We surveyed 101 women and 57 men between December 2018 and February 2019. The mean age of participants was 41.6 years with the mean age of men (44.1 years) being slightly higher than the mean age of women (40.2 years, p = 0.006). There were significant gender differences in educational level (p <0.001). Among those surveyed, 97% of all women and 76.8% of all men had no more than a primary education, while 25.7% of women and 10.3% of men had no education at all. No women in our sample attended more than two years of secondary school, while 8.9% of men were educated beyond two years of secondary school, and an additional 7.1% had at least some university education. The majority of participants (92.1% of women and 94.7% of men) were married, and among all women, 51.5% were in a polygamous household as related to significant gender differences in marital status (p = 0.004). The majority of our study population spoke one or both prevalent local languages, Malinké (62.7%) and Pulaar (59.5%). As is characteristic for the region, there are fewer Wolof (26.6%) and French (31%) speakers in our sample. It should be noted that there are significantly more male Wolof (36.8%) than female Wolof (20.8%) speakers (p = 0.039) as well as male French (45.6%) than female French (22.8%) speakers (p = 0.004). Among the women in our sample, 84.2% have never been screened for cervical cancer, 13.9% have been screened one time, and 2.0% have been screened multiple times (Table 1).
The mean age of women who were screened in our study is 42.4 years, with a range of 32 to 54 years. The mean age of the reported initiation of sexual activity among our study population overall was 16.7 years old, and the mean age of first pregnancy was 17.8 years. The mean number of lifetime births among women was 4.6. None of the women in our study sample were current smokers, 22.8% had a history of sexually transmitted infections, and 67.3% had no history of using oral contraceptives. We found significant differences by screening status in two categories. Women who were screened had a higher number of lifetime births (p = 0.016) and were more likely to report a history of a sexually transmitted infection (STI) (p = 0.047) (Table 2).
We found significant gender differences for certain health service utilization barriers and facilitators, including adequate support for duties when not able to work (p = 0.003), healthcare provider gender (p < 0.001), comfort with healthcare provider (p = 0.007), avoidance of healthcare due to cost (p = 0.044), use of personal funds to pay for healthcare (p < 0.001), spouse assistance with healthcare costs (p < 0.001), personal final say at home for healthcare decisions (p < 0.001), and spousal healthcare decision power (p < 0.001). A large portion of the study population (92.6%) stated that they have enough time to take care of their healthcare needs. The large majority of both women (88.7%) and men (100%) feel comfortable with their healthcare provider. Both women (35.0%) and men (51.8%) stated that at some point they have avoided going to the health facility because they could not afford the cost. Over half (52.0%) of the women use their own limited funds, while 30.0% are dependent on their spouse to pay for the healthcare. Among men, 78.9% stated that they have the final say at home regarding healthcare decisions. In contrast, only 16.0% of women reported making their own healthcare decisions, with 72% stating that their spouse made all the healthcare decisions. Of note, while there is not a significant gender difference, 18.8% of all participants stated that they had a negative experience at the health facility at some point when receiving care in Sénégal (Table 3).
When analyzing the language used in the healthcare setting with Malinké speakers, we identified several significant findings. There are differences between Malinké speakers and non-Malinké speakers in whether health services have been conducted in Malinké (p < 0.001), Wolof (p = 0.006), or French (p < 0.001). For those that speak Malinké, 48.0% received services in another language. Only 52.0% of Malinké speakers in our sample stated that they sometimes receive care in Malinké, 44.9% have received care at some point in Wolof, and 54.1% have at some point received care in French. Among participants, 34.4% did not receive any language interpretive services (formal or informal) (Table 4).
Concerning knowledge about cervical cancer, we found significant gender differences between women and men in the knowledge that a woman is at risk if she has multiple sexual partners (p = 0.010), a woman is at increased risk if her partner has multiple sexual partners (p < 0.001), smoking increases the risk of cervical cancer (p = 0.008), intrauterine devices (IUDs) offer a protective benefit against cervical cancer, (p = 0.006), oral contraceptive pills increase the risk of cervical cancer (p = 0.012), and that screening continues to be recommended for women after menopause (p < 0.001). About one third (31.6%) of the study population was unaware of cervical cancer at the time of this survey, equally split among the genders (31.7% of women and 31.6% of men). Likewise, only 52.2% of our study population was aware of the cervical cancer screening test. However, 94.8% of all respondents correctly stated (27.7% Agree and 67.1% Strongly Agree) that it is important for a woman to get screened for cervical cancer even if she has no symptoms. In addition, 87.8% of women either agreed (33.7%) or strongly agreed (54.1%) that a woman is more likely to get cervical cancer if she has had multiple sexual partners, whereas 67.9% of men either agreed (28.6%) or strongly agreed (39.3%) that a woman is more likely to get cervical cancer if she has had multiple sexual partners. When asked about the sexual behavior of men, 90.9% of women either agreed (28.3%) or strongly agreed (62.6%) that a woman is more likely to get cervical cancer if her husband has had multiple sexual partners, while only 37.5% of men either strongly agreed to this statement. Among women, 30.3% were undecided, 10.1% disagreed, and 9.1% strongly disagreed that a woman is less likely to get cervical cancer if she uses an IUD. Concerning the oral contraceptive pill, 24.5% of women were undecided, 13.3% disagreed, and 9.2% strongly disagreed that it increases the risk of cervical cancer. A large number of women are unaware that cervical cancer screening is recommended after menopause (8.1% are undecided, 44.4% disagree, and 12.1% strongly disagree). Men, as well, are largely unaware of this recommendation, with 32.7% being undecided, 18.2% disagree, and 25.5% strongly disagree. Among all respondents, a considerable number agreed (37.8%) or strongly agreed (51.9%) that If cervical cancer is found early, it can be cured (Table 5).
Among the women in our sample, 84.2% of women had never been screened for cervical cancer, with 14% having been screened a single time, while 2% have had multiple screenings. Only three women have been screened within the last 2 years. Among all women who have been screened, 75% strongly agree that they are satisfied with the screening and 50.0% strongly agree that the test was comfortable. In addition, 66.7% strongly agree that there was a lengthy wait time for screening, while 83.3% strongly agree that they received adequate orientation to the screening exam (Table 6).