Factors Associated with Uptake of Visual Inspection with Acetic Acid (VIA) for Cervical Cancer Screening in Western Kenya.
OBJECTIVE
Cervical cancer screening has been successful in reducing the rates of cervical cancer in developed countries, but this disease remains the leading cause of cancer deaths among women in sub-Saharan Africa. We sought to understand factors associated with limited uptake of screening services in our cervical cancer-screening program in Western Kenya.


METHODS
Using items from a previously validated cancer awareness questionnaire repurposed for use in cervical cancer and culturally adapted for use in Kenya, we interviewed 2,505 women aged 18-55 years receiving care in gynecology clinics or seeking other services in 4 health facilities in Western Kenya between April 2014 and September 2014. We used logistic regression modeling to assess factors associated with uptake (or non-uptake), associated odds ratios (ORs) and the 95% confidence intervals (95% CI).


RESULTS
Only two hundred and seventy-three women out of 2505 (11%) accepted VIA cervical cancer screening. Knowledge of just how women are screened for cervical cancer was significantly associated with reduced uptake of cervical cancer screening (OR: 0.53; CI 0.38-0.73) as was fear that screening would reveal a cancer (OR 0.70; CI 0.63-0.77), and reliance on prayer with the onset of illness (OR 0.43; CI 0.26-0.71). Participants who thought that one should get cervical cancer screening even if there were no symptoms were more than twice as likely to accept cervical cancer screening (OR 2.21; 95% CI 1.24-3.93). Older patients, patients living with HIV and women who do not know if bleeding immediately after sex might be a sign of cervical cancer were also more likely to accept screening (OR 1.03, CI 1.02-1.04; OR 1.78, CI 1.01-3.14; OR 2.39, CI 1.31-4.39, respectively).


CONCLUSIONS
In our population, a high percent of women knew that it is appropriate for all women to get cervical cancer screening, but only a small proportion of women actually got screening. There may be an opportunity to design educational materials for this population that will not only encourage participation in cervical cancer screening but also remediate misconceptions. The discussion illustrates how our findings could be used in such an effort.
Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.|Department of Reproductive Health, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya.
Elkanah Omenge
EO
Orang'o
Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.
Juddy
J
Wachira
Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.|Department of Medicine, School of Medicine, Indiana University, Indianapolis, United States of America.|Regenstrief Institute, Inc. Indianapolis, United States of America.
Fredrick Chite
FC
Asirwa
Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.|Department of Pharmacology/Oncology, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya.
Naftali
N
Busakhala
Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.|Department of Behavioral Sciences, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya.
Violet
V
Naanyu
Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.
Job
J
Kisuya
Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.
Grieven
G
Otieno
Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.
Alfred
A
Keter
Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.|Department of Behavioral Sciences, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya.
Ann
A
Mwangi
Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.|Department of Medicine, School of Medicine, Indiana University, Indianapolis, United States of America.|Regenstrief Institute, Inc. Indianapolis, United States of America.
Thomas
T
Inui
D019342:Acetic Acid / Q000737:chemistry; D000293:Adolescent; D000328:Adult; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005239:Fear / Q000523:psychology; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007630:Kenya; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D010353:Patient Education as Topic; D011287:Prejudice / Q000523:psychology; D011446:Prospective Studies; D012067:Religion; D012923:Social Class; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000473:pathology; D014626:Vaginal Smears / Q000379:methods / Q000706:statistics & numerical data*
D019342:Acetic Acid