ANNE MURUGI1,2 1.Amref Health Africa 2.University of Nairobi CERVICAL CANCER KNOWLEDGE & SCREENING UPTAKE AMONG WOMEN IN EMBU COUNTY,KENYA. ANNE MURUGI1,2 1.Amref Health Africa 2.University of Nairobi

OUTLINE Background Objectives Methodology Results Conclusion Recommendations

BACKGROUND Cancer is the leading cause of death worldwide and accounted for 8.2 million deaths in 2012. Cervical cancer. leading cause of cancer deaths among women in developing countries. 529,409 new cases occurred globally, with 274,883 of the women (52% of cases) dying. 86% of the cases occur in developing countries In SSA : magnitude of the problem is under-recognized and under-prioritized. In Kenya-second most frequent cancer among women and the leading cause of cancer deaths in women of reproductive age. 2454 new cases and 1676 deaths are reported every year Only 3.2% of women in Kenya have been screened for cervical cancer. (WHO 2008,WHO2013)

PROBLEM STATEMENT Morbidity and mortality of cervical cancer can be reduced through regular screening Screening is available in most facilities (VIA/VILI) and Pap smear Screening levels still remain low Study findings will provide relevant information to increasing uptake in rural areas

OBJECTIVES Broad objective Specific objectives To determine factors associated with cervical cancer screening uptake among women in Embu county, Kenya Specific objectives To determine cervical cancer awareness & knowledge among women in Embu To determine awareness & knowledge of cervical cancer screening To determine the uptake of cervical cancer screening To determine barriers to cervical cancer screening uptake

METHODOLOGY Study design Cross- sectional study survey Quantitative study Study population Women aged 18 years and above Inclusion Criteria All women aged 18 and above who gave consent Exclusion Criteria Declined to consent Ethical Considerations Ethics approval Informed consent Confidentiality Study site Embu County Data collection Structured Questionnaire Sampling Multi stage cluster sampling Sample size 269 women Data management and analysis Coding, data entry SPSS 17 Frequencies Bivariate analysis

SOCIO-DEMOGRAPHICS Characteristics Classification Frequency Percent Age in years <25 51 19.0 25-34 102 37.9 35-44 64 23.8 45-54 33 12.3 55-64 12 4.5 >64 7 2.6 Total 269 100  Marital status single (never married) 58 21.6 Married 177 65.8 Separated 20 7.4 Divorced 1 0.4 Widowed 13 4.8  269  100  Education level Primary 123 45.7 Secondary 104 38.7 Technical College 30 11.2 University 2 0.7 None 10 3.7  Employment status Employed Fulltime 34 12.6 Employed part time Unemployed 46 17.1 Self-employed 163 60.6 Full time home maker(house wife) 15 5.6 Retired 3 1.1 Others

CERVICAL CANCER AWARENESS

SIGNS AND SYMPTOMS Knowledge of signs of cervical cancer Yes No Don't know Vaginal bleeding between menses 31.6% 10.4% 58.0% Persistent vaginal discharge with unpleasant smell 32.7% 10% 57.2% Vaginal bleeding after menopause 34.6% 3.3% 62.1% Bleeding during or after sex 29.0% 7.4% 63.6%

CERVICAL CANCER RISK FACTORS  Risk factors of cervical cancer Disagree Not sure Agree Infection with HPV 5.6% 70.6% 23.5% Smoking cigarettes 14.1% 51.7% 34.2% Weakened immune system 13.1% 58.6% 28.1% Infection with STI's 9.3% 53.2% 37.3% Having multiple sexual partners 11.6% 50.6% 37.7% Having many children 31.2% 58.7% 10.0% Having a sexual partner with multiple partners 13.4% 53.9% 32.7% Not going for regular screening 11.9% 52.8% 35.3%

CERVICAL CANCER SCREENING KNOWLEDGE

CERVICAL CANCER SCREENING AWARENESS

CERVICAL CANCER SCREENING UPTAKE

BARRIERS TO CERVICAL CANCER SCREENING UPTAKE

ASSOCIATIONS Tests of association p-value Association between economic status and uptake of cervical cancer screening 0.027 Association between awareness of cervical cancer and age of respondent 0.031 Association between cervical cancer awareness and screening uptake <0.001 Association between awareness of cervical cancer screening and uptake Association between knowledge of prevention of cervical cancer and screening uptake

CONCLUSION Awareness of cervical cancer screening among the respondents was high Knowledge of the signs and symptoms and risk factors associated with cervical cancer was low. Screening uptake was very low despite the high levels of awareness of cervical cancer and cervical cancer screening. Awareness of cervical cancer, awareness of cervical cancer screening and knowledge of modes of prevention of cervical cancer were critical in determining cervical cancer screening uptake among the women.

RECOMMENDATIONS To the Government and County Governments Awareness campaigns and education programmes to encompass signs and symptoms, risk factors and modes of prevention of the disease. Research institutions Studies to explore the disparity between high awareness and low uptake should be conducted.

ACKNOWLEDGEMENTS University of Nairobi AMREF Kenya All women who participated