Knowledge, Attitudes and Practices of
Postpartum Women Regarding Cervical
Cancer in Maroua, Northern Cameroon
Dohbit JS1,2, Domkao NP2, Meka NUE1,2, Belinga E2, Joel Noutakdie Tochie3*, Ndjoumemi Z2, Ourtching C2,5 and Tebeu PM1,2
1 Departement of Gynaecology and Obstetrics, Yaounde Gynaeco-Obstetrics and Paediatric Hospital, Cameroun
2 Departement of Gynaecology and Obstetrics, University of Yaoundé, Cameroon
3 Departement of Surgery and Specialities, University of Yaoundé, Cameroon
4 Foumbot District Hospital, Cameroon
5 Departement of Gynaecology and Obstetrics, Maroua Regional Hospital, Cameroon
Submission: August 13, 2018;Published: September 06, 2018
*Corresponding author: Joel Noutakdie Tochie, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon;
How to cite this article: Dohbit J, Domkao N, Meka N, Belinga E, Joel N T, et al. Knowledge, Attitudes and Practices of Postpartum Women Regarding
Cervical Cancer in Maroua, Northern Cameroon. J Gynecol Women’s Health. 2018: 11(3): 555814. DOI: 10.19080/JGWH.2018.11.555814
Background: Worldwide cervical cancer is a real public health problem representing the third most common cancer and the fourth leading cause of female cancer-related death. In Cameroon it is the second most common cancer in women after breast cancer and the leading cause of cancer deaths in women due to lack of information on this pathology. Few studies have focused on analyzing the influence of knowledge and attitudes on women’s practices on how to prevent this cancer.
Aim: To determine the knowledge, attitudes and practices of postpatum women with respect to cervical cancer in the health districts of Maroua, northern Cameroon.
Methodology: This was an analytical study carried out in seven maternity units of the Maroua health districts in northern Cameroon from 1 February to 31 April 2018. The target population consisted of postpartum women aged between 25 and 45 years. The data on knowledge, attitude and practices of cervical screening, as well as sociodemographic data were collected on a pre-tested questionnaire. The odds ratio (OR) with its 95% confidence interval was used to assess the association between the different variables. The threshold of statistical significance was set at P-value < 0.05.
Result: We recruited a total of 622 postpartum women with a mean age of 28.9±4.26 years. Majority of participants were married (69.6%), housewives (60%), Muslims (51.5%), lived in urban areas (66.9%), had a secondary level of education (31.7%), and were multiparous (34.2%). The level of knowledge was unsatisfactory for 73.8% of participants. Housewives had a 31-fold increased risk to have insufficient knowledge [OR=31.96 (7.206-141.701)]. Christians were 8.421 times more likely to have satisfactory knowledge. Likewise, married women were more likely to have satisfactory knowledge [OR=6.894 (2.389-19.894)]. Despite 73.8% participants having unsatisfactory knowledge on, 96.6% had favorable attitudes. Women with poor knowledge had a 20-fold increase in having favorable attitudes [p=0.003 OR=20.149 (2.764-146.881)]. Practices were poor in 97.4% of the women. Compared to women with good knowledge, those with poor knowledge have a higher risk for poor practices regarding cervical screening [OR=33,673 (4,273-265,421)]. The level of attitudes did not seem to influence the level of practice.
Conclusion: The postpartum women in Maroua appear to have unsatisfactory knowledge on cervical cancer. However, they seem to adopt favorable attitudes with regards to its screening, although they portray poor practices.
Keywords:Knowledge; Attitudes; Practices; Cervical Cancer
Cervical cancer is a slow-growing cancerous disease that generally takes several years to undergo malignant transformation, from primary infection by the oncogenic human papillomavirus (HPV) to the various precancerous histological
lesions accompanying the persistence of the infection . Globally, this cancer is a public health threat. Worldwide, it is ranked the 3rd most common malignancy after breast cancer and colorectal cancer, the 10th most common cancer in developed countries and in developing countries, it is the 2nd most common cancer after breast cancer. About 530000 new cases of cervical
cancer occur annually . It is the 4th leading cause of death
in the world after colorectal cancer, lung cancer and breast
cancer, with 85% of cervical cancer-related deaths occurring in
developing countries. In 2012, the estimated global mortality
from cervical cancer was 275,000 deaths . Cervical cancer
accounts for 9% of all women’s cancers  and 8% of all cancer
In Cameroon, cervical cancer represents the 2nd most
encountered gynecological cancer after breast malignancy
and the 1st cause of cancer deaths in women . Its incidence
is estimated at 40/100000 woman-years and the average age
at diagnosis is 49 years. According to GLOBOCAN 2012, the
incidence of cervical cancer in Cameroon is 80.73/100,000
women . Organized screening for cervical cancer by cytology
and the treatment of precancerous lesions has allowed developed
countries to drastically reduce the incidence and mortality of
this cancer . However, in Cameroon and other developing
countries, the incidence of cervical cancer remains high and
patients often present late, with advanced cancer stages at the
time of diagnosis . In these resource-poor countries, there is
no systematic screening program for cervical cancer. Screening
is selective, opportunistic or sporadic in the form of campaign.
Inadequate financial resources, weak health systems and limited
numbers of skilled practitioners are the main reasons for low
coverage of cervical cancer screening in most low- and middleincome
countries . Cervical cancer is a real public health
problem in Cameroon. To know the methods of prevention of
this pathology in order to reduce its incidence and the mortality,
we proposed this study aimed at determining the knowledge,
attitudes and practices of postpartum women vis-à-vis cervical
cancer in the health districts of Maroua, Northern Cameroon.
This was an analytical KAP study carried out between
October 1, 2017 to May 31, 2018 in all of the three health districts
of Maroua in the Far-north region of Cameroon and involved
seven randomly chosen maternity units (out of 29 health
facilities) of the following hospitals; the integrated health centre
of Domayo Djarma, the integrated health centre of Ourotchédé,
the Catholic Sisters integrated health centre, the sub-divisional
hospital of Founangué, the integrated health centre of Zokok,
the Maroua regional hospital and the integrated health centre of
Our target population was all consenting consecutive
women aged between 25 and 45 years who had given birth in
the aforementioned health facilities during the study period.
The independent variables were age, residence, religion, marital
status, level of education, occupation, and parity. The dependent
Knowledge: having heard about cervical cancer, sources
of information, its causative agent, its signs or symptoms,
consequence, means of prevention and management.
Attitudes: feelings towards cervical cancer screening, desire
to carry out a voluntary screening test or not.
Practices: have done the screening test before, willingness
to carrying out of the screening, number of screening test done
and frequency, reason for not carrying out the screening.
The statistical analysis was done using the software Epi
Info 184.108.40.206, SPSS and Microsoft Excel 2016. We used the chisquare
test to assess the homogeneity of distribution of the
study population. The odds ratio (OR) with its 95% confidence
interval was used to assess the association between the different
variables. The threshold of statistical significance was set at
p-value < 0.05.
In the present study, all 622 postpartum women approached
consented to partake into the study, hence, a 100% response rate.
Majority of the participants were interviewed at the regional
hospital (30.4%), followed by the integrated health centre of
Djarengolkodek with 21.1% respondents. The mean age of our
participants was 28.9±4.3 years (range: 25-45 years) more than
half (64.3%) being aged between 25 to 30 years. The majority
of these participants were legally married (69.6%), while
25.9% lived in a common-law relationship. Most of them were
housewives (60.0%), 31.7% were secondary school students,
25.9% primary, 16.9% university and 25.6% were school
dropped out. With regards to their site of residence, 66.9% lived
in urban areas and 33.1% in rural areas. The Muslim religion was
the most represented at 51.5% and 48.2% were Christians. More
than one-third of participants had were multigravidas (37%)
and multiparous (34.2%).
In our series, 68.2% had never heard of cervical cancer, only
31.8% have heard of it. The most common means of information
was the media in 26.6%. Only 5.5% had heard of cervical cancer
in the hospital. Other means of information such as school, the
internet and posters globally accounted for 5.9%. Up to 94.5%
of the participants sample did not know the cause of cervical
cancer alone. Just 3.9% reckon HPV as the real cause of cervical
cancer, while 1.6% attributed its aetiology to magico-religious
causes. More than two-third (87%) did not know the risk factors
for cervical cancer and only 14% rightly cited its risk factors.
About one-fifth (21.1%) reported that it is not a sexually
transmitted disease, 74.7% did not know it could be transmitted
through sexual intercourse and only 4.2% said it was a sexually
transmitted disease. Only 14.9% claimed to know the clinical
manifestations of cervical cancer. About 11.3% reported that
the first is vaginal bleeding and 11.9% said they knew the
consequences, while 9.8% reported death as its consequence.
Almost one-quarter (24.4%) knew that cervical cancer
could be prevented, 70.8% did not know and 4.7% said that you
cannot prevent cervical cancer. Another 26.3% could enumerate
the preventive methods of this cancer, mainly through early
detection of precancerous lesions as reported by 16.1%.
As much as 81.5% did not know that there is a vaccine to
prevent cervical cancer; 8.7% said that the vaccine does not
exist and only 9.8% knew that there is a vaccine against cervical
cancer. More than half (69.3%) did not know that it is a curable
disease alone. While 27.2% knew that this cancer can be treated
and 3.5% reported that it is has no cure. Up to 71.7% did not
know that cervical cancer can be permanently cured, however,
22.3% knew that this cancer can be permanently cured. Table 1
illustrates the level of knowledge of participants.
The evaluation of the level of knowledge shows that 73.8%
of the respondents had poor knowledge, 23.5% had an moderate
knowledge and only 2.7% were satisfactory. The level of
knowledge could be divided into two categories, namely;
a) Unsatisfactory (poore and moderate N=605)
b) Satisfactory (satisfactory and excellent N=17)
The analysis shows us that 91.5% would go to the hospital
to care for them if they were to have cervical cancer; amongst
which 79.9% would seek a gynecologist and 11.6% a general
practitioner. On the one hand, 85.3% believed that screening for
cervical cancer is important and helps prevent cervical cancer.
Only 19.1% did not know the important of a cervical cancer
screening test. More than half (67.9%) were indifferent to
cervical cancer screening because they perceived that “cervical
cancer is like any other disease”. Meanwhile, 16.4% were would
not undergo screening for fear of the procedure and results.
On the other hand, 87.8% wanted to have cervical cancer
screening because: “You need to know your status to get better
care soon”. In contrast, 3.9% and 8.4% refused screening because
they did not asked their husbands’ permission and perceived the
price of screening to be very expensive, respectively. More than
two-third (79.8%) wished to start free screening campaigns in
Maroua, while 19.2% did not know (Table 2).
We found that 95.3% of the participants had a satisfactory or
positive attitude, 3.4% had an insufficient attitude and 1.3% had
a satisfactory approximate attitude.
a) Unfavorable (harmful and insufficient: N=21)
b) Favorable (Approximate and Satisfactory: N=601).
Of all the women interviewed, we only had 16 (2.6%) who
had cervical cancer screening at least once. The mean age at
screening was 28.3±4.4 years with a median of 28 years.
Of those who tested for cervical cancer, 15 (2.4%) received
their results; only 2 (12.5%) had twice been screened for cervical
Of those who had never been screened, 507 (83.7%) reported
that cervical cancer screening was not performed “I have never
heard of cervical cancer screening” 12.4% n have not had the
opportunity to do so (Table 3).
The practices were inadequate in 97.4% of the cases. Only
2.6% had a satisfactory practice.
The level of practice could be divided into two categories,
a) Bad (harmful and inadequate N=606)
b) Good (adequate N=16).
The unified analysis shows that age groups, residence and
reproductive history have no statistically significant influence on
knowledge because the P value> 0.05. On the other hand, there
is a statistically significant influence between level of education,
religion, marital status and occupation, and level of knowledge
(P < 0.05).
The logistic regression shows that the age group of 25-30
years had 3 times the chance of having unsatisfactory knowledge
[p=0.01, OR=3.343 (1.189- 9.394)]. Other professions were
fortunate enough to have a satisfactory level of knowledge of
cervical cancer. These results are statistically significant for
housewives whose likelihood for unsatisfactory knowledge was
increased by 31-fold [p˂0.05 OR = 31.956 (7.206-141.701)].
There is no association between the level of education and the
level of knowledge but the test was statistically significant with
a p=0.003. There is a statistically significant association between
marital status and satisfactory knowledge of women given
cervical cancer. Being a married woman allowed for a satisfactory
knowledge [p˂0.001 OR=6.894 (2.389-19.894)] (Table 4).
Christian women had 8 times the chance to have a satisfactory
knowledge of cervical cancer and the test was statistically
significant (p˂0.05, OR=8.421 [1.909-37.142]).
This table shows that mothers with poor knowledge had
20,149 times the chance of having favorable attitudes, and this
association was statistically significant because p˂0.05; p=0.003;
OR=20.149 [2.764-146.881] (Table 5).
Women who had poor knowledge seemed to have poor
practices because their chances were multiplied by 33 this
association was statistically significant [p=0.001; OR=33.676
(4.273-265.421)]. We did not find an association between
attitudes and practices
This study aimed to determine the knowledge, attitudes and
practices of postpatum women with respect to cervical cancer
in the health districts of Maroua in northern Cameroon. Overall,
participants had unsatisfactory knowledge on cervical cancer.
Although they portrayed poor practices, they adopted favorable
attitudes with regards to its screening.
A total of 622 postpartum women were included in present
study. We found that the average age of the women was 28.9 ±
4.26 years, with extremes of 25 to 45 years, and the highest age
group being 25 to 30 years old. Our results are slightly higher
than those of Mohamed H et al. in Tunisia in 2003, who observed
a mean age of 25.01±1.45 years justified by the fact that the
study was conducted on young undergraduate medical students.
Our mean age is however, slightly lower than the 32.8 years and
36.5±9.7 years observed by Mbongo et al.  in Brazzaville and
Mona et el in Congo, respectively. These can be justified by the fact
that their studies targeted all women with no age restrictions.
We found that the most represented level of education was
secondary school in 31.7%. Other authors have reported data
comparable to ours. This is exceeding lower compared to the
50.46 to 63.9% of secondary school participants reported by
authors from similar low-income settings [11-13]. Again, this
could be explained by the age restriction of our study population
between 25 to 45 years. Meaning we had a more elderly
population as evident by its mean age of 28.9±4.26 years, an age
at which many women have completed secondary education.
In contrast to Narayana et al.  in India, we observed that
majority of women (66.9%) delivered in urban areas. This could
be explained by the fact that the study setting, the Bathalapali
hospital of Narayana et al.  was located in rural area of
Similar to Adeka et al. in Nigeria and Mona et al. in Congo
who Majority of participants (69.6%) were married. This concurs
with findings made by Adeka et al. in Nigeria and Mona et al. in
Congo, who had a married studied population varying between
Unlike Narayana et al.  in India who had a minute
proportion of Muslims (27.3%), our study population was mostly
represented by Muslim women in 51.5%. This difference could
be explained by the fact that undue religion is more represented
This study shows that 60% of participants were housewives,
corroborating with results obtained by Tebeu et al.  in
Maroua, Cameroon. This may be explained by the fact that the Far
North region (the study setting) is an area of Cameroon where
early marriage and under-enrollment prevail, especially for girls.
Hence, females often do not attend higher level of education,
which hinders them from exercising a professional job later.
In the present study, only 31.8% have heard of cervical cancer.
By contrast, Mahoungou et al.  in the Congo found that 78.6%
of women have heard about cervical cancer. This difference could
be justified by the fact that it is common for women of Maroua,
Cameroon not to be interested in health information and that the
actors in the field of awareness have not undergone sensitization
training on this pathology. Thus, the lack of name of cervical
cancer in the local language.
The causes and risk factors of cervical cancer were less well
known amongst postpartum women with, only 5% reporting to
know the exact aetiology and 6.3% knowing the risk factors. This
observation differs from those of Ali-risasi C et al.  in Congo
and Tran NT et al.  in Korea who found 19.3% and 28.8%
respectively women who knew the cause of this gynecology
malignancy. This may infer inadequate health education or
sensitization campaigns on this pathology in the Maroua health
The assessment of the level of knowledge reveals that most
of the women interviewed had very poor knowledge, 73.8%.
Our result is similar to that of Tebeu et al.  in Maroua
(Cameroon) who found that 72% of women in this locality had
poor knowledge of cervical cancer. This can be justified by the
fact that women in this region are less informed and unaware
of this pathology, which represents a public health problem in
Cameroon. These results are close to those of Mahoungou F et al.
 and Ali-risasi C et al.  in Kinshasa who found insufficient
knowledge of cervical cancer in Congo. All are justified by the
fact that these countries are in areas where this pathology is less
known. Contrarily, Narayana G et al.  in India observed that
women had a good knowledge of cervical cancer, which could
be explained by the fact that India is a middle-income country
compared to Cameroon, a low-income country. Hence, India
could have a more robust program to inform women on this
pathology as well as to manage this pathology.
Our study showed that 96.6% of participants had a favorable
attitudes towards cervical cancer which can be explained by
the fact that these women globally consider all cancers as a
very dangerous disease, hence, they prefer its prevention. On
the other hand, women’s attitudes towards cervical cancer in
Kinshasa were poor . This could be explained by the fact
that Congolese women were not much interested in their state
In the current study, women’s practices towards cervical
cancer screening was poor in 97.4%, propably explained by the
fact that they did not have adequate awareness “I did not do the
screening because I have never heard of it’’. Interventions to
improve on their awareness and practices may include routine
health education and screening of cervical cancer to all volontary
pregnant women during antenatal care. Our findings corroborate
with those of Mbongo et al.  who found that only 4.8% of
women had Pap smear. This results re-iterates the fact that there
is no program for the fight against gynecological cancers in
Our results showed that the age group 25-30 years had a
3-fold increase in likelihood for unsatisfactory knowledge while
housewives had 31-fold increase. As expected, the age group 25-
30 years was made up of women with a low level of education
and given that early marriage is a common culture in northern
Cameroon, these may explain their unsatisfactory knowledge
towards cervical cancer. The other professions had satisfactory
knowledge of cervical cancer. There was a statistically significant
association between marital status and satisfactory knowledge
of women with regards to cervical cancer. Being a married
woman conveyed satisfactory knowledge [p˂0.001 OR=6.894
(2.389-19.894)]. This association can be justified by the fact
that the brides could be assisted by their husbands in obtaining
information about this pathology.
In the logistic regression we found that the mothers with
poor knowledge stood 20 times the likelihood to have favorable
attitudes. This association was statistically significant with
p˂0.05 value [p=0.003; OR=20.149 (2.764-146.881)]. This could
be justified by the fact that despite ignorance of these mothers
they want to have a healthy life.
Women who had poor knowledge seemed to have poor
practices because their chances were multiplied by 33 [P=0.001;
OR=33.676 (4.273-265.421)]. We did not find an association
between attitudes and practices. All these may be explained by
the lack of awareness of this category of women.
We acknowledge some drawbacks of this study. These
include the difficulties for the native participants of the Farnorth
region of Cameroon to comprehend the meaning of cervical
cancer in their local language, ‘’fufuldé’’. Also, being a qualitative
study, the interpretation of questions were subject to errors by
the participants. However, this study used a large sample size
(n=622) and robust analysis to contribute to the scarcity of data
available on knowledge, attitude and practices of cervical cancer,
a major public health problem in Cameroon.
Overall, the women of the three different health districts of
Maroua had unsatisfactory knowledge, favorable attitudes and
bad practices vis-à-vis cervical cancer. The level of knowledge
seemed to influence the attitudes of these women. Best practices
were related to good knowledge of cervical cancer. The practice
did not seem to be influenced by attitudes.