الفهرس 
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Abstract
Cervical cancer is a major public health problem throughout the world. It is considered one of the leading cancers deaths among women, especially in developing and underdeveloped countries. Prevention and control are the most important public health strategies empowerment of women, education, earlier screening (by VIA and Pap smear) and treatment of pre cancers are the most promising interventions to reduce the burden of cervical cancer. The intensification of preventive, screening and therapeutic measures starting by educating the population on these aspects which can bring the disease under control as it is in the developed countries.
Nurses can provide health promotion counselling to the women they serve in their day-to-day practice. They can fulfil a key role in health promotion and disease prevention.
Aim of the present study was:
Assess women’s knowledge, attitude and practice regarding cervical cancer screening in Mbeya Tanzania.
To fulfil the study aim:
A descriptive exploratory research design was used. It was conducted in seven selected health facilities representing Mbeya region. A convenience sample of 420 women attending the previously mentioned setting was enrolled (60 women from each hospital). The inclusion criteria included: age from 20 - 49 years.
Tools used in the study
Four tools were developed and used by researcher, to collect the necessary data. Tool 1: Socio-demographic characteristics and clinical data structured interview schedule, which entitled six parts: socio demographic characteristics, medical history, menstrual history, reproductive history, family planning, gynecology history, and sexual history. Tool ll:Women’s knowledge about cervical cancer structured interview. Tool lll:Assessment of attitude regarding cervical cancer screening. Tool lV: Cervical Cancer Screening practice interview questionnaire.
A pilot study was carried out on 42 women (excluded from the study subjects) to test the feasibility of the study as well as to ascertain the clarity and applicability of the tools in addition to calculate the time needed to complete them.
Data was collected from women attending ante natal clinic, family planning clinics, postnatal care clinics, and gynecological clinics.
Data was collected over the period of three months started from end September to end of December 2021, 4 days per week from 9am to 2 pm were specified for data collection.
Data was collected from women through an interview schedule, which was conducted individually and in total privacy.
After completion of data collection, women’s knowledge, attitude, and practice regarding cervical screening were identified.
Analysis of data carried out by researcher, the collected data were categorized, coded, computerized, tabulated and analysed using statistical package for social science (SPSS) version 20program. The following statistical measures were used: Simple frequency tables and Pearson correlation coefficient test was used to compare the significant differences of frequencies for categorical data. The level of significant used is P≤0.05
The main findings of the present study were:
Sociodemographic characteristics:
• It was noticed that more than two fifths (42.86%) of the study participants aged from 20 to 30 years, while 36.43% of them aged from 30 -40 years
• More than two fifths (41.90%) of the study participants completed primary level of education, while 26.67% had secondary education
• It was observed that more than two thirds (67.62%) of the study participants were married
• More than half (52.86%) of the study participants were not working
• It was noticed that more than half (53.38%) of the participants were urban dwellers.
Medical history
• Less than one fifths (14.76%) of the study participants had medical diseases
• More than half (53.23%) of them were having hypertension
• Only 4.52% were smoking cigarettes.
Menstrual history:
• More than three quarters (76.90%) had their menarche at the age between 12 and 16 years and 15.24% had their menarche at age of more than 16 years.
• More than two thirds (69.05%) had regular rhythm of menstruation while having irregular were only 30.95%.
• Interval of menstruations, ranged between 28 to 30 days was observed among two thirds (66.67%).
• More than two thirds (72.86%) of study participants had their menstrual flow ranged from 1 to 4days.
• More than four fifths (81.43%) of the participant had moderate amount of menstrual flow while scant amount of menstrual flow were (11.67%)
• More than two thirds (68.10%) of study participants didn’t feel any pain during menstruation.
• Majority (96.73%) of study participants were not in menopause while only 3.33% reached menopause.
Reproductive history
• It was noticed that more than quarter (29.52%) of study participants was married at the age between 21 to 25 years old, moreover 36.43% of them got their first pregnancy at the age between 26-30 years. And 36.67% of them had three or more pregnancies.
• Almost one thirds 33.16% of participants had three or more living children compared to 15.70% of them who have no any living child.
• More than three quarters (76.96%) of the study participants had no history of abortions.
• Only 34.18% of the interviewed participant had three or more deliveries.
• In addition, 90.89% of studied participant never had still births, while only 6.83% of them got one stillbirth.
• More than three quarter (76.71%) had vaginal delivery compared to 23.29% of them who had cesarean sections.
• A minority (4.56%) of them reported that, they got complications during pregnancy. 38.89% of them got preeclampsia/eclampsia.
• Furthermore, 7.34% of study participants got complications during delivery and 55.17% of them had fetal distress.
Family planning history
• It was clear that, more than two third (70%) of study participants used family planning methods before, while less than one third (30%) of them did not use any family planning method previously.
• It was noticed that about less than three quarter (73.13%) of the study participants used the method for one to four years and 12.58% of them used it for less than one year.
• During the time of data collection more than two fifths (44.76%) of women were on family planning, while more than half (55.24%) of study participants were not using any contraceptive method.
• Injectable was the main contraceptive method used by more than quarter (28.92%) of study participants followed by oral contraceptive pills 24.83%.
Gynecology history:
• More than four firths (86.67%) of the study participants didn’t have any gynecological condition.
• More than three quarters (76.79%) reported had fibroids.
• Only 5.24% of them had gynecological operations and 45.45% of them were operated 1 to 5 years ago. Moreover, more than three fifths (63.64%) of study participants had laparotomy for fibroid.
• A minority (7.85%) had vaginal infection, more than one third (39.39%) of them reported to have genital warts.
• Only 7.10% had a family history of cervical cancer however 63.33% of them the history was from their mothers.
Sexual history:
• Less than two thirds (65.24%) of study participants, had their first sexual intercourse at the age between 15 to 20 years. Furthermore, the majority (90.71%) of them had 1 to 5 sexual partners.
• Only 9.76% had reported bleeding during sexual intercourse and only 17.07% attended the hospital following the complaint. On the other hand, 14.52% of them had pain during sexual intercourse but almost one fifth (19.67%) of them had reported it to the hospital.
Study participant total score of knowledge regarding cervical cancer
• It was clear that more than two fifths (42.90%) of study participants had satisfactory knowledge about cervical cancer while more than half (57.10%) of them, their knowledge was unsatisfactory.
Study participant attitude regarding cervical cancer screening
• Positive attitude regarding the periodic screening for cervical cancer were found among 59.8% of study participants while two fifths (40%) of them had neutral attitude and only 0.20% of the study participants had negative attitude
• A significant association was found between the women total score of knowledge and their total score of attitude toward periodic screening of cervical cancer. (P=0.011)
Study participants practice of cervical cancer screening
• About two thirds (66.20%) of study participants never screen for cervical cancer while more than one thirds (33.80%) of them had screen for cervical cancer.
Recommendation:
• Establishing a screening recommendations guidelinewhich should be distributed at all hospitals and health centers.
• Free Campaigns to encourage women to regularly undergo these examinations as recommended.
• Increase awareness through mass media and disseminations of heath knowledge through posters and photos booklets as educational campaigns directed to the women with no symptoms at reproductive age.
• Vaccination against HPV should be disseminated among young girls and adolescents.
• Further research is needed to:
- Assess the perceived barriers to practice screening among women in Tanzania.