title: Low uptake of Pap smear testing among medical clinic attendees in a tertiary care hospital in Sri Lanka.
abstract: BACKGROUND
  The Papanicolaou (Pap) smear test is a safe and effective screening test for pre-invasive cervical cancer. The test is offered free of charge through well-woman clinics in Sri Lanka, but previous studies have shown poor awareness and uptake.
  
  
  METHODS
  We used an interviewer administered validated questionnaire to conduct a cross sectional survey among ever-married women between the ages of 25 and 65 years attending a medical clinic at the National Hospital of Sri Lanka. We obtained data on socio-demographic characteristics, awareness/knowledge and uptake status of Pap smear testing.
  
  
  RESULTS
  A total of 188/280 eligible women were interviewed (67.1%). Participant ages ranged from 29-65 years. Awareness about Pap smear testing was found in 111 (59.0%) women of whom 41 (36.9%) did not know that the Pap smear was used to detect pre-cancerous lesions. Only 34 (18.1%) subjects had ever had a Pap smear taken. Univariate associations related to Pap smear uptake were: prior awareness of the test (p<0.001), higher parity (p=0.022), and knowing someone with cervical carcinoma (p<0.001). Multivariate regression analysis confirmed the same as independent associations of test uptake (p<0.001, p=0.012, p=0.013 respectively).
  
  
  CONCLUSIONS
  Knowledge regarding Pap smear testing was poor. Pap smear uptake was very low, and did not parallel prior knowledge, although knowledge did influence uptake. Parity and contact with patients with cervical cancer correlated with uptake. There is an urgent need to increase uptake through a multi-pronged campaign.
authors.affiliation: University Medical Unit, National Hospital of Sri Lanka, Regent Street, Colombo 08, Sri Lanka mcs627@gmail.com.
authors.forename: Mitrakrishnan C
authors.initials: MC
authors.lastname: Shivanthan
authors.affiliation: Health Education Bureau, Colombo, Sri Lanka.
authors.forename: Komakal
authors.initials: K
authors.lastname: Arunakiri
authors.affiliation: Medical Officer of Health Unit, Boralesgamuwa, Sri Lanka.
authors.forename: Sumudu I
authors.initials: SI
authors.lastname: Wickramasinghe
authors.affiliation: Department of Family Medicine, Faculty of Medicine, Ragama, Sri Lanka.
authors.forename: Rukshala D N
authors.initials: RD
authors.lastname: Sumanasekera
authors.affiliation: Department of Clinical Medicine, Faculty of Medicine, Colombo, Sri Lanka.
authors.forename: Saroj
authors.initials: S
authors.lastname: Jayasinghe
authors.affiliation: Department of Clinical Medicine, Faculty of Medicine, Colombo, Sri Lanka.
authors.forename: Senaka
authors.initials: S
authors.lastname: Rajapakse
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008403:Mass Screening / Q000706:statistics & numerical data; D008875:Middle Aged; D065006:Papanicolaou Test / Q000706:statistics & numerical data*; D013188:Sri Lanka; D011795:Surveys and Questionnaires; D062606:Tertiary Care Centers / Q000706:statistics & numerical data*; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control*; D014626:Vaginal Smears / Q000706:statistics & numerical data*
keywords: Awareness; Cervical cancer; Cervical smear; Pap smear; Screening; Sri Lanka