The age group of 21 to 25 years (45%) was the largest which is contrary to the age group 26 to 30 years (50%) in a study conducted in Niger,[9]. All the respondents were Christians. Engaging religious groups in educating and encouraging their members about cervical cancer screening can also help in reaching women,[10].
Respondents (75%) knew that HPV was a risk factor of cervical cancer. This is in in line with a study by McBride and Singh,[11] in which more than 70% of the respondents were aware that HPV could cause cervical cancer but in contrast to a study by Vishwakarma et al.,[12] where only 32% of subjects knew about HPV. A few of the respondents were aware that cervical cancer can be asymptomatic, present as irregular menstrual bleeding, and present as vaginal bleeding after intercourse. This is less as compared to the study by Vishwakarma et al.,[12] and Urasa and Darj,[13] where more respondents were aware.
Pap smear was the most common screening test known among respondents. This is very similar to a study carried by Owoeye and Ibrahim,[9] in which 44.9% of the respondents knew about a pap smear test. However, this was very low compared to 88.4%, 83%, and 82% of the respondents that knew in studies by Shah et al.,[14], Mutyaba et al.,[15] and Vishwakarma et al.,[12], respectively. Other screening methods such as cytology-based and HPV DNA which are commonly used in developed countries are not available in Lesotho due to financial and technical constraints.
Cervical cancer screening through Pap smear could be very effective in detecting cervical neoplasia at a primordial stage, and this could be precipitated by a very effective treatment. Only 30% of the respondents knew that screening should begin at 21 years, which is comparable to 46% and 54.1% of respondents that knew in studies by Vishwakarma et al.,[12] and Shah et al.,[14], respectively. Majority of the respondents in this study knew that HPV vaccination was a preventive measure against cervical cancer, and this is a similar finding to a study that reported that 82.7% of the participants pointed HPV as a preventive measure,[16]. Similarly, majority of the respondents preferred doctors over nurses in performing the Pap smear tests. This is similar to a study by Shekhar et al.,[17] in which 71% the respondents preferred doctors over nurses, because they perceived cervical cancer screening to be a doctors’ procedure.
The higher mortality of cervical cancer in Lesotho can be attributed to late presentation of the cancer at health facilities. In this study, only 5% of the respondents had a Pap smear. This is very similar to 5.7% uptake in Nnewi,[18] and less as compared to 8.3% among Nigerian women,[19]. Another study conducted in Niger reported an 11.6% uptake,[9]. In a study carried out in Nigeria, the uptake was 8.7%,[20], and 8.5% in a study conducted in Ghana,[21]. In contrast, the uptake was 84% amongst Chinese American women in the United States,[22], whilst more than 80% of the adult females in United States had a Pap smear during the preceding 3 years,[23]. In majority of developing countries, particularly Lesotho, implementing such measures of coordinated intervention has seemed far impractical.
Poor screening uptake can be attributed to limited healthcare facilities in rural areas which are mostly found in highland regions of the country. In this study, majority of the respondents came from rural areas. This has also been reported in other studies where uneven distribution of medical facilities in the country was the reason for poor uptake,[24], and long distances to such facilities also affected uptake,[16]. In contrast, other reasons for poor cervical cancer screening was due lack of knowledge about the availability of screening, and culturally-influenced reluctance to undergo cervical smear tests,[25].
Respondents who had Pap smears experienced pain (65%) and discomfort (35%), which are deemed as misconceptions by other researchers,[26, 27]. The respondents were however keen to obtain more information about cervical cancer screening and this is similar to a study by Imam et al.,[28] where 95% showed interest in obtaining more information.