
---|---|---|
Used COC pills | ||
No | 327 | 64.6 |
Yes | 179 | 35.4 |
Had history of STI | ||
No | 387 | 76.5 |
Yes | 119 | 23.5 |
HIV test | ||
No | 126 | 24.9 |
Yes | 380 | 75.1 |
Serostatus | ||
Negative | 392 | 77.5 |
Positive | 114 | 22.5 |
Had given birth | ||
No | 8 | 1.6 |
Yes | 498 | 98.4 |
Age at first sexual intercourse | ||
<18 | 89 | 17.6 |
≥18 | 417 | 82.4 |
Multiple sexual partners | ||
No | 446 | 88.1 |
Yes | 60 | 11.9 |
From the study participants, 321 (63.4%) had heard about cervical cancer. Of those who had heard about cervical cancer, 293 (58%) knew about its risk factors, 215 (42.5%) knew about its symptoms, and 150 (29.5%) knew about its methods of prevention.
Concerning their source of information about cervical cancer, mass media was the most common source of information preceding by health workers and health extension workers. Two hundred two (39.9%) of the respondents have good knowledge, and 304 (60.1%) have poor knowledge about cervical cancer prevention.
The prevalence of cervical cancer screening utilization was found to be 52 (10.3%).
On bivariate analysis, factors found to be significantly associated with utilization of cervical cancer screening service were educational status, household monthly income, hearing about cervical cancer, history of the sexually transmitted disease, HIV test, multiple sexual partners, knowing the causes of cervical cancer, and knowing the prevention methods of cervical cancer.
After controlling for confounders using the multivariate analysis model, educational status, history of sexually transmitted disease, and multiple sexual partners were significantly associated with the cervical cancer screening service utilization.
This study revealed that the educational level has a significant association with the cervical cancer screening utilization; women who attended primary education and above were about 2 times more likely to utilize cervical cancer screening service than those who had never attended any formal education (
Women who have a history of sexually transmitted disease were about 2.6 times more likely to utilize cervical cancer screening when compared to those who have no history of sexually transmitted disease (
Women who have a history of multiple sexual partners were 4 times more likely to utilize cervical cancer screening when compared to those who have a single partner (
Regarding the knowledge status, women who knew that cervical cancer is a preventable disease were 4.3 times more likely to utilize cervical cancer screening service than those who do not know that cervical cancer is a preventable disease (
Bivariate and multivariate analyses of factors associated with cervical cancer screening utilization among women in the Shabadino district, Sidama Zone, Ethiopia, 2018.
Variables | Cervical cancer screening utilization | COR (95% CI) | AOR (95% CI) | ||
---|---|---|---|---|---|
Yes | No | ||||
Age group | |||||
30-34 | 17 | 160 | 1 | ||
35-39 | 22 | 171 | 1.14 (0.62-2.36) | ||
40-44 | 7 | 77 | 0.92 (0.34-2.15) | ||
45-49 | 6 | 46 | 0.77 (0.46-3.29) | ||
Educational status | |||||
Non-formal education | 9 | 191 | 1 | 1 | |
Primary education | 20 | 212 | 2.00 (0.89-4.50) | ||
Secondary school | 19 | 42 | 9.60 (4.06-22.70) | 1.89 (1.18-3.05) | 0.009 |
College and above | 4 | 9 | 9.43 (2.44-36.54) | ||
Occupation | |||||
House-wife | 38 | 383 | 1 | ||
Self-employed | 9 | 62 | 1.46 (0.67-3.17) | ||
Governmental employee | 5 | 9 | 5.6 (12) | ||
Had history of STI | |||||
No | 27 | 360 | 1 | 1 | |
Yes | 25 | 94 | 3.55 (1.97-6.39) | 2.57 (1.26-5.23) | 0.021 |
Age at first sexual intercourse | |||||
<18 | 27 | 621 | |||
≥18 | 25 | 392 | 0.15 (0.08-0.27) | ||
Have history of multiple sexual partners | |||||
No | 414 | 32 | 1 | 1 | |
Yes | 40 | 20 | 6.5 (3.39-12.34) | 4.01 (1.86-8.66) | 0.001 |
Knew the prevention methods of cervical cancer | |||||
No | 341 | 15 | 1 | 1 | |
Yes | 113 | 37 | 7.4 (3.94-14.07) | 4.34 (1.18-3.05) | 0.001 |
This community-based study was conducted to assess the level of cervical cancer screening service utilization and its associated factors among women in the Shabadino district, Sidama Zone, Southern Ethiopia.
This study revealed that only 52 (10.3%) of respondents had screened for cervical cancer. This result was low compared to studies done in different parts of Ethiopia which were 15.5%, 16.5%, 22%, and 25% [
The factors associated with the utilization of cervical cancer screening were educational status of the woman, presence of sexually transmitted diseases, presence of multiple partners, and knowledge of risk and prevention methods of cervical cancer.
Educational status was significantly associated with the utilization of cervical cancer screening. Women who attended primary school and above were 2 times more likely to utilize cervical cancer screening service compared to those who did not attend any formal education. This finding was consistent with the study done in Addis Ababa, Ethiopia [
The presence of sexually transmitted diseases was significantly associated with cervical cancer screening service utilization. Women who have a history of sexually transmitted diseases were 2.6 times more likely to be screened for cervical cancer than those who have no history of sexually transmitted diseases. This result is consistent with the study findings in different parts of Ethiopia [
Having multiple sexual partners was identified as a risk factor for cervical cancer screening utilization. Our study revealed that women who have a history of multiple sexual partners were 4 times more likely to utilize cervical cancer screening compared to those who have a single partner. The result is supported by studies done in Ethiopia and Malawi [
Knowledge on prevention methods of cervical cancer was found to be significantly associated with cervical cancer screening utilization. This study also showed that women with good knowledge of prevention methods of cervical cancer have a higher chance of cervical cancer screening utilization compared to those with poor knowledge. This result was similar to studies conducted in Hossana, Addis Ababa (Ethiopia), and Nigeria [
This study involved a sensitive matter that may be subjected to social desirability bias. Meanwhile, the procedure to screen for cervical cancer and precervical lesion was similar for the women. The study participants may face difficulty to differentiate the type they are screened for.
The study revealed that the magnitude of cervical cancer screening service utilization among women was very low. Educational status, history of multiple sexual partners, presence of sexually transmitted diseases (STDs), and knowledge about prevention methods were significant factors associated with cervical cancer screening service utilization.
Adjusted odds ratio
Crude odds ratio
Cervical Cancer Prevention and Control
Cervical intraepithelial neoplasia
Ethiopian birr
Federal Democratic Republic of Ethiopia
High-income countries
Human papilloma virus
International Agency for Research on Cancer
Low- and middle-income countries
National Cervical Cancer Prevention Program
Statistical Package for the Social Sciences
Sexually transmitted infection
Visual inspection with acetic acid
Visual inspection with Lugol’s iodine
World Health Organization.
All the data supporting the findings is contained within the manuscript.
Ethical clearance was obtained from the IRB of Madda Walabu University, Goba Referral Hospital. An official letter of permission was also obtained from the respective administrative district office.
Each respondent provided written and verbal consent before data collection has been carried out. Names of the respondents were not used to ensure anonymity and confidentiality.
The authors declare that they have no competing interests.
The contributions of the authors involved in this study are as follows: JK and AK: conceived and designed the study; JK, AK, BK, and HB: analyzed the data; and JK, AK, BK, and HB: prepared the manuscript. All authors read and approved the final manuscript before submission for publication.
Our especial gratitude goes to Southern Nations Nationalities and Peoples Regional Health Bureau and health institutions for their kind cooperation and continuous support. Finally, we would like to extend our gratitude to the study participants, data collectors and supervisors.