Abstract

Background: Cervical cancer screening rates remain disappointingly low in developing countries, largely due to inadequate knowledge and negative attitudes   toward the disease and its risk factors

Aim:  To assess the knowledge, assess the attitude and identify the proportion of sexually active women who have undergone cervical cancer screening.

Method: we carried out a hospital based cross-sectional study among sexually active females at the Buea Regional Hospital, Mount Mary Hospital and the Sub-divisional Hospital in Muea over a duration of 5 months from January 1st 2025 to May 31st 2025. Using a semi-structured questionnaire we collected data from 275 eligible participants and analyzed using Statistical package for social sciences version 26.

Results: The   mean age of the participants was 27.58 ± 5.66 years. About 38.9% of participants were aged 24-30, 48% were single and 48% had attained the university level of education. Most common cited source of information was the health facilities (38.5%), and the internet (27.4%) 53% correctly identified it as cancer of the cervix and regarding the causes, 47.9% correctly identified HPV infection, The majority of the participants (88.7%) agreed that cervical cancer screening is essential and only 21.2% of participants had ever undergone cervical cancer screening, and just 3.3% were doing so regularly. Overall, 47 (40.2%) participants demonstrated adequate knowledge of cervical screening , 52.7% of participants showed positive attitudes towards cervical cancer screening and  Only 29.5% of participants demonstrated good practice of cervical cancer screening.

Conclusion: More than half of sexually active women in the Buea Health District are not aware of cervical cancer screening. Enhance health education and awareness campaigns should be carried out in the Buea Health District to improve knowledge of sexually active women on cervical cancer screening.

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Cervical cancer is among the most common cancers globally, and ranks fourth for both incidence and mortality among all gynecological malignancies [1]. In 2024, the World Health Organization (WHO) estimated that over 604,000 women were diagnosed with cervical cancer, with an estimated 342,000 women dying from it [1].

Developing countries bear a disproportionate burden of the disease, experiencing age-standardized mortality rates that are twice those experienced in developed countries [2]. Sub-Saharan Africa (SSA), with its array of public health challenges, bears a larger portion of the burden [2], and in several countries in this region, cervical cancer is the leading gynecological malignancy [3].

The Global Cancer Observatory (GLOBOCAN) estimates show the disproportionate burden of cervical cancer across the different economic regions of the world, as well as the differences in relative mortality [4]. In some low and middle-income countries (LMICs), the current age-standardized incidence rates of cervical cancer are as high as 25 cases per 100,000 women, to 61.7 cases per 100,000 women in some countries, such as Zimbabwe [3].

Cameroon has one of the highest cervical cancer incidence rates in Africa, with an estimated 3504 new cases and 2046 deaths every year [4]. Limited healthcare infrastructures, inadequate screening programs, and low vaccination against Human Papillomavirus (HPV) contribute to the high burden of cervical cancer [[5]. Persistent infection with human papillomavirus (HPV) is the main etiologic factor for cervical cancer, and is responsible globally for more than 90% of cervical cancers [6]. Other risk factors, such as human immunodeficiency virus (HIV) infection,[7] oral contraceptive (OC) use,[8] and high-risk sexual behaviors [9] could have an effect either by influencing the acquisition of HPV infection or severely impairing the immune response after HPV infection. Nevertheless, prophylactic vaccination and screening are often recognized as the primary and secondary methods, respectively, for the prevention of cervical cancer [10].

Cervical cancer screening rates remain disappointingly low in developing countries, largely due to inadequate knowledge and negative attitudes   toward the disease and its risk factors [11]

Buea, a semi-urban center of the Southwest Region of Cameroon, is a microcosm of the country when it comes to cervical cancer knowledge and accessibility of healthcare. It is multicultural and consists of women who are different in socio-economic status, educational level, and cultures. Previous studies show that cervical cancer knowledge, its causation, and preventive practices continue to be poor among Cameroonian women, particularly in the rural and semi-urban population [12]. Cervical cancer screening is not on the agenda of most Buea women owing to financial constraints, fear of receiving a bad diagnosis, and gynecology check-up stigmatization. Lack of understanding of the vaccine against HPV has also hampered the use of this significant protective intervention [13].

1.2 Statement of the problem

Cervical cancer is a significant public health problem in Cameroon, and it is the leading cause of cancer-related deaths among Cameroonian women. Cervical cancer carries a significant burden in Cameroon, with a prevalence of up to 13.8%; based on a study carried out in the capital city Yaoundé [14] and 28.4% in the Buea Health District [15]

While extremely preventable by screening and treatment if diagnosed early, the coverage of cervical cancer screening is appallingly low [14]. It has been established that only about 3.5% of women of reproductive age in Cameroon have ever undergone cervical cancer screening [16].

In the Buea Health District, though some studies show a relatively higher degree of awareness, with 57.8% good knowledge regarding cervical cancer among women [16], there remains a gap between practice and awareness of screening. Factors such as lack of availability of screening services, cost, cultural beliefs, and misconceptions about the disease are contributing to this gap. Also, lack of awareness about the reality of the existence and need for screening programs further exacerbates the problem [13] The consequence of these problems is that the majority of women in Buea present with advanced stages of cervical cancer, whose treatment is limited, and whose prognosis is poor. This is a proof of the need to urgently assess and enhance the level of awareness and information on cervical cancer among women in this group.

1.3 Research Questions

1. What is the knowledge of cervical cancer screening among sexually active women in the Buea Health District?
2. What is the attitude of sexually active women towards cervical cancer screening in the Buea Health District?
3. What proportion of sexually active women in the Buea Health District have undergone cervical cancer screening among?

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