Knowledge of Cervical Cancer and Vaccine among sexually active Women in FMC, Keffi Nigeria

Introduction

Cervical cancer continues to be a significant public health concern globally, especially in low- and middle-income countries. According to the World Health Organization (WHO), it is the fourth most common cancer among women globally, with approximately 604,000 new cases and over 31 million deaths yearly [1]. South-East Asia, Central America, and sub-Saharan Africa have the highest incidence and mortality rates and these areas are also known for having little access to screening and immunization services [2]. In Nigeria, cervical cancer is the second most common cancer among women between the ages of 15 and 44, accounting for about 12,075 new diagnoses and 7,968 deaths each year [3]. The age-standardized incidence rate is approximately 18.4 out of every 100,000 women, indicating a serious public health concern [4]. At least 70% of cases of cervical cancer are caused by persistent infection with high-risk human papillomavirus (HPV) types, particularly HPV 16 and 18 [5]. Early sexual debut, having several sexual partners, smoking, using oral contraceptives for a long period of time, and immunosuppression are additional risk factors for cervical cancer. Socioeconomic factors, such as limited access to healthcare services and low educational levels, also increases the risk [6]. Nigeria has one of the highest rates of human papillomavirus (HPV)-related diseases in Sub-Saharan Africa and several studies suggest that HPV is highly prevalent among Nigerian women [7]. The disease significantly affects women’s health, resulting in considerable morbidity and mortality. In addition to physical health consequences, cervical cancer causes considerable psychological and economic burdens on affected women and their families [8].

The introduction of the human papillomavirus (HPV) vaccine has been an important breakthrough in preventing cervical cancer. This has significantly reduced the incidence of HPV infections and related cervical abnormalities. It serves as a primary prevention strategy. WHO recommends vaccinating girls aged 9-14 years before they become sexually active. The vaccines are highly effective against infections caused by HPV types 16 and 18 [9]. Clinical studies have proved the vaccine’s efficacy in preventing infections caused by high-risk HPV strains. For instance, a study published in the New England Journal of Medicine found that among Swedish females aged 10 to 30, quadrivalent HPV accination was associated with a substantially reduced risk of invasive cervical cancer at the population level [10]. In low- and middle-income countries (LMICs), modeling studies predict that girls-only HPV vaccination with 90% coverage could reduce the median age-standardized cervical cancer incidence from 19.8 to 2.1 cases per 100,000 women-years over the next century, representing an 89.4% reduction [11]. These findings underscore the critical role HPV vaccination plays in reducing cervical cancer incidence and mortality worldwide.

Despite these efforts, the HPV vaccine uptake in Nigeria is influenced by a number of factors. They include limited awareness about cervical cancer and the vaccine, cultural and religious beliefs, misconceptions about cervical cancer and HPV vaccines, concerns about vaccine safety and logistics issues related to vaccine distribution and accessibility. Addressing these barriers is crucial to enhance vaccine acceptance and coverage [3]. Previous studies have indicated that all these contribute to the low uptake of HPV vaccine in Nigeria [12,13]. This study aims to evaluate the knowledge of cervical cancer and the uptake of the HPV vaccine among women attending FMC Keffi. By identifying the factors influencing awareness and vaccination rates, the findings of this research will provide insights into effective strategies for increasing HPV vaccine acceptance and, ultimately, reducing cervical cancer prevalence in Nigeria.

Materials and Methods

Ethical consideration

This study aims to evaluate the knowledge of cervical cancer and the uptake of the HPV vaccine among women attending FMC Keffi. A written informed consent approved by the Ethic Committee of the Federal Medical Centre Keffi, Nasarawa State, Nigeria, was obtained from all the study participants.

Study design

A descriptive cross-sectional survey study designed was carried out on 250 female’s ages 18 to 50 years from September to December, 2024. The participants were informed about the study objectives after which information was collected using validated questionnaires on the knowledge on cervical cancer and vaccines were administered as well as demographics traits. By identifying the factors influencing awareness and vaccination rates, the findings of this research will provide insights into effective strategies for increasing HPV vaccine acceptance and, ultimately, reducing cervical cancer prevalence in Nigeria.

Participants

Inclusion criteria:

Eligible participants were female’s ages 18-50 years in the Federal Medical Centre Keffi whose informed consent to participate.

Exclusion criteria:

Patients <18-years-old or older than 50 years of age, and those who did not consent were excluded from the study.

Sampling:

A well-structured quantitative questionnaire was used to obtain data on the demographic factors such as age, educational level, marital status, parity, occupation, and income level. The questionnaire provided information on the knowledge on cervical cancer and vaccines among the participants. Partial entries and none responses were excluded.

Statistical analysis: Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS) version 27. Measures of central tendency (mean), variability (standard deviations), proportions (percentages), and occurrence (frequencies) were computed. The 10 items on the knowledge dimension, 5 items on the attitude and 5 items on the perception were assessed using a five-point Likert scale ranging from 1 to 5 (1=Strongly disagree, 2=disagree, 3= neutral, 4=agree, and 5=strongly agree. The mean scores were calculated by summing the items and dividing by the number of items. Higher mean scores represented better knowledge or attitude. Chi-square test was used to determine the influence of knowledge and sociodemographic characteristics on the utilization of cervical cancer screening services. A p-value less than 0.05 was considered statistically significant.

Result

A total of 250 individuals took part in the study. Table 1 presents the sociodemographic details of the respondents. The largest age group is 18-25 years, making up 60.8% of the participants, followed by those aged 26-35 years (29.6%), 36-45 years (6.8%), and 46 years and above (2.8%). The average age of the participants was 25.92 years with a standard deviation of 7.31 years. The majority (80%) are single, 16% are married, and 4% are widowed. Most participants (75.6%) have not experienced pregnancy, and a significant portion (92%) have attended tertiary education. Regarding occupation, 42% are students, 31.6% work in offices or formal jobs, 21.6% are involved in skilled trades or technical work, and 4.8% are unemployed. Additionally, 80.8% of the respondents live in urban areas, while 19.2% reside in rural areas.

Table 1:Socio-demographic characteristics.

Table 2 reveals that the majority of participants (96.8%) have not experienced menopause. Only 7.6% have ever undergone cervical cancer screening, with 36.8% of those having been screened over 5 years ago. A large portion (82%) reported no family history of cervical cancer, 3.6% confirmed a family history, and 14.4% were unsure. Regarding viral infections, 10% of participants have been diagnosed, with the most common being HBV (61.5%), followed by HIV (23.1%), and HCV (15.4%). Additionally, 1.2% of the participants reported have been diagnosed with cervical cancer in the past..

Table 2:Respondents’ history.

Table 3 indicates that the most frequently reported symptom among respondents is foul-smelling vaginal discharge (9.3%), followed by pelvic pain (9%), bleeding after sex (4.1%), and abnormal vaginal bleeding (2.2%). The majority of participants (75.4%) reported not experiencing any of these symptoms.

Table 3:Knowledge of respondents on cervical cancer.

*Strongly Disagree (SD = 1-1.8), Disagree (D=1.81-2.60), Neutral (N=2.61-3.40), Agree (A=3.41-4.20), Strongly Agree (SA=4 .21).

Table 4 demonstrates that respondents possess a high level of knowledge about cervical cancer, with all item means exceeding 3.4. The most agreed statement is pap smear is one of the tests for detecting cervical cancer (4.22±0.76), followed by cervical cancer is primarily caused by human papilloma virus HPV (4.07±0.79), cervical cancer is a preventable disease through vaccination and screening (4.06±0.90), vaginal bleeding is one of the signs of cervical cancer (3.96±0.81), pain during urination is one of the signs of cervical cancer (3.91±0.87), cervical cancer is more common in women who have multiple sexual partners (3.90±1.02), smoking increases the risk of developing cervical cancer (3.88±0.98), pain in the abdomen is one of the signs of cervical cancer (3.79±0.87), HIV positive individuals have a higher risk of cervical cancer (3.76±0.91), and itching in the vaginal is one of the signs of cervical cancer (3.73±0.92). Overall, 81.6% of respondents have good knowledge of cervical cancer, 16% have moderate knowledge, and 2.4% have poor knowledge.

Table 4:Attitude of respondents on cervical cancer.

*Strongly Disagree (SD=1-1.8), Disagree (D=1.81-2.60), Neutral (N=2.61-3.40), Agree (A=3.41-4.20), Strongly Agree (SA=4.21-5). This is reversed for Negative statements.

Table 5 demonstrates that respondents’ attitude on cervical cancer, The most agreed item is I believe that vaccines against HPV are effective in reducing the risk of cervical cancer (4.12±0.68), I feel confident discussing cervical cancer and screening with my healthcare provider (3.80±0.88), I trust the accuracy of cervical cancer screening tests (3.78±0.75), and Cervical cancer screening tests are too invasive and uncomfortable for women (3.52±0.98). Overall, 45.2% of respondents have positive attitude towards cervical cancer, 50.8% have moderate attitude, and 4% have negative attitude.

Table 5:Perception of respondents on cervical cancer.

*Strongly Disagree (SD=1-1.8), Disagree (D=1.81-2.60), Neutral (N=2.61-3.40), Agree (A=3.41-4.20), Strongly Agree (SA=4.21-5).

Table 6 presents respondents’ perceptions of cervical cancer. The most strongly agreed-upon statement is that cervical cancer is a serious health issue that should be prioritized in public health campaigns (mean=4.37±0.77). This is followed by the belief that stigma surrounding discussions of cervical cancer hampers open communication about the subject (mean=3.70±0.97). Additionally, respondents agree that religious or spiritual beliefs (mean=3.66±1.01) and cultural beliefs (mean=3.42±1.10) influence people’s views on cervical cancer and its prevention.

Table 6:Awareness of HPV vaccine.

Discussion

The study found that 60.8% of participants were between the ages of 18 and 25 years, with a mean age of 25.92±7.31 years. This age distribution correlates with the findings of Morounke et al. [14], demonstrating that younger women are largely the respondents in cervical cancer awareness studies. The considerable number of single participants (80%) and those possessing university education (92%) indicates that the study population is well educated, potentially affecting their understanding and perceptions of cervical cancer and its prevention. Comparable studies have shown that educational level is a major factor affecting cervical cancer awareness since women with higher degrees of education show better information on the disease, its risk factors, and preventative actions [15]. Despite the high awareness levels- 82.5%-only 7.6% of respondents have undergone cervical cancer screening. Given the success of early diagnosis in lowering cervical cancer morbidity and death, the low acceptance is concerning. By helping to early detection of precancerous lesions, hence permitting quick care, research has demonstrated that cervical cancer screening drastically reduces both the incidence and death rates of the illness [16]. Still, low screening rates have been recorded in Nigeria and other sub-Saharan African countries for reasons including poor awareness, cultural attitudes, limited resources, and poor healthcare infrastructure [17]. The difference between awareness and screening emphasizes the need of interventions linking knowledge with behavior.

On a Likert scale, the study assessed participants’ level of understanding. Most of the respondents (80%) correctly named human papillomavirus (HPV) as the main cause of cervical cancer; they also admitted the need of vaccination (81.2%), and the Pap smear as a detection tool (79.6%), Still, there are misunderstandings since 22.8% mistakenly believe that vaginal itching is a sign of cervical cancer. The results coincide with studies by Adegboyega et al. [18], showing that although many Nigerian women know about cervical cancer, common misconceptions on its symptoms and risk factors exist. This emphasizes the necessity of targeted health education campaigns to counteract false information and enhance the dissemination of factual knowledge in order to public health campaigns ought to give top priority to dispelling false ideas about cervical cancer and distributing accurate information via social media, community outreach initiatives, and medical professionals [19].

The main barriers to screening were lack of symptoms (75.4%) and inadequate knowledge of screening techniques. The results coincide with studies by Zenzano et al. [20], which highlighted the need of proactive healthcare policies encouraging regular screening, especially among younger women and pointed out similar obstacles. Moreover, healthcare workers represented a small information source (5.6%), which emphasizes the need of improved patient-provider communication right away. Screening rates can be significantly changed by increasing the involvement of medical professionals in campaigns against cervical cancer. Studies show that women who follow advice from doctors are more likely than those who rely on other sources to be screened [21]. This emphasizes the need of teaching and arming medical practitioners to provide correct information and support screening during regular visits.

Other noted obstacles include financial restrictions and diagnosis anxiety. Many low- and middle-income nations have great difficulty in the cost of cervical cancer screening. [22] found that women’s participation rates in Nigeria were much lowered by out-of-pocket screening costs. Reducing the cost of screening and including cervical cancer screening into main healthcare treatments could help to improve acceptance rates. Furthermore, deterring women from seeking screening services are psychological elements including fear of a cancer diagnosis, stigma, and fatalistic attitudes. To reduce anxiety and encourage involvement in screening programs, public health advertisements have to stress the benefits of early identification and the major treatability of precancerous lesions [23].

Though the study did not explicitly measure vaccination rates, awareness regarding cervical cancer prevention was rather strong. Still, accessibility and cost are important issues in Nigeria that restrict the general acceptance of HPV vaccinations. Makwe et al. [23] claim that low HPV vaccination coverage in Nigeria still results from high expenses, restricted availability, and ignorance. To boost coverage, policymakers should concentrate on helping HPV vaccines to be included into national immunization campaigns and subsidized. Countries that have effectively included HPV vaccination into their immunization programs have noted notable drop in cervical cancer incidence [24].

Over 90% of eligible girls in a study carried out in Rwanda, where the government runs a free HPV vaccination campaign, got the vaccination, so projecting a decline in cervical cancer cases over the next decades [25]. By working with international health organizations and pharmaceutical businesses to guarantee broad vaccination availability, Nigeria can implement such plans. Programs centered on communities can also serve to debunk false information and promote acceptance of vaccines.

Government actions aiming at cervical cancer prevention and screening acceptance should focus on strengthening healthcare systems, more financing for cancer control programs, and national screening rules application. Low screening rates discovered in Nigeria result from the absence of a well-organized national cervical cancer screening program. Because of their systematic screening campaigns, countries with organized screening systemslike the United Kingdom and Australia-have much lower cervical cancer incidence [26]. Early detection rates will be much improved by putting in place a thorough cervical cancer screening program combining regular Pap tests with HPV testing for qualified women.

Including cervical cancer screening into universal health coverage proposals helps to solve financial obstacles. Studies show that when insurance or government subsidies pay for the screening programs, women are more likely to participate. Mobile screening tools can also be used in rural areas to serve underprivileged groups who might not have access to medical facilities [26]. In conclusion, the burden of cervical cancer in the study area could be significantly reduced by awareness campaigns, access, and affordable screening services and vaccine uptake.

Conclusion

Based on our data, there is a lack of clear understanding of the risk factors associated with cervical cancer among the study participants which contributed to the low uptake of HPV vaccine. We advocated for awareness campaigns, access and affordable cervical cancer screening services vaccine uptake. Mobile screening tools can also be used in rural areas to serve underprivileged groups who might not have access to medical facilities.

Consent for Publication

Not applicable.

Availability of Data and Material

Data are available from the corresponding author upon request.

Competing Interests

The authors declare no conflict of interest.

References

1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. (2021) Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA A Cancer J Clinicians 71(3): 209-249.
2. Stelzle D, Tanaka LF, Lee KK, Ibrahim Khalil A, Baussano I, et al. (2021) Estimates of the global burden of cervical cancer associated with HIV. Lancet Global Health 9(2): e161-e169.
3. Olubodun T, Ogunsola EA, Coker MO, Olayinka SA, Elegbede WÀ, et al. (2024) HPV vaccine knowledge, attitude, and programme satisfaction among parents and caregivers of vaccine recipients in Ogun state Nigeria. Reprod Health 21(1): 179.
4. Lawson O, Ameyan L, Tukur Z, Dunu S, Kerry M, et al. (2023) Cervical cancer screening outcomes in public health facilities in three states in Nigeria. BMC Public Health 23(1): 1688.
5. Gamde SM, Yaroson SG, Williams B (2025) Promise and pitfalls of human papilloma virus vaccine: An updated review. Asian Pac J Cancer Nursing pp: 79-88.
6. Luvián-Morales J, Gutiérrez-Enríquez SO, Granados-García V, Torres-Poveda K (2024) Risk factors for the development of cervical cancer: analysis of the evidence. Front Oncol 14: 1378549.
7. Aminu M, Gwafan JZ, Oguntayo OA, Ella EE, Koledade AK, et al. (2014) Seroprevalence of human papillomavirus immunoglobulin G antibodies among women presenting at the reproductive health clinic of a university teaching hospital in Nigeria. Int J Womens Health 6: 479-487.
8. Singh D, Vignat J, Lorenzoni V, Eslahi M, Ginsburg O, et al. (2023) Global estimates of incidence and mortality of cervical cancer in 2020: a baseline analysis of the WHO Global Cervical Cancer Elimination Initiative. Lancet Global Health 11(2): e197-206.
9. World Health Organisation. Human papillomavirus vaccines: WHO position paper (2022 update). 50: 645-72.
10. Lei J, Ploner A, Elfström KM, Wang J, Roth A, et al. (2020) HPV vaccination and the risk of invasive cervical cancer. N Engl J Med 383(14): 1340-1348.
11. Brisson M, Kim JJ, Canfell K, Drolet M, Gingras G, et al. (2020) Impact of HPV vaccination and cervical screening on cervical cancer elimination: A comparative modelling analysis in 78 low-income and lower-middle-income countries. Lancet 395(10224): 575-590.
12. Ndikom CM, Ofi BA (2012) Awareness, perception and factors affecting utilization of cervical cancer screening services among women in Ibadan, Nigeria: A qualitative study. Reprod Health 9: 11.
13. Chigbu CO, Onyebuchi AK, Onyeka TC, Odugu BU, Dim CC (2017) The impact of community health educators on uptake of cervical and breast cancer prevention services in Nigeria. Intl J Gynecology Obstet 137(3): 319-324.
14. Morounke SG, Ayorinde JB, Benedict AO, Adeyayo FF, Adewale FO, et al. (2017) Epidemiology and incidence of common cancers in Nigeria. J Cancer Biol Res 5(3): 1105.
15. Dozie UW, Elebari BL, Nwaokoro CJ, Iwuoha GN, Emerole CO, et al. (2021) Knowledge, attitude and perception on cervical cancer screening among women attending ante-natal clinic in Owerri west L.G.A, South-Eastern Nigeria: A cross-sectional study. Cancer Treat Res Commun 28: 100392.
16. Loud JT, Murphy J (2017) Cancer screening and early detection in the 21^st Semin Oncol Nurs 33(2): 121-128.
17. Mafiana JJ, Dhital S, Halabia M, Wang X (2022) Barriers to uptake of cervical cancer screening among women in Nigeria: A systematic review. Afr Health Sci 22(2): 295-309.
18. Akinola A, Constance MS (2021) Impact of educational intervention on cervical cancer screening uptake among reproductive age women. Int J Community Med Public Health 8(4): 2053.
19. Petersen Z, Jaca A, Ginindza TG, Maseko G, Takatshana S, et al. (2022) Barriers to uptake of cervical cancer screening services in low-and-middle-income countries: a systematic review. BMC Womens Health 22(1): 486.
20. Zenzano T, Allan JD, Bigley MB, Bushardt RL, Garr DR, et al. (2011) The roles of healthcare professionals in implementing clinical prevention and population health. Am J Prev Med 40(2): 261-267.
21. Okagbue HI, Erekosima G, Sampson S, Atuhaire B, Samuel O, et al. (2025) Predictors of willingness of HPV vaccine uptake across Eight States in Nigeria. BMC Public Health 25(1): 745.
22. Wang Y, Feng W (2022) Cancer-related psychosocial challenges. Gen Psychiatr 35(5): e100871.
23. Makwe CC, Anorlu RI, Odeyemi KA (2012) Human papillomavirus (HPV) infection and vaccines: knowledge, attitude and perception among female students at the University of Lagos, Lagos, Nigeria. J Epidemiol Glob Health 2(4): 199-206.
24. Sayinzoga F, Umulisa MC, Sibomana H, Tenet V, Baussano I, et al. (2020) Human papillomavirus vaccine coverage in Rwanda: A population-level analysis by birth cohort. Vaccine 38(24): 4001-4005.
25. Olson B, Gribble B, Dias J, Curryer C, Vo K, et al. (2016) Cervical cancer screening programs and guidelines in low- and middle-income countries. Int J Gynecol Obstet 134(3): 239-246.
26. Gamde SM, Omotola OS, Avwioro GO, Adisa JO (2024) Examining the challenges and strategies for improving cervical cancer screening in Nigeria. International Journal of Human and Health Sciences 8(1): 22-31.