Women of almost all ages are susceptible to cervical cancer at one point or the other lives [1].  The key definition regards cervical cancer as a type of cancer that occurs in the cells of the cervix, which is found in the lower part of the uterus that connects to the vagina [2]. On the similar vein, [1] states that cervical cancer that affects the entrance to the womb.  The cervical cancer has however been found to be likely to affect all people aged between 9 and 26 years but according to the Centres for Disease Control and Prevention (CDC) it can affect all women and 26 to 45 years World Health Organisation [3]. It has noted that cervical cancer often has no symptoms in its early stages and in cases where these symptoms may appear, they are commonly abnormal vaginal bleeding, which can occur during or after sex, in between periods, or new bleeding after one has been through the menopause. However, the key concern is the causes of cervical cancer. According to the World Health Organisation, cervical cancer is caused by Human Papilloma Virus (HPV) and this virus is very common as it can be passed on through any type of sexual contact with a man or a woman.

Background of the Study

This study intended to investigate the factors that contribute to cervical cancer among women in Intermediate Hospital Oshakati. According to the World Health Organisation, cervical cancer which is also known as cervical carcinoma is the third most common gynaecologic cancer among all women and is common among younger women.  The average age at diagnosis is about 50, although it can affect women as young as 20 WHO [3] Oshana region has been regarded as one of the highly populated and rapidly growing regions in Namibia and is the second most populated region following the Khomas region [4]. It hails the dominant towns like Oshakati, Ongwediva, and part of Ondangwa.  Oshakati hospital is located in Oshana region and acts as the referral from a large catchment are stretching from as far as Tsumeb up to Opuwo. Statistics reveal that the hospital serves a population of close to 10000 on a monthly basis, among that number 30 are cervical cancer patients [5]. Moreover, the number of cases of cervical cancer in Namibia has increased by 50 percent lately [6]. From this information, it is clear that Intermediate hospital Oshakati has a greater propensity to attend to women with cervical cancer because 75 percent of these potential patients are women who have a 50 percent chance of contracting cervical cancer [6].

Problem Statement

The Ministry of Health and Social Service MoHSS reported recently that there has been an increase by 50 percent of the cases of cervical cancer and resultantly cervical cancer has become the second largest cause of deaths among women in Namibia [6] Moreover, even though cervical cancer is preventable, [7] has indicated that women in Namibia are reluctant to avail themselves for screening, infections increase. Thus, this study intended to investigate the factors that contribute to cervical cancer among women in Intermediate Hospital Oshakati.

Significance of the Study

This study would go a long way in assisting the health sector to identify the factors that contribute to cervical cancer among Namibians women specifically in Oshana region. The intended study would help the MoHSS to eventually translate the findings of this research to practices and to formulation of policies of improving the health of people regionally, and subsequently nationally. It would also expose the factors that contribute to of cervical cancer to the policy makers hence prompting increased facilities for cervical cancer screening and prognosis. The study, would act as an eye-opener for other public health potential researcher to identify research gaps in the field of cervical cancer and oncology in general.

General Overview of Cervical Cancer

Cervical cancer is cancer that begins in the uterine cervix, the lower end of the uterus that contacts the upper vagina (Maree, 2011). The cervix is the area of a female’s body between her vagina and uterus. According to Maree (2011), cells in the cervix become abnormal and multiply rapidly, cervical cancer can develop. Maree (2011) stated that specific type of virus called human papilloma virus (HPV) causes almost all of the cases of cervical cancer.  Cervical cancer occurs in almost hundreds of thousands of women each year in the world, leading to about 200 000 deaths [3] This review considers and characterizes recent research within a broader public health framework to organize and assess the range of cervical cancer research in Africa.

Factors Contributing To Cervical Cancer

Risk factors for cervical cancer may vary. The following factors have been dominantly regarded as primary contributors to cervical cancer namely;

Human Papillomavirus (HPV) Infection: According to [8], the most important risk factor for cervical cancer is infection with HPV. Moreover, research shows that infection with this virus is a risk factor for cervical cancer (WHO, 2015). HPV is spread by sexual activity or through skin-to-skin contact with a person who has the virus, where the main method of contact may be sexual intercourse [8]. Precisely, Human papillomaviruses (HPV) contribute to the production of two proteins known as E6 and E7 which put off some tumor suppressor genes. This may enable the cervical lining cells to enlarge rapidly and to form some changes in additional genes, which in some cases will lead to cancer [9].

Immune System Deficiency: When a woman has HIV, her immune system is less able to fight off early cancer. According to [9] women with a healthy immune system the HPV virus clears itself from the body within 12 to 18 months but people with HIV are at an increased risk, as much as those who are chronically immuno-suppressed, such as transplant patients or those with another chronic or acute illness. Precisely, Human immunodeficiency virus (HIV), the virus that causes AIDS, destroys a woman’s immune system and increases the risk of being attacked by HPV infections. In other word, the immune system is critical in destroying cancer cells and suppressing their growth and spread. For women with HIV, a cervical pre-cancer might develop into an invasive cancer faster than it tends to do to those with an uncompromised immune system.

Lifestyle: Those who smoke [3] are vulnerable to cervical cancer. In a study among the smoking women in the Western Cape [7] revealed that women who smoke are about twice as likely to develop cervical cancer as women who do not smoke. When someone smokes, the smoke itself affects all those exposed to the smoke where all the smoke is absorbed by the lungs and later spreads to the blood stream throughout the body. Research has shown that these substances damage the DNA of cervix cells and may contribute to the development of cervical cancer. Smoking also makes the immune system less effective in fighting HPV infections which is a virus that leads to the susceptibility to cervical cancer [8].

Age: In a study by Twe & [10] it was revealed that the peak age of developing cervical cancer is 47 years. Approximately 47% of women with invasive cervical cancer are younger than 35 years of age at diagnosis, whereas older women, above 65 years. In another study conducted by WHO , women who were younger than 17 years when they had their first full-term pregnancy were found to be almost 2 times more likely to get cervical cancer later in life than women who waited to get pregnant until they were 25 years or older.

Socioeconomic Factors: Cervical cancer also affects those with no access to screening for cervical cancer including black women and generally women in developing countries WHO. Moreover, according to Twe & Makhija, it affects women from lower socioeconomic classes because they have poor access to routine medical care.

Family History: Khoza also discovered that having a family history of cervical cancer increase the potential to contract the cervical cancer in their lifetime. Cervical cancer may target certain families simply because they have history of this cancer. If a mother or sister in a family had cervical cancer, the chances of developing the disease are higher than if no one in the family suffered the infection. Other researchers suspect that some instances of this familial tendency are caused by an inherited condition that makes some women less able to fight off HPV infection than others, In other instances, women in the same family as a patient already diagnosed could be highly likely to have one or more of the other non-genetic risk factors.

Oral Contraceptives: Some research studies indicate that oral contraceptive use, like pills and the development of cervical cancer are connected [3-7] also mentioned that oral contraceptives may also play a role in the development of invasive cervical carcinoma. Other studies have stated that there is evidence that taking oral contraceptives (OCs) for a long time increases the vulnerability to the risk of cancer of the cervix. It also suggests that the risk of cervical cancer goes up the longer a woman takes these pills, but the risk is retarded once one stops the oral contraceptives, and it returns to normal about 10 years after stopping. Mpofu, also indicated that women and their doctors should always agree whether the benefits of using OCs outweigh the potential risks associated with it.

Impact of Cervical Cancer on Families

The biggest impacts of cervical cancer on families are poverty, education, lack of knowledge and gender equity which are the first three Millennium Development Goals (MDGs) in Namibia. Many of those women who die due to cancer are breadwinners and caretakers of both children and elders WHO. Poverty due to cancer cause, more children specifically girls to be kept out of school due to lack of free education, books, or uniforms [11] According to Wittets & Tsu [11], cervical cancer can impact education in other ways as well, such as when schools lose experienced teachers to the disease. it should be noted that lower levels of female education are linked to decreased maternal and infant health . Other fact-files indicate that while death from cervical cancer is preventable with vaccination, screening, and treatment, there are still negative effects that are associated with the infection. In there have been an estimated 527,000 new cases of cervical cancer and 265,700 cervical cancer deaths worldwide recorded by the WHO. Furthermore, based on current estimates the number of deaths is projected to rise to 443,000 annually by 2030, a 67 percent increase while cervical cancer has been rated the 4th most common cancer in women worldwide and the key cause of cancer-related deaths among women in low- and middle-income countries in the world.

The following are some interventions that are identified by various studies in reducing the risk of cervical cancer;  

Pap Smear Tests: Pap tests enable doctors to detect abnormalities, any changes on the cells on your cervix and take action before cervical cancer develops. It also makes women aware about their health status. WHO states that it is advisable that all women should have a Pap test at least once every three years, beginning from the age of 21 years. At the age of 30, the pap smear should be done every five years as long as the HPV testing is done with Pap and the results are negative. Moreover, if any bleeding during intercourse it is advisable to see a gynaecologist. According to between 60 and 80 percent of women in the world with newly diagnosed invasive cervical cancer never had any Pap test in the past five years as recommended.

Follow Up On Abnormal Pap Smears: If an infection is present, doctors should treat the women and the Pap smear test is repeated at a later time [11] Pap smear test results, doctors may also perform an HPV DNA test, which can detect HPV on a woman's cervix [3].

Vaccination: There are two vaccines Cervarix and Gardasil available to protect against the types of HPV that cause the most cervical cancer [7] The Ministry of Health and Social Services should discuss the dosing schedule with the potential victim. Most of the cervical cancer vaccination programme uses this vaccine Gardasil, which protects against 4 types of HPV, including the 2 strains responsible for the majority of cervical cancers in many countries. It also helps to prevent genital warts [8]. Therefore girls are offered the childhood immunisation programme as a preventive measure. The vaccine is routinely given to girls within the ages 12 to 13 years old, with 2 doses given over a 6-month period although in some countries this vaccine might be expensive and available to affluent person, but some countries the vaccine is for free. As soon as the girls grow older than 14 years their vaccine need to also increase the dose Khoza.

Practice Safe Sex: Studies have shown that it is a good move if one is sexually active to use a condom every time they have sex. Furthermore research has shown that most cases of cervical cancer are related to an infection with the human papilloma virus (HPV). HPV can be spread through unprotected sex, so using a condom can reduce your risk of developing the infection. Mpofu, however noted that the virus is not just passed on through penetrative sex: it can be transmitted during any type of sexual contact. These types include any skin-to-skin contact between genitals; oral, vaginal or anal sex; and using sex toys, all these have equal chances of spreading cervical cancer.

Quit Smoking: Smoking cigarettes double the risk of developing cervical cancer and therefore cigarettes must be quitted [9]. The WHO studies in both developed and developing world indicated that one can reduce chances of getting cervical cancer by not smoking. People who smoke are less able to get rid of the HPV infection from the body, which can develop into cancer. In other words, if one decides to give up smoking, they increase their chances of preventing cervical cancer.

This study used a quantitative research approach so that an objective view of the factors contributing to cervical cancer could be grasped vividly. It is from this reason that a descriptive design opted for because it could enable an in-depth understanding of the phenomenon understudy. The population for this study aged between 20 and 60 years, who visit Intermediate Hospital Oshakati, in Oshana region, during the time of the study, the average admission of women with cancer in ward in ward 4 Intermediate Hospital Oshakati (IHO). According to admission book, the total numbers of women who are diagnosed with cervical cancer are 30 per month in ward 4, Intermediate Hospital Oshakati. Inclusion criteria: All women between the ages of 20-60 years, who are diagnose with cervical cancer in ward 4, Intermediate Hospital Oshakati. Exclusion criteria: All the women less than 20 years and women over 60 years, who are not diagnose with cervical cancer in ward 4, Intermediate Hospital Oshakati

Sample and Sampling Procedure

A sample, according to [12] is a subset of a population that is, a small part of anything or one of a number intended to show the quality, style or nature of the whole specimen.  In this study a sample was chosen through purposive sampling (judgmental). With this sampling procedure, the researcher chose the units for the sample based on the fact that they are knowledgeable of the subject understudy [2].

n = 15

 Data Analysis and Presentations of Findings

Data was collected from 15 respondents from the female medical ward 4 at Intermediate Hospital Oshakati, Oshana region, Namibia. Data in this case was collected from fifteen (15) respondents using questionnaire at Oshakati Intermediate Hospital, in Oshana Region, Ward 4 in particular. After data was collected, it was checked for completeness and inconsistencies. It was then coded, categorized and entered on the data master sheet. The following inter pretationn were produced. The data collected in this study has been presented in the form of appropriate visual aids such as bar graphs and pie chart in order to summarize the findings and give a meaningful interpretation of the variables.

Age Distribution

In this case the researchers had to find out the age of the respondents so as to be able to evaluate the opinions of the respondents in relation to their age. The respondents were 15 in total and the findings were as follows; The findings indicate that, out of the 15 respondents, the study was dominated by people between the ages 31 – 40 years, where 5 (33 percent) belong to this age group. There was also 4 (27 percent) each for those between 41 – 50 years and 51 – 60 years respectively. The least age was the 20 – 30 years which had 2 (13 percent). Just because the respondents were ranging between 20 and 60 years, the researcher felt the maturity level could enable informative data about the research topic.

Years Experiencing Cervical Cancer

The years of experiencing cervical cancer was also found to be necessary to capture because experience is a good teacher such that those who speak with full experience could share their exposure as shown below;The findings out of the 15 respondents indicate that the respondents who had been experiencing cancer for between 3 – 4 years totalled to 5 (33 percent) while 4 (27 percent) had up to 5 – 6 years of experience. There were also 3 (20 percent) of those with 4 – 5 years in cervical cancer while 2 respondents (13 percent) had 2 – 3 years. Only 1 (7 percent) had 1 – 2 years’ experience whereas none had 0 – 1 as well as 6 – 7 years. The findings show that the numbers of years with cervical cancer were balanced such that experiences could be shared for better understanding of the condition.

Cervical Cancer Sufferers

This variable targeted finding out whether the respondents had a direct experience with cervical cancer and also to allow them to share such experience in this study. The findings were as follows; The study revealed that all the 15 respondents, that is, 100 percent confirmed that they have a direct experience with cervical cancer. None indicated that they have never seen a person experiencing cervical cancer. This gave confidence to the researcher for knowing that the respondents were well-versed with the cervical cancer. At least the fact that the study dealt with people who have known how the infection feels would have informed responses.

Factors Contributing To Cervical Cancer

Risk Factors Leading To Cervical Cancer: This was the most crucial prompt which helped to establish the factors that contribute to one’s vulnerability to cervical cancer infection. The options available were based on some literature studies but there was still room for respondents to specify their choice. The following was established; The results indicate that cervical cancer cases among the respondents emanated from various factors where 8 (53 percent) respondents indicated that they attribute the risk to aging, while 5 (33 percent) considered usage of contraceptives. There were also others who identified lifestyle as the cause, with 1 respondent (7 percent) and also another 7 percent identified lack of knowledge. However, none of the respondents mentioned smoking, promiscuity or specified other risk factors. The findings thus, confirm that most of the cases of cervical cancer that respondents are familiar with are associated with age of the victim. Thus, the more one’s age increases of the higher the chances of being infected.

Knowledge of Cervical Cancer Screening: Based on the fact that some efforts being used by health facilities in combating cervical cancer include screening, this study also considered whether the respondents know about the existence of the screening provisions. The findings depicted the following; The indication is that most of the respondents know about the availability of cervical cancer screening at the health facilities. This was confirmed by the 11 (73 percent) of the respondents who indicated that they were fully aware of the screening. On the other hand, 4 respondents that is, 27 percent were not aware of the existence of such a service at the health facility. This finding brought a concern that shows the need for creating awareness in the communities in order to prevent infection of most women.

Role of Cervical Cancer Screening: The study also attempted to find out the importance of cervical cancer screening among women as an effort to minimize the effects of the infection. This was done through finding out the views of respondents about whether screening reduces risk of infection. The respondents indicated their views as follows; The respondents overwhelmingly indicated that they believed that cervical cancer screening can reduce the risk of being infected by cancer. The results revealed that all the 15 (100 percent) agreed that the screening process has a positive impact on reducing cervical cancer risks. None of the respondents had doubts about screening. These results could aid to confirm and affirm that there is need for screening of all women occasionally to reduce their chance of being infected.

Impact of Cervical Cancer to The Society: As part of the objectives of this study, the researcher intended to find out the effects that are associated with being infected by cervical cancer. The study considered the fact that some women can trivialize the infection and be reluctant to take precautions. The findings were as follows; The study findings revealed that respondents were convinced that cervical cancer leads to death. There was this indication from 12 (80 percent) of the respondents who noted that cervical cancer leads to death rate increase in the society while 3 (20 percent) indicated that cervical cancer can lead to infertility. None of the respondents indicated the effects towards child mortality neither those who suggested other effects. The findings gave a glimpse of the fact that some women may not take cervical cancer serious simply because they believe it only leads to infertility but with no consideration of death aspect.

Undergoing Pap Smear: It was also important to establish whether the respondents underwent Pap smear as an effort to combat some infection of cervical cancer. The findings in this regard reflected the following results; Results show that 10 out of 15 respondents, that is 67 percent, once underwent through Pap smear in their lifetime. On the other hand, 5 (33 percent) of the respondents indicated that they have never been through a Pap smear procedure. With these results, there is an indication that some women have not yet made efforts to combat infections of cervical cancer. This might also indicate a loophole on the side of health system in their efforts to fight cervical cancer.

Effectiveness of Pap Smear: Health institutions continue to conduct Pap smear among women to prevent cervical cancer potential but the question was; is the process effective in reducing the chances of Pap smear? This study also considered finding out this variable from the respondents and the findings revealed the following; From the results in the figure above, 11 (73 percent) of the respondents were very sure that Pap smear is very effective in reducing the chances of being infected by cervical cancer. On the other hand, 3 (20 percent) out of the 15 respondents cited Pap smear to be effective while 1 (7 percent) indicated that the process of Pap smear was not effective. None of the respondents indicated that the process was somehow effective. The assumption shown by the results is that Pap smear is useful and hence its accessibility must be improved in communities, whereas other might also have doubts about the process although they feel it is effective.

Relation of HIV and Cervical Cancer: With the increase of the spread of HIV and AIDS in the community, the compromised immune system made this study to consider the finding out what effect this could have on vulnerability to cervical cancer. The findings in this regard revealed the following; From the findings, it can be traced that respondents believe that there is a relationship between persons infected by HIV with vulnerability to cervical cancer infection. The response of 11 (73 percent) out of 15 confirmed this understanding by indicating a ‘yes’ to confirm the relationship. The other 4 (27 percent) of respondents indicated that there was no connection between the two statuses. The result shows that there is lack of information in the community on the effects of HIV to one’s body and to the susceptibility to cervical cancer. In other words there is still need for educating the community about some epidemics.

Strategies to Reduce Cervical Cancer: One of the key objectives of this study was to determine the strategies that could be adopted to reduce further infections of cervical cancer. The researcher proposed the strategies based on the literature studies although the study was open for other suggestions. The following findings were obtained; The study dominantly recommended the use of screening as the most useful strategy for reducing infections of cervical cancer. This was revealed by 11 out of 15 (73 percent) respondents while 3 (20 percent suggested the improvement of the health system as the suitable approach. On the other hand there was 1 (7 percent) who pointed to condomising as the strategy that can reduce the infections among women and none suggested another strategy. These strategies pointed much on screening yet there could be some other options to take, this indicates that women see limited option to combat cervical cancer.

Vaccination: As some researches have suggested, this study also considered finding out the impact of vaccination through enquiring about whether the respondents had once been vaccinated for cervical cancer. The findings in this regard showed the following; The findings reveal that vaccination was not a common practice for most of the women in ward 4 and hence 11 (73 percent) respondents indicated that they have never been vaccinated against cervical cancer. However, 4 (27 percent) indicated that they have been once vaccinated against infection. The results show that less has been done by health institutions to prevent and most women in the communities might be in need of vaccination for cervical cancer but the service is not available.

Other recommendations: There were other recommendations that emanated from the study as the respondents took advantage of the free response section about the research topic. The following were suggested;

• Continuation of Pap smear: The procedure to test for cervical cancer in women should be continued as per medical practitioner’s prescription. This will enable collection of cells from cervix and detecting cervical cancer early with a Pap smear gives women a greater chance to cure or manage it well.
• Accessibility to HPV vaccination: With this strategy the vaccine helps protect women against certain types of HPV that increase the chances of cancer or genital warts.
• Social mobilisation/campaign: This is about engaging communities and generating support for all those in need of health services in this case cervical cancer prevention and control, which lead to a community that is health conscious and participates in health programs. The campaigns and a series of preventive services can be a challenge but will help in cancer prevention.
• Educate women on cervical cancer: Through educational programs directed to sensitizing women to increase their awareness of cervical cancer, preventing cervical cancer can be up-scaled and be beneficial in the preventing cervical cancer.

This is a discussion that emanate from the 15 women of Ward 4 at Oshakati Intermediate Hospital. The objectives of this study were to:

• Identify factors that contribute to cervical cancer among women in Intermediate Hospital Oshakati, Oshana region
• Propose strategies to combat the risk of contracting cervical cancer among women

It will be based on these findings that the conclusions and recommendations as well as limitations of the study will be identified as discussed below.

Discussion of the Results

This study considered investigating cervical cancer which automatically confined the study to female respondents, however, the majority of these women were between the ages 31 – 40 years (67 percent), followed by 41 – 50 and 51 – 60 which both had 27 percent each. The last was the 21 – 30 years age group which had 7 percent. The study further determined that the number of years of people experiencing cervical cancer were ranging from 3 -4 years, being the highest frequency (33 percent), followed by 5- 6 years (27 percent), 4 -5 years (20 percent), 2-3 years (13 percent), 1-2 years (7 percent) and 0 – 1 year with 6 -7 years had no frequency. With the findings on the cervical cancer experiences, the study indicated that almost all the respondents had experienced or seen a victim of cervical cancer in their lifetime and were providing informed responses about the infection. Therefore according the findings above, the results were discussed as follows:

Objective 1: Identify factors that contribute to cervical cancer among women in Intermediate Hospital Oshakati, Oshana region

Respondents answered four main factors that intensively contribute factors to cervical cancer infections.

• Age - Of the sample N=15, 53 percent of the indicated that they believe age is the top cause of cervical cancer. Thus, they meant, the older a women grows the higher their chances of contracting cervical cancer. In other words elderly women are more susceptible to cervical cancer than younger ones.
• Oral contraceptives – the study also revealed that 33 percent of the 15 respondents in the sample considered that the use of oral contraceptives such as pills, to be the key contributor to cervical cancer.
• Lack of knowledge – Of the 15 sampled respondents, the indication was that 7 percent of them believed that cervical cancer spreads simply because most women lack proper knowledge of what cervical cancer is, how does one get infected or how can one prevent combat it.
• Lifestyle – Lastly, the other 7 percent of the 15 respondents pointed to the lifestyle of an individual to be the risk factor for cervical cancer among many women. Thus, how women conduct themselves, what they eat, what they do during leisure among others has a bearing on their vulnerability to cervical cancer.

Objective 2:  Propose strategies to combat the risk of contracting cervical cancer among women

Respondents suggested 4 (four) main strategies that prevent the occurrence of cervical cancer infections among women.

• Screening – Out of the 15 sampled respondents, 73 percent suggested that the use of screening procedure is important for preventing cervical cancer occurrences. This process involves checking the precancers in order to treat them at an early stage before they cause greater damage to the cervix.
• Improving health system – This was suggested by 20 percent of the 15 respondents who indicated that there is need to work out the health system so that it caters for prevention steps to all women through possible strategies like outreach screening and vaccination.
• Social mobilisation – There was a suggestion from 13 percent of the 15 respondents who indicated that cervical cancer can be prevented by conducting sensitization campaigns and educating the communities on the causes, risks and methods of preventing cervical cancer.
• Continuation of Pap smear – Among the 15 respondents, there was also a suggestion by 7 percent, who stated that those who have been recommended for pap smear should not grow weary in being administered in the process, but rather continue to fulfil their follow-ups for pap smear.
• Condomising – Another 7 percent also recommended condomising each time the women are involved in sexual intercourse.

Conclusions

Based on the findings, this study drew some conclusions relative to the preset research objectives. It can be concluded from the study that despite the fact that most of the women know or have experienced cervical cancer cases from family, friends or neighbours, there is a general understanding that cervical cancer is believed to be an old age occurrence. This conclusion also relates to another observation that there is lack of knowledge in the communities about cervical cancer. This could be reason why most of the respondents attributed the occurrence of cervical cancer to age but overlooking other important factors such as smoking, promiscuity, lifestyle among others. Moreover, another conclusion is that the study revealed that women know that cervical cancer is fatal for those who are infected or the would-be victims. That is also the reason why the researcher can also conclude that women understand indeed the effectiveness of interventions like Pap smear and vaccination. The last important and encouraging conclusion is that women understand that if they take precautions to prevent cervical cancer, they minimize the chances of its occurrence. Precisely, cervical cancer is more preventable if only women could play their active part in its prevention.

Limitations

The most significant limitation for this study was the size of sample which was way too small to account reliable inference to the largest population of the Oshana region. The study also was confined to female with consideration that they are the victims of cervical cancer; however this could have deprived very brilliant views from male counterparts who perpetrate some of the occurrences such as smoking, condomising and lifestyle. The data collection instrument was another limitation of the study because it consisted of closed-ended questions and these might have suppressed some detail from the respondents, in terms of elaborating further about their experience with cervical cancer. Lastly, the instrument appealed to the literate population yet some potential respondents could also have better information but limited by their literacy level.

Recommendations

The following recommendations are forwarded to the Ministry of Health and Social Services (MoHSS) as the custodian of public health in the country. Firstly, a collaborative approach is needed involving both individual and state organizations, health professionals and the general public. The MoHSS needs to be the leader that spearheads such partnerships so that they can bear fruits. Secondly, public education on cervical cancer and HPV vaccination needs to be delivered effectively through varied means to the communities, such as pamplets, road shows, demonstrations, provision of mobile healthcare facilities and outreach programs, involving teachers, youth organizations, community members and professional bodies. Moreover, there is need for intensive vaccination of adolescents aged 10–14 years using the non-avalent HPV vaccine because at this tender age they can be grow up with reduced chances of pre-cancers that lead to cervical cancer. The program of vaccination should be undertaken by the MoHSS from the centers of convenience to the adolescents such as schools. It is also the MoHSS that should ensure mobilizing and integration of public education on cervical cancer prevention, HPV vaccination and screening interventions in medical and public health services to ensure maximum coverage of all women.

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