Influence of the Knowledge and Attitude towards Cervical Screening Services on the Uptake of Cervical Screening Services among Antenatal Attendees in Rural and Urban Health Facilities in Ebonyi State, Nigeria

Abstract

Background: Cervical cancer remains a major public health challenge in Nigeria, accounting for substantial morbidity and mortality among women of reproductive age. Despite being largely preventable through early detection and vaccination against human papillomavirus (HPV), uptake of cervical cancer screening remains low, particularly in rural areas. Knowledge, attitudes, and access to screening services significantly influence utilisation. Objectives: The study aims to compare the influence of knowledge and attitudes towards cervical screening services on the uptake of cervical screening services among antenatal attendees at rural and urban health facilities in Ebonyi State, Nigeria. Study Design: A comparative cross-sectional study involving eligible antenatal attendees at selected rural and urban health facilities in Ebonyi State, Nigeria. Methodology: A total of 440 women attending antenatal clinics at the selected urban and rural health facilities in Ebonyi State were recruited using a systematic sampling technique. Data were collected using a structured, pre-tested questionnaire capturing socio-demographic characteristics, knowledge, attitudes, and cervical cancer screening uptake. The results were analysed using SPSS version 26, with appropriate tables. Results: The mean knowledge score among urban respondents was slightly higher (M = 60.64) than that among rural respondents (M = 27.27) (p < 0.01). Attitudes towards cervical cancer screening were significantly more positive among urban women (M = 58.86) than among rural women (M = 24.66) (p < 0.01). Despite this attitudinal advantage, screening uptake remained low, with 97 (44.1%) urban and 52 (23.6%) rural respondents reporting uptake. Conclusion: Irrespective of the greater knowledge of cervical cancer and its screening services and the significantly more positive attitudes among urban antenatal attendees, the uptake of cervical cancer screening remained low in both groups. Recommendation: Cervical cancer screening should be integrated into routine antenatal care services.