Knowledge, attitudes, and practices of cervical cancer and cervical cancer screening in a rural setting of a low-income country: A cross-sectional study in the Busoga Region of Uganda

Background: Cervical cancer (CC) is a major non-communicable health issue in low- and lower-middle income countries, such as Uganda. Effective cervical cancer screening (CCS) and vaccination can effectively eliminate the disease as a public health issue, but these initiatives are lacking behind as CC is the most common cancer in Uganda. Future information-, screening-, and vaccinationcampaigns should be founded on a scientific depiction of the women’s understanding of the issue and solutions, to ensure a sustainable public health benefit. Methods: We performed a cross-sectional study in 5 districts of the Busoga Region of Uganda to assess rural women’s knowledge, attitudes, and practices of CC and CCS. Women ≥18 years old were included through random sampling. Data was collected using a digital questionnaire administered by trained research assistants recruited from the study area. Results are presented with descriptive statistics and logistic regression for sociodemographic predictors of KAP scores via crude and adjusted models, at a p-value of .05. Results: 585 participants were included. 57% had primary education and 83.9% were farmers. 92.1% had heard about cancer and 87.5% CC, while a minority knew of any symptoms (36.8%), risk factors (42.5%), and preventive measures (49%) of CC. Lay beliefs included poor hygiene and contraceptives as risk factors. Attitudes showed a good understanding of CC severity, preventability, and curability, and little indication of taboo. The respondent’s attitudes lacked clarity on vaccination and screening benefits as 35.6% did not know that HPV vaccination prevents CC and 24.1% did not know that screening could detect early CC. 9.1% had ever attended CCS with 12% in the 30 - 49-year-old target group. Predictors of KAP scores were identified and discussed from the perspective of similar studies. Conclusions: This study identified CC knowledge gaps in symptom awareness, risk, and preventive factors. Most women held favourable attitudes towards the disease, but less favourable towards preventive measures. Low screening prevalence indicated a need to improve public health initiatives.