RESUMEN
The cancer disease burden is higher in the low- and middle-income countries like Kenya where uptake of screening services is low. Community health volunteers (CHVs) have been shown to be effective in improving uptake of health services and could also be used in cervical cancer screening. However, they still have inadequate knowledge hindering effective public education. The aim of this study is to determine the effect of focused training of the CHVs on their knowledge on cervical cancer and screening uptake among women of reproductive age. This was a quasi-experimental study in rural sub-counties of Nyando and Nyakach. Nyando was the intervention arm with 186 CHVs and Nyakach the control with 239 CHVs. Participants' knowledge on cervical cancer was assessed using a self-administered questionnaire. CHVs in the intervention arm were trained about cervical cancer and screening. Knowledge was re-assessed following a 6-month public education period. The focused training improved the CHVs' knowledge on cervical cancer to 60.9% compared to 13.4% in the control arm (p = 0.004) at the end-line. The knowledge was dependent on the level of education (χ2 = 34.41, p = 0.045), religion (χ2 = 25.85, p = 0.007), and occupation (χ2 = 95.04, p < 0.0001). Screening uptake was significantly associated with knowledge of risk factors (p = 0.019) and sign and symptoms (p = 0.017). Screening uptake improved in the intervention arm while declined in the control arm. The training significantly improved the CHVs' knowledge on cervical cancer and uptake of screening services in the intervention area, Kisumu County, Kenya, and should be continuous.
Asunto(s)
Neoplasias del Cuello Uterino , Agentes Comunitarios de Salud , Detección Precoz del Cáncer , Femenino , Humanos , Kenia , Salud Pública , Neoplasias del Cuello Uterino/diagnóstico , Neoplasias del Cuello Uterino/prevención & control , VoluntariosRESUMEN
BACKGROUND: Globally, cervical cancer is the fourth most frequent cancer in women, with an estimated 530,000 new cases in 2012, representing 7.5% of all female cancer deaths. Of the estimated more than 270,000 deaths from cervical cancer every year, more than 85% occur in less developed regions. In sub-Saharan Africa, 34.8 new cases of cervical cancer are diagnosed per 100,000 women annually, and 22.5/100,000 women die from the disease. Despite the magnitude of this problem, Kenya still has a screening rate of 3.2%; therefore, cervical cancer prevalence has not been established. Community Health Volunteers (CHV) are required to create demand for screening in the community and capture this in the Ministry of Health (MOH) reporting tool MOH 514. The objective of this study was to determine the knowledge of risk factors, signs and symptoms of cervical cancer and screening services' availability amongst CHVs to enable them sensitize the community about cervical cancer in Kadibo Division, Kisumu County. METHOD: In a cross-sectional study, a saturated sample of 188 CHVs was interviewed. The knowledge of cervical cancer was presented by use of frequencies and proportions; the relationship between demographic characteristics and knowledge was determined using chi-square. RESULTS: A majority, 161 (85.6%), were women, 47 (25.0%) were aged 40-44, 91 (48.4%) had primary education and 132 (70.2%) were small-scale farmers. A total of 128 (68.1%) had low, 60 (31.9%) had average and none had high amount of knowledge of risk factors. On average, 95 (50.5%) had low, 15 (8.0%) had average and 78 (41.5%) had high amount of knowledge of signs and symptoms. Finally, 77 (41.0%) had high, 40 (21.2%) had average and 71 (37.8%) had low knowledge of the availability of screening services. Education (p = 0.012, χ2 = 3.839), occupation (p < 0.0001, χ2 = 12.722), and health centre of attachment (p < 0.0001, χ2 = 71.013) were significant factors in determining the knowledge of risk factors. The knowledge of the signs and symptoms of cervical cancer was determined by the occupation of the CHVs (p = 0.030, χ2 = 15.110) and the years of work as a CHV (p = 0.014, χ2 = 8.451). Finally, the education level (p = 0.011, χ2 = 8.605), occupation (p = 0.002, χ2 = 18.335) and health centre of attachment (p < 0.0001, χ2 = 101.705) were significant in determining the knowledge of availability of screening services at the various health facilities. CONCLUSION: The following were found to significantly influence the knowledge of CHVs about cervical cancer: level of education, occupation, health facility of attachment and years of service as a CHV. There is need, therefore, for training on cervical cancer.