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Cervical cancer (CC) is the fourth most prevalent cancer among women in the world, especially
in Sub-Saharan African countries like Nigeria. Pap smear is the most effective method for cervical cancer
screening and prevention, yet utilization remains low. This study assessed awareness and participation in Pap
smear screening among cervical cancer patients before diagnosis at MEDSERVE-LUTH Cancer Centre
(MLCC).
A descriptive cross-sectional study was conducted among 198 histologically proven CC patients at
MLCC. Data were collected using a structured questionnaire capturing socio-demographic characteristics,
awareness, participation in Pap smear screening, and barriers to utilization. Statistical analysis was performed
with SPSS version 27. Associations between awareness, participation, and socio-demographic factors were
assessed using Pearson Correlation tests, with significance set at p < 0.05.
The mean age of respondents was 38.8 ± 6.0 years. Only 49.7% of participants had heard of the Pap
smear test, with the majority citing media (25.1%) and family/friends (16.1%) as sources of information, while
only 4.5% learned from healthcare providers. Misconceptions were common, with 35.2% believing the test
detects sexually transmitted infections. Participation in screening was very low, with only 12.1% ever having
undergone a Pap smear, mostly once or twice. Barriers included low perceived risk (55.3%), cost (11.1%), lack
of knowledge (9%), fear of results (6%), and cultural or religious beliefs (56.3%). Awareness was significantly
associated with participation (p = 0.000). Other factors influencing participation included religion (p = 0.015),
ethnicity (p = 0.017), occupation (p = 0.009), income (p = 0.030), and parity (p = 0.035).
Awareness and participation in Pap smear screening among CC patients before diagnosis were
critically low, with widespread misconceptions and socio-cultural barriers limiting utilization. Interventions to
improve awareness, reduce costs, and integrate culturally sensitive screening education into routine healthcare
are urgently needed to enhance preventive oncology in Nigeria and similar settings.
Cervical Cancer, Pap smear screening, Awareness, Participation, Barriers, Preventive Oncology,
Nigeria
Cervical cancer (CC) is the fourth most prevalent cancer among women in the world, with approximately
604,000 new cases and 342,000 mortality in 2020 (1). The disease burden is greater in low-and-middle-income
countries with age-standardized incidence rates varying from 75 per 100,000 women in highest-risk countries to
less than 10 per 100,000 women in lowest-risk countries (2). However, there is wide variation in incidence and
mortality rates from cervical cancer across different geographical locations worldwide. Africa is seen as having
the highest regional rates and mortality (3). These rates are seven to ten times lower in North America,
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Australia/New Zealand, and Western Asia (3). In Nigeria, cervical cancer is the second most prevalent cancer
among women after breast cancer. Studies reported that the prevalence of cervical cancer in Nigeria is 250 per
100,000 (4). Nigeria reported 102,079 cases of cancer, out of which 14,089 (13.8%) for cervical cancer (4).
Mortality rates showed that cervical cancer-related deaths were 8,240 (11.5%) of all cancer cancers in Nigeria
(4).
CC is preventable, and its mortality and morbidity could be greatly reduced using preventive health methods
such as sexual protection, and Pap smears (5). Evidence demonstrated Pap smear to be the most effective method
for cervical cancer screening and its prevention. The American Cancer Society advises women to undergo annual
Pap smear screenings, while the American College of Obstetricians and Gynecologists suggests women under
30 years should also have yearly screenings (6). Furthermore, for women above 30 who show no symptoms of
the disease, the recommendation is to have screening every two to three years (6). However, studies reported
that 20% of US women are not screened regularly and have not undergone Pap smear for the past three years
(6). Pap smear is a painless and effective screened method for cervical cancer diagnosis and infection, which
observes pre-cancer changes in patients (6). It has also been successful in reducing the incidence rates of cervical
cancer by almost 79% and cancer development (6). The variation in cervical cancer mortality rates observed
between developed and developing countries could be due to performing and non-performing Pap smears.
However, many studies have reported a positive relationship between mortality reduction and Pap smear
screening programs (6).
In Nigeria, Pap smear has been applied through opportunistic screening as payment for testing is usually done
out of pocket (5). However, this method is less effective as it targets only women who visit healthcare facilities
for other reasons (5). Additionally, in areas with limited knowledge and access to screening tests, many studies
have reported very low levels of Pap smear (5). Evidence has reported several factors influencing participation
in Pap smear testing, and these include poverty, level of education, reduced perception of risk of developing
cervical cancer, lack of awareness and knowledge about the benefits of Pap smear, and lack of familiarity with
screening locations (5). Healthcare practitioners also play a significant role in improving the knowledge about
cervical cancer screening and its participation (5). This could be attributed to a lack of awareness due to the lack
of recommendations for Pap smear testing by healthcare practitioners as the reason why women are unable to
participate in the screening (5). There is little or no studies on level of awareness and participation in Pap smear
screening among cervical cancer patients before disease diagnosis in the country. Hence, this study aims to assess
the level of awareness and participation in Pap smear screening among cervical cancer patients before disease
diagnosis at NSIA-LUTH Cancer Centre.
The study area was the MEDSERVE -LUTH Cancer Centre, which was established in 2019. The MEDSERVE
-LUTH Cancer Centre was a specialized cancer treatment centre that offered cutting-edge therapies and a modern
approach to cancer care in Africa. Situated within the site of Lagos University Teaching Hospital, it possessed
the largest and most experienced oncology team in Nigeria. The treatment centre was equipped with high-quality
modern technology, such as linear accelerators, brachytherapy machines, and treatment planning systems.
Several treatments were also available at the cancer centre, which included internal and external beam radiation
therapy, chemotherapy, and pharmacy treatments.
A descriptive cross-sectional study was conducted to assess levels of awareness and participation in Pap smear
screening among cervical cancer patients at the MEDSERVE -LUTH Cancer Centre before disease diagnosis.
The study population was composed of all cervical cancer patients who presented at the Radiation Oncology
Department in the MEDSERVE -LUTH Cancer Centre.
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Patients diagnosed at MEDSERVE-LUTH Cancer Centre.
Patients with histologically proven cervical cancer.
Patients receiving treatment at MEDSERVE -LUTH Cancer Centre.
Patients who gave consent and were willing to participate in the study.
Patients with incomplete medical records regarding their cervical cancer diagnosis.
The sample size was determined using Cochrane formula
n = z
2
pq/d
2
Where;
n = Sample size
z = Standard deviation (1.96 for 95% confidence interval)
p = (13.5% = 0.135) according to Yimer et al (7)
q = 1-p
d = Tolerable error (0.05)
2
1.96
2
x 0.135 x 1 – 0.135 = 179.44
0.05
2
The addition of 10% attrition rate was 17.944 + 179.44
Sample size = 197
A purposive sampling technique was used to select respondents who met the inclusion criteria.
Data were collected with the aid of a structured questionnaire, and information was obtained from the patients.
The study questionnaire was based on the research objectives and contained important information about the
patients, which included socio-economic and demographic characteristics, awareness of Pap smear screening,
participation in Pap smear screening, and barriers to participation in Pap smear screening.
Prior to data analysis, the data were collected with the aid of the questionnaire and manually entered into
Microsoft Excel Office. They were imported into Statistical Package for Social Science (SPSS) version 27 for
data analysis. The Kolmogorov–Smirnov test was utilized to check for normally distributed data. Data were
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presented in frequency, percentage, mean, and standard deviation (SD). Pearson correlation test was used to
assess the relationship between awareness and participation.
Ethical approval was obtained from the Lagos University Teaching Hospital (LUTH) Human Ethics Research
Committee. Informed consent was obtained from all the study participants, ensuring they knew the nature of the
study, their rights, and the process involved. Participants had the liberty to take part in and withdraw from the
study at any time without consequences. The privacy and confidentiality of the participants were strictly adhered
to throughout the study and beyond.
The majority of cervical cancer patients in this study were within the reproductive age group, with 59.3% aged
30–39 years and 35.7% aged 40–49 years, while only 1% were below 30 years and 0.5% were above 60 years.
Christianity was the predominant religion, accounting for 75.4% of the patients, followed by Islam (23.1%) and
traditional religion (1%). In terms of ethnicity, Yoruba constituted the largest group (69.3%), followed by Igbo
(22.6%), Hausa (4.5%), and others (3.5%). Most of the patients were married (92.5%), with a few widowed
(6%), divorced (1%), or single (0.5%). Regarding education, 46.2% had attained secondary education, 26.6%
had primary education, 24.1% had tertiary education, and 3% had no formal education. Occupationally, 51.3%
were self-employed, 32.2% were government or private employees, 8% were unemployed, and 2% engaged in
other forms of work. In terms of monthly income, 43.7% earned between ₦50,000 and ₦100,000, 39.7% earned
between ₦100,000 and ₦200,000, while 8% earned less than ₦50,000 and another 8% earned above ₦200,000.
Most patients had between two and four children, representing 34.2%, 29.6%, and 20.1% for parity two, three,
and four, respectively. In contrast, 9% had one child, 5.5% were nulliparous, and only 0.5% had five or more
children.
Table 1:Socio-economic and Demographic Characteristics of CC Patients
Age (38.8 ± 6.0)
18-29 years
2
1
30-39 years
118
59.3
40-49 years
71
35.7
50-59 years
6
3
60 years and above
1
0.5
Religion
Christianity
150
75.4
Islam
46
23.1
Traditional
2
1
Ethnicity
Yoruba
138
69.3
Igbo
45
22.6
Hausa
9
4.5
Others
7
3.5
Marital Status
Single
1
0.5
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Married
184
92.5
Widowed
12
6
Divorced
2
1
Educational Level
No formal education
6
3
Primary
53
26.6
Secondary
92
46.2
Tertiary
48
24.1
Occupation
Unemployed
16
8
Self-employed
102
51.3
Government/Private employee
64
32.2
Others
4
2
Monthly Income
Less than 50,000
16
8
50,000 – 100,000
87
43.7
100,000 – 200,000
79
39.7
Above 200,000
16
8
Parity
0
11
5.5
1
18
9
2
68
34.2
3
59
29.6
4
40
20.1
5 or more
1
0.5
Among cervical cancer patients studied, 49.7% had heard of the Pap smear test, while 50.3% had not. Of those
who were aware, the majority first learned about it through the media (25.1%), followed by family and friends
(16.1%), healthcare providers (4.5%), and community health programs (4%). Regarding knowledge of its
purpose, 35.2% believed Pap smear was for checking sexually transmitted infections, 10.1% thought it was for
early treatment of cervical cancer, 2% for treating cervical cancer, and 1.5% had no idea. In terms of frequency,
22.1% thought it should be done every six months, 3% once a year, 1% every three years, 11.1% only when
symptoms appear, while 12.1% had no idea. Concerning its preventive role, 20.1% believed Pap smear could
help prevent cervical cancer, 7.5% did not believe so, and 21.6% had no idea.
Table 2:Awareness Level of Pap smear Screening among CC Patients before CC Diagnosis
Have you heard of Pap smear test?
Yes
99
49.7
No
100
50.3
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If yes, where did you first hear about Pap
smear screening?
Hospital/Healthcare Provider
9
4.5
Media
50
25.1
Family/Friends
32
16.1
Community Health Program
8
4
What do you understand a Pap smear test
is used for?
To treat cervical cancer early
20
10.1
To treat cervical cancer
4
2
Check for sexually transmitted
infections
70
35.2
No idea
3
1.5
How often do you think a woman should
have a Pap smear test?
Every 6 months
44
22.1
Once a year
6
3
Every 3 years
2
1
Only when symptoms appear
22
11.1
No idea
24
12.1
Do you believe that Pap smear can help
prevent cervical cancer?
Yes
40
20.1
No
15
7.5
No idea
43
21.6
Among cervical cancer patients, only 12.1% reported ever undergoing a Pap smear test, while 87.4% had never
been screened. Among those who had it, 6.5% had it once and 5% twice. The most recent screening before
diagnosis was reported as less than a year prior (2%), 1–3 years prior (4%), more than 3 years prior (5%), while
1% could not remember. Recommendations came mainly from family/friends (5.5%), followed by self-decision
(4%), healthcare providers (1.5%), and a few who could not recall (1%). For patients who had never been
screened, the main reasons cited were: not feeling at risk of cervical cancer (55.3%), lack of awareness (9%),
cost of the test (11.1%), fear of the result (6%), time constraints (3%), distance to health facility (3%), and lack
of partner/husband support (1.5%).
Table 3:Rate of Participation of CC Patients in Pap smear screening before CC Diagnosis
Have you ever had a Pap smear test?
Yes
24
12.1
No
174
87.4
If yes, how many times have you undergone Pap smear screening?
Once
13
6.5
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Twice
10
5
When was your most recent Pap smear test prior to your diagnosis?
Less than a year before diagnosis
4
2
1-3 years before diagnosis
8
4
More than 3 years before diagnosis
10
5
I don’t remember
2
1
Who recommended your Pap smear test?
Doctor/Nurse
3
1.5
Family member/Friends
11
5.5
Self-decision
8
4
I don’t remember
2
1
If you never had a Pap smear test, what were the reasons?
I don’t know about it
18
9
I don’t feel at risk of cervical cancer
110
55.3
It was expensive
22
11.1
I was afraid of the result
12
6
I didn’t have time
6
3
The heath facility was too far
6
3
My partner/husband did not support it
3
1.5
The most frequently reported challenge was lack of knowledge about screening (58.3%) followed closely by
cultural or religious beliefs (56.3%) and stigma or embarrassment (46.7%). Financial constraints also played a
significant role, with 42.2% identifying the cost of the testas a barrier. Limited access to healthcare facilities
was reported by 39.2% of respondents, while 30.7% feared pain during the procedure. Additionally, 29.6% cited
family responsibilities as a hindrance to participation.
Table 4:Barriers to Participation in Pap smear screening among CC Patients before CC Diagnosis
Lack of screening knowledge
Yes
116
58.3
No
82
41.2
Fear of pain during the test procedure
Yes
61
30.7
No
137
68.8
Stigma or Embarrassment
Yes
93
46.7
No
105
52.8
Cost of the test
Yes
84
42.2
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No
114
57.3
Lack of access to healthcare facilities
Yes
78
39.2
No
120
60.3
Cultural or Religious beliefs
Yes
112
56.3
No
86
43.2
Family responsibilities
Yes
59
29.6
No
139
69.8
Table 5 demonstrates a statistically significant relationship (p = 0.000) between awareness of Pap smear
screening and actual participation in the test. Among those aware of Pap smear screening, 24 patients(12.1%)
reported having undergone the test, while none of the unaware patients participated. Conversely, among the
patients who had no awareness of Pap smear, 100 patients (50.5%) had not undergone screening, while 74
patients (37.4%) fell into the non-participation group despite some exposure.
Table 5:Relationship between Awareness Level and Participation of Pap smear screening
Level of Awareness
.000
Yes
24
12.1
0
0
No
74
37.4
100
50.5
Table 6 shows the factors influencing Pap smear screening participation rates among CC patients before
diagnosis. Age was not significantly associated with screening participation (p = 0.291), although women aged
30–49 accounted for most of those who had undergone screening. Religion was significantly associated with
participation (p = 0.015), with the vast majority of participants being Christians (23 patients) compared to only
one Muslim participant. Similarly, ethnicity showed a significant association (p = 0.017), with Yoruba women
more likely to have participated (22 patients) compared to Igbo (2 patients) and none among the Hausa or other
ethnic groups. Marital status did not show a significant relationship with participation (p = 0.213), although
married women dominated the screened group. Educational level was borderline significant (p = 0.052), with
higher participation seen among women with secondary (15 patients) and tertiary education (7 patients).
Occupation was strongly associated with screening (p = 0.009), with government or private employees showing
the highest rate of participation (15 patients) compared to self-employed (6 patients) and unemployed (1 patient).
Monthly income also showed a significant relationship (p = 0.030), with higher participation among women
earning between ₦100,000 and ₦200,000 (13 patients) and those earning above ₦200,000 (3 patients), and none
of those earning below ₦50,000 had undergone screening. Parity was significantly associated with participation
(p = 0.035), with the highest participation observed among women with 2–4 children (23 patients).
Table 6:Factors Influencing Pap smear Screening Participation Rates among CC patients before diagnosis
Age
.291
18-29 years
0
0
2
1
30-39 years
12
6
106
53.3
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40-49 years
12
6
64
32.2
50-59 years
0
0
0
0
60 years and above
0
0
1
0.5
Religion
.015
Christianity
23
12
126
63.3
Islam
1
0.5
45
22.6
Traditional
0
0
2
1
Ethnicity
.017
Yoruba
22
11
116
58.3
Igbo
2
1
42
21.1
Hausa
0
0
9
4.5
Others
0
0
7
3.5
Marital Status
.213
Single
1
0.5
0
0
Married
22
11
161
80.9
Widowed
1
0.5
11
5.5
Divorced
0
0
2
1
Educational Level
.052
No formal
education
0
0
6
3
Primary
2
1
51
25.6
Secondary
15
7.5
76
38.2
Tertiary
7
3.5
41
20.6
Occupation
.009
Unemployed
1
0.5
15
7.5
Self-employed
6
3
96
48.2
Government/Private
employee
15
7.5
48
24.1
Others
0
0
4
2
Monthly Income
.030
Less than 50,000
0
0
16
8
50,000 – 100,000
8
4
79
39.7
100,000 – 200,000
13
6.5
65
32.7
Above 200,000
3
1.5
13
6.5
Parity
.035
0
1
0.5
10
5
1
0
0
18
9
2
5
2.5
63
31.7
3
11
5.5
47
23.6
4
7
3.5
33
16.6
5 or more
0
0
1
0.5
The mean age of CC patients in this study was 38.8 ± 6.0, consistent with 30.7 years reported by Shrestha et al.
(8) among young adult women in Nepal and 38.0 years reported by Okunade et al. among women in Lagos (9).
Momodu et al. documented a mean age of 33.35 years among women in the outpatients department of Edo State
University Teaching Hospital (10). Another study in North Central Nigeria reported a mean age of 38.8 years
(11).
This study documented a 49.7% awareness level of the Pap smear test before diagnosis. Wright et al. reported
6.9% awareness among women in Lagos (12), and Okunade et al. found 38.8% among women in the control
arm of the mHealth-Cervix trial (5). Another study reported 38.6% among female civil servants in Jos (13).
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Momodu et al. documented 32.7% among women living in Edo North, Nigeria (14). Our study level of awareness
was low, considering that Pap smear screening remains one of the most effective methods of early detection and
prevention of CC (9). Among those who had heard of the test, the media emerged as the leading source of
information (25.1%), followed by family and friends (16.1%). In contrast, only 4.5% of participants reported
learning about Pap smear screening from healthcare providers, and 4% from community health programs. This
indicates missed opportunities within the health system to promote preventive practices during routine clinical
encounters
(15).
This study reported widespread misconceptions about the understanding of the purpose of the Pap smear. Most
patients believed the test was meant to check for sexually transmitted infections, while 10.1% correctly indicated
it as a tool for early detection of CC. A low proportion thought it was for treatment (2%). Hyacinth et al. reported
that 27% knew that regular screening could help prevent CC. Another study documented that 88.5% of women
said Pap smear can detect CC, 1.3% identified Pap smear for CC treatment, and 1.6% thought it was used for
treatment of sexually transmitted infections (8). These findings demonstrate poor knowledge and a lack of clarity
regarding the preventive role of Pap smear, which could discourage women from participating in screening due
to stigma associated with sexually transmitted infections
(8).
Only 22.1% patients believed the Pap smear test should be done every 6 months, 3% once a year, 1% every three
years, which is more in line with international standard guidelines (16). A significant portion (11.1%) stated that
Pap smear should only be done when symptoms appear, indicating a reactive rather than a preventive mindset.
Shrestha et al. reported 12.1% every 3 years, 3.8% every 5 years, 24.8%, and 24.8% every year if the woman
exhibited more than one risk factor (8). Another study documented 2.7% annually, 3.5% every 2 years, and 9.7%
every 3-5 years (10). These findings highlight the lack of public health education and the absence of
standardized, widely spread screening recommendations in this context (17).
This study found a low rate (12.1%) of participation of CC patients in Pap smear screening before their diagnosis,
while most patients (87.4%) had never undergone the screening. This low uptake is alarming, given that the Pap
smear is one of the most effective methods of detecting precancerous lesions and preventing progression to
invasive CC (16). This result was low compared with 37.6% in Nepal (8), 27.6% in Lagos (2), 52.4% in Iran
(18), and 100% in South Africa (15). Furthermore, this study was higher compared to 8.8% in Edo North, Nigeria
(10) and 10.2% in North Central Nigeria (11). Among those who had participated in screening, 6.5% had done
so only once and 5% had done so twice, indicating that even among those aware of Pap smear, adherence to
regular screening practices was extremely poor.
Most patients (87.4%) had never undergone a Pap smear in this study. Some patients (55.3%) stated that they do
not feel at risk of CC, which indicates low perceived susceptibility. However, this is a known barrier to
preventive health behavior (17). Other reasons included 11.1% stated cost of the test, 9% reported lack of
knowledge about the test, and 6% expressed fear of the test outcome. Furthermore, 3% mentioned time
constraints, distance to health facility (3%), and 1.5% complained about a lack of partner or husband support.
These results suggested the barriers faced by patients in participation, which include personal, socio-cultural,
and health system-related factors
(17). Mousavi et al. reported that cost, lack of healthcare facility access, fear
of results, embarrassment, and disapproval from the husband were among the reasons that prevent them from
participation (18). Another study documented that lack of awareness, lack of access to healthcare facilities,
anxiety about test results, and cultural beliefs were the main reasons that deterred participation (11). A study
conducted in South Africa reported fear of the procedure, anxiety regarding test outcomes, and cultural
dependence on traditional healers were major reasons that prevent participation.
More than half (58.3%) reported a lack of screening knowledge as a barrier to participation in Pap smear
screening. Women generally have a low awareness of cervical cancer as a significant public health issue. Even
those who have some knowledge of the disease often lack a complete understanding of its risk factors, preventive
measures, and signs and symptoms. Likewise, service providers noted that the low uptake of screening is due to
women's limited awareness regarding cervical cancer. This lack of awareness diminishes women's motivation to
pursue screening (19).
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Only 30.7% patients reported fear of pain during the test procedure. The apprehension regarding discomfort
during the procedure was noted as a deterrent to screening. Women receive negative feedback from friends or,
based on their previous negative screening experiences, opt to avoid future screenings. Service providers
observed that women often feel uneasy about pelvic examinations and fear that the insertion of the speculum
would be painful, which discourages them from seeking screening (19). About half (42.2%) of patients
complained about the cost of the Pap smear test. Many women and service providers regarded the test as costly.
This is partly attributed to the hidden expenses related to screening, even though the service is typically free at
most public health facilities (19).
Some patients (39.2%) mentioned lack of access to healthcare facilities as a barrier to participation. Women
expressed that their local health centers did not offer screening services. The significant distances they needed
to travel to access the nearest screening locations, located at higher-level healthcare facilities, stopped them from
getting screened (19).
Cultural or religious barriers (56.3%) are one of the main barriers to active participation in Pap smear screening
in this study. Certain women view participation in cervical cancer screening as inappropriate and contrary to
their cultural and religious values. African women are typically conservative and often feel embarrassed about
lying on their backs with their legs open, exposing their intimate areas for examination, particularly when a male
is administering the service. The exposure of genitals is perceived as an invasion of women's privacy. The
cultural and religious standards valued by some women dissuade them from revealing their private body parts
to anyone other than their husbands unless there are strong justifications (19).
This study showed a significant relationship between awareness of Pap smear screening and participation in the
test. These findings showed the impact of awareness on uptake, as women who had knowledge of Pap smear
were more likely to engage in preventive practices compared to those with no awareness. However, women
cannot make informed decisions about screening without knowledge of the test, despite the availability of
services (5).
Religion and ethnicity were significantly associated with Pap smear screening participation in this study. The
cultural and religious standards valued by some women dissuade them from revealing their private body parts
to anyone other than their husbands unless there are strong justifications. Modesty, embarrassment, and religious
convictions serve as significant obstacles to the use of screening services (19). Parity showed a significant
association with Pap smear participation (p=0.035). Women with 2 to 4 children were more likely to have had a
Pap smear compared to those without children. This suggests that reproductive women, especially those
attending antenatal or postnatal clinics, may have more exposure to CC prevention information. However,
nulliparous women or those with high parity may visit health facilities less frequently (11).
Occupation and income are important determinants of Pap smear screening participation in this study. Patients
who were government or private employees (7.5%) and those (8%) with higher income levels (above N100,000)
were more likely to have undergone a Pap smear compared to self-employed, unemployed, or low-income
earners. In contrast, unemployed and low-income women were particularly disadvantaged, indicating cost and
affordability as barriers.
CONCLUSION
This study identifies significant awareness, participation, and knowledge gaps among Pap smear screening in
cervical cancer patients before diagnosis. Nearly half of the women had never even heard of the Pap smear, and
very few had ever had the test done, typically irregularly and without professional counsel. Misconceptions about
the purpose of the Pap smear, limited knowledge about the recommended screening interval, and low faith in its
preventive effect also limited proper utilization. Other barriers to participation, including lack of knowledge,
cultural and religious beliefs, stigma, cost, reduced access to health facilities, and family competing
responsibilities, significantly hindered participation. Socio-demographic and reproductive determinants such as
occupation, income, parity, ethnicity, and religion also influenced uptake and revealed structural and cultural
differences in access to preventive healthcare. The research highlights the need to increase preventive oncology
in Sub-Saharan Africa by promoting community education, culturally sensitive health promotion, and increased
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ISSN No. 2321-2705 | DOI: 10.51244/IJRSI |Volume XII Issue XV October 2025 | Special Issue on Public Health
healthcare provider engagement in delivering Pap smear screening recommendations. Expanding access,
reducing costs, and integrating screening into routine health services are key measures to improve coverage and
ease the cervical cancer burden.
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