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Higher educational attainment associated with reduced likelihood of abnormal cervical lesions among Zambian women - a cross sectional study
BACKGROUND: The high burden of cervical cancer in Zambia prompted the Ministry of Health and partners to develop the cervical cancer prevention program in Zambia (CCPPZ) in 2006. Despite this intervention more women continue to die from the disease and there is little understanding of factors that m...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5640950/ https://www.ncbi.nlm.nih.gov/pubmed/29029626 http://dx.doi.org/10.1186/s12885-017-3680-z |
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author | Hamoonga, Twaambo Euphemia Likwa, Rosemary Ndonyo Musonda, Patrick Michelo, Charles |
author_facet | Hamoonga, Twaambo Euphemia Likwa, Rosemary Ndonyo Musonda, Patrick Michelo, Charles |
author_sort | Hamoonga, Twaambo Euphemia |
collection | PubMed |
description | BACKGROUND: The high burden of cervical cancer in Zambia prompted the Ministry of Health and partners to develop the cervical cancer prevention program in Zambia (CCPPZ) in 2006. Despite this intervention more women continue to die from the disease and there is little understanding of factors that may be linked with abnormal cervical lesions in the general population. We therefore examined if educational attainment is associated with abnormal cervical lesions among Zambian women aged 15 to 49 years. METHODS: This study used data from the cervical cancer prevention program in Zambia, where a total of 14,294 women aged 15 to 49 years were screened for cervical cancer at nine health facilities between October 2013 and September 2014. The data represents women from six provinces of Zambia, namely Southern, Central, Copperbelt, Luapula, North-western and Eastern provinces. Step-wise logistic regression analysis using the Statistical Package for the Social Sciences (SPSS) version 21 was used to estimate adjusted odds ratios (AOR) and 95% confidence intervals (CIs) for educational attainment with presence of abnormal cervical lesions as outcome. Multiple imputation was further used to obtain the imputed stabilized estimates for educational attainment. RESULTS: The prevalence of abnormal cervical lesions, using the Visual Inspection with Acetic-acid (VIA) test was 10.7% (n = 1523). Educational attainment was inversely associated with abnormal cervical lesions (AOR = 0.75; 95% CI:0.70–0.81, AOR = 0.74; 95% CI:0.68–0.81 and AOR = 0.46; 95% CI:0.41–0.51) among women with primary, secondary and tertiary education, respectively, compared to those with no formal education. CONCLUSION: We find reduced likelihood of abnormal cervical lesions in educated women, suggesting a differential imbalance with women who have no formal education. These findings may be a reflection of inequalities associated with access to cervical cancer screening, making the service inadequately accessible for lower educated groups. This might also indicate serious limitations in awareness efforts instituted in the formative phases of the program. These findings underline the prevailing need for urgent concerted efforts in repackaging cervical cancer awareness programs targeting women with low or no formal education in whom the risk may be even higher. |
format | Online Article Text |
id | pubmed-5640950 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-56409502017-10-18 Higher educational attainment associated with reduced likelihood of abnormal cervical lesions among Zambian women - a cross sectional study Hamoonga, Twaambo Euphemia Likwa, Rosemary Ndonyo Musonda, Patrick Michelo, Charles BMC Cancer Research Article BACKGROUND: The high burden of cervical cancer in Zambia prompted the Ministry of Health and partners to develop the cervical cancer prevention program in Zambia (CCPPZ) in 2006. Despite this intervention more women continue to die from the disease and there is little understanding of factors that may be linked with abnormal cervical lesions in the general population. We therefore examined if educational attainment is associated with abnormal cervical lesions among Zambian women aged 15 to 49 years. METHODS: This study used data from the cervical cancer prevention program in Zambia, where a total of 14,294 women aged 15 to 49 years were screened for cervical cancer at nine health facilities between October 2013 and September 2014. The data represents women from six provinces of Zambia, namely Southern, Central, Copperbelt, Luapula, North-western and Eastern provinces. Step-wise logistic regression analysis using the Statistical Package for the Social Sciences (SPSS) version 21 was used to estimate adjusted odds ratios (AOR) and 95% confidence intervals (CIs) for educational attainment with presence of abnormal cervical lesions as outcome. Multiple imputation was further used to obtain the imputed stabilized estimates for educational attainment. RESULTS: The prevalence of abnormal cervical lesions, using the Visual Inspection with Acetic-acid (VIA) test was 10.7% (n = 1523). Educational attainment was inversely associated with abnormal cervical lesions (AOR = 0.75; 95% CI:0.70–0.81, AOR = 0.74; 95% CI:0.68–0.81 and AOR = 0.46; 95% CI:0.41–0.51) among women with primary, secondary and tertiary education, respectively, compared to those with no formal education. CONCLUSION: We find reduced likelihood of abnormal cervical lesions in educated women, suggesting a differential imbalance with women who have no formal education. These findings may be a reflection of inequalities associated with access to cervical cancer screening, making the service inadequately accessible for lower educated groups. This might also indicate serious limitations in awareness efforts instituted in the formative phases of the program. These findings underline the prevailing need for urgent concerted efforts in repackaging cervical cancer awareness programs targeting women with low or no formal education in whom the risk may be even higher. BioMed Central 2017-10-13 /pmc/articles/PMC5640950/ /pubmed/29029626 http://dx.doi.org/10.1186/s12885-017-3680-z Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Hamoonga, Twaambo Euphemia Likwa, Rosemary Ndonyo Musonda, Patrick Michelo, Charles Higher educational attainment associated with reduced likelihood of abnormal cervical lesions among Zambian women - a cross sectional study |
title | Higher educational attainment associated with reduced likelihood of abnormal cervical lesions among Zambian women - a cross sectional study |
title_full | Higher educational attainment associated with reduced likelihood of abnormal cervical lesions among Zambian women - a cross sectional study |
title_fullStr | Higher educational attainment associated with reduced likelihood of abnormal cervical lesions among Zambian women - a cross sectional study |
title_full_unstemmed | Higher educational attainment associated with reduced likelihood of abnormal cervical lesions among Zambian women - a cross sectional study |
title_short | Higher educational attainment associated with reduced likelihood of abnormal cervical lesions among Zambian women - a cross sectional study |
title_sort | higher educational attainment associated with reduced likelihood of abnormal cervical lesions among zambian women - a cross sectional study |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5640950/ https://www.ncbi.nlm.nih.gov/pubmed/29029626 http://dx.doi.org/10.1186/s12885-017-3680-z |
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