Practice of Opportunistic Cervical Cancer Screening and Health Education Among Health Workers in Ogun State, Nigeria: A Qualitative Study of Barriers and Facilitators

Background: The burden of cervical cancer is highest in low- and middle-income countries. In the absence of organised screening programmes in Nigeria, opportunistic screening of women of reproductive age seeking maternal healthcare can help achieve increased uptake of cervical cancer screening. This study is aimed at understanding the practice of opportunistic cervical cancer screening and health education, and the barriers and facilitators experienced by health workers practicing in antenatal and postnatal clinics in Ogun State, Nigeria. Methods: This is a qualitative cross-sectional study. In-depth interviews were conducted among 43 health workers—doctors, nurses and community health extension workers, working in antenatal and postnatal clinics in public primary, secondary and tertiary health facilities. Data analysis was done using thematic analysis. Results: Health education on cervical cancer prevention was not done in most health facilities. Where cervical cancer health education was practiced, it was done mostly prior to family planning provision, and sometimes at antenatal, postnatal/infant immunization clinics. Facilities for cervical cancer screening was not available in most of the health facilities and patients had to travel long distances to tertiary facilities to have a Pap smear done. Barriers to cervical cancer screening and health education include, high cost of screening, manpower shortage, fear of positive result among patients, poor awareness among patients, and religious and cultural beliefs. The major facilitators to screening and health education mentioned were passion for their work and the desire that no woman should die from preventable cancers. Conclusion: Government should ensure adequate staffing of health facilities, health worker training, adequacy of reagents and equipment for screening, accessibility of screening centers and make screening free/more affordable. Awareness activities and community mobilization for cervical cancer screening is needed. It is recommended that health facilities include cervical cancer health education into routine antenatal and postnatal clinic activities, and screening at post-natal clinics.