Challenges and opportunities in cervical cancer screening: Insights from Enugu, Southeast Nigeria

Introduction: The uptake of cervical cancer screening among women in Enugu has remained low. The objective of this study was to determine the awareness and uptake of cervical cancer screening and the factors affecting cervical cancer screening in Enugu metropolis. Methods: A multi-centre, cross-sectional analytical study was conducted over six months (from October 2020 to March 2021) in Enugu metropolis among 240 sexually active women aged 25 to 65 years from five health facilities in Enugu Metropolis using interviewer-administered questionnaire for data collection. A multi-stage sampling technique was used to select the health facilities. Ethical approval was obtained from the Enugu State University Teaching Hospital Ethical Research Committee with approval number ESUTHP/C-MAC/RA/034/VOL.1/248. Data were analysed using IBM-SPSS version 25 and a p-value < 0.05 at 95% confidence interval considered statistically significant. Results: Only 93(39.4%) were aware of cervical cancer screening while only 9.7% had ever had any form of cervical cancer screening. Awareness of cervical cancer screening was significantly lower among those with primary (OR 0.10, 95% CI 0.02 to 0.46) and secondary (OR 0.25, 95%CI: 0.12 to 0.54) education compared to those with tertiary education. Middle-class women had higher odds of awareness than those in the lower class (OR 2.38, 95% CI: 0.86-6.58), while upper-class women were ten times more likely to be aware (OR 10.41, 95%CI: 2.72 to 39.78). Participants in the upper social class were about 7.5 times more likely to have undergone cervical cancer screening compared to those from the lower social class (OR 7.53, 95% CI: 1.82-3.49). Lack of awareness (58.7%) and not knowing where to access screening (21.1%) were the primary barriers to screening. Conclusion: Both the awareness and uptake of cervical cancer screening were low among women in Enugu metropolis. Education and social class significantly influenced cervical cancer screening awareness.