Background: Cervical cancer is the second most common cause of death from cancer among women in Kenya. Various international studies indicate that the knowledge level of cervical cancer and its predisposing and preventive measures is low among the nurses as well as general population. This study aimed to assess knowledge, practices and attitudes of nurses with regards to cervical cancer screening and preventive measures at two Nairobi hospitals in Kenya. Across-sectional quantitative descriptive study design was used. Convenience sampling method was applied and data were collected from respondents using self-administered questionnaire. About 114 nurses aged 18 years and above participated in the study. The study revealed that nurses have the information about cervical cancer, available screening tests and the purpose of screening. Nurses have the knowledge that cancer screening could detect this cancer at an early stage; however, uptake is low. Cervical screening services were hampered by barriers relating to health care institutions, nurses perception and fear of screening technique, embarrassment, stigma, social influence, financial costs and available sources of information / Health Studies / M.A. (Nursing Science)

Background Cervical cancer is one of the common cancers worldwide. Despite the available screening services, the uptake of cancer of the cervix is very low. The incidence and mortality in western countries has reduced greatly due to the introduction of cervical cancer screening programmes. However, this is not the same in Africa where cervical cancer is more prevalent in lower resource countries to lack of access to effective screening and services that enhances early detection and treatment. Purpose/Aim of the study The purpose of this research is to determine knowledge of cervical cancer and the level of awareness of screening regimes/routines among HIV positive women in Swaziland. The study was conducted at one hospital specifically at the HIV Care Unit and Public Health Unit between January and June 2015. Methods The questionnaire was administered to collect data and consisted both open and close-ended questions. The questionnaire comprises of three sections: Section A: Socio-demographic data and Section B: Awareness on Cervical Cancer. Section C: Awareness/knowledge on cervical cancer screening. The sample consisted of 123 HIV positive who are on antiretroviral therapy (ART) or ART naive. The mean age for the respondents was 35 years. Results From this study, N=28 (23%) out of 123 (77%) reported to have received annual Pap smear for cervical cancer screening. A low proportion of the respondents (45%) had knowledge on cervical cancer screening. In addition, 63% of those who got information about cervical cancer screening through the radio perceived themselves to be at risk of getting cervical cancer. Only 4% heard about cervical cancer at the ART clinic, despite having been followed up for their care at the HIV clinic. Those who screened for cervical cancer were younger in age 25-34 years (80%). This study also revealed that education increased the changes of a woman to be screened for cervical cancer. If a woman had a university or high school education, she perceived herself to be at risk of getting cervical cancer. Conclusion Knowledge is power, cervical cancer campaigns should be conducted at national level in order to promote prevention through screening. Cervical cancer screening should be fully integrated into HIV services / Health Studies / M.A. (Public Health)

Text in English / The purpose of the study was to explore perceptions, knowledge and attitudes of women undergoing cervical cancer screening in Omaheke, Namibia. A qualitative exploratory study was conducted. Data were collected from a purposive sample of eight participants using a self-developed interview guide. Data were analysed using Tesch’s descriptive method of open coding. Three themes were identified namely; cervical cancer as a disease, perception of cervical cancer and service delivery at the facility. The findings also revealed some suggestions for the facility that could improve screening uptake. The study proposes a community education programme on cervical cancer and related topics to be covered during health education sessions. In addition the study recommends the Omaheke directorate to look into operational issues in order to facilitate access to cervical cancer screening. / Health Studies / M.P.H.

The purpose of this study was to describe the factors that determine the utilisation of VIA, and to investigate the socio-economic status of women who undergone VIA. A retrospective document analysis of 323 clinical records was conducted at a specific rural hospital in Zimbabwe. A retrospective, cross-sectional, non-experimental, descriptive, analysis of clinical records was conducted using a checklist to extract data from the records of women who have undergone VIA for cervical screening at the specific rural hospital. The results revealed that 70% (N=225) were from outside the catchment area, 73% (N=234) were poor, 54% (N=173) were of high parity, 85% (N=275) were ill with conditions that included lower back and abdominal pains, excessive vaginal discharge and vaginal bleeding after intercourse. The study further revealed that 72% (N=226) had no prior cervical cancer screening and 87% (N=277) were screened by chance. The conclusion drawn was that socio-economic and logistical constraints hinder cervical cancer screening among rural women. It is recommended that VIA screening and health education on cervical cancer be offered to all women visiting healthcare facilities. Furthermore, the government should consider funding in order to prioritise women’s health issues. / Health Studies / M.A. (Nursing Science)

MPH / Department of Public Health / See the attached abstract below

Cervical cancer remains the main source of mortality among women around the world. It is a burden in developing countries and generally recognized through the complications of the advanced stages. The aim of this study was to investigate the utilisation of cervical cancer screening services among women living with HIV in Hawassa in order to develop a strategy to enhance cervical cancer screening service utilisation among this population in Ethiopia. A quantitative approach with a cross-sectional study design was used in this study. The data were collected using a standard structured questionnaire from 309 women living with HIV attending health care facilities in Hawassa city Administration. Statistical Package for Social Sciences version 25 software was used to analyse data. The results are presented based on the Health belief Model’s construct. The result revealed a low utilisation of cervical cancer screening services. Knowledge and perception of cervical cancer and cervical cancer screening service were also low. The main reason for being not screened was feeling healthy, lack of awareness, and embarrassment. Knowledge of cervical cancer was affected by factors such as knowing someone with cervical cancer, educational status, and monthly income. The finding indicated that utilisation of screenings could be determined by composite knowledge, perceived susceptibility to cervical cancer, duration on Highly Active Anti-Retroviral Treatment and willingness to be screened. The findings of this study, findings from the literature review and relevant legislation guided the researcher to develop a strategy to enhance cervical cancer screening service utilisation among women living with HIV Ethiopia. Relevant recommendations were put forward to promote utilisation of strategy and also for future research. The utilisation of the developed strategy may improve the uptake of screening for cervical cancer, improve early diagnosis and treatment of cervical malignant growth, and decrease mortality among women living with HIV in Hawassa city organization. / Health Studies / Ph. D. (Public Health)

MPH / Department of Public Health / Despite the availability of the South African cervical cancer screening guidelines at clinics, women are still seen in the out-patient department of selected rural district hospital in Thulamela Municipality, referred from Primary Health Care (PHC) facilities with no cervical cancer screening results. Thus, cervical cancer screenings are done at a hospital and results often came back positive for cervical cancer. Such practices pose a risk of delayed cervical cancer diagnoses and its discovery at an advanced stage, increasing cervical cancer mortality rates. The purpose of this study was to investigate the compliance of professional nurses at primary health care facilities to the South African cervical cancer screening guidelines in Thulamela Municipality. This study adopted a qualitative approach as it aimed to get a better understanding on compliance of professional nurses regarding South Africa’s cervical cancer screening guidelines. Nonprobability sampling was used to select primary health care facilities including interested participants who were judged to possess the information that was required to answer the research question of this study. The sample size of the study was determined by data saturation. Trustworthiness was ensured by four criteria of Guba and Linclon, namely credibility, transferability, dependability and confirmability. A digital recorder was used to log individual responses during interview sessions. Data from the digital recordings were transcribed verbatim. Results were analysed and interpreted thematically. This study established that clinic professional nurses are non –compliance to the South African cervical cancer screening guidelines; nurses face several challenges such as inadequate knowledge of the cervical cancer screening guidelines, shortage of resources and shortage of staff. Recommendations that emanated from the discussion of the findings and the conclusion of this study are likely to have implications and applications for supporting and advancing the cervical cancer screenings. / NRF

Indiana University-Purdue University Indianapolis (IUPUI) / Human papillomavirus (HPV) infection results in serious health issues including cervical, anal, vulvar, penile and oropharyngeal cancers. There are three vaccines against HPV but vaccination rates in the United States remain low. One barrier to uptake is a concern that individuals who are vaccinated may increase their risky sexual behaviors or decrease their use of cervical cancer screenings, an adjustment in perceived level of risk for HPV that can be studied using risk compensation theory. Methods Three distinct studies examined risk compensation after HPV vaccination. A systematic review examined literature from January 1, 2008-June 30, 2015, using three databases. A qualitative study using semi-structured interviews of 22 healthcare providers that assessed their beliefs regarding sexual disinhibition and cervical cancer screening following vaccination. A cross-sectional survey that assessed cervical cancer screening practices, awareness and comfort with recommendations, and knowledge regarding the purpose of a Papanicolaou (Pap) test. Results Twenty articles were included in the systematic review. None of the studies of sexual behaviors and/or biological outcomes found evidence of riskier behaviors after HPV vaccination. Instead, the studies found vaccinated individuals were less likely to report risky sexual behaviors, sexually transmitted infections (STIs), and pregnancy. Qualitative interviews found no healthcare providers believed the HPV vaccine would result in increased risky sexual behavior or decreased cervical cancer screening, and these concerns would not influence their vaccination recommendations. The survey included 291 women 21-35 years old; 62% were non-Hispanic black, 84% had a Pap test in the last three years, and 33% had at least one HPV vaccine. Logistic regression showed that vaccinated women did not have greater odds of having a Pap test in the past three years (OR=1.32; 95% CI=0.66-2.65; p=0.427). However, this odds ratio was significant when controlling for age and race (AOR=3.06; 95% CI=1.37-6.83; p=0.006). Conclusion These studies found no evidence of increased risky sexual behaviors or decreased cervical cancer screening rates after HPV vaccination. Furthermore, vaccinated women showed less evidence of risk compensation. These results should alleviate concerns about administering the HPV vaccination among parents and providers.

Indiana University-Purdue University Indianapolis (IUPUI) / Cervical cancer is caused by the persistent infection of human papilloma virus (HPV) in the cervix epithelium. Although effective preventative care is available, the widespread nature of infection and the variety of HPV strains unprotected by HPV vaccines necessitate a better understanding of the disease for development of new therapies. A major tumor suppressing mechanism is the inhibition of cell division by tissue structure; however, the underlining molecular circuitry for this regulation remains unclear. Recently, the Yap transcriptional co-activator has emerged as a key growth promoter that mediates contact growth arrest and limits organ size. Thus, we aimed to uncover upstream signals that connect tissue organization to Yap regulation in the inhibition of cervical cancer. Two events that disrupt tissue structure were examined including the loss of the tumor suppressor LKB1 and the expression of the viral oncogene HPV16-E6. We identified that Yap mediates cell growth regulation downstream of both LKB1 and E6. Restoration of LKB1 expression in HeLa cervical cancer cells, which lack this tumor suppressor, or shRNA knockdown of LKB1 in NTERT immortalized normal human dermal keratinocytes, demonstrated that LKB1 promotes Yap phosphorylation, nuclear exclusion, and proteasomal degradation. The ability of phosphorylation-defective Yap mutants to rescue LKB1 phenotypes, such as reduced cell proliferation and cell size, suggest that Yap inhibition contributes to LKB1 tumor suppressor function(s). Interestingly, LKB1’s suppression of Yap activity required neither the canonical Yap kinases, Lats1/2, nor metabolic downstream targets of LKB1, AMPK and mTORC1. Instead, the scaffolding protein NF2 was required for LKB1 to induce a specific actin cytoskeleton structure that associates with Yap suppression. Meanwhile, HPV16-E6 promoted Yap activation in all stages of keratinocyte differentiation. E6 activated the Rap1 small GTPase, which in turn promoted Yap activity. Since Rap1 does not mediate differentiation inhibition caused by E6, E6 may play a role in promoting cell growth through Rap1-Yap activation rather than preventing growth arrest through the disruption of differentiation. Altogether, the LKB1-NF2-Yap and E6-Rap1-Yap pathways represent two examples of a novel phenomenon, whereby the structure of a cell directly influences its gene expression and proliferation.

Text in English / Cervical cancer accounts for 34.6% of all the female cancers in Zimbabwe. The purpose of this study was to explore the knowledge, attitudes and perceptions of female student nurses regarding cervical cancer in Zimbabwe using the Health Belief Model (HBM) as a theoretical framework. The ultimate aim was to analyse female student nurses’ risk perception of contracting cervical cancer. A quantitative, cross-sectional descriptive research design was used, using a structured questionnaire for data collection. One hundred and thirty-two (132) respondents were conveniently selected. Descriptive and inferential statistics were calculated using Statistical Package for Social Sciences (SPSS) version 21 software program. The study revealed that 57.9% of the respondents perceive that they are at risk of developing cervical cancer. They believe that screening for cervical cancer is not embarrassing. Knowledge improved with increase in the level of study, there was lack of knowledge of HPV and cervical cancer link. More emphasis on cervical cancer should be put on curricula taught in undergraduate education earlier on in the programme. / Health Studies / M.A. (Nursing Science)