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SOICK>I . OF PlIBLIC HF.Al.TH 
COU.[GE UP HEAL m SC(E~Ct:S 
USIVERSITV or (~IIA~A 
KNOWLEDGE OF Ct:KHC..u. ("A."lC[K AND "PT AKt: 0." SCR[[NING A\tOSG 
PK[{f"lA.VT WO~": "-I .",Tn:!\Dl"G ANTF.:NATAL CLlNlC AT THF.IIO MUSlCIPAL 
IIOSP1T AI... VOLTA R£GION. GHANA 
(1178J467) 
TH1S mS-"t:RT AT lON IS SUBMITTED TO THE USIVt:RSITY 0.' GHA!'IiA. LE(;oN 
I~ PARTIAL ruUlLLMENT or THE REQUIRE!\1£NT fOR TIlE AWARD 
..,ASTER.,\ IS rUBl.IC Hf.AI.TH lJEGREl:. 
JULY.1t •• 
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I Oifty Oravie do hereby declare thai, apart from works done in relation to this subject &re8 
which have been duly acknowledged. this work was indepcndendy done by my under 
supervision. I alsodcclan: that this work has not been submined (or the award of any degree in 
thisWliversil),orelSC'Where 
..........~  
GIITY ORA VIE DATE 
(STUDE~T) 
DR. DL\II DWO\tOH DATE 
(SUP.:RVISOR) 
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I dedlC.le thiS WOrt!. 10 my f.-nit" and mends fOt lhcir words of enc:oun~. wppor1 and 
pn~~ I u,ygod richlybles.syou. 
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ACK.'\;O\\L[I>G[:\1(~T 
I .. ~ .,.a&d'uJ to the Almighty God for granting me for making I way fOf' this study 
I am sinurely indeblcd to my sUpe1'\'isot. Dr. Duah Dwomoh for his pallence and astute academic 
gaaidancchcoffercd~ahoutthestudyandal~loallothcrlecturersoftheSchoolofPublic 
Health., University of Ghana. Lelon (or their rich contribution towards my study 
My sincere &ralltude also loes to the :v!ed1C81 Director. Deputy OircctorofNursmg and Mld"lfc!,) 
SctvICCS. the midwife in-charse: and the r~art.h committee of the Ho Municipal lim.pltal for 
allowinaaccess inu»the facility to cany OUI my study successfully 
To the preJnaIll women who willingly pat1iclpatcd in the study. I appre!;l.alc your Immense 
contnbutionlOv.ardslhesucceiSofthisstudy 
Finally.IoIU mycol~, and fnends who haJ mlerCiI III my work and had offered IOrm helpina 
hand inonc way or tbe othcr, 1:..1)' lhankyou forcnh.1l1CinSIM: ~ucc;cS5ofm) ~Iudy 
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ABSTRACT 
BackgrouDd: Cervical cancer is one of the leading causes of morbidity and mortality among 
females across the globe, especially in developing countries like Ghana. The: level (l(women' s 
knowledge about cervical cancer is imponant In illCretiing efforts to minimizing the disease. 
AiID: thisstudywasaimedatascertainingthcknowlcdgcanduptakcofcervicalclUlcerscreening 
services among pregnant mothers attendmg antenatal clinic at the Ho MUnicipal Hospital. 
~etbodolog): The study adopted an anaJytiI; cross--sectional design liang with I quantitative 
method of dau. collection among pregnant women. Systematic sampling method was used in 
Klecting W respondents for lhe stud)" Descripliveand inferentiallUtllyseswere performed. 
Descriptive analysis involved su.mmary and CIOII-tlbulation to asKSS proportion of in de pen dent 
variabtes apillSl ckpmdent variable. Inferential analysis which involved equality of variance test 
to M~U the mean differences of knowledge scores Kross .11 domains. 
Fiadiap: this st\Idy found ahat the overall knowledge score on cervical nnccr amoni lhe 
respondents was 23.7%. Knowl~geontbe risk factOB ofccrvtul cancer showed that, respondents 
agreedtlwhivingmultiplescxpartners,smokingandearlyonsclofsexu,Q1 intercourse increase 
one's riik of acquiring the disease. It was round that age, religion. cducationallevei, averaae 
monthly income, marital ~tatus, number of children, number of pregnancy and age at first 
prcgnancysignifitantly influenccoverall knowlcdge score (p-value<O.05). Thcuptakeof c:ervic.ll 
~ screening among the rcspondenU within 1htcc years prccedina the study was as low as 
) 1.5%. Demognphu; chi.racteristh:s such as, age group, education level, employment Ibolus, 
average monthly income, marital ,tatus, number of children, number of pregnancy and age tanac 
a1~lprcgnanc)' .... eresignirlCanlllassocialc:dwithccrvicalcan«ruptake(p_vatue<O.OS). 
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COlKI..uo.:Thcn::suhofthisstudyrcvealedlh.teYCftthoug.h.\l.lJmnslevel~ashig.h.onl)fe\l 
prtpw1t women had adequate knowledp on cervical cancer Knll'wlcdge abolll """ut cancer 
reprdtnllU nsk factors. signs and symptoms, pn:vention and Ik.stmm is subopcima! among the 
populatIOn undcrlhiJpretcrl1 SUldy. There wl.$also poor uptakeofPIIfI smcarteltamonJ prejJW1t 
women withIn the three years preceding the study. The factors that innuen~d cervical cancer 
iCrttnmguptakewerciKkofhusbuldsuppon,bclngphyslullyhtalth).cultunlbelicfs,COIIof 
w:recnm"andla..:koffemaJehcallhworkerstoconducISCl'unins· 
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DECLARATIO~ ... . 
DEDICATION. ..... . 
ACKNOWLEDGEMENT• ... 
ABSTRACT _._.~." ... 
LIST or TABLES ... .. 
LIST or FIGURES .. .. 
I .IST 01' A88RLVIA TlONS •••• 
OPERATIONAL UEFINITIONS .... 
CHAPTER ONE ... 
to INTROlll CHON .... 
11Objec'Ivn 
1.3 .1 GcncralobJcClIVC 
Il:!S~IficObjectives .... 
14 ResearchQuest101U 
UtoI'K"pluaiframewori; 
1.6 JlISliflUllton ofthc slud~ 
CHAPTER TWO .... ·.· ........................ 10 
2.0 LITERATURE REVIEW , ... .. .... · ........ · .............. ..... , ................ 10 
22 CenlCal cancer in the wodel. 
2.J CcrvlCal cancer in Arrica .. 
2." CuvKaI canecrin Ghana. 
2.SK.no.lcdgeora'n'iClilcanccr 
2.6 F.cIOQ Uwt innucncc women knowledae of cervical cancer .. 
2.6 CavicaJ canccr ~rcemng uptake in Africa and in Gtwu .... 18 
2.7 Factonauoclatcd withcervie&Jc:anccrscrccnin. uplake 20 
CHAYTER TllRE[ ........ ,• . _ ....... _ ........ _._ 
············· •. ·. ..••...•••...• 23 
3.' METHODOLOGY ................. ____. _. .... . 
l.2Stud)an:.atlocldion .... 
lJ 
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3.3 Study Variables 
3.3.1 DependenlvariabJe .2' 
3.3.2IndcpenOenlvariable. ... 25 
1.4 Study population ...... .. . 25 
3.SlnclusionandExciusioncriteria .. .. .... 25 
3.S.llnclusioncritcria 25 
3.S.2ExclusiOllcrttcria ..... 26 
3.6SampleslzedctennlRation ...... 26 
1.1 Sampling Method 
3.80IlacoUccttonandstudyinstrument~ 
3.9 Qualil)'Assunnce. 
3.IODaupl'(K;esslRl:andanaly'Sis .27 
3.11 EthicalconsKimlion 
CHA1·TEH. FUl·R .... ..... .. 30 
.30 
30 
4.2 Demographic Profile of Respondents 30 
4,JAwarene"ofcervalcancer ... . .. 33 
4.4 Koo'Alcdge ofccl'Vical canc:cr .. . 34 
5.1 Kno'Alcdgc of pregnant women on cervical can.:cr . ...... 51 
5.2 Factors influencing Irnowledge on cervical cancer .. 55 
S.3 Prcvalenceofcervical cancerscreeningupi:ake ........ 56 
S.4FlCtorsinfluencinguptakcofeervtclllcanccr:K:reening 58 
S.SUmlLltionsofthcstudy ..... 59 
CHAPTER SIX ..................... 60 
6.0 CONCLUSION AND RECOMMENDATIONS ....... .. ............................ 60 
6.1 ConcllblOn 
62 Rocommendahons .... 
REFERENCES ................................ 62 
··················.· ..................••• _72 
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\)'!'r:\DIX C: QUESTIONNAIRE 
-\rl't:SDlX D: CLEARANCE LEnTH .... 
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LIST OF TABLES 
roble . ..., IJ<mo. ...... T_ ................ ......... 32 
r.we •.•' dl. ......." " TobIeof....,ondcnu .. .............. 33 
TIbIe 4.6: Knowkdse of caw;es and sigts and symptoms, fISk (acton'" preV'ClllCion of cervical 
.35 
Table 4.4: Pcrtcntagc: average score assessment on L:.nowkdgc of ccnicaJ c.ccr . 
Table 4.4&: Awnp percentage \COfe .~\enmenl on knowled"e of cervical cancer by dcmo. ...p hi~ 
Table 4.4b: Average percentage score as.~"mcnt on knowledge of ~cniical c.tn~er by 
Table 4.5a: Factors Nl"ucncing overall know1cdac w:o~ amon, preJRMlI ",omen showing 
UIIivll"iaz.eandmubivariMc:Zero-inn.tcdPoiuon~(WfflCicntl ... 
Table 4.6. Upc.U.c ofCcrvical CMea mccnifta 
TIblc4.7: Yearsohcrccninaandrcc~ionofCCSarnon.mpondats .... . 47 
TtItt. 4.8.: fadoB ..,Oucn~ing ccrvical cancer Sl;reeninK uptake amenK PR'JnUI women 
Table 4 Ib: Facto~ Influcncing ~crvlc .. 1 cancer screcnin8 upbke amona preanant women 
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Fiprc:I . I: concepcualflowdlagr.lm 
Fipre 3.1 Map ofHo Municipalil) 
fljure4.1 : Pre\'.lcm:cofuptak.eo(cen-lcalcanc~rshow;ng9.5"oCl error bar 
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LIST OF ABBREViATIONS 
European Medicine Agency 
Etht.;al RcviN' Committee 
Cervallntrxpithellal Neoplasm 
csSD Cenler Stenle Servlc.e Department 
DI:ilJict I-lealth Management Infonnatlon Syatem 
Food and Dnl,pAdministra!ioo 
lIumanPapiliomaVirus 
Ministry of Hcalth 
National HcalthlnsurafKcSchcmc 
SqUAmous IntraqJllhellal Lesions 
UniledSWts 
Visuallnspttlton ~ Ith Acetic Acid 
WOfldHalthOrganizalion 
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OPERATIONAL OEFlNlTlONS 
Kaowledge; This is whal1hc n:spondents know about Cft'Vlcal cancer tnd how it can be Kquimf 
Aware ...:  This is wbother n:spondenlS have eu:r heard or cervini cancer. 
Uptake:Thisiswhether1hcrespondentshavce"erperfonncdceTVicaicancer~reening 
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cflAPTER ONE 
INTRODl'CTION 
1.1 Background 
c.ncer.lsokno .... nuufClnoJ1\l.isagcncralclusificationoft!lgroupofdl)ea5Cs. ltisdescribed 
81thcunteStraincddeveiopmenlllrldspreadofabnorm.lcclioutsidetheirlimit whichCUlatrcct 
lis$ucsofthebody.nd.lsospl"Udtoochc:rcwgans(WHO, 20U). 
CMtcr of the cervIx is prev.lent among aduh females ,Iabally. About 528.000 freshl y Identified 
cases and 266,000 mortalities \.\-en: estimated 10 have occWTed in 2012. More than 85% of tn"aslve 
,crvic.1 cancer cun occur in devclopina ~ntries. Yearly an estimated 3.151 women are 
dlaWKtSed With 2.119 monalitin (WHO. 2013). Cerv,,~al cancCf is counted among the J1\I.jor public 
heaIIh problmu glob&lIy. mo~1 paniculatly in dc"eloping and resource challenged nations. It is 
lIansmiacd sexuall)' and cawed by some &roup of lIuman Papilloma Virus (HPV). mostly IIPV) 
16 and 18(WHO, 2016). 
In20IB,cancCfofthtcervl:\ .... asranked the (ourth funhcnnostprc\'Iilingcanccramon glcmalc!) 
.... 1111 • proJC'1Cd 570.000 new ~~ sipifying 6.6% of all cancers occurring amona "limen 
(WHO ICO. 2018). Cwrmtly, Vacclnc~ ~ made .....i lable lh11 gives immunily apiA"~ common 
,ancer .:liUJing types of Human Papilloma Virus and can reduce appreciably the rbk llf cervical 
,M1~cr In women l.'m,·crs.ally cervical cancer mikes up 12% of III female cancers and ~tand5 as 
the leading synecolo,ical malignancy. The risk for cervical cancer is hip in many resource 
chaIlCIIgedcoun&riatypKaJlyduclounaVlilabilityorlnadequac:)ofell.l\lmgprcvtTItivepropaml 
(WHOIICO. 2011). More than 75.000 new CUCi IRd 50,000 monalitia l)!;Cur yearty in sub-
":m..n Africa where thc lIffccted population continues to increase btimates suUest a p,bal 
death rate of mon: than 443.000 by 2030. mos1 of .... hich \\111 happen in sub-Saharan Africi 
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(Mbownba Bo~ e1 aI., 2017). Women In their adulthood with high level of both social and 
economlcproduclillirylreaffectedbycervicaICU'ICC,.Absenceorscrec"ing""hich~ibfor 
earlydcteccion ofpreunccrous celli and carly Sl3ge of cervical cancer results in its increucd 
prcvalmct (Ele. Emeka·lmn., & Edcgbe. 2013) 
The !utuatlOO is no different in Ghana. In Ghana, thi~ malignancy plays the second position among 
the most arising cancen Iffecting fcma.les and mostlyoc:curring in tnose within the age range of 
IS and 44 ~. ElIen though there is no available documented data on the burdenofHPV on the 
Mlion Ghana, in West Africa. the province in which Ghana is located, roughly 4.3% of women 
are projected 10 havcncervical HPV 16orI8infectionsgenerallyatlpointintime,and55.6Y.of 
this malignancy is assoc.aled ~ Ith lhcsc HPV types (WHOIICO. 2007). 
lII.healthanddealhassociatedwitbeervicalc:ancerhasbeenreportedtobereduceddrasllC:allyin 
advanc:ednationsmainlyduetocffecti\"cscrceningprogJ1lms. The eXACt oppositc is tne sitUlJtion 
in under deveklped rw:ionsduc:tononexiSlcneeofscreeningprogram!i (Canfcllelal.,2006). A[ 
least 1% of women in their child bearing age will be diagno!>Cd of Cervical Intracpitbelw 
Neopwm (CIN) In developed countries. mo~1 cervical abnormalities reported amon, women 
were detected durin; antenatal care where iCreening services were provided {Esike etal .• lOIS) 
About 2-1million abnormal Pap In'ICIt ate documented to be diagnosed aMUIlly in thc United 
States (US) 0lU: ofw hich 5%[013% aredecected duringprcgnancy (Jones&. Davey. 2000). Several 
risk factors including numerous scxual partncT5. mUltiparity. eariy inception of coital debul, low 
socio-economic class and immunoslippreuion have been reportcd 10 predlspme women to cervical 
cancer (Pathology, 2012). Clinical and histopathological stuche& fonnerIy done revealed dw 
Ghanaian femaln with the disease condition mostly report in melMtatic phase to health racilities 
III.I.J.n<lrtc) &.:. AlOcmang. 2018) 
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In Ghana. provision of maternal, neonaW and child heIIlth care services and gynecol", care 
5ervic~ m.y perhaps hne im~ on the knowledge and uptake of screening since these clinics 
are imponam poinl of entry in the health facilities where W~lmen are scremed, infonned and 
cduc.ICd ....h isn:searchtherefon:aimslomcasurelheln'elofllnowledgeoneervicalcaneerand 
uptake of screening among pregnant "omcn .nending anten.tal clinic II: the Ho Municipal 
Hospital. 
UProbleOlstate.cnt 
Cancer of the cervix is one oflhe most occurring m.lignances in adult fem.les globally and 
common m undcr dcveloped countries. The high levels oftheoccum::nce of the disease is relate d 
to lack ofeffccti\'e screening programs and where Sl:recning services are available, Its utihzat ion 
is poor due 10 facton such as inadequate knowledge and poor health seeking behaVIOr 
(Ifcmelummact al .• 2019). Globally, diagnosis of me maliiJIancy is made mostly in its advanecd 
... CervjQl canur managcment III Its advanc:ed stage m.y )ield very linh: effectiveneu and 
may expose women to complications instead (VislAd et .1 .• 2011). 
At present. !oCrcening of the cervix is known to be the most effective means to control cervical 
cancer. Despite the increasing health campaigns, warning labels m the health facilities and advice 
from he.lth profes.sionals. some women still do nUl a.:knowledgc thc observed cvMlcnce ord angers 
of ccrvieaI cancer. Gcognlphtcal location of womcn wmelimes affects lheir knowledge on the 
condibonand knowle.dge on lhe availability ofscrecnins: forearlym:oanil6on. prevention and 
tra:tment (Obalaseet al.. 2011). 
CuvICaI ~er plays. leading ro)c considermg causes of female mortalities in Ghana. The death 
raleissaidlObetlveetimesmorethanlhatllfthcgl()balburdcn_E\'enthough~recningserviccl 
~ .v.ilabk in Ghana. only 3~,. of Gharuli1n \\o,"cn undergo screening at regular intervals 
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(Wilham e1 aI .• 201~l. The: growth and mortalities from cervical cancer in the counlry repTCKf'lts 
oncoftbe most alarming worldwide and the:se occurrences have been on the tncre&Se lIulC:adof 
decml5ing (Awua, S.:key.Osci. Asmah. &. Wiredu, 2016). 
L..evel ofkaowledgc and uptake of screening ha\·c remained very low over the ycars even lhough 
thtR have been several StudlCS on lhc disease condition . For instance. a study conducted among 
"omen in Bangladesh revealedtha,only 12%oftheparticipanlS had adequale knowledge on the 
disease (UndUlon (Fc:rdous elal., 2014). Apin. 920/. of women 5tUdied in nonh<entral Nigeria 
dc:monw..ted poor knowledge on cervical cancer (Ido"u et a l., 2015). In South·Easlem Niaeria 
llUdiei among pregnant women rc'·c:alcd madcqualc knowledge and screening uptake. These were 
linked to facton such as abscnceofhcallh educl1lon and absencc of patient's privacy (Ingwu. 
:WI7) 
StudlC:, ha\iCaiio shown thai in Ghana. there is poor know!edge on all aspects of the disease 
.,;oOOilIOn amonl patients living with cervical cancer before being diaanoscd. Tne disease 
,ondillon hu impec\Cd ncptJ\iely on their dall~ life (Binka. Doku. & AWUSlbo-aure. 2017) 
StudIO amonl women livina with the diiCaSe condition from two major Icaching hospitals 
between 2010 and 2013 in Ghana revealed that most women presenled with the condition at late 
!itaps(HIIi & Cox.. 2011) 
Poor knowledge abouIthcdiKUC condilion and uplakcofscrccningposcthreulto its prevention 
and b"ealmc"nt in Ghana. In developina counlrics sucn as Ghana, most ~omen pallOnize 
rcproduc:ti,·c ncalth care iervices such as antenatal. postnatal care, family plannin, and 
gyna;ologlCaI~i(nbutmo$tfacihlicl>an:-notequippedtopro\'idecervjc.lc.ancerservtces. 
Previous rescarcbes !uI,·c mostl) a)~s!>Cd the awareness level on cervical cancer among hospital 
staff, men and ccn.·ical cancer patients among others in Ghana. This n:search therefore !>CeQ to 
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aness the level of knowlcdae on cervtcal cancer and upW:.~ of sereenlflg among pr~gnanl molbers 
attcndinlatltenatalchnic inthc: Ito Municipal Hospitlll as il servcs &5 tM: fint re(elTlll pol n(for 
dients In the Ho municipality and iu nelghborinl districts and also one of the I'Mjor pn:mdcr of 
hcalthcarefO(pn:~lwomen 
LJObjeclives 
1.J.lGuentiobjedi\'c 
To aucn the Itnowkdp: and uplake of CCf"ViuI cancer serumn, urvicH among pregnant mothcn 
allend;n~ J.ntena&al dinic at the Ho Municipal Hospital 
I.l.lS~iOcObj«lives 
• TO&5snstheknowledgeofpregnant ....o mcnoncervicalc.anur 
• To dctcnnine factors Influentinl knowledac on cervical c.&I'I<:er 
• To de~ine facton auoc:iMcd with cervICal .;ancer screening uptakc among pregnant 
1.4 Rcsnrcb QUftlioD\ 
Whal IS 1M: Ic\ cluf ~tk ..... ledMe of prclP'\&nl women on cervical cancer'? 
Whal faclots mflucllCC knowledge on cervical carcinoma'! 
WhatistheprcvalenceofcCTVlcalcan.;crKreenlnguplakeinthethrecyearspn:ccdin8Ihe 
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Fitwt' I aboveshowsthcinter.rel3tKlflshipof the various ,ari:ablesofinterest in the study based 
on exis1ing literature. Severa] facets hue been identified 10 influence the level ofL:nowledge and 
upweofscl'cefHng Thcscincludc5OCio-demographic;,health~rvice. "oclocullu ... landolhtr 
individ~faceu . Lac.kofperceivedneceiSil)',personalexpcriencdoandlangua8ebarrieraresome 
oflhelndlvidualfac;tor'thalmayde[erminc:lhcd«lslOn!OK~n(Njugun.etal.,2017). 
Tht nature of the tesl and programme is highlysignific.ant in ccrvicalcancerscrecninahcllCC. 
prostarnmcst. .. teliesthatincludeaddres~inggcndcrn'lnns,culturalbdieveandperceptionslbout 
SCItt1Iinl: Incl'ClK cavic.l canccr ~n:cnm" uptak.e Individuals with perception of their 
\UloCCPhbilily to cervical cancer coupled with ils complications rna)' overcome pc:rccived burien 
tcost,pain and discomfort during procedure) and beopllmistic lowards acceptance of screenin, 
~nlca.ln the Northern pan of Yangon, Myanmar. migrants who had positive perception towards 
pnttived burien wen: found to be 2.24 times more probable to SCrHn than lOOse with neptive 
peretpiions(Nandat.Chompikul,&:'Laosce.20IS) 
Oiffetent$ludink..vealsofoundotherdetennirwllsincludingage,education,maritalstilus.,nsk 
and uptake of sauning (Idowu. Olowookere. Faabemi, & Ogunlaja. 2016). In Turke}. the: 
knov,·ledge of(emale5 aged over 20years was u!Oesscd. Analytic findingi showed that, 940/. ofthc 
stud) pmicipants hM IIkqIWe knowledge on the condition, our of which 680/. had infonnation 
onPapunc&ttesland46.I%werelc$lCdmorethanoncc:.Women',,,ceandknowled8e.boutlhe 
diseascoondlttonwereestabliihtobedlrcctlylinkedloac:cepUn«0(cervu:alcanccr~rttnin8 
(Onsu.t.. Hiduuglu. SariOL, Metintas, & KaRvm, 2014). In Ethiopia, women who wen: emplo)w 
either ~ « b) the government were three to four times more probab~ to partake In 
sc:reeninlthanunernployedhotaewivn(Tewncet.I., 2019) 
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UQlth looCrvice related factors h~e long ~tienl waiting ,ime, problems reaching the consullil1l 
room to be seen by a physician and makmg payment fot consultation and testing 81 fee counter, 
rude behavIors exhibited by heelth workers and having doubts about the cleanliness of the 
materials uscd were reported to have played a fundamenlal role in tbe uptakco(scrcening in India  
(Singh & Badaya, 2012). On thc other hand advocacy by the health care provider coupled with 
rcmoval or subsidizing of cosI  may lead to increased uptake ofcervu;al Cllncerscrecn mg(Breen, 
Wagener. Browa. Davis. & Ballard·Uarbash. 2(01). 
1.6 Jwtilinlioa oftbe.tudy 
Cancef of the cervix is cwrently a foremoSi public health concern with implications on government 
with rcsp«t to health resources. It also ha!; an increased toll on the wellbeing of women around 
the \\-orad which goes a long way to alTeclllOt only their close but also extended families. 
Knowlcdac plays an ImpOftarlt role in an mdlvldullh deciSion making to practice and ensure 
pre\~ive mcasures in health and time!) seeking oflreatment. knowledge on the disease condition 
may influence women'. decision o.)n (nlms after which Ihe)' may proceed to be ,'accinated or leek 
c:arlytreatment depending on the outcome. The many studies and literature available in tihanaon 
cervical C&nCcr wcrc mostly targetcd IowardshcalthSlaIT, studentsand nursc:slnd rc:suhs indica te 
an appra:iable knowiedse level. This is much C'Xpected as these cltegories of persons have some 
higher level of echlCalion and could acquire much knowlcdSC. 
HPV infections leadina to cervical cancer do not present willi early warning signs and symptoms 
souloprompifore&rl)"treatment.Forthisreason.awarellCS!creationand~reeningplay key role 
in cervical canccr pn::vcnlion 
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BlumcnthaJ el al .. (2017) ROIed thai evm though Ihcre is an alarminS \l.J.II~th; mdiCAlmg smow 
conccm, cavical cancer p"vcnuve education is not given the needed recognition in Ghana. 
Tberefon:i1 is Ya}'neces.sIf)'locstablisb the level o.)flrno","lcdge and uptakc of screeni nI  in line 
.,jib «tVM:aI cww;:er amon& expectant mothers accessing health care in the Ho MWlicipai Hospital 
to help infonn poll') makers and health practitioners to come out With policy modificatIOns to 
help In reducing ccrYlul unccr in women u well as intensifying a","arencss creatlo.)n on cervtUl 
cmceTscreenins_Fu\dinpc:ouldbeuscdinprovidingstructu.n:dmoduJc\tobcusedineducalion 
on cervical cancer in the hor.pitals. inform women of the need for self-v.ccmalion and their female 
d~lldren and also help infonn mcasUl'Ci 10 be put in place to eliminate blockadn 10 Krecnina. 
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CUAPTER TWO 
LITERATURE REnEW 
l.1CervkalcaMtr 
Human ~illom.lvirus (HPV) infection is the cause ofe.snecr of the cervix. The \'lruS IS 
transmilkd Iel". ... Ily. About 50-80% of women who Indulge in sc"ual acU\ IIlt~ art open 10 • 
minimum of one HPV type at OM pOint In their lifetimt (Nabtr e:t al.. 2016). The highest rates of 
oceurmKA: antot in majority of femaJn y.. . thio 5 to 10 years of the commencement of ~xual 
Inte:rcoune and tbt- highest meident rates are apparent in women wOOse aat ranats from 20 10 24 
}urs l~bk .... c: &:. Ihuoma. 2012). The danger of beina: infested with HPV is predisposed by the 
ap:of.M:XYaldcbut. ha\,lnJl, scveta1 sexual putncn, ha\'in, a partner", ith nurTICf'QU.!o sexual partners 
arw1 hi..-ory ofOlhcr $C),ually transmin.ed infCC1ton~. Relative to cervic.1 unc:er and precursor 
k-siom. HPV'IIR:C&tegnrll.c:dinlohighri!k(16, 18, 31 , 33.34.35. ]9,45,SI . S2, 56, $&. 59.66. 
61. and 70). and low nsk (6. I 1.42, 43. and 44) risk HPVlypelO. rhe former arc frequently ieen in 
SquamouJ Intrlepilhclw leaions (SILa) whilst tant' are sporadicall)' seen in cCf'VlCal carcinomas 
(Burd.201l]) 
CcnK.&! CIftCCiI' ryptcalJ} bc:a,ins in the superficial c.ells of the: cervix. compnSlnJ columnar or 
5qIWnCNlQelk. TMcellshqucatJyin\'ohcdatelhe ""Iuamousc:ells. Usually. the pre-cancer 
lesionsprogressslowlyandil$pranalUrediscovCf)'tan.impJybc:aRamedlhrough Pap smear 
tcsCinaand II tot.lI> curable. J(left WUlOCK:cd.pIe-eancu lesiom can advance mloec:n'ical cancer 
and metul&l.uc: tu othn Sltuctu~ includmi the womb. ovaries. bt.dOer and Ii\'tt among others 
(Hendersoo..SaralY. ... Manll'CZ,Hatpc:r. &S.. ..... ) •. 2011). 
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2.lCervicalca.~i.lkeworld 
Cancer ofdw: cervix is 8J*Ied (ounh among the pre"iling cancers affecting females and seventh 
in all common cancers (WHO. 2016). In 2012, approximately 528,000 newly diagnosed cases were 
recardcd WGrtdwide with most cases (around 8S%) occurring in underdeveloped regions where it 
contribulel to almost 12% of all cancers in femalcs. Globally, in 2012. approximately 266,000 
cervg cancerde.aths which constituted 7.5% ofc ancer demises in women occurred. Almo5187% 
ofCCO'K::al c:ancer rclated dc:aths oc:cWTCd in underdeveloped countries (WIIO, 2016). ln 2018, 
about 570.000 newly diagnosed CUC$ accountinl for 6.6"8 of all cancers in females was estimated 
and '" reSOW"Ce challenged nations., about 90% of their mortalities were from cervical cancer 
(WHO. 2018) 
rhc pfCnlence and monalilies from cervical canc:erare highcst in sub-Saharan Africa. Southeast 
Alia., I....atin America and Caribbean and central and Eastern Europe. In Zimbab. ..... e, Malawi and 
Upnda, the rates were two times higher as those in all other registries. Western Asia however 
rec:onied one orm. ... inddencc rates (TOO"e, Sicael. Ward, & Jenwl. 2016). Cervical cancer 
mortaJitynuadiffa"fromoneregionlOlhcothcrglobillywitb rewerlhan2 in IOO.OOOpcrsons 
in We$tem Asia. WC5Wn Europe and Australia but more than 20 in 100.000 persons in Melanesia 
and Middle East and Africa (Vacnrella. Lavenanne, Feria), & Bray, 2017}. Some important 
faccorsinnucncethcincidenceanddeathrlJainthevarlousregions.Thek: factor.. IndudeaCCft5 
10 screeninl program ... Incidence of human papilloma VlnJr. and Kti\(" inhibitIon incllJdin, 
ImmunIZatIon against human papilloma vil1lS. TIle a«wrence of caneen. has decreased draslicaUy 
In .... ell advanced ..i ons where ~rftfling programs are cstablished and carried OUI over the ~ars 
This i) not die cue in under de"'dopcd eountries as the tlItc of meidence is either stalled or 
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increased duc to fitctors such as shonfalls 10 ltIncIardotscreening. low Krttnin. cO\lerageor no 
KIUfWlI(Tom: ctat. 2016). 
Smce2006, Imml.lflOlUlic..safcandcfTectiveprophylacticvac:cincs have bten developed aga inst 
HPV infcction and are made available 10 manycount(lcs globally. There are three t~ ot\laccines 
cumdly. 11w: Q.dn\;alcnt \I(cmc (Gardasil) devctopcd against HPV r)-pc$ 6. II , 16 and 18. the 
BiYalenlvlCClne(Cet'\'avLx)developcdapina HPV t)pe~ 16 and IS end the Nonavaknt YaCCllK', 
dcveloped~HPVtypa6.11 , 16,18,3I,33,4S.52and.s8 . TheNona\lalentvlICCinels Yid 
to protect against ncatl) 90% of cervical cancer and nearly 90% &enilai warts (Momcnimovahed 
& Salthlm~a. 1017) In low and middle c<>untncs ho~ever, factors Inclu.dina .otio-cul1U1a1. 
he.atthc:are '),iten'l and political flC10B has been identified as lhc: maLn bar"cr~ to the use of lhese 
vac.cLnCS(Wi.Lc..Cout.&.Watson-Jona.20IJ). 
"The WHO hal proJ«lro ihal HPV IOreclloos contribute to about 68,000 cervtcal cancer CIlK~ 
)carly In Arne&. 1"he\c ratn an: belieYed to be under reponed due to difficult,,:s in heath 
Infonnabcwl system and cancer reliilrics in the province. E,,'cn thoop CCf\'tcal cancer is 
pK\cntable. II accounts mostly (or the eawes or cancer in Africa and contributes to 22% of all 
fcmaJc canccn. Out of evcry 100.000 females. 34 arc diaanoscd o( the condilton and 23 die 
annually. In many African COIJftbics.. the malipnc) II mo)tly Idcntlned at its pco~UI\"I~ ... 
oWlftStoractorssuchulnsu.fficientreproductiveheahh\oCrvlces.pOOfKrcenI1l8ICrvicesand 
dclayedQ'CallnCnt uuUltion (Mboomtt. Bo\wsa etal., 2017). 
cutcm and IoOUthcm Africa (Denny &: Anorha. 2012) . Also. lhere is poor 8Cl;eu 10 artll-cancfl 
tbctaipy in mGIl A&itan countncs. In 2001 , WHO established thai, In Arriciln counlrte,. only 22% 
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had Kcat to anticancer drup lik.ened 10 91% in Europe (WHO. 2001). Also. crained health 
persOMeI are limiled in Amca due 10 faetors such as poor salaries. lack of carrier advancement 
and poor anfrastrucrurc amongothmi. Women who ITIO$Uy aa:ess treatment for cervical cancer in 
Afnea will most often rc«ive radiation therapy mostl~ inlended to",ards curalive or pallialive 
purposes. LinfOr1unalcl~. not all African countries have radiation facililies and in thoscCOUIUries 
where lhcyc:ouldbc found, they are either limited in numbn.loc:ated in higher or priVale 
instilll1tons and are tttqucndy non-functional 01 had poor m.intenan« (Denny & Anorha. 2012). 
HIman)lllpiIIoma virustypa 16. 52.35. II. Sa. 51, 45. 31. S3 and 56 have beenc:onfinned 10 be 
the most prevalent Iypes of virus affecting females in Africa. A Wide: variety in the human 
paplllomJl Virus infoctlonhas been secn in relaiont{.loc:allonwith South AfriCi l'CCoroingthe 
Northc:m (12.1%) Africa. s~irteally. HPVs 16 and 18 ",ere found 10 be hish among Afri~ 
women. Women _lid 2S 10 34ycIlN wele found 10 have the highest HPV dominance (SO.S%), 
tailed by those who are 15 to 24yean of age. Women -Fd 35 10 44 and 4S 10 54 ye:IB h..t an 
infection rate of3f. l~~and 31.6%respecti"el~ tOganboetal .• 2015). 
2.4C~n'icalcauceriIlGhana 
In <..h ....... abouI a.S7million women aged I Syears and above are exposed to developing cctViCiI 
canc:cr.Currendy. approximl&ely 1.ISI womcnarc da.gnosed yellJ"ly oflhe disease condmon with 
lbouI2,119 deadu occwrina. CavicaJ cancer il second orall c,""rllm~'Cting adult females in 
Ghaniind the ICCOnd ~umlly occUlTIng cancer affecting adult femalft ",llhin the age range of 
I S and 44 )'C-In (HPV Informllion Center. 2011). The World Health Orpnizallon predicts 5.000 
newly diagnosed person, and 3)61 cervical cancer mortalitIes by 2025 (WHOI1CQ, 2007). Even 
though these fipm. ue worryin& cervical cancer is poorl) promoted in Ghana as compared with 
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other ailments like malaria, luberculosls.. HIV/AJDS and moslly breast cancer which receives bulk 
of allocated health capilals for ilS promotion. The proportions ofscrecning in Ghana is also 
reponed LO be cxtrerntly low (Williams & Amoateng. 2012) 
(;an.;:cr pteVcntionpolK:y was (jrstdc,"doped in Ghana in 2005 as component of the natIOnal 
reproductive health poliC). It recommends the usc of VIA for screening and management of pre-
cancerous cdl~ with cryotherapy for females aged 25 1045 years and cytolog) screening with Pap 
smear for fanak~ who arc 45 years and above. Tnese strategies include awareness creation through 
health communactlliun mesSlips by use of pictures, llycl'S and media. employing planned and 
re50UrCeful screening 10 reach target population(MOH. National Strategy for Cancer Control in 
GbIna, 2012-2016). However, currently, no national screening program ~ carried out in Uhann 
and thil has eontribuaed tOtAe increased unplanned screening where somephysicianspreM:ribe 
Pap smear or VIA for women who visit the hospitals for either total medical checkups or for 
consultations not related to cervical cancer tAdanu etal.. 2011). Also, [here is poordocumetltatlon 
ontbefmtumc:yanddcalhsoccurrinsfromthcdiseaseeonditioninGllanaowingtononcll.I)lence 
of cervical cancer resistry and most Ghanaian women with Ille disease condilion report in the 
Invuive stage orthc disease. This may be relaled to facton such as cost of diagnosis and treatment, 
poor knowkdSC on disease condition and the role of tradilional nnd alternative medical 
pr;&clillonen (Hill & Cox. 2018). Cosaofscnxnmg tesls in GhlM are also not absorbed by the 
National Health Insurance Scheme (NHlS) hence leil kiUi and laboratory examinations mllSt be 
paid forpriu1ell byclienls prior to the procedure which ii InOitly perfonned for diagnostic 
purpo~lUandlo@lcnetaJ .• 20J4) 
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l.!i Knowledge ofumcal cucer 
The level of iuh.-'wkdgc on ccr.I~1 canc:er and its predisposing factors are expecled 10 posilivdy 
influence the ftIIdincss ofwomen folk to screen. However, re:>earches hnc ,.hown poor knowlcdac 
and screenm& uptake (Assoumou cl al., 20 I S). A study among 368 female scudenta in LqoI 
university,NiFia In 2012 reveaJedthal 214 (S6.4%) of participants kncwofurvicalcaneerout 
oIwbidl 40 (11.1%) o(tbe I*ltcipants had heard of concurrent genital HPV infectIOn leading to 
cervical caaccr. Majority of those who have Itcard of ceo'ical cancer had no knowledge- of its 
psociation with HPV infcaion. sexual IClivity. age at sc;(ual intercourse and haYing severallCXual 
pIftnCn and only 26 (12.7%) were aw~ of ill. prevention by meaM of Pap smear (Makwc, 
Anorlu. & Odcycrni. 2012). Abo. a ~ud) amana Gobancsc: women found some kftoy.'ledge lIP 
repniinjriskfact(n.lnihisstudy. f&C1Otssuchasabortions,dou<:hingandpoorhygiencwcre 
mcnllOned amona the Pfcdisposing (Ktan 10 acquiring the disease. High pant) and age at first 
pregnaney were among the least Idenufied factors that polO higher rilk of acquiring the di$CAse 
(Auownoueeal .• 20IS) 
In Ghana, a study among 300 females revealed that approxinwely 700/. (200) of the stud)' 
~"'vcnC"'\Cfheardoftheconditton.Outo(thc:l()G/.(lOO)whokneworcerYicalcancer. 
23~o(2J'statcdthatthC)tt.dinfonnal:iononthepredl,.po .. ingfaclon.l7%(I7}Nidlhcywerc 
aware of its sians and symptoms and 14'Y. (14) slKi they knew lboul the mode of detection. Onl)' 
3%(9)ofthc rnpondcnts had ever screeRCd (Opokuclal. • 2016). A study in Bolpcanga. in lhc 
Nortbem pwt of Ghina also fOUDd thai majoril)' of the participanli who had hiJ,her cducatton 
(1O.9S%)hadhcan:J ofthccliscuecondilloo .... hlltl thosewilh IlJ"cr educabon or no fannal 
(19.05%) b.d Rever heard of it (Ziba. aafrt)C, Daparc, Shinu., '" Anluamwine, 201S) 
IS 
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In India. certain SNches have presented low knowledae and lack of .""armeu of cancer of the 
cervix amonl aduk fcmaks . A survey Qrned out among 194 adult females to eonfinn (he extent 
ofundemanclin,tndawartflCSSofccrvicaleancerinchcated that 7Wehad no Idea. Whllc 12% of 
the panKlp.I1U ~Id!.he) had heard of\-lrlll infection of the ccrvix, only 6". knew It was caused 
by HPV infection and only 9% had heard that HPV is tranunmed through 10. With regards to 
koo~lcdse ofOlhrr predisposing factors. only 4% oflhl: women rc)pondcd positively towards its 
a""atcnQS. It ... u conclOOcd thal tMre """as an urgent neceuity to upsurae Lono" ledge and 
a"armcssbymcansofhcalthoch.w::ldion(Arora&:' Wani. 2012) 
Maharajanctal .• {20IS)stuciied knowledae on cervical c.anc:erand willingness to a cceptscreening 
amid ethnically diverse medical SCience ,tudents lR MaI3)Ma. The sur. .. c) rcVftlkd .dequab: 
infonnallOO and undcMancHng on HPV. Vac'lnalk.IfI. -..;rcening 5ervlCtS .vaillblc and It.s 
u&ocaatcd risk fackWS. They reported that 900/. of the sutdcnts represc-nlina the majority 
demonstraled high k' c1 mfonnallen and understanding on the condition And il~ inoculAtion 
0wraI1. 11% indicaaed thai immunlzin.against HPV is protecl;\c of cervical cancer whilst 81.S% 
said chcy ~· ill mdonc: HPV vl.(Cmahon to the people (MaharaJan. RajWi, Num, & Yong, 20IS). 
A study on awarcnes5 and behavior of UYJhar females in Xinjiang pmvirK:e on aVOidance and 
limel) rewgnilioft 0( cctval canc:er !;atnc out thllt, vel)' few of the ~tudy 51mple (27%) h.cl an 
Kka ofthc (onditioft. In this study, female,"1\0 ~ttc undergraduates or higher were mostly aware 
of the (O'1(:IItIO)(l U (ompared 10 thoic wRh Io"'et educationalle,·e), This study ldentiftcd a 
aipificantvariac.0tIInthestage.sofcdutahonofltspartkipantahavinISOnteva'1A110n5inrelalion 
to knowlcdgc on lhcdlseuccondillOO. The $&1m appllcdtothc a8e range ofre.ponclents. 
RespondCQU apd ) 1-4Oyean "'.ere: aware of ce".ul cancer than ~ len or equal 10 20 ~can 
(AbudukadceretaJ .. 20IS) 
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A study conducted among Gabonese MlIll females concluded that, 0111 of the 452 respondcnu. 
91.604 (414) knew ofccrvical c:anccr. Only 22.7% (94) knew its causes. 29.8% (28) and 28.7"'. 
(27) ofw women who reported knowing the caliseS most frcqucnlly cited abortion and )CxuaJly 
transmitted infections as well as HPV correspondingly as the SOUrtes of cervical cancer. The least 
frequentlycltcdcau)(:1>wcreearlypregnanc)'andmulliparity(2.1%}cac:h.Only27.qoJ.. (126)of 
lhc sludy par1lclpaIIb were aware of screening <15. a means of pre\lenllon Among the total ~Iud~ 
urnpll:. only 8.8% (40) were aware of HPV. It wa:!. further reported thai 65% (26) representing 
highest sample: size said that HPV is the main pmlisposing factor and 7()OI. reported tNt it was 
aequlm:! sexually. Ans\\m gl\lCn 10 the questions regarding HPV were used in creating a 
knowkdge SCDn' Analysis re\lcalcd 35% (14) oflhc re~pondents had poor knowledae. 60"'/, (24) 
had f.ir Imo .... ledgeand merely So/.(2) had a adequate knowledgc leveJ (Assoumouet al .• 2015) 
A croiS-sectional study conducted In Uganda found an appreciable knowledge level among slud) 
panKip&nlSonlhcmkfa"otsasmost78.4o/,(706)statedha\lingmultiplepanners.beinginf«ted 
wi"" HPV 884°,. l760j, early scluMI debut 73.9% (66S) upturns one', risk of acquiring cervicill 
cancer. With rc:speet to the sisru and symptoms.. abdominal pain 57.S". (520), vaginal bleeding 
43.3% (390) and (oul vaginaJ di!lCharge 3J.I'lt,(298) were u1>ually acknowledged (Mukama, 
Ndc:jjo.Musabyimana,Ha1age.&.Musoke.2017), 
2.6 facton tb• • lafluenee WODleD knowledge of cervical cancer 
A community bued cross-secltonal survey by ~Iitilo:u and Tefera .. (2016) I'CVClled tNt hA\ling 
adequatcknowled&eoncervicalc:ancerwuhighl}'&S50ciatedwilhhigherle\lelo(educ:ationand 
Income. v.'omcn who had basic or more education were morc probable to have adequate 
understanding on the disease condition compared with those: "iUt no formal education 
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Furthermore, ",omen who earned averagely 1500 Elhtopian birr (ET8) and more per month wen: 
mon: like!) to have adequate knowledge than those who earned less than 500 ETB monthly. 
A C~S'KCtlonai study conducted in Addis Ababa Ethiopia by Segni el al.. (2011) found that 
rapondc:nb who were married had adequolte knowledge thin !hose single. Also. being employed 
was more lil.":ened to being kno .... lcdgeable on the collClition than thc ummployed. Majori ty(96o/t) 
offe!,pondcnts with advancededucacion had sufficicnt understandin" while leiS than 1% who was 
uncdUClilcd had satisfacwryknowledge. 
CrUll and Darj .. (2011) in a descriptive cross sectional study found a signilicanl association 
bet .... cen knowledge levels on causes and tranSftliSSII.)f1 of HPV and age. Knowledge was more 
pRvalent lIJ110ng the young lh.n old, 
2.6 Cen'iul e ••n rscRcniDg uptake 10 Afrie:. and iD Ghllna 
Cervical cam:er screening remam~ J ~ Ltal means to the prevention, primary recognition and prompt 
conlrollin, o(ccrvical cancu.ln spite oflhc inlroduclion of HPV vaccination. $Creening will still 
lidlDR:Cognizincindividualswilblhc:infe.:.:tionbutas)mptomatic.lncreaseduptakco(scrttning 
will therefore imply that more fcmalcs in the precancerous phase will be identifted and managed. 
Adversely, reduced uptake will mean more women prescntin.,; .11 the advanced stage leading 10 
increased ill heallb, mortality and incapacity (Amu, 1011). A population based world health survey 
analysis in2015which mc:uun:d "rvical canccrscreeningcovc:rllge indiclUed 1h atco\lcragein 
lessadvancedcountriC$onaveragc:isl()O~asequaledto63%inhighincomecountricsandranacs 
from 1'-_ In underoevcloped cO\lntries to 73"_ in advanced countries (Gakidou, Nordhasm. & 
!Jbennc>u,200') 
In NiBttia. out "flhe 388 health care providen who knew the scrceninB regularity is ~ in every 
1 yeacs. only lO.6"a h;,d ~rccned. 28.4% ofthc n:)pondents Slid the reason for non.s.creening was 
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lhat lhcy had not lIusht of it whibt 10.8"-" .nributcd their non-screming 10 anxLct). AmortIlhosc 
who sclftftCd. 61 (&5") SQ'OInC:d once ",lUlst 12 (IS%) K reencd t .. icc (Ifemclwnml et II .. 2019). 
IIITlnZ&nialttudY lAlOA8137fcmalcnLWSCifOUAdthafmajoricy of thcscnw'SCs 116(84.6%) 
nnter hid a Pap smcar cxammatLOn done. The most fiequcnt reason (54.7%) was that lhc:)'did not 
hlvclCCCUto ..y scrceninaCCrMCf. niswasfol~by h.vingnornociv ..i onrOC'e&rr)'ing"", 
the In' (13.1'%). procedural (car (9.S%) and bcinS tnptc:ncd O(pOSllhiC mull. (7.3~.) (Urbl &. 
Duj.101I) 
Apin. a lIud)' 1ft south-wcMem NiSCna Indic&lcd that merely 'tenth of tho 260 respondcnl5 had 
ever 1CtCCftCd. 111& poot uptake Will ucribcd to facton:.uch as insuffiCient advice from Ihe rncdiuI 
tc~.abseac:eorhca"hedllCatiun.dimcultyinpl",nlacCC'SSloscrC'CnlnlserYices.incrcascdc051 
of5Crtenlll,andanxicty ofJ*in(AInu. 2017). lR Kenya. il wu estabJiththat only 4lo/.oflht ]84 
rnpondcnb haw ever been scrccne4. Amon, thes-t. 49% (63) h8d the: Int carried out as , 
prncnllvc mthloft wht15t 2S% (39) had it done because II was IUDmmended by the doc:lOt. 47% 
(7S)ofthetoc.al rapondcnuwho t\adCVCfl(:f'CICMd hM 11 donc once. 2 1%(33)had it more tt.n 
line urnes 19% (30) performed rwice "'hi" 13~ (20) performed the: tnt three times (Ombech &. 
Muipi.10ll). 
In MalaY'ia. onl)' 87 (27.1%) ofthc 320 parttcipants hiId Pap smear done in thC thm; years 
~i"& the stud)' (NWabKhK. Manaf. A IvnaiI.10Il). Alto. in Upnclaonl)' 43 (4 &0/.) 0111 of 
'JOOrc,pMdcnl,"udicdc\CT,arncdOUl.PapIfDCar~m"ite't.MOilofthe",'omen2S(S8.1%) 
had the ~rccnin&donr "'I"tlln Ihc e.1~ 1211\OQths ~ lhc Mudy and only 14 (ll .S%) hid 
net screened twlCC or more.. 21(41.'%) had their screenin, done becau~ the health worker 
prnntbcd it wtten:as If) (l7.2%) wiliItatY saftftCd to be a..;quainlcd wilh their ltatu, (SdejJo. 
\.1ukama.Mut.ab~imana,&'MuM)ke.20 l6) 
19 
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10 Soulhcm part of Afiica, a study among 440 university studen15 showed that only 15% (221121) 
of 5tw1cnts who are sexually active and knew about eervical eancer had ever carried out a Pap 
smear (Hoque. Ghuman. Coopoosmay, &, Van Hal. 2014). In southem Ghana. a study amona 
scx.uallyaclive femalesrevealc:d that only three (O.So/.) of the 392 respondents have everscrecned . 
Inlhis swvcy. complete education and elimination of access bklcbdes were indicated as important 
III minimiz.ing risk related with the disease and to promote women's hellth (Ebu, Sylvia C. Mupepi, 
Mate4S1alova. &. Sampsclk. 2014). Adanu et al.. (2011) found that only 25 (2 .1%) oflhe 1193 
Ghanaian women studied had ever performed a PIP smear. These women hid advanced 
tducahonals[atusandhadad\'lncedsoc'o·economlcs. .. tusthantho~\\'hohadnevers.creened 
(Adanu etat. 201 1). 
Z.7 Facton associated ,,'ilb cervical caacer screening uplake 
The screenLni upl&ke in lcssdeveloped countricli is reported to be poor due to several factors 
Includinl educational levell, Ige. mantal statu," and knowkdge of thc disease condition amona 
othen. Maay s&uI1ics have n:portcd that ha\'ing hipereducation leaditoinc:rea.sedscreeningrale. 
For ~ in a itUdy conducted in Tanzania. fewer relipondents with secondary or lower 
education had saeened as equated 10 those with higher c:ducation (Lyimo & Beran. 2012) 
III Zimbabwc. 203 participants "-'CR: as~sed on cervical cancer Kreening upta.ke. Only 18.10/. 
have C:\oCT Kreened despite the high I..-."an:neu Incl (62.2%). Scrrxmng was minimal among 
multiparous women and Ai parity reduced, screening \\IS rcpon.cd 10 be i!)Cn:ued . Prior 
knowledge of the condilion WIS identified as the strongest predictor to uptake of sen:cnin. and 
a:rvical screening upcake was sianifKUltly associakd with housing area (Mantula &:. Mwisonao. 
2018) 
20 
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Having higher education however rna) nol nteenaril) lran§lale into seeking for Krecning hence 
odIerfacton mlyatsobeconsiclered.lnNWUlvlk. olderageand havinaahisloryofnochikiRn 
were rcpoded til important detetminant5 of untimely Pap smear screenin". OutcomC$ also propose 
thai baving a Kreening test done was relaled to lhc ~tronagc: of reproductive care as Pap smear is 
irw;ludcd in an&eMCIil and po§lnatAl YllilS (Ceriso. Coutl6c., Franco. &; Bnward. 2013). FlClon 
such as believe of DO( hay"" any prcdiJpolinc f.:cot. fear of pnxeduftl.1 discomfort and also fear 
of leSt results ...-e linked with cervicaJ cancer Kft:ICning upllkc (Dehe. Kaoje. G.na. &; Ango. 
2011). Bema re"Hlent in lemi-urban and _ban ateb and livi", in household$ with live or less 
mcmben".,'ercsuongdetc:nnlnanloflikcJlhoodtoundergolcreening. Also. having knowledge of 
at IeMI one ~ of Kroming and knowinc someone: who had ever sereened or has b«n 
diaposed of the diIeuc wore cb:wncnled as fa(1ars strongly related with Kf"mng uptAke 
(Ndejjoelal..2016) 
A racan:h in soulh-castern Nlaena among pregnant women found inadcquale health education 
from health wo$en, In\ l!olon lJf ptl"KY. negallVe health worker', anjfude and long waiting lime 
as major faclon mmgaling against cervical cancer screenin" uptake (Inl:l"u. 2016). In Malaysia, 
being mamc:d was found 10 influence hip uptake of s<:reenina in the pMl three years. Married 
females "CfC' two times more likely to have a good uptake when matched with unmarried women. 
Knowledp: of the Ji~a~ condition was .110 seen 10 be an imperative delenninanl of screenina 
uptake in the preceding three)'Un. WOIMn with adeqUiIe knowhtl" on cervical cancer were more 
probable to have aJOOd upCakewhm compared with lhosc".,hohad lo\\' L.llO'Aledse.ln addition. 
""'lmenwith iowperccivaiblnic:rlo)Crccnmg were thr]ce more likcl) toh.vel aood uptake 
"hen compared with Ihose with hip perui\ed bamcn (NwablChic et al.. 2018). Allhoush 
Uowkdgc is rc::porte.d 10 be stronaiy n:1IIod wilh Kr«nmg uptake. some women fail 10 screen 
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For imtanceonly 20.6~;' of respondents who had good informalion and knowledge of cervical 
c&Il(:er had e\-er accn~ scrttning (Ifemelumma eI 81 .. 2019). A study in Ethiopia found matwed 
fern_let _ilh chikftm 10 be three limes more likely to utilize: sc:reening Se:rvtcel. Women willi 
mulliplesnual putners werealio trice more like:ly 10 carry out a scre:eningleSt. Furthc:nnon:. 
adequate knowledge: and pOSlllve: aniNde were hiply related to ~n:cnm, acceptance (Teame el 
al.. 2019). HUIbInd's approul_as stronlly as.scx:ialCd with the screening slatus of_omm (Lyimo 
& Beran. 2012). Women who wen: kno_lcdgellble of symptom .. of cervical Cllllcer, women 
ptldic:ina fMlily plaminc atlhc time of stud) omd those "'ho had their husband's suppon. MIl a 
high screening uptake (Gan & Dahlui. 2013). Miaranl$ in the Nonhem District of Yangon with 
hlghc1leve( ofknowlcdgc _ere found 10 be 2.~ I times more probable to perform screening than 
theother\(NandarelaJ. . 20IS).Thiscalllforlhe~forlncrca'>Cda .... arenc:sscrC:.lionthrough 
heahh promoC~ prosrams and the media on cervICal cllIIcer M;n:cnmg 
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CHAPTER THR.t:E 
METHODOLOGY 
3.IStud), desil!!. 
1bc SWd) Wb an analytic cro$S-sectional design .Iong with. qu. .u ilIItive method of data 
collection among pregnant women.ged 18yars and above 
3.2S(udy8na.·luutiun 
Inc lin \1unacipai Hospilal was constrUCted in lhe year 1927 and commenced \\,otk Ihe samc year. 
II 1\ bounded by the Regional PoslOffice, District Polite Headquarters, and Region.1 Museum 
and !oeparated from the Ho Prisons by Bmajor road. eefore Fcbru.ry 1999. il servcd as the regiorull 
hospiu.1 but in the SUM year, it was renamed 1.$ the district hospitlll when the new Volta Regional 
HOIpilil. now Ihc: Ho Teaching Hospital was commissioned. It has. lotal land surface Mea of 
about3.93acresor 1.57 hectares. The faciliryistotaU, encl05cd wilhin walls, which h.s two gales 
for both vehicular and pcdeslrian movements. II is. 140 bed capacity hospit.1 whi4:h comprises 
122bedsand 18cou. IIscrvesasthcfirslreferratpointinlhemunicipalilylRdprovidcsemc:r gcncy. 
outpallenland inp,ltiCAt SCl'Yiccs induding Anlcnltal care 10 all in lhe municipality IJId bey ond. 
Other services provided arc: laborator) . radiology. anesthesia and pharmaceutical services. The 
,upponmgunibincludesoci.lwork,biostatlstics.administntion.eslate,clinic.lengincerinaunit, 
security, proc~mrntfstoln. diet therapy. hospitality. physiotherapy, Center Sterile Service 
[)qNu1ment (CSSD). accoun(s., intemal audil, c:nYironmcnral.lranspOn and nwrtuar). The facility 
is under me Ho Municipal Health Direl;torale and crucial for providinl eft'ect.ive,.ffoniablc, and 
c:qult.blc sctvl!;a.11 is hea6ecI by. medic.1 supcrintendcRi. Averagely, 906 pregnant women with 
aces ranging bctwcm 14 to 45 yun n:cci ... c: antel\l.tal CIIC from Ihc: fa.cility monthly 
23 
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~ ~ . . '~~~f~" ~--=" . ' .. - --..---
FlaareJ.lMapof EloMu.iclp.tity 
Sotrc:c: Gt.N ~ical!ltt\'ices, (2010) 
3.JShldyVariabla 
Two variables wC!'Cconsidcred in lhis study. The dependent and independent variables 
J.J. t DepNdem variable 
The dcpcndcnI Vlriaba tMt wert comWiered in this study wtte knowledge on ceT'Vtcal \:anccr 
screening and uptake of screening. For th.t know~d&e on cervical cancer, 20qunlions were 
HteSted to achiC"tc the study objective. Thcsequestions were further classified intoknowlodge 
on; Came. signs Iftd symptoms ..mic:h comprised 9 questions. risk of getting cerYlcal uncef 
comprised of 6 qlKStion and preventioo of cervICal un«r with S qumKJns. COfT'Cel rnponses 
carry I nuuk and incorrect response 0 mark. The maximum man is 20 and minimum IS O. In all 
thete questions., 8 pr«cding question whidt goes as "HaIW fOIl MQTd ofarvtcDl cuttcer ~/on" 
with rapoMe of "'Yes and No", A ""No" reIpOftSe for this question automatically live 0 marl( (Of 
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• knowledge question . Alta procculAI the dIlL all $COreS were converted mto percenta!De'S fot 
c:asyundc:rslanding. In addition, uptake ofcervicaJ cancer wilhin thc laslthrccyearsprcceding tht 
J.J.2Iodcpnldenlnriabk 
1bc independent variable was demographic dWKteristlcs whkh compnsc) of roll .... ages which 
was f\ar\her n:du~lficd Into ":529 years" and '~30 ye.n. ... ethnicity (GalAdangbe, Akan. Ewe, 
Sorthcm etlmici()' and Other (KoKomba and Guan), reli,lOn (Chn~tlan , Islam and 
TradltionaJ+Nooe). educ:allOnal lewl (None or rrimaJ) , Junior Secondary/Middle school. 
Secondary and Teniaf}l fraining collegefl'echnieal), employment status (Unemployed. Self-
cmplo)cd" Student and fonnal-cmpk))'Od), .YCtIge monthly income level (<GHt200, GHe201-
GH~ 400 and >GHI!400). marital natul (Sin,le. Marned and Others). number of children (None. 
One. Two and Three and above) Number of pregnancy (One, Twa, Three alld Four and .bove) and 
final/).geranpllrltllpRgnancy(Bek)w 18,IS-30o :!,:]I}. 
J ... St ...y Pop. ...... 
The population of .cud)' was made up of all pregnant .... omen served by the Ho Municipal Hospi. .1  
an«cnaIal who arc or II yean or age and above 
J.Slocl.sloa .... Eulwionc rileria 
JS.lloc1usioDcritcria 
.\ II pn::gnanl women aged 18 years and abo"e, .nendine anlmllli clinic al the Ito Munici~1 
""'pltal ~ho we willing to panlclpate. emotionally and physically stable and 1Irt' ,l(~ent.t the 
IIIIIC of ~Iud) 
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3.5.2 EsciusioDcrileria 
Pregnant ",omen below 18 yean; of age and other women who attendcd other clinics in the hospital 
\.\ere e~cluded. Abo. pregnant women who fall within the inclusIOn criteria but are not willing to 
patttCipaleandthosewhoarenotemotionlllyandphysicaiIYSllblc"e~excllKlcd . 
3.6 Sample lizedetermioatioo 
The Ymple size fOf the study wu dcurmined u.sing Taro Yamane's fannula 
/I 
"-Kl+N(.)tj 
n~ sample size of adjusted population. N " population s.ize of pregnant women IttcndinJ lhc: 
hoIpitalandc-accqMedleveloferrortakingslpllauO.OS. 
Avaqely, the number of pregnant "omen seen aI the Ho Municipal Hospital monthly was 
estlmaiCd from District Health Infonnation ~anagement System (DIIIMS) to be about 906 
Suhstitutlng this figure inlo the fonnuls above, a sample size of277 was obtaine d. 
A IO"l.noorcsponseralcwasexpectedhcncetheadjustedwM{IO/IOO)·277"'23.Addins!he IQ-/.. . 
rlOCVCIpOf1\C'raIe(277+23),thesampksi.z.cis305. 
3.7SalbpliniMetbod 
S)'Stcmall~ ',lmpllfi1> method was used in sclecting lhc respondenls for the stud),. To ascertain the 
Internl of sticction. the estimated number of pn:gnant women who n:ceive antenatal Cale monthly 
(906) ftom the flCility was divided by the calculated sample siz.e (305). Thil gave I sample inte rnl 
or3. The hospital identificalion cards collecled from the prepwlI women by the midwivcs during 
can: provi§ion "'cre used in sciecting respondents. The first hospital identification cud was 
26 
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)Cla:ted a~ a reh;r"'I:~: point and subsequentl). rc~pf,Jndenb were selected based on the sampJina 
J.8D.&acolJectioDlIndstud~ illstl'1lmeats 
A strumIrro questionnaire with mostl)" closed ended quc:olions was administered to paniclpants 
byscl(," \W:lIastramcd research assiSiants. The questionnaire was made up o(the dt'mographic 
backg,roundo(n::spondenu,knowledgeofccrvicalcanc:eranduptakeofcerviCilcanc:erscreenina· 
The qucslionrwn: wu read and explained 10 the participants who chose options that they had 
~,msideredappropriate 
J.9QualityAssuraoce 
Iwlhcpurposeso(\"liJit) and reliability oflhe sludy. the resean;h assistants engaged \lie re 
In.ined on how to translatequcstions into local dialect and ethics indllacoliccUontoaWJ colic elion 
ofaccunueresponsc:frompanicipanu. Thc rescarchassistants were introduced to the aim oftbe 
5tudyandbowto!ekctehgibleparticipantsforthestudy.Pre-testofquestionnalre was carried out 
II the Ho Polyclinil; WhOloC allendanU had similar characteristics as those m:civing can: a' the 
study area to help chcd; for consistency o(variables and also 10 hclp Identify possible errors for 
correction, Datil collected wen: checked al the pomt of collection daily for lCCW'Xy and 
completeness and any errors noticed were diilCUSsc:d with reiearch assistants for immediate 
.:orrectionandtopreventitsrcoccunence.Thosethatcouldnotbecorrectedwereexc!udedfrom 
the swdy. Care was taken during d"la entry into the computer sothure to avoid errors 
3.10 Data processiog and ualYiill 
Qucsttonnl.irn adm'nl~tered were retrieved. coded and keyed imo Microsoft Excel. The data was 
thm exported to STATA version ISforanal}'Sis. Twoapproachesofdataanalysilwerepcrformed 
which involved descriptivc and infcre.llia1 ....I ysis. Descriptivc analysis involved sUftUlW)' and 
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cross-tabulation to usess proportion of independent vari.bln againsl ckpmcknl variable. 
Infetmh.1 lInaIyIas wtllch involved eqUiliry of "ariance teSI 10 ISKSS the mean differences of 
knowkldae S(:o~ .cTO)$ all domains (Oiuse, siJIIs and symptom5. risk of getting cervical cancer, 
prevcntlonofcervtcaicancerandoverallknowJcdce),chi-squvcleslwudonelOdetennlllcthe 
uSOCI&lIon bdwun the dependent and Independent "Ill.blcs (uplake ofccrviCliI canccr). Further 
Infcn:ntiaI analysis which in'iOI\·cd bl\fari.te and multivari.blc data analysis of ZerO-Inn.led 
POI"",", regression modeled on overall counl of kno" ledge §corn 10 &sSC" fKtOn innuencinl 
knowkdgc. This was applied due to the fact that. there werc excess zero in the overall COWIt 
lnowkdgc \ariabk. In addition. logistic rcgrcuton involving bivariate and mulll\llriable data 
anaJysis "ete also perfonncd 10 determine signiracanl factors that influence uptake ofeervical 
cancer. The level of significance wu accepled "hen: the po ... alue was p:$O.OS at 95% confidence 
incllbcresull!wcrepresenlcdinlablesandgrapn 
3.1 1 EtblCll ceaaWenalloa 
Approval was sou"" from the Elh.cal Re\lc\\ Commincc (ERC) ofthc Ghanllliealth Service 
(GHS). Accra. An Introductory letter obtained from the Head of Department. Populahon, Family 
and ReproductiveHCIIIth, School of Pub he lieallh,CoUegeofHeallhSciencn, Leaon logether 
"iIh I permission Icaer fonn the Principal Im'ntia;ator was senlto the Ho MunKipal Hospiw for 
IIpprovalloc:anyOUllMlotudyinthcfacalit) 
RopondmtJinthelotudywereindlviduall> approachcdandobJccli\csofthC" Ioludy cxplaincd to 
Ibcm before the)· pOll'luok In the study. Respondents were made to either sign or thumbprint. 
wrinen consent form priortoputaking In thc stud) 
Ques.tIOMalresu'ied indatacollcclionwcrccodcdandnameiofparticipanll"c:rcnoe included in 
Its ,ompk1aoa. To guarantee the privac:y of pu'licipants. interview was conducted in private with 
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cachpartlcipanl. Infonnation gathch.-d during data collcctioo was kept slrictly confidenlial by 
keeping completed quc)tlOfUUlres under lock and key and only the principal investigator has 
a.;ccss 10 the key. Soft copy of data coll~ctcd was ftaved on the principal invcstiplOf', computeT 
and protected with a pas~word known to only the principal invesllgator. Participant's names were 
Mlusedinlhcreponoflhcstlldy. 
No compemalion was given for partaking and participants were acc:ordingly mformed before they 
cboICtopiWUkc in the study or not. Participants lost not len than 30mioutes of their time each i 0 
completing the questionnaire. Apart from time lo!>t, there was 00 risk or cost m plrtakina in the 
,tudy . AltO, there were nodircct profiulUoWl;iltcd with partaking in the study. It is however 
e:xpeded \hit o,*,omcs of the S1udy will influence policies thai will go a loog way to Imp~t 
posllively the qualiry of repro due live heallh services in the facility and regiooatlarge. 
Respondents had thc: 0PPOItunity hJ pull out from thcslud} at any point in time and this did not in 
any way create any problemnor.ffected the quality of care rccelvcd in the facility. Participants 
were given thc opportuniry to answer or ianorequestioRS thlll maycauK some discomfon 
No conflict of interest was declared in the siudyas participants "ere assured thal.part from 
ICadtmk work and public health importance, the principal invc~rigalor had no personal interest in 
1'berc wu no fundlnlfrom.n> source in carTJing oul Ihc\lud) hencealicostesrimllolcd toWards 
theSludywassolelybomebylheprincipalinvestigalor 
29 
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CHAPTER f·OVR 
RESUI.TS 
ThischapterpresentstheresullSoftheanalyzeddag. ltcommencedwilhapraentationofbio-
d.lu{,flhc respondents. Subsequcntly, lhe OUt00me5 of the analysis which wlSccnlered on th e 
objcctin:s of the study were presenlcd 
4.2 Demograpbic Profi&tofRespondeots 
Three-hundred and five (30S) respondents were enrolled for the study. The rate ofrespome was 
100-/0 and all questionnaires we~ rightfully completed since the questionnaires were administered 
bytheinacrviewer. 
The age of the respondents ranges from 18-46 yellrs with melln (SD) of 29.3(6.2). Age groupings 
depicts lhIt, most of the re5pondenlS wen: 29 yea", of age and below 178 (~8.4O/.). With respect 
to cthnlcily. morc than half of the respondents 253 (83.00/.) we~ EweS ",hiisl 13 (4.3) were 
GaiAdangbc, 21 (6.9"/.) were Akans. 9 (3.0%) wercofnorthem ethnicity, 9 (3.0%) were Kokomba 
and GUMS. Overall, 282 (92.5%) of the respondents were Christians, IS (4.90/.) were Islamic, 
8(2.6%)hadnoreligi~affili.tionorwcrctraditionillist. 
Thcstud)' also foundtMt. 119 (39.0%) ofrcspondenlS had junior aod middle schooleducalioo 
This was fonowed by 71 (23.3%) who had secondary school eduCIltion. 66 (21.60/.) had 
tcrtlaryltraining college/technical education. 49 (16.1%) had no and primary educationall 
bKkground. Also. 106 (34.8%) were traders. 71 (23.3%) were artisans and vocational workers, S5 
(18.,"".) were salaried "'orkcrs. 43 (14.1%) were uncmplo)'ed, 13 (4.3%) w~ fanning. 9 (3.0%) 
..... m laborers, 8 (2.6%) were evangelist. scn'icc personnel and studcnts 
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Also, 134 (43.9%) of rnpondcnt~ had an a\'ctqe monthl) Income of less than GHC!'200, 98 
(32.10/.) earned GHI1' 200.00 to GH<t 400 and 73 (24.0%) earned more than GIfC 400.00 per 
month. Tbt rcsuhs alia indicated that 214 (70.2%) of the respondents were mamed, 27 (8.CWo) 
were single. 64{21.0) were divorced and J (1.0%) wen: wldow~ 
Aboulooc third. 107 (3S.I%)ofstudy participanh had no chikj. Also, 89 (29.2%) had one child. 
62(20.l%)hadtwochikirenand47(15.4)hadlhrcechildrcnandabovc.Agaln.105(34.4%) 
rqwnerllingthe majorit)' of respondents hid onc preanancY, 881289"'o)had rwopregnanclcs., 63 
(20.7%) hid Itne pregnanc:tcs. and 49(16.1Of.) had four pregnancies or more. Jnaddition, majori", 
ofdle rnpondcnu242 (79.l%) weft J81030yearsdurinatheirfirslprcgnarK)·,4J (13.4%) ,,"ere 
below 18 years dwina their first prcpancy whiles 22(7.2%) \\ere 31 years and more durina Ihel,. 
flf'AJngnancy This il in Table 4.1 
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I.blt 4.1a: lkmograpbic Tabk o(rapoDdeab 
Oe.~nlpllicc".ra"'fl'ristics ."reqUtDI:y Pucenlage 
(N~30S) -I. 
Al:teroup 
29 lMln"llI) 178 58 .' 
30+1""''''' 127 41.6 
MW>(SO) 6.2 
El!wdty 
GalAdonpe )) 4.3 
AkIn 21 6.9 
E• • 253 83 .0 
'ior1fttmdhruclt) 9 3.0 
Oth«{KoKombaiand GUlI.ns) 9 3.0 
Rtlie;ioo 
ChriSlI..IIl 282 
IS 4.9 
lradllional ... ~one 8 2.6 
[ducalio. .1 1evd 
' HncfoPrimary 4. 16.1 
JUftiorSocondA1) \hJJJc~ho. . ' 1 119 39.0 
s.con.s.ry 71 23.3 
Tc:rtiaryfTnliningcolll'lCclTechnlCal 66 21.6 
E.plu~mcDI11.tu5 
Unanplo)ed 43 14.1 
Selr~mplo)'ed · Studenl 198 64 ,9 
Fonnal·cmpio) cd 64 21.0 
A"'Cnlktmolll.J)· iaro.elnrtl 
<(jitt200 134 43.9 
(jHt201·GHCI'400 98 32 .1 
>GHt400 73 24.0 
MuhailtalUJ 
S"'ak 27 8.9 
Mwricd 
0",,,, 214 70.2 64 
Sullrc-;;FicfdData. -jOI9 21.0 
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TabIe4.1b:l>emognphicTableorrespoodenlltoDtinued 
~::beror Ch ild.!!!!-
107 35.1 
One 89 29.2 
62 20.3 
Thm;;&fldabovc 15.4 
Numbe r orprq:nalllcy 
0"" 34.4 
ho 88 28.9 
11vu 63 20.7 
49 16.1 
AgcraD&eatnnl pregoaDcy 
Below la[Min- IS) 41 13.4 
18·)0 242 79.3 
~1[M,"·181 22 7.2 
23.2(5.1) 
Source: ~'ield U8'8,2019 
Inordertodefinethele\clofa\\afcnc:n.par1icipanlSwerequeslionedirtncyhadheardofcervical 
CInCer. A hnk m~ than half 178 (58.4-;.) affirmed they had heard of it whi lst 127 (41.6%) said 
theyhldncvCfheardofi1.Most IOJ(56.7%)ofthestudypar1iclpanlSwhohadhcardoflhedisease 
cOf_htl,K1 uid they heard orit VII the medii. Also, 12 (18.00;') ofrnpondents had acc:e-ssed the 
information allhc health centR and ANC.)O (16.9%) had information in Khool and IS (SA%) 
IhrouP their famll) andfncnds. 
33 
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4.4te..owied&eolcenicalcanccr 
Fanclinpshowslhll 55 (11l.O~~)of~tudyparticipantsapeed dYllhedilcuc is caused by ViNS and 
l&(12.5%}dtdnola,rce.Furthmnore, 71 (23.3%) agreed thIl it is l>Cxuallytransmined and 43 
(14.1%)dlsagrecdlothis.Also.91(29.8%)oflberespoAdentsagreedccrvicalcancc:r affe!.:ls only 
women, whilSi 36 (II II~ ~ I disapcd. lik.ewise, 61 (22.30/.) aareed it can lead to the dnIh or its 
vic:limwbila 29 (9.S%)diWigreN. Al$O. 43 (14.2%) agreed bleeding per v.ginum durinS or after 
snc:ouldbc.sipofcervic.1 cancerwhilsI39(12.r/o)disa8fC'Cd. Apin. 44 (14.4%) apeedlower 
back pain could be. sip, whilst 47 (IS.4%) disap-eed. Ag_in. 38(12.S%) agreed vaainalbleedina 
.ftermmopalllC"" bc a sign ofcervic:1l canccr whilst 60 (l9.7'10) disagreed and S3(17.4) agrccd 
unexpected wa_lou could be a sign whil~1 -48 (15.7%) dlsawud. 
KnowlcJ,c on tho"* ractors dcpim in Table 4.21hat, IS (27.9%) agreed that having numerous 
putnen Increases one's risk wilh 63(20.7%) ."eeing hning a patlner who has man)' partncn 
lnc~ one's risk of £cning ccrvical c:anc:ct. Meanwhile, 72 (23.6%) agreed th.1 smokina riSC(t 
onc'sriskof&ClUinaccrvicalcAnCCrand7J(23.9%)aareedeariyonsetofsexualaclivilyincreascs 
one'srUk.o(geninacervicalcancet. Likewisc. 68 (22.3'10) and 77(2S.J'I.)respectivcIY'areed 
that,prolonpin&ak.c oronlcontnKcptivn increasc§ onc'sriskorgcl1ingccn-icll cancer and 
infection with HPV (Human Papilloma Virus) in,rta~c::~ one's risk ofptting cervical cancer. 
Knowlcdae on w.ys or prevention ~hll~s that. « (14."%) -arced scr«nin, for cen-ical ca~cr 
canhelpprncntcervic.alunccrwhiles-46(151·1.)disagreedpapsmcartestisnota~recningtest 
to help prncnl cervae.1 cancer. Intuiti\cl). 31(10.2%), aarced vaa:inatina 'Pim,1 human 
~llomaviN!ocanhclrprevcnlcervicllcan"'J6(l1.8%)diilgreedpapsmearshouldbcdonc 
once cwry Ihrcc ~ IS • way 10 prncnl "",iul cancct and finally. 2S(8.2"4) .greed 
-=ciaatintall P"tsorage 910 IS year'!.:an hc:lpprevcnl cCfVae.1 cancer. (See Tabk4.2) 
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T.bIe 4.2: Kaowkdce or causes ..d  liC.' .wI symplollll, risk r.clon .... prevue». of 
·-- Do-.'-'-
Kaowledaevariable ----y"- No kaow 
c.viclllctllfurl("In4I~_ ... n(%o) n("I.) 
1. C ......D I.adI}'. ...... 
Ccn-icalcanccrls~by.nrus) H(18.0llI(12.S) 2'2(69.5) 
c.mcaIcanm'isICJul.)I)'uan~miQcd 71{2] .]) 43(14.1) 191(62.61 
c.me.J '*Klft'atrecuonJ), women 91(29.8) 36(11.1) 171(514) 
CmicaleMCerilaseriou.heatthproblemanclmaykadiodutb 68(22.3) 29(9.S) 201(61.2) 
VI,mal bkedin,dlUin, or aftcr sex (;ould bcat.ipofcuvical 43(14,1) S3(11.4) 20'>(61.5) 
Vaginal blccdina between mcnses could be a s.ipofcervicaJ canccr 39(12.8) 48(IS.7) 218(71.S) 
Pcniskmt lowcr*k pain could bea sipofccrvic.al cancer 44<14.4) 47(15 .4) 214(70.2) 
V.,w.1b1eedilllaf\umenop8USCcanbe.,ipofoet\licalcMCcr 38(12 .5) 60(19.7) 207(67.9) 
tJacxpcrckdwci .... "-c:ouIdbe.lolgnClf~cn·Q1Canc:cr 53(17.4) 48(15.1) 204(66.9) 
1. 17., ...., .,isld..,· U.Ul!tlSt Jour rill (If g~rring c~Mlit:QI canur 
~,muhlpk)Mr'tftCfS 85(27.9) 33(10.8) '81(61.3) 
Havin,lputnerwholwmWtlplep3Itner-.. 63(20.7) 47(15.4) 195(63.9) 
-, n(23.6) 40(13.11 193(63.3) 
EatlyorudofsuuaJaetivity 73(23.9) )0(98) 202(66.2) 
UlCoforalconrnctprivaforalonBlX'riodoflimc 68(22.3) 21(9.2) ;.'!0Q(68 .5) 
InrcctionwidiHPV 77(25.2) IOCl.l} 211(11.5) 
J. n ..'  .....i ,.8 eM II. .. bf "e~"e"t;on uf ctrvic.l ca"cer 
Scrotninlfor(cmDlCMCa' 44(14.4) 43(14.1) 218(71.5) 
P.lmClrtnc"a"teeninKIe$llohclpprevcntccrvicaicAACtf 45(148) 46{15.1) 214(70.2) 
Veccinal'-! a,aiMe human papilloma virus aRcr Kl'tItninC 31(IO .~) 41(13.4) 233(76.4) 
Papsmn.rshouklbedoneoncc:ew:ry3)e&r1 2J(1.S) )6(11 ." 246{KO.7) 
Vac.cinalin, all girb of &hoe 910 IS *! 25(8.2) 1020).4. 11~ 
SMru:fleIddata.1GI9 
0ve..U man (SO),core for Imowl~gc was 11.4(23.7). Howcvtr. knowtedgc: domlin, shows that. 
the man (SD) for CoIuseS. liens and 5)mptoms. risk factors and prnmlion of Qef\/ical cancer were 
11.3(259). 2l.9(lO.(i} and 1 1.9(20.2)wrreipondin&!y (sce Tablc 4.4). 
35 
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Table 4J: Pcrcenlu!ee average score lI..seu.enl 00 knowledge of cerviu l UDcer 
KnOtlll~"Gro,.~ · ---~n(SD)% 950/£1 
Cause. lIgnsaM s}mplOmS IB .3(25.9} IS.4-21 .2 
Ri"ofgettiAi ce ..... ical cancer 23.9(30.6) 
Prcvenl;ooofoervlQlcancer 11 .9(20.2) 9.7-14 .2 
Ovc/""III 18.4(23.7) 15.7-21.1 
Domain ~Kumcnl of mean knowledge on cervical cancer scores was assessed across 
danograiphic characlcmlks. For I\crage k.nowledge scom on causes. sians and symptoms, the 
"*lit Ibow that. prtifWlt women aged 29 years or below had high mean(SD) score .s compared 
with those Iged)O)UIS and above [Mean(SD)"'20.2(27.0)vs 15 .6(24.3)]. Acrossethnicity,lhe 
high and 10",· mean scores wm among the Altaru and Ewes respectively (Mean(SD)- 29.6(27.9) 
and 111(26.2) respectively] whiles traditional and none religious Gombined had the highest mean 
KOtC (Mean(SO)-31 9(18.2)j Intuitively. tertiary educational holders and primary or no 
cduca1aon ",·ereobservcd to Ilave hiahand lo\,\,· mean scorercspcclively[Mean(SD)-47.6(J06) 
and 1.6( 16.4) rnpectively.ln addition. ronnllily employed pregnant women had the highl:st mun 
KOfC amona employment stalUS (Mean (SO) -4) .4(JO.S)] whiles marital stalus ~hows high mean 
ICCIft: among p~gnal1l women who wen: slnblc I~can (SO) ~2.7i34.S)J. Pregnant women with 
no cbild ~m: obscn ed 10 neve high score IMean (SO) "'29.002.7) where increasing parity shows 
dcac.asing mean knowledge ~corc on caUKS and signs and symptoms. Pregnant women '" Ith one: 
and four or more were respectively obscrved 10 have hiah and low mean score [Mean (SO) 
-29.U(]28).and 8,4(12.7)respecti\'ely] whiles Igc at first preiJW"6C)' shows thos e who had thcir 
rust prqnancy at 31 years and above "'-trc ob~rvcd to hne hid! mean sc.ore 
(~ttan\.S())-4S .9()S . J)J. CDntraty to the: auc~small of significant difference of mean score on 
cau!>C, ~d ~I&nll and symplOnU across demographics depict that, the mcan diffcorence among Rge 
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group. religion, educauonal level. employment status. average monthly income level. marital 
status, number of children, number of pregnancy and age range at first pregnancy were stalistically 
SlpuficanL 
For average kno\\ledge scores on risko(gc:ttmg..:c:rvical cancer, the result show that. p regnant 
women aged 29 years or below had high mean(SD) SC;:Of'e as compared those aged 30 years and 
above (Mcan(SD)-27.0(32.4) vs 19.7(27.6». Aetoss elhmcit)", the high mean score was among 
lhc Abns (Mean (SO) '-41.3{39.3)J whiles traditional and none religious combined had the highest 
meanscore(Mean(SD)"'39.6(19.8)J.lntullwely.teniaryfiJucalionilholderswereobservcdha ... e 
highmcan score (Mean(SD)-S2.8(33.8»).ln .cidilion, fonnaUyemployed pregnant had the 
hia,he:ll mean score among emp50yment su.tus [Mean (SD) "'42.6(34.4)1 whiles average monthly 
InCome and marital status 5ho~' ~ high mean score among pregnant women who earn GHt40 I and 
above and WCfe single respcclivc!y[Mcan (SD)-36.5(35.2)and48.1(36.8) respccti velyJ.Pn:gnant 
.... ·omcn with no child were observed 10 hive hip SCOR (Mean(SD)"32.5(36.7)J whiles pregnant 
women with one and four or more were respectively observed to hive hien and low mean score 
(Mcan(SO)t-31.6(36.2) and 16.3(22.9) respecti\·eI)"). Age at lirst pregnancy shows those who had 
their first pregnane)" at 31 )'afS and abm.: were observed to have hiah mean score 
IMean(S0)-47.7(37.2)]. Signific:anttcstofdirfcrenccofmcans'llreon risk ofJClting cervical 
cancer "ross all demographic characteristics "'etc: SlItistically signifICant (see Table 4.4) 
Relati\,cly.rOla\lmageknowlcdgescoresonpreventionofcervicaieancer.lhcresulI show that, 
pregnant \Ooomcn "ged 29 )'Can 01 bciow had high mean(SD) score as compared those aged 30 
yursand abow IMean(SO}-13.1(21.7) \IS 10.2(17.7»). Acrosscthnicity.thchighme an score was 
among the AXans LMean(SDI"'IS.2(26.0)) whiles trwiitioRiI and none religious combined had Ihe 
higtaL mean score (Mean{SDl'"'15.0(20.7)J. Intuitively. tcniary fiJuC"aliOfUlI holden were 
17 
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observed 10 have high mean scon:(Mc.n (SO) "30.)(28.1)). In addition, fonnallyemployed 
pregnant women Iwd the highest mean Store among employment SlalUS (Mean (SO) -25.3(26.2» 
whiln av(tage monthly income and marital ~Iatus shows high mean score among pregnant women 
who cam GII¢401 and above and wcrc single respectively [Mean (SO) =19.1(25.3)and J3.3{30.4) 
respeclivd)J Pregnant women with no chiLd were observed to have hiah score (Mean (SO) 
-19.4(26.4)) while .. pregnant women with one and four or more were respectively obscn.·cd 10 
have high and low mean score (Mean (SO) '} x(2o.7) and 5.1(11.5) re$pettivclyJ. Moreover, age 
at flrSl: pregnancy shows those who had thclr tir:.t pregnancy at 31 yearsand.bove were obscrved 
lObavehighmcanscon: [Mean (SD)-22.1(3 I.O}j. Intcresllngly.signiflcllnltes t of mean difference 
on prevention knowledge score across aU demographic: ch ....c teristics wen: statistically sianificant 
(scc Table 4.3) 
Finally, overall (combine knowledge of all domains) average knowledge :>cores of cervic al cancer 
dePict that, pregnant women aFd 29 years or below Iw:I high mean(SD} score as compared those 
aged )0 yellS and above [Mcan(SD)=-20.4(25.1) vs 15.5(21.3)). Ethnidty show high mean score 
amon& the Akans (Mean (SO) -29.5(28.2)} whiles traditional and none religious combined had 
the highest mean score [Mean (SO) "30.0( 1).1)]. Intuitively, lertiary educational holden; were 
obsctvcd 10 ha\·e high mean ~ore {Mean (SO) -44.8(27.8)J. In addition. formally employed 
prepanl: women had the highest mean score among employment statuS [Mean (SD) -39.5(27.6)J 
whiles average monthly income and marital SlaWS shows high mean score among pregnant women 
who cam GHJ!401 and above and were single respectively (Mean (SO) -)0.9(28.9) and 42.0(31.7) 
respcctiv-cly). Prqnant women WIth no child were observed to ha\le high score (Mean (SO) 
"27.1(30.4») whiles pregnant women with one were observed to ha\·c high mean score [Mean (SO) 
"27.S(JO.3)J. Mon:over, age at rlntpregnancy showstbole who had their first pregnancy at31 
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)-eus and IboYc WCR obscrved to hllVe hip mean score [Mean (SO) =40.7(31 .6)). ASsasmcn1 of 
overall knowled8lt significant difference of mcani score on cervical canter across demopaphic 
depicts. that. the mean difference among age group. religion, educalionallcvel. employmenl status. 
l\'eRgc monthly nw;ome le\'cI, marital SlatU5. number of children, number of pregnancy and sac 
r.ngc al fir..1 prepancy were fUlistiCilly si,nificam (sec Table 4.4). 
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Tablr 4.~. : A'·t ...... ~ftft.1C..-c ...._ .loa "'.Wcc.f«n"kalcaaC'cr by de..acrapbieda. ...t ntrtks 
Cause, "DS aDd Rhk of IcUi., ul"'Vlnl PrevntloD of cuvical 
~-=I~~~~' !}_plG. caK'tr UHU Uvuall_ __  
Mean{SD) Mean(SD) MeM(SD) 
% F·taI Mean(SD~ F~·"" F-ccst % F-InC 
1l.5" 
Age eroup 
:::;29 20.2(27.0) 27.0(32.4) 1l.1(21.7) 20.4\2S.I) 
Jo. IH(24l) 19.1(27.') 10.2(17.7) 15.5(213) 
rlhnitill 
U&'Oan~t>c 23.1(12.9) 16.7(20.4) 7.7(12.0) 17.)(11.7) 
AU. 29.6(17.9) 41 .3()9.l) 15.2(2A.0) 29.5(212) 
Ewe 11.2(26.2) 22.1(30.2) 12.2(20.5) 17.6(2'.7) 
Northtmelhniclt} 74(11 .1) 16.7(2S0) 6.7(10.0) 10.0(15.0) 
Odtet (KoKomba and Gun) 25.9(23.6) 33.3(27.6) 6.7(100) 2) .3(21.2) 
Rdi2iolll 
Chrl .. IIJrl 18.6(26.5) 242(311) 12.l(20.6) 11.7(24.2) 
10'- H(9.2) 10.0(20 71 4.0(1.3) 60(12.4) 
T,.itMJaiI+Nonc 31.9(112) 39.6(19.8) 15(20.7) 30.0(13.1) 
36.9'· II.S" 
[duc ...... "'-ul 
Nonc+Prinwy 1.6(16.4) 167123..) 9.0(14.7) 11.1(15.9) 
Junior Secondary! 
.....1  
-, S.9(1I.5) 10.1(1'.') 4.5(123) 7.1(11.) 11.3(22.8) 24.2(2'.1) ' .2(14.7) 17.1(20.4) 
T..,.",IT. ...... 
..u..rr- 47.6(30.') H .8m.8) 30.3(28.1) 44.1(27.1) 
11.0-' 10.2" 
E_pllI}mnldaIUl 
lJ"'n1rl, .~~ 10.6(21 .1) 12.4\24.9) 12.1(20.1) 11 .5(21.3) 
Self-r:mplo)'Cd 1I .1(19.S) 19.4\27.1) 7.6(IS.I) 13.1(18.5) 
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}·~rmal-c:mp50)'ed _ _ 4l.4(JO.s) 42.6()4.") 25.3(26.2) )9.5a7.6) 
NOTE ·p-\lIluc· 0 OS. "p-nlUC'<'O.OI. ···p-nlue < 0.001 If: Ap: JI"OUP was analyzed usine .I..(est 
T.b. .. 4.4b: A\cl"le JK:nula,e KOrl' anelSlaeDI on k.oowled&e orten-lui canur by de_ocrapkk chanclltmltcs coatinaltd 
A\~ monthl) Income level 
<GH;200 12.1(19.4) 28 .". . ,17.2(25.5) 110'" 11.6(18.5) 9.2'" 1l.6(19.2) 
GH~201'(iHC 400 11.2(23.9) 23.1(30.7) 6.1(16.2) 15.6(21 .8) 
-.QHj400 33.1(32.7) ]6.1(312) 19.7(25.]) 10.9(2' .• ) 
Marlhtl ~l;11u~ 24.5'" 
~mlle 42.7(341) 48.1(36.') 11.3(30.4) 42.()(l1.7) 
Man~d 17.6(24.7) 24.4{30.1) 11.1(18.7) 10.0(221) 
10.1(19.5) 12.2In.8) 16(1l. 1) 9.6(17.0) 
Numbu'lrduldft:b 
None 290(32.7) 12.\(36.7) 19.4(264) 27.7(30.4) 
On< 14.4{20.9) 19.1(26.0) 1.8(14 .8) 13.8(18.4) 
11.1(20.7) 220(283) 12.6(110) 11.7(18.1) 
1.0(12.1) 11.2(21.1) 1.1(11.6) 96112.8) 
N.mbt'rofpre&nan",. 
On< 290{J2.lIJ 11.6(362) 19.8(26.7) 27.1(103) 
Two I 4.4{2 1.4) 21.0(281) 1.9(14.6) 141(19.5) 
""." 11.6(20.1) 21.2(2 •. 8) 12.1(110) 11,\117.1) 
Fourand.bow ' .4{12.7) 16.1(22.9) 1.7(11 .1) 10.1(1].6) 
A2rnn2tltnnfprqoaDCY 
HclllW IS 20.3(25.4) )0.9(29.5) 8.J{14.8) 20.5(20.4) 
18-30 112(23.6) 20.6(29.1) 11 .6(19.6) 16.<1(22.4) 
!31 419(31.1) 477(37.2) 22 .7(31.0) 40.7(l1 .6) 
NOTE 'p-vatue<O.05. "p-utue<O.OI and "'p--va2ut<O.OOI 
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Objective}: FaclorsiaOueDceluiowledgeoDcervicalearciDoma 
Bivarialeand multivariabledat. anal)'scs ""en:: carried out to assess the factors that influence 
o\crall kllOwledgescon:~and isprcscnted in table 4.5. Uivariatc analysisdc:ptcts that. age group. 
rcligKHI. educational level. average monthl)' income, marital statut, number of children. number 
of pregnant and age at firsl bmh signiftcanlly innucnceoverall koowledge score (p-v alue<O.05). 
However. multivariate inferential analysis depicts thai. IIge group. educational status, employment 
stalw. a\c"'ae monthly income, mariw sialus., number of children, nwnber of pregnanc), and age 
alfirslPJCJIWlcyadjustablyinnuencethecxpecled log count of overall knowlcdge 
AdjUilingforcovariate variables shows that. being a prcgnant woman aged 30) ears and above 
ineMscstheexpetted log count ofo,·erall knowlcdge b} 0.45 compared to those.ge d 29 years or 
below (J3(95%cI)-O.4S(O,IS.0.71]. The expected loa count of 0\·er311 knowledge on cervical 
cancer amon, JWlior and Middle Khool leaver .. negatively influence by 0.70 compared with 
primary or no education Ip{95%CI)--O.7(..(l.9S--42)]. howe,·er, positively innuence among 
TenW'y edl.tCation by 0.6S compared with primary or no education [P(9!l%CO-O.65(O,)S-0.94)] 
Furtbctmote, being. pregnant woman e&ming Ghe200-400 and G))¢401 and above Increases the 
expccted loa of overall knowledge by 0.47 and 0.25 respectively (13(95Y.cI}'"O.47(-O. 18-0.13) and 
0.25(0.02-0.48) respectivel)]. Being single pregnant woman increases the expected log count of 
ovaall kno",ledge by 0.51 compamlto marTlI:d pregnant woman (P(95%CI)"0.5I(O.29.0.72)) 
whilesrcspondenb With one child dccreua the expected logcounto(ovcralllrno\\lcdge by 0.71 
compared Wllh respondents wilh three or more children 113(95Y.cI)-o.71 (-1 .17-0.30». Intuitively, 
JftSJ'IRt women with three pregnancies decreases lhe ~pecled log count of o'·erall knowledge by 
0.46 compued wich those \\IUI four and above pregnancies 1P<95"I.c1)--0.46('().64.0.27») MIl 
pregnanl women who had their tim prqnancy ~ 18-30 yearsdecreaaa the eXpC!("red loa by 
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0.44 compared with ~gnanl women who had their first pn:gnancy al teenage (below 18 years) 
(sceTabIc4.5). 
Table " .Sa: Facturs ianueneiDg uvel'tlll knowlrdge score amuag prrgDIiIDt womea .howing 
~(95%C1) P(95%CIJ 
Agegrhp 
,g9 Kef Rer 
30' 0.2310.02-0.44j· 0.45[0.18-0.711··· 
Ethalelty 
GalDangbe R.f 
Aiw> 0.39(-008-0.85J 
E"" 0. 18(-019-0.57) 
"'I:'lfthemetMK:ity 0.06(-030-0.<3J 
()thC'r (KoKombaand GUIUl) 0.06(-0.51-0.63J 
Relig50u 
Christian Ref Ref 
Islam -0.13(-0.23--0.02)" -0. 1 I [-0.46-0.25J 
Tradillonal+Nonc 0.01 [-0. 14-0. 16J -0.03 [0.34-0.28) 
EdueaUottalk"el 
Nont"tPrimary R.f 
.0.4S(...Q.71--
JuniorSecondaryl Middle school 0.19)··· -0.701·0.98--0.42,··· 
Sooondary -O.02(-O.29-0.24J 0.19[-O.46-0.09J 
TtftiatyfTf'IIinins collegelTechnica! 0.63[0.42-O.84Jo" 0.65(0.35_0.94JoOO 
Empaoyment.latus 
Fonnal<mpki)'N R.f Rer 
U"""pioyod .O.41[-O.82-Q.Ol]· 0.471·0.81--0.13)·· 
-0.54(-0.73--
Self-employed 0.35]··· 0.25[0.02.0.481· 
Avenla:emootblyincGDlelevel 
>GHj!:400 Kef 
-O.b2[-O.S. .... 
<GHc200 0.39)·" -0.081-0.31.0.15] 
GHt201-GH¢400 .0.33[-0.5.. ..- 0.11] •• -014(-0.34-0.071 
Nate: Ref· RefCRnC4!C&tclOf)' •• p-v.lue<O.S• •• p-v.lur<O.O I .••• p_n!tK<;O.OOI 
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Table ".Sb: Faclon innuegcigg overall kno,,"'ledge score among pregoaDI women .howl_, 
bivarialeandmullivariableZcro-lnn;jtwPOI)JlOncoefficicatseoDtiDued 
MaritaJstatUI 
Muricd Rd Ref 
S"'&k 0.7I(0.56-0. ••J '" 0.51(0.29..0,721· .. • 
oo.e" -<1.10(-<1.39-0.191 0.21(0.2-0.40)' 
NumberorchHdn:n 
Thm:."dtbovc Rd R,' 
N_ o ~410 51J.1.l1j .... 0.53(-1.09-<l.03J 
On< 033(005-06 1J' .074[. \ 17-0,)0)·" 
Two 013[-0.08-053J -0.11(-046-0.25) 
N ••b ernrprrgnaDCY 
Fow-andabo'rc R<I Rd 
0"" 079(0.53-1.05)'" 0,211·0.17.0.60] 
T_ 0.35(0.070641' 0.48(0.21-0.75)··· 
n. ... 0. 121·018-0.43J .046[.0.64.-0.271• •• 
A~raDlealfinlpr~l;nllDcy 
Iklo~ 18 Ref Ref 
18·)0 006(-O_18-0.32J· -0,44[.0.69··0.19)·" 
~JI . 0.6210.34-0.92 1·" -0.16[.0,63-0.301 
SOTE Ref- Reference catep)'. ·.,..vaI~.OS. ··p-vllue<O.OI and ···p-v.I~<O.OOI 
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Obj«fi\Il'J;Prll'vIlIClluofe:ervkllICSDcerse:rHni.ll_ptakeiDtbetbreeyean prec:tdiDgtbr 
lntbissc(lion,~dc:ntJwcretikedquestionstoKicntlfythefactonthataK&sSOCI.ted"lth 
sereenini uptake: As presented in Table 4.6 several (1("(0fS were enquired. The prnalcn« of 
tcteenina among respondenu ,,"u about 31 .S%l9S".c1- 26.S·36.9) (sec Table 4.4 and F,gure 4.1), 
However, I] 1(43.0"1.), 18(25.6'Y.). 94(30 8%). 102(33.4%) and 10)(33.'''.) rr~pe:ctively .&.reed 
that not having support from the husband, COSI involved In screening, lack IlffemaJc health workers 
to conduct scrOll'nln~ cultural beltefs and beina phYSically healthy were (acton that influence 
sct'CClungupeakc. 
Table 4.6: Uptakil' of Cervical uacrr tCl'Hnial 
N. V. . ~u~ 
n(%) n(%)9S%C1 n(%) 
Had any cervical cancerscreenins in the last three 
)U' 82(26.9) 96(31.5) 127(41.6) 
som~ foctort ,IIal cuu/j ;"Jlwnc~ c~rviclll callC"r' 
xnnll·6"pltd~ 
NOCha\linalUppor1fromthch~ 4105.4) 111(43.0) 127(41.6) 
Costinv04\1cdinsctca\in& 93(30.5) 78(25.6) 134(4) .9) 
Lackoffemalebealthworksloconducl)Cr«nina 17(25.2) 94lJUJI) 134(43.9) 
Cuhu,..jbelic\c\ 69(22.6) 102(33.4) 114{43.9) 
Bcinl ~~~IC.II\ hr.Jth\ 6li22.3) 10lP).') 1}4(O.9) 
Suurt"e:rlClddat.a.2019 
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0.. of the 96 respondents who Md cervical cancer \Creening in the put three years, a little more: 
thlnhllf53(55,2%)hlldtheirlastscreeninginl~sth .. ayear.Alto.40(41.1%)hadtheirlast 
Kreening one to two YC:1Ir.I I8P Ind 3 (3.1%) said three years ago. 47(49.0%) of the respondents 
hldrecommendMion forscreming from nunes, whilst 35 (36.5%) qid thcy did itbythemselvcs 
... 14 (14.6%) said throu@hdoc1or's recommendillion. Also, out of the 82 respondents who had 
notbeenKrCened mthe past, 46(56.1%) notedthltthey did not know the inlCrvai for screening, 
aha 32 (32.9%) said it is expensive and 2 (11.0%) felt shy 8Oin, for the ICreaJinl. Final'y. amona 
all of the 82 n::~ems who Md not been screened in the past three yean, .lmostalilO (97.6%) 
notcdthilthey-..ouldifgivcnthechlnccto(seeTable4.S). 
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Tabk ~.1: ye. ... OhCrttDi1i1it ud recommeDdlitioD orees .mODe respolldeuu 
-Fr:eQ-u-eD-o-' -P;e;r:a=nta=ge  
Mostrcc:entcervic.alcancerscrttnlng 
Lcsslhanlycar 53 55 .2 
1-2 years 40 41.7 
3,..,. 3 3.1 
~m:.ommcndcd the scremingtest 
14 14.6 
Nunc 47 49 
Self 35 36.5 
whalwas your rnson(s) for not having a scrccningdonc 
I don't know the scn:ening illtcrvalJ 46 56.1 
I feel shy 2 II 
hisexpensive 32 32.9 
Given a ctlancc n0\\. \\oukl you do the test 
No 2 2.4 
~ ----- 80 97.6 
SHn:r : F'irltlDlltll.2019 
Objec:tivr~: . ·aclor illfluencinl! Uplakr of Cervical cancer screening 
and bdov. had ITIOf'C uptake compared with Lhtlsc ageJ )0 years and above (40.9% vs 24.7%) 
Meanwhile. cthnicity ShoWi more uPlake pn:v.altflCe &mOIlJ the: Akans (42.901.) whiles reliJion 
shows ~ uplake prntlence occurred among the Irad1tional and no reliaion (37.5%). However, 
IMlarycducuionprcgn8nlwomcn\.\creobservedlohil\chig,ho:\tpn:\'alenceofcervicaI cancer 
uptake (59.1%) and formally employed wert! also idenlified 10 have high uptake (56.2%). AIIO. 
pregnant wamen who eam GH¢401 or more were observed 10 have more uptake (45.2%). Also. 
motc uptakc CXlit among single prcgnant women (44.6%), Ln adJilion, more prevaJenee were 
found 10 be c:ommon amongpregnanl women wilh nochikt. one pregnancy, and 31 ycarsoraSC 
.1 fif'St pregJWlC'y (39.30/. . 400-/0 and 68.2% respectively). AsSOClahon of dcmop-aphic 
~ks With ter\'lcaJ cancer uptake shows 1M\, age aroup. cduc:alion level. cmplo)'mcnl 
scatus.. a\cragemcahlyinr:onk, marital status, numbernfo.::hildrcn. numbcrofprclJ"&M)' and aSC' 
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nlnP' at first JWpn'~ "'cte sipufic.antly auoc:~ with eCf'\'ic&J eanc:er uplAke (t-9.0S. "1.93. 
23.4, 15.95. 10.52. J7MI. 17.00 and 24.90respec:tively. p-value<O.OS]. 
Counter Intultlwly. pMLt). BRvjly and a~ range: at fim pregnancy were: signiflC.lncly influence 
,ervl>:31 '3n.,:c:t upw.t: (p-value<O.OS). MullLvanale- analysis shows that. tertiary school cduc.a(ion 
education IeIlVcts laOR(9~%CI)=J.3&(1.06-IO .73)J Self.employed prei'\&nl ",omen were ~1% 
tibIy t.w uptake of cervical CU'ICft' comP'lrc:d "'1m formal "orke~ laOR(95%CI)-G.Sl(O.20. 
1.29) wh.1n respondenu whoeam Ghc:200 .... 00u monthl) a'crase income- we-I'C 3.95 limc-s likely 
4.51 lima and 1.)8 limes respective!) lIke!> 10 ILkel) to experience cervkal e&netr uptake 
,ompand with respondent wiIh twC" or more child~ and dnc or more pregnancirs 
laOR(95~.CI) ·4 58(1 lJ.18.S) and ),]8( 1.19-9.61) respectiwlyl. Finally. preanant women "'ho 
WCR 31 yan of age at linl pregnancy were 13 .89 hme-s likely to have screeninG uptake compared 
widllhosc below 18 yun I' firM preS",LnC) {aOR(95¥..cI}-IJ.89(1.88·I02)J (stt Table 4.8). 
48 
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Table 4.8a: Facto", influeoc::ing cervical canter scree. i_a: uptake among pre2oaot women 
- - .---
.n.e.. .......  ---'--~--raptlic Cervkalcaoceruetake cORI95"1.CII .ORI95°;'CII 
NIF209{68.~ Yes 96!31.51 
nW.) n(~o) 
Ace group 9.05" 
)0-. 75(59. 1) 52(40.9) Rei Rei 
!;,Z'J I 34(7S .3) 44(24.7) 0.47{O.29-O.77]·· 1.16(0.0-3.12J 
£tII.idly 2.060 
GWAdangbc: 10(76.9) 3(23.1) Rei 
Ah" 12(57.1) 9(42.9) 2.S(0.S3-11.81] 
E. . 174(68.8) 79(31.2) 1.5 1(0.4 I-S.6SJ 
Nonhctncthnic:ity 6(66.7) 3(33.3) 1.67(0.25-11.07) 
Otho, 7(77.8) 2(22.2) 0.9S[0.12-7.27J 
Relicioa 1.080 
Oviltian 192(68.1) 90(31.9) Rd 
!111m 12(80.0) 3(20.0) 0.53(0.1 5-1.94) 
Traditionai+NolK 5(62.5) 3(37 .S) 12810.30.5.47) 
Education.llnd 
None+Primary 31(63 .3) 
Junior Secondaryl 
_1. ..1 0001 103(86.6) 16(13.4) 0.27[0. 12-0.58)"· 0.23(0.09-0.571 •• 
So<ondo<y 48(67.6) 23(32.4) 082(0.38-1.77) 1.96(0.73-S.26) 
TatiaryfT,.inin. 
C:Ollqe/Tcchnical 27(40.9) 39(59.1) 2.49(1.16-5.32)· 338(1.06-10 ,73J· 
r..pIoy~Dtstatv.s 
FormaI-emplo)"ed 2X(43.! ) 36(56.2) Ref Ref 
Unemplo)'ed 34(79.1) 9(20.9) 0.21[0.08·0.50)-" 0.23{O.06-0.79). 
Self-employed 147(74.2) 51(25 .8) 0.27(0.14-0.48)"· 0.51(0.2!)'1.29) 
Average monthly 
t.o.&elevel 
>GH.400 40(54.8) 33(45.2) Rd Ref 
<CH.200 88(6S.7) 46(34 .3) 0.63[0.35-1.131 .19511.47-10 . .58]" 
GHt201-GHCl'400 81(82.7) 17(17.3) 0.25(0. 13·0 .. 51)"· 0.7"'rO.29--1 .88J 
:\tarilaillalul 
~!amed 140(654) 74(34.6) 
''"oJ< Ref 15(55.6) 12(44.4) 1.51[0.67-3.40) 0.91(0.32-2.6IJ 
Othm 54(844) 10<15.6) 0.3510. 17-0.73'" 0.l6(O.24-1 .291 
Note: Ref., Reference catcaOty, -p-value<O.O.5. --p-value<O.OI, '.'p-valuc<O.OOI 
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Table4.8b: Factonionuencincurviulcancerscreeni.gupfakeamongprcgnanl",omen 
Nu.bcrordlikireo 17.68··· 
Two and above 68(62.4) 41(37.6) Rer Rer 
Non< 65(60.7) 42(39.3) 1.01[0.61-1.85) 0.57[0.09-3.51) 
One 76(85.4) 13(14.6) O.2810.14.().57)·" ' .58[1.13-11.S[' 
Sumber 
pregnancy 17.00'" 
Thn:cand.oo\c 71(63.4) 41(36.6) Re' Rd 
0.. 63(60.0) 42(40.0) 1.35[0.73-2.49[ 3.38[1.19-9.61)' 
Two 15(85.2) 13(14.8) 0.3510.16·0.761·' 3.72[0.'9-28.2) 
Aef noge a' lint 
pteguncy 24.90'·' 
Bell)" 18 38(92.7) 3(7.3) Rcr 
18·)0 164(67.8) 78(32.2) b.O:![UI1.;!OI2}" 3.60[0.96-13 .53 
~I 7(31.8) 15(68.2) :!7 J~[6 . 18·[1IQl·" 13 .•9 [1 .88-102[ 
NOTE: Ref Reference category. 'p-value<O.05. "p.value<O.OI and ···p.v;lIuc":O.OOI 
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CHAPT£R FIVE 
This chapter provides a summary or major findings of the study related 10 the objectives. The 
findings suggna inadequate level of knowledge of pregnant women on cervini cancer coupled 
with poor upWtc of screenina: in the Ho Municipality 
S.l Kaowledge ofpreeoaot women 011 cervini cancer 
Findings from this sludy suggest that the ovenll knowledge avc11Ige score amon. the respondenti 
W1II 23.7%. Higher figu~ of '6.4% and 90% were documented by Makwe et a!.. (2012) and 
Malwajan el aI., (2015) among students in Lagos University, Nigeria and Malaysi. respectively. 
thai majority demonstrated high level information and understandinson cervic.1 cancer The 
variancecouid be auribulCd 10 the flCl that thcir n:spondenls were siudentsand would h.vebecn 
!nOR exposed to cervical cancer education than these prescnt siudy respondents. The knowlcdF 
domains in this study indicated thai, the pcrcentaie .veraie score for Cause, sign!. and symptoms, 
n~k Ixtors and prnenlion were 2~ .9%. 30.6% and 20.20;' respeclil·ely. This contradicts the 
findincbyAssoumouelaJ. , (lOIS)intheGabonthatlheknowlcdgcl>Coreanal}'5isrevealcdlS". 
ofthcrespondents had poorkno\\ledge. 60% had a fair levcl of knowledge and only S'Ye(2) had 
.ctequalc knowledge level on cervical cancer. The findings in this study revealed that 18.0% of the 
pre-gnanl "'omen agrccd 101 virus bcing Ihc: eausalive organism of cervical cancer and 23. 3% 
I'eIpOndc:nb Igro:d that cervical cancer is lranimilled sexu.all)'. These flndinp conforms with 
lower figure a previous study conducted by Arora and Wani (2012) dw 12% of the participanlS 
said the) had heard of \ lral infection of the cervix, only 6~e knew it was eaused by HPV in(ecllon 
and only 9% had heard that HPV is transmitted through §ex. AS50um0U el .1. (2015) also reported 
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with a highcr pmportion thai 700/,oflhcirrespondents notcdlhalcervicalcancet wBSacquired 
Thi~ cUfTCOl study has found. lack of knowledge around warning signs and risk factors of cervical 
cancer. As such, less than half of the participanls knew oot all the risk flllCtOfS which could be 
ex.pllincd by pool knowledge about the di~ase. In relation to know1edae: of risk factor~, only 4% 
of the women responded positiYely towards Its awareness. This study also found thll some 
rapoodents also agreed that lowcrbackpain,post.menopausal vaginal b1ecdinadurin, or after 
sex.andun~pectcd"eightlosscouldbeasignsofcervic.lc.ncer . Thissimilartothcfindinpo( 
a cross-sectional study conducted by Mulwna d al.. (2017) in U&lIlda. that abdominal pain 
(s7.8%), bleedin& per vqinum (43.3%) and offensive vaginal discharge (33.1%) were commonly 
In this prcscnt ~Iud). l..no"lcdge on the risk: factors also showed that, respondents .grt:cd that 
haYing multiple sex p4t1.nerS (27.1)0/.), smokina (23.6%). early onse1 of sexual acliyity (23.9%) 
increase one's rlak of getlina the discase Similar findinas were reported with greater fijUfCs by 
Mukama et al. (2017), that 78.4% of !heir respondents slated ha,·mg multiple pannels, and "rl~..  
sexual debut (73.9%) increases a woman's possibility of acquiring cervical cancer. Different to 
this rmdiD&, Assownou ct at. (2015) found among Gobanc5e women \hal facton such as high 
pariI)' and age at first pregnMCY were &mOnS Ihe least idcmified factors that pose risk of acquiring 
ecn-tc.l~er.Oteresultsofth1icurrentsfudyalsorevealcdlhat22.3%and2S.3%lespectively 
IIIfCCdthal,prolongcdinlakeoforalcontraccplivesandinfectionwilh HPV raises one's risk of 
getting CCl'o'ical cancer. Thls ~ with ies!>Ct pctccn~gc (&8.4%) wh., "as reported by Mukama 
et al .• (2017) IhaI being infmed with HPV c).JK»C~ individuals to cavic.1 cancer mfectlon . The 
findingoflhc pre!>Cnl ~tudy however, did not ~uppon *haI was rqtOrtcd inalhldy conducted by 
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MakweetaJ,(2012),thatrnajOrityoftheirstudypatticipilntswhowtTea"arcofceTV,calclnCCt 
had no knowlcdac of its relationship with HPV infection. scxUlII activeness. age at ~lI.ual initiation 
andxvcraJJCltUilpartners. 
Kno ... Jcdgc on way, or pRventins cervical canc:n shoW! thai ' .... 4% respondenu .peed thai 
screenina fCN' cervical CM\Cercan help prevent it and IS I%agre:ed that Pap smear test hclps in 
prevenlini cervical cancer. A similar result was also reported by Makwe elal .. (2012) thaI only 
12.1% of their stud} respondent) me"'- thai dlseasc could be prevented by Pap smear. The n:suIu 
fw'Ihtt indieale INt just some 102% oflhis study's respondenu .greed 11\11 vlCclIllling against 
hUmM pap.llomaVIN5 can help prevent cervical cancer with 12% rnponden15 , ugge5tin& that 
vaccinating all girls lie 9 10 I S yean can help prevent the disease. thiS finding is In line with thaI 
... hw:h was curled out by MahanJan C1 .1., (lOIS) who reponed that. toc.l of 180/. respondents 
Indlc.&&td that immuniling against HPV is preventive of C(,NIC.) cancer .... hlht 11.5% saMi they 
wiliendorscHPVvlC.cinaliontothcpcoplc 
nllsstl.ldyftndinpkaveal50reveak.dthatrnost(5I .... ~.)oflheparticipalllsl.n('woreervjc.a1 
cancer. Thu find In, dis&p'tlCd with ... tat Arora and Wanl (2012) .nd Opoku et .1 .. (2016) haw 
rt'portcd in IMha and Ghana that ",.. and 70% ohlle population under 11udy were not .WIn of 
cancer oflhe cerviX respectively The results oflhi, study (unher showed thai mljority (56.7%) of 
thtrcspclftdmbwhoevethcardo(cenicalcancerheardnthrouahthemedia. 
The retuItJ oflhi.s study mow that the nerage kno. ... ledge IC0l"t5 on C&U$e5., ,ilN and sympcom~ 
of prt'iJWIl women apd 29 years or below had hiah mean KO~ as compared Yo ilh those sied 30 
ycars and above and pregnant women .,ed 29 years or belo ... ha,·inl higher mean score u 
CClmp.n:d 10 lhoK qed 30 ~an: and abO\c (Mean"'n.O vs 19.1) ThilJ findina difTtn (rom whM 
was reported in the Xinjianl Province b) Abudukadeer ct al. (20IS) thai most mpondenu.peI 
53 
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31-40yearswercawareofcervicaJcancerthanlhose less or equal 10 20 years. Acrossethnicity, 
the high mean scon: was amona the Akans [Mean (SD) -29.6(27.9») with tndilaon.l and none 
religious combined havinglhe highest mean score. EdUCIJion was onc of the client's socia. 
demographic factors which wu found in tills stud} to sIgnificantly affect clienu' know1edae on 
cervICAl cancer. For instance,leniary cdlotCationlil holders were foWldto have high mean (47.6) 
knowiedge scxwc of " ..... K:al cancu. This findmg might resulted from Inc fact thal oducation 
enabks people to be infonnedand make Infonmddecision~andhealthchoicesespcc"l1ythosc 
related to maternal heatth. Women .... ho ate educated are most likely 10 appt'ccille the 
complications associated with their hcahh (USFPA, 2010). A similar lindings were reported by a 
study conducted in Bolgatanp. in the Northern part of Gilana which found that majority of the 
partiCipants who had higher education (80.95%) had t.eaRl of lite discASe condicion whilst those 
~lIh lowcr cducahon or no formal (19.05%) had never heard orit (Zibaccal .. 20IS). Respondenu 
" '00 wac Connally employed and were singJc had tile hi&hcst mean score among (43.4 and 42.7 
tcSpCCtively). Thispm;entstudy findinss also showed thai an increasing pariry fcsull indecreas ing 
man knowledge score on causC'5 and signs and symptoms of cervical cancer. This study findings 
aIIo ~ chat though then: is Importun differencc of mean ICOn: on causes and signs and 
symptoms ac:rossdemographlc, tnc meMl ditTerence among agc group. reliaion. cducacional level, 
empioyment rtltus. average monthly Income level, marital !ttltus, number of children. number of 
pregnancyandageranleatfimpregnanc:ywerestrltI511callysignifKant. 
A.$Cumenl of overall knowledF significanc diffcfaKe of means lCore on cen'lcal cancer acrou 
demographiC depicts Ihat, the mean difference amena age group, reil,ion. cducallOfllI level, 
cmplo,.mcnt stat~ average moochly income level, marital statU5. number of chiklrat, number of 
pregnanc}andageranscltflfSlpR:grwtc)'"ef'estali5tlcaUysigmlicant 
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5.2 Factor-sinOueaclngkaowledgeoDcervicaluocer 
Assessing the f.clOl"$ Ihal impact ovaall knowledge scor« of pregnant women in the Ho 
municipality. it was found th&t ag~, religion. cducationallevel, average monthly income, marital 
status. numberofcnildn:n. number of pregnancy and age at first birth significantly innuence 
overall knowledge score (p-value<O.OS). On the other hand, muitl\"llfiate infemltial analysis shows 
thal. sac. educational, employment, marital slatuses, average monthly income. parity, paviry and 
IF II r. .. st pregnancy influenced the o~'cnll knowledge of the respondents on cervical cancel 
Similar oulcomc~ WCf"C noted in a communil) b~ cross-sectional survey by Mitiku and Tefen. 
(2016) who found that havinSadvanced educ:ation and income were significantlyrellted t ohavlftg 
~ufficient knowledp on the diieaSC condition. Respondents who had primary or more education 
had a significant hiahlikelihood ofhavingsufficic:ntknowledge likened to thoscwi th no formal 
education. Apin. earnins an a\'Cl1Igc of 1500 Ethiopian birr (ETB) monthly WII$ $Cen to influence 
knowledp than e&minllw than SOO ETB monthly. 
TheresulU in this study a]so showed that, respondents aged JO)earsand above hredaninc:reascd 
expected overall knowledge by 0.45 compared to those aged 29 )ean. The expc.:lcd ovCflllI 
kno",ledge on cerviCAl CatKC't amon, lURIor and Middle schoolle.ven negatively influenced by 
0.70 compared with primary or 00 edUoCal:ion. Furthermore. respondents who earned GHt200-400 
and. GH~401 and above incrCIIKs the: expected o\cratl knowledge by 0.47 and 0.25 respectively 
Bemg smgle o&1so Increases the expcclC"d on:rall !..nowledge by O.S I compand to nwned pregnant 
..... oman. This flnding differed from what xlVu d al. (2017) who reponed in Addis Ababa Ethiopia 
that malTled women had sufficient knowledge than sinales. Prepanl women who hid their firn 
Jnsnan.:y between 18-30 yean dectcases the expected 10i by 0.44 compared with prcanant 
women who had. thtirfU"St pregnancy at teenage:: (belo", 18 yean). Thiscouki be: as a rnultofthc 
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relevant relationship observed between knowledgc Ic\"ds of callSCS of cervical cancer and 
lJ'anWnission of HPV and aae as reponed in some literature (Urua & Darj, 2011). Urasa and Darj 
(2011) noted in theIr descriplive cross sectionll stud)' that Imowledge of their study respondents 
was more accept.abk among the young (p" 0.027) than old. 
S.JPrevaluceofcervk:alcaocerscrteoinguplake 
In thii itudy. the prcvalcm:c of screening among Ihe respondents was about 31.5%. This is simil., 
10 the finding of a population based worLd health survey analysis by Oakidou ct al.. (2008) who 
aslalCd cervical cancer scrccning covcl'IIgc and indicated that covcrage in leu advanced countties 
on avel'llge was 19% ti compared to 630/. in high income countries. This present study findmg also 
supports whaa was reported in NIgeria by Ifemdumma et al.. (2019) among health care providers 
wtUch showedlhat out of the 388 total participanls who kne'wthe scrcening frequency, only 20.6% 
ofdwm "ere ~reened. In Tanzania. 8 conltadiClOry finding was however reponed by Urasa and 
D_j (201 I) that 84.6% respondents never had • screening done. Out of the 96 respondents who 
ever had '>Crceningin this study, amaJoOty (SS.2%) of them have had Iheirlast sc reeningmlcss 
than. rear and some 41.7°/. had theirs one toNG }ears ago. In Malaysia, a study amonaAmcan 
women however. showed that ou1 oflhc 320 rcspondcnlS, only 27.2% had screened in the three 
years prccedina: the study (N~abichiect aJ., 20IS). Also. (49.00/.) oftne respondcnLs who had ever 
screened were adVISed b) nune!. Intem;1lDgly. this study finding showed that some 36.5% of the 
rapondenu who -.ere ilV,an:: did a volunlary sueemng_ This wa, almost the same as what Ndeiio 
d aI. (2016) have reported in Upnda thai 37.20/. \oluntarily sereened to know their status. It was 
funherfoundinthisstudythatI4.6%lUpondentssaidthcydidthepapsmcartestlhroughdoctors ' 
rccommcndatKlo. A similar mutt was rqxmed in Kenya and Uganda WIth higher figures by 
Ombcch and Muipi (2012) and Ndejjo et .1. (2016) where 25% and 4S.II% respondenti 
S6 
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respectively had screeningdonebeawc: it was prescribed by the doclOrand or health workers. 
11rese findings however, differs from that ofa pne\'ious study conducted in Ihe south-western 
Nigeria by Amu (2017) which reveal.:d that the poor uptake of screening was due to factors such 
uinsufficientMvicefrom Ihe mcdical team. lack of health education, difficulty in acc:euing 
screeninlservices. Most (56.1%) of this study's respondents who were not screcned in the puI. 
noted that they did not know the interval forlhe screening and a linleabove (Wo-fifth (32.901.) 
mpondenl5 saying the exercise is e"pensive. This finding conformed with what Amu (2017) 
reportcddtat increased COSC of screening and pain relatedanxicty resulted in the failure of 
tnpondcnu from undertaking cervical cancer screening. Almost all (97.6%) the respondents, who 
have not becn screened in the past. noted thatlhey would screen Ifgi\'en the chance 
Cervical cancer!ocreening uptake by demographic chal1lcteristics shows thai, pregnant .... omen 
apeS 29 yean Iftd \)etcw had more uplake compared with those aged )0 years and above (40.~o 
vs24."/.). Ethnicit}' and religion sho .... more screeninauptake among the Akans and traditio nallno 
rclicion (42 .9"0 and 37.5·/0 respectively). Moreover. rcspondents with tcniar) education and 
fonnaU) employed were r~pcctivcly 59.W.and 56.20/. found to have highest prevalence: of 
screening. In this 5tudy. pregnant women who cam al least GHt401 were observed to have more 
ptnalc:ncc (45.2%) of sc:reemng. This if> similar to whit Adanu et al.. (2011) found where women 
with higher educational and higher socio-c<:onomic had aood screen ins uptake (Adanu et al.. 
2011). The study's findings .Iso show Ihu pre\'alcnce of screening was common among pregnant 
wumen with no child and one ~c)" (39.3%. and 68.2'Y. respcclively). This suppo"cd "hat 
Mantu .. and MwisonBo (2018) reported in Zimbabwe that cervical cancer scn:cning wu minimal 
among mUltiparous women and as parity reduced, screcnin& was reported to be increucd 
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5.4 Fadon I.Ouellciog uptske of cervical cancer ~creeninl! 
In the current study. rnpcmdmts haw: idcntijied several factors related "ith scm:ning uptakc in 
the Ho mUlllcipalilY. The respondenb agn:ed that IKk of husband support, kina physically 
heahhy, cultural beliefs. cost of SCf"ning, and absence of female health workers 10 conduct 
screen"'J (43JW. . 33.8%, 33.4%, 30.8% and 25.6e;. respectively) were factors WI influenced 
S(temin~ uptake. Different rea.sons were however. stated by lfemelumma et al. (2019) that in their 
stud)' ""hc:re 28.4t'oofthe respoooents said the reasonfornon.screeningwasdwtthcyh.d not 
laUIht ofit whilst 10 8e;"attributed ittoanxiery. 
Aswciation of demographic chal'llctenstic5 with cervical cancer uptake ~hows that. age group, 
education ievel. anployme.u status.. average monthly Income, mantal ~tatus, number of chiLdren. 
nwnber of pregnanc~ and age range at first pregnancy were significantly associated with screeninJ 
uptake.lnsomestud\l:~,comparablcoulcomeswerereported. for instance. in a study conducted 
in Tanunaa. fe"'cr rnpondenlS with secondary OJ lower educ:adon h.d screened as compared to 
lhose WIlt! higher education (Lyimo &. Beran, 2012). However. havina higher education may not 
necessanly IBnslate intosccklRg for screeninG hcnc:eoiherfacrors may also be considered . This 
findmlis also related to "hat was reported in NU!\lvill., by CerilO e1 a!. (2013) thai older age and 
having a histofy of no cl1ildren ""ere reponed as significant predictors of untimely Pap smear use 
The multivariate anal~is shoy,~ that. tertiary school education leaven. and monthly average 
income from GHt200,,",OO, were 3.38, and 3.9S times respectively more likely to have uptake of 
~n:cning compared to those wilt! no or primary education or r9ponden1s who eam more than 
GHt400 There is possible lb.t having higher socMl-economie slatus places an indi,·idual in a better 
positioneconomic:allyandknowledgewisetobewillingtoundcrtakethescrccningel.erclse. Self· 
employed pregnant women were 51% l110fe likely to uve undergone Pap smear te~inl compared 
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with formal workers. The findings from this ~Iud~ aiM) s,ho", thai respondents wIlli OM child .,.d 
one pregnancy 'A-ete 4.58 times and 3.38 times respectively more likely to experience cervic.1 
c.nccrupCakc ,ompared with respondent with two or more children and thn:e or more pregnanctcs. 
lnlhis study,prcsnanl women who were JI years okl aa ftrStprepancy ncrc 1)II911rna likcl)'to 
hive scrttning uptUi.c ..:ompared with those be~ 18 yean at first prq.nanc:y. Similar finding was 
reported by Teame ct.1J. (2019) in Ethiopia that matured females with children were three times 
more likely to ulihze cervical cancerscreerung 
5.5 LlaitatiouoftllcJtudy 
The study was condw:ted lnonJy Ihe Homuniclpai hospilal. wtUch may prohibil ~Iization of 
the outcomes 10 all women in lhe Ho municipalily. Also, this study Jacked qualitative aspects 
",htch help to measure lhe indepch possible unanticipaled facts which could.ft"ect rcsponde:n til' 
kno",lcd~c and uptake oflheccrvical cancer screenin. 
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CONCLUSION A."'lU H.ECOM.\1ESDAn ONS 
6.JCoadus"'. 
The study found that only 23.7% pregnant women had adequate knowledge on cervical cancer 
despite the high IWarcn«S level (58.4%) of cervical cancer among the respondents. The study 
findm~ show that knowledge of risk factors. signs and symptoms, prevention and management is 
suboptimal among the respondents_T he age, religIOn, Nucationallevcl. II.verqe monthly income. 
marital status, number of children. numbC'r of pregnancy and age al first birth were identified IS 
import&nlconuibutingfac:torsofknowlcdseofcervical..:ancCT 
The findinp of this study aJio ,howed poor uptake of screening among pregnant women. The 
(actors \\hl..:h inOuCflced scrccnmg uplake were lack of husband suppon, beingphys icallyhea!lthy, 
cultural beliefs. C051 ofscr«ning, and absenccoffcmllehtalthworkerslOcondliCtsc reening 
6.1 Rec:ommeadatioas 
I. The Ho Munkipal Health Management Team and stakeholders should consider establishing 
helhh polic~ and $Iralegiei thai promote the prevcntion and mana~ement of cen-ieal carw:cr in 
thcmunic:ipaliry 
2 Chcnt centred health education cervical cancer in the Homunicipal hospital should be aiven 
~cprefCTencelohelpjncreasewomen·sknowledgeonthcdisease.Thissbouktbecharactcriscd 
b)'lhchcallhcarepersonnetgivmganmdeplheduclltionandcounscllingonthcdiseucincludLng 
Ihcimponanceo(rcgularscrecnlng 
3. Educalion on lIlc disease condition mould be extended to include men u hu\band ~upp'ln 
plll)""!O II ~ignificant role in Ike uptake of cervical cancer Krcening 
University of Ghana http://ugspace.ug.edu.gh
4 A communll}' level sludin should be conducted taking into con!>lckmlion qualitalivc study as 
_cillo get a clCU'CT plclure ofkno.lcdee teYel of women on cervical cancer 
S. Preventioo programs should be rolled out With more focus on women with lower cduafional 
Inels, lower economic status snd cullural beliefs. 
6. Government should .bIorb the COR of screening ~ th.1 all women have an equal chance of 
beinatcreenedwhenduc 
University of Ghana http://ugspace.ug.edu.gh
REFERESCES 
Abudukadeer, A ,Azam, S., MUllUhpu, A. Z., Qun, L., Guilin, G., & Mijiti, S. (20IS). Knowln:l8C 
and attitude of Uyghur women in Xinjiang province of China related to the pn:,'cntion and 
arly detection of cerviul Gancer. World Journal 0/ SurgICal OTtcoJogy, 13(1), 1-7. 
hnp$:lIdoi.ori/IO.II86/sI29S7-OIS-OS31-8 
Adanu, R., SefTah. J. t Duda, R .• Darko, R., Hill, A., It Anam, J. (2011). Clinic visits and cervical 
Ghana Medical Journal, 44(2). 
hUps·lfdoi.orgfl 0.43 14/gmj.v44i2.68885 
Amu EO, o. F and N. S. (2017). Cervical Cancer Screening Uplake and Barriers 10 Screening 
among Females in Somolu. South Western Niac:ria. Commumry M~d HetJl,h Care, 1(3), 
Assownou.. S. z.. Mabika, B. M .• Mbiguino. A, N., Mouallif, M., Khattabl. A., & Ennaji. M. \II 
(201 S). Awareness and knowledge regarding of cervical Gancer, PIP smelr screening and 
human papillomavirus infection in Gabonese "omen. B.WC Womtn's Health. /$(1). 1-7. 
hl1p~ fdoi.l'rs'IO.11 K6'~1290S.o15-0193-2 
As5ownou, S. z.. Mabika. B. M .• Mbiguino. A. N., Mouallif. M .• Khattabi, A., & Ennaji. M. M. 
(2015). Awareness Ind Irnowkdge regarding of cervin i cancer, PIP smelr screening and 
human paplllomaVlrus IOfc';lion in Glbonne women. BMC Womt"n'J HetJl'h, 1.5(1). 
hnps:J/doi.orgfI0.IIS6I,1290S-OIS-OI93-2 
Awua. A K. Sackey, S. T. . D!OeI. Y. D. • Asmah. R. H. . & Wiredu. E. K. (2016). Prevllence of 
human papillomavinas genotypes among women with terVical cancer in Ghana Cancer 
ccn1erS in low· and mtddle-inc:omc counlries. Infocllow Agrnu and Cancer, //(1), 1-9. 
University of Ghana http://ugspace.ug.edu.gh
https:lldoiurWIO.11861sl3027-016-00S().4 
Binka, c., Doku. D. T .. &. Awusabo-a.sare. K. (2017). Experiences ofcerviall cancer palienb in 
Nr.11 Ghana: An exploralory study. PLoS ONE 12 (10): e0185829. 
hUps:lldoioryJIO.1371/joumal.pooe.0185829 
Breen, N .. Wagener, O. K., Brown, M. L, Davis, W. W., & BaUard·Barbash, R. (2001). Progress 
in CUKerscrecning over a dccadc:: Resulls ofuncer sc:rcenina from the 1987,1992.aoo 1998 
National Health Int~iew Surveys. Jowno/ offill! National Cancer Instltule, 9J(22), 1704-
1713_https:l/doi.orgllO.I093/jncil93.22.1704 
Bunt, E. (2003). Hwnan papiliomlVirus and cervi~.1 cancer. Available at: 
http·/Iwww..5Ciencedirecl.comisc:iellCCiarticlclpil/SOI40673607614160.C/;n.lAicrobioJ Rev, 
16(1). 1-17. https:fldoi org':IO 112&1CMR.16.U 
Cerigo, H., Coull6e, F., Franco, E. L., &. Brusard, P. (2013). Facton associated with cervical 
cancer screcmna uptake among Inuit women in NunlVik. Quebec. Canida, BMC Pub/Ic 
Heulth./J(I).https:lldoi.org/IO.118&1471-2458.13·438 
Chru Dun Arora. Reena J Wani. A, K. and S. G. (2012). Knowledge and awarene5.S regarding 
cervlCal cancer with respect to FIsk factors. $Creening and vllccmatlOn. AustralaSian MedICal 
JOUl'nal. 5(1), from 
htlp:llamj.net. .u lindex..php?joW1\lI-AMJ&pagc-artkle&op::IView&pathO/.5BO/.SD"" I 192& 
plth%5B%SD=896%SCnhnp:llovidsp.ovid.com/ovidweb.egi?T-JS&PAGE--'reference&D'" 
emedlO&NEWS"'N&AN"'70678465 
(anfell, K. • Silas. F., & Berai, V. (2006), Cervical cancer in Aultralil.nd the United Kinadom' 
comparison of screening polK)' and uptake. and unlX'r incidence and monaliry. TJw Med/col 
JounJQ/ (1 Australia, 185(9), 482-486 hnpi.'fdoi.or&lI0.569-4/J.1326-
University of Ghana http://ugspace.ug.edu.gh
5377.2006.TB00661.X 
Denny, L., & Anotlu, R. (2012). CerviC411 cancer in Africa. Cancer Epidemiology B,omarkerJ and 
PrtWlIl101f,2J(9), 1434-1438. https:lldoi.orgIIO. 1158/1055-9965.EPI-12-0334 
Ebu. N .. Sylvia C. Mu,pepi. 5., Mate-Siakwa. P., & Sampsclle. C. (2014). Knowledge, ptactice., 
and banic:rs toward cervical cancer screening in Elmina. Southern Gilana. Inl~mQlionoJ 
Jownm 0/ Wonlen's Health. 7,31. hnps:lldoi.orgll0.2147IUWH.S71797 
£like. C., Edegbe, F., Ezeonu, P.O., UWlbe, C. t. Agbata.. A. T., Anozie. O. B., ... Elcwedigwe. 
K. c. (2018). Prevalence and Pattern of Abnormal Pap Smear among Pregnant Women 
AltendlOg Antenatal ClinK: In a MISSionary lIospilil in AbaklJik,. Southeast Nigeria. (}pi" 
of ObJIttrlcs Gynrcolol{Y. 08(08), 728-740. 
hnps:lldoi.DrF/IO.4236/ojoS·2018.88077 
Ezc. J. N., Emcka-irem, E. N .. & Edc&be. F. O. (n.d.). Clinical Medicine Insights: Oncoloi)' A 
Silt-Year Study of the Clinical Presentation of Cerviall Cane« and the Management 
Challcnp:s Encountered al a State "fe.uhing Hospital in Southeast ~Igena. IS I-158. 
hnps:J/doi.or&'I0.4137ICMo.SI2017 
Gakidou. E .• Nordhlgcn. S .• & Oberme)"t:r. Z. (2008). Coverage of Cervical Cancer Screening in 
S7 Countries: Low Average Levels and Large Inequalities. PLoS Medicine, .1(6), el32 
http~,','dOUN'gil 0.137 1/journal.pmed.OOSOI32 
Oan. D. E. H .. & Dahlui. M. (2013). CerviQI screening upl.ke and its predicton among rural 
women in malaysia. Smgapon: Medical JolII'naf, j./(3). 163-168. 
hnps:lldoi.orgII0. 116221smedj.2013047 
Handlogtm. K. S. Molitor. R. J., Roekcr, L. l:. . !'>larla. N. P .. Bachman, M. J. • Quayson. S .• 
ANona. O. (2014). Cervical Cancer Screening In Ghana. West Africa./"'"ltDlkNtal Journal 
University of Ghana http://ugspace.ug.edu.gh
of Gyrt«o/ogicoJ Pathology. J3(2). 
197-202. 
https;:1/doi,orWIO.I097IPGP,ObOIJe31829Sage6 
Henderson. J. T .. SanUya. M., Martinu. G .. Harper, C. C •• & Sawaya, G. F. (2013). Chanau to 
CCTViul cancer prevention guidelines: Effects on screening among U,S. women ages IS-29. 
PreventIve Mt:dicme. 56(1), 25. hnps:lldoi,orglIO.IOI6lJ.YI'MED.2012.IO.02S 
Hill. P. C .• &. COil. B. (2018). Cen'ical Cancer in the Great" Accra and Ashanti Regions ofGh. .... 
J(6), 782-790. hnps:lldoi.orWIO.1200/JOO.2016.00S744 
Hoque. M. E. . Ghuman, S .. Coopoosmay, R.o & Van Hal, G. (2014). Cervical cancer screenina 
among universIty students in South AfrIca. use of health belief model. InternallmlOl JownaJ 
oflnf«IIOW DISI:auS, 1/. 424. hnps:lldol.orgfIO.IOI6lj.ijtd.2014.03.1295 
HPV Information Center. (2017), 11. CompielMnlary dtJla on ct!rvicai canur pre\'tntion. 
Retrievcdfromwww.hpvcentre.nel 
ldowu, A., Olov.ookere. S. A., F'gbemi, A. T., &. 0aunllja. O. A. (2016). Detffft'linants of 
CervicAl Cancer Screening Uptake among Women in lIorin. North Cmlrai Niaeria: A 
Community-Based Study. JoJll'naJ of Cancer Epidemiology, 2016(Vili). 
hnps:lldoior~IO.J15512016.'6469240 
Ifemdumma, C. c.. Anikwe. C. C, Okorochukwu, B. C. Onu, F. A., OOOna, J. A., Ejikeme, B. 
N .• & Ezconu, O. P. (2019). Cervical Cancer Scrcenina: Asseumc-nt of Perception and 
Ucilizaboa of ~r.I .. e. :mlOO& Health Workm in tow RCiOUr(:e Senine. Imern<.llililra/ 
Joumal 0/ ReprooucllVe .lJedlcme, 1019, 1-8. https:lldoi.orglIO.115SI2019/6S05482 
Ingwu.J. (2016). Knowledge and Scrttning Prac!l(:CSofCcrv"ll Cancer among Pregnant Women 
Aucnding Antenatal ClinK: in Tertiary lIospitals in Enugu, South·Eastern Nigeri •. Jouma/ 0/ 
Can«rand TIUftOf" IrilernwiontJl • .f(2). 1......1). hltps:lldoi orglIO.9734/jctil2016127118 
University of Ghana http://ugspace.ug.edu.gh
Ingwu. J. (20t n. Knowledge and Screening Pracliccso(CavKal Cancer among Pregnant Women 
Attending: Antenatal Clinic in Tertiaty Hospitals in Enugu , South-Eastern Knowledge and 
Screening Pnclic:es ofCen>ical ClIIICcr among Pregnant Women Anendu'18 An1enltaJ ClinM: 
in Tel". (January 2016). hnps :lldoi.orglIO.9734JJCTII2016127118 
Jones BA, Davey DO. Quality management in gynecologic cytotoJ)' using interlaboratory 
companson. Arch Pathol Lab Med. 2000;124:672-81 
Lyimo. F. S .. & Ikran, T. N. (2012). Demographic. knowtedge. attitudinal, and accnsibility 
(acton. bwdated wilh uptake o( cervical cancer screening among women in a runtl district 
of Tanzania: Three public p:>licy implications. BMC Public H~Dllh, J2{I). 22. 
M. S. Williams and P. AmOllcn&- (2012). Knowledge and belieb about cervical cancer screening 
amoaa men in Kumasi. Ghana. Ghmw .Wed/cal JOllrnal, "'6(3), 147-151. Retricved from 
llnp:lIwww .cmbase .comlsearchlre~ults.!subaclion .. viewrecord&from·cxpon&id-U630177 
02~Cnhap:Jlwt3cf4d2l.sean:h.~ri.l!>~oluIIO''IS.com?sid=EMBASE&issn·OOI69560&id-
doi:.btille=-Knowlcdse+and+beliefs"'aboul+cervical+callcer+screenina+among+men+in+ 
Maharajan, M. K .• Rajiah, K. , Num, K. S. F .. & Yon&. N. J. (20t5). Knowledge of Human 
Papillomavirus Infl."(;llon, Cervtcal ~r and Willinpess 10 pay (or Cervi,al Cancer 
VaccinalMx'l among Ethmcally Diverse Medical Students in Malaysia. A.slall PacIfic JOlITnoI 
of ('ancer Pre~~nl/(Jn AP.lCP. /fJ( 1-1), 5733-5739. Retrieved &om 
http://w_.ncbi.nlm.nih.80v/pubmcdl26320444 
Mak-we. C . c.. Anotlu. R. I.. " Odeyemi. K. A. (2012). Human papillomavirus (HPV) in(<<tion 
and V&Cl;lIIes: Knowlcdp. auitude and perceplion amona femlle students at the Uni\lersity 
University of Ghana http://ugspace.ug.edu.gh
of up, t...aos. Nileria. JotJrnal of EpIdemiology ond vlohoJ Ht'Q/lh, 2(4), 199-206 
hnps:lldoi.or~101016{j.jegh.2012.11.0()l 
Manlula.F.,..t. Mwisonao. A.(2018) Uplakeofcerviealcaneerscreenmgamongwomenanendinc 
8provincw hospital in Zimbabwc. African JOllrna[oj M"JwJfot)'QndW~"', JktJ/I" 12(1), 
35-43.hnps:lldoi.orJlI0.12968/ajmw.2018.12.1.35 
Mboumbl B0U&H8. R.-S .• prazuck. T .• Lelhu, T .• len8bWt, M.-A .• Meye., J. • f., &. SC,", L. (2017). 
Cervical cancer in sub-Sah8rIn Afric8: 8 prevenlab~ noncommunicable disease. £xi¥rl 
uf Alfli./Ifj«tiw TMrapy, /5(6), 61)-627 
hltpS:/fdOl.orViIO. I08WI47S7210.2017. 1322902 
Mitiku, I .. A Td'cra, f. (2016). Knowledge about cervical cancer Mel associated factors amon, 
IS-49 year old women in dessie town., nonheast ethiopia. PLoS ONE, JI(9). 1-10 
htlps:lldoi.orWIO.137I1jownal.pone.OI63136 
Momenimovahcd, Z .• & Salehiniya, H. (20 17). Incidence, mortality and risk factors of cervical 
cancn in the ~orld. Bw~Jkal Rlwarr:h tmd l'Nrapy, 4(12). I79S. 
hUps:lldoICKr/IO.IS4191bmn&.v4iI2.186 
\.{ul..;!ma, T" NdejJo, R. Musabyimana. A. . lialagc, A. A., " Musoke, O. (2017). Women's 
know5cdSC and anitude) towards CCl'VKaI CilllCCf prevention: A cross sectional study in 
Easlem Upnda. 8.we Wm,,,"II's H~oJl", 17(1), 1-8. hnpt,;/ldoi.or"IO.Il~sI290S-017_ 
NAber, S. K. MatthiJssc. S. M., RO.lemcijer. K .• Pennin&. c." de Kok, I. M. C. M., Ii: van 
IblIcpJIJCfl. M. (2016). Cervl,,.1 l'~cr ScreeninG in Panly HPV VacciUlOd Cohorts _ A 
COit-Effectivcnest AMly\l\ PLOSO.v£ 11(1). 10145548 
https:lldou.M'g.101371 IJoumal.pone.OI45S48 
University of Ghana http://ugspace.ug.edu.gh
Nandar. <: S. Chompikul, 1. . & Laosec. O. (2015). DdemunAnh of cervieaJ cancer screening 
among migrants in thc Northern district ofVangon . Myanmar Journal 0/ fubHc Heal'" (md 
/In¥lop,,.ffI. /J(2), 17-31 . 
N:ni()nal StrategyforC;mccrControl in Ghao3. (2012.2016) 
hnp:llwww.iccpprutal.orglsileSldef.uJtlfileilplans/Cllncer-/.20Plan".20GhllNl%202012-
2016.pclf 
Ndcjjo. R .• Mul..ama, L ~Iu~byimana. A .• It. Musoke. D. (2016). Up'uc of Cervical Cancer 
Scrttning and Associated FU:lors among Womcn in Rural Uganda: A Cross Sectional Study. 
PIoSOnt,JJ(2),e0149696.httpt:J/doi.orgtlO.1371/joumal.ponc.OI49696 
Nwabichie. C. c.. Manaf. R. A., A. Ismail. S 8. (20U!,. factors Arrecting Uptake of Cervical 
Cancer Screenin& Among African Women In Klang Valley, MalaYSIII. Aslan Pacific 
Jownol ojCQlfttt' PrlWnllon . APJCP. 19(3), 825-831 . 
hnps:Jldl'loq;i IO.22034/APJCP.2018.19.3 .82S 
Oeht. M. 0 .• Kao~ A. U. . Gana. G., a: Ango, J. T. (201l). Cancer of the ce"·I)I. and cervical 
screemng: Current knowledge, attitude and praclices of female health workers in Sokolo. 
NI8«ia. /flurnol'uttQ/. JOtITnU/ Q/ .\,(~,J'CIIK und AHdicoJ Scf~nc~s, 5(4), 184-190. 
http$Jldoi.org/IO.S897/JJMMS201301HI6 
Oacmbo.R. K. • Oona, P. N. . Sc)mour,A. J .• Park, H.S.-M .. Bam. P. A. . Maranda. L,a: Ogembo, 
J. G. (2015). Prn.tence of Human PapillomlviruJ Genotypellmong African Women with 
NonnaJ Cervic:al C)1OIogy and Neopluia: A Systemal~ Re\IC:'oI. and Meta-Analysis. PLOS 
ON£.J0(4),c01224SS.hnpsildiJi.OlW IO. 1371 /joumal.pooc:.0122488 
Ombech I:Ju:.bc:th , Muigai Anne, W. P. (2012). Awarenes$ of cervical cancer risk (actO" and 
pt'3oI;tl" of Pap smear lc~ing amona female primary ~hoollClChen in Ka.sarant diVIsion. 
University of Ghana http://ugspace.ug.edu.gh
Nairobi Kenya Aft J Health Sc,., 21(2), 121-132. Retrie. ... ed from 
httpJlwww.aJh5joumal.or.keladmin/cwn:ntlartJcte4.pdf 
On5uz, M. F .• HMiiroglu, S., Sarioz. A .. Melinw. S., & Karavus. M. (2014). Knowledge. anitudes 
and beha .... iors of women over 20 years old on cervix cancer in Istanbul, Turkey. Asian PacifIC 
Jounwl 0/ rlllll«r prevention ' IIPJCP, 15(20). 8801-8807 Retrie .... ed from 
http://wwwncbl.nlm.OIh,go.,.tpubmcdl25374211 
Opoku. C . A .• Browne, E. N. L..Spangenbcrg, K .. Moyer, C., Kolbilla, D., &. Gold, K. J. (2016). 
Perception and risk (actors (or cervical Cllncer among women in nonhcm Ghana. Ghana 
Medlc(l/Journal,50(2),84.hnps:lldoi.OfglI0.4314/gmj.vSOi2.6 
Pathology, C. (2012). Cervical Cancer Screening Recommendations, 2012 Objcc:tives o( 
Scrcening. the american society (or colposcopy and cervical pathology. 
Sept. M. T., Demissie, H. F, Tade~se, O. M., Amdemlchllcl, R., Mamo, Y. T., &. WOfku, A. 
(2017). J...evel o( Knowledge and AS50Cialed Factor to\\ !lId Cervical Cancer amons Women 
AJC (21-64) Yean Visiting Health Facilities in Gulele SulKity Addis Ababa Ethiopia. JOP. 
JounttJI oft" Poncmu, 18(1), 44-48 
Sinsh. S., & Badaya. S. (2012). FaclOr~ Influencing uptake of Cervini Cancer Screening among 
Women in India: A Hospital hued Pilot Study. J()1Ir1Ull a/Community ,\kd;w~ &- HroJtlt 
£ducaliolt,(Januuy).https:lldoi·orwIO.4172J2161~0711.IOOOIS7 
Teame, H., Gebremariam. L. Kahsay, T .• Berhe. K .• Gebreheat. G., &. Gebremariam. G. (2019). 
Factors affecting utilization of cervical cancer screening services among women attending 
publ~ hospitals in Tigray I'!:Jion, Ethiopia, 2018; Case control study_ PLOS ONE, 14(3), 
e02I1S46.htips:lldoi.orgllO.1371Ijoumal.ponc.0213S46 
Torre, LA., Sicsel. R. L, W:mJ. L~ \L &. Jemal. A. (2016). Global Cancer IncIdence and 
69 
University of Ghana http://ugspace.ug.edu.gh
Monaht)' AMes and T~An Upd.ale CalfCer I:.j",HmlOJogy. BM/ff""t~rJ &- Prew nlion 
A PtlbJrculwn of IItt AlMrJcon Association fM Coneer Research. CosponsMl!d by IIw 
AmerictM 5«.1)1 0/ PrY!l'ellllW Ortcology. 15(1), 16-27. https:lldoi.c:qIIO.1l 58110SS-
996S.EPI·IS"()S7I 
UNFPA. (20 10) Prosrcu ~ lhJ llcn~c, \\\.mcn·~ Hcalth ... lJNFPA . u nrtc:d ~Jtion .. 
PotNIaliaRFund.pdr. Twkc), 
Urasa, M . &; Oat). E. (20 II). Knowledge of cCTVlcal cancer and !oCreenmg prucllcel o f nurses a' a 
regionJlbotpicaJinTanzania.IJ(l). 
VIC~11a, S .• lnmanne. M .. Ferlay. J. • lit Brny. F. (2017). Cervical cancer in Africa. Latin 
Amc:ria. and the Caribbc:u aDd As,-: Rcgional inequalities and changing trmds 
InltrnallOnalJownoJ o/( 'ancu , 141(IO) , 1997- 200I . httpS:lldoi .orgfIO. IOOV ijc.30901 
World Hc.JIh OrganlZallon )Cervical cancer. (2018). WHO. Retllcvc:d 
WHOIICO. (2001) Infonnahon Ccnb"c on HPV and Cervical Cancer (HPV Infonnalion 
Centre, Summal) repon on HPV and cervical cancer .tatislic~ In Ghani 
WiaJe. J .. ec.., E .• " Waban·Jones, D. (2013 ) Human papillomavirus (HPV) \llICCtne 
impkiMntahon In low and middle-income countries (LMICs): Heahh system experiences 
andprospecu. YGCClne'.J/(37},J811-3117. https:lldoi.orglIO. IOI6/j .vlICCine.2013 .06.016 
William. M . Kuffour.G., Ekuadzi. E .• Yeboah, M . EIDuah. M .. & Tuffour. P. (2014). Assessment 
orpsychokJllcal berrien to cervical cancer SCrttll1ng amon. women In Kumasi. Ghana USIn. 
• mixed mclhod~ appro.ch AfT/CUll Health .'k. I~n<·t'1. I J(4). 1054. 
https:J/dcK.or&lIO.4314/ahs.vIJI4.28 
WorkiIieahbOrpnlzalK'ln. (2016) . CanccrFact~et CerviWCanccr. WHO . WorIdHeol,1t 
University of Ghana http://ugspace.ug.edu.gh
(}rJ(cJ''':atiotr.,Sp.Rdr)evedfromhttp://aco·wc.frllod~y/dalalpdf)'ract. 
shecu. canc:nw'canur·rlloCt.sheeLS·16.pd~/.SCnhltpS:"8co. l an; . rrl1oday/rllCl·sh«ts.-
lib&. F . EMfToc. P .. Dapate. P .• Shittu. S., &. Antuamwinc. B. (lOIS). Awarenn~ and knowkd,e 
level of cervicaJ cancer llffiOrIi women of reproductive alt' in Bolg~langa mUniCipality 
Journal Q/.\kd/cal and B,omedKul ScieffC~$. 1(2), I. hl1ps:lldoi.Of&IIO 43 14/Jmbs v",.2 I 
71 
University of Ghana http://ugspace.ug.edu.gh
APPENDICES 
APPfo:NDLX A: PARTICIPANT I2"FORMATION SHEET .·UR PREGNANT WOMEN 
KDuwlcdge oreervi"1 CaReer aod uplake of Screening amoog Pregoul Women 
Aneodi.1 AalcnalaJ CIiDM: al Uo Muoicipal Hospital, Volta Regioo, (;hana. 
I am Miss Glfty Dravic. a Maters of Public Heailh student of the University of Ghana. l.e80n. 
School of Publk He.tth. I am. \\cda:nd student 
Mobile number' ~ 233 246529206 
Bad'l;roulM! 
I am conducting a raearch on the tOPIC Knowledge of c:ervlc:al cancer and uptake ofscreoeni8C 
al8Oll& pretDa.t women .tteDdingaolenalal clinic at Ho Munidpal Hospital in an UteSlmC1lt 
IOlnformthc:lc\clofknO\~Ic:dgeofcervic.I.;: .. ",crand~rttrllnguptakc.Pletictake_tirne 
to read the inrunnatlon pro\'lded here, which ..... 11 explain the details of this project. Pleue uk the 
rc5earcher any question about any part of this project that you do not full> undcntand. his\'cry 
Importanllhlt)OUllfefullysarislicdthal)'ouc:learlyWlderslandwhatthisre~chenlailsandhow 
yl1ucan be inYOlwd. 
"atureofresearcb: nm research alms at acccs5inithe levcl ofkno. ... ledge on cervical cancer 
iIOd uptakc of screcmng among prcgruUlt ..... omen attending antcNltal clinic at the lIo MUOIclpal 
Hospital, Votta Rcaion, Ghana. Jt is PUfllOSed towards knowing the proponion of pregnant women 
ha\'lnl adequate knowledge on cervi~al cancer and has undergone screening and \0 work OUI 
possibLe rcwmmendations. Thii researeh ""ill in'<'olve 30S preananI women aced ISycms and 
.bo.l\c. .... hoov,cwillingtopani~lp .. lc volunlafll> 
Duratton .ad what is involved: I will be administering questionnaires 10 you to p&hcr 
Information on knu\\lcd&c ofccrvical canc:cr and uptU.eorlCrccOing in HoMunkip&lHospital. 
Volu Region, and tihan.t Cl)mpleting this qunltonnairc will take "bout 3Omlnutes. You will be 
rl:\luln:dtotlncJr.lhcm~tapproprtatercsponseto1hcqueSltolUiasJr.cd 
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Potential Risks: This study wiU pose minimal risk 10 you.. This mainly will be the discomfon )OU 
mayencountcflOansweringsomeofthequeslionsandtimespent 
Beoefits: You will not benefit dife(:tly from this study. but the answen you p,m'ide will be used 
10 inform poliq for the Unprovement in cervical Canl:et knowkdae and screenina among pregnalll 
Coal: n.crc is no diro:t cost 10 be Incurred in this ~tudy . Uowever, the time spent "ould be \'cry 
mU(hJpprecilkd 
COnl(M!Ollatioo: There would be no compensation forpaniclpatlOn in the study. 
Coefldeatiality aDd Anonymity: Whatever)oo say would be treated as strictly confidential and 
would be u:ted onl) for the purpose of th,~ rCKan:h. Your nunc would not be wrinen on the 
questionnaire nor used In any publication and no one would be able 10 tnKe back 10 you whateyu 
)OU said. However. lhIdy codes or nwnbers will be allocated to you 
Vol_Diary participatia. I wl~drawal: Your participation is 10UlII), voluntary. and you can at 
any point withdraw your parliclpatlon Declinina 10 be involved will in no way affect you 
nq,aUvdy. You also havc thc libert)' to "Ithdraw from the stlJdy at any point cvcn afteralfCCina 
lOpu1icipeae. Vou will be requircd 10 endotse or thumb prinl a wrictcncoment (orm. Vourdecision 
wiD be duly mpected. 
Outcome 8Rd feedback: Data collected will be processed, analyzed and the reaults will be used 
to ,upp. .. rt other rt;'>('Jr~h works \\ohlCh will intern innuence policin on cCfVical CUICCf. No direct 
fccdbackwillbcglvetllOYOU. 
Fuodiog iafono.tioo: Thisresc,,,.h i~ IOlely funded by the principal in\"e,llgatur 
SII.ri.lof.,.rtici.,.ac,.'.fortnalio./cbla:Onlytheplincipal In,-estigatorand , upeT\lI5Orwili 
hJ\eaccculOltK:infonnationyoupro\lide.AlIinfonnationcollectcdwlllbelockcdancablncts 
aOO \\oould be destroyed after 5 years 
ProvisiH ofinfurmillion aDd consul: -\ cOP) oflhc mfonnation sheet and consent form will be 
&I\c:nto)ouaftcr"twbeensicned,.rlhumb·priniCdIOkccp 
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11W. roearch has been reviewed and appro\ed by lhc Ghana Ht.lth Service Ethks Review Board 
(GHSERC) FOf further questions COfICemm, this research you may OOIlUlcl: Gifty Dravic 
(princ:'p.al JnVCSllgalOf) on +233 246529206 or via email: 4""'JShienUOil!ll@gIDI.Jcom or DR. 
Ot.aah Dwomoh (Wpervisor) SPH, UG on +233 207861179. For funher c!atif.UJion on cthtcal 
issues and )our riPI in per)()n. you may contact Ms. Hannah Frimpong. QHS ERe Admmilll'lllGr 
00+233243235221 or+2J.l 057 04122.l 
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Af'PE~DlX U: CONSENT FORM fOR I'REGNANT WOMEN 
KaoM'iedge of Cervical CaHer aDd _Plake of Screeoiog amoog Prqaant WomeD 
Attending Antenatal Clinic al 80 Mlloicipal Hospital. Voila Region, Ghana, 
I ac.kno~·kdge that I MoVC read or Mo ... c had the purpose and contents of me Participants' 
In(ormationShecl re&dand aU questioru ulIs(actl>rllyexplained 10 me in a lanauaae I undentand 
(Enilish a /Ewe 0 ([wi 0). I fully understand thc conlents and any potential implication$ a$ well 
as my right 10 change my mind (i.e. withdraw from the research) even after I ha\lc Signed this form. 
I voluowilyagree to be part ofthi!> research. 
InitiabofPartlclp3nl 
Participants'Si£,natw"c 
INTERPRETERS' STATEMENT 
lintcT]x'e1.edthepurpo~andcontentsoflhc: "anlclpallts'lnformationShecllolheaforenamed 
panlClpam 10 the best of my ability in the ( 'Ewe a lTwi 0 ) language 10 her proper undemanding. 
All qUC$tlOr\J, appropriate clarifiwions sort by the participant Inu answer!> Wft'C also duly 
ilUCtprCte<itohersatisfactlon. 
Name of Interprcter , 
SicnaturcoflnkTJIf't1cr 
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STATEMENT Of WITNESS 
I w.uprnelllwhenlhepurposeVKIcontcnLSoflhc Particip&nl'slnfonnallOn Sh«1 was fe,id and 
explained s.at1sfactorily to the paltkipant In the language she understood (Ewe 0 f Twi 0) 
I confirm dlat helshe was gl\cn the opportunity coasr. questionYscdc.c1arilicaclons and same wcn: 
dulyalUwered10 hislhersatis(aCllonbe(orevoluntarIly agreeing 10 be pan of the n:scareh. 
ORThumbPrint ... 
Dale: .. 
1.thr:Wlde~lgncd . hneexplainedthecoruentformtolhcsubJcel$hctw.unders\OOdlhepurpose 
oflhc)ludy. procedures and risks and benefits. ThesubJccthasfreelyagfn"<ilopanlcipalcinthc 
....y . 
SisnanueofR~hc:r 
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APPENDlX C: Ql ESTlONNAlRE 
Knowled~e of Cervical Canter and Awareae5S of Screening and its Upta ke among 
Prego8.t Women Attendiog Auten.tal Cliole 8t the AD Municipal Hospital 
Intervu:: .... er·sName: _______  
lnlerviewdatc(ddimmlyyyy):_ ' __ 12019 
Participanl' sID: ___  
A. Socio·Demngral'blcCbaraderistia 
1. How old arc you? (age allast birthday) _ ___  
2. Whatisyourdateofbirth?(ddlmmlyy) __ 
3. Whalis yourethnicity1 
I. Krobo 0 1. Akan J . GalDangbe 5 Northern elhnicity ~ 6 . 
I_ify_ __- ---' 
4 . Whatis~urreligiou).ffiliatlOn·) 
1. Christian 0 2. Islam :: 3. Traditional C 4 . None [: 5. Others (specify _ _ _ 
S. Whalisthehighestformaleducationlevelyouhavccompleted? 
O. None ~ I.Primary C: 2. lunior SecoooarylMiddle School : 3.Secondary 
4. Technical or Commercial :':: S.TertiarylTraining College ~ 
6. wtw is the main thini you do for a livini? 
O. Uncmplo)cd L Fanning :~ 1. Fishing ~) J. Trader C 4. lAborer I S. Salaried C Worker b 
7. Other(Specify_ _ _ _ _- -> 
7. On a\'mgc what is your monthly income 
1. $200 GIK 2. 201-400 (iliC 3. 401-600 l GHC .. . 601-800 c: GHC 5. >800GHC ::: 
l Whalis)"urmarltaistat",'> 
I . Sin&Ie '; Z, Marrjcd :: J.Co-habitlng 4. 0ivorced :-: S.WKlowcd i. 
9. How many children do you ha\lc" ____  
IO.lncludingthlsonc.ho'o\ manyllmesbaveyoubcingprcgnant'! __ 
University of Ghana http://ugspace.ug.edu.gh
'I AtwhilaaediclyouMvefU'Stpreanancy"' _____  
StOlON R. A Wd,BENESS Of qt:RVlCA.1 CANCER 
12.H.veyouc\"crheardofurvicalcucer? I. Yes02.NoC 
13.I(YEStoqucstionll,howdidyoufinlthevofit? ___  
UNO 10 qUe'St'- II. diKo.ti ..e  ialenlew 
StTTION C KNOWLEPGE ON C\USFS AND SIGNS ANn SYMPTONS OF CERVICAl 
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~.:CTI()N D. KNOWLF.J)(;t: ON RISK FACTORS AND PRfVENTION 
~ ... r"":=-::":r_ 
I Orce"jaccerviulca.cr~.~care 
iaterestediayouroplDlOD 
241-1. . ,;n,. ...- ""'~ 2S. H.vin, • penner who has multiPle 26. Smokmil\ 
27 . EarI)"onsdofse~u.IKtlvity t~~ ~ 
1I. Uwofonlcontr.ceptivesforalonl 
period of time 
29. lnftcltOn-w""ab:;:--"H""PV"".".-...+ --
·TbriOJlOWID&~\"e. ·~· 
o(cervkaJcuur.U. ..u c.duyo. 
~'«n::;~f~:::7~:c.nccr 
31 . Pap sme., Int it. sC·rce=C~n'=n-:-:'Ie-=~""O+-­
helpptnentcervicaltancer 
32. Veccuwina ...... ttum.n -
j2IpiJJom.a\lirusafterKr«n" 
14. V.cciNlinC·ll prlsof •• 91015 T 
)<an 
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SEcnON IE. UPl'AKE or CERVICAL CANCER SCR.EENING 
35 Ha •• you had OD)'--..-ing In the IuIdneyeus? I. Va02. 1'100 
36 Thofiillowlll8 .......... _tbaloouIdlnflucn. .....l caI __n lnauptakc 
Statemoll 
Not having 9Uppon: from 
husband 
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APPESDlX 0: CLEARANCE LETTER 
... ...,. .... Wpt"''''' ..l kkn''I ...' .nl.~'''t''''.'''.Jlr. . I ....· ..•  .. • ..., ..,_.''''.''. ... 1.o1 ...... dI ... .ppro. . odprolOCot 
"O"LO>~ •. • . _ 
DR.. CYNTHIA BANNHlUdAN 
(O~~RC CHAIRPtDtlON, 
('( 1 .... 1), __ ."-doA~IOt ......... ONMI ...l 'IIttSe"' ... "-
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