Neenu Baby
Neenu Baby
Neenu Baby
BANGALORE, KARNATAKA
MRS.NEENU BABY
BOMMANAHALLI
BANGALORE -560068
1
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA.
DISSERTATION
3 COURSE OF THE
STUDY AND M.Sc. NURSING-1ST YEAR
SUBJECT
OBSTETRICAL AND GYNECOLOGICAL
NURS ING
4 DATE OF ADMISSION
30.10.2018
TO THE COURSE
2
6: BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
Women’s health Issues have become a focus for science and politics. Women’s
work roles, possible exposures to workplace hazards, social class, social roles, social
stress, access to health care, and health behaviors are the factors that act together to help
carcinoma is a cancer that begins in a tissue that lines the inner or outer surfaces of the
body, and that arises from cells originating in the endodermal, mesodermal and ectodermal
germ layer. Carcinomas occur when the DNA of a cell is damaged or altered and the cell
Cervical cancer is a disease that affects the cervix in the female reproductive
system. The cervix is the lower portion of the uterus that connects the upper vagina to the
uterus. It is about two inches in length. During childbirth, the cervix dilates, allowing the
baby to travel from the uterus to the vagina. In the early stages of cervical cancer, there are
invading deeper into the cervix and surrounding tissue. As the disease progresses, women
may experience abnormal vaginal bleeding, post-coital bleeding, dyspareunia, pelvic pain
and heavy vaginal discharge. The main risk factors of cervical cancer are due to infection
with the human papilloma virus (HPV) that is transmitted through sexual contact. Other
factors include having sex at an early age, smoking cigarettes, having multiple sexual
3
The cervix is the narrow portion of the uterus where it joins with the top of the
vagina. Most cervical cancers are squamous cell carcinomas, arising in the squamous
(flattened) epithelial cell that line the cervix. Adenocarcinoma, arising in glandular
epithelial cells is the second most common type. Very rarely, cancer can arise in other
In most of the developed countries, however, cancer of the cervix is the second
most common cancer in women after cancer of breast. The relation breast carcinoma and
cervical cancer is 3:1. Major factor affecting the prevalence of carcinoma cervix in a
population are economic factor, sexual behaviour and degree of effective mass screening.5
Cervical cancer ranks as the most frequent cancer among women in India and
most frequent cancer among women between 15 and 44 years of age. [1] Cancer of the
cervix uteri is the second most common cancer among women worldwide, with an
estimated 529,409 new cases and 274,883 deaths in 2008. About 86% of the cases occur in
developing countries, representing 13% of female cancers. About 11,150 new cases of
invasive cervical cancer are expected to be diagnosed in 2017, with approximately 3670
India accounts for one-fifth of the world burden of cervical cancer. There are no
the provincial states. Data from population-based cancer registries in different regions
indicate a slow, but steady, decline in the incidence of cervical cancer. However, the rates
are still too high, particularly in the rural areas, and the absolute number of cases is on the
increase due to population growth. Also in two sub districts of western India where the
literacy among women is less than 20% there have been attempts to evaluate the role of
4
improved awareness in the early detection and control of cervical cancer.7
The main reasons for the higher incidence and mortality of cervical cancer in
1. Lack of awareness of cervical cancer among the population, health care providers
2. Absence or poor quality of screening programmes for precursor lesions and early-
stage cancer. In women who have never been screened, cancer tends to be
2015). 8
Carcinoma Cervix is the most common cancer affecting Indian women with an
estimated age-adjusted incidence of 30.7 per 1,00,000 women and 1,32,082 new cases in a
year. By 2025, the no. of new cervical cancer cases in India is projected to 2,26,084. India
Cervical cancer is treatable disease if identified at the early stage. Cancer of the
cervix is the second most common cancer among women worldwide, with an estimated
529,409 new cases and 274,883 deaths in 2008. About 86% of the cases occur in
there are 6 million new cancer cases, of which 52% occur in developing countries. The
magnitude of the problem of cancer in the Indian sub-continent in terms of sheer number
is most alarming. The estimated new cases of cancer in India per year are nearly 6.5 lakhs
and at the start of the next millennium estimated to be 8.6 lakhs. The crude incidence of
5
cancer in India is approximately 100 per 100,000 populations. The Cancer in women in the
Indian Sub-continent constitutes more than 50% of the total cancer. The most common
cancer observed by Indian registries are those related to tobacco usage in males while
among females, the most common cancer are those of the Uterine Cervix, Breast and Oral
cavity. In Karnataka a state in the southern part of India, it is estimated that annually there
are about 35,000 new cases whereas, the prevalent cancer accounts to about 1, 50,000.10
Educating people regarding the disease will help drive away the fears and stigma
associated with the disease. Well- illustrated audio-visual educational materials are
of the population have resulted in early detection of and survival from cervical cancer in
backward regions of India. Also, where the literacy among women is less than 20% there
have been attempts to evaluate the role of improved awareness in the early detection and
India which accounts for one sixth of world’s population also bears one fifth of
the world’s burden of carcinoma cervix. There are approximately 130,000 new cases of
cervical cancer in India per year .and the disease is reported to be responsible for all most
20% of all female death. India’s cervical cancer age standardized incidence rate [30.7 per
100,000] and age standardized mortality rate [17.4 per 100,000] are highest in South
Central Asia. The Indian national AIDS control organization suggests that there is a strong
association between HIV &HPV infection. Each year there are approximately 465,000
new cases of invasive cancer of the cervix and more than 200,000 deaths from the disease.
IV).Where as in developed countries 90% of the cases are diagnosed in the early stages
(stageI&stageII) and only 10% cases in advanced stages (stageIII& IV). “The number of
6
death due to cervical cancer in India is estimated to rise 79,000 by the year 2010 and the
high risk is seen among the age group of (35-64 years) according to a survey conducted in
Chennai.” In Karnataka a survey study was conducted and it reveals that out of 7846
women, carcinoma cervix made up 26%of all cancers, 40% of female malignancies and
screening for cervical carcinoma in rural India. The samples were collected by cluster
method and 131,746 healthy women between ages of 30& 59 years were selected. The
result reveals that 127 subjects were diagnosed with carcinoma cervix. The study was
concluded that in a low resource setting, a single round of HPV testing was associated
with a significant reduction in the number of advanced cervical carcinoma and death from
cervical cancer. 13
still do not have access to cervical cancer prevention programmes. Cervical cancer is not
corrected. Health promotion, including education and counselling of women and men,
education should aim to ensure that women, their families and the community at last
A study conducted by the New England Journal of Medicine reveals that about
1.3 lakh new cases of cervical cancer are reported every year, in India and about a quarter
of the five lakh cases globally.“Even the educated class are not aware of cervical cancer
and often link it with the neck. We have to explain to them that cervical cancer is caused
in the lower part of the body," says gynaecologist, In the hospital based cancer registries
7
(HBCRs), the leading site for cervical cancer is Bangalore and Chennai, the second
leading site in Mumbai and Thiruvananthapuram and the third leading site in Dibrugarh.
cancer in Chennai, Trivandrum and Bangalore it has been reported that they didn’t receive
active treatment.15
Review of literature plays a vital role in research project. It highlights what was
previously done, what were the methods that have been used by the previous researchers
and how we can combine the previous research results to improve knowledge. Review of
literature relevant to the study helps the investigator to develop insight on what had done
in the past. Literature review is based on extensive survey of books, journals and internet
identification, location, scrutiny and summary of written materials that contain information
on research problem.16
An extensive review of literature relevant to the research study topic was done to
gain information and insight and to build the foundation of the study. The literature
reviewed for the present study is organized and presented under following sections;
8
6.2.1 Section I: Review related to incidence of carcinoma of cervix
and results of cytological assessment in the context of cervical cancer screening activities.
The subjects included women less than or equal to 14 years of age living in two districts of
Barcelona [n =129327] between the year 2001& 2006. the results shows that the
participation of women aged 20-34 years [63.8%] is higher than those among 50-64 years
[36.0%] and the rate of pathological results increased from 11.4/1000 in 2001to 29.0 /1000
in 2006 and this increase was high among young women ,due to an increase in the rate of
intra epithelial leisions[LSIL].The study was concluded that a low rate of participation in
the public cervical cancer screening programmes and an increase in the number of
and gynaecology team collected demographics of 231 patients and 199 Thin prepared pap
smears, which were analyzed cytologically for the presence of HPV DNA.The results
shows that of 231 patients of mean age 32.2, 76% had seen physician four times or less
and from 199 pap smears performed,21.6% consists of both high risk and low risk
HPV,16.6% of women had high risk HPV,6.5% of abnormal pap smears of which 4.5%
had atypical squamous cells of undetermined significance, .5% had atypical glandular
cells,1% had low grade squamous intraepithelial lesions and .5% had high grade squamous
intraepithelial leisions.Other findings were 9% had Trichomonas Vaginalis and 13.5% had
Candida. The study was concluded that improved access to health care and cervical cancer
9
screening programmes may help to decrease transmission of HPV and subsequent cervical
of self collected vaginal swabs for HPV DNA can be used to screen for cervical disease in
women aged 35 years & older. The screening was performed in 1365 previously
unscreened black South African women aged 35-65 years. The result shows high grade
squamous intraepithelial lesions were identified in 47 of 1365 women and there were 9
cases of invasive cancer of women with high grade disease, 66.1% had high risk HPV
detected in self collected vaginal samples. The false positive rates for HPV DNA testing of
self collected vaginal samples was 17.1%.A high risk type of HPV DNA was detected in
83.9%of women with high grade disease and 15.5% of women with no evidence of
cervical disease using a clinician obtained cervical sample. The study concludes that HPV
testing of self collected vaginal swabs is less specific than a clinician obtained cervical
sample for detecting high grade cervical disease in women aged 35 years & older in
addition to this HPV testing offers an important new way to increase screening in settings
An evaluative study was done for the detection of precancerous lesions and to
prevent cervical cancer on a screening programme using visual inspection of the cervix
with acetic acid and cryotherapy.The subjects were taken by cluster method and it
included 16 of 64 districts. The result shows that even though the level of resources is poor
visual inspection of cervix using acetic acid can be carried out by trained doctors, nurses
and paramedical workers and the women, their partners and families are not aware of the
disease and its consequences. The study concludes that cervical cancer can be identified
earlier by creating awareness about the disease among women and their families. (27)
10
A survey study was conducted to assess the need and potential for improving the
quality of cervical cancer prevention and treatment services. The result shows that the
policy makers, community members and clients were mostly unaware about carcinoma
cervix and its preventable nature although they express a strong interest in having services
available to women in their communities. The study concludes that a gap in services,
unmet needs, standards, policies and integrated interventions are the potential factors to
simple cervical cancer screening test where pap smears not available, as it is a simple in
expensive method and can be used to detect cervical cancer in countries where women do
not have access to pap smears. The subjects included 49,311 women between the age
group of 30 & 59 years. The result shows that the group of women who underwent visual
inspection of cervix using acetic acid has a 25% reduction in cervical cancer incidence and
35% reduction in deaths when compared with control group who received existing care so
this method is effective as a method of cervical cancer screening. The study concluded that
in the developing countries the screening over multiple visits is often not possible and
vaccination against human papilloma virus is currently too expensive,” Visual inspection
of cervix using acetic acid screening because of its simplicity and cost, is an effective
A survey study was conducted to confirm the importance of genital hygiene in the
fight against cervical infections that have a role in the development of cervical dysplasia
and cancer. The results shows that most of the women in rural areas are not using sanitary
pads and the facilities for washing after coitus are unavailable. The survey concludes that
11
health education, satisfactory living standards and the empowerment of women are
A descriptive and cross sectional study was conducted to assess the knowledge of
cervical cancer, one of the leading causes of cancer death is women, and current screening
practices among female student at the University of Ibadan, Nigeria. A multi - Stage
sampling technique was used to select. 350 respondents. Semi – structured questionnaires
were used. Nearly 2/3 (63%) of respondents have heard about cervical cancer. Knowledge
of predisposing factors for the disease was high for early exposure to sex (82%) and sex
with multiple partners (70.6%). Only 15.7% knew that abnormal menstrual bleeding is
symptomatic of cervical cancer; 14.9% perceived themselves for screened 2.6% for the
disease. The study revealed that Intense and integrated educational programs are urgently
during 1965 – 2005 on cervical cancer with emphasis on screening by pap smear and
other alternative methods. The predominant risk factor is persistent infection with human
papilloma virus (HPV). Conventionally, pap smear cytology is the only method for
screening, but recently various studies have been carried out to explore alternative
methods like Visual inspection methods could be more feasible for organized population
based screening in a low resource country. A study revealed that a need for initiating
of all cervical cancers. HPV types 16 and 18 are responsible for approximately 77% of
cases and peak prevalence occurs in females younger than 25 years of age. The recent
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implementation of HPV vaccination provides females with the opportunity to prevent
infection. School nurses are advocates of student health and often a primary source of
information. Therefore, they can play a key role in promoting vaccination prior to sexual
debut. They can also promote regular cervical screening post vaccination, which may not
be apparent to many students and parents. To deal with such issues, greater understanding
of HPV disease and prevention among school nurses, students and parents may lead to
Cancer of the cervix is the second most common cancer in women worldwide and
Worldwide, approximately 500,000 cases of cervical cancer are diagnosed each year.
Routine screening has decreased the incidence of invasive cervical cancer in the United
States, where approximately 13,000 cases of invasive cervical cancer and 50,000 cases of
cervical carcinoma in situ are diagnosed yearly. Invasive cervical cancer is more common
in women middle aged and older and in women of poor socioeconomic status, who are less
likely to receive regular screening and early treatment. There is also a higher rate of
incidence among African American, Hispanic, and Native America women. (ACS 2007).26
Boer MA, etal 2008 Conducted a population based study on prevalence of human
papillomavirus in Indonesia: in the three regions. A sample of 2686 women, aged 15-70
years, in Jakarta, Tasikmalaya, and Bali, Indonesia. The overall HPV prevalence was
11.4%, age-standardized to the world standard population 11.6%. The most prevalent
types found were HPV 52, HPV 16, HPV 18, and HPV 39, respectively, 23.2, 18.0, 16.1,
and 11.8% of the high-risk HPV types. In 20.7% of infections, multiple types were
involved. Different age-specific prevalence patterns were seen. HPV 52 was the most
13
Dr. RangaswamySankaranarayananetal (2007) conducted study on “Effect of visual
screening on cervical cancer incidence and mortality in Tamil Nadu, India: a cluster-
randomized trial” They assessed the effect of screening using visual inspection with 4%
acetic acid (VIA) on cervical cancer incidence and mortality in a cluster randomized
controlled trail. 114 study clusters in Dindigul district, 57 were randomized to one round
of VIA by trained nurses, and 57 to a control group. Healthy women aged 30 to 59 years
were eligible for the study. The primary outcome measures were cervical cancer incidence
and mortality. 49311 eligible women in the intervention group, 31 343(63.6%) were
screened. 30 958 control women received the standard care. 3088 (9.9%) screened
positive, 3052 had colposcopy, and 2539 directed biopsy. Of the 1874 women with
precancerous lesions in the intervention group, 72% received treatment. In the intervention
group, 274 430 person years, 167 cervical cancer cases, and 83 cervical cancer deaths
were accrued compared with 178 781 person-years, 158 cases, and 92 deaths and in the
control group during 2000-06 ( includes hazard ration 0.75 [ 95% CI 0.55-0.95] and
cancer in rural areas of Udupi district, Karnataka, India”. Population included all married
women in the age group of 35-59 years in two villages of the field practice area. Two
ANMs were trained in history taking, visual inspection of the cervix, using of speculum
and collecting Papanicolaou smears. After training, they made home visits and identified
women with gynaecological symptoms suggestive of cervical cancer. These women were
asked to report to Rural Maternity and child Welfare homes where the ANMs did a visual
inspection of cervix and made a cervical smear. A total of 1402 women were registered of
the ANMs could identify 368 women (26%) with sumptoms. Only 192 (52.2%) of these
14
women reported for examinations. Chronic cervicitis accounted for the largest proportion
of the cases (48.8%) three cases were diagnosed as suspected cases of cancer cervix. And
three cases (1.5%) turned out to be malignant. When clinical findings of the ANM
compared with results of cytological examination, ahigh degree of sensitivity (78.4%) and
findings.29
6.5.HYPOTHESIS:
H1- There will be significant difference between the pretest and posttest knowledge score
of multiparous women regarding carcinoma of cervix
15
6.6. VARIABLES
6.8.ASSUMPTIONS:
16
Structured teaching programme is an effective method to enhance the knowledge
of multiparous women regarding prevention of carcinoma of cervix.
Multiparous women will be interested to learn about the prevention of carcinoma
of cervix.
6.9 DELIMITATIONS
Data will be collected from multiparous women who are admitted in the
gynecological ward.
The research design for the study will be quasi experimental one group pre-test
posttest design.
7.1.3 Settings:
7.1.5 Population:
17
during the period of data collection.
i. Inclusion Criteria:
SCORING PROCEDURE
If answer is no 0
SCORING INTERPRETATION
Good :- 75-100%
Average :- 50-75%
18
7.2.3.DATA COLLECTION METHOD
The multiparous women in the selected hospital will be selected for the study
using non-probability purposive sampling. Formal administrative permission will
be obtained from the hospital authority. The data will be collected from 50
multiparous women after obtaining their consent. The procedure will be
explained to them and confidentiality will be assured. Pre-test will be
conducted using questionnaire on carcinoma of cervix and the structuredteaching
will be administered on the same day and after 6 days the post test will be
conducted with the score knowledge questionnaire.
7.4. Has ethical clearance been obtained from your institution in case of 7.3?
19
8. REFERENCES :
1. Jean Jenkins RN, MSN, OCN et al. The effects of cancer on women. Seminars in
https://en.wikipedia.org/wiki/Carcinoma
3. Lisa Fayed, Former. Cervical cancer 101, what is cervical cancer?. 2007 Dec 20.
cervical.htm
4. Dutta D.C,” A Text book of Gynaecology’’,4th edition New Central Book Agency
en.wikipedia.org/wiki/cervical_cancer.
age risk of cervical cancer, Women,s Health Weekly 2001 May 31.
10 june 2010
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11. SankaranarayananR,Budukh AM, Rajamanickam R. Effective screening
M.D, “HPV Screening for cervical cancer in rural India”, The new England Journal
of Medicine 2009;361:304-06.
16. 13..Polit & Hungler, “Nursing Research: principles and methods”, 6thedn,
18. Schnatz PF, Markelova NV, Holmes D, “The prevalence of cervical HPV and
19. Amarin ZO, Badria LF, Obeidat BR, “Attitudes and beliefs about cervical smear
testing in ever married Jordanian women”. East Mediterr Health J.2008 Mar-
Apr;14[2]:389-97
21
Matters.2008 Nov; 16(32):78-85.
21. SreeLatha.M, “Vinegar provides simple cervical cancer screening test where Pap
screening services among Nigerian student. Int Q Community Health Educ. 2008-
25. Patro BK, Nongkynrih B. Review of screening and prevention strategies for
cervical cancer in India. Indian J Public Health. 2007 Oct-Dec; 51(4): 216-2
prevention: a guide for school nurses. J SchNurs. 2009 Aug; 25 (40): 261-9. Epub
27. Luiz carlosZeferino MD “Cervical cancer in the developing world” Best practice
and research and clinical obstetrical & gynecology volume 20, Issues 3, Jun 2006,
pages 339-354.
cancer incidence and mortality in Tamil Nadu, India”. A cluster- randomized trial
22
30. Rao RS, et al, “Downstaging for cervical cancer: a community based study in the
rural areas of Udupi district, Karnataka, India. Trop Doct. 2007 Apr;37(2):73-5.
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9 SIGNATURE OF THE CANDIDATE
DESIGNATION OF GUIDE
11.2 . SIGNATURE
11.3 . CO-GUIDE -
11.4 . SIGNATURE -
11.6 .SIGNATURE
12.2. SIGNATURE
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