Mezgebu First Draft

YOM INSTITUTE OF ECONOMICS MSC SEMINAR AND THESIS
YOM POST GRADUATE COLLEGE DEPARTMENT OF

PROJECT PLANNING AND MANAGEMENT
KNEWOLEDGE, ATTITUDES, AND ASSOCIATED FACTORS ON PRACTICE OF CERVICAL

CANCER SCREENING AMONG FEMALESEXWORKERS IN BAHIR DARCITY COMMUNITY
BASED STUDY
Student: Mezgebu Alamirew
Supervisor: Birehan Sisay(PhD)
THESIS SUBMITTED TO YOM POST GRADUATE COLLEGE for PARTIAL

FULFILLMENT OF THE REQUIREMENT of MASTER OF SCIENCE (MSC) IN PROJECT
PLANNING AND MANAGEMENT
January, 2022G.C
Bahir Dar, Ethiopia
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Declaration
I Mezgebu Alamiraw, registration number I.D. Number -----------, do hereby declare that this
thesis is my original work and that it has not been submitted partially; or in full, by any other person
for an award of degree in any other university/institution.
Submitted by:
Full Name: Mezgebu Alamiraw Signature Date
Approved by:
This Thesis has been submitted for examination with my approval.
Name of Advisor Birehan Sisay (PhD) Signature Date

-
Board of Examiners
Chair person Signature Date

_______________
Internal Examiner Signature Date
External Examiner Signature Date
ii
APPROVAL
The undersigned certify that they have read and hereby recommend to Yom Post Graduate College
Department of Project Management to accept the Thesis submitted by Mezgebu Alamiraw and entitled
knowledge, attitudes, and associated factors on practice of cervical cancer screening among female sex
workers in Bahir Dar city community based study. In partial fulfillment of the requirements for the award of
a Masters Degree in Project Management.
Submitted by:
Full Name : Mezgebu Alamiraw Signature Date
Approved by:
Name of Advisor Birehan Sisaye(PhD) Signature Date
Name of Internal Examiner Signature Date
Name of External Examiner Signature Date
Name of Head of Department Signature Date
iii
ACKNOWLEDGMENTS
First and foremost, many thanks is directed to God, the supporter and the owner of peace and love for
giving me the endurance and patience in accomplishing this piece of work.
Special thanks go to my advisor, Birehan Sisaye(PhD) for his invaluable and constructive comments on
the manuscript starting from proposal development to the final Thesis preparation.
I am particularly indebted to my husband Segenet Mekides, for her unreserved moral support,
encouragement and responsibility her took in taking care of our children during my study.
I am very glad to acknowledge the sample Female sex workers for their willingness and patience in responding
me to my questionnaire at the expense of their invaluable time. If they had not extended their cooperation, it
would have been impossible to complete this thesis.
Last but not least; I would like to express my heartfelt appreciation and gratitude to my children for their support
and encouragement. Above all, I praise God the almighty and Saint Marry, for allowing me to make my dreams
come true after a very difficult journey and a burdensome effort.
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Table of Contents
Table of Contents Page
Declaration............................................................................................................................................................... ii
APPROVAL...........................................................................................................................................................iii
ACKNOWLEDGMENTS.......................................................................................................................................iv
Table of Contents ....................................................................................................................................................v
List of Tables........................................................................................................................................................viii
List of Figures ........................................................................................................................................................ix
ABBREVIATIONS AND ACRONYMS.................................................................................................................x
Abstract................................................................................................................................................................... xi
CHAPTER ONE......................................................................................................................................................1
1.1.Background of the Study....................................................................................................................................1
1.2. Statement of the Problem..............................................................................................................................2
1.3. Objective of the Study...................................................................................................................................3
1.3.1. General Objective of the Study...............................................................................................................3
1.3.2. Specific Objectives.................................................................................................................................3
1.4.Research Questions........................................................................................................................................3
1.5.Hypothesis of the Study.................................................................................................................................4
1.6.Scope of the Study..........................................................................................................................................5
1.7. Significance of the Study...............................................................................................................................5
CHAPTER TWO......................................................................................................................................................6
2. REVIEW OF RELATED LITERATURE............................................................................................................6
2.1. Literature Review..............................................................................................................................................6
2.1. The theory of cervical cancer........................................................................................................................6
2.2. The Concept of Cervical Cancer....................................................................................................................7
2.3. The Concept of Cervical Cancer Screening...................................................................................................7
2.4. Empirical Review Practice of Cervical Cancer Screening.............................................................................7
2.4.1.Knowledge on Cervical Cancer Screenings:............................................................................................7
2.4.2.Attitude toward Cervical Cancer Screening.............................................................................................8
2.4.3.Practice of Cervical Cancer Screening.....................................................................................................9
2.5. Associated Factors on Practice of Cervical Cancer Screening.................................................................10
2.5.1. Demographic Characteristics................................................................................................................10
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2.5.2. Health System Associated Factors Influencing Cervical Cancer Screening Practice............................11
2.5.Conceptual Framework.................................................................................................................................12
CHAPTER THREE................................................................................................................................................13
3. RESEARCH METHODOLOGY......................................................................................................................13
3.1. Research Approach......................................................................................................................................13
3.2.Study Design:...............................................................................................................................................13
3.3.Data Type and Sources of Data....................................................................................................................13
3.3.2. Data Collection Instrument.......................................................................................................................14
3.4.Study Population......................................................................................................................................14
3.4.1.Sampling and Sample Size Determination.............................................................................................15
3.5. Data analysis................................................................................................................................................16
3.5.1. Descriptive analysis..............................................................................................................................16
3.5.2 Pearson Correlation analysis..................................................................................................................16
3.5.3 Linear and Multiple Regression Analysis................................................................................................16
3.6. Model Specification.....................................................................................................................................17
CHAPTER FOUR..................................................................................................................................................19
4. DATA PRESENTATION AND ANALYSIS....................................................................................................19
4.1. Descriptive Analysis.....................................................................................................................................19
4.1.1. Response Rate..........................................................................................................................................19
4.1.2. Demographic Characteristics of Respondents......................................................................................20
4.1.3. Levels of Education of Respondents.........................................................................................................21
4.1.4. Religious of participants.......................................................................................................................21
4.1.5. Ethnicity of Participants........................................................................................................................22
4.1.6. Average monthly income (ETB) per month...........................................................................................22
4.2. The Descriptive statistics of perceived variables by female sex workers.....................................................23
4.2.1. The level of knowledge of cervical cancer screening among female sex workers................................23
4.2.2. The attitude of cervical cancer screening among female sex workers..................................................28
4.2.3. Associated factors affecting the practice of cervical cancer screening among female sex workers.....30
4.2.4. Female sex workers cervical cancer screening practicing...................................................................30
4.3. Inferential statistics.....................................................................................................................................31
4.3.1. Correlation Analysis..............................................................................................................................31
4.3.2. Multiple Regression Analysis................................................................................................................34
4.8. Hypothesis Testing.......................................................................................................................................35
CHAPTER FIVE....................................................................................................................................................38
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5. MAJOR FINDINGS, CONCLUSION AND RECOMMENDATION...........................................................38
5.1. Major Findings.............................................................................................................................................38
5.2. Conclusion...................................................................................................................................................40
5.3. Recommendations.......................................................................................................................................40
REFRENCES:........................................................................................................................................................41
Annex.....................................................................................................................................................................45
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List of Tables Page
Table 3.1: Proportional allocation of the sample size by the sub-city administration in Bahir Dar city. ............15
Table 3.2: Variable Definitions and Expected Sign On Practice Of Cervical Cancer Screening ........................17
Table 4.1:- Response rate of the respondents..................................................................................................... 19
Table 4.2. Age of study participants (in years).................................................................................................. 20
Table 4.3 Education Status of respondents......................................................................................................... 20
Table 4.4. Religions Participants........................................................................................................................ 21
Table 4.5. Ethnicity of respondents.................................................................................................................... 22
Table 4.6. Average monthly income (ETB) per month...................................................................................... 22
Table 4.7: Risk factors for cervical cancer.......................................................................................................... 23
Table 4.8: Prevention measures for cervical cancer........................................................................................... 24
Table 4.9: The level of knowledge of cervical cancer screening among female sex workers .............................25
Table 4.10: The level of knowledge of cervical cancer screening among female sex workers ...........................26
Table 4.11: What is your Source of information for cervical cancer screening for the first time? ......................27
Table 4.12: The attitude of cervical cancer screening among female sex workers ............................................. 29
Table 4.13: Associated factors affecting the practice of cervical cancer screening among female sex workers . 30
Table 4.14: Female sex workers cervical cancer screening practicing ................................................................ 30
Table 4.15:Have you discussed on cervical cancer with health care providers? ................................................. 31
Table 4.16: Correlation between dependent and dependent variables ................................................................ 32
Table 4.17: Coefficients of independent and dependent variables..................................................................... 34
Table 4.18:- Summary of hypothesis.................................................................................................................. 37
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List of Figures Page

Figure- 1: Conceptual framework for factors influencing cervical cancer and its screening program which
developed to show associated factors of screening practice by reviewing different articles. ..................................12
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ABBREVIATIONS AND ACRONYMS

CCS Cervical Cancer Screening
DNA Debonuclic Acid
FSWs Female Sex Workers
Ha Alternative Hypothesis
Ho Null Hypothesis
HPV Human Papilloma virus
SSA Sub-Saharan African
STI Sexual Transmitted Infection
VIA/VILV Visual inspection with acetic acid/Visual Inspection with Logos Iodine
WHO World Health Organization
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Abstract
The purpose of this study is to assess knowledge, attitudes, practice of cervical cancer screening and
associated factors among female sex workers in Bahir Dar city. To achieve the objectives of the study,
this study used a purely quantitative research approach and co relational research design. The study
population includes all female sex workers in Bahir Dar city. This population includes all female sex
workers who had worked in the industry for more than 6 months. The sample size of the study is 374
female sex workers. The data collection instrument that employed for the study is questionnaire. The
data analysis techniques of the study were descriptive, Pearson Correlation and Linear and Multiple
Regression Analysis respectively. The findings of this study were the level of knowledge of cervical
cancer screening among female sex workers is very low. The attitude of cervical cancer screening
among female sex workers is not promising. Most of sex workers did not have cervical cancer screening
practicing. Knowledge, Attitudes and Health system and related factors have positive and significantly
related to Assessment of the practice of cervical cancer screening. To conclude the level of knowledge of
cervical cancer screening among female sex workers is very low. Similarly, the attitude of cervical
cancer screening among female sex workers is not promising and most of participants did not Cervical
or vaginal examination due to pregnancy or any other and most of sex workers did not had cervical
cancer screening practicing. Eventually, Knowledge, Attitudes, Health system and related factors have
positive and significantly related to Assessment of the practice of cervical cancer screening.
Key words: Cervical cancer, screening, Practice, knowledge, attitude
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CHAPTER ONE
1.1. Background of the Study

Cervical cancer is a cancer arising from the cervix of the uterus, which is due to the abnormal growth of
cells that have the ability to dissimilate and invade other part of the body. It is mostly caused by human
papilloma virus (HPV), specifically the two strains HPV 16 and HPV 18. Cervical cancer screening is a
way to detect abnormal cervical cells, including precancerous cervical lesions, as well as early cervical
cancers. Routine cervical screening has been shown to greatly reduce both the number of new cervical
cancers diagnosed each year and deaths from the disease. According to guidelines, women ages 21
through 29 should be screened every three years and women with certain risk factors should screen more
frequently (Singh, 2012).There are many cervical cancer screening tests globally accepted or being
studied around the world traditional and modern screening methods. They are cervical cytology, Liquid-
based cytology (LBC), New screening methods like, HPV DNA test and Visual tests: VILIV and VIA
(Singh, 2012).
In Ethiopia from the reproductive age group of women the incidence was 17.3%, mortality 16.5% and
five year prevalence was 18.2% (Singh, 2012). Cervical cancer disease trend is significantly reduced in
developed countries due to early diagnosis and treatment. Whereas, due to poor access of quality
screening and treatment service, the trend is increasing in developing countries (Cervical Cancer
Screening in Developing Countries, n.d.). Therefore, according to trend analysis on cervical and breast
cancer between the year 1980 and 2010, Cervical cancer trend is increasing from 378 000 (256 000–489
000) to 454 000 (318 000–620 000) an average annual increase of 0.6% (Tesfa, 2010). New cases of
cervical cancer occur more often in developing countries than in developed countries in all age groups.
In developing countries, among individuals aged 15–49 years, there were 154 000 (106 000–208 000)
cases of cervical cancer(Tesfa, 2010). In 2010, 76 100 (17%) of these cases were found in sub- Saharan
Africa. The number of cases of cervical cancer has been increasing for all regions except in developed
countries(Tesfa, 2010). Screening for cervical cancer remains the most effective way for early detection
and its management. Even though, screening service offers protective benefits and is associated with a
reduction in the incidence of invasive cervical cancer and cervical cancer mortality(Torre et al.,
2017).But, from the total population of women in Ethiopia there is very high morbidity and mortality
rate by cervical cancer despite to this the cervical cancer screening practice is very low(<1%). Though
sex workers having a high chance to exposed for several risk factors such as multiple sexual partners,
teenager initiation into sex, smoking, alcohol and presence of different sexually transmitted infection
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(STI) and at highest risk for developing and dying of by cervical cancer and are less likely to be
screened(Bray et al., 2018). Therefore, the purpose of this study is to examine the knowledge, attitude
and associated factors on the practice of cervical cancer screening among female sex workers on the
community of Bahir Dar city.
1.2. Statement of the Problem

Cervical cancer is among all malignancies the most common cancer disease in women globally (WHO
Technical Specifications, n.d.2012).In 2012, in the world about 266,000 cervical cancer deaths occurred
and 90% of cases registered in low income countries, especially series in Sub-Saharan Africa(SSA)
region this disease is the leading killer of females with in reproductive age groups(WHO Technical
Specifications, n.d.2016).Also in Ethiopia, because of cervical cancer every year 7095, 4732 cases and
deaths occurred respectively (HPV and Related Diseases Report, 2019). Different studies shows
annually a highest estimated amount of deaths occurred in developing countries for example, in Ethiopia
16.3% (Hpv & Centre, 2015) and in Nigeria 20.3% (Arbyn et al., 2020)mortality rates. Studies done in
Northwest Ethiopia on the total population of women that shows there is gap in knowledge about
cervical cancer risk factors, symptoms and preventive options (B. M. C. Cancer et al., 2013). The other
study done in Addis Ababa shows that educated persons even health professionals having a low
knowledge and poor practice on screening of cervical cancer(Ababa et al., 2019).Even if cervical cancer
is a preventable disease , in most first world countries show studies on average cervical cancer screening
practice was about 23% but in Ethiopia 0.6% which was low( Carey et al.,, Jia et al.,2013 , HPV &
Related Diseases Report, 2019).
Cervical cancer is a disease caused by infection of HPV it also transmits through sex most commonly
(Comprehensive Cervical Cancer Control, n.d.2014). Therefore, sex workers are highly exposed to HPV
infection because of usage of condom inconsistently, HIV/AIDS co-morbidity and having of multiple
sexual partners (Couture et al., 2012).
In this regard various researchers tried to assess the practice cervical cancer screening for instance:
Bekele(Muluneh & Atnafu, 2019) conduct a study predictors of cervical cancer screening service
utilization among commercial sex workers inBahir Dar city: Northwest Ethiopia facility based case
control study. However, in Ethiopian context are scanty. In contrast the other studies ( Kibichi, 20114,
Visanuyothin et al.,2015&Bessler et al., 2007) he researched that knowledge is not the determinant
factor for practice of cervical cancer screening, He was done the research paper by collecting the data in
a single commercial sex worker clinic / Family Guidance Association of Ethiopia North West Area
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Office confidential sex worker clinic only/ the sample is not representative for community population
because they are not served only in this clinic they can go to other health institutions in Bahir Dar city.
Despites the growing number of cervical cancer cases in Ethiopia, still there is gap in knowledge,
attitude and associated factors with low screening practice. Knowledge about cervical screening is low.
By considering the increasing pattern of the disease, low practice of screening and high prevalence of
risk factors, in the country Information related to cervical cancer like knowledge of the disease, attitude
and practice towards screening is very limited. So my study, would be contribute for policy makers,
administrators and others to the development of strategy and program for cervical cancer prevention and
screening. Consequently, this research conducted by incorporating knowledge, attitude and associated
factors that affect the practice of cervical cancer screening in the study area that helps to a valuable
addition for the concern by using the advanced econometric model. .
1.3. Objective of the Study

1.3.1. General Objective of the Study
To assess knowledge, attitudes, practice of cervical cancer screening and associated factors among
female sex workers in Bahir Dar city.
1.3.2. Specific Objectives

 To assess the level of knowledge of cervical cancer screening among female sex workers in
Bahir Dar.
 To assess the level of attitudes of cervical cancer screening among female sex workers in Bahir
Dar;
 To identify associated factors affecting cervical cancer screening practice among female sex
workers in Bahir Dar.
 To assess the practice of cervical cancer screening of female sex workers in the study area.
 To assess the relationship between knowledge, attitudes and associated factors of cervical
cancer screening among female sex workers and the practice of cervical cancer screening of
female sex workers.
1.4. Research Questions

This study was designed to answer the following questions.
 What is the level of knowledge of cervical cancer screening among female sex workers in Bahir
Dar?
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 What is the level of attitude of cervical cancer screening among female sex workers in Bahir
Dar?
 How associated factors affecting the practice of cervical cancer screening among female sex
workers at in Bahir Dar?
 To What extent female cervical cancer screening practicing in the study area?
 What is the relationship between knowledge, attitudes and associated factors of cervical cancer
screening among female sex workers and the practice of cervical cancer screening of female sex
workers
1.5. Hypothesis of the Study

Ha:-is the level of knowledge of cervical cancer screening among female sex workers in Bahir Dar?
Ha - There is positive and significant relationship between knowledge and the practice of cervical
cancer screening among female sex workers in Bahir Dar?
Ho – There is no positive and significant relationship between knowledge and the practice of cervical
Ha – There is positive and significant relationship between attitude and the practice of cervical cancer
screening among female sex workers in Bahir Dar?
Ho - There is no positive and significant relationship between knowledge and the practice of cervical
Ha – There is positive and significant relationship between heaths related associated factors and the
practice of cervical cancer screening among female sex workers in Bahir Dar?
Ho - There is no positive and significant relationship between heaths related associated factors and the
Ha – There is positive and significant relationship between sexual and reproductive health and the
Ho - There is no positive and significant relationship between sexual and reproductive health and the
4
1.6. Scope of the Study
The study will focus on the assessment of knowledge, attitude, sexual and reproductive health and
associated factors on the practice of cervical cancer screening on female sex workers in Northwest
Ethiopia in Bahir Dar identifying factors that associate on the screening practice of cervical cancer. The
target study population includes all sex workers lives in Bahir Dar city greater than six months. This
study will be conducted and completed from March 1- April 30/2021.
1.7. Significance of the Study

In most low income a countries implementing an effective cervical cancer screening program has been
difficult for a long period of time. However, women need to screen all risk groups so as to detect early
stage cervical cancer successfully. By 2020, Ethiopia plans to increase screening coverage up to 85%
(N. Cancer & Plan, 2020); Despite this fact very low amount of women has been screened. At the
present status of screening will not have a great contribution for prevention and control of cervical
cancer in Ethiopia. Because of their working behavior female sex workers are more vulnerable to STI
like HPV, despite of this there is no more data locally and nationally cervical cancer screening practice
of these groups of populations.
So this study aimed to explore the knowledge, attitude and screening practices for early detection and
identifying the factors associated with knowledge, attitudes and practices towards cervical cancer
screening among female sex workers in Bahir Dar. Findings from this study will provides available
information to authorities so that proper measures can be taken according to the results to save the lives
of victims women by creating awareness and provide screening services in the health centers, clinics and
hospitals . At the end of this study the recommendation will give to the concerned bodies to fill the gaps
based on the findings, it will also help as a baseline for further researches.
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CHAPTER TWO
2. REVIEW OF RELATED LITERATURE
2. Literature Review
Theoretical literature, concepts, empirical literature, and conceptual framework are included in
this chapter to obtain the existing knowledge, attitude, associated factors and different findings on
cervical cancer screening practices.
2.1. The theory of cervical cancer

Cervical cancer is a complex disease that, by its association with human papilloma virus (HPV),
has elicited research in a broad range of areas pertaining to its basic diagnostic and clinical aspects.
The complexity of this association lies not only in the fundamental relationship between virus and
cancer but also in its translation to pathogenic diagnosis and clinical management. Offshoots from
the relationship of virus to pathology include studies targeting the link between papilloma virus
infection and cervical epithelial abnormalities, the molecular epidemiology of papilloma virus
infection, and the potential use of HPV testing as either a screening technique or a tool for
managing women who have Pap smear abnormalities. A second variable that is critical to the
pathogenesis of cervical neoplasia is the cervical transformation zone. The wide range of invasive
and noninvasive lesion phenotypes associated with HPV infection in this region indicates that not
only the virus but also specific host target epithelial cells in the transformation zone an important
part in the development of cervical neoplasia. Further understanding of this relationship between
the virus and the host epithelium will hinge on determining the subtypes of epithelial cells in the
transformation zone and their phenotypic response to infection. New technologies, such as
expression arrays, promise to clarify, if not resolve, the complexity of molecular interactions
leading to the multiplicity of tumor phenotypes associated with HPV infection of the uterine
cervix. Throughout the past 20 years, the perception of cervical carcinoma has shifted from that of
a mysterious, sexually transmitted disease to one inti-mately related to human papilloma
virus(HPVs).This evolution is understanding has been driven by a powerful association between
virus and disease and by a wealth of molecular data supporting mechanisms of papilloma virus-
mediated tumorigenesis(Alani & Monger, 2021).
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2.2. The Concept of 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 the vagina. Various strains of the human papillomavirus (HPV), a sexually
transmitted infection, play a role in causing most cervical cancer. When exposed to HPV, the
body`s immune system typically prevents the virus from doing harm. In a small percentage of
people, however, the virus survives for years, contributing to the process that causes some cervical
cells to become cancer cells. You can reduce your risk of developing cervical cancer by having
screening tests and receiving a vaccine that protects against HPV infection(Pandey, 2017).
2.3. The Concept of Cervical Cancer Screening

This concept is not new back to dates the 1940s. The identification of preinvasive lesion of the
cervix is possible by combining a Pap test and histological verification, and follow appropriate
treatment, that is removal or destruction of preinvasive lesions, which interrupts the natural course
of cancer of the cervix and prevent the progression of the disease(Bray et al., 2005).
Cervical cancer screening is very confident and effective strategy for the prevention of cervical
cancer (WHO Technical Specification, n.d.2013, WHO Technical Specification, n.d.2014 and
WHO, 2013). World Health organization (WHO), The United States Preventive Service Task
Force (USPSTF) and the American cancer Society (ACS) cervical cancer screening guide line state
once in lifetime significantly reduces the risk of incidence of advanced morbidity and mortality by
cervical cancer respectively ( Peirson et al.,2013, Report,2013 & Health, 2014).
2.4. Empirical Review Practice of Cervical Cancer Screening

2.4.1. Knowledge on Cervical Cancer Screenings:
Across the world previous studies have demonstrated that cervical cancer risk factors and cervical
screening knowledge is extremely poor (Wong,2011&Oliveira et al., 2006).
Study done on knowledge of cervical cancer in southeast Nigeria, about its preventable nature of
cervical screening was below 40% (Eze et al., 2012). Study done in South Africa on University
student`s shows that 33% of the participants heard about screening of cervical cancer and 33% of
them knew that cervical cancer can be prevented by screening (Hoque, 2010).
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A community based study done Gondar in Ethiopia 47% did not Know the risk factors about
cervical cancer, 36.1% was not know the measures of its preventive, 39.6% did not know its
symptoms and 33.9% did not know options of treatments and 63.9% was know it can be prevented.
According to this study women only 13.7% of had heard about screening technique (Pap smear)
(B. M. C. Cancer et al., 2013). This study result revealed that knowledge of women was poor about
cervical cancer, though majority of the women had heard about cervical cancer disease.
Specifically, about risk factors, signs and symptoms the knowledge of women was poor, therefore
the education must include the information about the disease of cervical cancer its risk factors, sign
and symptoms (B. M. C. Cancer et al., 2013).A knowledge, attitude and practice study of Pap
smear among nurses in Addis Ababa showed that, even though they are health care providers but
having low knowledge (Ababa et al., 2019). All the above studies show the general population
Knowledge of women, Therefore sex workers are more marginalized population in Ethiopia their
knowledge is below the general population of women, the study done on Kenya’s Female sex
workers, even though sex workers were more aware of cervical cancer but they didn´t have detail
knowledge about the disease(Mugai et al., 2020).Thelow percentage (1.9%) who hadn´t ever heard
of cervical cancer. This low percentage could be shortage of familiarity preventive concept of
health care. They had no information cervical cancer screening where was done(Mugai et al.,
2020). Other studies conducted in Addis Ababa, Ethiopia showed that shortage of knowledge were
the main barriers of cervical cancer screening (Id et al., 2019).
2.4.2. Attitude toward Cervical Cancer Screening

The study done in Fenoteselam Northwest Ethiopia, From the respondents 63 % having a negative
attitude towards cervical cancer screening and 7.3% had a history of screening for the
disease(Zone et al., 2018) . The study done in Addis Ababa on women’s reproductive age group
showed that 56% was having negative attitude towards cervical cancer screening (Getachew et al.,
2015). The other studies done in South Ethiopia, Hosanna Town 34% was having negative attitude
towards screening of cervical cancer(Aweke et al., 2017).All the above studies show that the
attitudes of women’s in general population, I can`t found the data about female sex workers
attitudes towards cervical cancer and screening in Ethiopia, there is high gap. So my study will fill
this gap.
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2.4.3. Practice of Cervical Cancer Screening
Although cervical cancer is a major worldwide cause of morbidity and death in women`s, it was
found to be one of the most preventable human cancer. Globally, the high incidences of cervical
cancer is associated with lack of regular screening of cervical cancer (Situational, 2004 &Lee et
al., 2002) sex workers were highly exposed to HPV due to having multiple sexual partner in spite
of low screening practice of cervical cancer.
According to the study done in Botswana the screening rate of cervical cancer is very low when
compared the goal of Ministry of health ccs of at least 75% or more. In the same study the
respondents only 39% was participate in Pap smear test (Ibekwe et al., 2011). This low screening
practice of cervical cancer participation is consistent with other studies done in low income
countries which reported an average participation, follow up 23% and 46% rates within 3 years
interval respectively (Carey et al., 1993)&Jia et al., 2013). Result from study conducted in Kenya
and Tanzania showed that the screening practice of cervical cancer was 22% and121.6%
respectively ( Gichangi et al. & F.Lyimo,2012).In general, When we compared to other African
contraries screening practice of cervical cancer in Ethiopia was very low (1 %)(HPV & Related
Diseases Report, 2019). And study was done in Gondar, Ethiopia from the respondents that have
knowledge only 14.7% of them had cervical cancer screening test (B. M. C. Cancer et al.,
2013).The Other study conducted in Dire Dewa, Facility based crossectional study that cervical
cancer utilization of women`s ,from all the respondents only 4% was having cervical cancer
screening test pap smear practice(Belay et al., 2020). The other studies conducted in Gurage zone
Southern Ethiopia from the respondents only 3.8% were practice of cervical cancer screening
(Adane et al., 2020).When we compared this to other low income countries also very low.T he
above studies showed that how much less in practice of cervical cancer screening of the general
population among women’s in Ethiopia, but there is no data about female sex workers in Ethiopia
locally or nationally.
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2.5. Associated Factors on Practice of Cervical Cancer Screening
2.5.1. Demographic Characteristics

In many studies different factors associated with practice of cervical screening. Age was one of the
significant factors accessing towards practice of screening of cervical cancer. Age greater than 45
years old women had a 90% less chance of screening cervical access compared with 25 up to 34
years old women (Mupepi et al., 2011). On the same study, the factors related to health facility
such as affordability, accessibility and availability of service of screening at the nearest possible
place is related to among women practice of screening. Socio economic factors play an important
role in uptake and access of screening service, Who were women`s financially independent, having
formal education and 25-34 years old were more likely access services of screening (Mupepi et al.,
2011). The other study conducted in Gurage zone in Southern Ethiopia showed that having
multiple sexual partners were significantly associated with the screening practice of cervical
cancer (Adane et al., 2020).
The other significant associated factors for the practice of cervical screening in Thailand were
beliefs of religious, getting of information about screening of cervical cancer and perceived risk of
developing cervical cancer which was affects positively the screening service whereas shortage of
time the screening service was affects negatively. Shortage of time for screening service was also
affecting cervical cancer screening practice in Malaysia. Other factors which was affecting
screening practice of cervical cancers were educational status, painful procedure and income level
(Wongwatcharanukul et al., 2014 and Roba et al., 2012).
The study done in Northwest Ethiopia educational status secondary and above, someone knowing
about cervical cancer and also visit the health institution were shown to be significant predictors
of knowledge when adjusted for variables p value less than 0.2. Participants with secondary and
above education were also about 1.2 times more likely to be knowledgeable than women with no
formal education(AOR=2.18, 95%CI (1.20-3.95)). In addition knowing someone with cervical
cancer(AOR=4.91, 95%CI (3.16-7.62)) and ever visit to health institution (AOR=8.13, 95%CI
(3.19-20.75)) were also factors that are more likely to increase about knowledge of cervical cancer
(B. M. C. Cancer et al., 2013).
10
Given this show over all series shortage of awareness, only in the urban areas there were a
significant association was seen between the education level and their awareness of cervical
cancer. Among women`s those who had received higher education having a greater knowledge of
the disease, this was evident among the urban females (Arbyn et al., 2020). All the above studies
shows among the general population of women`s. The study done in Kenya on female sex
workers, the respondent was having high awareness of cervical cancer screening, but there was
having low knowledge of associated risk factors of cervical cancer. This shows that the general
knowledge level of female sex workers about the disease were high but there was no the cervical
cancer or its progression detailed knowledge(Mugai et al., 2020).
2.5.2. Health System Associated Factors Influencing Cervical Cancer Screening Practice
The study done in Kenya about Knowledge and health system factors influencing utilization of
cervical screening services among sex workers, this study shows health system factors, most
respondents who lived near a health facility ,72.6% of female sex workers was utilized cervical
cancer screening, however, there was no significant association. Most respondents said that health
care workers attitude was very good, 81.2% of female sex workers was utilized cervical cancer
screening, and so health care workers attitude was significant association with cervical cancer
screening(Mugai et al., 2020).
On the other studies physical distance have significant effect on health seeking behavior For
example, Studies done in Nigeria on knowledge attitude and practice of cervical cancer screening
among urban and rural Nigerian Women, location and accessibility of health facility as a factor
which could affects the health service utilization( Abiodun et al., 2013). The study done
inTanzania the practice of cervical cancer screening among women in rural district of
Tanzania ,This study also revealed that the health facility physical distance influences the
women`s cervical cancer screening practice(Lyimo & Beran, 2012). Long distance affects the
probability of women participating in cervical cancer screening(Mupepi et al., 2011).
11
2.5. Conceptual Framework
The conceptual frame work of the study shows the relationship between dependent and
independent variables that is the dependent variable (the practice of cervical cancer screening) and
the independent variables (demographic characteristics of respondents, knowledge, attitude, health
service related factors and sexual and reproductive health related factors).
Socio demographic
characteristics:
Knowledge
Age
Knowledge on
Religion
Cervical cancer
Income Information on
cervical cancer
Educational Status screening
Attitude Source of information Health care
Attitude towards related factors

cervical cancer
screening Access of cervical
Cervical cancer cancer screening
Fear of positive
result screening Practice facilities
Lack of familiarity
with the concept of Recommendation
preventive health by health provider
care
Perceive probability Facility working
Other sexual/
of illness hour.
reproductive factors
Perceived Previous history of Women’s sex
susceptibility to vaginal examination Preference on
cervical cancer Sexual transmitted health Provider
infections
Perceived barriers
for cervical cancer
Figure- 1: Conceptual framework for factors influencing cervical cancer and its screening program
screening
which developed to show associated factors of screening practice by reviewing different articles.
12
CHAPTER THREE
3. RESEARCH METHODOLOGY
INTRODUCTION
Research methodology is a way to find out the result of a given research problem. Research
methodology is the procedures by which researchers go about their work of describing,
explaining and predicting phenomena. It is also defined as the study of methods by which
knowledge is gained. Thus, after the researcher identify the research problem, research
objectives and hypotheses, and review the published and unpublished information, the researcher
going to discuss about the research methodology in this chapter. Therefore this chapter present in
detail about the research approach, research design, data type and sources of data, population and
sample frame, sample size, sampling technique, data collection tools and data analysis
techniques.
3.1. Research Approach

To achieve the objectives of the study, so this study used a purely quantitative research approach,
where it used of a questionnaire provided predominantly descriptive and quantify data.
Quantitative approach was involved for analysis of data and information that are descriptive in
nature and qualify (Yamane (1997) cited in Israel, G. D. (2003).
3.2. Study Design:
The study employed community based cross sectional followed by co-relational research design
which helps the researcher to gather a large variety of data related to the problem under
a predetermined time and to determine cause and effect relationships between dependent and
independent variables. Therefore, co relational research design is appropriate for this study to
examine factors affecting the practice of cervical cancer screening.
3.3. Data Type and Sources of Data
In order to generate relevant data for the study primary data source would take in to consideration
and also secondary data were used.
13
3.3.1 Primary Source of Data
According to Biggam (2008), primary data is the information that the researcher finds out by
him/herself regarding a specific topic. The main advantage with this type of data collection is that
it can be collected with the research’s purpose in mind. This means that the information resulting
from it is more consistent with the research questions and purpose. The data that collected directly
by the researcher from the respondents’ and this provides with important information. Besides this
the adoption of the survey instrument would helpful to represents a wide target population, and
generates numerical data as well as to gather information that would not available from archive
records. Babbie (1990) noted that the survey as the preferred type of data collection procedure for
study because it is used to generalize from a sample to a population.
Primary data is preferred because it is original and relevant for the topic especially when
the researcher is interested in primary data about demographic characteristics,
attitude/opinion/interest, awareness/knowledge, intentions, motivation and behavior (Noor
Sharoja, 2014). Therefore the data required for this research will collected mainly from primary
sources through self-administered questionnaire.
3.3.2. Data Collection Instrument

Data collection instrument is a kind of measuring instrument use for this research. The Data
collection instrument that employed for the study is questionnaire. According to Zikmund, Babin,
Carr, and Griffin (2010) questionnaire is defined as a technique for collecting data in which it
requires the respondents to answer the same set of questions in a predetermined order. Therefore
data collection for this study utilized the researcher-administered questionnaire survey method.
This method of data collection employed as a measure to obtain more reliable survey
responses with a possibility of achieving a higher response rate, thus improving the validity of this
study. In most cases, questionnaires were personally distributed to ascertain the person’s
willingness to participate in this study. This arrangement also provide the opportunity for
researchers to explain verbally on the importance of the study.
3.4. Study Population
The study population includes all female sex workers in Bahir Dar city. This population includes
all female sex workers who had worked in the industry for more than 6 months. Female sex
14
workers at Bahir Dar who is likely to be new to the industry (<6 months of work) were not include
in the study.
3.4.1. Sampling and Sample Size Determination

To determine the sample size of the study Yamane (1967:886) adopted:
Where n is the sample size, N is the population size (according to Bahir Dar city administration
health office mapping survey of 2013 E.C N= 5812, this is the total number of FSWs in the Bahir
Dar city), and e-is the level of precision. When this formula is applied to the above sample, A 95%
confidence level and e= 0.05 is assumed for equation
n=374
Table 3.1: Proportional allocation of the sample size by the sub-city administration in Bahir Dar
city.
Name of sub- Number of #of% of # of FSWS on the study Sample size

city admin.in FSWS FSWS area based on based on the
Bahir Dar city by sub-city proportional allocation above formula
Fasilo 2490 43% 161

Ats/Tewoderos 342 6% 22
Gish Abay 623 11% 41
BelayZeleke 702 12% 45
Tana 598 10% 38
15
Dag/Minilik 1057 18% 67
Total 5812 100% 374 374
Source:- own computation 2021
3.5. Data analysis

Questionnaires collected from respondents were tallied, organized, coded and structured
systematically. Then the collected data entered in to Excel and imported to STATA version 14.2
for analysis. Both descriptive and inferential tests used in the analysis. Data would be described or
summarized using descriptive statistics such as, cross tabulation, frequencies and mean, which
helps in meaningfully describing the distribution of responses. Inferential statistics method used to
infer population characteristics from the sample.
3.5.1. Descriptive analysis

The descriptive statistical results would be presented by tables, frequency distributions and
percentages, mean and standard deviation to analyze the demographic characteristics of
respondents , to identify assess the level of knowledge of cervical cancer screening among female
sex workers in Bahir Dar, the level of attitudes of cervical cancer screening among female sex
workers, associated factors affecting cervical cancer screening practice among female sex workers
and assess the practice of cervical cancer screening of female sex workers.
This would be achieved through summary statistics, which includes the mean values, standard
deviation and percentages which would be computed for each variable in this study.
3.5.2 Pearson Correlation analysis

In this study Pearson correlation coefficient utilized to determine the relationships between
dependent variable (the practice of cervical cancer screening) and independent variables
(demographic characteristics of respondents, knowledge, attitude, and health service related factors
and sexual reproductive health related factors).
3.5.3 Linear and Multiple Regression Analysis

Linear regression analysis was used to investigate the relationship between independent variable
with that of dependent variable. Whereas, multiple regression analysis use to examine the effect
of each factors determined on the practice cervical cancer screening.
16
3.6. Model Specification
In this study the dependent variables that mean PCCS and the independent variables (KAF, AAF,
SDCH, HSRF and SRHFs), the cervical cancer screening practice utilization criteria`s are direct
and the regression analysis as a statically tool for the investigation of relationships between the
outcome and each independent variables is important. At this point, we seek to ascertain the
association of one variable upon another. So that for this data analysis, the Binary and Multiple
Logit or probit Response Model is appropriate.
The specific model is as follows:
Y =ꞵo +ꞵ1X1+ꞵ 2X2+ꞵ3 X3+…. +€, Where: ꞵo = Intercept, ꞵ1 = Slope for X1, ꞵ2 =
Slope for X2, € = residual (error term), etc.
CCSP=ꞵo+ꞵ1KAF+ꞵ2AAF+ꞵ3SDCH+ꞵ4HSRF+ꞵ5SRHF+……+€
Where
PCCS= Practice of cervical cancer screening
KAF=Knowledge associated factors
AAF=Attitude associated factors
SDCH=Socio demographic characteristics
HSRF=Health system related factors
SRHF=Sexual and reproductive health factors
In this regard, the Cronbach alpha stability test and all diagnostic tests are conducted to approve
the acceptability of the response and the model.
Table 3.2: Variable Definitions and Expected Sign On Practice Of Cervical Cancer Screening
N Variables Definition Expected sign
17
o
1 PCCS Dependent variable, Cervical cancer screening practice
2 KAF Knowledge associated factors( independent variables) +ve
3 AAF Attitude associated factors(independent variables) +ve
4 HSRF Health system related factors(independent variables) +ve
5 SDCH Socio demographic characteristics(independent +ve

variables)
6 SRHF Sexual and reproductive health factor (independent +ve

variables)
CHAPTER FOUR
4. DATA PRESENTATION AND ANALYSIS

4.0. Introduction
18
This chapter has presented both descriptive statistics and inferential statistics analysis. It has three
sections. The first section focuses on the descriptive statistics which summarizes the main features
of the study variable such as mean, frequency and percentage. The second section focuses the
correlation analysis which shows the degree of association between the study variables. The third
sections of the chapter dedicates the regression results report output of the regression models.
4.1. Descriptive Analysis

Descriptive analysis is a set of procedures for gathering, measuring, classifying, computing,
describing, synthesizing, analyzing and interpreting systematically acquired quantitative data. This
basic analysis would be carried out on the data gathered from section one of the questionnaire,
which focused on response rate and the respondents’ demographic profile.
Respondents profile data are more of self-explanatory; therefore, the analysis outcome is to
provide a summary of the respondents’ profile. For section one the analysis done on frequency
distribution and percentage. Frequency distribution and percentage were created for each
respondents profile to show the segmentation of respondents in terms of sex, educational status and
work experience.
4.1.1. Response Rate

To conduct the research 374 questionnaires were distributed to the respondents and the response
rate indicated in the table 4.1 below.
Table 4.1:- Response rate of the respondents
Item Response rate

No. Percentage
Sample Size 374 100
Collected 374 -
Remain uncollected - -
Source: own survey, 2021
As the result in table 4.1 indicate that, out of 374 distributed questionnaires 374 (100%) and
collected.
19
4.1.2. Demographic Characteristics of Respondents
Demographic characteristics of the respondents such as Age, level of education, Religious and
Ethnicity of the study participants were presented and discussed.
Table 4.2. Age of study participants (in years)

Frequency Percent Valid Percent Cumulative
Percent
16-20 years 173 46.3 46.3 46.3
21-25 years 109 29.1 29.1 75.4
25-29 Years 62 16.6 16.6 92.0
Valid
30-34 Years 21 5.6 5.6 97.6
35-39 Years 9 2.4 2.4 100.0
Total 374 100.0 100.0
Source: Own field computation, 2021.
The level of education of respondents in the above table 4.2 indicated that from 374 respondents
173(46.3%) of the respondents were participants whose age category found in 16-20 years ,
109(29.1%) participants found in the age category of 21-25 years, 62(16.6%) participants were
found in the age category of 25-29 years,21(5.6%) participants found under the age category of 30-
34 years and the rest 9(2.4%) were found under the age category of 35-39 years. This result
indicates that most of the participants were found under the age category of 16-25 years.
4.1.3. Levels of Education of Respondents
Table 4.3 Education Status of respondents

Frequency Percent Valid Cumulative
Percent Percent
20
Unable to read and

86 23.0 23.0 23.0
write
Primary (Grade 1-8) 51 13.6 13.6 36.6
Valid
Secondary (9-12) 143 38.2 38.2 74.9
College and above 94 25.1 25.1 100.0
Total 374 100.0 100.0
The level of education of respondents in the above table 4.3 indicated that from 374 respondents
143(38.2%) of the respondents were participants who have secondary education, 94(25.1%) were
participants who have collage and above 86(23%) were participants who were unable to read to
write the rest 51(13.6%) were primary education. This result indicates that most of the participants
were secondary education this confirmed that their awareness about cervical cancer is very low.
When we see collage and above holders of participants even if their awareness about cervical
cancer is relatively high unemployment may be forced the participants to join the sector.
4.1.4. Religious of participants
Table 4.4. Religions Participants

Percent Percent
orthodox 260 69.5 69.5 69.5
Muslim 70 18.7 18.7 88.2
Protestant 20 5.3 5.3 93.6
Valid
catholic 15 4.0 4.0 97.6
5.00 9 2.4 2.4 100.0
Total 374 100.0 100.0
Source: Own field computation, 2021
As table 4.4 indicated that most of participants of this study 260(69.5%) were orthodox and
70(18.7%) participants were Muslim. But the result is obtained because of the study area more
resides by Orthodox and Muslim.
21
4.1.5. Ethnicity of Participants
Table 4.5. Ethnicity of respondents

Frequency Percent Valid Cumulative Percent
Percent
Amhara 344 92.0 92.0 92.0
Oromo 6 1.6 1.6 93.6
Tigray 2 .5 .5 94.1
Valid
Agew 20 5.3 5.3 99.5
Specify 2 .5 .5 100.0
Total 374 100.0 100.0
Source: own field computation, 2021
As table 4.5 indicated that most of participants of this study 344(92%) were Amhara Ethnicity and
20(5.3%) participants were Agew. But the result is obtained because of the study area more resides
by Amhara people.
4.1.6. Average monthly income (ETB) per month
Table 4.6. Average monthly income (ETB) per month

Percent Percent
1000-5000 Birr 268 71.7 71.7 71.7
5001-10,000 Birr 92 24.6 24.6 96.3
10,001-15000
12 3.2 3.2 99.5
Valid Birr
15001-20000
2 .5 .5 100.0
Birr
Total 374 100.0 100.0
As table 4.6 indicated that 268(71.7%) participants of this study monthly income is found under
the income category of 1000- 5000 birr 92(24.6%),12(3.2%) and the rest 2(.5%) participants their
monthly income were found under 5001-10,000 Birr monthly income found under the income
category of 10,001-15,000 Birr. The result of this study indicated that most of respondents’
22
monthly income found under the category of 1000-5000 birr this income is not sufficient for their
livelihood.
4.2. The Descriptive statistics of perceived variables by female sex workers
4.2.1. The level of knowledge of cervical cancer screening among female sex workers
The knowledge about cervical cancer screening emphasis on Risk factors for cervical cancer,
Prevention measures for cervical cancer, Other issues that indicated the level of knowledge of
cervical cancer screening among female sex workers/cervical cancer screening is helps to treat
cervical cancer becomes series Cervical cancer screening is helps to knowing the disease, Is
Cervical cancer curable if detected early? Do you know that early initiation of sexual intercourse
increases the risk of getting cervical cancer? Do you know that cervical cancer is sexually
transmitted infection? Do you know at what sex workers should undergoing cervical cancer
screening? /At what years of age/? /and, Source of information for cervical cancer screening the
obtained result were discussed as follows.
4.2.1.1. Risk factors for cervical cancer

The data collected to analyze Risk factors of cervical cancer screening mainly focus on Multiple
sexual practice, Early initiation of sexual intercourse HIV infection and cigarette smoking were
discussed.
Table 4.7: Risk factors for cervical cancer

Frequency Percent Valid Percent Cumulative
Percent
Multiple sexual practice 207 55.3 55.3 55.3
Early initiation of sexual

85 22.7 22.7 78.1
intercourse
Valid HIV infection 66 17.6 17.6 95.7
Cigarette smoking 14 3.7 3.7 99.5
Don’t know 2 .5 .5 100.0
Total 374 100.0 100.0
Source: Own field computition,2021
23
As indicated in table 4.7.As of participants responded that among the risk factors to cervical
cancer Multiple sexual practice accounted for 207(55.3%), Early initiation of sexual intercourse
85(22.7%)and HIV infection accounted for 66(17.6%). The result of this study assured that the
most risk factors for cervical cancer screening are multiple sexual practice, early initiation of
sexual intercourse and HIV infection accounted for risk factors for cervical cancer respectively.
Table 4.8: Prevention measures for cervical cancer

Frequency Percent
Avoiding unprotected multiple
sexual partners 146 39.0
Avoiding early sexual intercourse 100 26.7

Vaccination against HPV 78 20. 9
Valid
Early screening and treatment 40 10.7
Avoid cigarette smoking 8 2.1
Don’t know 2 .5
Total 374 100.0
4.2.1.2. Prevention measures for cervical cancer

In this study the presentation measures for cervical cancer focused on Avoiding unprotected
multiple sexual partners, Avoiding early sexual intercourse, Vaccination against HPV, Early
screening and treatment and Avoid cigarette smoking and discussed in the following manner.
24
Table 4.8 confirmed that in preventing cervical cancer avoiding unprotected multiple sexual
partners account for 146(39%), Avoiding early sexual intercourse 100(26.7%), Vaccination against
HPV7820.9% and Early screening and treatment 40 (10.7) respectively. Therefore Avoiding
unprotected multiple sexual partners, Avoiding early sexual intercourse, Vaccination against
HPV and Early screening and treatment respectively are preventive measures for cervical cancer.
Table 4.9: The level of knowledge of cervical cancer screening among female sex workers
No. Items Yes No I do not

know
Fr. % Fr. % Fr. %
Cervical cancer screening is helps to
1. 141 37.7 18 4.8 215 57.5
treat cervical cancer becomes series
Cervical cancer screening is helps to 109 29.14 139 37.16 126 33.68
2.
knowing the disease
Is Cervical cancer curable if detected 66 25.2 140 37.4 140 37.4
3.
early?
146 39 174 46.5 54 14.4
4. Do you know that early initiation of
sexual intercourse increases the risk of
getting cervical cancer?
Do you know that Cervical cancer is 34 9.1 336 89.8 4 1.1
5.
sexually transmitted infection?
Do you Know at what sex workers 158 42.2 209 55.9 7 1.9
6.
should undergoing cervical cancer
screening? /At what years of age/?
25
4.2.1.3 Other issues that indicated the level of knowledge of cervical cancer screening among
female sex workers
In this study knowledge about cervical cancer discussed by giving emphasis on Cervical cancer
screening is helps to treat cervical cancer becomes series, Cervical cancer screening is helps to
knowing the disease, Is Cervical cancer curable if detected ,Do you Know at what sex workers
should undergoing cervical cancer screening? /At what years of age/? Do you know that cervical
cancer is sexually transmitted infection? And do you know that early initiation of sexual
intercourse increases the risk of getting cervical cancer?
Table 4.10: The level of knowledge of cervical cancer screening among female sex workers
No. Items Yes No I do not
know
Fr. % Fr. % Fr. %
Cervical cancer screening is helps to
1. 141 37.7 18 4.8 215 57.5
treat cervical cancer becomes series
Cervical cancer screening is helps to 109 29.14 139 37.16 126 33.68
2.
knowing the disease
Is Cervical cancer curable if detected 66 25.2 140 37.4 140 37.4
3.
early?
146 39 174 46.5 54 14.4
4. Do you know that early initiation of
sexual intercourse increases the risk of
getting cervical cancer?
Do you know that Cervical cancer is 34 9.1 336 89.8 4 1.1
5.
sexually transmitted infection?
Do you Know at what sex workers 158 42.2 209 55.9 7 1.9
6.
should undergoing cervical cancer
screening? /At what years of age/?
Table 4.10 assured that the level of knowledge of cervical cancer screening among female sex
workers depicted in the following manner
26
 Cervical cancer screening is helps to treat cervical cancer becomes series among
participants 141 (37.7%) responded yes, 18(57.5%) responded No and the rest 215(37.5%)
responded that they did not know.
 Cervical cancer screening is helps to knowing the disease 109 (29.14%) responded yes,
139(37.16%) responded No and the rest 126 (33.68%) responded that they did not know.
 Is cervical cancer curable if detected early? 66 (25.2%) responded yes, 140(37.4%)

responded No and the rest 140 (37.4%) responded that they did not know.
 Do you know that early initiation of sexual intercourse increases the risk of getting cervical
cancer? 146 (39%) responded yes, 174(46.5%) responded No and the rest 54 (14.4%)
responded that they did not know.
 Do you know that cervical cancer is sexually transmitted infection? 39 (9.1%) responded
yes, 336(89.8%) responded No and the rest 4 (1.1%) responded that they did not know.
 Do you know at what sex workers should undergoing cervical cancer screening? /At what
years of age/? 158 (42.2%) responded yes, 209(55.9%) responded No and the rest 7 (1.9%)
responded that they did not know
The result of this study indicated that the level of knowledge of cervical cancer screening among
female sex workers is very low.
4.2.1.6. Source of information for cervical cancer screening
In this study the source of information that sex workers obtained about cervical cancer discussed in
the following manner.
Table 4.11: What is your Source of information for cervical cancer screening for the first time?
Frequency Percent Valid Cumulative Percent
Percent
From Colloquies’ 223 59.6 59.6 59.6
From Health
89 23.8 23.8 83.4
Valid Professionals
From Mass media 62 16.6 16.6 100.0
Total 374 100.0 100.0
27
As table 4.11 indicated that the source of information for sex workers about cervical cancer
screening for the first time From Colloquies’223(59.6%), From Health Professionals 89 (23.8%)
and From Mass media 62(16.6%) respectively. The result of the study indicated that the main
source of information for sex workers for the first time is their colloquies.
In this regard The majority (83.8%) of respondents had heard about cervical cancer. About 76.9%
of respondents didn’t know any cervical cancer symptoms.Whereas8.8%, 5.0%,5.0%,and0.4% of
respondents believed that having multiple sexual partners, initiation of sexual intercourse at an
early age, cigarette smoking, and acquiring human papillomavirus(HPV) respectively were the
major risk factors for cervical cancer. All most all(97.7%)of the respondents didn’t know any
methods of cervical cancer screening. The majority(56.0%) of respondents have acquired
information about cervical cancer screening from mass-medias(Table3).The mean score and
standard deviation of respondents’knowledgeaboutcervicalcancerscreeningwere39.38
4.2.2. The attitude of cervical cancer screening among female sex workers
In this study to analyze the attitude of sex workers about cervical cancer the following points were
considered cervical cancer is a preventable sexually transmitted disease, cervical cancer Screening
is painful to the client, cervical cancer screening service can help in the prevention of cervical
cancer, all sex workers should present themselves for cervical cancer screening is a good one,
cervical cancer screening is necessary for all women who are sexually active, I look forward to
being screened for Cervical cancer screening, Women that maintain good genital hygiene and
one sex partner do not need cervical cancer screening?, I feel embarrassed when attempting
cervical cancer screening and Cervical cancer screening would make a women’s life very difficult
were discussed in detail. The analysis done based on the following key information.
1. Strongly Agree, 2. Disagree, 3. Neutral, 4. Disagree, 5.Strongly Disagree
28
Table 4.12: The attitude of cervical cancer screening among female sex workers
N Mean Std. Deviation
Cervical cancer is a preventable sexually transmitted disease 374 1.5214 .52121
Cervical cancer Screening is painful to the client. 374 3.1604 .96086
Cervical cancer screening service can help in the prevention of
374 3.6203 .72505
cervical cancer.
Screening of cervical cancer is having side effect for screened
374 3.7968 .62254
clients
All sex workers should present themselves for cervical
374 2.8396 .96643
cancer screening is a good one.
Cervical cancer screening is necessary for all women who are
374 3.7353 .70766
sexually active.
I look forward to being screened for Cervical cancer screening 374 3.5749 .83715
Women that maintain good genital hygiene and one sex

374 3.5187 .93684
partner do not need cervical cancer screening?
I feel embarrassed when attempting cervical cancer
374 3.2112 .99908
screening.
Cervical cancer screening would make a women’s life Very
374 3.1765 1.01510
difficult
Valid N (listwise) 374
Except Cervical cancer is a preventable sexually transmitted disease and all sex workers should
present themselves for cervical cancer screening is a good one have good attitude for cervical
cancer screening because their mean is less than(3) the rest have no good attitude towards cervical
cancer screening among female sex workers because their mean is greater than(3). Therefore this
study indicated that the attitude of cervical cancer screening among female sex workers is not
promising.
29
4.2.3. Associated factors affecting the practice of cervical cancer screening among female sex
workers
Table 4.13: Associated factors affecting the practice of cervical cancer screening
among female sex workers
No. Items Yes No
Fr. % Fr. %
Have you had previous cervical or vaginal 136 36.4 238 63.6
1.
examination due to pregnancy or any other ?
Have you had diagnosis and treated for sexually 348 93.0 26 7.0
2.
transmitted infections?
Source: Own field computition,2021
As table 4.13 confirmed that Cervical or vaginal examination due to pregnancy or any other ?
136(36.4%) responded Yes and 238(63.6%) responded No.
Have you had diagnosis and treated for sexually transmitted infections?348 (93%) responded yes
and 26(7%) responded No.
4.2.4. Female sex workers cervical cancer screening practicing
Table 4.14: Female sex workers cervical cancer screening practicing

Frequency Percent
Zero times 215 57.5
one time 121 32.4
Valid Two times 37 9.9
three times 1 .3
Total 374 100.0
As table 4.14 confirmed that sex workers cervical cancer screening practicing 215 (57.5%) Zero
times, 121 (32.4%) responded that one times and 37(9.9%) responded that two times.
30
Table 4.15:Have you discussed on cervical cancer with health care providers?
Frequency Percent Valid Percent Cumulative Percent
Yes 86 23.0 23.0 23.0
Valid No 288 77.0 77.0 100.0
Total 374 100.0 100.0
As table 4.15assured that discussion of sex workers on cervical cancer with health care providers
86(23%) responded yes and the rest 288(77%) responded No. therefore the result of the study
convey that most of sex workers did not make discussion with health care providers.
4.3. Inferential statistics

4.3.1. Correlation Analysis
The Pearson correlation coefficient is used to measure the degree of relationship between two
variables. As stated by Lind, Marchal, and Wathen (2008), any correlation coefficient that found
within -1.00 or +1.00 indicates a perfect correlation between the variables. Therefore, variables
that are found with Pearson r- value that is closer to -1.00 or +1.00 identified as perfectly related.
Nevertheless, the significance of relationship between variables also determined by the
significance level with p-value, which is less than .05, an indication that most researches used.
In this section, correlation analysis conducted in the light of each research objectives and
hypotheses developed. The relationship between dependent and independent variable was
Investigated using correlation analysis. This provided correlation Coefficients, which indicated the
strength and direction of relationship. The p-value also indicated the probability of this
relationships’ significant.
31
Table 4.16: Correlation between dependent and dependent variables
Correlations
K CCS ASWCCS OSRHRF HSRF APCCS
Knowledge on cervical cancer Pearson Correlation 1 .796 **

.809
**
.743 **
.730**
screening among female sex Sig. (2-tailed) .000 .000 .000 .000
workers N 374 374 374 374 374
Attitude of Sex workers Pearson Correlation .796 **
1 .872
**
.755 **
.667**
towards cervical cancer Sig. (2-tailed) .000 .000 .000 .000
screening N 374 374 374 374 374
Other SRH related factors for Pearson Correlation .809 **
.872 **
1 .827 **
.710**
cervical cancer screening Sig. (2-tailed) .000 .000 .000 .000
among sex workers N 374 374 374 374 374
Pearson Correlation .743 **
.755 **
.827
**
1 .693**
Health system and related
Sig. (2-tailed) .000 .000 .000 .000
factors
N 374 374 374 374 374
Pearson Correlation .730 **
.667 **
.710
**
.693 **
1
Assessment of the practice of
Sig. (2-tailed) .000 .000 .000 .000
cervical cancer screening
N 374 374 374 374 374
**. Correlation is significant at the 0.01 level (2-tailed).
4.3.1.1. The relationship between Knowledge on cervical cancer screening among female sex
workers Assessment of the practice of cervical cancer screening
This correlation analysis is conducted to know the relationship between knowledge on cervical
cancer screening among female sex workers Assessment of the practice of cervical cancer
screening.
Table 4.4:- Above confirmed that the results of the relationships Knowledge on cervical cancer
screening among female sex workers and Assessment of the practice of cervical cancer screening.
Thus, Knowledge on cervical cancer screening among female sex workers positively and
significantly related to Assessment of the practice of cervical cancer screening (r=0.730 and
p=.000).
4.3.1.2. The relationship between attitudes of Sex workers towards cervical cancer screening
Assessment of the practice of cervical cancer screening
32
This correlation analysis is conducted to know the relationship between attitude of sex workers
towards cervical cancer screening and Assessment of the practice of cervical cancer screening.
Table 4.4:- Above confirmed that the results of the relationships between attitudes of Sex workers
towards cervical cancer screening and Assessment of the practice of cervical cancer screening.
Thus, attitudes of Sex workers towards cervical cancer screening positively and significantly
related to Assessment of the practice of cervical cancer screening (r=0.667 and p=.000).
4.3.1.3. The relationship between Other SRH related factors for cervical cancer screening
among sex workers and Assessment of the practice of cervical cancer screening
This correlation analysis is conducted to know the relationship between the relationships between
Other SRH related factors for cervical cancer screening among sex workers and Assessment of the
practice of cervical cancer screening
Table 4.16:- Above confirmed that the results of the relationships between Other SRH related
factors for cervical cancer screening among sex workers and Assessment of the practice of cervical
cancer screening . Thus, Other SRH related factors for cervical cancer screening among sex
workers positively and significantly related to Assessment of the practice of cervical cancer
screening (r=0.710 and p=.000).
4.3.1.4. The relationship between Health system and related factors and Assessment of the practice
of cervical cancer screening
This correlation analysis is conducted to know the relationship between Health system and related
factors and Assessment of the practice of cervical cancer screening.
Table 4.4:- Above confirmed that the results of the relationships between Health system and
related factors and Assessment of the practice of cervical cancer screening. Thus, Health system
and related factors and significantly related to Assessment of the practice of cervical cancer
screening (r=0.693 and p=.000).
33
4.3.2. Multiple Regression Analysis
Regression models used in an explanatory study where the researcher is interested in predicting the
value of dependent variable based on the value of independent variable. While in the case of more
than one independent variable dimensions in the study researcher has to make use multiple
regression models Lind et al., (2008). Multiple regression analysis employed to examine the
effects of the independent variables/ Knowledge on cervical cancer screening among female sex
workers, Attitude of Sex workers towards cervical cancer screening, Other SRH related factors for
cervical cancer screening among sex workers and Health system and related factors on dependent
variable / Assessment of the practice of cervical cancer screening/
Model:-1. The model summery of multiple regression analysis of leadership styles on

affective commitment
Model R R Square Adjusted R Square Std. Error of the Estimate
1 .769 a
.592 .587 .29182
a. Predictors: (Constant), Health system and related factors, Knowledge on cervical cancer screening
among female sex workers , Attitude of Sex workers towards cervical cancer screening, Other SRH
related factors for cervical cancer screening among sex workers
As indicated in model-1. Above the adjusted R square from the table above is 0.587 which means
that the independent variables can explain 58.7% of the variation in the dependent variable.
However, there are 41.3 % of the variance remain unexplained in this study.
Table 4.17: Coefficients of independent and dependent variables
Model Unstandardized Coefficients Standardized t Sig.
Coefficients
B Std. Error Beta
1 (Constant) .446 .078 5.697 .000
Knowledge on cervical
cancer screening among .373 .058 .393 6.470 .000
female sex workers
Attitude of Sex workers

towards cervical cancer .013 .067 .014 .199 .842
screening
Other SRH related factors .177 .081 .181 2.195 .029

for cervical cancer screening
among sex workers
34
Health system and related

.236 .060 .240 3.946 .000
factors
a. Dependent Variable: Assessment of the practice of cervical cancer screening
As shown in table 4.17 above the p-value of independent variable (Knowledge on cervical cancer
screening among female sex workers p=.000, Attitude of Sex workers towards cervical cancer
screening p=.842, Other SRH related factors for cervical cancer screening among sex workers
p=0.029, Health system and related factors p=0.000,) is less than alpha value of 0.05. Therefore,
these independent variables are significant to predict the variation in dependent variable. Whereas
Attitude of Sex workers towards cervical cancer screening p=0.842 is greater than alpha value of
0.05.
This confirmed that Attitude of Sex workers towards cervical cancer screening is insignificant to
predict the variation in dependent variable.
A multiple regression equation formulated from the Beta value under unstructured coefficient in
the table 4.17 which is indicated as bellow:- 0.446+ 0.393(Knowledge on cervical cancer screening
among female sex workers + .014 (Attitude of Sex workers towards cervical cancer screening) +
.181 (Other SRH related factors for cervical cancer screening among sex workers) + .240 (Health
system and related factors).
4.8. Hypothesis Testing

Based on the standardized coefficient of beta and p-value, the hypotheses of the study were tested
and the results of the study presented below.
Hypothesis One
H1 - There is positive and significant relationship between knowledge and the practice of cervical
cancer screening among female sex workers in Bahir Dar.
The obtained result indicated that the results of the relationships of knowledge and the practice of
cervical cancer screening among female sex workers.
Knowledge is positively and significantly related to the practice of cervical cancer screening
among female sex workers (β=0.393, p=.000).
35
There for H1 is fully accepted
Hypothesis Two
H2 – There is positive and significant relationship between attitude and the practice of cervical
cancer screening among female sex workers in Bahir Dar.
The findings of this study confirmed that the results of the relationships of attitude and the practice
of cervical cancer screening among female sex workers is positively and significantly related to
the practice of cervical cancer screening among female sex workers (β =0.014, p=.842).
There for H2 is partially rejected
Hypothesis Three
H3 – There is positive and significant relationship between heaths related associated factors and the
The results of the analysis indicated that heaths related associated factors is positively and the
practice of cervical cancer screening among female sex workers (β =.181, p=.029).
There for H3 is fully accepted
Hypothesis Four
H4 – There is positive and significant relationship between sexual and reproductive health and the
practice of cervical cancer screening among female sex workers in Bahir Dar.
The result of the analysis specified that sexual and reproductive health positively and significantly
related with the practice of cervical cancer screening among female sex workers (β =0.240,
p=.000).
There for H4 is fully rejected
36
Table 4.18:- Summary of hypothesis

No. Hypothesis Beta p- value Result
value
H1 There is positive and significant relationship β=0.393 p=.000 accepted

between knowledge and the practice of cervical
cancer screening among female sex workers in
Bahir Dar.
H2 There is positive and significant relationship 0.014 .842 partially

between attitude and the practice of cervical rejected
cancer screening among female sex workers in

Bahir Dar.
H3 There is positive and significant relationship β =0.181 0.029 accepted

between heaths related associated factors and the
practice of cervical cancer screening among
female sex workers in Bahir Dar.
H4 There is positive and significant relationship 0.240 0.00 accepted

between sexual and reproductive health and the
practice of cervical cancer screening among
female sex workers in Bahir Dar.
37
CHAPTER FIVE
5. MAJOR FINDINGS, CONCLUSION AND RECOMMENDATION
5.1. Major Findings
The first objective of this study was to assess the level of knowledge of cervical cancer screening
among female sex workers in Bahir Dar.
In line to risk factors the finding revealed that the most risk factors for cervical cancer screening
are multiple sexual practice 207/55.3%) and early initiation of sexual intercourse 66 (17.3%)
respectively.
In preventing cervical cancer avoiding unprotected multiple sexual partners account for 146(39%),
and avoiding early sexual intercourse 100(26.7%) respectively are the measure preventive
measures for cervical cancer.
In general the result of this study indicated that the level of knowledge of cervical cancer screening
among female sex workers is very low.
with regard to the source of information for sex workers about cervical cancer screening for the
first time Colloquies’223(59.6%) ,Health Professionals 89 (23.8%) and From Mass media
62(16.6%) respectively. The result of the study indicated that the main source of information for
sex workers for the first time is their colloquies.
The second objective of the research was to assess the level of attitudes of cervical cancer
screening among female sex workers in Bahir Dar;
Except Cervical cancer is a preventable sexually transmitted disease and all sex workers should
present themselves for cervical cancer screening is a good one have good attitude for cervical
cancer screening because their mean is less than(3) the rest have no good attitude towards cervical
cancer screening among female sex workers because their mean is greater than(3). Therefore this
study indicated that the attitude of cervical cancer screening among female sex workers is not
promising.
38
The third objective of the study was to identify associated factors affecting cervical cancer
screening practice among female sex workers in Bahir Dar in this regard Cervical or vaginal
examination due to pregnancy or any other 136(36.4%) responded Yes and 238(63.6%) responded
No. This result confirmed that most of respondents might not Cervical or vaginal examination due
to pregnancy or any other. Have you had diagnosis and treated for sexually transmitted infections,
348 (93%) responded yes and 26(7%) responded No. This result assured that most participants had
diagnosis and treated for sexually transmitted infections.
The fourth objective to assess the practice of cervical cancer screening practice of female sex
workers in the study area, Female sex workers cervical cancer screening practicing 215 (57.5%)
Zero times,121 (32.4%) responded that one times and 37(9.9%) responded that two times. assured
that discussion of sex workers on cervical cancer with health care providers 86(23%) responded
yes and the rest 288(77%) responded No. therefore the result of the study convey that most of sex
workers did not had cervical cancer screening practicing.
The last objective was to assess the relationship between knowledge, attitudes and associated
factors of cervical cancer screening among female sex workers and the practice of cervical cancer
screening of female sex workers. the result of the study assured that:-
 Knowledge on cervical cancer screening among female sex workers positively and
significantly related to Assessment of the practice of cervical cancer screening
(r=0.730 and p=.000).
 Attitudes of Sex workers towards cervical cancer screening positively and
significantly related to Assessment of the practice of cervical cancer screening
(r=0.667 and p=.000). Other SRH related factors for cervical cancer screening
among sex workers positively and significantly related to Assessment of the
practice of cervical cancer screening (r=0.710 and p=.000).
 Health system and related factors and significantly related to Assessment of the
practice of cervical cancer screening (r=0.693 and p=.000).
39
5.2. Conclusion
Based on the major findings conclusion of the study was forwarded:-
The level of knowledge of cervical cancer screening among female sex workers is very low.
Similarly, the attitude of cervical cancer screening among female sex workers is not promising and
most of participants did not Cervical or vaginal examination due to pregnancy or any other and
most of sex workers did not had cervical cancer screening practicing.
Eventually, Knowledge, Attitudes, Health system and related factors have positive and
significantly related to Assessment of the practice of cervical cancer screening.
5.3. Recommendations
Based on the findings of the study the following recommendations were forwarded:-
 Regional health bureau and Bahir Dar City Administration health department and
concerned NGOs should develop training system at health institution level to raise the level
of knowledge, attitude and associated factors about cervical cancer.
 Regional health bureau should create health institutions access for practicing cervical
cancer.
 Regional health bureau should prepare program and use different media to raise the
awareness to practice female sex workers to cervical cancer screening.
40
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44
Annex
Annex II - Consent form (English version)
Introduction
Hello, my name is -----------------. I am working with Mezgebu Alamirew who is doing a research
as partial fulfillment for the requirement of MSC in PPM in YOM post-graduation collage on “
ASSESMENT OF KNEWOLEDGE, ATTITUDES AND ASSOCIATED FACTORS ON
PRACTICE OF CERVICAL CANCER SCREENING AMONG FEMALE SEXWORKERS IN
BAHIR DAR CITY :2020 NORTHWEST ETHIOPIA
I am requesting your permission to participate in this research for the study of identify “
assessment of knowledge, attitudes and associated factors of cervical cancer screening practice
among female sex workers in Bahir Dar City, North West Ethiopia in order to generate
information necessary for the planning of appropriate strategies (interventions) for timely detection
which is important to decrease the number of advanced cervical cancer cases, the financial burden
of treating advanced cases and the loss of life secondary to the disease.
I assure that whatever information I obtained will only be used for the purpose of this research and
will not be made available to anyone outside the research team.
Do you agree to participate and answer the questions listed below?
A –Agree….. (If agree continue) B-Disagree….. (If Disagree stop)
7.QUESTIONNAIRE
Section 0: questionnaire identification data
001 Questionnaire Identification code ___________
003 Data collectors’: code _____________
004 Supervisor’s: code ______________
45
005 Date of data collection: _____\_______\________ day\ month\ year
1. Socio demographic characteristics of female sekworker
NO Question Coding Categories Skip to
101 Age of study participants (in years) ……………….
102 Educational status unable to read and write ….1
Primary(1-8 grade)…….2
Secondary(9-12 grade)…..3
college and above
103 Religion Orthodox……..1
Muslim………..2
Protestant……..3
Catholic……….4
104 Average monthly income(ETB) per month ---------
105 Ethnicity Amhara…..1
Oromo…….2
Tigray……..3
Agew…..4
Other specify……………5
46
2.Knowledge on cervical cancer screening among female sex workers
# Questions Possible answers skip
201 What are the risk factors for cervical cancer? (Don’t Multiple sexual practice….1
read. Respondent tells without solicitations)
Early initiation of sexual
intercourse…………2
HIV infection……….3
Cigarette smoking……..4
Don’t know…………5
202 What are Prevention measures for cervical cancer? Avoiding unprotected multiple
(Don’t read. Respondent tells without solicitation) sexual partners..1
Avoiding early sexual

intercourse…2
Vaccination against HPV…..3
Early screening and treatment….4
Avoid cigarette smoking…..5
Don’t know……6
203 Do you know cervical cancer screening is help to Yes…..1

prevent cervical cancer?
No………..2
I don`t know…..3
204 cervical cancer screening is helps to treat cervical Yes……………1

cancer becomes series
47
No……………2
I don`t know….3
205 Cervical cancer screening ishelps toknowing the Yes……...1

disease
No……...2
I don`t know………3
206 Is Cervical cancer curable if detected early? Yes………1
No………2
I don`t know….3
207 What is your Source of information for cervical cancer from Colloquies’……1
screening for the first time?
From Health professionals…..2
from Mass media………3
Other specifies………….4
208 Do you know that early initiation of sexual intercourse Yes………1

increases the risk of getting cervical cancer?
No……….2
209 Do you Know at what sex workers should undergoing Yes……..1

cervical cancer screening? /At what years of age/?
No…….2
210 Do you know that Cervical cancer is sexually Yes……1

transmitted infection?
No……2
3.Attitude of Sex workers towards cervical cancer screening
48
(Instruction for Interviewer: Put “x” in line with your option.)
# constructs of atitudes Measurements
Strongly Agree Neutral Disagree Strongly

Agree =5 Disagree=1
=4 =3 =2
301 Cervical cancer is a preventable sexually

transmitted disease
302 Cervical cancer Screening is painful to the

client.
303 Cervical cancer screening service can help

in the prevention of cervical cancer.
304 Screening of cervical cancer is having side

effect for screened clients
305 All sex workers should present themselves

for cervical cancer screening is a good one.
306 Cervical cancer screening is necessary for

all women who are sexually active.
307 I look forward to being screened for
Cervical cancer screening.
308 Women that maintain good genital

hygiene and one sex partner do not need
cervical cancer screening?
309 I feel embarrassed when attempting
49
cervical cancer screening.
310 Cervical cancer screening would make a

women’s life Very difficult
4.1. Other SRH related factors for cervical cancer screening among sex workers
No Question Answer Skip to
4.1.1 Have you had previous cervical or vaginal Yes……….1

examination due to pregnancy or any other ?
No……….2
4.1.2 Have you had diagnosis and treated for sexually Yes…….1
transmitted infections?
No…….2
4.2.Health system and related factors
No Question Answer Skip to
4.2.1 How many times did you visit health care

providers per year(Averagely)
----------
4.2.2 Have you discussed on cervical cancer with Yes……1

health care providers?
No……2
4.2.3 Is the working hour convenient for cervical Yes……1

cancer screening for you?
No……2
50
4.2.4 For Q#4.2.3, if time is not convenient for
screening service, which time is comfortable
--------------(in Hour)
for getting the service for you?
5.Assessment of CCS practice
No Questions Response Skip
501 Have you ever screened any reproductive health Yes……1 If your answer
screenings like HIV, STIs…? is No go to
No……2
question no
507
502 Have you ever screened for cancer of Yes...................1 If your answer
the cervix? No....................2 is NO go to
question
number 507
503 Where did you screen? Hospital Mention)....1

private(Mention)......
Health centers. (Mention).....2
SW Clinic (mention)…3
504 What was the indication? Self-initiated...................1

offered by the health
professionals....................2
other(specify) ..................3
505 If yes how many times in since you Once...........................1

become sexually active More than once..............2
506 When was the last time you screened? Within the past three years
51
..................1
More than three years ago.
..................2
507 If no screened, why? I don’t know screening

sites……1
I am healthy(Not ill for

screening ) ….2
I have never recommended by

health professionals …….3
Afraid of positive
result…………..4
Time shortage………5
Peer influence not to be

screened……6
If any other Specify …………7
THANK YOU!
Annex iii- Amharic version information sheet
የመረጃቅፅ
የጥናቱአርዕስት:
ሴተኛአዳሪዎችየማህፀንበርየቅድመካንሰርምርመራለማድረግተያያዥምክንያቶችንለማወቅነዉ፡፡
52
መግቢያ
ይህየመረጃቅፅየተዘጋጀውለማህፀንጫፍቅድመካንሰርምርመራተያያዥምክንያቶችንለማጥናትነዉ፡፡
በዚህጥናትዋናተማራማሪ፣መረጃሰብሳቢዎችተቆጣጣሪእናከዮምድህረምረቃኮሌጅአማካሪዎችይሳተፉበታል፡
የጥናቱዋናዓላማ
ለማህፀንጫፍቅድመካንሰርምርመራተያያዥምክንያቶችንለማጥናትነዉ፡፡
በዚህጥናትመሳተፍዎናመተባበርዎየማህፀንበርጫፍካንሰርምርመራለማድረግያሉትንተግዳሮቶችለማወቅከፍተኛ
አስተዋፅኦይኖረዋል፡፡
ስለዚህለማህፀንጫፍቅድመካንሰርምርመራተያያዥምክንያቶችተለይተውከታወቁችግሩንአስቀድሞለመቆጣጠር
ና፣ለሌሎችጥናቶችእንደመነሻሃሳብሆኖለማገልገልትልቅሚናይኖረዋል፡፡
በተጨማሪምይህጥናትየተለያዩመንግስታዊናመንግስታዊያልሆኑድርጅቶችበነዚህችግሮችዙርያእንዲሰሩናየተቻላ
ቸውንእንዲያበረክቱያደርጋልየሚልጽኑእምነትአለን::
የአሰራርሁኔታ
በዚህጥናትበባህርዳርከተማዉስጥየሚኖሩሴተኛአዳሪዎችይሳተፉበታል፡፡
እርስዎበጥናቱላይእንዲሳተፉበክብርእንጠይቃለን፡፡
ለመሳተፍፍቃደኛከሆኑየጥናቱዋናአላማናበጥናቱየሚካተቱጥያቄዎችንናአስፈላጊነትግልፅየሆነግንዛቤአንዲኖርዎ
ትእንፈልጋለን፡፡
ጥቅማጥቅሞችናጉዳቶች
በዚህጥናትበመሳተፍዎትምናልባትየተወሰነጊዚሊወስድስለሚችልደሰየሚልስሜትላይሰማዎትይችላል፡፡
ይሁንእንጂጥናቱየማህፀንጫፍቅንድመካንሰርምርመራለማድረግናየተየያዙጉዳዮችንበማየትችግሮችንለመፍታት
ትልቅአስተዋጸኦይኖረዋል፡፡በዚህጥናትበመሳተፍዎትምንምአይነትጥቅምወይምጉዳትአይደርስብዎትም፡፡
ሚስጥርመጠበቅ
53
ማንኛውምከእርስዎየምንሰበስበውመረጃከስምዎትጋርአይያያዝምስምዎትንእናአድራሻዎትንእንደማይጠቅእናለ
ማንምአካልተላልፎእንደማይሰጥልናረጋግጥልዎትእንወዳለን::የዚህጥናትውጤትግንተጠርዞእናተዘጋጅቶለሚመለ
ከታቸውየጤናድርጅቶችወይምለሌሎችአካላትሊሰጥይችላል::
ያለመሳተፍ/የማቋረጥመብት
ለመሳተፍበሚጠየቁበትጊዜወይምበመጠይቁጊዜጥሩስሜትካልተሰማዎትያለመሳተፍወይምበማንኛውምጊዜአቋ
ርጠዉየመሄድመብትዎየተጠበቀነው፡፡
በተጨማሪይሄጥናትበዩምየድህረምረቃኮሌጅየጥናትእናምርምርኮሚቴየፀደቀመሆኑንልንገልፅልዎእንወዳለን፡፡
የተማራማሪአድራሻ:
መዝገቡአላምረው (የፕሮጀክትእቅድናአመራርተማሪ )
ሞባይል፡- +251912013368 ኢሜል፡- mezgeb3@gmail.com
Annex IV-ፈቃደኝነትንመጠየቂያቅፅ (consent, Amharic Version)
ስሜ ------------------------- ይባላል፡፡
የማህፀንጫፍቅድመካንሰርምርመራጋርየተየያዙጉዳዮችለማወቅበዮምድህረምረቃኮልጅከሚሰጡየፕሮጀክትእቅ
ድናአመራርትምህረትተመራቂተማሪጋርእየሰራሁነዉ፡፡
የጥናቱዋናአላማየማህፀንጫፍካንሰርምርመራጋርየተየያዙምክንያቶችንማጥናትነዉ፡፡
ይህየማህፀንጫፍቅድመካንሰርምርመራአጠቃቀምእናየተየያዙጉዳዮችንማጥናትየአጠቃቀምሁኔታመመዘኛዎች
ንለመለየትናትኩረትእንዲሰጥባቸዉለማድረግየተዘጋጀመጠየቅሲሆንእኔምየጥናቱመረጃሰብሳቢነኝከዚህበመቀጠ
ልያሉትንጥያቄዎችበመመለስትብብርእንዲያደርጉልኝበትህትናእጠይቃለሁ፡፡
የሚሰጡትአስተያያትበፍፁምለሌላሰዉአይነገርም፡፡
በራስተነሳሽነትካልሆነበስተቀርበዚህጥናትመሳተፍግዴታየለብዎትም፡፡
በቃለመጠይቁጊዜበማንኛዉምሰዓትመልስመስጠትዎንለማቆምወይምመመለስየማይፈልጉትንጥያቄያለመመለ
54
ስሙሉመብትአለዎት፡፡
ምናልባትበጥናቱላይጥያቄወይምሀሳብካለዎትዋናአጥኚውንወይምየጥናትናምርምሩአማካሪዎችንበሚከተለዉአ
ደራሻማግኘትይችላሉ፡፡
ዋናተመራማሪ፡
መዝገቡአላምረውአሳየ(የፕሮጀክትእቅድናአመራርተማሪ)
ሞባይል፡- +251 912013368 ኢሜል:mezgeb3@gmail.com
የጥናትናምርምሩአማካሪዎች
ዶ/ርብርሀንሲሳይ
ሞባይል፡251+913831282 ኢሜል፡hiwete2000@gmail.com
በጥናቱለመሳተፍፈቃደኛነዎት?
አዎ------ይቀጥሉ 2.አይደለሁም---ያቁሙ
የጥናቱመለያቁጥር ……………..
መጠይቁየተካሄደበትቀን___/____/2013 ዓ.ም
የጠያቂውስም___________________ ፊርማ_______________
የተቆጣጣሪስም ___________________ፈርማ_______________
01.የሴተኛአዳሪዎችንየማህፀንበርካንሰርምርመራበተመለከተማህበራዊጉዳዮችንየሚመለከትመጠይቅ
ተ.ቁ መጠይቅ አማራጮች እለፉ/ፊ
101 እድሜሽ (በዓመት) ------------------
102 የትምህርትደረጃ አልተማርኩም….1
55
ማንበብናመፃፍእችላለሁ…..2
አንደኛደረጃ…….3
ሁለተኛደረጃ…….4
ኮሌጅናከዚያበላይ…….5
103 ሀይማኖትሽ ኦርቶዶክስ………1
እስልምና……….2
ፕሮቴስታንት……….3
ካቶሊክ………………..4
ሌላካለይገለጽ---------5
104 አማካኝወርሃዊየገቢመጠን (በኢትዮጵያብር) ----------------------
105 ብሄር አማራ………1
አሮሞ……..2
ትግራይ……3
አዊ……….4
ሌላካለይገለጽ………..5
02.የሴተኛአዳሪዎችስለማህፀንበርካንሰርአጋላጭምክንያቶችናመከላከያመንግዶችያላቸዉንእዉቀትለመለካትየተዘጋጀመ
ጠይቅ
ተ.ቁ መጠይቅ መልስ እለፍ/ፊ
201 ለማህፀንበርካንሰርአጋላጭምክንያቶችምን ከብዙ

ድንናቸዉ? ወንዶችጋርጥንቃቄየጎደለዉየግብርስጋግንኙነትማድረግ
…….1
56
በአፍላእድሜቀደሞየግብርስጋግንኙነትመጀመር……..2
የኤችአይቪህሙማንመሆን…………………3
ሲጋራማጨስ……………………………4
አላዉቅም………………………………..5
202 የማህፀንበርካንሰርመከላከያመንግዶችምንድ ልቅየሆነየግብረስጋግንኙነትንማስወገድ…..1

ንናቸዉ?
የመራቢያየአካልክፍሎችሳይዳብሩበአፍላእድሜቀድሞየ
ግብረስጋግንኙነትአለመጀመር……….2
የማህጸንጫፍካንሰርንሊከላከልየሚያስችልክትባትመከተ
ብ……….3
የቅድመካንሰርምርመራናህክምናማድረግ……….4
ሲጋራማጨስንማቆም………………..5
አላውቅም…………………………………6
203 የማህጸንበርቅድመካንሰርምርመራየማህፀን አዎ…………..1

ካንሰርንለመከላከልእንደሚጠቅምያዉቃሉ?
አይከላከልም…..2
አላውቅም….3
204 የማህጸንበርጫፍቅድመካንሰርምርመራየማ አዎ…….1

ህፀንካንሰርንከፍተኛደረጃሳይደርስለማከም
አይጠቅምም…..2
ይጠቅማል
አላውቅም…….3
205 የማህጸንበርጫፍቅድመካንሰርምርመራበሽ አዎ……..1

ታዉንቀድሞለማወቅእንደሚጠቅምያዉቃ
አይጠቅምም…………2
57
ሉ? አላውቅም……………3
206 የማህጸንበርጫፍካንሰርቀድሞከታወቀማዳን አዎ…..1 አይቻልም…..2

ይቻላል;
አላውቅም…..3
207 የማህፀንበርቅድመካንሰርምርመራእንዳለመ ከጓደኛየ……..1

ረጃየትሰሙ/መረጃየትአገኙ?/
ከጤናባላሙያ……..2
ከብዙሀንመገናኛ……..3
ሌላ ካለ ይገለጽ…….4
208 በወጣትነትጊዜቀድሞየግብረስጋግንኙነትመ አዎ………….1

ጀመርለማህፀንጫፍካንሰርየመደራግእድልእ
አላዉቅም………….2
ንደሚጨምርያዉቃሉ?
209 ሴተኛአዳሪዎችየማህፀንጫፍቅድመካንሰር አዎ…….1

ምርመራመቼማድረግእንዳለባቸዉያዉቃሉ(
አላዉቅም…..2
ከስንትአመታቸዉጀምሮ)
210 የማህፀነበርካንሰርበግብረስጋግንኙነትእንደ አዎ……..1

ሚተላለፍያዉቃሉ?
አላዉቅም….2
03 .የሴተኛአዳሪዎችንየማህፀንበርካንሰርለመመርመርያላቸዉንአመለካከትለመለካትየተዘጋጀመጠይቅ
አመለካከትንለመለካትየተዘጋጁመጠይቆች መለኪያ
በጣም እስማ ሀሳብየ አልስማማ በጣምአልስማ

ማለሁ ለኝም ም ማም
እስማማለ
=4
ሁ =5 =3 =2 =1
58
301 የማህፀንበርካንሰርመከላከልየሚቻልበግብረ
ስጋግንኙነትየሚተላለፍበሽታነዉ፡፡
302 የማህፀንበርካንሰርምርመራዉህመምአለዉ
፡፡
303 የማህፀንበርካንሰርምርመራማድረግየማህፀ
ንበርካንሰርንለመከላከልይጠቅማል፡፡
304 የማህፀንበርካንሰርምርመራማድረግለሚመ
ረመሩሰዎችጉዳትአለዉ፡፡
305 ሁሉምሴተኛአዳሪዎችየማህፀንበርካንሰር
ምርመራመመርመርአለባቸዉ፡፡
306 የማህፀንበርካንሰርምርመራአገልግሎትየግ
ብረስጋግንኙነትየጀመሩሴቶችሁሉመመር
መርአስፈላጊነዉ፡፡.
307 ከዚህበኋላየማህፀንበርካንሰርምርመራለማ
ድረግዝግጁነኝ፡፡
308 አንዲትሴትየማህፀንንፅህናዋንከጠበቀችንበ
አንድየወንድጓደኛየተወሰነችከሆነችየማህፀ
ንበርካንሰርምርመራመመርመርአያስፈልጋ
ትም፡
309 የማህፀንበርካንሰርለመመርመርሳስብጥሩስ
ሜትአይሰማኝም፡፡
310 የማህፀንበርካንሰርሴትልጅንለከፍተኛአደጋ
የሚዳርግበሽታነዉ፡፡
59
4.1.ከተዋልዶጤናጋርየተያያዙለማህፀንበርካንሰርምርመራምክንያቶችንለማወቅየተዘጋጀመጠይቅ
ተ.ቁ መጠይቅ አማራጮች
4.1.1 ከዚህበፊትበወሊድምሆነበሌላምክንያትየማህፀንምርመራ አዎ …... ..1

አድርገሽታዉቂያለሽ? አላዉቅም…..2
4.1.2 የአባላዘርበሽታህመምአሞሽተመርምረሽናታክመሽታዉቂያለሽ? አዎ………1
አላውቅም….2
4.2.የሴተኛአዳሪዎችንየማህፀንበርካንሰርምርመራንበተመለከተየአገልግሎትመስጫተቋማትጋርተያያዥምክንያቶችንለማ
ወቅየተዘጋጀመጠይቅ
ተቁ መጠየቅ መልስ ወደ.ይለፉ
4.2.1 በአመት ስንት ጊዜ የህክምና ተቋማትንና ……………..

የጤና ባለሙያዎችን ጎብኝተሻል?
4.2.2 ወደ ህክምና ተቋም በምትሄጅ ሰዓት ከህክምና አዎ……1

ባለሙያ ጋር ስለ ማህፀን ጫፍ ቅድመ ካንሰር
አላዉቅም……….2
ምርመራ ታወያይታችሁ ታዉቃላችሁ?
4.2.3 የማህፀን በር ቅድመ ካንሰር ምርመራ አዎምቹነዉ…….1

አገልጎሎቱን ለማግኘት አገልግሎቱ
ምቹአይደልም……….2
የሚሰጥበት ሰዓት ለእርስዎ ምቹ ነዉ?
4.2.4 አገልግሎቱ የሚሰጥበት ሰዓት ለእርስዎ ……………../ሰአት/

ምቹ ካልሆነ ለእርስዎ አገልግሎቱን
ለማግኘት ምቹ የሚሆነዉ ስንት ሰዓት ቢሆን
ነዉ?
60
5. ስለ ማህጸን በር ካንሰር ምርመራ የተግባርጥያቄ
ተራ ጥያቄዎች መልስ ይለፉ

ቁጥር
501 በስነተዋልዶ ዘርፍ ያሉ አዎ…………..1

ቅድመ ምርመራወችን
አላውቅም……..2
አድርገዎታውቂያለሽ (
ለምሳሌ ፦ ኤች አይቪ፡
የአባላዘር በሽታወች
ምርመራ........)
502 የቅድመ ካንሰር ምርመራ አዎ………………….1 አላውቅምከሆነወደ#507 ይለፉ

አድርገሽ ታውቂያለሽ?
አላውቅም……………2
503 የቅድመ ካንሰር ሆስፒታል………………..1

ምረመራውን የት
ጤናጣቢያ……………..2
አደረግሽ?
ሌላካለይጠቀስ……….3
504 የቅድመ ካንሰር በራሴአነሳሽነት………….1

ምርመራውን ለማድረግ
በጤናባለሙያወች………..2
ምን አነሳሳሽ?
ሌላካለይጠቀስ………………3
505 ስንት ጊዜ ተመረመርሽ? አንድጊዜ……………...1
ከአንድጊዜበላይ……..2
506 ለመጨረሻ ጊዜ ባለፈውአንድአመት ...........1

የተመረምርሽው መቼ
ባለፈው 3
61
ነው? አመት……………….2
ከ 3 አመትበፌት………………3
ሌላካለይጠቀስ………………4
507 ለምንአልተመረመርሽም? አገልግሎት የሚሰጡ ተቋማትን

ስለማላዉቅ…..1
አሞኝ ስለማያዉቅ መመርመሩ

አስፈላጊ ስላልሆነ……..2
መመርመር እንዳለብኝ ከጤና

በለሙያዎች በኩል መረጃ
ስላልተሰጠኝ……..3
ተመርምሬ ቢኖርብኝ ዉጤቱን

ስለምፈራ….4
ጊዜ ስለሚያጥረኝ…….5
የጓደኛተፅዕኖ………..6
ስለትብብርዎከልብእናመሰግናለን!!
62

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YOM INSTITUTE OF ECONOMICS MSC SEMINAR AND THESIS

YOM POST GRADUATE COLLEGE DEPARTMENT OF

KNEWOLEDGE, ATTITUDES, AND ASSOCIATED FACTORS ON PRACTICE OF CERVICAL

Student: Mezgebu Alamirew

Supervisor: Birehan Sisay(PhD)

THESIS SUBMITTED TO YOM POST GRADUATE COLLEGE for PARTIAL

Bahir Dar, Ethiopia

This Thesis has been submitted for examination with my approval.

Name of Advisor Birehan Sisay (PhD) Signature Date

Chair person Signature Date

Internal Examiner Signature Date

External Examiner Signature Date

Full Name : Mezgebu Alamiraw Signature Date

Name of Advisor Birehan Sisaye(PhD) Signature Date

Name of Internal Examiner Signature Date

Name of External Examiner Signature Date

Name of Head of Department Signature Date

List of Figures Page

ABBREVIATIONS AND ACRONYMS

DNA Debonuclic Acid

FSWs Female Sex Workers

HPV Human Papilloma virus

SSA Sub-Saharan African

STI Sexual Transmitted Infection

WHO World Health Organization

Key words: Cervical cancer, screening, Practice, knowledge, attitude

1.1. Background of the Study

1.2. Statement of the Problem

1.3. Objective of the Study

1.3.2. Specific Objectives

1.4. Research Questions

1.5. Hypothesis of the Study

1.7. Significance of the Study

2. REVIEW OF RELATED LITERATURE

2.1. The theory of cervical cancer

2.2. The Concept of Cervical Cancer

2.3. The Concept of Cervical Cancer Screening

2.4. Empirical Review Practice of Cervical Cancer Screening

2.4.2. Attitude toward Cervical Cancer Screening

2.5.1. Demographic Characteristics

Attitude towards related factors

3.1. Research Approach

3.3.2. Data Collection Instrument

3.4.1. Sampling and Sample Size Determination

Name of sub- Number of #of% of # of FSWS on the study Sample size

Fasilo 2490 43% 161

Source:- own computation 2021

3.5. Data analysis

3.5.1. Descriptive analysis

3.5.2 Pearson Correlation analysis

3.5.3 Linear and Multiple Regression Analysis

The specific model is as follows:

PCCS= Practice of cervical cancer screening

KAF=Knowledge associated factors

AAF=Attitude associated factors

SDCH=Socio demographic characteristics

HSRF=Health system related factors

SRHF=Sexual and reproductive health factors

1 PCCS Dependent variable, Cervical cancer screening practice

2 KAF Knowledge associated factors( independent variables) +ve

3 AAF Attitude associated factors(independent variables) +ve

4 HSRF Health system related factors(independent variables) +ve

5 SDCH Socio demographic characteristics(independent +ve