Project – Prevalence of cervical cancer at Benue state university teaching hospital Makurdi

CHAPTER ONE

INTRODUCTION

• Background to the Study

Cervical cancer remains a significant public health concern globally, especially in low- and middle-income countries (LMICs). According to the World Health Organization (WHO, 2023), cervical cancer is the fourth most common cancer in women worldwide, with an estimated 604,000 new cases and 342,000 deaths in 2020. The burden is disproportionately high in sub-Saharan Africa, South Asia, and Latin America, where access to screening and treatment services is limited. In contrast, high-income countries have witnessed a sharp decline in incidence and mortality due to widespread implementation of cervical screening programs and HPV vaccination.

In many LMICs, the prevalence of cervical cancer is exacerbated by a lack of awareness, insufficient health infrastructure, and cultural barriers to screening. For instance, a study by Arbyn et al. (2020) highlights that countries like Malawi and Zimbabwe report some of the highest age-standardized incidence rates, often exceeding 50 per 100,000 women. These elevated rates correlate with inadequate access to early detection services and high rates of human papillomavirus (HPV) infection, the primary etiological agent of cervical cancer.

HPV prevalence itself varies by region and strongly influences cervical cancer incidence. Bruni et al. (2019) conducted a comprehensive meta-analysis revealing that HPV types 16 and 18 account for approximately 70% of all cervical cancer cases globally. In regions with limited vaccination coverage, such as parts of Asia and Africa, the prevalence of high-risk HPV types remains alarmingly high, directly contributing to elevated cervical cancer rates. The lack of effective HPV vaccination programs and screening strategies in these areas perpetuates the high disease burden.

In high-income countries, cervical cancer has become relatively rare due to effective public health interventions. For example, the implementation of the Pap smear test and, more recently, HPV DNA testing has significantly reduced both incidence and mortality. According to Saslow et al. (2020), countries such as Australia and the United Kingdom have demonstrated the success of organized screening and vaccination campaigns, achieving reductions in cervical cancer rates to fewer than 10 per 100,000 women. This success underscores the importance of preventive strategies in controlling the disease’s prevalence.

Despite these advances, disparities persist even within high-income nations. Underserved populations, including racial minorities, immigrants, and rural residents, often experience higher cervical cancer rates due to socioeconomic barriers and limited access to healthcare services (Benard et al., 2021). This suggests that national-level statistics may obscure significant within-country variations, highlighting the need for targeted interventions that address these inequalities.

In conclusion, while global efforts have led to notable declines in cervical cancer prevalence in many regions, the disease remains a major health challenge, particularly in LMICs. The uneven distribution of screening, HPV vaccination, and healthcare access continues to drive disparities in disease burden. Future research and policy should focus on expanding HPV vaccination, improving screening coverage, and addressing social determinants of health to achieve the WHO’s goal of eliminating cervical cancer as a public health problem.

• Statement of the Problem

Cervical cancer is one of the leading causes of cancer-related morbidity and mortality among women in Nigeria. Despite its preventable nature through early screening and HPV vaccination, the disease remains highly prevalent, particularly in underserved regions such as Benue State. At Benue State University Teaching Hospital (BSUTH), Makurdi, an increasing number of women present with advanced stages of cervical cancer, suggesting delays in diagnosis and limited access to preventive services. This growing trend poses a serious challenge to the hospital and the wider healthcare system in the region.

The burden of cervical cancer at BSUTH reflects broader public health issues, including low awareness, cultural stigma, and inadequate screening programs. Many women in Makurdi and surrounding communities are unaware of the risk factors and early symptoms of cervical cancer, leading to late presentations at the hospital when the disease is already in advanced stages. This has contributed to poor prognosis and increased mortality rates. The hospital’s oncology unit frequently manages cases that could have been prevented or effectively treated if identified earlier.

There is a significant gap in the availability and utilization of cervical cancer screening services at BSUTH. Although the hospital offers Pap smears and visual inspection with acetic acid (VIA), the uptake of these services remains low. Factors such as cost, limited health education, and misconceptions about cancer contribute to poor health-seeking behavior. In addition, the lack of a well-structured cervical cancer prevention program at BSUTH hampers efforts to identify and treat precancerous lesions before they develop into full-blown cancer.

Furthermore, data on the actual prevalence and demographics of cervical cancer patients at BSUTH is scarce and poorly documented. The absence of comprehensive hospital-based records limits the ability of healthcare professionals and policymakers to assess the true burden of the disease and to plan effective interventions. Without accurate and up-to-date data, resource allocation, public health campaigns, and clinical strategies remain inadequate and poorly targeted.

The problem is further compounded by workforce and infrastructural limitations at BSUTH. The hospital struggles with an insufficient number of trained personnel in oncology, limited diagnostic facilities, and irregular supply of essential medical equipment and consumables. These challenges impede the timely diagnosis and management of cervical cancer cases, often resulting in referrals to tertiary institutions in other states, thereby delaying care and increasing patient expenses.

In summary, the high prevalence of cervical cancer at Benue State University Teaching Hospital, Makurdi, represents a significant public health concern that requires urgent attention. The combination of late presentation, poor screening uptake, inadequate health education, and systemic healthcare challenges exacerbates the problem. Addressing these issues will require coordinated efforts in awareness campaigns, improved screening and diagnostic infrastructure, staff training, and robust data collection systems to reduce the burden of cervical cancer in Makurdi and its environs.

• Aim and Objectives of the Study

The aim of the study is to examine prevalence of cervical cancer at Benue state university teaching hospital Makurdi. The specific objectives are:

1. To determine the overall prevalence rate of cervical cancer among patients at the hospital.
2. To identify the demographic characteristics of patients diagnosed with cervical cancer at the hospital.
3. To assess the stage of cervical cancer at diagnosis among patients at the hospital.
4. To evaluate the treatment modalities and outcomes for patients with cervical cancer at the hospital.

• Research Questions

The research questions are buttressed below:

1. What is the overall prevalence rate of cervical cancer among patients at Benue State University Teaching Hospital in Makurdi?
2. What are the demographic characteristics of patients diagnosed with cervical cancer at Benue State University Teaching Hospital in Makurdi?
3. What is the stage of cervical cancer at diagnosis among patients at Benue State University Teaching Hospital in Makurdi?
4. What are the treatment modalities and outcomes for patients with cervical cancer at Benue State University Teaching Hospital in Makurdi?

1.5. Research Hypothesis

The hypothetical statement of the study is buttressed below:

Ho: Treatment modalities will not affect the outcomes for patients with cervical cancer at the hospital

H1: Treatment modalities will affect the outcomes for patients with cervical cancer at the hospital.

• Significance of the Study

Understanding the prevalence of cervical cancer at Benue State University Teaching Hospital (BSUTH) is crucial in addressing the high burden of this preventable disease in Makurdi and its surrounding regions. This study provides valuable epidemiological data that can guide healthcare policymakers and medical practitioners in formulating effective cancer control strategies. By documenting the magnitude and trends of cervical cancer cases in this tertiary health institution, the research highlights areas of urgent need, such as screening, early diagnosis, and treatment access.

Secondly, the study plays a pivotal role in identifying the sociodemographic characteristics of women most affected by cervical cancer. This includes factors such as age, parity, educational status, and sexual behavior patterns. Such insights are essential in tailoring awareness campaigns and screening programs to reach the most vulnerable populations. Targeted interventions based on empirical data increase the likelihood of successful outcomes in reducing the incidence and mortality associated with cervical cancer.

The findings of this study also draw attention to the stage at which most cervical cancer cases are diagnosed at BSUTH, which is typically in the advanced stages. This has significant implications for public health because early-stage diagnosis greatly improves treatment outcomes and survival rates. Highlighting this late presentation trend can spur the development and implementation of more robust community-level screening programs and health education efforts aimed at early detection.

Additionally, this study contributes to the limited body of local literature on cervical cancer in North Central Nigeria. Much of the existing data on cervical cancer in Nigeria is concentrated in urban areas in the southern parts of the country. Therefore, this study fills an important gap by providing region-specific data that reflects the unique cultural, economic, and healthcare access issues affecting women in Benue State. Such localized research is necessary for developing context-appropriate health policies and interventions.

Another significant contribution of the study is its potential to influence resource allocation and training priorities at BSUTH and similar healthcare institutions. Evidence of a high prevalence of cervical cancer may prompt investments in colposcopy units, HPV DNA testing kits, radiotherapy facilities, and training programs for gynecologists and oncology nurses. Moreover, it may encourage partnerships with non-governmental organizations and international health bodies to support cervical cancer prevention and treatment services.

Finally, the study’s implications extend beyond healthcare professionals to the general public. It can serve as an advocacy tool for increasing awareness about cervical cancer, encouraging women to undergo routine screening, and fostering a culture of health-seeking behavior. When communities understand the risks and recognize the signs and symptoms of cervical cancer, they are more likely to participate in preventive measures and seek timely medical attention—ultimately reducing the disease’s impact on women’s health and productivity in the region.

• Scope of the Study

The study examines Prevalence of cervical cancer at Benue state university teaching hospital Makurdi. The study is limited to cervical cancer patients at Benue state university teaching hospital Makurdi

1.8. Operational Definition of Terms

1. Prevalence: Prevalence refers to the total number of cases of a particular disease or condition in a specific population at a given time. It includes both new (incidence) and existing cases. Prevalence is usually expressed as a percentage or as the number of cases per a specific number of people (e.g., per 1,000 or 100,000 individuals). It is used to understand how widespread a health problem is within a community or region.
2. Cervical Cancer: Cervical cancer is a type of cancer that occurs in the cells of the cervix—the lower part of the uterus that connects to the vagina. It is most commonly caused by persistent infection with high-risk types of the human papillomavirus (HPV). Cervical cancer develops slowly, often starting as precancerous changes that, if not detected and treated early, can progress to invasive cancer. Common symptoms in later stages include abnormal vaginal bleeding, pelvic pain, and pain during intercourse.
3. University Teaching Hospital: A university teaching hospital is a medical facility that is affiliated with a university and serves two primary functions: providing healthcare services to the public and offering clinical training and education to medical students, interns, residents, and other health professionals. These hospitals are usually involved in research and often serve as referral centers for complex medical cases. They play a crucial role in advancing medical knowledge and improving healthcare quality through their academic and clinical work.

Project – Prevalence of cervical cancer at Benue state university teaching hospital Makurdi