Knowledge, Attitude, and Practice on Cervical Cancer Screening and Associated Factors Among Women Aged 15–49 Years in Adigrat Town, Northern Ethiopia, 2019: A Community-Based Cross-Sectional Study

Figures & data

Figure 1 Schematic presentation of the sampling procedure of this study.

Abbreviation: HH, household.

Table 1 Socio-Demographic Characteristics of Reproductive Age (15–49) Years Women on Cervical Cancer in Adigrat Town Eastern Zone, Tigray, Ethiopia, November 2019

Variables	Categories	Frequency (%)
Age of respondents	Less than 29 years	274(44.8)
	29 up to 39 years	232(37.9)
	Greater than 40 years	106(17.3)
Religion of respondents	Catholic	41(6.7)
	Muslim	30(4.9)
	Orthodox	541(88.4)
Ethnicity of respondents	Tigran	576(94.1)
	Erob	36(5.9)
Marital status of respondents	Married	376 (61.4)
	Single	236(38.6)
Educational status of respondents	Illiterate	49(8.0)
	Primary(1–8)	203(33.2)
	Secondary (9–12)	243(39.7)
	Diploma and above	117(19.1)
Husband Educational status (450)	Illiterate	16 (2.6)
	Primary(1–8)	127 (20.8)
	Secondary (9–12)	160 (26.1)
	Diploma and above	147 (24.0)
Occupational status of respondents	Employed	247 (40.4)
	Unemployed	365 (59.6)
Husband occupational status (450)	Employed	335 (54.7)
	Unemployed	115 (18.8)
Household family	0 up to 4 family size	404 (66.0)
	Greater than 4 family size	208(34.0)
Household perceived Monthly income	Less than 200 ETB	99(16.2)
	200 up to 500 ETB	54(8.8)
	Greater than 500 ETB	459 (75.0)

Table 2 Knowledge of Respondents About Risk Factors, Signs and Symptoms, and Methods of Prevention and Treatment of Cervical Cancer in Adigrat Town, Eastern, Tigray, Ethiopia, November 2019

Variables	Categories	Frequency (%)
Anyone cervical cancer	Yes	87(14.2)
	No	525(85.8)
Family history of CC	Yes	31(5.1)
	No	581(94.9)
Ever received information about cancer	Yes	487(79.6)
	No	125(20.4)
Ever received information about CC screening	Yes	432(70.6)
	No	180(29.4)
Risk factors mentioned by respondents
Prolonged use of oral contraceptive	Yes	118(19.3)
	No	494(80.7)
Early age marriage	Yes	195(31.9)
	No	417(68.1)
Age at first pregnancy	Yes	21(3.4)
	No	591(96.6)
Sexually transmitted infection	Yes	237(38.7)
	No	375(61.3)
Early-onset sexual activity	Yes	97(15.8)
	No	515(84.2)
Smoking	Yes	69(11.3)
	No	543(88.7)
Alcohol drinking	Yes	45(7.4)
	No	567(92.6)
Multiple sexual partners	Yes	37.3(37.3
	No	62.7(62.7)
Having many children	Yes	17(2.8)
	No	595(97.2)
Number of abortion	Yes	80(13.1)
	No	532(86.9)
Aged 30–65 years	Yes	8(1.3)
	No	604(98.7)
Signs and symptoms of cervical cancer mentioned by respondents
Bleeding or pain after sexual intercourse	Yes	153(25)
	No	459(75.0)
Vulvar itching or burning sensation	Yes	306 (50.0)
	No	306 (50.0)
Post-menopausal bleeding	Yes	103(16.8)
	No	509 (83.2)
Excessive vaginal discharge	Yes	105 (17.2)
	No	507(82.8)
Abnormal vaginal discharge	Yes	156(25.5)
	No	456 (74.5)
Inter-menstrual bleeding	Yes	93 (15.2)
	No	519(84.8)
Longer or heavier menstrual periods	Yes	38(6.2)
	No	574(93.8)
Pelvic, back, or leg pain	Yes	130 (21.2)
	No	482 (78.8)
Urinary frequency	Yes	79 (12.9)
	No	533 (87.1)
Prevention and treatment
Cervical cancer screening	Yes	273 (44.6)
	No	339 (55.4)
Reduce numbers of sexual partners	Yes	340 (55.6)
	No	272 (44.4)
Vaccine for HPV	Yes	84 (13.7)
	No	528 (86.3)
Delaying sexual debut	Yes	46 (7.5)
	No	566 (92.5)
Being faithful to a partner	Yes	221 (36.1)
	No	391 (63.9)
Late marriage and late childbirth	Yes	11 (1.8)
	No	601 (98.2)
Avoid having too many children	Yes	52 (8.5)
	No	560 (91.5)
No smoking	Yes	3(0.5)
	No	609(99.5)
Consistent condom use	Yes	3(0.5)
	No	609(99.5)
Do not know	Yes	64 (10.5)
	No	548 (89.5)
Radiation therapy	Yes	98 (16.0)
	No	514 (84.0)
Surgery	Yes	73 (11.9)
	No	539 (88.1)
Chemotherapy	Yes	191 (31.2)
	No	421 (68.8)
Herbal remedies	Yes	13 (2.1)
	No	599 (97.9)
Do not know	Yes	328 (53.6)
	No	284 (46.4)
Overall knowledge of cc screening utilization	Knowledgeable cc screening utilization	284(46.4)
	Not knowledgeable cc screening utilization	328(53.6)

Abbreviation: cc, cervical cancer.

Figure 2 Frequency of cervical cancer screening among 15–49 years in Adigrat town, Eastern zonal Tigray, Ethiopia, 2019.

Figure 3 Source of information about cervical cancer screening on women 15–49 years in Adigrat Town Eastern zone Tigray, Ethiopia, 2019.

Table 3 Attitude of Respondents on Cervical Cancer Screening Utilization in Adigrat Town, Eastern, Tigray, Ethiopia, November 2019

Variables	Categories	Frequency (%)
Feeling shy to have cervical screening	Disagree	553(90.4)
	Agree	46(7.5)
	Do not know	13(2.1)
Cultural belief prevented me from having cc screening	Disagree	561(91.7)
	Agree	38(6.2)
	Do not know	13(2.1)
I am a virgin and I do not need cc screening	Disagree	477(77.9)
	Agree	105(17.2)
	Do not know	30(4.9)
I am healthy and I do not need cervical cancer screening	Disagree	356(58.2)
	Agree	225(36.8)
	Do not know	31(5.1)
HPV infection is the major risk factor for the development of cervical cancer	Disagree	59(9.6)
	Agree	334(54.6)
	Do not know	219(35.8)
HIV (the virus that causes AIDS) can increase the risk of developing cervical cancer	Disagree	73(11.9)
	Agree	398(65.0)
	Do not know	141(23.0)
Smoking can increase the risk of developing cervical cancer	Disagree	80(13.1)
	Agree	416(68.0)
	Do not know	116(19.0)
Having given birth to three or more children can increase the risk of developing cervical cancer	Disagree	281(45.9)
	Agree	112(18.3)
	Do not know	219(35.8)
Using birth control pills for a long time (five or more years) can increase the risk of developing cervical cancer	Disagree	217(35.5)
	Agree	205(33.5)
	Do not know	190(31.0)
Possible signs of cervical cancer include vaginal bleeding and pelvic pain	Disagree	87(14.2)
	Agree	382(62.4)
	Do not know	143(23.4)
Lack of health service facility in my area prevented me from having cc screening	Disagree	477(77.9)
	Agree	82(13.4)
	Do not know	53(8.7)
Bad attitude toward doctors/nurses/midwifery prevented me from having cervical cancer screening	Disagree	565(92.3)
	Agree	12(2.0)
	Do not know	35(5.7)
Cervical cancer screening is painful	Disagree	505(82.5)
	Agree	30(4.9)
	Do not know	77(12.6)
I could not afford the cost of having cc screening	Disagree	433(70.8)
	Agree	54(8.8)
	Do not know	125(20.4)
Any reproductive age woman is susceptible to develop cervical cancer	Disagree	293(47.9)
	Agree	254(41.5)
	Do not know	65(10.6)
Like any women, I am susceptible to develop cervical cancer	Disagree	266(43.5)
	Agree	306(50.0)
	Do not know	40(6.5)
Cervical cancer can be severe and may be hazardous	Disagree	30(4.9)
	Agree	559(91.3)
	Do not know	23(3.8)
Precancerous cervical cancer screening may be beneficial to my wellbeing	Disagree	25(4.1)
	Agree	565(92.3)
	Do not know	22(3.6)
Overall Attitude of cc screening utilization	Positive Attitude	326(53.3)
	Negative Attitude	286(46.7)

Table 4 Respondents on Cervical Cancer Screening Practice in Adigrat Town, Eastern, Tigray, Ethiopia, November 2019

Variables	Categories	Frequency (%)
Have you ever screened for any reproductive health screenings like HIV, STIs	Yes	471(77.0)
	No	141(23.0)
Have you ever screened for cancer of the cervix	Yes	64(10.5)
	No	548(89.5)
Women 25 and above years screened for cervical cancer	Yes	317(51.8)
	No	295(48.2)
Screened of Prostitute for cervical cancer	Yes	195(31.9)
	No	417(68.1)
Do not know	Yes	111(18.1)
	No	501(81.9)
Where did you screen (64)	Governmental Hospital	10(1.6)
	Private Hospital	54(8.8)
Who was initiated for screening (64)	Offered by Health Professionals	27(4.4)
	Self-initiated	37(6.0)
How many times since you become sexually active (64)	Once	50(8.16)
	More than once	14(2.28)
When was the last time you screened (64)	Within the past three years	49(8.0)
	More than three years ago	15(2.45)
Willing to be screed soon	Yes	466(76.1)
	No	146(23.9)
Overall practice	Screened	233 (38.1)
	Not screened	379 (61.9)

Table 5 The Association Between Knowledge of Cervical Cancer Screening Utilization with Different Variables of Women 15–49 Years Age, Adigrat Town, Tigray Regional State Eastern Zone, 2019

Variables	Categories	Knowledge of Cervical Cancer Screening Utilization		95%,CI
		Knowledgeable (%)	Not Knowledgeable (%)	COR	AOR
Age of respondents	Less than 29 years	104(38.0)	170(62.0)	1.00	1.00
	29 up to 39 years	107(46.1)	125(53.9)	0.7(0.501, 1.019)	0.8(0.532, 1.213)
	Greater than 40 years	73(68.9)	33(31.1)	0.3(0.171, 0.446)	0.4(0.204, 0.704)
Religion of respondents	Catholic	14(34.1)	27(65.9)	1.00	1.00
	Muslim	20(66.7)	10(33.3)	0.3(0.096, 0.702)	0.4(0.145, 1.300)
	Orthodox	250(46.2)	291(53.8)	0.6(0.310, 1.176)	0.9(0.460, 2.017)
Educational status of respondents	Illiterate	39(79.6)	10(20.4)	1.00	1.00
	Primary(1–8)	103(50.7)	100(49.3)	4(1.794, 7.994)	1.9(0.837, 4.435)
	Secondary (9–12)	106(43.6)	137(56.4)	5(2.406, 10.560)	2.3(0.975, 5.439)
	Diploma and above	36(30.8)	81(69.2)	9(3.951, 19.490)	3.7(1.443, 9.433)
Occupation status of respondents	Employed	92(37.2)	155(62.8)	1.00	1.00
	Unemployed	192(52.6)	173(47.4)	0.5(0.385, 0.744)	0.8(0.523, 1.142)
Household family size	0 up to 4 family size	165(40.8)	239(59.2)	1.00	1.00
	Greater than 4 family size	119(57.2)	89(42.8)	0.5(0.368, 0.725)	1.0(0.677, 1.558)
Anyone with cervical cancer	Yes	9(10.3)	78(89.7)	1.00	1.00
	No	275(52.4)	250 (47.6)	0.1(0.052,0 0.214)	0.14(0.065, 0.304)
Family history of cervical cancer	Yes	5(16.1)	26(83.9)	1.00	1.00
	No	279(48.0)	302(52.0)	0.2(0.079, 0.550)	0.6(0.198, 2.015)
Ever received information about cancer	Yes	194(39.8)	293(60.2)	1.00	1.00
	No	90(72.0)	35(28.0)	0.3(0.167,0 0.396)	0.4(0.233, 0.593)

Notes: the bold values under AOR showed that these factors are significant with the knowledge of cervical cancer screening utilization whereas bold values under COR only showed a bivariate association.

Table 6 The Association Between the Attitude of Cervical Cancer Screening Utilization with Different Variables of Women 15–49 Years Age, Adigrat Town, Tigray Regional State Eastern Zone, 2019

Variables	Categories	The Attitude of Cervical Cancer Screening Utilization		95%,CI
		Favorable Attitude (%)	Not Favorable Attitude (%)	COR	AOR
Educational status of respondents	Illiterate	36(73.5)	13(26.5)	1.00	1.00
	Primary(1–8)	101(49.8)	102(50.2)	2.8(1.401, 5.583)	2.7(1.297, 5.699)
	Secondary (9–12)	131(53.9)	112(46.1)	2.3(1.196, 4.685)	2.6(1.250, 5.445)
	Diploma and above	58(49.6)	59(50.4)	2.8 (1.357, 5.848)	2.9(1.329, 6.493)
Willing to screened near the future	Yes	236(50.6)	230(49.4)	1.00	1.00
	No	90(61.6)	56(38.4)	0.6(0.437, 0.933)	0.8(0.576, 1.322)
Perceived HH monthly income	Less than 200 ETB	82(82.8)	17(17.2)	1.00	1.00
	200 up to 500 ETB	26(48.1)	28(51.9)	5(2.462, 10.962)	5(2.505, 11.469)
	Greater than 500 ETB	218(47.5)	241(52.5)	5(3.066, 9.275)	4.8(2.783, 8.577)

Notes: the bold values under AOR showed that these factors are significant with the attitude of cervical cancer screening utilization whereas bold values under COR only showed a bivariate association.

Table 7 The Association Between the Practice of Cervical Cancer Screening Utilization with Different Variables of Women 15–49 Years Age, Adigrat Town, Tigray Regional State Eastern Zone, 2019

Variables	Categories	Cervical Cancer Screening		95%, CI
		Screened (%)	Not Screened (%)	COR	AOR
Educational status of respondents	Illiterate	38(77.6	11(22.4)	1.00	1.00
	Primary(1–8)	66(32.5)	137(67.5)	7(3.447, 14.917)	4.9(2.238,10.885)
	Secondary (9–12)	91(37.4)	152(62.6)	6(2.810, 11.850)	3.4(1.565, 7.458)
	Diploma and above	38(32.5)	79(67.5)	7(3.310, 15.583)	3.2(1.335, 7.607)
Occupation status of respondents	Employed	78(31.6)	169(68.4)	1.00	1.00
	Unemployed	155(42.5)	210(57.5)	0.6(0.445,0 0.878)	0.8(0.556, 1.250)
Perceived HH monthly income	Less than 200 ETB	55(55.6)	44(44.4)	1.00	1.00
	200 up to 500 ETB	20(37.0)	34(63.0)	2(1.077, 4.194)	2.3(1.096, 5.036)
	Greater than 500 ETB	34(34.4)	301(65.6)	2(1.533, 3.700)	2.2(1.367, 3.696)
Anyone with cervical cancer	Yes	11(12.6)	76(87.4)	1.00	1.00
	No	222(42.3)	303(57.7)	0.2(0.103, 0.381)	0.4(0.170, 0.748)
Family history of cervical cancer	Yes	5(16.1)	26(83.9)	1.00	1.00
	No	228(39.2)	353(60.8)	0.3(0.113,0 0.787)	0.9(0.286, 3.031)
Ever received information about cancer	Yes	161(33.1)	326(66.9)	1.00	1.00
	No	72(57.6)	53(42.4)	0.4(0.243, 0.543)	0.9(0.558, 1.598)
Ever received information about cervical cancer screening	Yes	120(27.8)	312(72.2)	1.00	1.00
	No	113(62.8)	67(37.2)	0.2(0.158, 0.330)	0.4(0.241,0.675)
Knowledge of cervical cancer screening utilization	Knowledgeable	152(53.5)	132(46.5)	1.00	1.00
	Not Knowledgeable	81(24.7)	247(75.3)	3.5(2.493, 4.946)	1.8(1.156, 2.698)

Notes: the bold values under AOR showed that these factors are significant with the practice of cervical cancer screening utilization whereas bold values under COR only showed a bivariate association.