Knowledge, attitudes, and practices concerning cervical cancer prevention in Uganda: a review of literature and critical appraisal

Presenter: Pamela Bakkabulindi

Poster file: [download]
Background Cervical cancer is the leading cause of preventable deaths in women in Uganda where it accounts for 80% of all female cancers in the country. The human papillomavirus (HPV) is the primary cause of cervical cancer but uptake of HPV vaccination remains low in Uganda. The aim of this literature review was to assess the knowledge, attitudes, beliefs and practices regarding cervical cancer and its prevention, with an emphasis on HPV vaccination, the reasons for use and non-use. Methodology We conducted an electronic search of databases including PubMed, Medline, Scopus, Cochrane library, Science Direct, Embase, Google scholar between January – February 2018, using the key words; knowledge, attitudes, practices, beliefs, cervical cancer, HPV vaccination, Uganda. Duplicates were removed and content analysis was used to analyse the narratives in each article. Results The initial search yielded 210 articles, but the final review included 67 full articles after removing duplicates and screening by title and abstract. The age standardized rate of cervical cancer had doubled between the 1960’s and 2015 (19.7 vs. 47.5/100,000). Baseline cervical screening rates were low (4.8% in rural; 30% in urban areas); knowledge on cervical cancer screening and HPV vaccination was low (as low as 41% and 8.3% respectively) but acceptance rates for HPV vaccination were high (96.6%) in demonstration projects. Cited barriers to cervical cancer screening included; limited knowledge and awareness; inadequate screening; misconceptions; fear of embarrassment; stigma; poor health worker attitude and inadequate screening supplies at the health facilities. Others included community misconceptions that HPV vaccination was associated with infertility; death; harm to the body; disability of injected arm; birth of twins; cause of cervical cancer; weakened intellect; abdominal cramps; heavy bleeding; and child birth complications. Discussion The rollout of the HPV vaccine in Uganda provides an immense opportunity to curb the burden of cervical cancer. One of the significant short fall of the nationwide HPV vaccination roll out in 2015 was a lack of involvement of key stakeholders like the national and district education officials including head and class teachers. The high levels of willingness for HPV vaccination of 96.6% as demonstrated one of the studies despite the low levels of knowledge of 17.6% as shown in another study presents an opportunity for communication strategies aimed at increasing education and awareness on HPV vaccination. Evidence shows that massive sensitisation involving all key players (school girls, parents, health workers, teachers, district leaders, community leaders) through targeted education is critical in improving the vaccine coverage. Mobilisation activities that focus on creating awareness while providing accurate information builds acceptability, sustains demand for HPV vaccination, and counters rumours/misinformation.