Cervical cancer is the most common genital cancer and leading causes of death among female population. Fortunately, this cancer is preventable by screening for premalignant lesions but this is rarely provided and in case of provision it is hardly utilized [1]. Cancer is increasingly growing as a major public health problem in both developed and developing countries but it is rapidly increasing in low and middle-income countries, where resources for prevention, diagnosis and treatment are limited or non-existent, amongst the chronic diseases that impose health, heavy economic and social burden [2]. Breast and cervical cancers are the leading cancers among women in developing countries, with estimated annual new cases of 882,900 and 444,500 respectively. More than 324,300 and 230,400 women die from these cancers every year, respectively. Globally, the number of new cases and deaths from cervical cancer is projected to continue to rise 720,415 and 394,905 respectively in 2025 [3]. Cervical cancer is regarded as the second most common female cancer in Nigeria with an estimated 14,089 cases diagnosed annually [4]. It ranks third among the most common cancers affecting women the world over with an estimated 529,000 new cases in 2008, 85% of which were recorded in the developing world. Cervical cancer contributes to 20 to 25% of all cancers among women in sub-Saharan Africa, about twice the percentage in women worldwide [5]. According to the latest global estimates, 493,000 new cases occur each year and 274,000 women die of the disease annually [6]. According to the American Cancer Society, Cancer is the second most common cause of death in the US and accounts for nearly 1 of every 4 deaths. The World Health Organization estimates that worldwide, there were 14 million new cancer cases and 8.2 million cancer-related deaths in 2012. Cervical cancer is a leading cause of cancer death in women in the developing countries. A key factor linked to the relatively high level of cervical cancer in these populations is the lack of awareness and access to preventive method [7].

In the developing countries of the world, a large proportion of cervical cancers are diagnosed in advanced stages, with poor rates of survival. Cervical screening is the best cancer screening test in the history of medicine and most cost effective of all medical screening tests [8]. 

Abiodun et al. [9], in their study identified that there is still low level of awareness for cervical cancer (22.6%) and its screening test (17.9%). Similarly, Aweke et al. [10], discovered 88% correctly perceived cervical cancer to  be preventable and only 32.6% had ever have cervical cancer screening done and main reasons for non-use included lack of time (50.8%), fear of result (13.9%) and not being sexually active (6.3%). Ifemelumma et al. [11] findings showed good knowledge of cervical cancer as all (388) were aware that cervical cancer is a preventable disease but utilization was poor (20.6%). The most common reason for non-screening was that they have not thought of it (28.4%). On the contrary, Toye et al. [5], revealed that 100.0% of the respondents had good knowledge of cervical cancer, more than half of the women (67.0%) have had at least one cervical cancer screening done previously. Study by Aweke et al. [10] shows that most of the women had poor knowledge and had not undergone screening for cervical cancer. Similarly, another study carried on knowledge attitude and practices related to cervical cancer among women shows that despite the fact that women had suboptimal level of knowledge regarding cervical cancer, their attitude is favorable for screening. However, uptake is low in actual practice [11].

Cervical cancer has been identified to still have high incidence rate among women and most of the cases are diagnosed at advanced stage. Hence, there is need to assess the perception and acceptance of cancer screening services among women of child bearing age attending postnatal clinic in Ifako-Ijaiye General hospital, Lagos.

Research Design

A non-experimental descriptive research design was adopted to assess the perception and acceptance of cervical cancer screening among child bearing age women attending postnatal clinic in Ifako-Ijaiye General Hospital, Lagos state, Nigeria.

Sample Size and Sampling Technique

The sample size was derived using the Fischer's formula 1935;

Sample size (n) = Z²pq/d²

Where;

n= the sample size

p= the proportion of the disorder in the study population i.e. 67.3% of women were not using Cervical cancer screening (only 32.7% have been screened [1]) =0.673

q=1-p; 1-0.673

q=0.337

Z=standard normal deviate at 95% confidence interval corresponding to 1.96

d=degree of accuracy set at 0.1

n= (1.96)² (0.673) (0.337) / (0.1)²

n = 3.8416*0.226801/0.01

n=0.871279/0.01

n=87.12

Purposive non-probability sampling technique will be used to select 87out of total population of 230 women of child bearing age attending postnatal clinic.

Method of Data Analysis

A total of 87 questionnaires were distributed, 80 was dully filled and returned for analysis, which was assessed for completeness, coded and entered into computer for analysis using Statistical Package of social sciences (SPSS) version 20, research questions were presented using descriptive statistics (tables, frequencies and percentages), while hypothesis was analyzed using Pearson correlation coefficient.

The demographic results shows that majority (40%) of the respondents were between the age of 25 -34 years, while just 5% were between 45-54 years, also, 55% of the respondents are Christians, 70% are married, 70% are Yoruba, 40% of the respondents are first degree holders, 70% of the respondents have 1 or 2 children (Table 1).

Table 1: Respondents Demographic Variables

Majority 69 (86%) of the respondents claimed that cervical cancer is preventable, 70 (88%) of the respondents are of the opinion that screening services help to prevent cervical cancer. 68 (85%) of the respondents are of the opinion that screening services should be carried out as soon as sexual intercourse is initiated. 73 (91%) of the respondents are of the opinion that it is necessary that every woman should undergo cervical cancer screening irrespective of being sexually or not sexually exposed. 40 (50%) of the respondents are of the opinion that cervical cancer screening should be carried out yearly, 73(91%) opined all women are prone to cervical cancer and 65 (82) believe that cervical cancer is very severe (Table 2).

Table 2: Respondents response on perception on the use of screening services

About 35 (44%) of the respondents claimed they have undergone cervical cancer screening exercise, 16 (47.1%) did last year while 16 (47.1%) did it more than five years. Majority of the respondents 21 (61.8%) of those that went for the cervical cancer screening service claimed they were satisfied with the procedure, 21 (61.8%) of them has just done it once, 56.8% agreed they will soon return for the procedure again, 70 (87.5%) accepted that cervical cancer screening can reduce cervical cancer deaths (Table 3).

Table 3:   Respondents use of cervical cancer screening service

Majority 30 (37.5%) said the fear of results prevented them from going for cervical screening (Table 4). 

Table 4: Respondents response on factors that affect cervical cancer screening acceptance 

While 66 respondents strongly agreed that screening should be made free in Government hospitals, privacy and confidentiality should be paramount as strongly agreed by 67 respondents and 70 stated that pain relief should be given after the procedure (Table 5).

Table 5:   Ways of improving acceptance of cervical cancer screening

The study on perception and acceptance of cervical cancer screening among women of child bearing age attending postnatal clinic in Ifako- Ijaiye General Hospital, Lagos state. Out of a total of 87 questionnaire that were distributed, 80 was duly filled and returned for analysis, given a response rate of 90%.

The age range of respondents were 25-34 years with a percentage of 40% this is similar to the findings of Oluwole et al. [6] also, the age group used in this survey is in line with the American Cancer Society which recommends that all women should begin a cervical screening on or before 21 years of age because sexual intercourse has been found to have started in most women at this age [8].

Women perception of cervical cancer screening service as shown in this study, reveals that there is a good perception towards the use of screening services. It was found out that 86% of respondents claimed that cervical cancer is preventable while 88% agreed that screening exercise help to prevent cervical cancer this is similar to the findings of similarly, Nwabichie et al. [2] discovered 88% correctly perceived cervical cancer to be preventable. Ifemelumma et al. [11] findings showed good knowledge of cervical cancer as all (388) were aware that cervical cancer is a preventable disease, Toye et al. [5], revealed that 100.0% of the respondents had good knowledge of cervical cancer, on the contrary, other studies still reveals poor knowledge and uptake is low in actual practice [10,12].

On the acceptance of cervical cancer screening services, 56% of the respondents have not undergone a cervical cancer screening procedure, this agrees with studies done by Abiodun et al. [9], in their study identified that there is low uptake screening test (17.9%), Aweke et al. [10] only 32.6% had ever have cervical cancer screening done, Ifemelumma et al. [11], poor utilization was recorded also, (20.6%). But on the contrary, Toye et al. [5], revealed that more than half of the women (67.0%) have had at least one cervical cancer screening done.

However, factors that could affect utilization of screening methods are Lack of time (25%), fear of result (37.5%), cumbersome procedure (18.8%), cost consideration (12.5%) while other factors not stated was 6.3%, Ngwogu et al. [13] identified lack of time (50.8%), fear of result (13.9%) and not being sexually active (6.3%) while Ifemelumma et al. [11], identified that they have not thought of it (28.4%). Chizoma and Bola [7], low level of awareness of services, embarrassment and possible violation of privacy, lack of spousal support, societal stigmatization, cost of accessing services and health services, factors like proximity facility, facility navigation waiting time and health care personnel attitude. In addition, test of hypotheses using inferential statistics of Pearson Product moment correlation revealed that there is statistically significant relationship between age of respondents and perception of screening services with r-calculated value of 0.63 at 0.05 level of significant; the null hypothesis was rejected. However, it was revealed that there is a statistically significant relationship between the parity and acceptance of screening services with r-calculated value of 0.59 at 0.05 level of significance, the null hypothesis stated was rejected.

In conclusion, cervical cancer screening test has been proven effective in detecting cervical abnormalities and thus allow for early treatment, this study identified that these women had good perception towards the use of screening services but uptake of screening still remains low. Hence the need to intensify sensitization programs on the benefits of cervical cancer screening, screening services should be made available, accessible and affordable to the women while sustaining awareness campaigns.

Ethical Approval

Ethical permission was obtained from Babcock University Health Research Ethics Committee, then letter of introduction was obtained from Dean and taken to authorities in the hospital and their consent gained. An informed consent was obtained from respondents and confidentiality ensured. The right to refusal was also be explained to the respondents.

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2. Nwabichie, C.C. et al. “Global burden of cervical cancer: a literature review.” International Journal of Public Health and Clinical Sciences, vol. 4, no. 2, 2017, pp. 43-52.

3. Kumar, H.N.H. and T. Shubham. “A study on knowledge and screening for cervical cancer among women in Mangalore city.” Annals of Medical and Health Science Research, vol. 27, no. 6, 2014, pp. 26-32.

4. Bruni, L. et al. Human Papillomavirus and Related Diseases in Nigeria. ICO Information Centre on HPV and Cancer, October 2016. Accessed 23 December 2017.

5. Toye, M.A. et al. “Knowledge, perceptions and practice of cervical cancer prevention among female public secondary school teachers in Mushin Local Government Area of Lagos State, Nigeria.” Pan African Medical Journal, vol. 25, no. 6, 2017, pp. 15-22.

6. Oluwole, E.O. et al. “Cervical awareness and screening uptake among rural women in Lagos, Nigeria.” ResearchGate, 2017, www.researchgate.net/publication. Accessed 23 December 2017.

7. Chizoma, M.N. and A.O Bola. “Awareness, perception and factors affecting utilization of cervical cancer screening services among women in Ibadan.” Reproductive Health, 2012, https://doi.org/10.1186/1742-4755-9-11. Accessed 18 January 2018.

8. Abia, N. “Cervical cancer as an icon of hope and hopefulness.” Committee Encouraging Corporate Philanthropy (CECP) Nigeria, 2015, www.cecpng.org/?p=1352. Accessed 27 December 2017.

9. Abiodun, A.B. et al. “Awareness and perception of risk for cervical cancer among women in Ogbomoso, Nigeria.” Tropical Journal of Obstetrics and Gynaecology, vol. 34, no. 8, 2017, pp. 218-223.

10. Aweke, H.Y. et al. “Knowledge, attitude and practices for cervical cancer prevention and control among women of childbearing age in Hossana Town, Hadiya Zone, Southern Ethiopia.” PLOS ONE, 2017, https://doi.org/10.1371/journal.pone.0181415. Accessed 25 January 2018.

11. Ifemelumma, C.C. et al. “Cervical cancer screening: assessment of perception and utilization of services among health workers in low resource setting.” International Journal of Reproductive Medicine, 2019, pp. 18-25.

12. Owoeye, I.G.O. and I.A. Ibrahim. “Knowledge and attitude towards cervical cancer screening among female students and staff in a tertiary institution in the Niger Delta.” International Journal of Medicine and Biomedical Research, vol. 2, no. 1, 2013, pp. 48-56.

13. Ngwogu, K.O. et al. “Prevalence of squamous cell carcinoma among cervical cancer.” International Journal of Community Research, 2014, www.arpjournals.com. Accessed 18 November 2017.