Cervical cancer knowledge and screening uptake by marginalized population of women in inner-city Durban, South Africa: Insights into the need for increased health literacy

BACKGROUND: Cervical cancer in South Africa accounts for 15.85% of all female cancers and 30.29% of African female cancers, resulting in over 5000 deaths annually. South Africa’s proposed move towards universal healthcare places emphasis on health promotion through education and screening, but there is little data on the baseline levels of knowledge and screening uptake regarding cervical cancer. This study explored the levels of knowledge and screening rates of cervical cancer among vulnerable women living in the inner-city of Durban, South Africa. METHODS: A mixed-method study was conducted within the context of a Women’s Health outreach initiative. Data were collected from women attending the outreach (n = 109), many of whom were from marginalized communities. A pre-intervention survey was used to collect the data. This was followed by cervical cancer education sessions and the opportunity for a free Pap smear. RESULTS: Knowledge of cervical cancer was low (<25%) and only a third of the women had previously been screened. After the educational sessions, 64% of women (n = 70) took advantage of the opportunity for Pap smears, with many expressing the need for wider cervical cancer education, screening centres and support groups. Only 20% of the Pap smears were normal (n = 14). Half of the women tested positive for infections (n = 36; 51.4%), and a small proportion (n = 8; 11.4%) tested positive for human papilloma virus. Abnormal cervical intra-epithelial neoplasia (CIN1 and CIN 2) were also detected in this population (n = 12; 17.1%). CONCLUSION: Cervical cancer knowledge and screening among vulnerable women in Durban, South Africa, is inadequate, especially considering the high levels of abnormality found in the Pap smears. Education drives, accompanied with the provision of free testing, are required. Community health outreach initiatives in collaboration with non-government organizations set in accessible locations could be a possible course of action.