FACTORS ASSOCIATED WITH CERVICAL CANCER SCREENING. A CASE STUDY OF MUKONO MUNICIPALITY BY BYARUHANGA CHRIS BPS (Mak) A DISSERTATION SUBMITTED TO THE DIRECTORATE OF RESEARCH AND GRADUATE TRAINING IN PARTIAL FULLFILMENT OF THE REQUIREMENTS FOR THE AWARD OF DEGREE OF MASTER OF SCIENCE IN POPULATION AND REPRODUCTIVE HEALTH OF MAKERERE UNIVERSITY JANUARY, 2018 i ii Dedication This research work is dedicated to my wife, Agatha Byaruhanga, Mr. and Mrs. Kiconco K Patrick, Mr. and Mrs.Bakiga Goddie Willy, my entire family, School of Statistics and Planning, Makerere University, Mukono District Health Officer (DHO), Misinde Cyprian (PhD), Asiimwe JohnBosco (PhD), Dr. Godwin Turyasingura, John Mushomi (PhD), Ven. Can. Enos Kagodo, Ven. Can. George William Kittyo, Rev. Wilson Senkanga, Rev. Daniel Balabyekubo, Rev. Merab and Rt. Rev James William Ssebagala of Mukono Diocese for their physical and spiritual support towards my academics at Makerere University. May God be gracious to you, make His face shine on you and bless you (Psalms 67:1-2). iii Acknowledgement Enormous thanks go to Almighty God and His Son Jesus Christ for good health and wisdom that enabled me to produce this work. I thank my supervisors Asiimwe JohnBosco (PhD), Dr. Godwin Turyasingura and all my lecturers who were more than generous with their expertise required for proposal development, data collection and writing of this dissertation. I would like to acknowledge and thank Ass. Prof. Robert Wamala, Misinde Cyprian (PhD)-the head of population studies, School of Statistics and Planning for granting me the approval to conduct this research. I appreciate Kiconco K. Patrick, Barbra Bakiga, Claire, Kenneth, Graham, Pearl, Alex, Maama Asiimwe, Rt. Rev. James William SSebagala, and Ven. Can. Rev. George W. Kityo, Rev. Wilson Senkanga, Rev. Daniel Balabyekubo, Rev. Merab, and Ven. Enos Kitto Kagodo for their physical, spiritual and emotional support. I also wish to thank my research assistants; Allan, Douglas, Sam, and Joseph who collected the data for this dissertation, and I wish to acknowledge and thank all the females who participated in this study. Their willingness to respond to the research made the completion of this research an enjoyable experience. Finally, I extend special thanks to all my student colleagues especially; Richard Imarkit, Stephen Eduru, Evelyn, Diana, William, Jonas, Fred, Peace, Liz, Daisy, Victoria Nabbona, and Amex for their overwhelming assistance and encouragement in the academia. iv Table of Content Declaration ............................................................................................... Error! Bookmark not defined. Approval .................................................................................................. Error! Bookmark not defined. Dedication .............................................................................................................................................. iii Acknowledgement ................................................................................................................................. iv List of Acronyms .................................................................................................................................. vii ABSTRACT ......................................................................................................................................... viii CHAPTER ONE: INTRODUCTION ..................................................................................................... 1 1.0 Background ................................................................................................................................... 1 1.1 Problem statement ......................................................................................................................... 2 1.3 Objective of the study ................................................................................................................... 2 1.5 Conceptual frame work ................................................................................................................. 4 1.6 Structure of the dissertation .......................................................................................................... 6 1.7 Scope of the study ......................................................................................................................... 6 1.8 Operational Definitions ................................................................................................................. 6 CHAPTER TWO: LITERATURE REVIEW ......................................................................................... 7 2.0 Overview of cervical cancer screening ......................................................................................... 7 2.1 The literature related to the study.................................................................................................. 7 CHAPTER THREE: METHODOLOGY ............................................................................................. 10 3.0 Introduction ................................................................................................................................. 10 3.4 Data collection techniques and tools ........................................................................................... 11 3.5 Data management and analysis ................................................................................................... 12 3.6 Ethical considerations ................................................................................................................. 13 CHAPTER FOUR: STUDY FINDINGS .............................................................................................. 14 4.0 Introduction ................................................................................................................................. 14 4.1 The narrative form of the univariate analysis results .................................................................. 14 4.2 Socio-economic, demographic factors with HPV screeninguptake ............................................ 18 4.3 Factors associated with cervical cancer screening uptake .......................................................... 21 4.4 Discussion of findings of study based on predictors in the final model...................................... 22 CHAPTER FIVE: SUMMARY OF THE FINDINGS, CONCLUSIONS AND RECOMMENDATIONS ...................................................................................................................... 27 5.0 Introduction ................................................................................................................................. 27 5.1 Summary of the findings ............................................................................................................. 27 5.2 Conclusion .................................................................................................................................. 27 5.3 Recommendations ....................................................................................................................... 28 v LIST OF TABLES TABLE 4.1: DESCRIPTIVE ANALYSIS OF SOCIO -ECONOMIC , DEMOGRAPHIC AND OTHER FACTORS ...... 15 TABLE 4.3. A BINARY LOGISTIC REGRESSION (BLRM) TO DETERMINE PREDICATORS ....................... 21 LIST OF FIGURES FIGURE 1: CONCEPTUAL FRAME WORK ................................................................................................... 5 FIGURE 4.1: BAR GRAPH PRESENTING BARRIERS TO ............................................................................. 17 LIST OF APPEDICES APPENDIX 1: CERVICAL CANCER SCREENING STUDY HOUSEHOLD TOOL , 2016 ............................... 32 APPENDEX 2: DECLARATION OF ORIGINALITY FORM ....................................................................... 40 APPENDIX 3: RESEARCHER ’S STATEMENT ......................................................................................... 41 APPENDIX 4: INTRODUCTION LETTER ................................................................................................ 42 APPENDEX 5: A MAP OF MUKONO DISTRICT .................................................................................... 43 vi List of Acronyms ACCP Cervical Cancer Prevention for Africa ANC Antenatal Care AORs Adjusted Odds Ratios ASPIRE Advances in Screening and Prevention in Reproductive Health BCC Behavioural Change Communication DHO District Health Office HIV/AIDS Human Immune Virus/Acquired Immune deficiency syndrome HPV Human Papilloma Virus IARC International Agency for Research on Cancer ICC Cervical Cancer Incidence ICO Information Centre on HPV IEC Information Education Communication KNBS Kenya National Bureau of Statistics BLRM Binary Logistic Regression Model MTRH Moi Teaching and Referral Hospital NCBI National Center for Biotechnology Information NGOs Non-Governmental Organizations PNC Post Natal Care UBOS Uganda Bureau of Statistics USA United States of America W.H.O World Health Organization PAP Papanicolaou test AFS Age at First Sexual intercourse AFM Age at First Marriage vii ABSTRACT The main objective of the study was to assess the factors associated with knowledge and attitudes towards cervical cancer screening that could influence females to undertake cervical cancer screening. Cross-sectional descriptive study of 384 women aged 15-49 was done using an interviewer- administered questionnaire. At bivariate level of analysis, chi-square tests were used and logistic regression analysis was performed