Cervical cancer is a major public health problem that accounted for 311,000 deaths in 2018, of which 88% were in low resource settings.1 The concurrent HIV epidemic is fuelling the incidence of cervical cancer cases and deaths in East and Southern Africa where respectively 64% and 27% of women with cervical cancer are living with HIV.2 Cervical cancer screening as opposed to vaccination against Human Papilloma Virus (HPV), is the most frequently used prevention strategy in sub-Saharan Africa (SSA).3 However, cervical cancer screening coverage is at most 54% with most studies reporting less than 10% coverage of screening in SSA.4 In Uganda, the cervical cancer screening coverage is low, at 4–35%, across different settings.5–9 This is partly due to low knowledge levels on cervical cancer and its prevention.7,9 Targeted community-based cervical cancer health education interventions have been found to increase the uptake of cervical cancer screening by increasing awareness and modifying behaviour among women.10,11 Effective and impactful community interventions heavily rely on use of locally available health promotion resources like community audio towers to engage, educate and mobilise communities to seek public health preventive services.
Community Audio Towers (CATs) are a community-based channel of communication comprised of powerful fixed speakers hoisted on bamboo or steel poles, and can send information in a 5 kilometre radius.12 In some communities, CATs are considered area-local FM stations because they disseminate contextually relevant information to communities and are, therefore, ideal for rural settings where access to other media is hampered by cost, literacy levels and a lack of understanding of the local context.12 Despite CATs being ideal as a channel where health issues can be communicated in rural communities, evidence about their availability and use in Uganda and across the globe remains scanty.
Therefore, this study focused on determining the availability and utilisation of CATs in health education for prevention of cervical cancer among health workers in Kyotera District, Uganda.
The study was carried out in Kyotera, a rural district located in southern central Uganda between March and April 2020. Kyotera District was part of Rakai district where the first case of HIV/AIDs in Uganda was discovered, located at the border with Tanzania. The district is known for the high HIV prevalence, currently standing at 8.0% (UPHIA, 2016). There is a known link between HIV/AIDS and cancers, including cancer of the cervix, which shares similar risk factors. Kyotera is largely a physical community given the fact that it is a rural area that mainly depends on local communication resources to receive information on social issues. Further, the characteristics of individuals enable them to come together for a common goal through use of available resources to address shared challenges, which in this case is prevention of cervical cancer.
This was a cross-sectional study among health workers in Kyotera, a rural district in central Uganda. The study was carried out in selected level three and four (Health Centre IIIs and IV) health facilities and a general hospital in Kyotera District. Eligible participants were health workers employed across these facilities who had worked for at least a year. Working with health facility in-charges, health workers were randomly selected from duty rotas to participate in this study.
Data Collection Tools and Procedures
After providing informed consent, data were collected using self-administered questionnaires. The questionnaire sought for demographic characteristics of the participants, convenience of accessing CATs and history of CATs utilisation in health promotion. The questionnaire was pre-tested in Lwengo district, a nearby district to Kyotera.
Sample Size Calculation
Using the Kish-Leslie formula13 and assuming that 50% of the health workers utilised CATs for cervical cancer health promotion, we estimated that 385 participants would be adequate to determine utilisation of the CATs, considering a 95% confidence interval. However, the number of health workers in Kyotera District was 271 in 2019 according to the Kyotera District local government health department records. Therefore, using sample size adjustment formula14 for a finite population, the sample size was adjusted to 176 participants considering a 10% non-response rate.
Data were analysed using Stata 14. Data were summarised as frequencies and proportions. At bivariable analysis, associations between utilisation of CATs and each of the independent variables was assessed by ordinary logistic regression to generate crude odds ratios (CORs), their 95% confidence intervals and p-values. Multi-variable logistic regression analysis was applied to all variables that were significantly associated with CAT utilisation at bivariable analysis. All statistical tests were two-sided; 95% confidence intervals were used and variables with p-value ≤0.05 were considered statistically significant.
Ethical Approval and Consent to Participate
The study was approved by the Institutional Review Board (IRB) of Mildmay Uganda (#REC 0801–2020) and the Uganda National Council of Science and Technology (UNCST) (SS 5233). Administrative clearance was sought from the Ministry of Health and Kyotera District Local Government. Participants provided written informed consent before data collection was undertaken. All study procedures were in accordance with the Declaration of Helsinki.
Between March and April 2020, we enrolled 176 health workers. However, 16 did not complete the study questionnaire (a response rate of 91%).
Characteristics of Study Participants
Among the 160 health workers, 102 (63.8%) were female and majority (63.1%) had been employees in the district for 1–6 years. The majority were nurses (69, 43.1%), laboratory technicians (32, 20.0%) and midwives (30, 18.8%). Other characteristics of the study participants are shown in Table 1.
Table 1 Characteristics of Study Participants
Availability of CATs for Cervical Cancer Health Communication
Most of the participants, ie 143 (89.4%), reported that the nearest CAT is within a walkable (5kms) distance from their workstation. Additionally, 129 (80.6%) reported that it was easy to secure airtime on CATs for purposes of sensitizing the public on health issues. Furthermore, 114 (71.3%) and 115 (71.9%) of the respondents reported that operators of CATs easily accept pre-recorded and printed materials with cervical cancer prevention, respectively. Lastly, 140 (87.5%) health workers reported that the environment where CATs are located is convenient to health workers for public engagements on prevention of diseases.
Utilisation of CATs for Cervical Cancer Health Promotion Communication
Among the health workers, 149 (93.1%) reported that they listen to CATs in their area and 151 (94.4%) opined that CATs can be used to educate communities’ health issues. However, only 50 (31.3%) had ever utilised CATs for health promotion, among whom 26 (52%) had utilised CATs for cervical cancer prevention promotion. Therefore, the overall level of CATs utilisation for cervical cancer prevention communication was 16.3% (26/160). As shown in Figure 1, among those who utilised CATs for health promotion, 29 (58.0%) had utilised them only once in the preceding year.
Figure 1 Frequency of Use of CATs in health communication for cervical cancer prevention.
Factors Associated with Utilisation of CATs for Cervical Cancer Health Promotion
As shown in Table 2, at multivariate analysis, health workers at facilities without a plan that includes CATs as a channel of health communication (OR=0.04, 95% CI (0.0043–0.37), p=0.005) were less likely to utilise CATs, while health workers who had ever participated in the management of a patient with cervical cancer (OR = 16.48, 95% CI (3.4–79.7), p < 0.001) were more likely to use CATs.
Table 2 Factors Associated with CATs Utilisation Among Health Workers
This study aimed at determining the availability and utilisation of CATs by health workers in health communication for prevention of cervical cancer in Kyotera District, Uganda. We found that most health workers felt that CATs were within reach from their workplace, conveniently located, and easy for them to secure airtime to sensitise the public on cervical cancer prevention….
Read More:Utilisation of Community Audio Towers in Health Education | RMHP