PREVALENCE AND KNOWLEDGE OF ORAL SEX AS A RISK FACTOR OF ORAL CANCER AMONG NURSING STUDENTS IN IBADAN METROPOLIS, NIGERIA Kanmodi KK1, Aladelusi TO1, 2, Amoo BA1, Sopeju A3   1Cephas Health Research Initiative, Inc, Ibadan, Nigeria 2Department of Oral and Maxillofacial Surgery, University of Ibadan, Nigeria 3Department of Virology, University of Ibadan, Nigeria

INTRODUCTION Cancer is one of the leading causes of death all over the world (Stewart BW and Kleihues, 2003) Oral cancer, which is the most common cancer of the head and neck region, ranks eighth among the most prevalent cancers in the world [2,3] The incidence rate of oral cancer varies across different countries, and it ranges from 0.1 to 31.5 per 100,000 persons per year, with higher prevalence reported in the developing countries [1,5-7].

INTRODUCTION (CONT’D) In Nigeria, the incidence rate of oral cancer cannot be ascertained, due to the very high population – dentist ratio, inadequate hospital facilities, and poorly structured national cancer registries [8,9]. In 2005, an average rate of 20 cases of oral cancer was reported to be seen yearly in a government hospital in the city of Maiduguri, North-eastern Nigeria [8]. I Oral cancer constituted 2.7% of all cancer cases seen at the University of Nigeria Teaching Hospital, Enugu State, South-eastern Nigeria in 2007 [10]. The incidence of oral cancer has been known to be directly related to risky behaviours such as oral sex, cigarette smoking, consumption of smokeless tobacco, and alcohol [11-13]. Human Papilloma Virus (HPV) has been found to be involved in the pathogenesis of many of the emerging oral cancer cases, particularly among the young adults [14,15].

JUSIFICATION There is very little literature evidence about the prevalence of oral sex in Nigeria and other sub-Saharan African countries [18]. Studies have reported nursing students as one of the high risk groups of young adults for contracting sexually transmitted infections due to risky sexual behaviours (RSBs) that is prevalent among them [21-25]. Furthermore, the knowledge of the risk factors and clinical manifestations of oral cancer has also been found to be inadequate among some nursing students, and even among hospital nursing officers [26-28]. This study was conducted to determine the prevalence of oral sex, the awareness of the risk factors for oral cancer, and the knowledge of the common symptoms of oral cancer among nursing students in the metropolitan city of Ibadan, Oyo State, South-western Nigeria.

Materials and methods Study Design This research was a descriptive cross-sectional study. Study Setting This study was conducted among nursing students in three conveniently selected nursing schools in Ibadan, Oyo state, Nigeria. Ethical Considerations Approval was obtained from the ethical review committee of the Ministry of Education, Ibadan, Nigeria. Informed verbal consent was also obtained from all participants, and their participation was anonymous

Both open-ended and close-ended questions. Study Tool The study tool used was a pre-tested, anonymous 14–item questionnaire, and it obtained information about: the bio-data, sexual behaviours, awareness of oral sex and other risk factors for oral cancer, and the common clinical symptoms of oral cancer from each of the study participants Both open-ended and close-ended questions.

Data Collection and Analysis The study participants were approached in their various classrooms, and informed consent was sought from them Only 158 nursing students volunteered to participate. All questionnaires were self-administered and returned back to the researchers. No questionnaire was discarded because they were all appropriately filled. Data collected was entered into the SPSS version 16 software for analyses using descriptive statistics. The arithmetic mean, standard deviation, and frequencies were obtained and illustrated using tables and charts

RESULTS The majority (83.5%) of our respondents were ≤ 25years, and 126 (79.1%) were females (Table 1). Only 39 (24.69%), out of all our respondents reported to have had sex, and all of them have had vaginal sex (2/39 (5.23%) have had anal sex, while only 1/39 (2.56%) have had oral sex. Furthermore, only 22/39 (56%) have used condom during sex, and they indicated that they used condom in order to prevent sexually transmitted diseases and/or unwanted pregnancy, The remaining 16/39 individuals have never used condom during sex because of the following reason(s): unreachable access to condoms; need to gain their partners’ trust; and/or maximum sexual pleasure.

Only 115 (72.8%) respondents indicated that they aware of oral cancer. Concerning the 115 respondents that knew about oral cancer, the top three sources of their information were from lectures (52.17%), books (42.37%), and newspapers (19.49%). (Table 1)

Table 1: Source of information about oral cancer among the respondents that were aware of oral cancer Source of Information ( N= 115) Frequency % Books 50 43.5 Lectures 60 52.2 Newspapers 23 20.0 Radio 16 13.9 Television 21 18.3 Family & Friends 11 9.6 Dentist/Doctor 13 11.3 Internet 10 8.7

Furthermore, they were asked if they were aware if HPV could be transmitted through genital fluids, and only 86.1% (99/115) indicated that they were aware. We further enquired about their awareness of oral sex as an oral cancer risk factor, and only 77.4% (89/115) were aware. Information on other risk factors of oral cancer was also obtained from them using an open-ended question, and only 42/115 (36.5%) indicated some other risk factors for oral cancer.

Table 2: Opinion of respondents on risk factors (other than oral sex) for oral cancer Risk factors for oral cancers (N=42) Frequency % Poor Oral Hygiene 7 16.7 Hereditary factors 14 33.3 Chemicals such low quality toothpaste, cosmetics 5 11.9 Cigarette smoking 11 26.2 Alcohol consumption Sun exposure/Radiation 4 9.5 Halitosis 2 4.8 Oral infection Mouth sore Bleeding 1 2.4 Poor nutrition 3 7.1 Kissing

Figure 1: knowledge of the oral cancer-informed respondents on the symptoms of oral cancer (n=115)

Study Limitations We were not able to meet our targeted sample size because many of our respondents were not willing to participate

Conclusion The prevalence of oral sex among nursing students in Ibadan is very low (1.0%). Many (43.7%) of them were not aware that oral sex is a risk factor of oral cancer; many were also not aware of other oral cancer risk factors. Also, they have inadequate knowledge of the symptoms of oral cancer.

Recommendation Educating our study population on oral cancer prevention is of benefits as they are future nursing officers, and their role in early cancer detection cannot be overemphasized in clinical practice [27], particularly in a country like Nigeria where we have inadequate medical and dental personnel [8,9].

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