1. FACTORS AFFECTING UPTAKE OF CERVICAL CANCER SCREENING AMONG WOMEN IN NAKASONGOLA DISTRICT, UGANDA AFENET Scientific Conference Authors: John Kamulegeya, J Bukenya, F Makumbi 1

2. Background Cervical cancer is leading cancer among women in Uganda Incidence rate 40.7/100,000 80% of patients at Mulago National Hospital, present with advanced disease Screening significantly reduce morbidity and mortality Free cervical screening using VIA at static/ outreach Only 52%of program target realized in 2012 Reasons for low uptake not known 2

3. Study Objectives 1. To determine the uptake of cervical cancer screening among women aged 25-49 years, district-wide 2.To establish factors associated with uptake of cervical cancer screening 3

4. Methodology 1 A cross-sectional community survey, March-May 2012 Interviewed 526 women, 4 focus group discussions, 8 key informant interviews Inclusion criteria Women aged 25- 49 years Resident in Nakasongola district for 6+ months Exclusion criteria Very ill and unable to participate in the interview. History of total hysterectomy at least 3 years prior to the study 4

5. Methodology 2 Multistage cluster sampling, randomly selecting participants from sampled household Uptake ascertained as proportion of screened between Feb. 2009 - Feb. 2012 Associated factors obtained by logistic regression Odds ratios (OR), 95%CI used as measure of association 5

6. Results 1- Uptake Only 14.6% (77/526) of the women reported ever screening for cervical cancer. Majority of screening, 79.2% ( 61/77) conducted within the district Only 6.5%(5 /77) of ever screened, had two or more screenings Willingness to adhere to next screening appointment was almost universal, 97.4% (75 /77) 6

7. Results-2 Social Demographic Factors CharacteristicsEver Screened % Adjusted OR ( 95% CI) Age group 25-298.5 (18/211) 1.0 35-3921.7 (15/69) 3.17 (1.30 -7.75)* 40-4421.2 (11/52) 2.81 (1.01-7.87)* 45-4917.4 (8/56) 1.82 (0.61-5.36) Education Level Secondary19.7 (26/132) 1.96 (0.56 - 6.87) Tertiary36.4 (8/22) 4.75 (0.99 - 22.81) Marital status Single 10.5 (6/57) 1.0 Divorced 18.3 (13/22) 5.05 (1.18 - 21.57)* Widow 20.0 (7/35) 5.76 (1.15 - 28.76)* Married 14.0 (51/363) 2.48 (0.72 – 8.55) 7

8. Results-3 Factors associated with Uptake CharacteristicsProportion Ever Screened % Adjusted OR( 95% CI) Knowledge about CxCaS Good63.2 (12/19) 1.0 Fair36.4 (32/88)0.30 (0.09-1.06) Poor 7.9 (33/419) 0.06 (0.02-0.19)* How likely is it to get cervical cancer in your life time? Likely28.1 (27/96) 1.0 Not Likely11.6 (50/430) 0.37 (0.15-0.6)* Having CxCa related signs and symptoms No8.3 (34/408) 1.0 Yes37.4 (43/112) 7.45 (3.93-14.16)* Screening is embarrassing Yes11.63 (52/447) 1.0 No31.65 (25/79) 3.45 (1.68-7.1)* 8

9. . Study Limitation Response bias Conclusion Uptake of Cervical cancer screening in Nakasongola district is very low, 14.6% Factors associated with poor uptake: –Low knowledge of CaCX screening –Embarrassment about screening –Low risk perceptions 9

10. Recommendations Improve women's knowledge about cervical cancer screening Sensitize women on importance of screening even when free of signs Expand screening services 10

11. Acknowledgements Makerere University School of Public Health(MakSPH) Nakasongola District Local Government FETP, Uganda Family Health Research and Development Center (FHRDC)- MakSPH Ndejje University 11

12. Thank you for your attention ! 12