Uptake and determinants of cervical cancer prevention services among female college students in Kenya: A cross-sectional survey

Abstract Introduction Cervical cancer is the leading cause of cancer death in women in low- and middle-income countries. In Kenya, cervical cancer incidence and prevalence have been increasing and in 2018 alone, there were 3286 deaths from cervical cancer. Previously, studies on cervical cancer prevention strategies have focused on women above 30 years old. However, as the risk factors for cervical cancer are acquired as early as in the teen years, an understanding of the awareness, uptake and determinants of screening services among college female students will help inform prevention strategies. This study sought to determine the awareness, uptake, determinants and barriers to cervical cancer screening services among colleges students in Kenya. Methods This was a multicenter cross-sectional study conducted in eight universities spread all over Kenya. Participants were interviewed using a self-administered structured questionnaire on sociodemographics, reproductive history, awareness on cervical cancer including screening practices, and attitude towards cervical cancer prevention services. Descriptive statistics were summarized using means and standard deviation (SD) for parametric data and median and interquartile range (IQR) for non-parametric data. Univariable and multivariable logistic regression analyses were done to determine odds ratios of factors associated with uptake of cervical cancer screening services. P-value of <0.05 was considered statistically significant. Results Between January 2017 and Sept 2017, we screened 800 and enrolled 600 female colleges students from eight universities in Kenya. In total, 549 of the 600 (92%) participants completed the questionnaire. The median age (IQR) was 21(20,22) years. Nearly two-thirds 338(62.7%) were sexually active, while 54(16%) had concurrent sexual partners. The main form of contraception was oral postcoital emergency pills 123(64.7%). Only 76(14.4%) had screened for cervical cancer, and the commonest approach was a Pap smear 47(61.8%). About one half 40(54.1%) did not like their experience due to pain, discomfort and bleeding. Four out of five participants (439, 80.7%) had poor knowledge on cervical cancer screening. On bivariate analysis, increased level of awareness (odds ratio [OR] 1.08 95% Confidence Interval [CI] 1.03,1.18, p = 0.004), knowledge of someone with cervical cancer(OR 0.43 CI 0.23,0.78 p=0.006) and a perception of self-risk (OR2.6 CI 1.38,4.98 p=0.003) were associated with increased odds of uptake of cervical cancer screening. In the multivariate analysis, high awareness was significantly associated with increased odds of cervical cancer screening (OR 1.12 CI 1.04, 1.20 p=0.002). Conclusions Female college students in Kenya had low levels of awareness on cervical cancer and had very low uptake of cervical cancer screening. However, high perception of self-risk and perceived benefit was associated with increased odds of cervical cancer screening. Recommendations Since female colleges students are generally thought to be more knowledgeable and have better access to information compared to the general population, the low levels of knowledge and uptake of cervical cancer screening, calls for a rethink of strategies that focus on the younger population including those in primary, high school and universities. Such strategies include HPV vaccination and incorporation of cancer prevention in school curriculum.