Awareness of cervical cancer risk factors and preventive approaches, and perceived causes of cervical cancer among secondary school girls: a cross-sectional study in Northern Uganda

Figures & data

Table 1. Socio-demographic Characteristics of participants.

Characteristics	Frequency	Percentage
School ownership; N = 11
Private schools	6	54.5
Public schools	5	45.5
Students enrollment in the study; N = 644
Private schools	308	47.8
Public schools	336	52.2
Age group (years); N = 644
12 – 15	145	22.5
16 – 19	499	77.5
Median age (Interquartile Range)	16 (16–17)
Class; N = 644
Senior 1	202	31.4
Senior 2	185	28.7
Senior 3	136	21.1
Senior 4	121	18.8
Religion; N = 644
Roman Catholics	377	58.5
Anglicans/Protestants	166	25.8
Pentecostals	93	14.4
Muslims	7	1.1
Others	1	0.2
Level of education of fathers; N = 607
No formal education	19	3.1
Primary education	188	31.0
Secondary education	273	45.0
Tertiary education	56	9.2
Not aware	71	11.7
Level of education of mothers; N = 636
No formal education	71	11.2
Primary education	385	60.5
Secondary education	130	20.4
Tertiary education	13	2.1
Not aware	37	5.8
Distance to nearest health facility (kilometers - km); N = 644
< 5 km	139	21.6
≥ 5 km	505	78.4

Table 2. Cervical cancer awareness, sources of information, prevention and self-perceived risk.

Issue assessed	Frequency	Percentage
A: Awareness of cervical cancer
Ever heard about cervical cancer; N = 643
Yes	624	97.1
No	19	2.9
B: Sources of knowledge on cervical cancer
Main source of information about cervical cancer; N = 624
Friends	194	31.1
Health workers	143	22.9
School	99	15.7
Radio	66	10.6
News papers	35	5.6
Television	26	4.2
Family members	22	3.5
Neighbors	16	2.6
Churches/ Mosques	6	1.1
Others	17	2.7
C: Cervical cancer prevention awareness and practices
Ever heard of vaccine against cervical cancer, N = 644
Yes	380	59.0
No	264	41.0
Ever been vaccinated against cervical cancer, N = 380
Yes	124	32.6
No	256	67.4
Number of times vaccinated; N = 124
Once	57	46.0
Twice	52	41.9
Thrice	15	12.1
Cervical cancer can be prevented, N = 620
Yes	550	88.7
No	56	9.0
Do not know	14	2.3
Cervical cancer can be prevented through:
(i) Vaccination of young girls before sex; N = 556
Yes	290	52.2
No	266	47.8
(ii) Frequent vaginal examination at a health facility; N = 555
Yes	157	28.3
No	398	71.7
D: Self-perceived risk of cervical cancer
Perceives self to be at risk of cervical cancer; N = 639
Yes	150	23.5
No	420	65.7
Do not know	69	10.8

Table 3. Recognition of cervical cancer risk factors and perceived causes of cervical cancer.

Characteristics	Frequency	Percentage
A: Epidemiologic risk factors for cervical cancer
Early onset of sexual activity before age 11 years; N = 642
True	98	15.3
False	468	72.9
Not sure	76	11.8
Getting infected with HPV; N = 640
True	45	7.0
False	509	79.5
Not sure	86	13.5
Multiple sexual partnership; N = 642
True	47	7.3
False	538	83.8
Not sure	57	8.9
Smoking cigarettes/tobacco; N = 638
True	9	1.4
False	178	27.9
Not sure	451	70.7
Bearing many children (> 5 children); N = 633
True	11	1.7
False	216	34.1
Not sure	406	64.1
B: Perceived causes of cervical cancer
Being poor; N = 642
True	1	0.2
False	154	24.0
Not sure	487	75.8
Having sex with a polygamous man; N = 641
True	9	1.4
False	569	88.8
Not sure	63	9.8
Rough sexual intercourse; N = 639
True	3	0.5
False	475	74.3
Not sure	161	25.2
Having sex with a man who does not believe in God; N = 641
True	170	26.5
False	470	73.3
Not sure	1	0.2
Cervical cancer is contagious; N = 639
True	2	0.3
False	53	8.3
Not sure	584	91.4
It is inherited; N = 640
True	3	0.5
False	58	9.0
Not sure	579	90.5
Not cleaning a woman’s genital after sexual intercourse; N = 639
True	13	2.0
False	466	72.9
Not sure	160	25.1
Having sex during menstruation; N = 640
True	6	0.9
False	421	65.8
Not sure	213	33.3

Table 4. Socio-demographic factors and early sexual debut as the cause of cervical cancer.

	Cervical cancer is caused by early sexual debut		Crude Odds ratio (95%CI)	*Adjusted Odds ratio (95%CI)
Characteristics	Yes N (%)	No N (%)
Age group (years); N = 624
12–15	18 (19.2)	119 (22.5)	1.00	1.00
16–19	76 (80.8)	411 (77.5)	1.22 (0.70–2.12)	1.08 (0.55–2.09)
Class; N = 624
Senior 1	27 (28.7)	164 (30.9)	1.00	1.00
Senior 2	19 (20.2)	162 (30.6)	0.71 (0.38–1.33)	0.69 (0.35–1.35)
Senior 3	26 (27.7)	106 (20.0)	1.49 (0.82–2.69)	1.38 (0.70–2.72)
Senior 4	22 (23.4)	98 (18.5)	1.36 (0.74–2.52)	1.30 (0.64–2.64)
Religion; N = 624
Roman Catholics	55 (58.5)	311 (58.7)	1.00	1.00
Anglicans/Protestants	24 (25.5)	136 (25.7)	1.00 (0.59–1.68)	1.01 (0.60–1.71)
Pentecostals	14 (14.9)	76 (14.3)	1.04 (0.55–1.97)	1.10 (0.58–2.10)
Muslims	0 (0.0)	7 (1.3)	NA	–
Others	1 (1.1)	0 (0.0)	NA	–
Category of schools; N = 624
Private schools	38 (40.4)	262 (49.4)	1.00	1.00
Public schools	56 (59.6)	268 (50.6)	1.44 (0.92–2.25)	1.37 (0.87–2.16)
Presence of school dispensary; N = 624
No	77 (81.9)	424 (80.0)	1.00	1.00
Yes	17 (18.1)	106 (20.0)	0.88 (0.50–1.56)	0.84 (0.47–1.50)
Presence of school health program; N = 618
No	48 (51.6)	269 (51.2)	1.00	1.00
Yes	45 (48.4)	256 (48.8)	0.99 (0.63–1.53)	0.96 (0.61–1.50)
Perceived risk to cervical cancer; N = 621
Yes, I am at risk	19 (20.2)	130 (24.7)	1.00	1.00
No, I am not at risk	68 (72.3)	340 (64.5)	1.37 (0.79–2.37)	1.58 (0.89–2.79)
Do not know	7 (7.5)	57 (10.8)	0.84 (0.33–2.11)	0.97 (0.38-–2.49)
Distance to nearest health facility (kilo meters – km); N = 624
≥5 km	77 (81.9)	413 (77.9)	1.00	1.00
< 5 km	17 (18.1)	117 (22.1)	0.78 (0.44–1.37)	0.78 (0.44–1.39)
Sexual experience; N = 613
Ever had sex	17 (18.1)	82 (15.5)	1.00	1.00
Never had sex	77 (81.9)	442 (83.5)	0.84 (0.47–1.49)	0.96 (0.52–1.78)
Prefer not to mention	0 (0.0)	5 (1.0)	NA	–

* Adjusted for all factors in the table; Bold face = Factors statistically significant; NA: Not Applicable (numbers too few).

Table 5. Socio-demographic factors and multiple sexual partners as the cause of cervical cancer.

	Cervical cancer is caused by having sexual intercourse with multiple sexual partners		Crude Odds ratio (95%CI)	*Adjusted Odds ratio (95%CI)
Characteristics	Yes N (%)	No N (%)
Age group (years); N = 624
12–15	14 (29.79)	123 (21.32)	1.00	1.00
16–19	33 (70.21)	454 (78.68)	0.64 (0.33–1.23)	0.25 (0.11–0.60)
Class; N = 624
Senior 1	8 (17.02)	183 (31.72)	1.00	1.00
Senior 2	15 (31.91)	166 (28.77)	2.07 (0.85–5.00)	3.70 (1.39–9.84)
Senior 3	12 (25.53)	120 (20.80)	2.29 (0.91–5.76)	5.43 (1.79–16.51)
Senior 4	12 (25.53)	108 (18.72)	2.54 (1.01–6.41)	6.27 (1.99–19.74)
Religion; N = 624
Roman Catholics	26 (55.32)	340 (58.93)	1.00	1.00
Anglicans/Protestants	12 (25.53)	148 (25.65)	1.06 (0.52–2.16)	0.98 (0.47–2.02)
Pentecostals	9 (19.15)	81 (14.04)	1.45 (0.66–3.22)	1.38 (0.61–3.12)
Muslims	0 (0.00)	7 (1.21)	NA	–
Others	0 (0.00)	1 (0.17)	NA	–
Category of school; N = 624
Private schools	20 (42.55)	280 (48.53)	1.00	1.00
Public schools	27 (57.45)	297 (51.47)	1.27 (0.70–2.32)	1.21 (0.65–2.24)
Presence of school dispensary; N = 624
No	40 (85.11)	461 (79.90)	1.00	1.00
Yes	7 (14.89)	116 (20.10)	0.70 (0.30–1.59)	0.77 (0.33–1.79)
Presence of school health program; N = 618
No	27 (57.45)	290 (50.79)	1.00	1.00
Yes	20 (42.55)	281 (49.21)	0.76 (0.42–1.39)	0.73 (0.39–1.34)
Perceived risk of cervical cancer; N = 621
Yes, I am at risk	11 (23.40)	138 (24.04)	1.00	1.00
No, I am not at risk	27 (57.45)	381 (66.38)	0.89 (0.43–1.84)	0.91 (0.43–1.93)
Do not know	9 (19.15)	55 (9.58)	2.05 (0.81–5.23)	2.39 (0.92–6.24)
Number of boyfriends; N = 351
One only	26 (83.87)	238 (74.38)	1.00	1.00
More than one	5 (16.13)	82 (25.62)	0.56 (0.21–1.50)	0.55 (0.20–1.50)
Sexual experience; N = 623
Ever had sex	10 (21.28)	89 (15.45)	1.00	1.00
Never had sex	37 (78.72)	482 (83.68)	0.68 (0.33–1.42)	0.69 (0.31–1.54)
Prefer not to mention	0 (0.00)	5 (0.87)	NA
Distance to nearest health facility (km), N = 624
≥5 km	39 (82.98)	451 (78.16)	1.00	1.00
< 5 KM	8 (17.02)	126 (21.84)	0.73 (0.33–1.61)	0.78 (0.35–1.74)

* Adjusted for all factors in the table; Bold face = Factors statistically significant, NA: Not applicable (low cell counts).

Table 6. Socio-demographic factors and knowledge that cervical cancer is preventable.

Characteristics	Cervical cancer is preventable		Crude Odds Ratio (95%CI)	*Adjusted Odds Ratio (95%CI)
	Yes N (%)	No N (%)
Age group (years); N = 606
12–15	118 (21.5)	12 (21.4)	1.00	1.00
16–19	432 (78.6)	44 (78.6)	1.00 (0.51–1.95)	0.67 (0.31–1.46)
Class; N = 606
Senior 1	163 (29.6)	23 (41.1)	1.00	1.00
Senior 2	163 (29.6)	13 (23.2)	1.77 (0.87–3.61)	2.06 (0.96–4.44)
Senior 3	118 (21.5)	9 (16.1)	1.85 (0.83–4.14)	2.31 (0.96–5.56)
Senior 4	106 (19.3)	11 (19.6)	1.36 (0.64–2.90)	1.66 (0.72–3.85)
Religion; N = 606
Roman Catholics	324 (58.9)	33 (58.9)	1.00	1.00
Anglicans/Protestants	140 (25.5)	17 (30.4)	0.84 (0.45–1.56)	0.82 (0.44–1.53)
Pentecostals	79 (14.4)	6 (10.7)	1.34 (0.54–3.31)	1.38 (0.56–3.43)
Muslims	6 (1.1)	0 (0.0)	NA
Others	1 (0.2)	0 (0.0)	NA
Category of school; N = 606
Private schools	259 (47.1)	29 (51.8)	1.00	1.00
Public schools	291 (52.9)	27 (48.2)	1.21 (0.70–2.09)	1.22 (0.70–2.13)
Distance to nearest health facility (kilometers-km); N = 606
≥5 km	433 (78.7)	43 (76.8)	1.00	1.00
< 5 km	117 (21.3)	13 (23.2)	0.89 (0.47–1.72)	0.89 (0.46–1.73)
School has dispensary; N = 606
No	439 (79.8)	48 (85.7)	1.00	1.00
Yes	111 (20.2)	8 (14.3)	1.52 (0.70–3.30)	1.59 (0.73–3.49)
School has school health program; N = 600
No	266 (48.9)	38 (67.9)	1.00	1.00
Yes	278 (51.1)	18 (32.1)	2.21 (1.23–3.96)	2.24 (1.24–4.06)

* Adjusted for all factors on table; Bold = Factors statistically significant, NA: Not applicable (low cell counts).

Data availability statement

The data that support the findings of this study are available from the corresponding author (ADM), upon reasonable request.