DOI: 10.3886/e112185
title: Knowledge and awareness of cervical cancer in Southwestern Ethiopia is lacking: a descriptive analysis

description: Purpose <br> Cervical cancer remains the second most common cancer and cancer-related death among women in Ethiopia. This is the first study, to our knowledge, describing the demographic, and clinicopathologic characteristics of cervical cancer cases in a mainly rural, Southwestern Ethiopian population with a low literacy rate to provide data on the cervical cancer burden and help guide future prevention and intervention efforts. Methods <br>A descriptive analysis of 154 cervical cancer cases at the Jimma University Teaching Hospital in Southwestern Ethiopia from January 2008 – December 2010 was performed. Demographic and clinical characteristics were obtained from patient questionnaires and cervical punch biopsies were histologically examined. <br>Results Of the 154 participants with a histopathologic diagnosis of cervical cancer, 95.36% had not heard of cervical cancer and 89.6% were locally advanced at the time of diagnosis. Moreover, 86.4% of participants were illiterate, and 62% lived in a rural area. <br>Conclusion A majority of the 154 women with cervical cancer studied at the Jimma University Teaching Hospital in Southwestern Ethiopia were illiterate, had not heard of cervical cancer and had advanced disease at the time of diagnosis. Given the low rates of literacy and knowledge regarding cervical cancer in this population which has been shown to correlate with a decreased odds of undergoing screening, future interventions to address the cervical cancer burden here must include an effective educational component.
description: Not applied.
description: Response Rates: A total of 240 women presented with various gynecological complaints to the outpatient clinic from January 2008 – December 2010. Eighty six women were excluded: 30 of these women had a diagnosis other than cervical cancer such as cervicitis or a cervical polyp but their remaining data was insufficient to analyze; the remaining 56 women were excluded due to an uninterpretable or equivocal biopsy. This left 154 cases to be analyzed
description: Presence of Common Scales: A Likert-type scale was used
description: face-to-face interview~~on-site questionnaire~~Verbal/oral consent was only able to be obtained as opposed to written consent given that a significant proportion of the study population was not literate. The verbal/oral consent was recorded by the residents who were interviewing the subjects/performing the procedure onto individual survey sheets, which were then transcribed into a central document. Data was collected by residents in the Department of Obstetrics and Gynecology who were informed regarding the study parameters and were in charge of the outpatient service on a rotation basis. All non-pregnant women with cervical lesions were invited to participate during the study time period. The patients were informed about the indications, contraindications, and alternative options of undergoing a cervical punch biopsy to recognize any cervical pathology. Oral consent was obtained from each case before the interview, punch biopsy procedure and data collection for participation in the study. Then each patient was interviewed using a standardized questionnaire to extract information regarding additional clinical features, sociodemographic characteristics, maternity history, and knowledge about cervical carcinoma, amongst others. Questionnaires were collected weekly and checked for adequacy - those with inadequate data (missing data or unrecognizable responses) were excluded. Pelvic examination was conducted to characterize the cervical lesion(s) and determine the clinical stage. Thorough speculum examination of the cervix was performed to describe any lesion(s) and subsequently a four quadrant punch biopsy of the cervix was taken. The biopsy material was preserved in 10% formaldehyde and submitted to the Department of Medical Laboratory Sciences and Pathology. In the Department of Pathology the formalin fixed tissue was embedded in paraffin, sections were cut and subsequently stained as described. From each case, four microscopic slides were prepared – one remained in the Department of Pathology for clinical management and three were used for the current study. The slide used for clinical management was stained with hematoxylin and eosin (H&E) and diagnosed by a pathologist in the Department of Pathology according to the World Health Organization histological classification of tumors of the uterine cervix and this pathologic report was recorded and relayed to the physician specific to the case for clinical care. The H&E study slides were identified by the biopsy and code number assigned by the initial physician on the biopsy request sheet and questionnaire and were submitted for diagnosis to a pathologist from Touro University California who was blinded regarding the case for quality control. If there was disagreement in the reports between the slide used for clinical management and the second observer report, the slide was given to a third pathologist and the agreement of the two pathologists was taken as the gold standard report to be recorded. Data was initially entered into Microsoft Excel after which it was coded and analyzed using STATA 15.0 software. Data cleaning was performed only in the form of eliminating missing data so as to improve accuracy, and descriptive statistics were subsequently used to summarize all variables.
description: Non-pregnant women attending the Jimma University Teaching Hospital Department of Obstetrics and Gynecology outpatient clinic who had evidence of cervical lesions on initial pelvic examination.Smallest Geographic Unit: Ethiopia
description: Non-pregnant women who had evidence of cervical lesions on initial pelvic examination. A total of 240 women presented with various gynecological complaints to the outpatient clinic from January 2008 – December 2010. Eighty six women were excluded: 30 of these women had a diagnosis other than cervical cancer such as cervicitis or a cervical polyp but their remaining data was insufficient to analyze; the remaining 56 women were excluded due to an uninterpretable or equivocal biopsy. This left 154 cases to be analyzed