SOCIAL DETERMINANTS OF HEALTH AND UPTAKE OF CERVICAL CANCER PREVENTIVE SERVICES AMONG WOMEN IN ABAKALIKI LOCAL GOVERNMENT AREA, EBONYI STATE

Abstract

Social Determinants of Health (SDH) are conditions in which people are born, grow, live, work and age and which affects their health outcomes. Cervical cancer is the leading cause of cancer mortality among women in developing countries and Nigeria has a mortality rate of 22.9 deaths per 100,000. Although a lot of research has been conducted on uptake of cervical cancer preventive services, not much has been documented on the association between SDH and cervical cancer preventive services in Nigeria. Proper documentation would guide policy formulation and implementation of these services. Hence, this study was designed to investigate the association between SDH and uptake of cervical cancer preventive services among women in Abakaliki Local Government Area, Ebonyi State. ln a cross-sectional study, three-stage sampling technique was used to randomly select 1 woman each from 400 of l 093 women, 3 of 20 wards and 12 of 23 settlements in Abakaliki Local Government Area. Respondents were interviewed using a pretested, semi-structured questionnaire containing information on socio-demographic characteristics, SDH such as income, employment, education and health access), knowledge of cervical cancer prevention, utilisation of the Papanicolaou (Pap) smear and HPV vaccine. Knowledge was assessed using a 17 point scale. Scores greater than or equal to 9 points were categorized as good knowledge. Uptake of cervical cancer preventive services was defined as utilization of Pap smear and Human Papilloma Virus (HPV) vaccine at any time in the past. Health access was assessed on the domains of ease of transportation to health facility. Data were analyzed using descriptive statistics and logistic regression at 5% level of significance. Age of respondents was 29.0±9.0 years. 76% had at least secondary education and 80.0% were in monogamous family setting. Sixty two percent were employed and 70% earned less than the minimum wage of N18, 000. Seventy two percent of the respondents could not pay for HPV vaccine of WI 8,000 but 88% were willing to take the vaccine if provided free. Eighty nine percent could pay for a Pap test of N3,500. Also, 89.0% were willing to take the test if provided for free. Knowledge score was 5.6±3.2 with I 0.7% having good knowledge of cervical cancer prevention. Only 37.0% and 3.0% had ever had Pap test and HPV vaccine respectively. Respondents aged 15-24 years were less likely to receive HPV vaccine (OR=0.2, CI=0.04-0.81 ). Respondents who were employed were more likely to have good knowledge (OR=2.3, CI=l.08- 5.06). Respondents who had personal vehicles were about 4 times more likely to have Pap test (OR=J.6. CI=l.11-11.52). Respondents who earned less than the minimum wage were less likely to have Pap smear (OR=O. l, CI=0.02-0.35) and HPV vaccine (OR=0.1, CI=0.02-0.41). Income was a predictor of the utilisation of Pap smear and HPV vaccine. Efforts to improve utilisation of Pap smear and HPV vaccination among women should be centered on highly subsidized provision of these services.