Cervical cancer is the malignant neoplasm of the cervix uteri. Globally, there are nearly 1.5 million cases of clinically recognized cervical cancer . Eighty five percent (85%) of these are in developing countries like Nigeria. While industrialized countries have reduced its incidence by over 70% in the last 50 years, the burden seems to be on the rise in less developed countries . It is expected that the incidence of cervical cancer in developing countries will rise from 444,546 to 588,922 between 2012 and 2025 .
The most important risk factor is Human Papillomavirus (HPV) infection, whereas lack of accessible cervical screening services is a major barrier to screening uptake. Other risk factors are early age at sexual contact, early marriage (below age 20 years), multiple partners, polygamy, multi-parity and lack of awareness of the disease . Cervical cancer is attended by huge financial and social burden. It is a social disease especially of the poor and less educated in whom the risk factors are most prevalent. Nigeria is extrapolated to lose between 347.4 and 482.7 million US Dollars each year to cancers . Cancer of the cervix can be prevented by providing widespread and regular cervical screening services for all women who have been sexually active. This is done by the HPV test, Pap test or the Visual Inspection of the Acetic Acid painted cervix (VIA) which is affordable and more sensitive . Vaccination of women against the HPV before the onset of sexual activity also prevents the disease . However, this is very expensive at the moment. The One-Visit Approach – screening with VIA by trained personnel and provision of cryotherapy for obvious mild to moderate cervical dysplasia is recommended for developing countries .
In Nigeria, 40.43 million women are at risk of developing cervical cancer . Current estimates indicate that every year, 14,089 women are diagnosed with cervical cancer and 8,240 die from the disease . About 23.7% of women are estimated to harbour cervical HPV infection while over 90% of invasive cervical cancers are attributed to HPV subtypes 16 or 18 . It is projected that in 2025, there will be 19,440 new cervical cancer cases and 10,991 cervical cancer deaths in Nigeria . Cervical cancer was found to be the commonest cancer of women in many parts of Nigeria [6, 7] and has a national age standardized incidence rate of 33.0 cases per 100,000 women per year . However, the level of awareness is quite low. Only about 15% of women aged 20-65 yrs in the south-west region of Nigeria have heard about the disease . Majority (60%) of the population live in rural areas with no access to cervical screening. Currently in Nigeria, less than 10% of women have ever had cervical screening , whereas, 40 to 50% of women are screened in developed countries .
Nigeria does not have a well-articulated and widely disseminated National Cervical Cancer Policy and there is no widespread cervical screening for women . Therefore, women come to hospitals with invasive cancer of the cervix at advanced stages when radiotherapy is of little or no benefit and even radical hysterectomy is of no benefit . There is a pressing need for accessible and affordable screening services. This is particularly important because at least 70.8% of Nigerians live on less than US$1 per day . It is an investment into the nations’ and families’ fortunes and future .
The World Health Organization supported a study of the effectiveness and acceptability of VIA and Cryotherapy in six African countries including Nigeria . In the Nigerian project site, 100 healthcare workers in 49 health facilities in Ogun State were trained and equipped to undertake VIA in their community settings. During the period between September 2007 and May 2010, a total of 5,529 women were screened for cervical cancer. Large variations were observed in the implementation of screening programmes in the various facilities across Local Government Areas (LGA). Indeed, at more than half of the health facilities, fewer than two women were screened per month on the average. Over this period, only 118 women were screened in Odogbolu local government area and one of the three VIA centres in the local government area did not have any screening done at all .
Videos as a medium of health education have proved to be invaluable visual aids with high levels of effectiveness when used as health education tools in many different settings [11–14]. In recent times, the home video industry has thrived in Nigeria and the populace appears to have a greater preference for local films depicting their culture and tradition. Women and Children have been observed to spend much time watching these videos either in their homes or in the neighborhood. They are attracted more to these videos because they are cultural, colorful, and watched in a relaxed atmosphere . A culturally appropriate health education video in the Yoruba language titled “Asunle” was developed and targeted at women, young girls and indeed the general population. The purpose of the video was to promote the uptake of cervical screening among adult women and promote vaccination among eligible girls by highlighting the risk factors and symptoms of cervical cancer and educating them about ways of preventing cervical cancer.
This study evaluated the effectiveness a home video centered Health Education intervention among Yoruba speaking adult women in a rural LGA in Nigeria.