Knowledge of cervical cancer among adolescent girls in selected secondary schools in Ile-Ife, Nigeria

 Corresponding author: Oluwaseyi Mercy Adebayo. Copyright © 2025 Author(s) retain the copyright of this article. This article is published under the terms of the Creative Commons Attribution License 4.0. Knowledge of cervical cancer among adolescent girls in selected secondary schools in Ile-Ife, Nigeria Oluwaseyi Mercy Adebayo 1, *, Godson Okwu-Dike 2, Eyiyemi Toluwase Akeju 3, Adebayo Martin Adebambo 4 and Taiwo Olawumi Adebayo 1 1 Department of Medicine, Obafemi Awolowo University, Ile-Ife, Nigeria. 2 Department of Community Medicine, Ahmadu Bello University, Zaria, Nigeria. 3 Department of Community Medicine, Obafemi Awolowo University, Ile-Ife, Nigeria. 4 Department of Medical Microbiology and Parasitology, UNIOSUN Teaching Hospital, Osogbo, Nigeria. World Journal of Advanced Research and Reviews, 2025, 26(03), 813-825 Publication history: Received on 28 April 2025; revised on 04 June 2025; accepted on 06 June 2025 Article DOI: https://doi.org/10.30574/wjarr.2025.26.3.2245 Abstract Background: Cervical cancer continues to be one of the major causes of death among women, ranking as the fourth most common cause of female death globally. Over 90% of cases and related deaths occur in lowand middle-income countries (LMICs), including Nigeria. Methods: This was a cross-sectional study with sample size of 251 among adolescent girls of senior secondary schools in Ile-Ife. Selection was through a multistage sampling process. Data was obtained using a self-administered structured questionnaire and result was analysed using the Statistical Packaged for Social Sciences version 25.0. Results: A total of 254 responses were collected. The data showed that 9.1% of participants had good knowledge about cervical cancer. Factor like occupation of the father was associated with knowledge of cervical cancer. Conclusion: Majority of the participants have poor knowledge on cervical cancer. Keywords: Knowledge; Cervical Cancer; Adolescent Girls; Secondary Schools; Ile-Ife; Nigeria 1. Introduction Cervical cancer is a malignant tumour that grows at the squamo-columnar junction, which is the area where the epithelial lining of the ectocervix meets the endocervix (Tomasi, Opata and Mowa, 2019). It is the fourth leading malignancy among women and the second major cause of mortality due to cancer, after breast cancer in women globally (World Health Organization; WHO, 2018; WHO, 2022). Cervical cancer is a disease that ensues from many risk factors like early exposure to sexual intercourse, multiple sexual partners, tobacco smoking, immunosuppression and family history of cervical cancer (Murray, Rosenthal and Pfaller, 2015). Yearly, over 530,000 new cases are reported worldwide, and roughly 270,000 women die as a result of cervical cancer worldwide (Jodjana, Windiani, Adnyana, Pratiwi and Soetjiningsih, 2023). In the United States, findings had shown that adolescents between 14 - 19 years who are sexually active had the highest prevalence of HPV infection which is the major risk factor of cervical cancer (Santos, Silva, Carneiro, Coura-Vital and Lima, 2020). The World Health Organization emphasized that, 19 of the leading 20 countries with the highest cases of cervical cancer were in sub-Saharan Africa (WHO, 2022). Over 80% of incidence and mortality is in low-and-middle World Journal of Advanced Research and Reviews, 2025, 26(03), 813-825 814 income countries (LMICs) with the highest mortality in sub-Saharan Africa (Sung et al., 2021). As stated in 2018, Nigeria had 14,943 new cases of cervical cancers and 10,403 associated mortality which amount to one-fifth of cancer mortality in West Africa (GLOBOCAN, 2018; Morhason-Bello, Kareem and Adewole, 2020). Cervical cancer continues to be a public health issue across the world causing high mortalities among women (WHO, 2021). Human papillomavirus (HPV) is the major risk factor for cervical cancer, and this virus is identified in 99.7% of cervical cancer cases worldwide (Krieking, Castellsague, Cibula and Demarteau, 2014). Almost all cases of cervical cancer are associated to HPV, contracted mainly by sexual intercourse (Bosch, Lorincz, Muñoz, Meijer and Shah, 2022). The highest rates of HPV infections was found to be common among women below 25 years old (Santos, Silva, Carneiro, Coura-Vital and Lima, 2020; Ifediora and Azuike, 2018). Screening program using the Papanicolaou test (Pap test) can help in early detection and this has contributed to significant decrease in death due to cervical cancer (AbdAllah et al., 2016). As option to the Papanicolaou test, some other screening methods have been developed and used, especially in developing countries (AbdAllah et al., 2016). Visual inspection with acetic acid and Lugol’s iodine tests have been considered (AbdAllah et al., 2016). Asides screening tests for early diagnosis and treatment, mortality from cervical cancer can also be avoided through the HPV vaccination of adolescents (Canfell et al., 2020). 2. Material and methods The study was carried out among adolescent senior secondary schools’ girls in Ile-Ife, Osun state, Southwest, Nigeria. The population of the city was over 500,000 people, which is the highest in Osun State according to population census of 2006 (The Guardian Nigeria News, 2019). The main city of Ile-Ife is divided into two local government areas; Ife-east and Ife-central with a total of 21 political wards each (The Osun State Government, 2024). The city is located between latitudes 7°28′N and 7°45′N and longitudes 4°30′E and 4°34′E (Ajala and Olayiwola, 2013). Ile-Ifẹ is known worldwide for its ancient and naturalistic bronze, stone and terracotta sculptures, as far back to between 1200 and 1400 CE (Suzanne, 2015). The ancient city is known as the cradle of Yoruba ethnic group and also has Obafemi Awolowo University and Obafemi Awolowo University Teaching Hospital Complex. The research was a descriptive cross-sectional elicited among adolescent senior secondary schools. Sample size was determined by using the sample size formula as follows: 𝑛 = 𝑧2𝑝q 𝑑2 Where n= sample size z=1.96 (standard normal deviate) at 95% confidence interval p= Proportion of individuals with the factor of interest = 18.1% (0.181), i.e., respondents who had good knowledge of cervical cancer based on study by Amu, Ndugba and Olatona (2019). q = 1 − p = 1 − 0.181 = 0.819 d= Absolute standard error or confidence interval set at 0.05 Therefore, n = 1.962×0.819(1−0.819) 0.052 n = 227.78 n is approximately 228. Factoring in a non-response rate of 10%, minimum sample size =228 + ( 10 100 × 228) = 228 + 22.8 = 250.8. Therefore, minimum sample size is 251. However, 254 data were collected. Instruments for data collection were selfadministered questionnaires, designed after consideration of previous studies. It includes both open and closed ended questions divided into three (3) sections of study objectives. Socio-demographic characteristics, awareness of cervical cancer and knowledge of cervical cancer among adolescent girls in secondary school in Ile-Ife. World Journal of Advanced Research and Reviews, 2025, 26(03), 813-825 815 Data was collected by means of paper based self-administered questionnaires. Respondents were interviewed during break session and the interview was conducted at a location that ensured respondents privacy and comfort. Each data collection lasted for a period of 15 minutes. Three (3) research assistants were trained over a period of three days on how to administer questionnaire. The minimum qualification of the research assistants was Bachelor of Science (BSc). One public and 2 private secondary schools were selected from each of the two Local Government Areas in Ile-Ife by simple random sampling. Giving a total of six schools (2 public and 4 private). Data was entered manually into the IBM SPSS version 25 software. Data was then checked for completion and subsequently cleaned. Statistical Package for the Social Sciences (SPSS) version 25 was used for the analysis of data collected. Frequencies, proportions and percentages for categorical variables of interest were computed. Variables were measured using quantitative methods. Independent variables were the socio-demographic characteristics of the respondents while the dependent variable was knowledge of cervical cancer. In determining the knowledge of cervical cancer, an 18-point questions covering knowledge on cervical cancer (from the knowledge section of the questionnaire was used). Each correct response was scored one while I don’t know or wrong response was scored zero. Respondents who scored 9-18 were categorized as having good knowledge while those that scored 0-8 were categorized as having poor knowledge. Level of knowledge of cervical cancer and factors associated with knowledge of cervical cancer were expressed as the proportion of the adolescent girls attending the school during the period of study and expressed as a percentage of the total study population. All variables were presented using descriptive statistics (frequency and percentage). To determine whether the independent and dependent variables were associated, the chi-square test was employed, at a 95% confidence interval, p<0.05 was deemed statistically significant. Ethical approval was obtained from the Research Ethics Committee of the Osun State Ministry of Health, Osogbo. Consent was obtained from the parents of the selected participants by sending the consent forms through their children or wards. The form contained a brief explanation of the objectives and procedures of the study. Prior to administration of questionnaires, participants were furnished with adequate information about the study and their assent obtained. Participants were assured of their confidentiality and the anonymity of the obtained information. Participation was voluntary, and participant were informed they can withdraw their participation at any point without any prejudice. 3. Results Table 1 Socio-demographic Characteristics of the Respondents on Biodata (n=254) Characteristic Frequency Percent Age (Years) 10 - 13 29 11.4 14 - 16 215 84.6 17 - 19 10 3.9 Mean = 14.8661 SD = 1.28759 Religion Christianity 202 79.5 Islam 47 18.5 African Traditional Religion 5 2.0 Ethnicity Yoruba 223 87.8 Hausa 18 7.1 Igbo 5 2.0 Others** 8 3.1 Place of Residence World Journal of Advanced Research and Reviews, 2025, 26(03), 813-825 816 Urban 220 86.6 Rural 34 13.4 Type of school Private 167 65.7 Public 87 34.4 Class SS 1 104 40.9 SS 2 103 40.6 SS 3 47 18.5 Sub-class Science 159 62.6 Commercial 27 10.6 Art 68 26.8 ** Others ethnic group: Edo, Isobo, Ghanian Table 2 Socio-demographic Characteristics of the Respondents on Social activities (n=254) Characteristic Frequency Percent Ownership of mobile phone with internet services Yes 168 66.1 No 86 33.9 Ownership of social media account Yes 147 57.9 No 107 42.1 Membership of School Health Club Yes 51 20.1 No 203 79.9 Table 3 Socio-demographic Characteristics of the Respondents’ Parents (n=254) Characteristic Frequency Percent Father’s occupation Civil servant (Non-Health Professional) 74 29.1 Civil servant (Health Professional) 23 9.1 Business man 100 39.4 Petty trader 3 1.2 Farmer 24 9.1 Others** 30 11.8 World Journal of Advanced Research and Reviews, 2025, 26(03), 813-825 817 Mother’s Occupation Civil servant (Non-Health Professional) 43 16.9 Civil servant (Health Professional) 41 16.1 Business woman 110 43.3 Petty trader 40 16.7 Farmer 1 0.4 Others** 19 7.5 Father’s level of Education Primary 4 1.6 Secondary 61 24.0 Tertiary/Higher Education 189 74.4 Mother’s level of Education Primary 7 2.8 Secondary 57 22.4 Tertiary/Higher Education 190 74.8 **Other Fathers’ occupation: Transporter, Carpenter **Other Mothers’ occupation: Seamstress, Hair stylist Table 4 Sources of Information on Cervical Cancer among Adolescent Girls in Secondary Schools in Ile-Ife (July 2024) Sources Frequency(n=254) Percentage# Healthcare worker 68 42.5 Family members 59 36.9 Friends 57 35.6 Social media/Internet 76 47.5 Television/Radio 58 36.2 Book/Magazine 46 28.8 School/Class lesson 78 48.8 Church/Mosque 24 15.0 Market 7 4.4 # = Multiple response Table 5 Cervical Cancer Knowledge among Adolescent Girls in Secondary Schools in Ile-Ife (July 2024) Knowledge Statement Frequency(n=254) Percent Cervical cancer affects both men and women Yes 67 26.4 No 67 26.4 Don’t know 120 47.2 Human papilloma virus (HPV) is not a risk factor of cervical Cancer Yes 38 15.0 No 50 19.7 World Journal of Advanced Research and Reviews, 2025, 26(03), 813-825 818 Don’t know 166 65.4 Human papilloma virus (HPV) can be sexually transmitted Yes 67 26.4 No 33 13.0 Don’t know 154 60.6 Having multiple sexual partners is a risk factor for cervical cancer Yes 73 28.7 No 47 18.5 Don’t know 134 52.8 Adolescent girls do not need to be vaccinated against Human Papilloma Virus (HPV) Yes 39 15.4 No 88 34.6 Don’t know 127 50 Smoking is not a risk factor of cervical cancer Yes 50 19.7 No 67 26.4 Don’t know 137 53.9 Cervical cancer can be caused by spiritual attack Yes 32 12.6 No 95 37.4 Don’t know 127 50.0 Early sexual activity is a protective factor for cervical cancer Yes 30 11.8 No 78 30.7 Don’t know 146 57.5 Giving birth to many children is a risk factor for cervical cancer Yes 28 11.0 No 68 26.8 Don’t know 158 62.2 Abnormal vaginal discharge is not a symptom of cervical cancer Yes 46 18.1 No 42 16.5 Don’t know 166 65.4 Bleeding in between period is a symptom of cervical cancer Yes 42 16.5 No 36 14.2 Don’t know 176 69.3 Foul smelling vaginal discharge is not a symptom of cervical cancer World Journal of Advanced Research and Reviews, 2025, 26(03), 813-825 819 Yes 43 16.9 No 41 16.1 Don’t know 170 66.9 Cervical cancer may not present with signs and symptoms at early stage Yes 69 27.2 No 32 12.6 Don’t know 153 60.2 Cervical cancer is treatable if it presents early Yes 99 39.0 No 19 7.5 Don’t know 136 53.5 There are currently vaccines for cervical cancer prevention Yes 97 38.2 No 25 9.8 Don’t know 132 52.0 Cervical cancer cannot be prevented with vaccination Yes 38 15.0 No 69 27.2 Don’t know 147 57.9 It is not possible to screen for cervical cancer Yes 30 11.8 No 57 22.4 Don’t know 167 65.7 Pap smear is a test to screen for cervical cancer Yes 34 13.4 No 25 9.8 Don’t know 195 76.8 Table 6 Cervical Cancer Knowledge Categorization among Adolescent Girls in Secondary Schools in Ile-Ife (July, 2024) Frequency(n=254) Percent Good 23 9.1 Poor 231 90.9 Table 7 Association between Knowledge of Cervical Cancer and Socio-demographic Characteristics among Adolescent Girls in Secondary Schools in Ile-Ife (July, 2024) Poor Knowledge Good Knowledge χ2 p-value Age 10 – 13 25 4 2.602 0.272 World Journal of Advanced Research and Reviews, 2025, 26(03), 813-825 820 14 – 16 196 19 17 – 19 10 0 Religion Christianity 186 16 2.759 0.252 Islam 40 7 African Traditional Religion 5 0 Class SS1 91 13 3.021 0.221 SS2 95 8 SS3 45 2 Sub-Class Science 144 15 0.406 0.816 Commercial 24 3 Art 63 5 Place of Residence Urban 200 20 0.003 0.960 Rural 31 3 Tribe Yoruba 204 19 1.012 0.798 Igbo 16 2 Hausa/Fulani 4 1 Others 7 1 Usage of internet-enabled Phone Yes 155 13 1.045 0.307 No 76 10 Social Media Accounts Yes 136 11 1.047 0.306 No 95 12 Type of School Private 155 12 2.069 0.150 Public 76 11 Presence of School Health Club Yes 44 7 1.703 0.427 No 144 10 School without Health Club 73 6 Occupation of Father Civil servant 69 5 13.736 0.017** World Journal of Advanced Research and Reviews, 2025, 26(03), 813-825 821 (Non-health Professional) Civil servant (Health Professional) 19 4 Business Man 92 8 Petty trader 3 0 Farmer 18 6 Others** 30 0 Occupation of Mother Civil servant (Non-health Professional) 42 1 8.966 0.110 Civil servant (Health Professional) 37 4 Business woman 98 12 Petty trader 36 4 Farmer 0 1 Others** 18 1 Father’s Level of Education Primary Primary 4 0 1.244 0.537 Secondary 57 7 Tertiary/Higher Education 173 16 Mother’s Level of Education Primary 7 0 1.475 0.478 Secondary 51 6 Tertiary/Higher Education 173 17 ** Father’s Occupation: Transporter, Carpenter ** Mother’s Occupation: Seamstress, Hair stylist ** Tribe: Edo, Isobo, Ghanian There was a statistically significant relationship between respondents’ knowledge of cervical cancer and the occupation of their fathers (p=0.017). Other socio-demographic characteristics were not found to have statistically relationship with knowledge. 4. Discussion A total of 254 students participated in this study with response rate of 100%. Mean age was 14.87 ± 1.3. This was similar to a study conducted by Aimiosior and Omigbodun (2020) among female secondary school students in Ibadan, Nigeria where the mean age of the respondents was 14.4 ± 1.2. Also, it was consistent with a survey conducted by Fagbule et al. (2020) among senior secondary school students across six states in Nigeria with mean age of 16.4 ±2.0. Furthermore, Nakayita et al (2023) conducted a study among school girls on HPV vaccine uptake in Uganda with the mean age of 12.11 ±1.651. In a similar study carried out in Brazil, the mean age of the participants was 12.4 ± 1.0 (Santos et al., 2020). Most participants 202 (79.5%) were Christians, this could be because Ile-Ife has been known with existence of various Christian missionaries which have been existing more than a century ago, among them is Saint Paul’s Anglican Church, Ayegbaju, Ile-Ife which was built over 100 years ago (Punch Newspaper, 2023). 223 (87.8%) of participants were of Yoruba ethnicity, this could be because the study was carried out in south-western part of Nigeria which is dominated