Rural Zulu women’s knowledge of and attitudes towards Pap smears and adherence to cervical screening

Abstract

BackgroundCervical cancer is the most common form of cancer in black women in South Africa and has almost a 60% mortality rate. However, adherence to cervical screening programmes of black women living in rural South Africa is not universal.AimThe aim of this study was to gain a better understanding of rural Zulu women’s knowledge of and attitudes towards Pap smear tests, and their reasons for participation or non-compliance with cervical screening.SettingThis study was conducted at the gynaecology and antenatal clinics in a secondary referral hospital in rural KwaZulu-Natal.MethodsA hospital-based cross-sectional study was undertaken in the form of a semi-structured patient questionnaire survey with open and closed questions. The responses to the open-ended questions were manually analysed by the authors using a thematic approach. Outcome measures included whether the woman had a previous Pap smear, her understanding of the cervical screening programme and causes of cervical cancer.ResultsThis study included a total analysis of 234 responses. The mean age was 29 years (s.d. = 8.3 years). Overall, 32.5% of women had previously had a Pap smear. Among the responders, 33.3% were human immunodeficiency virus (HIV)-positive and 53.0% were HIV-negative. Only 19.2% of women understood that a Pap smear was related to screening for cervical cancer.ConclusionsThis study illustrated a poor understanding of cervical screening, which may result in the low level of uptake of Pap smear reported; this is particularly concerning in HIV-positive women, who are at higher risk of developing cervical cancer. Urgent and extensive public health campaigning is required within rural South Africa to improve cervical screening uptake and decrease cervical cancer mortality.

Combining cervical cancer screening for mothers with schoolgirl vaccination during human papillomavirus (HPV) vaccine implementation in South Africa: results from the VACCS1 and VACCS2 trials

“…Poor knowledge of disease detection and prevention has often been linked to high prevalence and late diagnosis of cervical cancer, but evidence about interventions that effectively addresses this problem is limited 25. Consistent with previous reports, the present study confirmed that South African women lack this basic knowledge 26 27. Importantly, in this report simple health education during a vaccine implementation project had a measurable and significant positive effect on the knowledge of mothers of primary school children.…”

Cervical cancer in women living in South Africa: a record linkage study of the National Health Laboratory Service and the National Cancer Registry

“…Specifically, 40% of Black women reported ever having done a Pap smear compared to 91% White, 83% Coloured and 78% of Asian women [26]. The barriers to CC screening in black women in South Africa include lower socioeconomic position, lack of knowledge on CC screening, cultural beliefs as well as fear and stigma [26][27][28][29].…”

Cervical cancer knowledge and screening uptake by marginalized population of women in inner-city Durban, South Africa: Insights into the need for increased health literacy

“…This lack of knowledge about cervical cancer has also been reported in other studies within the province of KwaZulu-Natal (KZN) as well as other provinces in South Africa and elsewhere in Africa. 16,18,19,29,[40][41][42][43] Women have previously expressed the need for female targeted education, screening centres and support groups. 29 Participants in this study also stressed the importance of the community both in terms of education and support.…”