Factors Associated with Pre- and Post-Educational Intervention Knowledge Levels of HPV and Cervical Cancer Among the Male and Female University Students, Northwest Ethiopia

Figures & data

Table 1 Socio-Demographics of Male and Female University Students, N=638

Variables	N	%
Gender
Male	384	60.2
Female	254	39.8
Age range
<21 years	276	43.3
21 and 22 years	271	42.5
≥23 years	91	14.3
Area
Rural	319	50.0
Urban	319	50.0
Region
Addis Ababa	84	13.2
Amhara	335	52.5
Oromia	123	19.3
Other	96	15.0
Level of education
Under-graduation (UG)	607	95.1
Post-graduation (PG)	31	4.9
Year of study
First year of UG	98	15.4
Second year of UG	377	59.1
Third year of UG	83	13.0
Fourth year of UG and above	80	12.5
Stream of study
Biological sciences	271	42.5
Other sciences	161	25.2
Humanities	206	32.3
CGPA
<2.5	332	52.0
2.5–3.0	225	35.3
>3.0	81	12.7
Marital status
Unmarried	608	95.3
Married	30	4.7
Religion
Orthodox	492	77.1
Protestants	83	13.0
Muslims	63	9.9
Father’s education level
Illiterates	220	34.5
Primary	215	33.7
Secondary	106	16.6
Higher	97	15.2
Mother’s education level
Illiterates	283	44.4
Primary	212	33.2
Secondary	80	12.5
Higher	63	9.9
Father’s occupation
Employed	177	27.7
Business	151	23.7
Other occupation	270	42.3
No employment	40	6.3
Mother’s occupation
Employed	97	15.2
Business	95	14.9
Other occupation	97	15.2
Homemaker	349	54.7
Family size
≤5	334	52.4
≥6	304	47.6
Family income (ETB)
<5,000	519	81.3
5,000–10,000	84	13.2
>10,000	35	5.5

Notes: The mean age of the study respondents is 21.07 years (±SD. 1.96).

Abbreviation: ETB: Ethiopian Birr.

Table 2 Awareness About Cervical Cancer and McNemar Test Before and After Educational Intervention at P≤0.001 Significance Level, N=638

Categories Inquired	Pre-Intervention Correct Responses		Post-Intervention Correct Response		Difference %	Chi^2 value p≤ 0.001
	N	%	N	%
Symptoms
What is uterine cervical cancer?	174	27.3	581	91.1	63.8	401
Is cervical cancer a preventable disease?	54	8.5	338	53.0	44.5	253
Is a persistent unpleasant vaginal discharge could be a sign of c. cancer?	102	16.0	459	71.9	55.9	322
Is menorrhagia a symptom of cervical cancer?	76	11.9	470	73.7	61.8	374
Is vaginal bleeding between periods could be a sign of cervical cancer?	53	8.3	403	63.2	54.9	322
Is vaginal bleeding after menopause could be a sign of cervical cancer?	47	7.4	410	64.3	56.9	353
Persistent pelvic pain could be a sign of cervical cancer?	63	9.9	395	61.9	52.0	311
Discomfort or pain during sex could be a sign of cervical cancer?	95	14.9	415	65.0	50.1	287
Vaginal bleeding during or after sex could be a sign of cervical cancer?	82	12.9	441	69.1	56.2	327
Risk factors
Is poor hygiene a risk factor for cervical cancer?	142	22.3	434	68.0	45.7	237
Multiple sex partners is a risk factor for cervical cancer?	164	25.7	508	79.6	53.9	298
Coitus at an early age is a risk factor for cervical cancer?	131	20.5	464	72.7	52.2	303
No knowledge of cervical cancer is a risk factor?	160	25.1	449	70.4	45.3	246
Swelling of the cervix is a risk factor for cervical cancer?	103	16.1	385	60.3	44.2	248
Consuming contraceptive pills could be a risk factor for cervical cancer?	80	12.5	394	61.8	49.3	286
Could unprotected intercourse be a risk factor for cervical cancer?	148	23.2	505	79.2	56.0	325
Is high parity a risk factor for cervical cancer?	57	8.9	283	44.4	35.5	186
Could smoking be a risk factor for cervical cancer?	108	16.9	460	72.1	55.2	320
Human Papilloma Virus (HPV)
What is the causative organism of cervical cancer?	86	13.5	455	71.3	57.8	329
HPV can infect women	123	19.3	474	74.3	55.0	307
HPV infections can cause cervical cancer	101	15.8	495	77.6	61.8	344
HPV is a sexually transmitted infection	81	12.7	448	70.2	57.5	321
HPV infections are usually obvious and usually resolve their own	37	5.8	275	43.1	37.3	206
Can HPV infect men?	27	4.2	250	39.2	35.0	194
Can HPV infections cause genital warts?	68	10.7	369	57.8	47.1	259
Can HPV infections cause oral/pharyngeal cancers?	53	8.3	324	50.8	42.5	235
Can HPV infections cause genital cancers in males?	28	4.4	265	41.5	37.1	208
HPV infections can cause anal cancers?	23	3.6	248	38.9	35.3	196
Screening
Have you heard of screening for cervical cancer?	88	13.8	478	74.9	61.1	348
Ever heard of the Pap smear test?	109	17.1	526	82.4	65.3	397
Why is the Pap smear test used?	56	8.8	331	51.9	43.1	249
Can Pap smear tests pick up cell changes that may go on to become c.c.?	47	7.4	383	60.0	52.6	310
Vaccination
Have you heard of a vaccine for cervical cancer?	64	10.0	434	68.0	58.0	342
HPV vaccine exists that protects against cervical cancer	45	7.1	426	66.8	59.7	367
A vaccine for HPV is available to men	19	3.0	222	34.8	31.8	184
To which age group should HPV vaccines be given?	25	3.9	99	15.5	11.6	50
Can HPV vaccines be given to boys?	39	6.1	326	51.1	45.0	256
Which is the most appropriate stage for HPV vaccination?	57	8.9	293	45.9	37.0	210

Table 3 Mean Level of Awareness on Various Broad Categories of Cervical Cancer and McNemar Test Score at P≤0.001 Significance Level, N=638

Category	Pre-Intervention	Post-Intervention	Difference	Chi^2 value*
Symptoms	1.17	6.13	4.96	433
Risk factors	1.71	6.08	4.37	364
HPV	0.39	5.65	5.26	224
Screening	0.47	2.70	2.23	354
Vaccination	0.35	2.84	2.49	219
Overall knowledge about cervical cancer	4.09	23.4	19.31	335

Note: *p≤0.001.

Table 4 Bi-Variable and Multi-Variable Logistic Regression Analysis of Potential Factors Associated with Cervical Cancer Knowledge Before Education Intervention, N=638

Variable	Category Domain	Knowledge		COR (95% CI)	AOR (95% CI)
		Sufficient	Not Sufficient
Gender	Symptoms
	Male	20	364	0.38(0.20–0.72)^b	2.57(1.37–4.82)^a
	Female	33	221	Reference	Reference
Year of study
	1st year UG	7	91	0.21(0.08–0.55)^b	4.65(1.8–11.97)^a
	2nd year UG	15	362	0.12(0.05–0.25)^a	8.23(3.9–17.3)^a
	3rd year UG	10	73	0.31(0.13–0.75)^b	3.13(1.3–7.43)^b
	4th year UG and above	21	59	Reference	Reference
Family income	(ETB)
	<5,000	35	484	0.20(0.07–0.52)^a	4.95(1.9–12.87)^a
	5,000–10,000	10	74	0.30(0.90–0.95)^c	3.25(1.04–10.16)^c
	>10,000	8	27	Reference	Reference
Gender	Risk factors
	Male	52	332	0.47(0.31–0.72)^a	2.09(1.37–3.19)^a
	Female	62	192	Reference	Reference
Family income	(ETB)
	<5,000	75	444	0.23(0.11–0.48)^a	4.3(2.08–9.01)^a
	5,000–10,000	25	59	0.54(0.23–1.27)^ns	1.82(0.78–4.22)^ns
	>10,000	14	21	Reference	Reference
Mother’s education level
	Illiterates	40	243	0.43(0.22–0.83)^b	2.31(1.2–4.47)^b
	Primary	31	181	0.41(0.21–0.80)^b	2.43(1.24–4.76)^b
	Secondary	20	60	0.61(0.28–1.29)^ns	1.64(0.77–3.47)^ns
	Higher	23	40	Reference	Reference
Age range	HPV
	<21 years	6	270	0.16(0.05–0.45)^a	6.16(2.21–17.18)^a
	21 and 22 years	25	246	0.79(0.36–1.73)^ns	1.26(0.57–2.75)^ns
	≥23 years	12	79	Reference	Reference
CGPA
	<2.5	16	316	0.29(0.12–0.66)^a	3.44(1.51–7.81)^a
	2.5–3.0	15	210	0.42(0.18–0.97)^c	2.35(1.02–5.39)^ns
	>3.0	12	69	Reference	Reference
Father’s education	Screening
	Illiterates	9	211	0.3(0.12–0.74)^b	5.75(1.97–16.8)^a
	Primary	8	207	0.27(0.10–0.69)^a	4.89(1.79–13.37)^a
	Secondary	3	103	0.20(0.56–0.75)^c	4.58(1.24–16.96)^c
	Higher	12	85	Reference	Reference
Family income(ETB)	Vaccination
	<5,000	5	514	0.10(0.24–0.45)^a	9.63(2.2–42.13)^a
	5,000–10,000	1	83	0.12(0.01–1.28)^ns	7.78(0.78–77.58)^ns
	>10,000	3	32	Reference	Reference

Notes:^aSignificant at p ≤0.001; ^bsignificant at p ≤ 0.01; ^csignificant at p ≤ 0.05.

Abbreviation: ns, not significant.

Table 5 Bi-Variable and Multi-Variable Logistic Regression Analysis of Potential Factors Associated with Cervical Cancer Knowledge After Educational Intervention, N=638

Variable	Category Domain	Knowledge		COR (95% CI)	AOR (95% CI)
		Sufficient	Not Sufficient
Area	Overall knowledge
	Rural	148	171	0.57(0.41–0.79)^a	1.75(1.25–2.43)^a
	Urban	198	121	Reference	Reference
Year of study
	First year of UG	71	27	3.68(1.94–6.99)^a	0.27(0.14–0.51)^a
	Second year of UG	172	205	0.94(0.49–1.78)^ns	1.06(0.56–2.02)^ns
	Third year of UG	69	14	5.26(2.24–12.31)^a	0.19(0.08–0.44)^a
	Fourth year of UG and above	34	46	Reference	Reference
CGPA
	<2.5	172	160	0.59(0.35–1.01)^ns	1.67(0.98–2.84)^ns
	2.5–3.0	123	102	0.46(0.24–0.88)^c	2.16(1.13–4.13)^c
	>3.0	51	30	Reference	Reference
Age range	Symptoms
	<21 years	222	54	1.96(1.02–3.76)^c	0.5(0.26–0.97)^c
	21 and 22 years	211	60	1.67(0.91–3.07)^ns	0.59(0.32–1.09)^ns
	≥23 years	63	28	Reference	Reference
Year of study
	First year of UG	90	8	2.86(1.06–7.73)^c	0.34(0.12–0.94)^c
	Second year of UG	269	108	0.72(0.394–1.35)^ns	1.37(0.74–2.54)^ns
	Third year of UG	77	6	4.21(1.55–11.45)^a	0.23(0.87–0.64)^a
	Fourth year of UG and above	60	20	Reference	Reference
Mother’s occupation
	Employed	70	27	0.45(0.22–0.93)^c	2.23(1.08–4.59)^c
	Business	74	21	0.58(0.27–1.23)^ns	1.81(0.85–3.84)^ns
	Other occupation	81	16	0.64(0.35–1.18)^ns	1.56(0.85–2.87)^ns
	Homemaker	271	78	Reference	Reference
Year of study	Risk factors
	First year of UG	89	9	4.12(1.77–9.56)^a	0.25(0.10–0.58)^a
	Second year of UG	279	98	1.1(0.64–1.9)^ns	0.87(0.5–1.48)^ns
	Third year of UG	76	7	4.69(1.87–11.77)^a	0.22(0.09–0.56)^a
	Fourth year of UG and above	57	23	Reference	Reference
Level of education	HPV
	Under-graduation (UG)	275	332	0.34(0.13–0.88)^c	2.92(1.13–7.56)^c
	Post-graduation (PG)	19	12	Reference	Reference
Year of study
	First year of UG	51	47	2.28(1.11–4.67)^c	0.43(0.21–0.89)^c
	Second year of UG	157	220	1.47(0.69–3.16)^ns	0.67(0.31–1.44)^ns
	Third year of UG	51	32	3.3(1.38–7.9)^b	0.3(0.12–0.72)^b
	Fourth year of UG and above	35	45	Reference	Reference
CGPA
	<2.5	142	190	0.53(0.32–0.88)^c	1.88(1.13–3.12)^c
	2.5–3.0	104	121	0.58(0.31–1.08)^ns	1.72(0.91–3.22)^ns
	>3.0	48	33	Reference	Reference
Area	Screening
	Rural	179	140	0.59(0.42–0.82)^a	1.68(1.2–2.36)^a
	Urban	223	96	Reference	Reference
Level of education
	Under-graduation (UG)	380	227	0.24(0.09–0.63)^a	4.16(1.56–11.04)^a
	Post-graduation (PG)	22	9	Reference	Reference
Year of study
	First year of UG	75	23	5.2(2.49–11.21)^a	0.18(0.08–0.4)^a
	Second year of UG	221	156	2.46(1.32–4.58)^a	0.4(0.21–0.75)^a
	Third year of UG	66	17	6.42(2.9–14.22)^a	0.15(0.07–0.34)^a
	Fourth year of UG and above	40	40	Reference	Reference
Year of study	Vaccination
	First year of UG	42	56	0.79(0.41–1.54)^ns	0.88(0.48–1.62)^ns
	Second year of UG	113	264	0.4(0.2–0.8)^b	1.55(0.94–2.56)^ns
	Third year of UG	49	34	1.32(0.59–2.91)^ns	0.46(0.24–0.86)^c
	Fourth year of UG and above	32	48	Reference	Reference

Notes:^aSignificant at p ≤0.001; ^bsignificant at p ≤ 0.01; ^csignificant at p ≤ 0.05.

Abbreviation: ns, not significant.