INTEGRATING UPTAKE OF CERVICAL CANCER SCREENING AWARENESS CREATION IN COMMUNITY HEALTH STRATEGY IN KAKAMEGA COUNTY, KENYA

Abstract

Cervical cancer (CC) is the second most common cancer among women globally and in Kenya. Although early cervical cancer screening, (CCS) and treatment is an effective method of controlling the disease, there is generally poor uptake of screening services in Kenya and Kakamega County in particular. Currently, women only screen for cervical cancer when they experience symptoms suspected to be associated with it or when they are asked by health workers. Community health strategy (CHS) is a health-care delivery approach in which community people are empowered to participate in their own health- promoting activities with the help of Community Health Volunteers (CHVs). The main objective of the study was to integrate uptake of cervical cancer screening awareness creation in community strategy in Kakamega County. Specifically, the study sought to identify available resources supporting Cervical Cancer Screening in public health facilities, assessed knowledge, attitude and practices on Cervical Cancer Screening; evaluated the impact of providing focused cervical cancer education and awareness creation through Community Health Volunteers, (CHVs) on the uptake of cervical cancer screening and analyzed post intervention factors influencing uptake of Cervical Cancer Screening. This was a cluster randomized trial study design. Multistage sampling techniques were utilized. Sixteen Community Units out of 422 in Kakamega County were randomly selected and assigned either to intervention (n=8) or control (n=8) groups. A total of 872 women aged 25-49 years from the community were enrolled in intervention (n=432) and control (n=440) groups. Intervention was Health education on aspects of Cervical Cancer Screening. The Health Education was administered to women by Community Health Volunteers from their homes. Participants responded to the questionnaire at enrollment (all) and at six-month follow-up (intervention group). The primary outcomes were final screening rates and change in knowledge and attitude scores at six-month follow-up. Secondary outcomes were changes in awareness about cervical cancer screening, perception of personal cervical cancer risk, and screening acceptability. During follow up, significantly more participants in the intervention (58%) than control group (31%) screened for cervical cancer (p=0.01), had good knowledge (88%) about signs of cervical cancer, and risk factors (84%) for developing cervical cancer (p<0.01). Significantly more women in the intervention group perceived that they were at risk for developing cervical cancer (97%), it is possible to detect cervical cancer early by screening (94%) and a positive VIA/VILI test does not indicate presence of cervical cancer (p<0.01). In conclusion, integrating uptake of CC awareness creation for screening in community strategy is an effective strategy of increasing demand for CCS services among women. It is recommended that Community Health Volunteers should be empowered through training and expansion of scope of practice by the county governments to create awareness on cervical cancer screening among women.