Cervical Cancer Screening: Awareness and Barriers Among University Students in Dar es Salaam, Tanzania. A Cross-Sectional Study.

Cervical Cancer Screening: Awareness and Barriers Among University Students in Dar es Salaam, Tanzania. A Cross-Sectional Study. | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Cervical Cancer Screening: Awareness and Barriers Among University Students in Dar es Salaam, Tanzania. A Cross-Sectional Study. Meshack Mushobozi Brighton, Charles John Nhungo, Gasto Frumence This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4611605/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Cervical cancer (CC) remains a global public health concern in 2020 and beyond. It is the 4 th most frequent cancer in women and stands in the 8 th place in terms of most commonly prevalent cancer globally. CC starts in the cervix and is mainly caused by high-risk strains of Human-Papilloma Virus (HPV), which are sexually transmitted. In Tanzania, there is insufficient knowledge and concerns about attitudes and perceived convenience among students regarding CCS despite the increasing incidence of the disease. Aim: This study aimed to assess the knowledge, attitudes, and perceived convenience of cervical cancer screening among university female students in Dar es Salaam, Tanzania. Methods: Data was collected using a structured questionnaire from 183 respondents who were randomly selected. The questionnaire was designed to evaluate the participants' knowledge of cervical cancer, their attitudes toward screening, and their perceptions of the convenience of undergoing cervical cancer screening. Information related to demographics and past screening experiences was also included in the questionnaire. Data analysis included both descriptive and inferential statistical methods to examine the responses and identify factors associated with knowledge, attitudes, and perceived convenience. Results: Among the 183 participants, 94% were aware of cervical cancer, and 56.9% knew about its risk factors. Knowledge about screening was limited to 36.5%, but a noteworthy 88.5% had a positive attitude towards it. There is a very weak positive correlation between the perceived convenience of the test in terms of female university students’ confidence in the physician’s ability to perform a Pap smear correctly and the rate of cervical cancer screening (r(155) = 0.352; P<0.01). Students’ perception of cervical cancer screening was influenced by personal experiences with the disease (P = 000), and their level of awareness correlated with participation in the screening program (P ≤ 0.01). Conclusion: Despite awareness and positive attitudes, a knowledge gap hampers cervical cancer screening, hindering Pap smear uptake. Healthcare practitioners should prioritize awareness and education, involving nurses who are in the front line in performing cervical cancer screening in awareness campaigns and specialized programs. Authorities should develop strategies to enhance knowledge and prevent cervical cancer in young females. Cervical cancer HPV screening perceived convenience female university students Background Cervical cancer (CC) remains a global public health concern in 2020 and beyond ( 1 )( 2 ). It is the 4th most frequent cancer in women and stands in the 8th place in terms of most commonly prevalent cancer overall globally ( 3 ). According to recent global health estimates, there is an annual incidence of over 569,847 new cases of CC, representing approximately 6.6% of all female cancers ( 3 ). These statistics highlight a significant global burden of CC, leading to approximately 250,000 deaths annually worldwide due to this disease ( 2 , 4 ). East African countries continue to be ranked among the top 20 countries with the highest age-standardized incidence rate of CC, standing at 40.1, which is three times higher than the global age-standardized incidence rate of 13.1 ( 5 ). Within the sub-Saharan African region, approximately 9.24% of all new CC cases, totaling around 52,633 cases, are reported from the East African region ( 3 ). CC starts in the cervix and is mainly caused by high-risk strains of Human-Papilloma Virus (HPV), which are sexually transmitted ( 2 ). Most HPV infections resolve spontaneously without symptoms, but if the infection persists, it can lead to the development of CC ( 6 ). Tanzania is among the five countries with the highest CC rates in Africa ( 7 ). Other top four leading countries are Malawi with age standardized rate per 1000 of 75.9 ( 8 ), Zambia with age-standardized rate per 1000 of 66.4, and Zimbabwe with age-standardized rate per 1000 of 62.3 ( 9 ). About 15.9 million women in Tanzania are at risk for CC and the country records a prevalence rate of 3.3% with about 9,772 women diagnosed with cervical CC year ( 7 ). Tanzania has set a strategic objective to decrease cancer incidence and mortality by 2030 ( 10 ). Female students have the potential to play a significant role in promoting cervical cancer screening (CCS), vaccination and serving as an important source of information for their female relatives, parents, teachers, healthcare professionals, and the broader community ( 3 ). In Tanzania, there is insufficient knowledge and concerns about attitudes and perceived convenience among students regarding CCS despite the increasing incidence of the disease. This study focused on university students because they are the future leaders of tomorrow’s generations and are responsible for increasing awareness about CCS. Methods and Materials The cross-sectional study was conducted from August to October 2021 at three universities located in Dar es salaam, the largest city in Tanzania. The city is home to several universities and colleges, attracting students from various regions of the country and beyond. The research involved women aged 15–50 years who attended the University of Dar es Salaam (UDSM), Muhimbili University of Health and Allied Sciences (MUHAS), and Ardhi University. Those with a history of hysterectomy or who declined to provide written informed consent were excluded. While the national guidelines for cervical cancer screening in Tanzania focus on women aged 30 years and above, this study included women aged 15–50 years. A sample size of 203 participants was determined to be statistically sufficient. A systematic sampling approach was employed to select participants, and standardized questionnaires were administered to eligible individuals at the three universities. The participants had various educational backgrounds and zones of origin but shared the same local language. Data on sociodemographic characteristics and variables related to CCS were collected. The questionnaires were reviewed for completeness by the principal investigator. The data were entered, cleaned, and analyzed using SPSS for Windows version 20.0, performing descriptive analysis (frequency, mean, median, SD, percentages). The chi-square test was utilized to examine the association between knowledge and attitude, as well as knowledge and perceived convenience. Univariable and multivariable logistic regression analyses were planned to examine the relationship between socio-demographic factors and knowledge of CCS. Significant relationships with a p-value < 0.2 in the univariable model were considered for inclusion in the multivariable regression model. Variables such as sex, age, and education were also taken into account for potential inclusion in the multivariable regression model. To assess knowledge, attitude, and perceived convenience on CCS, the following criteria was used. Correct responses received a score of one, while incorrect responses were assigned a score of zero for knowledge-related questions. The scores for each knowledge area were summed up and divided by the number of questions to obtain the mean score, which was then converted into a percentage. Knowledge was considered satisfactory if the percent score was 60% or higher and unsatisfactory if it fell below 60%. Attitude towards CCS was evaluated using a 5-point Likert scale, ranging from strong disagreement to strong favorable attitude. The mean score was computed by summing the item scores and dividing by the total number of items. These scores were converted into percentages, with means and standard deviations calculated. Attitudes were classified as ‘favorable’ if the percent score was 60% or higher and ‘unfavorable’ if it was below 60%. Perceived convenience was assessed by determining if respondents had undergone a screening test for precancerous lesions, either once or within the past 3 years. Those who had undergone screening were classified as following the recommended practice, while those who had not were classified differently. Results Demographic characteristics of study participants. Out of the 200 female students from three universities who were asked to fill out the questionnaires, a total of 183 students completed them, resulting in a response rate of 91.5%. The age of the participants ranged from 18 to 29 years, with an average age of 22.4 years. The majority of participants (53%) were from UDSM, and a significant proportion (28.4%) came from the northern zone (Table 1 ). Table 1 Demographic characteristics of study participants (N = 183) Variables and Categories Scores Age of respondents Frequency (n) Percentage (%) 15–19 Years 2 1.1% 20–24 Years 167 91.3% 25–49 Years 14 7.6% Schooling University Ardhi University 48 26% MUHAS 38 21% UDSM 97 53% Marital Status Single 166 90.7% Married 8 4.4% Widowed 1 0.5% Cohabiting 8 4.4% Area of residence Lake zone 38 20.8% Central zone 34 18.6% Eastern zone 28 15.3% Northern zone 52 28.4% Southern 5 2.7% Southern highland zone 22 12.1% Western zone 3 2.0% Respondents religion Christian 167 91% Muslim 16 9% Parity (number of children) At least one child 29 16% None 154 84% Knowledge of participants on Cervical Cancer and screening. About 94% were aware of CC and approximately 56.9% of the participants had prior knowledge of CC and its associated risk factors. Among them, 40.9% believed that having multiple sexual partners was a major risk factor, while 48.2% identified early initiation of sexual intercourse and 10.9% recognized HPV as significant risk factors for CC. In terms of prevention, 57.1% mentioned avoiding multiple sexual partners, 26.3% mentioned preventing HPV infection, and 16.6% mentioned using condoms during sexual intercourse. Only a small percentage (8.4%) of participants was aware that CC could lead to death. Mass media, such as television and radio, served as the main source of information about CC (54.2%), followed by health workers (24.9%) who were mainly nurses, brochures and posters (15.7%), and teachers (5.2%). Merely 39.1% of participants were knowledgeable about screening procedures, with 58.6% mentioning Pap smear and 41.3% acknowledging visual inspection with the application of acetic acid. Mass media (TV and radio) were the primary source of information on screening procedures (97.2%), while reading books (2.4%) and teachers (0.29%) accounted for a smaller proportion. Overall, the findings suggest that the participants’ knowledge of CC and its screening was inadequate. Specifically, 63.47% of participants demonstrated unsatisfactory knowledge of CCS. Attitude on cervical cancer screening. The analysis showed that a majority of the participants, 88.5%, acknowledged the screening is an essential part of women’s health care. Similarly, 93.4% of the participants agreed that CC is a deadly disease if diagnosed late. More than half (51.4%) of the participants agreed that Pap smear is important at their present age. On the other hand, significant number (61.2%) of participants said they will be ashamed to be screened for CC while 70.5% of participants do not believe that screening will ever prevent cancer development if it has already started. See Table 2 . Table 2 Attitude towards CC screening among study participants (N = 183) Variables and categories Attitude Mean Score Positive attitude (%) Negative attitude (%) Cervical cancer screening is an essential part of women’s health care 162 (88.5%) 21 (11.5%) 4.58 Cervical cancer is a very serious disease 171 (93.4%) 12 (6.6%) 4.64 A cervical cancer screening program should be started in my community 172 (93.9%) 11 (6.1%) 4.67 Pap tests are important for a woman at my age 94 (51.4%) 89 (48.6%) 3.15 I would not be ashamed to lie on a gynecologic examination table and show my private parts during a cervical exam 71 (38.8%) 112 (61.2%) 3.69 I prefer a female health worker to conduct cervical exams 31 (16.9%) 152 (83.1%) 4.41 Having cervical exams takes too much time 94 (51.4%) 89 (48.6%) 3.56 If there is cancer development in my destiny, having cervical exams will prevent it 54 (29.5%) 129 (70.5%) 3.58 I will not be stressed after finding the cancer screening results 26 (14.2%) 157 (85.8%) 3.86 Perceived convenience. Regarding perceived convenience of screening, the findings suggest that only 4.4% of participants had ever received a Pap smear. Among those who reported undergoing a test within the past 12 months, the majority (90%) stated that they had the test less frequently than every two years, while only a small percentage (10%) reported having a test annually. The study discovered that the perceived convenience of the Pap smear test procedure is slightly related to the rate of cervical cancer screening (r(161) = 0.678; P < 0.01). Additionally, there is a very weak positive correlation between the perceived convenience of the test in terms of female university students’ confidence in the physician’s ability to perform a Pap smear correctly and the rate of cervical cancer screening (r(155) = 0.352; P < 0.01). Conversely, the test model showed a negative correlation between the reasons for undergoing cervical cancer screening and the actual uptake of screening among female university students (r(174) = -0.278; P < 0.01). Discussion The findings of this research indicate that over 94% of the respondents are familiar with CC. The study’s notable level of awareness could possibly be linked to the fact that it was conducted in a city where students have media exposure and their educational background grants them access to written resources about diseases ( 6 ). Comparable levels of awareness were observed in research conducted among women in various locations, including Erciyes University in Turkey, Hawasa University in Ethiopia and Niger-Delta University in Nigeria ( 11 – 13 ). In contrast, awareness of CC in this study was significantly higher than similar studies conducted in Botswana and South Africa ( 14 , 15 ). In this study, participants cited mass media (54.2%) as the main source of information on CCS, followed by health workers (24.9%) and none reported to have heard from teachers. Similar findings have been reported among women in India and other Asian countries, where the majority relied on mass media for information ( 16 , 17 ). This indicates that health workers and teachers should step up their efforts to educate the public about cervical cancer screening, as there seems to be a gap in their expected contributions. Enhancing awareness and education on CCS can lead to better early detection and prevention. Approximately 56.9% of the participants in the study possessed sufficient knowledge regarding CC and its risk factors. Knowledge regarding CCS, on the other hand, was only present among 36.5% of the participants. Similar percentages were observed among women in South Africa and Zimbabwe, where fewer than 40% were aware of CC screening ( 18 , 19 ). Studies in South Africa, Nigeria, Qatar, and Zimbabwe revealed insufficient knowledge and awareness about CC and its screening ( 20 – 23 ). Unlike the aforementioned studies, a study in a Malaysian tertiary institution found that knowledge about CC was considered satisfactory ( 24 ). In this study, a significant proportion (88.5%) of participants had a positive attitude towards CCS, although higher compared to similar studies in Arsi University (81.8%) and Wollenga University in Western Ethiopia (44%) ( 6 , 25 ). Only 51.4% understood the significance of Pap smears in identifying precancerous lesions, and 70.5% questioned the potential for early detection of cervical cancer to halt disease progression. These insights highlight the need for improved education and information dissemination on this critical health issue. Insufficient knowledge about CC and screening is linked to a low uptake of CCS, especially the Pap smear test. Among those aware of the test, the uptake rate was approximately 7.9%, surpassing the 3% uptake rate observed among Zimbabwean female university students ( 26 ). According to results documented by this study, perceived convenience of discomfort/pain was found to dictate willingness on a Pap smear test among most female university students (89.62%). And based on the study, the perceived convenience played a significant role in predicting the uptake of CCS. Similar findings were reported in a study which was conducted in Namibia on women’s perception of CC Pap smear screening ( 27 ). In contrast to the studies mentioned earlier, a study conducted in Botswana found that perceived convenience did not emerge as a significant predictor for CCS ( 28 ). Concerning factors predicting CCS uptake rate, not being aware of the test (56.4%) was a major factor. Similar observations in South Africa recognized that inadequate awareness of the screening test contributed to low participation in CCS ( 1 ). The results of study also reveal that a participation rate of woman in screening is attributed to fear of CC diagnosis and treatment (34.62%). Other fences towards participation in CCS among university female students were not being convenient/no time, marital status, geographical location and parity in number of children. Anyhow this study may be considered as the first study to report the influence of geographical area of residence on Pap smear test uptake rate among study participants and other female university students in Tanzania. Knowledge level on CCS specifically on the eligibility for the Pap smear test was low/poor among most respondents with only 30.8% demonstrating satisfactory understanding on Pap smear test eligibility and others were uncertain. Study Limitation. The utilization of a cross-sectional design in this study prevents the establishment of a cause-and-effect relationship. Additionally, the small sample size poses a potential limitation that could lead to statistical imprecision. Conclusion Despite a heightened level of awareness and favorable attitudes, a noticeable knowledge gap persists in the domain of CC screening, which, in turn, is a contributing factor to the limited adoption of Pap smear tests. Healthcare practitioners should place a premium on enhancing awareness and dispensing educational resources. In many healthcare contexts, the responsibility of conducting CCS is typically delegated to nurses, making their active participation in awareness campaigns imperative. It would be advantageous to orchestrate specialized programs aimed at bolstering awareness. Pertinent governing bodies and authorities ought to formulate comprehensive strategies, enact policies, and establish healthcare initiatives geared toward augmenting knowledge and preventing cervical cancer among the younger female demographic. Declarations Patient or Public Contribution: This research did not involve direct patient or public contribution in the data collection process, as data was gathered solely through the structured questionnaire. Ethics approval and consent to participate. Ethical approval was obtained from the IRB of University of Dar es salaam, College of Social Sciences, Dar es salaam Tanzania, REF: UDSM-REC-29-20201916. All methods were carried out in accordance with relevant guidelines and regulations. All participants signed informed consent for participation in the study and provided their information for use in this research. Consent for publication. Not applicable. Availability of data and materials All materials pertinent to this research are available and will be provided by the corresponding author upon reasonable request. Competing interests There are no known conflicts of interest associated with this publication to disclose. Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Author contributions The principal investigators (Meshack Brighton &Charles Nhungo) prepared the full-text article of this article, and all other authors reviewed and contributed their expert opinions. Charles Nhungo and Meshack Brighton had access to all the data in this study, took full responsibility for data integrity and ensured the accuracy of the data analysis. Concept and Design: M.B &C.N. Acquisition, analysis, and interpretation of data: M.B &C. N Drafting of Manuscript: M.B &C. N Critical revision of the manuscript for intellectual content: G.F Statistical analysis: M.B &C. N Administrative, technical, or material support: M.B &C. N Supervision: G. F Acknowledgements To everyone who contributed any resources for the accomplishment of this project. Author declaration. We confirm that all persons who contributed to the manuscript are listed, that the manuscript has been read and revied by all named authors and that the order of the authors listed has been approved by every author. We confirm that we have given due consideration to the protection of intellectual property associated with this work and that there are no impediments to publication, including the timing of publication. We confirm that all work in this manuscript involving human patients has been conducted with ethical approval from all relevant bodies and that such approvals are acknowledged within the manuscript. References Lim JNW, Ojo AA. Barriers to utilisation of cervical cancer screening in Sub Sahara Africa: a systematic review. Eur J Cancer Care (Engl). 2017 Jan;26(1). Bruni L, Albero G, Serrano B, Mena M, Collado JJ, Gómez D, Muñoz J, Bosch FX de SS. Human Papillomavirus and Related Diseases in United Republic of Tanzania. ICO/IARC Inf Cent HPV Cancer (HPV Inf Centre) [Internet]. 2021;Summary Re(October). Available from: www.hpvcentre.com Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394–424. Statistics World Health. Monitoring Health for the SDGs, Sustainable Development Goals. WHO. 2019; M. Kei R. Challenges of Cervical Cancer Screening Among Women of Reproductive Age in Kisii Town, Kisii County, Kenya. Sci J Public Heal. 2016;4(4):289. Tilahun T, Tulu T, Dechasa W. Knowledge, attitude and practice of cervical cancer screening and associated factors amongst female students at Wollega University, western Ethiopia. BMC Res Notes [Internet]. 2019;12(1):1–5. Available from: https://doi.org/10.1186/s13104-019-4564-x Gesink MP, Chamberlain RM, Mwaiselage J, Kahesa C, Jackson K, Mueller W, et al. Quantifying the under-estimation of cervical Cancer in remote regions of Tanzania. BMC Cancer. 2020;20(1):1–8. Msyamboza KP, Phiri T, Sichali W, Kwenda W, Kachale F. Cervical cancer screening uptake and challenges in Malawi from 2011 to 2015: retrospective cohort study. BMC Public Health. 2016 Aug;16(1):806. Kuguyo O, Matimba A, Tsikai N, Magwali T, Madziyire M, Gidiri M, et al. Cervical cancer in Zimbabwe: a situation analysis. Pan Afr Med J. 2017;27:215. Levin A, Yuma S, Swai E, Morgan W, Gauvreau CL, Broutet N, et al. Comprehensive approach to costing cervical cancer prevention and control: a case study in the United Republic of Tanzania using the Cervical Cancer Prevention and Control Costing (C4P) tool. BMC Med [Internet]. 2022;20(1):1–10. Available from: https://doi.org/10.1186/s12916-022-02576-x Gultie T. Knowledge and attitude towards cervical cancer screening and associated factors among female Hawassa university college of medicine and health sciences students. MOJ Public Heal. 2018;7(3):151–8. Owoeye IOG, Ibrahim . IA. Knowledge and attitude towards cervical cancer screening among female students and staff in a tertiary institution in the Niger Delta. Int J Med Biomed Res. 2013;2(1):48–56. Borlu A, Gunay O, Balci E, Sagiroglu M. Knowledge and attitudes of medical and non-medical Turkish university students about cervical cancer and HPV vaccination. Asian Pacific J Cancer Prev. 2016;17(1):299–303. Tapera R, Manyala E, Erick P, Maswabi TM, Tumoyagae T, Letsholo B, et al. Knowledge and attitudes towards cervical cancer screening amongst University of Botswana female students. Asian Pacific J Cancer Prev. 2017;18(9):2445–50. Hoque E, Hoque M. Knowledge of and attitude towards cervical cancer among female university students in South Africa. South African J Epidemiol Infect. 2009;24(1):21–4. Schliemann D, Su TT, Paramasivam D, Treanor C, Dahlui M, Loh SY, et al. Effectiveness of Mass and Small Media Campaigns to Improve Cancer Awareness and Screening Rates in Asia: A Systematic Review. J Glob Oncol. 2019 Apr;5:1–20. Harsha Kumar H, Tanya S. A Study on Knowledge and Screening for Cervical Cancer among Women in Mangalore City. Ann Med Health Sci Res. 2014 Sep;4(5):751–6. Mudzindiko T, Mukona DM, Zvinavashe M, Ndaimani A, Mhlanga M. Knowledge of cervical cancer and uptake of cervical cancer screening in women aged 18-45 years at a central hospital in Harare, Zimbabwe. Nova. 2017;6(1):1–8. Omoyeni O, Tsoka-Gwegweni J. Knowledge, attitudes and practices of cervical cancer screening among rural women in KwaZulu-Natal, South Africa. Pan Afr Med J. 2022;42:188. Ramathuba DU, Ngambi D, Khoza LB, Ramakuela NJ. Knowledge, attitudes and practices regarding cervical cancer prevention at Thulamela Municipality of Vhembe District in Limpopo Province. African J Prim Heal care Fam Med. 2016 Jun;8(2):e1--7. Maree JE, Moitse KA. Exploration of knowledge of cervical cancer and cervical cancer screening amongst HIV-positive women. Curationis. 2014 Oct;37(1):1209. Tapera O, Dreyer G, Kadzatsa W, Nyakabau AM, Stray-Pedersen B, Sjh H. Health system constraints affecting treatment and care among women with cervical cancer in Harare, Zimbabwe. BMC Health Serv Res. 2019 Nov;19(1):829. Ramaiah R, Jayarama S. Knowledge, attitude and practices about cervical cancer among rural married women: a cross sectional study. Int J Community Med Public Heal. 2018;5(4):1466–70. Al-Naggar RA, Low WY, Isa ZM. Knowledge and barriers towards cervical cancer screening among young women in Malaysia. Asian Pac J Cancer Prev. 2010;11(4):867–73. DBaW Y. Knowledge, attitude and practice towards cervical cancer screening among Arsi University female students. J Women’s Heal Care. 2016;5(6). Ghotbi N, Anai A. Assessment of the knowledge and attitude of female students towards cervical cancer prevention at an international university in Japan. Asian Pac J Cancer Prev. 2012;13(3):897–900. Siseho KN, Omoruyi BE, Okeleye BI, Okudoh VI, Amukugo HJ, Aboua YG. Women’s perception of cervical cancer pap smear screening. Nurs Open. 2022;9(3):1715–22. Ibekwe CM, Hoque ME, Ntuli-Ngcobo B. Perceived benefits of cervical cancer screening among women attending Mahalapye District Hospital, Botswana. Asian Pac J Cancer Prev. 2010;11(4):1021–7. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4611605","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":318213985,"identity":"c611a3b6-1f26-4075-9245-e50b76530139","order_by":0,"name":"Meshack Mushobozi Brighton","email":"","orcid":"","institution":"Muhimbili University of Health and Allied Science","correspondingAuthor":false,"prefix":"","firstName":"Meshack","middleName":"Mushobozi","lastName":"Brighton","suffix":""},{"id":318213986,"identity":"223f1800-97fb-4069-8685-063918b76e92","order_by":1,"name":"Charles John Nhungo","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9ElEQVRIiWNgGAWjYDACCSB+AMQGYF4FEDMzNxDWkgDXcgakhZEULYxtYBK/Fv7Zzc8+JFTU5ZlL5B5+8XFebTR/O1DLj4ptuC25c8x4RsKZw8WWM/LSLGduO5474zBjA2PPmds4tRhIJBgzJLYdSNxwI8fMmHfbsdwGoBZmxjZ8WtI/MyT+q4NqmXMsdz5hLTlAWxqYQVqMH/M21ORuIKRF4kZOMUPCscOJG868MWOccexA7kagloP4/MI/I30zw4caoMOO5xh/ADJy550/fPDBjwrcWpABGzCODoNZB4hSDwTMHxgY6ohVPApGwSgYBSMIAACpYmCB/VhuLAAAAABJRU5ErkJggg==","orcid":"","institution":"Muhimbili University of Health and Allied Science","correspondingAuthor":true,"prefix":"","firstName":"Charles","middleName":"John","lastName":"Nhungo","suffix":""},{"id":318213987,"identity":"3a176255-624a-4f27-a51e-4e5f70c6c62a","order_by":2,"name":"Gasto Frumence","email":"","orcid":"","institution":"University of Dar es Salaam","correspondingAuthor":false,"prefix":"","firstName":"Gasto","middleName":"","lastName":"Frumence","suffix":""}],"badges":[],"createdAt":"2024-06-20 12:00:52","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4611605/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4611605/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":84475323,"identity":"b796f6b3-da88-4ebf-bdb5-e3e795fff061","added_by":"auto","created_at":"2025-06-12 11:17:09","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":690407,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4611605/v1/092149a9-6828-49b3-9360-b26fcf7b853a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Cervical Cancer Screening: Awareness and Barriers Among University Students in Dar es Salaam, Tanzania. A Cross-Sectional Study.","fulltext":[{"header":"Background","content":"\u003cp\u003eCervical cancer (CC) remains a global public health concern in 2020 and beyond (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). It is the 4th most frequent cancer in women and stands in the 8th place in terms of most commonly prevalent cancer overall globally (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). According to recent global health estimates, there is an annual incidence of over 569,847 new cases of CC, representing approximately 6.6% of all female cancers (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). These statistics highlight a significant global burden of CC, leading to approximately 250,000 deaths annually worldwide due to this disease (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). East African countries continue to be ranked among the top 20 countries with the highest age-standardized incidence rate of CC, standing at 40.1, which is three times higher than the global age-standardized incidence rate of 13.1 (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Within the sub-Saharan African region, approximately 9.24% of all new CC cases, totaling around 52,633 cases, are reported from the East African region (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eCC starts in the cervix and is mainly caused by high-risk strains of Human-Papilloma Virus (HPV), which are sexually transmitted (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Most HPV infections resolve spontaneously without symptoms, but if the infection persists, it can lead to the development of CC (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Tanzania is among the five countries with the highest CC rates in Africa (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Other top four leading countries are Malawi with age standardized rate per 1000 of 75.9 (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e), Zambia with age-standardized rate per 1000 of 66.4, and Zimbabwe with age-standardized rate per 1000 of 62.3 (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). About 15.9\u0026nbsp;million women in Tanzania are at risk for CC and the country records a prevalence rate of 3.3% with about 9,772 women diagnosed with cervical CC year (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTanzania has set a strategic objective to decrease cancer incidence and mortality by 2030 (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Female students have the potential to play a significant role in promoting cervical cancer screening (CCS), vaccination and serving as an important source of information for their female relatives, parents, teachers, healthcare professionals, and the broader community (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). In Tanzania, there is insufficient knowledge and concerns about attitudes and perceived convenience among students regarding CCS despite the increasing incidence of the disease. This study focused on university students because they are the future leaders of tomorrow’s generations and are responsible for increasing awareness about CCS.\u003c/p\u003e "},{"header":"Methods and Materials","content":"\u003cp\u003eThe cross-sectional study was conducted from August to October 2021 at three universities located in Dar es salaam, the largest city in Tanzania. The city is home to several universities and colleges, attracting students from various regions of the country and beyond. The research involved women aged 15–50 years who attended the University of Dar es Salaam (UDSM), Muhimbili University of Health and Allied Sciences (MUHAS), and Ardhi University. Those with a history of hysterectomy or who declined to provide written informed consent were excluded. While the national guidelines for cervical cancer screening in Tanzania focus on women aged 30 years and above, this study included women aged 15–50 years. A sample size of 203 participants was determined to be statistically sufficient.\u003c/p\u003e\u003cp\u003eA systematic sampling approach was employed to select participants, and standardized questionnaires were administered to eligible individuals at the three universities. The participants had various educational backgrounds and zones of origin but shared the same local language. Data on sociodemographic characteristics and variables related to CCS were collected. The questionnaires were reviewed for completeness by the principal investigator. The data were entered, cleaned, and analyzed using SPSS for Windows version 20.0, performing descriptive analysis (frequency, mean, median, SD, percentages). The chi-square test was utilized to examine the association between knowledge and attitude, as well as knowledge and perceived convenience.\u003c/p\u003e\u003cp\u003eUnivariable and multivariable logistic regression analyses were planned to examine the relationship between socio-demographic factors and knowledge of CCS. Significant relationships with a p-value \u0026lt; 0.2 in the univariable model were considered for inclusion in the multivariable regression model. Variables such as sex, age, and education were also taken into account for potential inclusion in the multivariable regression model.\u003c/p\u003e\u003cp\u003eTo assess knowledge, attitude, and perceived convenience on CCS, the following criteria was used. Correct responses received a score of one, while incorrect responses were assigned a score of zero for knowledge-related questions. The scores for each knowledge area were summed up and divided by the number of questions to obtain the mean score, which was then converted into a percentage. Knowledge was considered satisfactory if the percent score was 60% or higher and unsatisfactory if it fell below 60%.\u003c/p\u003e\u003cp\u003eAttitude towards CCS was evaluated using a 5-point Likert scale, ranging from strong disagreement to strong favorable attitude. The mean score was computed by summing the item scores and dividing by the total number of items. These scores were converted into percentages, with means and standard deviations calculated. Attitudes were classified as ‘favorable’ if the percent score was 60% or higher and ‘unfavorable’ if it was below 60%.\u003c/p\u003e\u003cp\u003ePerceived convenience was assessed by determining if respondents had undergone a screening test for precancerous lesions, either once or within the past 3 years. Those who had undergone screening were classified as following the recommended practice, while those who had not were classified differently.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e \u003cb\u003eDemographic characteristics of study participants.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eOut of the 200 female students from three universities who were asked to fill out the questionnaires, a total of 183 students completed them, resulting in a response rate of 91.5%. The age of the participants ranged from 18 to 29 years, with an average age of 22.4 years. The majority of participants (53%) were from UDSM, and a significant proportion (28.4%) came from the northern zone (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic characteristics of study participants (N\u0026thinsp;=\u0026thinsp;183)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables and Categories\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eScores\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge of respondents\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u0026ndash;19 Years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20\u0026ndash;24 Years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e167\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e91.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25\u0026ndash;49 Years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSchooling University\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eArdhi University\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMUHAS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUDSM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e166\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e90.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWidowed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCohabiting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eArea of residence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLake zone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCentral zone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEastern zone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNorthern zone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSouthern\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSouthern highland zone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWestern zone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRespondents religion\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChristian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e167\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e91%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMuslim\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eParity (number of children)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAt least one child\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e154\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e84%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eKnowledge of participants on Cervical Cancer and screening.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eAbout 94% were aware of CC and approximately 56.9% of the participants had prior knowledge of CC and its associated risk factors. Among them, 40.9% believed that having multiple sexual partners was a major risk factor, while 48.2% identified early initiation of sexual intercourse and 10.9% recognized HPV as significant risk factors for CC.\u003c/p\u003e \u003cp\u003eIn terms of prevention, 57.1% mentioned avoiding multiple sexual partners, 26.3% mentioned preventing HPV infection, and 16.6% mentioned using condoms during sexual intercourse. Only a small percentage (8.4%) of participants was aware that CC could lead to death. Mass media, such as television and radio, served as the main source of information about CC (54.2%), followed by health workers (24.9%) who were mainly nurses, brochures and posters (15.7%), and teachers (5.2%). Merely 39.1% of participants were knowledgeable about screening procedures, with 58.6% mentioning Pap smear and 41.3% acknowledging visual inspection with the application of acetic acid. Mass media (TV and radio) were the primary source of information on screening procedures (97.2%), while reading books (2.4%) and teachers (0.29%) accounted for a smaller proportion. Overall, the findings suggest that the participants\u0026rsquo; knowledge of CC and its screening was inadequate. Specifically, 63.47% of participants demonstrated unsatisfactory knowledge of CCS.\u003c/p\u003e \u003cp\u003e \u003cb\u003eAttitude on cervical cancer screening.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe analysis showed that a majority of the participants, 88.5%, acknowledged the screening is an essential part of women\u0026rsquo;s health care. Similarly, 93.4% of the participants agreed that CC is a deadly disease if diagnosed late. More than half (51.4%) of the participants agreed that Pap smear is important at their present age. On the other hand, significant number (61.2%) of participants said they will be ashamed to be screened for CC while 70.5% of participants do not believe that screening will ever prevent cancer development if it has already started. See Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAttitude towards CC screening among study participants (N\u0026thinsp;=\u0026thinsp;183)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables and categories\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eAttitude\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMean Score\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePositive attitude (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNegative attitude (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCervical cancer screening is an essential part of women\u0026rsquo;s health care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e162 (88.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21 (11.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.58\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCervical cancer is a very serious disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e171 (93.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12 (6.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.64\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA cervical cancer screening program should be started in my community\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e172 (93.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11 (6.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.67\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePap tests are important for a woman at my age\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e94 (51.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e89 (48.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI would not be ashamed to lie on a gynecologic examination table and show my private parts during a cervical exam\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e71 (38.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e112 (61.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.69\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI prefer a female health worker to conduct cervical exams\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e31 (16.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e152 (83.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.41\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHaving cervical exams takes too much time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e94 (51.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e89 (48.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.56\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIf there is cancer development in my destiny, having cervical exams will prevent it\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e54 (29.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e129 (70.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.58\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI will not be stressed after finding the cancer screening results\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26 (14.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e157 (85.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.86\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003ePerceived convenience.\u003c/b\u003e \u003c/p\u003e \u003cp\u003e Regarding perceived convenience of screening, the findings suggest that only 4.4% of participants had ever received a Pap smear. Among those who reported undergoing a test within the past 12 months, the majority (90%) stated that they had the test less frequently than every two years, while only a small percentage (10%) reported having a test annually.\u003c/p\u003e \u003cp\u003eThe study discovered that the perceived convenience of the Pap smear test procedure is slightly related to the rate of cervical cancer screening (r(161)\u0026thinsp;=\u0026thinsp;0.678; P\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Additionally, there is a very weak positive correlation between the perceived convenience of the test in terms of female university students\u0026rsquo; confidence in the physician\u0026rsquo;s ability to perform a Pap smear correctly and the rate of cervical cancer screening (r(155)\u0026thinsp;=\u0026thinsp;0.352; P\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Conversely, the test model showed a negative correlation between the reasons for undergoing cervical cancer screening and the actual uptake of screening among female university students (r(174) = -0.278; P\u0026thinsp;\u0026lt;\u0026thinsp;0.01).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe findings of this research indicate that over 94% of the respondents are familiar with CC. The study\u0026rsquo;s notable level of awareness could possibly be linked to the fact that it was conducted in a city where students have media exposure and their educational background grants them access to written resources about diseases (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eComparable levels of awareness were observed in research conducted among women in various locations, including Erciyes University in Turkey, Hawasa University in Ethiopia and Niger-Delta University in Nigeria (\u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). In contrast, awareness of CC in this study was significantly higher than similar studies conducted in Botswana and South Africa (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). In this study, participants cited mass media (54.2%) as the main source of information on CCS, followed by health workers (24.9%) and none reported to have heard from teachers. Similar findings have been reported among women in India and other Asian countries, where the majority relied on mass media for information (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). This indicates that health workers and teachers should step up their efforts to educate the public about cervical cancer screening, as there seems to be a gap in their expected contributions. Enhancing awareness and education on CCS can lead to better early detection and prevention.\u003c/p\u003e \u003cp\u003eApproximately 56.9% of the participants in the study possessed sufficient knowledge regarding CC and its risk factors. Knowledge regarding CCS, on the other hand, was only present among 36.5% of the participants. Similar percentages were observed among women in South Africa and Zimbabwe, where fewer than 40% were aware of CC screening (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Studies in South Africa, Nigeria, Qatar, and Zimbabwe revealed insufficient knowledge and awareness about CC and its screening (\u003cspan additionalcitationids=\"CR21 CR22\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Unlike the aforementioned studies, a study in a Malaysian tertiary institution found that knowledge about CC was considered satisfactory (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). In this study, a significant proportion (88.5%) of participants had a positive attitude towards CCS, although higher compared to similar studies in Arsi University (81.8%) and Wollenga University in Western Ethiopia (44%) (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Only 51.4% understood the significance of Pap smears in identifying precancerous lesions, and 70.5% questioned the potential for early detection of cervical cancer to halt disease progression. These insights highlight the need for improved education and information dissemination on this critical health issue.\u003c/p\u003e \u003cp\u003eInsufficient knowledge about CC and screening is linked to a low uptake of CCS, especially the Pap smear test. Among those aware of the test, the uptake rate was approximately 7.9%, surpassing the 3% uptake rate observed among Zimbabwean female university students (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). According to results documented by this study, perceived convenience of discomfort/pain was found to dictate willingness on a Pap smear test among most female university students (89.62%). And based on the study, the perceived convenience played a significant role in predicting the uptake of CCS. Similar findings were reported in a study which was conducted in Namibia on women\u0026rsquo;s perception of CC Pap smear screening (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). In contrast to the studies mentioned earlier, a study conducted in Botswana found that perceived convenience did not emerge as a significant predictor for CCS (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eConcerning factors predicting CCS uptake rate, not being aware of the test (56.4%) was a major factor. Similar observations in South Africa recognized that inadequate awareness of the screening test contributed to low participation in CCS (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). The results of study also reveal that a participation rate of woman in screening is attributed to fear of CC diagnosis and treatment (34.62%). Other fences towards participation in CCS among university female students were not being convenient/no time, marital status, geographical location and parity in number of children. Anyhow this study may be considered as the first study to report the influence of geographical area of residence on Pap smear test uptake rate among study participants and other female university students in Tanzania. Knowledge level on CCS specifically on the eligibility for the Pap smear test was low/poor among most respondents with only 30.8% demonstrating satisfactory understanding on Pap smear test eligibility and others were uncertain.\u003c/p\u003e \u003cp\u003e \u003cb\u003eStudy Limitation.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe utilization of a cross-sectional design in this study prevents the establishment of a cause-and-effect relationship. Additionally, the small sample size poses a potential limitation that could lead to statistical imprecision.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eDespite a heightened level of awareness and favorable attitudes, a noticeable knowledge gap persists in the domain of CC screening, which, in turn, is a contributing factor to the limited adoption of Pap smear tests. Healthcare practitioners should place a premium on enhancing awareness and dispensing educational resources. In many healthcare contexts, the responsibility of conducting CCS is typically delegated to nurses, making their active participation in awareness campaigns imperative. It would be advantageous to orchestrate specialized programs aimed at bolstering awareness. Pertinent governing bodies and authorities ought to formulate comprehensive strategies, enact policies, and establish healthcare initiatives geared toward augmenting knowledge and preventing cervical cancer among the younger female demographic.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003ePatient or Public Contribution:\u003c/strong\u003e This research did not involve direct patient or public contribution in the data collection process, as data was gathered solely through the structured questionnaire.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the IRB of University of Dar es salaam, College of Social Sciences, Dar es salaam Tanzania, REF: UDSM-REC-29-20201916. All methods were carried out in accordance with relevant guidelines and regulations. All participants signed informed consent for participation in the study and provided their information for use in this research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll materials pertinent to this research are available and\u0026nbsp;will\u0026nbsp;be provided by the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere are no known conflicts of interest associated with this publication to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe principal investigators (Meshack Brighton \u0026amp;Charles Nhungo) prepared the full-text article of this article, and all other authors reviewed and contributed their expert opinions. Charles Nhungo and Meshack Brighton had access to all the data in this study, took full responsibility for data integrity and ensured the accuracy of the data analysis.\u003c/p\u003e\n\u003cp\u003eConcept and Design: M.B \u0026amp;C.N.\u003c/p\u003e\n\u003cp\u003eAcquisition, analysis, and interpretation of data: M.B \u0026amp;C. N\u003c/p\u003e\n\u003cp\u003eDrafting of Manuscript: M.B \u0026amp;C. N\u003c/p\u003e\n\u003cp\u003eCritical revision of the manuscript for intellectual content: G.F\u003c/p\u003e\n\u003cp\u003eStatistical analysis: M.B \u0026amp;C. N\u003c/p\u003e\n\u003cp\u003eAdministrative, technical, or material support: M.B \u0026amp;C. N\u003c/p\u003e\n\u003cp\u003eSupervision: G. F\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo everyone who contributed any\u0026nbsp;resources\u0026nbsp;for\u0026nbsp;the\u0026nbsp;accomplishment of this project.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor declaration.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe confirm that all persons who contributed to the manuscript are listed, that the manuscript has been read and revied by all named authors and that the order of the authors listed has been approved by every author.\u003c/p\u003e\n\u003cp\u003eWe confirm that we have given due consideration to the protection of intellectual property associated with this work and that there are no impediments to publication, including the timing of publication. We confirm that all work in this manuscript involving human patients has been conducted with ethical approval from all relevant bodies and that such approvals are acknowledged within the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eLim JNW, Ojo AA. Barriers to utilisation of cervical cancer screening in Sub Sahara Africa: a systematic review. Eur J Cancer Care (Engl). 2017 Jan;26(1).\u003c/li\u003e\n \u003cli\u003eBruni L, Albero G, Serrano B, Mena M, Collado JJ, G\u0026oacute;mez D, Mu\u0026ntilde;oz J, Bosch FX de SS. Human Papillomavirus and Related Diseases in United Republic of Tanzania. ICO/IARC Inf Cent HPV Cancer (HPV Inf Centre) [Internet]. 2021;Summary Re(October). Available from: www.hpvcentre.com\u003c/li\u003e\n \u003cli\u003eBray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394\u0026ndash;424.\u003c/li\u003e\n \u003cli\u003eStatistics World Health. Monitoring Health for the SDGs, Sustainable Development Goals. WHO. 2019;\u003c/li\u003e\n \u003cli\u003eM. Kei R. Challenges of Cervical Cancer Screening Among Women of Reproductive Age in Kisii Town, Kisii County, Kenya. Sci J Public Heal. 2016;4(4):289.\u003c/li\u003e\n \u003cli\u003eTilahun T, Tulu T, Dechasa W. Knowledge, attitude and practice of cervical cancer screening and associated factors amongst female students at Wollega University, western Ethiopia. BMC Res Notes [Internet]. 2019;12(1):1\u0026ndash;5. Available from: https://doi.org/10.1186/s13104-019-4564-x\u003c/li\u003e\n \u003cli\u003eGesink MP, Chamberlain RM, Mwaiselage J, Kahesa C, Jackson K, Mueller W, et al. Quantifying the under-estimation of cervical Cancer in remote regions of Tanzania. BMC Cancer. 2020;20(1):1\u0026ndash;8.\u003c/li\u003e\n \u003cli\u003eMsyamboza KP, Phiri T, Sichali W, Kwenda W, Kachale F. Cervical cancer screening uptake and challenges in Malawi from 2011 to 2015: retrospective cohort study. BMC Public Health. 2016 Aug;16(1):806.\u003c/li\u003e\n \u003cli\u003eKuguyo O, Matimba A, Tsikai N, Magwali T, Madziyire M, Gidiri M, et al. Cervical cancer in Zimbabwe: a situation analysis. Pan Afr Med J. 2017;27:215.\u003c/li\u003e\n \u003cli\u003eLevin A, Yuma S, Swai E, Morgan W, Gauvreau CL, Broutet N, et al. Comprehensive approach to costing cervical cancer prevention and control: a case study in the United Republic of Tanzania using the Cervical Cancer Prevention and Control Costing (C4P) tool. BMC Med [Internet]. 2022;20(1):1\u0026ndash;10. Available from: https://doi.org/10.1186/s12916-022-02576-x\u003c/li\u003e\n \u003cli\u003eGultie T. Knowledge and attitude towards cervical cancer screening and associated factors among female Hawassa university college of medicine and health sciences students. MOJ Public Heal. 2018;7(3):151\u0026ndash;8.\u003c/li\u003e\n \u003cli\u003eOwoeye IOG, Ibrahim . IA. Knowledge and attitude towards cervical cancer screening among female students and staff in a tertiary institution in the Niger Delta. Int J Med Biomed Res. 2013;2(1):48\u0026ndash;56.\u003c/li\u003e\n \u003cli\u003eBorlu A, Gunay O, Balci E, Sagiroglu M. Knowledge and attitudes of medical and non-medical Turkish university students about cervical cancer and HPV vaccination. Asian Pacific J Cancer Prev. 2016;17(1):299\u0026ndash;303.\u003c/li\u003e\n \u003cli\u003eTapera R, Manyala E, Erick P, Maswabi TM, Tumoyagae T, Letsholo B, et al. Knowledge and attitudes towards cervical cancer screening amongst University of Botswana female students. Asian Pacific J Cancer Prev. 2017;18(9):2445\u0026ndash;50.\u003c/li\u003e\n \u003cli\u003eHoque E, Hoque M. Knowledge of and attitude towards cervical cancer among female university students in South Africa. South African J Epidemiol Infect. 2009;24(1):21\u0026ndash;4.\u003c/li\u003e\n \u003cli\u003eSchliemann D, Su TT, Paramasivam D, Treanor C, Dahlui M, Loh SY, et al. Effectiveness of Mass and Small Media Campaigns to Improve Cancer Awareness and Screening Rates in Asia: A Systematic Review. J Glob Oncol. 2019 Apr;5:1\u0026ndash;20.\u003c/li\u003e\n \u003cli\u003eHarsha Kumar H, Tanya S. A Study on Knowledge and Screening for Cervical Cancer among Women in Mangalore City. Ann Med Health Sci Res. 2014 Sep;4(5):751\u0026ndash;6.\u003c/li\u003e\n \u003cli\u003eMudzindiko T, Mukona DM, Zvinavashe M, Ndaimani A, Mhlanga M. Knowledge of cervical cancer and uptake of cervical cancer screening in women aged 18-45 years at a central hospital in Harare, Zimbabwe. Nova. 2017;6(1):1\u0026ndash;8.\u003c/li\u003e\n \u003cli\u003eOmoyeni O, Tsoka-Gwegweni J. Knowledge, attitudes and practices of cervical cancer screening among rural women in KwaZulu-Natal, South Africa. Pan Afr Med J. 2022;42:188.\u003c/li\u003e\n \u003cli\u003eRamathuba DU, Ngambi D, Khoza LB, Ramakuela NJ. Knowledge, attitudes and practices regarding cervical cancer prevention at Thulamela Municipality of Vhembe District in Limpopo Province. African J Prim Heal care Fam Med. 2016 Jun;8(2):e1--7.\u003c/li\u003e\n \u003cli\u003eMaree JE, Moitse KA. Exploration of knowledge of cervical cancer and cervical cancer screening amongst HIV-positive women. Curationis. 2014 Oct;37(1):1209.\u003c/li\u003e\n \u003cli\u003eTapera O, Dreyer G, Kadzatsa W, Nyakabau AM, Stray-Pedersen B, Sjh H. Health system constraints affecting treatment and care among women with cervical cancer in Harare, Zimbabwe. BMC Health Serv Res. 2019 Nov;19(1):829.\u003c/li\u003e\n \u003cli\u003eRamaiah R, Jayarama S. Knowledge, attitude and practices about cervical cancer among rural married women: a cross sectional study. Int J Community Med Public Heal. 2018;5(4):1466\u0026ndash;70.\u003c/li\u003e\n \u003cli\u003eAl-Naggar RA, Low WY, Isa ZM. Knowledge and barriers towards cervical cancer screening among young women in Malaysia. Asian Pac J Cancer Prev. 2010;11(4):867\u0026ndash;73.\u003c/li\u003e\n \u003cli\u003eDBaW Y. Knowledge, attitude and practice towards cervical cancer screening among Arsi University female students. J Women\u0026rsquo;s Heal Care. 2016;5(6).\u003c/li\u003e\n \u003cli\u003eGhotbi N, Anai A. Assessment of the knowledge and attitude of female students towards cervical cancer prevention at an international university in Japan. Asian Pac J Cancer Prev. 2012;13(3):897\u0026ndash;900.\u003c/li\u003e\n \u003cli\u003eSiseho KN, Omoruyi BE, Okeleye BI, Okudoh VI, Amukugo HJ, Aboua YG. Women\u0026rsquo;s perception of cervical cancer pap smear screening. Nurs Open. 2022;9(3):1715\u0026ndash;22.\u003c/li\u003e\n \u003cli\u003eIbekwe CM, Hoque ME, Ntuli-Ngcobo B. Perceived benefits of cervical cancer screening among women attending Mahalapye District Hospital, Botswana. Asian Pac J Cancer Prev. 2010;11(4):1021\u0026ndash;7.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Cervical cancer, HPV, screening, perceived convenience, female university students","lastPublishedDoi":"10.21203/rs.3.rs-4611605/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4611605/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Cervical cancer (CC) remains a global public health concern in 2020 and beyond. It is the 4\u003csup\u003eth\u003c/sup\u003e most frequent cancer in women and stands in the 8\u003csup\u003eth\u003c/sup\u003e place in terms of most commonly prevalent cancer globally. CC starts in the cervix and is mainly caused by high-risk strains of Human-Papilloma Virus (HPV), which are sexually transmitted. In Tanzania, there is insufficient knowledge and concerns about attitudes and perceived convenience among students regarding CCS despite the increasing incidence of the disease.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAim:\u003c/strong\u003e This study aimed to assess the knowledge, attitudes, and perceived convenience of cervical cancer screening among university female students in Dar es Salaam, Tanzania.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e Data was collected using a structured questionnaire from 183 respondents who were randomly selected. The questionnaire was designed to evaluate the participants' knowledge of cervical cancer, their attitudes toward screening, and their perceptions of the convenience of undergoing cervical cancer screening. Information related to demographics and past screening experiences was also included in the questionnaire. Data analysis included both descriptive and inferential statistical methods to examine the responses and identify factors associated with knowledge, attitudes, and perceived convenience.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Among the 183 participants, 94% were aware of cervical cancer, and 56.9% knew about its risk factors. Knowledge about screening was limited to 36.5%, but a noteworthy 88.5% had a positive attitude towards it. There is a very weak positive correlation between the perceived convenience of the test in terms of female university students’ confidence in the physician’s ability to perform a Pap smear correctly and the rate of cervical cancer screening (r(155) = 0.352; P\u0026lt;0.01).\u0026nbsp; Students’ perception of cervical cancer screening was influenced by personal experiences with the disease (P = 000), and their level of awareness correlated with participation in the screening program (P ≤ 0.01).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Despite awareness and positive attitudes, a knowledge gap hampers cervical cancer screening, hindering Pap smear uptake. Healthcare practitioners should prioritize awareness and education, involving nurses who are in the front line in performing cervical cancer screening in awareness campaigns and specialized programs. Authorities should develop strategies to enhance knowledge and prevent cervical cancer in young females.\u003c/p\u003e","manuscriptTitle":"Cervical Cancer Screening: Awareness and Barriers Among University Students in Dar es Salaam, Tanzania. A Cross-Sectional Study.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-12 04:43:10","doi":"10.21203/rs.3.rs-4611605/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c0495d5a-220d-41fd-aa43-ef19f00da0fa","owner":[],"postedDate":"July 12th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-06-12T11:08:57+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-12 04:43:10","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4611605","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4611605","identity":"rs-4611605","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}