Haerani.,Nurul HB.,Kurniati A., Husnul K.
Comprehensive Health Care, 6 (2022) 125-135
Haerani.,Nurul.HB.,Kurniati.A., Husnul.K./ Comprehensive Health Care Vol 6, No 3 Desember 2022
https://ojs.stikespanritahusada.ac.id/index.php/chc/Index
Factors Related To Screening Of Cervic Carcinoma With Method IVA At Borongrappoa
Health Center Bulukumba Regency
Haerani*, Nurul Hidayah Bohari, Kurniati Akhfar, Husnul Khatimah
DIII Midwifery Study Program, Midwifery Academy of Tahirah Al Baeti Bulukumba, Indonesia
ABSTRACT
Article Info Cervical cancer screening is one way of examining cells for the
Article History: identification of malignant cells in the cervix at an early stage, by
Received : 15 November 2022 taking cervical cells through a cotton swab and then examining
Revised : 25 November 2022 them carefully under a microscope to see the changes that occur.
Accepted: 12 December 2022 occurs in cells. The research method is quantitative research with a
cross sectional study approach. The sampling technique used was
*Corresponding Author : purposive sampling. The sample consisted of 118 case groups and
haerani987@gmail.com 118 control groups.The results showed that marriage story had a
DOI relationship with Cervical Carcinoma Screening with the IVA
https://doi.org/10.37362/jch. Method at the Borongrappoa Health Center, Bulukumba Regency
v6i3.885 in 2018 with a p_value of 0.00 less than 0.05, meaning there was a
relationship. Knowledge has a relationship with Cervical
P- ISSN : 2722-1563 Carcinoma Screening With the IVA Method at the Borongrappoa
E -ISSN : 2580-7137 Health Center, Bulukumba Regency in 2018 with a p_value of 0.00
less than 0.05, meaning there is a relationship. Motivation has a
relationship with Cervical Carcinoma Screening With the IVA
This is an Open Access article Method at the Borongrappoa Health Center, Bulukumba Regency
distributed under the terms of in 2018 with a p_value of 0.00 less than 0.05, meaning there is a
theCreative Commons Attribution-
NonCommercial4.0 International
relationship. To the Borongrappoa Health Center, they pay more
License, whichallows others to remix, attention to WUS who have been married more than once because
tweak, and build upon the work non- they are included in the risk group. WUS whose level of knowledge
commercially as long as the original
work is properly cited. The new
is still low so that screening participation increases by means of
creations are not necessarily licensed health promotion about cervical cancer.
under the identical terms
Keywords: Screening Carsinoma; IVA
INTRODUCTION
Cervical cancer screening is one way of examining cells for the identification of
malignant cells in the cervix at an early stage, by taking cervical cells through a cotton
swab and then examining them carefully under a microscope to see the changes that
occur. occurs in cells. Changes in cervical cells that are detected early, allow treatment to
be carried out before these cells develop into cancer cells or malignant cells.
According to Hacker, (2010) Screening results are said to be abnormal if the cells
originating from the cervix or cervix, the results of the examination are different from
normal cells. The WHO publication regarding the results of cervical cell screening
through various methods entitled "HPV and cervical cancer in the world" (2010), stated
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Haerani.,Nurul.HB.,Kurniati.A., Husnul.K./ Comprehensive Health Care Vol 6, No 3 Desember 2022
that: at the world level the population of women aged 15 years and over is 2,329.08
million who are threatened with cervical cancer. , and 493,243 of them were diagnosed
as cervical cancer, 273,505 died every year. Furthermore, it was stated that: Cervical
cancer is the second most common cancer affecting women aged 15-44 years in the
world. From the results of screening of 14595 cervical cancer patients, 87.2% included
those with HPV with a Confidence Interval (CI: 86.7-87.8).
In the WHO report, 2010 also describes the distribution of cervical cancer
screening results by continent as follows: In the United States the population of women
aged 15 years and over and at risk for cervical cancer is 336,500 who are at risk of
developing cervical cancer, and every year 86.532 million women diagnosed with
cervical cancer, of which 38.436 million died from cervical cancer.
In Europe, the population of women aged 15 years and over and at risk for cervical
cancer is 321.8 million and, and every year 59,931 million are diagnosed with cervical
cancer, of which 29,812 million die from cervical cancer. In Africa, the population of
women aged 15 years and over who are at risk for cervical cancer is 267.9 million and
every year 78,897 million women are diagnosed with cervical cancer, of which 61,897
million die from cervical cancer.
In Oceania, the population of women aged 15 years and over who are at risk for
cervical cancer is 12.6 million and every year 2002 women who are diagnosed with
cervical cancer, of these 844 die from cervical cancer. In Asia, the population of women
aged 15 years and over who are at risk for cervical cancer is 1390.4 million and every
year 265.884 million women are diagnosed with cervical cancer, of which 142,735 die
from cervical cancer. Especially in Indonesia, the population of women aged 15 years
and over who are at risk for cervical cancer is 87.57 million and every year 15050
women are diagnosed with cervical cancer, and of that number 7566 die from cervical
cancer. In terms of the order of cancer patients in Indonesia, cervical cancer ranks
second in terms of incidence and mortality rates.
Anatomical Pathology Laboratory of CiptoMangunkusumo Hospital, conducted
data collection in 2003, by screening using Screening as many as 2580 women and 2537
in 2004, showing the high incidence of cervical cancer in Indonesia and the cause is the
lack of awareness of married women in Indonesia to check with screening as an effort to
detect cervical cancer early.
Through regular screening examinations, it can help detect early cervical cancer
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(KLR) in women who are at risk for getting cervical cancer (KLR). Screening
examination is useful as a filter and tracer of cell changes towards malignancy at an
early stage so that precancerous abnormalities can be detected while helping to reduce
the cost of treatment which is relatively easier and cheaper (Hillegas, 2015). In addition,
this examination can also detect viral infections such as the Human Papilloma Virus
(HPV) and infections from bacteria that can cause sexually transmitted diseases such as
Chlamydia and Gonorrhea.
The highest cancer in Indonesia in women is breast cancer and cervical cancer.
While in men are lung cancer and colorectal cancer. Other data from Globocan estimates,
International Agency for Research on Cancer (IARC) in 2012, the incidence of cancer in
Indonesia is 134 per 100,000 population with the highest incidence in women being
breast cancer at 40 per 100,000 followed by cervical cancer at 17 per 100,000 and
colorectal cancer at 10. per 100,000 women. While in men the highest incidence is lung
cancer 26 per 100,000, colorectal cancer 16 per 100,000 and prostate cancer 15 per
100.00 men. Based on data from the 2010 Hospital Information System, inpatient cases
of breast cancer were 12,014 cases (28.7%), cervical cancer 5,349 cases (12.8%).
Cervical cancer is a cancer with a high prevalence in Indonesia in 2013, which was
0.8% and it is known that the age group of 25-44 years, and 45-54 years is an age group
with a fairly high prevalence of cancer. (Infodatin, 2015), this data shows that the
number of cases of cervical or cervical cancer is still quite high, and is the most common
type of cancer suffered by Indonesian women. It is estimated that 40-45 new cases
appear every day and about 20-25 women die every day due to cervical cancer.
The results of the 2013 Basic Health Research show that the prevalence of
tumors/cancer in Indonesia is 0.8%. The highest figure is in the Special Region of
Yogyakarta, North Maluku, and Riau Islands (1.5% of the population) and the lowest is
in Papua Province (1.3%). The prevalence of tumor/cancer was higher in women (0.8
%) than in men (0.2 %).
According to Edianto (2011) more than 90% of the causes of cervical cancer (KLR)
are Human Papilloma Virus (HPV) which is transmitted through sexual intercourse. In
addition to HPV, several risk factors for cervical cancer (KLR) include; (1) The incidence
is higher in those who are married than those who are not married, (2) women whose
first coitus (Coitarche) is experienced at a very young age (<16 years), (3) Incidence
increases with high parity, especially if the delivery distance is too long. close, (4) they
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are from low socioeconomic groups (poor sexual hygiene), (5) sexual activity that has
multiple partners (promiscuity), (6) often found in women who experience HPV
infection (Human Papilloma Virus)- type 16 or 18, and (7) often in women who have a
smoking habit.
Currently, several methods of early detection of cervical cancer are known, namely,
pap smear test, IVA, enlargement of IVA with gynecology, colkoscopy, cervicography,
thin prep and HPV test. However, in accordance with conditions in developing countries
including Indonesia, using the IVA method, because the technique is easy and simple, the
cost is low, the sensitivity is high, fast and accurate enough to find abnormalities at the
stage of cell abnormalities (dysplasia) or before pre-cancer. However, the lack of
awareness of women of childbearing age to perform early detection of cervical cancer
makes this IVA examination less desirable.
IVA examination is an examination by a doctor / midwife or paramedic, on the
cervix which is given 3-5% acetic acid by inspection with the naked eye. Precancerous
lesions of uterine ectocervical tissue smeared with acetic acid (vinegar acid) will turn
white (acetowhite). However, if a macroscopic lesion is found that is suspected to be
cancer, the application of acetic acid is not done and the patient is immediately referred
to a more complete facility (Sulistiowati, 2014).
There are still many women who have not done early detection of cervical cancer
for various reasons. According to Wahyuni's research (2013), the influence of
knowledge factors (p value: 0.000 and OR: 0.265), attitudes (p value: 0.000 and OR:
2.191), husband's support (p value: 0.000 and OR: 3.050) and peer support towards
early detection behavior of cervical cancer in Ngampel District, Kendal Regency, Central
Java. Meanwhile, the factors of age, education, economy, and affordability showed no
effect on early detection behavior carried out by WUS.
Data obtained from the South Sulawesi Provincial Health Office (2018) The
number of women of childbearing age is 415,175 people. There were 10,986 people who
did cervical cancer screening. Positive IVA 370 people and 10 people affected by cervical
cancer. In January - March 2019 there were 3,341 people who did cervical cancer
screening examinations, Positive IVA 95 people. (South Sulawesi Provincial Health
Office, 2018).
Bulukumba City Health Office, in Get the number of women of childbearing age
16,485. There were 1,639 people who did cervical cancer screening. Positive IVA 47
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people and 6 people affected by cervical cancer. In January - March 2019, there were
423 people who did cervical cancer screening examinations, and none of them had a
positive IVA. (Bulkumba City Health Office).
Borongrappoa Health Center is one of the health centers that has a fairly wide
working area, which is located in the city of Bulukumba. The data obtained, in 2018 who
conducted cervical cancer screening examinations as many as 170 people and 1 person
detected cervical cancer from the total number of women of childbearing age (WUS),
which was 3886 people, which means only 4.3% of the total WUS in the working area of
the Puskesmas. Borongrappoa, this shows that the participation rate of WUS to perform
Screening with the IVA method is very low.
METHODS
This type of research is quantitative research with a cross sectional study
approach. The sampling technique used was purposive sampling, with criteria for
inclusion and exclusion. The sample consisted of 118 case groups and 118 control
groups.Data analysis using chi square
RESULTS
Based on table 1, the largest age group is the age group >25 years, namely 66
respondents (55.9%) while the age group <25 years is 52 respondents (44.1%). Based
on marital history, most of the marital history is not at risk, namely 95 respondents
(80.5%) while respondents who are at risk are 23 respondents (19.5%).
Table 1. Distribution of Respondents by Age Group and Marriage History in Women of
Childbearing Age in the Borongrappo Health Center Area
Characteristic Frequency (F) Percentage (%)
Age
< 25 years old 52 44.1
˃25 years old 66 55.9
marriage history
No risk 95 80.5
Risky 23 19.5
Total 118 100
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Table 2. Distribution of Respondents' Answers About Knowledge of Women of
Childbearing Age in the Borongrappo Health Center Area
Yes no ρ Value
No Question
n % n %
Have you ever heard of or done cervical
1 44 37,3 74 62,7
cancer screening?
Pap Smear, IVA and HPV test is an early
2 37 31,4 81 68,6
examination of cervical cancer. 0.000
Those who can screen for cervical cancer (ρ <
3 are all sexually active women for 3 years 52 44,1 66 55,9 from
except menopause the
Cervical cancer screening is carried out value
4 38 32,2 80 67,8 of =
every year
Cervical cancer screening can treat cervical 0.05)
5 53 44,9 65 55,1
cancer
Cervical cancer screening function detects
6 39 24,6 89 75,4
cervical cancer early
Cervical cancer screening can be done in
7 68 57,6 50 42,4
hospitals and health centers
One of the conditions for screening is, 24
8 hours before taking the test it is forbidden 53 44,9 65 55,1
to have sexual intercourse
Cervical cancer is cancer that attacks the
9 57 48,3 61 51,7
neck/mouth of the womb
10 cervical cancer can be cured 52 44,1 66 55,9
Table 3. Distribution of Respondents' Answers About Motivation in Women of
Childbearing Age in the Borongrappo Health Center Area, Bulukumba City
Yes no
No Question ρ
n % n %
Value
Mother feels the need to do cervical cancer 51 43,2 67 56,8
1 screening, because she doesn't want to get
cervical cancer
Cervical Cancer Screening Examination needs to 57 48,3 61 51,7
2
be done even at your own expense
3 Cervical Cancer Screening is done at will 48 40,7 70 59,3 0.000
Mothers get a lot of information about the 51 43,2 67 56,8 (ρ <
4 importance of screening for cervical cancer so from
that mothers are interested in getting tested the
Mother did Cervical Cancer Screening because 36 30,5 82 69,5 value
5 of =
of the urge to be a healthy husband's companion
Mothers go for an examination because of the 55 46,6 63 53,4 0.05)
6
urge to detect uterine cancer early on
Every 6 months, Mother will do KLR after the 53 44,9 65 55,1
7
age of 40 years
If the vaginal discharge, the mother will 57 48,3 61 51,7
8
immediately screen
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DISCUSSION
Relationship of Marriage History to Cervical Carcinoma Screening with IVA Method
Based on the table, it is known that of the 16 respondents who had screened for
cervical carcinoma using the IVA method, 56.2% were the risk group, while only 43.8%
were the non-risk group. Meanwhile, of the 102 respondents who had never screened
for cervical carcinoma using the IVA method, 13.7% were at risk and 86.3% were not at
risk.
Based on the results of the chi square, the value of = 0.000 (ρ < from the value of =
0.05). This means that there is a relationship between marital history and cervical
carcinoma screening using the IVA method at the Borongrappoa Health Center.In this
study, of the 16 respondents who had screened, 9 of them were those whose marriage
history had been married more than once or were included in the risk group category.
Referred to as a risk group because women with high sexual activity, and often change
partners. Changing partners will allow the transmission of venereal diseases, one of
which is the Human Papilloma Virus (HPV). This virus will change the cells on the
surface of the mucosa to divide into more and uncontrollably so that it becomes cancer.
the rest there are 7 respondents who have been screened but are not included in the risk
category, namely those who have been married no more than once.
Awareness of groups at risk for screening, triggered by the awareness of these
groups that they are more likely to get cervical cancer, after receiving attention from
related health workers, and those who are not included in the category of risk groups
but do screening, based on good motivation and knowledge of cervical cancer.
This study is not in line with Yuliwati's research (2012), regarding factors related to
WUS behavior in early detection of cervical cancer using the IVA method in the Prembun
Health Center area in 2012, with a p-value of 0.649.
The Relationship of Knowledge to Cervical Carcinoma Screening with the IVA Metode
Method
Based on the table, it is known that of the 16 respondents who had performed
cervical carcinoma screening using the IVA method, 93.8% had good knowledge, while
only 6.2% had poor knowledge. Meanwhile, of the 102 respondents who had never
screened for cervical carcinoma using the IVA method, 27.5% had good knowledge and
72.5% had poor knowledge.
Based on the results of the chi square, the value of = 0.000 (ρ < from the value of =
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0.05). This means that there is a relationship between knowledge of cervical carcinoma
screening using the IVA method at the Borongrappoa Health Center.In this study, where
WUS who had carried out early detection of cervical cancer were more WUS who had
good knowledge as many as 15 people. The rest there is 1 person who has poor
knowledge, this can happen because there are other factors outside of knowledge that
can encourage someone to do screening, such as family support, an invitation from a
friend, or being motivated by seeing other people doing screening. While WUS who have
never done early detection of cervical cancer are still many WUS who have less
knowledge, namely as many as 74 people. This can lead to low IVA visits. In addition,
based on the results of research where WUS who have good knowledge are as many as
28, but do not want to do it because it is influenced by other factors such as socio-
cultural or family support, thus influencing respondents' decisions in early detection of
cervical cancer. To address this, it is better to do more health education or promotion by
health workers or local government regarding the importance of early detection of
cervical cancer.
The lack of public knowledge and awareness of health and disease can result in
diseases that occur in the community which are often difficult to detect. Even people find
it difficult or unwilling to be examined. This will cause people to not get proper health
services.
This is in line with Indah Kurniawati's research (2015), on the effect of knowledge,
motivation and husband's support on IVA examination behavior in the group of women
of childbearing age at the Kedungrejo Health Center. . The results of this study are
relevant to Desi's research (2016) at the Padang Pasir Public Health Center that there is
a significant relationship between knowledge and WUS action in early detection of
cervical cancer using the IVA method. The results of this study are also in line with
research conducted by Sri (2012) in Ngampel District, Kendal Regency, Central Java,
showing that knowledge has a significant relationship with early detection behavior of
cervical cancer.
The Relationship of Motivation to Cervical Carcinoma Screening with the IVA . Method
Based on the table, it is known that of the 16 respondents who had performed
cervical carcinoma screening using the IVA method, 87.5% had good motivation, while
only 17.5% had poor motivation. Meanwhile, out of 102 respondents who had never
done cervical carcinoma screening using the IVA method, 35.5% had good motivation
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and 64.5% had poor motivation.
In this study, there were 14 respondents who had good motivation and had been
screened, but there were 2 respondents who had good motivation but did not do
screening. This is because women who have good motivation for health values do not
always manifest in real situations (behavior), because Good motivation will be followed
by behavior that refers to other people's experiences or is based on a person's many or
little experiences, such as fear of trying or bad experiences from other people who have
done it.
Meanwhile, motivation is not good for cervical cancer early detection, related to
their low knowledge and not knowing the purpose and benefits of IVA examinationThis
research is in line with research conducted by Suarniti,
CONCLUSIONS
Marital status has a relationship with Cervical Carcinoma Screening With the IVA
Method at the Borongrappoa Health Center, Bulukumba Citywith a p_value of 0.00 less
than 0.05, meaning there is a relationship. Knowledge has a relationship with Cervical
Carcinoma Screening With the IVA Method at the Borongrappoa Health Center,
Bulukumba City with a p_value of 0.00 less than 0.05, meaning there is a relationship.
Motivation has a relationship with Cervical Carcinoma Screening With the IVA Method at
the Borongrappoa Health Center, Bulukumba City.
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