Barriers to Cervical Cancer Screening in Nigeria (Dissertation Sample)

Dissertation submitted as partial requirements for the degree of Masters of Public Health, Faculty of Health and Social Care, University of Chester
Barriers to Cervical Cancer Screening in Nigeria
An Explorative Qualitative Systematic Review
Student Name: (KENNY)
Student Number: 2020389
Supervisors Name: Jackie Cinnamond
Date of Submission:
Declaration
I hereby declare that this thesis is my work and effort and has not been submitted elsewhere for any award. Where other sources of information have been used, they have been acknowledged.
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Acknowledgement
Abstract
Background: Cervical cancer ranks second amongst malignant conditions with the most fatalities in Nigeria, and greater Sub-Saharan Africa. The country, like most in the developing world suffers from a high disease burden from the condition despite it being easy to treat with screening and early detection. Pap smear application, and HPV vaccination are the two screening options for cervical cancer. While they remain fairly straight forward and easy to implement, the presence of various barriers ensures that uptake of such screening options remains limited.
Aim: The aim of this systematic review was explore barriers to cervical cancer screening in Nigeria
Methods: The review performed a systematic literature search across four electronic databases namely, PubMed, SageHub, Science Direct and ResearchGate. Grey literature sources that included Google Scholar, Google, and Yahoo and Bing was also performed. Collectively, the literature search resulted in 2100 citations. Applying and rigorous inclusion/exclusion criteria enabled these studies to be reduced to 11 publications that were determined to be relevant to the study. A total of 3901 participants were covered across these 11 citations, with the data being rigorously analysed, and summarized using qualitative techniques to arrive at the research findings.
Results: A systematic review of the 11 studies identified in the inclusion/exclusion criteria established that various barriers were to blame for the sustained low cervical cancer screening numbers. These barriers also covered economic, psychosocial, educational, geographical, and hospital-related themes. In all the studies reviewed, presence of such barriers worked to make cervical cancer screening (CSS) less effective leading to higher incidences of cervical cancer. To rectify the situations, various interventions have been suggested within the studies reviewed, including increasing sensitization efforts to fight myths and falsehoods about cervical cancer, as well as ensuring women are economically empowered.
Conclusion: The review above revealed various inter-related barriers that were to blame for low CCS in Nigeria. The studies reviewed also showed various interventions would be effective at tackling such barriers with sensitization of communities and their economic empowerment being the best remedies. Yet, the various gaps identified, including the need for more theme-specific studies remains high, if only to make interventions more targeted and effective.
List of tables
TOC \h \z \c "Table" Table 1: Summary of Findings39
Table 2: Initial Study Selection Process62
Table 3: Data Extraction Table63
Table 4: Sample Bias Rating Table 68
Table 5: CASP Checklist for Qualitative Studies (The title includes a hyperlink to the CASP checklist used)69
List of figures
TOC \h \z \c "Figure" Figure 1: PRISMA flow chart29
Figure 2: Diagrammatic representation of meta-synthesis40
Chapter 1: Introduction & Background
1.1 Introduction
Cervical cancer ranks second as the most common malignancy amongst women, only placing behind breast cancer worldwide. The disease sees at least 600,000 new positive diagnoses recorded, and approximately 300,000 deaths are reported every year (Bray et al., 2018). As Berman & Schiller, (2017) and Prue et al. (2017) explain, the disease is frequently traced back to the human papillomavirus (HPV). The HPV virus attacks the squamous cells found in the inner surfaces of various organs, and this can be a precursor for malignant growth. When such an HPV infection attacks the cervix, cervical cancer might arise. As Prue et al. (2017) explain, it is typical for such an infection to go away without any medical intervention within 12 – 24 months. However, if left unchecked, such an infection can lead to the cells found around the cervix turning cancerous. According to Bednarczyk (2019), it takes between 10 – 30 years from the time a HPV infection takes root to the development of a tumour. It would take at least a decade before a cancerous disease arises from HPV further proves that cervical cancer is entirely preventable, as Prue et al. (2017) share. Further evidence of such prevention can be seen across North America, Europe, and most developed nations, where mortality traced back to cervical cancer continues to reduce significantly (Williams et al., 2021). Extensive HPV vaccination campaigns and cervical cancer screening (CCS), which acts as an effective means for secondary prevention, have been the primary tools to make gains against this disease (Bray et al., 2018).
Timely cancer screening remains an effective means of cancer prevention (Liverani et al., 2020). Patients revealed to be at risk of contracting the disease get to receive referrals for colposcopy, plus other definitive treatments for malignancy and any abnormal cervical cancer cells detected (Hossain, 2018; Zhang et al., 2020). Yet, women living in low-income countries remain at significantly higher risks of contracting the disease because of regularly low screening numbers. Such higher chances are primarily due to the many barriers to cervical cancer screening. According to Pilleron et al. (2019), approximately 60% of all cancer cases are recorded in Asia, Africa, Central America, and South America. These regions also account for about 70% of all cancer deaths (Shrestha et al., 2018; Pilleron et al., 2019).
As much as one-third of all new cases of cancer reported in the developing world remain easy to prevent, with another third being treatable on early detection (Bahnassy et al., 2020). Yet actual treatment and prevention numbers due to early detection in these countries remain grim. For instance, Nigeria sees approximately 12,000 women develop cervical cancer every year, with some 8,000 also dying from the disease (Morhason-Bello et al., 2020). As Bahnasy et al. explain cancer is a low priority disease with many African nations because of other conditions such as malaria, tuberculosis, and HIV are thought of as more deadly. A similar trend regarding healthcare priorities is also evident across other developing countries in Asia and South America (Hamdi et al., 2021).
However, recent data paints a different picture, with cancer rising into an emerging health problem in developing countries. Across the world, cancer cases are projected to grow by roughly 70% as the world’s population continues to grow and age (Hamdi et al., 2021). In Africa, the threat posed by the disease is even more acute as deaths traced back to cancer have already surpassed the numbers blamed on Malaria, Tuberculosis, and Aids combined (Hailu, 2017: Makhafola & McGaw, 2017: Krishnatreya, 2019). In Nigeria, various types of cancers combine to make the sickness among the deadliest non-communicable disease. For instance, approximately 12,000 women in Nigeria develop cervical cancer every year, with some 8,000 dying of the illness (Morhason-Bello et al., 2020). Currently, only breast cancer accounts for more deaths from the disease amongst women in the country (Hamdi et al., 2021). As Afolabi et al. (2019) conclude, such high mortality and morbidity rates could also be much lower if more commitment were shown towards fighting the disease in the country.
Yet, as with most other African nations, Nigeria continues to pay more attention and commit more healthcare resources to fight communicable diseases at the expense of non-communicable illnesses like cancer and diabetes (Bahnassy et al., 2020). Limited resources to safeguard the population’s healthcare means that the country must prioritise their spending according to the severity attached to a disease. As Hamdi et al. (2021) explain, cancer treatment and detection significant sums of money that most African countries cannot manage with ease. Accordingly, reports many of the deaths that can be traced back to the disease go prevented. More specifically, Afolabi et al. (2019) report that about 30% of all cervical cancer deaths that occur remain preventable. Yet, uptake of such preventative options as HPV vaccination and Pap smear application remains low in the country, and the consequences can be seen in persistently high morbidity and mortality rates. Regrettably, cervical cancer screening in low-income countries remains a complex affair hampered by multiple barriers (Cohen et al., 2019). For example, Afolabi et al. (2019) share that women in many developing countries fail to screen regularly because such services are ineffective, unavailable, or both. In places where such services are available in these countries...