Factors influencing utilization of cervical cancer screening services by women at selected clinics of Lusaka urban district of Zambia

Abstract

Zambia has one of the highest cervical cancer incidence and mortality rates in the world due to under-utilization of cervical cancer screening service (CCSS). Lusaka urban district is privileged to have a lot of screening centres, yet the debate is whether, having the screening programme, has impacted on all women aged 18 years and above, as low utilisation rates have been recorded. It is evident from the statistics that women in Lusaka have not been utilizing the service, as the number of women who so far have accessed the service is still very low, at about 3% coverage. The aim of this study was to evaluate the factors that influence utilization of cervical cancer screening services by women in Lusaka urban district. This study was a non-interventional, descriptive cross-sectional study comprising of 368 respondents from four clinics. A multi stage sampling technique was used where the study population of women were chosen using the simple random sampling technique. The clinics were chosen using the fishbowl technique of sampling. The data was collected using a semi structured interview schedule. Data was processed and analysed using Statistical Package for Social Sciences (SPSS) version 22. Descriptive statistics was used to describe data. Furthermore, chi-square test was used to test associations between the outcome variable (utilisation) and other independent variables. The statistical significant level was set at confidence interval of 95%. Logistic regression analysis was also performed. The study, established that most respondents, 313 (84.6%) had heard of cervical cancer screening before but only 26% out of the 84.6% knew what it was. However, 148 (40%) had utilised the service before, of these 7 (5%) respondents went for screening willingly and 141 (95%) screened after observing a problem. In-line with attitudes 250 (67.9%) respondents were not interested in screening. Cultural beliefs, busy schedules and fear were the most common reasons women gave for not screening. There was an association found between utilisation and social demographic characteristics such as education level, age and employment status, with p values of 0.05, 0.008 and 0.003 respectively. Possible interventions included, good prompt and creative health education as important activities that should be rendered to all women. However, the study discovered that the knowledge levels of the women were low in relation to the utilization levels. There is need, therefore, to intensify efforts on promoting awareness towards cervical and screening of cervical cancer. When cervical cancer is found early, it is highly treatable and associated with long survival and good quality of life. Keywords: Attitude, Cervical cancer screening, Knowledge, Utilization and Women.