1.1 Introduction
Cervical cancer is a malignant condition arising from the abnormal and uncontrolled growth of cells in the cervix, most commonly associated with persistent infection with high-risk types of human papillomavirus (HPV). It is one of the most preventable yet deadly cancers affecting women globally, particularly in low- and middle-income countries where organized screening programs are limited (World Health Organization, 2021). Early detection of precancerous changes through effective screening remains the cornerstone of cervical cancer prevention and control.
The Papanicolaou test, commonly known as the PAP smear, is a cytological screening method used to detect premalignant and malignant changes in cervical cells before the development of invasive cancer. The test involves the microscopic examination of exfoliated cervical cells to identify abnormalities that may indicate early disease progression. Evidence consistently shows that regular PAP smear screening significantly reduces the incidence and mortality of cervical cancer by enabling early diagnosis and timely intervention (Arbyn et al., 2020).
As a prelude to other parts of this study, this chapter will discuss the background upon which this study was initiated, the statement of problems that led to this study, the Aim and Objectives of the study. Others are significance of the study, scope of work, research hypothesis and questions, limitation of the study and definition of terms.
1.2 Background of Study
Cervical cancer is recognized as a major public health problem globally, particularly in low- and middle-income countries where screening and early detection are limited. According to the World Health Organization (2021), cervical cancer ranks as the fourth most common cancer affecting women worldwide, with an estimated 342,000 deaths recorded in 2020. The burden is disproportionately high in sub-Saharan Africa, where inadequate awareness, poor access to healthcare facilities, and socio-cultural barriers hinder effective prevention and early detection.
The Papanicolaou (PAP) smear is a well-established cytological screening method used to detect precancerous and cancerous lesions in the cervix. Arbyn et al. (2020) reported that regular PAP smear screening significantly reduces the incidence and mortality of cervical cancer through early detection and timely intervention. It is affirmed that PAP smear is a reliable, cost-effective, and widely recommended screening tool that forms the backbone of cervical cancer prevention programs in both developed and developing countries.
In Nigeria, several studies have contended that awareness and uptake of cervical cancer screening remain low despite the increasing availability of services. Eze et al. (2018) stated that many women are unaware of the benefits of regular PAP smear screening or are constrained by cost, cultural beliefs, and fear of diagnosis. It is further reported that even when screening services are accessible, follow-up of abnormal results is often poor, limiting the effectiveness of prevention efforts. Adewole et al. (2017) asserted that targeted interventions by non-governmental organizations, including Marie Stopes Nigeria, have improved access to cervical cancer screening; however, the effectiveness of these interventions in terms of screening coverage, client follow-up, and early detection outcomes remains under-evaluated.
On the other hand, structural and operational challenges in healthcare delivery, such as inadequate laboratory facilities, shortage of trained personnel, and limited public awareness campaigns, continue to undermine the potential impact of PAP smear programs. According to Bruni et al. (2020), these factors collectively contribute to late diagnosis and poor treatment outcomes, highlighting the need for continuous monitoring and evaluation of cervical cancer screening services. This study is set against the backdrop of these persistent challenges, aiming to evaluate the effectiveness, utilization, and outcomes of PAP smear screening at Marie Stopes Nigeria.
1.3 Statement of Problems
Investigation revealed that cervical cancer remains a major public health concern in low- and middle-income countries, particularly in Nigeria, where late presentation and limited access to effective screening services continue to contribute to high morbidity and mortality among women of reproductive age. The Papanicolaou (PAP) smear is globally recognized as an effective method for the early detection of precancerous cervical lesions, and its consistent use is associated with significant reductions in cervical cancer incidence and deaths (World Health Organization, 2021).
Furthermore, the absence of routine program-level evaluation of PAP smear screening limits the ability to assess whether current practices align with national and global recommendations for cervical cancer prevention. This situation is particularly concerning given Nigeria's commitment to reducing preventable female cancers and achieving universal health coverage. A systematic evaluation of cervical cancer screening using PAP smear within Marie Stopes Nigeria is therefore essential to identify existing gaps, assess performance, and generate evidence that is relevant for program improvement and public health planning. It is against this backdrop that this study seeks to evaluate cervical cancer screening using PAP smear at Marie Stopes Nigeria.
1.4 Aim and Objectives of Study
The aim of this study is to evaluate the utilization, effectiveness, and outcomes of PAP smear screening among women attending Marie Stopes Nigeria at Marie Stopes Nigeria. In achieving this aim, the following specific objectives were laid out as follows:
- To evaluate the level of utilization of PAP smear screening services among women attending Marie Stopes Nigeria.
- To assess the effectiveness of PAP smear in detecting precancerous and cancerous cervical lesions.
- To identify the socio-cultural, economic, and systemic factors affecting the uptake of PAP smear screening.
- To examine the follow-up practices for women with abnormal PAP smear results.
- To provide recommendations for improving cervical cancer screening services at Marie Stopes Nigeria.
1.5 Research Questions
The study came up with research questions so as to be able to ascertain the above stated objectives. The specific research questions for the study are stated below as follows:
- What is the level of utilization of PAP smear screening services among women attending Marie Stopes Nigeria?
- How effective is PAP smear in detecting precancerous and cancerous cervical lesions among the clients?
- What socio-cultural, economic, and systemic factors affect the uptake of PAP smear screening?
- How are follow-up procedures for abnormal PAP smear results conducted at Marie Stopes Nigeria?
- What strategies can be implemented to improve cervical cancer screening services at Marie Stopes Nigeria?
1.6 Research Hypothesis
In order to pursue the objective of this study, the following generalized statements have been designed to guide and aids in obtaining the result for the experiment to be conducted. For this work, the null hypothesis will be represented with H0 while the alternative hypothesis will be represented with hypothesis H1.
- H0: There is no significant relationship between the utilization of PAP smear screening services and the early detection of cervical abnormalities at Marie Stopes Nigeria.
- H1: There is a significant relationship between the utilization of PAP smear screening services and the early detection of cervical abnormalities at Marie Stopes Nigeria.
1.7 Significance of Study
The outcome of this research will benefit women directly by identifying barriers to screening, such as cultural beliefs, cost, or limited access, allowing healthcare organizations like Marie Stopes Nigeria to implement targeted interventions that encourage regular participation in PAP smear screening.
Furthermore, women attending Marie Stopes Nigeria will benefit from increased awareness and improved access to screening services.
Lastly, the study will add to the existing body of knowledge on cervical cancer prevention in Nigeria, providing a foundation for future research, program development, and public health education campaigns.
1.8 Scope of Study
The scope of this research is focused on evaluating cervical cancer screening using PAP smear at Marie Stopes Nigeria, Lagos State. It covers the level of utilization, effectiveness in detecting cervical abnormalities, challenges faced by clients, and follow-up practices for abnormal results. The research is limited to women accessing services at the selected Marie Stopes clinics in Lagos State.
1.9 Limitations of the Study
The study was limited by the availability of complete records of PAP smear screenings. Some clients were unable to participate due to personal constraints, and infrastructural limitations in the clinics were encountered during data collection.
1.10 Definition of Terms
Cervical Cancer: A malignant tumor of the cervix, typically associated with persistent infection by high-risk human papillomavirus types (WHO, 2021).
PAP Smear: A cytological screening test designed to detect precancerous and cancerous cells in the cervix, facilitating early diagnosis and treatment (Arbyn et al., 2020).
Screening: The systematic process of identifying individuals at risk of a specific disease, often before symptoms develop, to enable early intervention (Bruni et al., 2020).
Marie Stopes Nigeria: A non-governmental organization providing reproductive health services in Nigeria, including family planning and cervical cancer screening.
Follow-up: The process of monitoring and managing clients with abnormal screening results to ensure timely treatment and reduce progression of disease.
Utilization: The extent to which women access and make use of available PAP smear screening services at healthcare facilities.
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