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\title{Awareness and Perception towards the Utilization of Cervical Cancer Screening (CCS) Services among Nurses in a Teaching Hospital in Ibadan, Nigeria}
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             \author[1]{Umezurike  Emeka}

             \affil[1]{  Department of Microbiology, Lead City University Ibadan.}

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\date{\small \em Received: 14 December 2017 Accepted: 31 December 2017 Published: 15 January 2018}

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\begin{abstract}
        


Invasive cervical cancer is the second-most common cancer in women world-wide, 80% of these cases were discovered through records to be from developing countries Although it can be  readily detected in the premalignant phase, cervical cancer remains the second most common cancer in Nigeria and fifth in the United Kingdom. The objective of this study is to determine awareness and perception affecting utilization of cervical cancer screening services awareness, perception and factors affecting utilization of cervical cancer screening services among nurses in Adeoyo Maternity Teaching Hospital, Ibadan, Oyo State, Nigeria. The research was a descriptive and cross-sectional study conducted in Adeoyo Maternity Teaching Hospital Ibadan, Nigeria. The study showed a high level of perception 106 (59.9%) among the nurses within this study and the nurses that had positive perception only 8 (19.0%) had undergone cervical cancer screening in the past.  Their knowledge of cervical cancer was not poor; 97.7% of the respondents have heard of cervical cancer screening as a form of cervical cancer prevention and 168 (94.9%) are familiar with the age range (between 16-65 years old) that are eligible to go for CCS, only 128 (72.3%) were aware of modern day CCS equipment under Oyo state hospital management board facilities. However only 16 (9.0%) have worked in CCS unit and only 8 (4.5%) had privileged to attend refresher course training to enhance their knowledge of CCS practice. The findings of this study show that majority of the Nurses at Adeoyo Maternity Teaching Hospital though they are aware yet only few have undergone cervical cancer screening.

\end{abstract}


\keywords{nurses, cervical cancer, screening, awareness, perception.}

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\let\tabcellsep& 	 	 		 
\section[{Introduction}]{Introduction}\par
nvasive cervical cancer is the second-most common cancer in women world-wide, 80\% of these cases were discovered through records to be from developing countries Although it can be readily detected in the premalignant phase, cervical cancer Remains the second most common cancer in Nigeria and fifth in the United Kingdom as opined by \hyperref[b1]{Ahmed, Sabot and Iris (2013)}.\par
According to United States Cancer Statistics (1999-2011) Cervical cancer was rated the leading cause of cancer death among women living in the United States however, the number of cervical cancer cases reported in the past 40 years and the number of deaths have decrease significantly. This reduction was related to the fact that many women got regular Pap test which enabled them has a pre-cancer detection before it turns to cancer. By 2011, about 12,109 women in the United States were diagnosed with cervical cancer while 4,092 women death was from cervical cancer. Internationally, cervical cancer has been regarded as the third most popular type of cancer among women asides breast and colorectal cancer this was reported by Al-Meer, as eel, Al-Khalid, Al-Kowari and Ismail  {\ref (2009)}.\par
As a developing country, Nigeria is not spared of the cervical cancer public health problem; Olaniyi (2010) reported that cervical cancer is the commonest female cancer and is the leading cause of female death. This is observed to be secondary to late presentation at an advanced stage of the disease and which could be due to false reassurance associated with having no symptoms of disease.\par
Jamal, Bray, Centre, Farley and Ward (2011) are of the opinion that cervical cancers are a preventable disease through proper screening, treatment and follow up. However, it is a serious public health problem as it account for over 275,000 female deaths and approximately 529,000 new diagnoses each year were recorded in global cancer statistics The World Health Organization (WHO) also reported that cervical cancer is the most common cause of the female cancer globally (WHO, 2012).\par
Blair (2009) not only agree that early detection is a proven cost-effective intervention for cervical cancer control strategy but are also of the opinion that cervical cancer screening has its potentials to greatly reduce deaths occurring from cervical cancer. \hyperref[b4]{Guido (2008)} however views it as a major challenge for developing countries where lack of resources limits coverage of the cervical cancer screening.\par
An assessment of women's knowledge of cervical screening was considered important as up to 92\% of those dying from this form of cancer have never been tested \hyperref[b7]{(Nacelle, 2009)}. It has been noted that some women lack the knowledge about prevention of cervical cancer tests and its indications. Many women do not have a clear understanding of the meaning of an abnormal smear or the concept of pre-cancerous changes and many believe that the purpose of the prevention of cervical cancer test is to detect cancer \hyperref[b0]{(Ackerson, 2010)}. 
\section[{a) Objectives of the study}]{a) Objectives of the study}\par
To determine awareness and perception affecting utilization of cervical cancer screening services awareness, perception and factors affecting utilization of cervical cancer screening services among nurses in Adobo Maternity Teaching Hospital, Ibadan, Oyo State, Nigeria. Sampling procedure and sample: This is a descriptive and cross-sectional study aimed at assessing and documenting the awareness, perception and factors influencing cervical cancer screening among nurses working at Adobo Maternity Teaching Hospital using a validated structured questionnaire. Sampling Techniques: Stratified, proportionate and simple random sampling techniques were adopted for the selection of the 180 nurses from a total of over 204 nurses from all cadres of nurses in the hospital. The sample is a subset of the total population which gives representation size of 88\% of the total Nurses population will be used. 
\section[{b) Specific Objectives includes}]{b) Specific Objectives includes} 
\section[{Sample size determination:}]{Sample size determination:}\par
The sample size formula for estimating proportions will be used to calculate the required sample size for this study. n= Z 2 (up) d 2 n= minimum sample size d= desired precision of the estimate, set at 0.05 (level of accuracy desired/sampling error (tolerance error 5\%) z= standard normal deviate (set at 1.96 for 95\% confidence level) p=the proportion of the population having the characteristic being measure 87\% (cited in Arulogun et al, 2012) q=the proportion of the population that does not have the characteristics (1-p) p =prevalence of awareness of cervical cancer screening among female Nurses in NnamdiAzikwe University Teaching Hospital, Knew, Nigeria = 87 Therefore, p is 0.87 q = 1-0.87 = 0.13 Substituting for the values in the formula, n= 1 (0.05) 2   .96 2 ×0.87×0.13 n= 3.8416 x 0.87 x 0.13 0.0025 = 173.79 n=173.79 Estimated Sample size = 180. 10\% non-respondent=1-10 100 =0.9 (used for pilot study=20) 
\section[{b) Inclusion Criteria}]{b) Inclusion Criteria}\par
All the Nurses that volunteer to participate in Adobo Maternity Teaching Hospital, Hemet, and Ibadan.  
\section[{c) Ethical Approval}]{c) Ethical Approval}\par
Ethical approval was sought and obtained from the Oyo State Ethical Approval Board before this research was carried out. 
\section[{III. Results}]{III. Results} 
\section[{a) Age distribution of respondents}]{a) Age distribution of respondents}\par
The age of the respondent ranged from 23 to 59 years; the median age ± standard deviation was 40 ± 9.5 years. 
\section[{b) Research Question 1: What is the level of awareness of CCS among Nurses in Adeoyo Maternity Teaching Hospital?}]{b) Research Question 1: What is the level of awareness of CCS among Nurses in Adeoyo Maternity Teaching Hospital?}\par
To provide answer to this question, the frequency counts and the percentages of respondents to the items in section B and D of the instrument were computed and the results represented in table 9 and figure 4.9.\par
More than half of the respondent are aware of the cervical cancer screening 97 (39.5 and 15.2= 54\%). 
\section[{c) Discussion, Summary and Recommendation}]{c) Discussion, Summary and Recommendation}\par
There is a high level of perception 106 (59.9\%) had positive perception only 8 (19.0\%) had undergone cervical cancer screening in the past. The Chi square X 2 =10.172, degree of freedom (df) is 1 and P value is 0.002 thus the null hypothesis is rejected. 
\section[{d) What is the level of awareness of CCS among}]{d) What is the level of awareness of CCS among}\par
Nurses in Adobo Maternity Teaching Hospital?\par
In order to determine their level of awareness the respondents were asked to define cervical cancer higher percentage of the Nurses could not define cervical cancer 103 (58.2\%) while 74 (41.8\%) were able to define it correctly. However, majority of the respondent 168 (94.9\%) are familiar with the right age to have cervical cancer done. The respondents are also aware that the facilities where the test can be done 165 (93.2\%) Their knowledge of cervical cancer was not poor; 97.7\% of the respondents have heard of cervical cancer screening as a form of cervical cancer prevention and 168 (94.9\%) are familiar with the age range (between 16-65 years old) that are eligible to go for CCS, only 128 (72.3\%) were aware of modern day CCS equipment under Oyo state hospital management board facilities. However only 16 (9.0\%) have worked in CCS unit and only 8 (4.5\%) had privileged to attend refresher course training to enhance their knowledge of CCS practice.\par
The knowledge of availability of various types of cervical cancer screening method was fair: 130 (73.4\%) of the respondents are aware of Pap smear, 49 (27.7\%) Human Papiloma virus test, 10 (5.6\%) Cone biopsy test, 12 (6.8\%) Liquid based cytology and 46 (26\%) Visual inspection with acetic acid.\par
Although their knowledge of cervical cancer screening as a form of prevention of deadly disease such as cervical cancer was fair only 42 (23.7\%) have undergone CCS and only 8 (4.5\%)had done a repeat screening (screened twice).\par
In Arul gun's (2012) study respondents' pattern of utilization of cervical cancer screening (CCS) services that only 174 (34.6\%) of the respondents had made use of cervical cancer screening services. However pattern of utilization showed that 80 (46.0\%) had accessed CCS only once, 48(27.6\%) twice, 15(8.6\%) thrice and 31(17.8\%) four or more times with the University College Hospital being the mostly patronized (85.6\%).\par
Unlike Arul gun's study only few Nurses have had cervical cancer screening in the past (42, 23.7\%) and less than have had a repeat test (8, 4.5 \% had done it twice) however (132, 74.5\%) perceived it as crucial to women's health.\par
The research revealed that the Nurses level of awareness is in significant in making an informed decision; Nurses have adequate information but are not health informed. It then become a concern how well can they be an advocate that women should go for cervical cancer screening when they have not fully utilized its benefits personally. 
\section[{e) What is the perception of Nurses at Adobo Maternity Teaching Hospital on cervical cancer screening?}]{e) What is the perception of Nurses at Adobo Maternity Teaching Hospital on cervical cancer screening?}\par
According to Table \hyperref[tab_1]{11} which showed the perception of respondents towards CCS. 130 (74\%) respondents are of the opinion that not all Nurses are well trained to conduct cervical cancer training. 128 (72.4\%) claimed that cervical cancer screening is time consuming and that it is not easy to leave work to go for CCS 121 (62.7\%). Majority 107 (60.4\%) of the respondents claimed that CCS is a painful procedure and they cannot withstand the pain thus cannot go for it.\par
According to Kholo et al (2011) some women sometimes have their own perception about cervical cancer and the Pap smear, their study reveal that some women believe that women attend screening programs because they engaged in an active sexual lifestyle or contracted a sexually transmitted infection (STI). Because of this perception, many women do not attend for screening until the systems are well established and the condition is life threatening. Previous research also revealed that if women feel healthy, they feel no immediate need to attend for screening.This is similar to Kholo study only few of the respondents 25 (14.1\%) perceived having multiple sexual partner as a possible risk for having cervical cancer. Majority of the respondents 168 (94.9\%) disagreed that cervical cancer screening is for people of the lower class.\par
On accessibility \hyperref[b6]{Muppet (2011)} study is of the opinion that proximity is a key factor to utilization, in her study with Zimbabwean women rural areas have limited access to health centre providing CCS the respondents complained of distance being too far. Here the respondent working in a facility that has CCS service view its nearness to them positively 99(55. (\%) strongly agree to have the CCS done at their work place.\par
Respondents 132(74.5\%) believes nurses see cervical cancer screening as crucial to women's health. 129(72.9\%) disagreed that cervical cancer screening should be out of hospital -based services. Majority of the respondents 99 ( 55.9\%) feels comfortable going for cervical cancer screening at their place of work.108(61\%)respondents feels Hospital based cervical cancer screening services discourages Nurses .\par
The summary of group perception revealed that 106 (59.9\%) among the one hundred and seventy seven Nurses at Adobo Maternity Teaching Hospital had a positive perception. Even though the general attitude is positive, 71 (40.1\%) of the Nurses who have negative perceptions about cervical cancer screening needs to be targeted for re-orientation. 
\section[{IV. Conclusion}]{IV. Conclusion}\par
The seriousness and hazards which cancer brings into the lives and existence of sufferers of the disease cannot be quantified. Cervical cancer is a type of cancer limited to and suffered by women and has serious adverse effect on the ability of women to function properly within their sphere as mothers, care givers and sometimes bread winners. Nurses due to their daily contact with patients, their relatives, friends and the general public can be viewed as fountains of knowledge. It is therefore important that they have the right kind of knowledge to disseminate information to the public\par
The findings of this study show that majority of the Nurses at Adobo Maternity Teaching Hospital though aware of cervical cancer, the availability and importance of screening, yet only few have undergone cervical cancer screening.\par
The Nurses' health promotion unit should also be resourced to handle promotional activities and programs through in-service trainings in providing informative education to help improve the level of awareness about cervical cancer screening among Nurses in general Year 2018          
\section[{Global}]{Global}\begin{figure}[htbp]
\noindent\textbf{}\includegraphics[]{image-2.png}
\caption{\label{fig_1}}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{311}\includegraphics[]{image-3.png}
\caption{\label{fig_3}Figure 3 :Table 11 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{1} \par 
\begin{longtable}{P{0.371875\textwidth}P{0.17708333333333334\textwidth}P{0.30104166666666665\textwidth}}
Age range (years)\tabcellsep Frequency\tabcellsep Percentage (\%)\\
23-29\tabcellsep 24\tabcellsep 13.6\\
30-39\tabcellsep 60\tabcellsep 33.9\\
40-49\tabcellsep 54\tabcellsep 30.5\\
50-59\tabcellsep 39\tabcellsep 22.0\\
Total\tabcellsep 177\tabcellsep 100\end{longtable} \par
  {\small\itshape [Note: Figure 1: Bar Chart Showing Distribution of Respondents by Age]} 
\caption{\label{tab_1}Table 1 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{2} \par 
\begin{longtable}{P{0.0232421875\textwidth}P{0.17265624999999998\textwidth}P{0.3486328125\textwidth}P{0.126171875\textwidth}P{0.179296875\textwidth}}
S/N\tabcellsep Variables\tabcellsep Options\tabcellsep Frequency N=177\tabcellsep Percentage \%\\
1\tabcellsep Age group\tabcellsep \tabcellsep \tabcellsep \\
\tabcellsep \tabcellsep 23-29 years\tabcellsep 24\tabcellsep 13.6\\
\tabcellsep \tabcellsep 30-39 years\tabcellsep 60\tabcellsep 33.9\\
\tabcellsep \tabcellsep 40-49 years\tabcellsep 54\tabcellsep 30.5\\
\tabcellsep \tabcellsep 50-59 years\tabcellsep 39\tabcellsep 22.0\\
2\tabcellsep Ethnic group\tabcellsep \tabcellsep \tabcellsep \\
\tabcellsep \tabcellsep Igbo\tabcellsep 6\tabcellsep 3.4\\
\tabcellsep \tabcellsep Yoruba\tabcellsep 171\tabcellsep 96.6\\
3\tabcellsep Marital status\tabcellsep \tabcellsep \tabcellsep \\
\tabcellsep \tabcellsep Never married\tabcellsep 12\tabcellsep 6.8\\
\tabcellsep \tabcellsep Married\tabcellsep 157\tabcellsep 88.7\\
\tabcellsep \tabcellsep Widowed\tabcellsep 8\tabcellsep 4.5\\
4\tabcellsep Religion\tabcellsep \tabcellsep \tabcellsep \\
\tabcellsep \tabcellsep Christianity\tabcellsep 158\tabcellsep 89.3\\
\tabcellsep \tabcellsep Islam\tabcellsep 19\tabcellsep 10.7\end{longtable} \par
 
\caption{\label{tab_2}Table 2 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{3} \par 
\begin{longtable}{P{0.425\textwidth}P{0.16630434782608697\textwidth}P{0.25869565217391305\textwidth}}
Marital Status\tabcellsep Frequency\tabcellsep Percentage (\%)\\
Never married\tabcellsep 12\tabcellsep 6.8\\
Married\tabcellsep 157\tabcellsep 88.7\\
Widowed\tabcellsep 8\tabcellsep 4.5\\
Total\tabcellsep 177\tabcellsep 100\end{longtable} \par
 
\caption{\label{tab_4}Table 3 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{4} \par 
\begin{longtable}{P{0.031716417910447756\textwidth}P{0.13955223880597015\textwidth}P{0.10783582089552239\textwidth}P{0.1966417910447761\textwidth}P{0.18395522388059699\textwidth}P{0.19029850746268656\textwidth}}
\tabcellsep \tabcellsep \tabcellsep \multicolumn{2}{l}{Religion}\tabcellsep \\
\tabcellsep \tabcellsep Frequency\tabcellsep Percent \%\tabcellsep Valid Percent \%\tabcellsep Cumulative Percent \%\\
\tabcellsep Christianity\tabcellsep 158\tabcellsep 89.3\tabcellsep 89.3\tabcellsep 89.3\\
Valid\tabcellsep Islam\tabcellsep 19\tabcellsep 10.7\tabcellsep 10.7\tabcellsep 100.0\\
\tabcellsep Total\tabcellsep 177\tabcellsep 100.0\tabcellsep 100.0\tabcellsep \end{longtable} \par
 
\caption{\label{tab_5}Table 4 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{5} \par 
\begin{longtable}{P{0.2617753623188406\textwidth}P{0.015398550724637682\textwidth}P{0.09855072463768116\textwidth}P{0.17862318840579708\textwidth}P{0.05235507246376812\textwidth}P{0.11702898550724637\textwidth}P{0.12626811594202897\textwidth}}
Year 2018\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
34\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
Volume XVIII Issue II Version I\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
D D D D )\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
(\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
Medical Research\tabcellsep Valid\tabcellsep RN\tabcellsep \multicolumn{2}{l}{Educational status Frequency Percent \% 19 10.7}\tabcellsep Valid Percent \% 10.7\tabcellsep Cumulative Percent \% 10.7\\
Global Journal of\tabcellsep \tabcellsep RN/RM B.Sc. nursing B.Sc.\tabcellsep 136 16 6\tabcellsep 76.8 9.0 3.4\tabcellsep 76.8 9.0 3.4\tabcellsep 87.6 96.6 100.0\\
\tabcellsep \tabcellsep Total\tabcellsep 177\tabcellsep 100.0\tabcellsep 100.0\end{longtable} \par
 
\caption{\label{tab_6}Table 5 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{6} \par 
\begin{longtable}{P{0.023224043715846993\textwidth}P{0.12540983606557377\textwidth}P{0.10683060109289617\textwidth}P{0.19043715846994536\textwidth}P{0.19508196721311474\textwidth}P{0.20901639344262293\textwidth}}
\tabcellsep \tabcellsep \tabcellsep Cadre\tabcellsep \tabcellsep \\
\tabcellsep \tabcellsep Frequency\tabcellsep Percent \%\tabcellsep Valid Percent \%\tabcellsep Cumulative Percent \%\\
Valid\tabcellsep NO I\tabcellsep 17\tabcellsep 9.6\tabcellsep 9.6\tabcellsep 9.6\\
\tabcellsep NO II\tabcellsep 44\tabcellsep 24.9\tabcellsep 24.9\tabcellsep 34.5\\
\tabcellsep SNO\tabcellsep 22\tabcellsep 12.4\tabcellsep 12.4\tabcellsep 46.9\\
\tabcellsep PNO\tabcellsep 52\tabcellsep 29.4\tabcellsep 29.4\tabcellsep 76.3\\
\tabcellsep CNO\tabcellsep 41\tabcellsep 23.2\tabcellsep 23.2\tabcellsep 99.4\\
\tabcellsep ACNO\tabcellsep 1\tabcellsep .6\tabcellsep .6\tabcellsep 100.0\\
\tabcellsep Total\tabcellsep 177\tabcellsep 100.0\tabcellsep 100.0\tabcellsep \end{longtable} \par
 
\caption{\label{tab_7}Table 6 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{7} \par 
\begin{longtable}{P{0.006439393939393939\textwidth}P{0.2975\textwidth}P{0.17386363636363636\textwidth}P{0.06439393939393939\textwidth}P{0.06439393939393939\textwidth}P{0.1339393939393939\textwidth}P{0.10946969696969697\textwidth}}
\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep Year 2018\\
\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep 35\\
Valid\tabcellsep Casualty Main theatre Labour room Antenatal ward I Antenatal war II\tabcellsep \multicolumn{3}{l}{Area of practice Frequency Percent \% Valid Percent \% 11 6.2 6.2 2 1.1 1.1 41 23.2 23.2 13 7.3 7.3 11 6.2 6.2}\tabcellsep Cumulative Percent \% 6.2 7.3 30.5 37.9 44.1\tabcellsep Volume XVIII Issue II Version I\\
\tabcellsep Paediatrics\tabcellsep 8\tabcellsep 4.5\tabcellsep 4.5\tabcellsep 48.6\tabcellsep D D D D )\\
\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep (\\
\tabcellsep SCBU Lying-in-wards I Lying-in-wards II CHOPD\tabcellsep 7 19 6 6\tabcellsep 4.0 10.7 3.4 3.4\tabcellsep 4.0 10.7 3.4 3.4\tabcellsep 52.5 63.3 66.7 70.1\tabcellsep Medical Research\\
\tabcellsep ANC Crèche Gynae/septic ward Family planning NHIS\tabcellsep 2 1 4 3 1\tabcellsep 1.1 .6 2.3 1.7 .6\tabcellsep 1.1 .6 2.3 1.7 .6\tabcellsep 71.2 71.8 74.0 75.7 76.3\tabcellsep Global Journal of\\
\tabcellsep Gynaecological clinic\tabcellsep 7\tabcellsep 4.0\tabcellsep 4.0\tabcellsep 80.2\\
\tabcellsep Administrative Nurse\tabcellsep 1\tabcellsep .6\tabcellsep .6\tabcellsep 80.8\\
\tabcellsep Not disclosed\tabcellsep 34\tabcellsep 19.2\tabcellsep 19.2\tabcellsep 100.0\\
\tabcellsep Total\tabcellsep 177\tabcellsep 100.0\tabcellsep 100.0\tabcellsep \end{longtable} \par
 
\caption{\label{tab_8}Table 7 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{10} \par 
\begin{longtable}{P{0.28977272727272724\textwidth}P{0.08113636363636363\textwidth}P{0.11977272727272727\textwidth}P{0.15840909090909092\textwidth}P{0.2009090909090909\textwidth}}
Respondent\tabcellsep Frequency\tabcellsep Range of scores\tabcellsep Percentage \%\tabcellsep Remark\\
Awareness score of\tabcellsep 80\tabcellsep 0-40\tabcellsep 45.2 \%\tabcellsep Poor awareness\\
respondent about cervical cancer screening\tabcellsep 70 27\tabcellsep 41-69 70-100\tabcellsep 39.5 \% 15.2 \%\tabcellsep Average awareness Good awareness\\
Total\tabcellsep N=177\tabcellsep \tabcellsep 100 \%\tabcellsep \end{longtable} \par
 
\caption{\label{tab_9}Table 10 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{13} \par 
\begin{longtable}{P{0.010413476263399694\textwidth}P{0.4308575803981623\textwidth}P{0.07679938744257274\textwidth}P{0.07679938744257274\textwidth}P{0.08070444104134762\textwidth}P{0.08200612557427259\textwidth}P{0.09241960183767228\textwidth}}
S/N\tabcellsep ITEMS\tabcellsep Strongly Agree\tabcellsep Agree\tabcellsep Undecided\tabcellsep Disagree\tabcellsep Strongly Disagree\\
1\tabcellsep All Nurses are well trained to conduct cervical cancer screening.\tabcellsep 5 (2.8\%)\tabcellsep 22 (12.4\%)\tabcellsep 19 (10.7\%)\tabcellsep 72 (40.7\%)\tabcellsep 59 (33.3\%)\\
2\tabcellsep Cervical cancer screening is time consuming.\tabcellsep 3 (1.7\%)\tabcellsep 15 (8.5\%)\tabcellsep 31 (17.5\%)\tabcellsep 81 (45.8\%)\tabcellsep 47 (26.6\%)\\
3\tabcellsep It is not easy to leave work and go for cervical cancer screening.\tabcellsep 9 (5.1\%)\tabcellsep 44 (24.9\%)\tabcellsep 13 (7.3\%)\tabcellsep 70 (39.5\%)\tabcellsep 41 23.2\%)\\
4\tabcellsep Cervical cancer screening is painful and I can't withstand the pain.\tabcellsep 7 (4.0\%)\tabcellsep 22 (12.4\%)\tabcellsep 41 (23.2\%)\tabcellsep 76 (42.9\%)\tabcellsep 31 (17.5\%)\\
5\tabcellsep I do not have multiple sexual partners, so I do not need cervical cancer screening.\tabcellsep 6 (3.4\%)\tabcellsep 19 (10.7\%)\tabcellsep 10 (5.6\%)\tabcellsep 74 (41.8\%)\tabcellsep 68 (38.4\%)\end{longtable} \par
 
\caption{\label{tab_10}Table 13 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{14} \par 
\begin{longtable}{P{0.008429752066115704\textwidth}P{0.4720661157024793\textwidth}P{0.07024793388429752\textwidth}P{0.07446280991735538\textwidth}P{0.07165289256198347\textwidth}P{0.07727272727272727\textwidth}P{0.07586776859504132\textwidth}}
6\tabcellsep Cervical cancer screening is for people of lower social class.\tabcellsep 2 (1.1\%)\tabcellsep 5 (2.8\%)\tabcellsep 2 (1.1\%)\tabcellsep 65 (36.7\%)\tabcellsep 103 (58.2\%)\\
7\tabcellsep Nurses see cervical cancer screening as crucial to women's health.\tabcellsep 62 (35.0\%)\tabcellsep 70 (39.5\%)\tabcellsep 12 (6.8\%)\tabcellsep 20 (11.3\%)\tabcellsep 13 (7.3\%)\\
8\tabcellsep Cervical cancer screening should be out of hospital -based services.\tabcellsep 8 (4.5\%)\tabcellsep 23 (13.0\%)\tabcellsep 17 (9.6\%)\tabcellsep 77 (43.5\%)\tabcellsep 52 (29.4\%)\\
9\tabcellsep I feel comfortable to go for cervical cancer screening in my workplace.\tabcellsep 26 (14.7\%)\tabcellsep 73 (41.2\%)\tabcellsep 24 (13.6\%)\tabcellsep 38 (21.5\%)\tabcellsep 16 (9.0\%)\\
10\tabcellsep Hospital based cervical cancer screening services discourages Nurses.\tabcellsep 16 (9.0\%)\tabcellsep 29 (16.4\%)\tabcellsep 24 (13.6\%)\tabcellsep 70 (39.5\%)\tabcellsep 38 (21.5\%)\end{longtable} \par
 
\caption{\label{tab_11}Table 14 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{} \par 
\begin{longtable}{P{0.07828947368421052\textwidth}P{0.17335526315789473\textwidth}P{0.2069078947368421\textwidth}P{0.04473684210526315\textwidth}P{0.016776315789473684\textwidth}P{0.04473684210526315\textwidth}P{0.10625\textwidth}P{0.1789473684210526\textwidth}}
\tabcellsep User\tabcellsep Non-User\tabcellsep X 2\tabcellsep df\tabcellsep P-value\tabcellsep Remark\tabcellsep Decision\\
Aware\tabcellsep 41\tabcellsep 132\tabcellsep 0.004\tabcellsep 1\tabcellsep 1\tabcellsep Insignificant\tabcellsep We fail to reject\\
\tabcellsep (97.6\%)\tabcellsep (97.8\%)\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep the H 0\\
Not Aware\tabcellsep 1\tabcellsep 3\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
\tabcellsep (2.4\%)\tabcellsep (2.2\%)\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
\tabcellsep 42\tabcellsep 135\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
\tabcellsep (100\%)\tabcellsep (100\%)\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \end{longtable} \par
 
\caption{\label{tab_12}F}\end{figure}
 			\footnote{© 2018 Global Journals 1} 			\footnote{© 2018 Global JournalsF Awareness and Perception towards the Utilization of Cervical Cancer Screening (CCS) Services among Nurses in a Teaching Hospital in Ibadan, Nigeria} 			\footnote{© 2018 Global Journals} 		 		\backmatter  			 			 			  				\begin{bibitemlist}{1}
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\end{document}
