Cervical cancer screening uptake and its determinants among rural women in North Central Nigeria: a cross-sectional study.
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INTRODUCTION: Cervical cancer is the third most common cancer in Nigeria, with 13,676 new cases and 7093 deaths in 2022 (according to GLOBOCAN estimates). Cervical cancer survival is poor in Sub-Saharan Africa, with nearly half of diagnosed women dying within 3 years. Most cases occur in women aged 15-44 years, resulting in significant social, economic, and psychological consequences. Despite this disease being preventable and curable when detected early, many Nigerian women present at advanced stages due to low awareness, misconceptions, and limited screening. Previous studies have been largely hospital-based or limited in scope. This study assessed knowledge, attitude, and screening uptake of cervical cancer among rural women in North Central Nigeria and identified significant predictors of these outcomes. METHODS: A community-based cross-sectional study was conducted in Omala local government area, Kogi State, Nigeria between September and October 2023. Using multistage sampling, 416 women aged 15 years and above were recruited from four rural communities to ensure representativeness. Data were collected by trained interviewers through a semi-structured, pretested questionnaire administered by face-to-face interviews or self-completed depending on literacy levels. The instrument included sociodemographic variables, four domains of knowledge (general, risk factors, signs/symptoms, screening), attitude assessed on a five-point Likert scale, and uptake of cervical cancer screening. Consolidated knowledge scores were calculated and categorized as poor or fair/good. Willingness to undergo screening was categorized as 'yes', 'no' and 'not sure'. Logistic regression models were fitted to identify independent predictors of knowledge, attitude, and uptake, with results expressed as odds ratios (ORs) and 95% confidence intervals (CIs). Ethics approval was obtained from the National Open University of Nigeria, and informed consent was secured. RESULTS: Most participants were 40 years or less (71.7%) and married (58.2%). Overall, 41.7% had fair/good consolidated knowledge of cervical cancer, with substantial variation across domains: general knowledge (59.2%), knowledge of risk factors (15.5%), knowledge of signs and symptoms (26.8%), and knowledge of screening (45.2%). Only 42.3% recognized HPV infection as a risk factor, while fewer than one-third recognized intermenstrual or postcoital bleeding as symptoms. Mass media (36.7%) and hospitals (26.6%) were the most common sources of information. The median attitude score was 3.3, with positive attitude expressed toward the curability of cervical cancer if detected early and to the effectiveness of Pap smears and vaccination. Nonetheless, only 12.2% of women reported ever undergoing screening although 36% expressed willingness to undergo a screening test. Reported barriers included lack of knowledge about the test (23.3%), absence of symptoms (22.4%), and low perceived susceptibility (11.1%). Multivariable analysis showed that higher education (p (trend)=0.001), increasing age (OR=1.07, 95%CI 1.03-1.11), later commencement of sexual intercourse (OR=1.04, 95%CI 1.00-1.08), smaller family size (OR=2.62, 95%CI 1.34-5.11), and family history of cervical cancer (OR=3.72, 95%CI 1.18-11.68) were associated with good knowledge. Positive attitude was predicted by higher education (p=0.037), nulliparity (OR=2.61, 95%CI 1.04-6.54), and smaller family size (OR=2.16, 95%CI 1.14-4.10). Screening uptake was significantly associated with positive attitude (p=0.006), being married (OR=3.50, 95%CI 1.08-11.39) or divorced/separated (OR=6.03, 95%CI 1.21-30.02), and knowledge of screening (OR=2.54, 95%CI 1.00-6.69). CONCLUSION: Knowledge of cervical cancer and its risk factors among rural women in North Central Nigeria remains poor, and uptake of screening services was profoundly low. Positive attitude, marital status, and good knowledge were key drivers of screening uptake. These findings highlight the need for context-specific health promotion programs, improved access to screening, and targeted education strategies in rural settings. Lessons from this study have broader implications for rural health systems globally, particularly in low-resource contexts where similar barriers persist.