Journal of Clinical Oncology Reports

Abstract

Background: Developed nations have well-structured health systems where cervical cancer (CC) screening is routine, accompanied by effective treatment and follow-up for positive cases. In contrast, many developing countries, particularly in sub-Saharan Africa, lack specialized health infrastructure, treatment options, equipment, and qualified healthcare professionals. Screening initiatives are often limited in scope and lack sustained follow-up. As a result, approximately 90% of CC cases in these regions are diagnosed at advanced stages, exacerbated by socioeconomic challenges.

Aim: This study aims to explore the socioeconomic and cultural factors contributing to cervical cancer risk among women in Doukoula, Far North Region of Cameroon.

Method: A community-based cross-sectional study was conducted from November 3-9, 2021, among women aged 16 to 80 years in Doukoula and surrounding areas. Data collection involved face-to-face interviews using a structured questionnaire with 26 questions covering respondent identification, demographics, and cervical cancer screening (CCS) information. Data were entered into a Microsoft Office Excel spreadsheet, checked for consistency, and analyzed using CDC Epi Info version 7.2.5.0. Associations between respondent characteristics and CCS uptake were assessed using the Pearson Chi-square (χ²) test (significance level: 0.05).

Results: Socioeconomic and cultural factors, including area of residence, age at first sexual activity, number of sexual partners, lack of information, education level, poverty, illiteracy, poor communication, cultural beliefs, and awareness gaps, were identified as barriers to effective cervical cancer prevention and control.

Conclusion: This study highlights the complex socioeconomic and cultural vulnerabilities contributing to cervical cancer risk among women in Doukoula. Addressing these factors is crucial for improving prevention, early detection, and treatment outcomes.

Background

The economic downturn in Cameroon from the mid-1980s to early 2000s, known as the "Cameroon Economic Crisis," was officially acknowledged by the government in 1987[1,2]. In response to this crisis, the World Bank and International Monetary Fund (IMF) initiated the Heavily Indebted Poor Countries (HIPC) Initiative in 1996 to alleviate unsustainable debt burdens.

Cameroon qualified for the Enhanced Heavily Indebted Poor Countries (HIPC) Initiative in May 2006 [ 3,4]. The Far North Region, which has long suffered from structural underdevelopment and recurrent natural disasters such as floods and prolonged droughts, records some of the highest poverty rates in the country. Between 2007 and 2014, the number of impoverished individuals in Cameroon rose by 12%, reaching 8.1 million, largely due to inadequate poverty reduction efforts compared to population growth rates [ 2,5].

The Far North Region, the most populous and northernmost region of Cameroon [5,6]. The extreme north was already the poorest area in the country before the outbreak of civil unrest caused by Boko Haram, with 74% of its population living below the poverty line [ 7,8,9]. The conflict with Boko Haram has further exacerbated the region's economic instability [5,10].

Despite an approximate 4% growth in Cameroon’s GDP in real terms over the past five years, progress in poverty reduction remains insufficient [ 11]. Access to basic services, such as water, affects half of the population, and these socioeconomic conditions directly impact public health, including access to clean water, sanitation, and hygiene [12].

Climate and Hydrology

The Far North Region of Cameroon is characterized by a sudano-sahelian climate, with high temperatures averaging a daily maximum of 36 degrees Celsius. These temperatures peak between January and April, occasionally reaching as high as 46 °C. The rainy season extends from July to October, during which the region receives precipitation for 25 to 30 days annually. Rivers experience low flow during the dry season (October to April) and significant flow during the wet season (May to September). Many streams dry up completely or nearly so during the hottest months of the dry season due to the Sahelian environment [ 13,14].

Access to potable water in rural areas remains a critical challenge. Despite an average annual GDP growth rate of 4%, over two-thirds of the local population lack access to essential social amenities, including safe drinking water [15]. During the dry season, water quality often deteriorates, leading both humans and animals to rely on the same contaminated sources [16]. This has contributed to cholera outbreaks in the Far North, resulting in more deaths than in any other region over the past decade [ 17].

Research on water quality has revealed significant contamination, with fecal pollution detected in 81.2% of samples from ruminants and 21.7% from human sources [18]. While urban areas in Cameroon saw a slight increase in access to improved sanitation sources—from 82% to 85%—between 1990 and 2015, rural areas have experienced no such improvement [19]. Additionally, conflicts over water resources between nomadic herders and sedentary farmers occasionally escalate into violence [ 20].

Electricity

Access to electricity is crucial for economic development and enhancing living standards. However, the situation remains dire, with 87.5% of rural residents and 18.5% of urban residents nationwide lacking access to electricity. In northern Cameroon, these figures are even more alarming compared to the national average [21]. Frequent power outages are a common occurrence across the country, impacting major cities such as Douala and Yaoundé as well [22].

Housing and Roads

The region's housing predominantly features small, circular dwellings alongside adjacent structures. Flooding frequently occurs during the brief wet seasons, worsened by the area's generally flat terrain and clay soils [23]. Rainwater runoff exacerbates the deterioration of already poor roads and tracks [24, 25]. Flooding results in both human and material losses, significantly hindering access to healthcare and other essential services [26, 27].

Healthcare

The healthcare system in the Far North Region has been severely impacted by both economic decline and the insecurity stemming from Boko Haram's activities. Key challenges include limited access to healthcare facilities and shortages of essential supplies, such as laboratory equipment, cold chain power, and qualified personnel [28, 29]. The ongoing conflict has further compounded economic difficulties, impeding advancements in education, healthcare, and social security [29].

Education

Education is a well-established factor in preventing cervical cancer (CC) [30]. Structural adjustment plans in the 1990s had significant impacts on the social sectors of sub-Saharan economies [ 31 ,32]. In our study, the percentage of participants who had never attended secondary school education was statistically significant. Education plays a crucial role in knowledge acquisition [30]. In the Extreme North region of Cameroon, many elementary schools lack proper buildings, forcing students to attend classes under trees. They sit on the ground or on stones, exposed to harsh weather conditions that are not conducive to learning. The intense heat, heavy rain, and even the threat of reptiles can create an uncomfortable and unsafe environment. These challenging circumstances can significantly undermine students' motivation to attend school. [33]

 Formal schooling increases awareness; however, nearly 25% of participants in our study had never attended formal schooling (NFE), and 47% had only completed elementary school. Combined, 72% had either NFE or elementary school education. Secondary school graduates constituted 21.11%, and postsecondary graduates were 7.17%.

Low-income and educated women are more likely to lack awareness of cervical cancer and its preventive measures, potentially leading to inadequate screening and gynecological follow-up [34,35,36]. It was found that women with secondary and post-secondary education were more likely to undergo screening compared to those with primary education or less. This could be attributed to higher levels of empowerment and health knowledge among more educated women [37,38,39]. Low income and education levels are associated with lower awareness of cervical cancer and its preventive measures, which may contribute to insufficient screening and follow-up [30].

Number of Sexual Partners

Having multiple sexual partners is a statistically significant risk factor for cervical cancer (p < 0.45) in this study, despite 69.2% of participants being monogamously married. Multiple sexual relationships with different partners are universally recognized as a risk factor for cervical cancer. Lifetime sexual partners increase the risk of HPV infection. The likelihood of contracting HPV and having multiple sexual partners both increase with exposure [40].

Occupation

Out of the studied population, 187 (81.3%) were unemployed and engaged in subsistence farming amid harsh climatic conditions. Regarding participants' occupations, the majority were housewives (78, 39.4%) and farmers (73, 36.9%). Several studies consistently associate low socioeconomic status, defined by education, income, and occupation, with cervical cancer [41, 42]. Additionally, uneducated, unemployed, or underemployed women often depend economically on their husbands, which can lead to households living below the poverty line. In such circumstances, women's ability to prioritize their health is severely compromised. Socioeconomic and cultural factors intersect in influencing women's health-seeking behaviors. In impoverished nations, particularly in Africa, women may resort to traditional healing methods or faith-based healing before seeking medical attention. Routine examinations and visits to medical facilities are uncommon [43, 44].

Culture

While not statistically significant, 53% of women in this research had given birth to four or more children. In the Far North, where 57% of the population lives below the poverty line according to many authors’ assessment, a woman's cervix becomes more susceptible to HPV with each birth [45]. The number of births, or parity, has been linked to increased cervical cancer risk among women infected with HPV. Meta-analyses have shown that women with higher parity have significantly greater odds of developing cervical cancer [45, 46]. The risk increases with the number of children a woman has borne.

Materials And Methods

Study Design, Setting, Sampling, and Ethics

A community-based cross-sectional study was conducted from November 3rd to November 9th, 2021, among women of reproductive age selected from Doukoula and its environs. The population of Doukoula is approximately 26,624 (2022) [11]. Women aged 16 to 80 years were enrolled in the study by peer educators who explained the questionnaires to the respondents. Questionnaires were then administered to those who provided consent to participate in the study.

This study was conducted in accordance with the Helsinki Declaration [12] and was approved by the Institutional Review Board (IRB) of the Atlantic Medical Foundation Hospital Mutengebe. All participants signed an informed consent form prior to being interviewed. They were informed that the data collected would be used solely for research purposes and that their individual responses would remain confidential.

Study Population and Target Sample Size

The study population consisted of women of reproductive age who were conveniently sampled. The inclusion criteria were being a woman, aged 16 years or older, and providing consent to participate in the study. The exclusion criteria included those who refused to grant consent and those who were menstruating.

In the absence of similar studies in the area, a minimum sample size of 182 was calculated using CDC Epi Info 7.2.5.0 (Centers for Disease Control, Georgia, USA) StatCalc with the following parameters: an estimated district population size of 42,963 in 2023[11,13], an estimated proportion of women with knowledge of cervical cancer in Cameroon of 13.8% [14], a design effect of 1.0, an accepted error margin of 5%, and one district. Considering potential non-responses, the sample size was adjusted by 10% (19 respondents), resulting in a final sample size of 201.

Definition of Concepts and Study Variables

Dependent and Independent Variables:

To conduct this study, the following independent/demographic variables were collected: age, age at first sexual intercourse, religion, occupation, marital status, and educational status.

Response/Outcome Variables:

The study aimed to determine the socio-economic factors influencing cervical cancer screening (CCS) among women in the study area. The primary outcome was CCS uptake, assessed based on responses to three questions in the questionnaire (Table 1).

Table 1: Questions Regarding CCS and Coding Scheme

CC: Cervical cancer

The potential responses to the three questions were combined and graded on a two-point scale [16,17].

Data Collection and Analysis

Data were collected using well-structured questionnaires in face-to-face interviews. The questionnaire, consisting of 26 questions, aimed to gather information on respondents’ identification, demographic characteristics, and details about CCS.

Demographic variables such as age groups, marital status, religion, education, and occupation were summarized as counts and percentages. Age, age at first sexual intercourse, parity, and gravida scores were expressed as ranges and means. Data were entered into a Microsoft Office Excel spreadsheet, double-checked for consistency, and then exported to and analyzed using CDC Epi Info version 7.2.5.0 (Centers for Disease Control, Georgia, USA). Associations between respondents’ characteristics and CCS uptake were evaluated using the Pearson Chi-square (χ²) test. The significance level was set at 0.05.

Results

Characteristics of Study Population

A total of 306 respondents were initially contacted, with 250 (81.7%) successfully participating in the study. The general characteristics of the participants are outlined in Table 2

These characteristics highlight the demographic and socioeconomic profile of the study population, providing essential context for interpreting the results and implications of the research.

Table 2: Socio-demographic Characteristics of Study Participants (n = 250)

#; number, %; proportion of respondents, 95% C.I; 95% Confidence interval, ATR; African Traditional Religion, SD; Standard Deviation

• The age range of respondents was from 16 to 80 years, with a mean (± SD) age of 37.36 ± 13.14 years.
• The largest group of participants fell within the 21–30 age range, accounting for 35.6% (95% CI: 29.7–41.9) of the respondents.
• The next largest group was the 31–40 age range, comprising 24% (95% CI: 18.8–29.8) of the participants.
• The least represented age group consisted of individuals aged 20 years or younger.
• The mean (± SD) gravida and parity of study participants were 4.86 ± 3.22 and 4.20 ± 2.95, respectively.
•  More than two-thirds of the respondents (69.2%, 95% CI: 63.1–74.9) were married.
•  Approximately four-fifths (81.3%, 95% CI: 75.7–86.1) were unemployed.
•  Only about one in ten (10.5%, 95% CI: 6.1–16.5) practiced African Traditional Religion.
•  Only about one in 20 participants (5.5%, 95% CI: 2.5–10.1) reported having multiple sexual partners.
•  More than four-fifths (86.9%, 95% CI: 81.3–91.3%) of individuals reported engaging in their first sexual experience before the age of 20. The confidence interval for this parameter is narrow, indicating minimal variability in the estimate. This suggests that the sample data is highly reliable. Consequently, it can be inferred that between 81.3% and 91.3% of women engage in sexual activities before the age of 20.       
•  24.8% of the study population had no formal education (NFE).
• Additionally, 46.8% had only primary or basic education. Combined, this means that 71.6% of the respondents had either no formal education or only elementary-level education.

 Approximately four-fifths (81.3%, 95% CI: 75.7–86.1) of the respondents were unemployed. The 95% confidence interval (CI: 75.7–86.1) for unemployment in the study population indicates that we can be 95% confident that the true unemployment rate within this population falls within this range.

Chart 1: Level Of Education

Socio-Economic Determinants of Cervical Cancer Screening Uptake

Table 3: History of Prior CCS, HPV Vaccine Uptake, HIV Status, and Genital Warts

The uptake of cervical cancer screening (CCS) among the study population was found to be low. Less than two percent of respondents reported ever having undergone cervical cancer screening. Specifically, only four respondents (1.8%, 95% CI: 0.5–4.6) indicated that they had been screened previously. Detailed findings are presented in Table 3 and Chart 2.

Chart 2: History of Prior CCS, HPV Vaccine Uptake, HIV Status, and Genital Warts

Approximately two-thirds of the respondents (161 individuals, 64.4%, 95% CI: 58.1–70.3) exhibited a poor overall uptake of cervical cancer screening (CCS). Bivariate analysis revealed that CCS uptake was significantly associated with the respondent's locality, age at first sexual encounter, and the number of sex partners (see Table 4).

Approximately two-thirds of the respondents (161 individuals, 64.4%, 95% CI: 58.1–70.3) demonstrated a poor overall uptake of cervical cancer screening (CCS). Bivariate analysis indicated that CCS uptake was significantly associated with the respondent's locality, age at first sexual encounter, and the number of sex partners (see Table 4).

These findings underscore the presence of significant socio-economic barriers to cervical cancer screening within the studied population. A more detailed exploration of the factors contributing to this poor uptake is essential for developing effective interventions.

Table 4: Association between Socio-Economic Characteristics and Probable Uptake of CCS
Dependent Variable: Uptake of CCS (n = 89)

Bolded p-values indicate statistical significance. χ²: Pearson Chi-Square, DV: Dependent Variable.

Analysis

1. Age Groups (Years):

There is no significant association between age groups and uptake of CCS (p = 0.528, χ² = 3.177).

2. Locality:

A significant association exists between locality and uptake of CCS (p = 0.016, χ² = 5.766).
Individuals from Doukoula are less likely to have a good uptake of CCS compared to those from outside Doukoula.

3. Occupation:

No significant association between occupation and uptake of CCS (p = 0.899, χ² = 0.016).

4. Marital Status:

No significant association between marital status and uptake of CCS (p = 0.686, χ² = 0.752).

5. Age of First Sex:

There is a significant association between age of first sex and uptake of CCS (p = 0.025, χ² = 7.364).
Those who had their first sexual encounter at a younger age (< 20 years) have a higher likelihood of poor uptake compared to those who started later.

6. Number of Sex Partners:

A significant association exists between the number of sex partners and uptake of CCS (p = 0.045, χ² = 4.004).
Individuals with more than one sex partner are more likely to have a good uptake of CCS compared to those with 0-1 partners.

7. Number of Pregnancies:

No significant association between the number of pregnancies and uptake of CCS (p = 0.629, χ² = 0.233).

8. Number of Deliveries:

No significant association between the number of deliveries and uptake of CCS (p = 0.498, χ² = 0.459).

9. Education:

A significant association exists between education level and uptake of CCS (p = 0.0004, χ² = 18.156).
Higher education levels (tertiary) are associated with better uptake of CCS compared to lower levels (NFE, primary, secondary).

In summary

Significant Factors Influencing CCS Uptake are: Locality, age of first sex, number of sex partners, and education.

Non-Significant Factors are: Age groups, occupation, marital status, number of pregnancies, and number of deliveries.

This analysis highlights the importance of education, locality, sexual history, and number of sex partners in influencing the uptake of CCS. Interventions aimed at improving CCS uptake may benefit from focusing on these significant factors.

Based on this classification:

• Highly Significant: Education (p = 0.0004)
• Significant: Locality (p = 0.016), Age of first sex (p = 0.025), Number of sex partners (p = 0.045)
• Not Significant: All other variablesTop of Form

Discussion

In this study, the uptake of cervical cancer screening (CCS) is the dependent variable, while the other variables are independent. We aimed to investigate the relationship between the independent variables and the dependent variable.

A low p-value (p ≤ 0.05) suggests that the relationship is significant, indicating that the variables are not independent. This means that the observed results are unlikely to have occurred by chance, providing evidence of a real effect or relationship within the data

In terms of importance, education had the smallest p-value, indicating a highly significant result: Education (p = 0.0004)

In the extreme north of Cameroon, where a significant portion of the population lives below the poverty line and many lack formal education, the interplay between low educational attainment and cervical cancer screening can have profound negative effects.

Women with a strong educational background tend to have increased awareness of health issues, including cervical cancer and the importance of screening. They recognize the benefits of early detection and preventive measures, resulting in higher participation rates in screening programs. This group of women is health literate, which is essential for understanding medical information. Their access to the healthcare system is generally better than that of those with less education, enabling them to adopt preventive attitudes by engaging in regular health check-ups. Education is a significant determinant of employment and income, empowering these women to make informed decisions about their health due to their financial independence. Our findings indicate that 72% of women have only attained an elementary education, highlighting that education remains a barrier to effective cervical cancer prevention. These results align with the findings of several other authors [47, 48, 49].

Our study contrasts with the consensus of many authors who suggest that cervical cancer screening uptake is higher in urban areas compared to rural areas for various reasons [50, 51]. However, our findings indicate that rural communities showed statistically significant uptake of cervical cancer screening. This can be attributed to the mobilization of supportive local leadership, including local leaders such as chiefs, quarter heads, pastors, imams, resource persons, town criers, and medical personnel. Additionally, the availability of affordable care, including free screening and treatment aimed at low-income populations, can lead to higher participation rates despite the overall poverty in these areas [52, 53].

Our study highlights the statistically significant relationship between age at first sexual activity and uptake of CCS. This finding aligns with the results of several other authors.

Interconnected factors may explain this significance, including targeted community outreach that raises awareness of cervical cancer and screening, even in low-education settings. Community leaders are crucial in shaping health-seeking behaviors. Younger individuals often have strong social networks that prioritize health discussions. Women who engage in sexual activity earlier may face different social pressures regarding healthcare. Well-designed outreach programs can effectively convey the importance of screenings, while access to free or low-cost services may encourage their use, particularly in preventive health campaigns. Informal channels like community conversations and media also play a role in helping those who start sexual activity early seek vital health information. [54,55].

The number of sexual partners is statistically significant regarding cervical cancer screening uptake, a consensus among all authors, including ourselves. This relationship can be understood through various interconnected dimensions within Doukoula's challenging socioeconomic context. The link between the number of sexual partners and cervical cancer screening reflects a complex interplay of social, cultural, and health factors. Individuals with multiple partners often discuss health topics, which can encourage them to seek screenings. Those with multiple partners may perceive a higher risk for STIs and cervical cancer, driving them to pursue preventive measures. Despite low formal education, many receive health information through informal channels like community gatherings, making them more informed about the importance of screenings. Additionally, sexually active individuals often have more interactions with healthcare providers. If screening services are accessible and low-cost, they are more likely to utilize them. Local leaders advocating for health screenings can also motivate those with multiple partners to participate in screening initiatives [56,57].

While our study primarily examines the socioeconomic challenges affecting cervical cancer screening uptake, it also uncovers several potential risk factors for cervical cancer that merit attention. Notably, 81.3% of participants were unemployed, a significant risk factor that limits financial autonomy and access to preventive care. This unemployment often results in delayed screenings and vaccinations.

Economic stress can foster unhealthy behaviors and negatively impact immune function, thereby increasing vulnerability to HPV infections. Additionally, lower levels of education and health literacy may reduce awareness of cervical cancer risks, while economic instability exacerbates social issues that contribute to health disparities. These findings resonate with the research conducted by Neh Fru and Tassang Andrew [58,59,60].

In our study, 53.3% of respondents were multiparous, a factor closely associated with an increased risk of cervical cancer for several reasons. Repeated pregnancies can lead to hormonal fluctuations and elevated estrogen levels, which may encourage the development of HPV-related lesions. Furthermore, pregnancy can alter the immune system, making it more challenging to clear HPV infections. Women with higher parity often experience reduced access to preventive healthcare services, such as Pap smears, particularly in low-resource settings. Multiparity is frequently linked to lower socioeconomic status and education, which can further heighten cervical cancer risk due to limited healthcare access. This observation is consistent with the findings of C. Neh Fru and Tassang Andrew [58,61,62].

Additionally, 85.1% of respondents reported having sexual contact before the age of 20. Early sexual exposure significantly increases the risk of cervical cancer, often leading to a greater number of sexual partners and, consequently, a higher likelihood of acquiring HPV. The cervix of younger women is particularly vulnerable to HPV infection and subsequent oncogenic changes. Initiating sexual activity at a young age also prolongs the period of risk for HPV-related progression to cervical cancer, especially in the absence of regular screenings. This risk is exacerbated by socioeconomic factors, including lower education levels and limited access to healthcare, which can impede preventive measures. These findings align with prior research conducted by these same authors [63,64,65].

Conclusion

The situation in Doukoula , in the extreme north region of Cameroon, underscores the crutial intersection of socioeconomic factors and health outcomes, particularly in relation to cervical cancer screening.

This study underscores the significant socio-economic barriers to cervical cancer screening (CCS) among women in Doukoula, extreme north of Cameroon. Key findings indicate that education plays a pivotal role in raising awareness and promoting health-seeking behavior. Additionally, factors such as locality, age at first sexual activity, and the number of sexual partners are significantly associated with CCS uptake.

In the extreme north of Cameroon, where 74% live in poverty, low education levels and inadequate healthcare access hinder effective screening efforts. Environmental challenges like flooding and water contamination further worsen health outcomes, contributing to disease outbreaks that restrict care access. Additionally, risk factors such as unemployment, early sexual contact (before age 20), and multiparity were identified as significant contributors to cervical cancer risk.

Recommendations

The government of Cameroon should address the challenges faced by the poor communities in the extreme north region in general, and Doukoula in particular, regarding health and socioeconomic development by implementing the following:

1. Enhance Healthcare Access:

It is essential to establish more health facilities in rural areas to reduce travel distances for residents. Additionally, implementing mobile health clinics can effectively reach remote populations, providing essential services such as cervical cancer screening and vaccinations.

2. Increase Health Education:

Launching community awareness campaigns about the importance of cervical cancer screening and reproductive health is crucial. Collaborating with local leaders and educators to facilitate workshops and seminars will further promote health literacy in the community.

3. Improve Educational Opportunities:

Investing in the construction and staffing of schools, particularly for secondary and vocational education, is vital for improving literacy and skill levels. Furthermore, providing scholarships and financial incentives for girls will help address gender disparities and encourage them to continue their education.

4. Support Economic Development:

Promoting small-scale agriculture and local entrepreneurship through microloans and training programs can stimulate economic growth. Additionally, facilitating access to markets for local products will enhance income opportunities for residents.

5. Develop Infrastructure:

Improving transportation networks to interconnect localities in the extreme north region with larger urban centers is important for enhancing access to services and job opportunities. Investing in clean water and sanitation facilities will also contribute to better overall public health and quality of life.

6. Encourage Community Engagement:

Involving local communities in decision-making processes related to health and development initiatives is essential for ensuring that programs meet their needs. Establishing community health committees can help oversee health programs and ensure their effectiveness.

7. Increase Funding for Health Initiatives:

Allocating more budgetary resources for preventive health measures, including cancer screening programs and HPV vaccination campaigns, is critical. Seeking partnerships with NGOs and international organizations can provide additional funding and support for these health initiatives.

8. Monitor and Evaluate Programs:

Implementing regular assessments of health and education programs will help determine their effectiveness and allow for necessary adjustments. Utilizing data-driven approaches will inform policy decisions and prioritize interventions based on community needs.

9. Empowering Women Through Comprehensive Programs

Empowering women requires the creation of effective programs that address various aspects of their lives. Key areas of focus include:

a. Education and Training:

Access to quality education at all levels, including vocational training and adult education programs, is essential for women’s empowerment. Additionally, creating scholarship opportunities specifically for girls and women can significantly encourage their educational attainment.

b. Healthcare Access:

Improving access to healthcare services, including reproductive health and family planning, is crucial for empowering women. Implementing health education programs that inform women about their rights and the available services can further enhance their health and well-being.

c. Economic Opportunities:

Supporting women’s entrepreneurship through microloans, grants, and training in business skills fosters economic independence. Promoting access to markets for women’s products and services is vital for helping them achieve financial self-sufficiency.

d. Legal Rights and Protection:

Advocating for legal reforms that protect women’s rights and promote gender equality is essential. Providing resources and support to help women understand and exercise their legal rights empowers them to advocate for themselves.

e. Leadership and Participation:

Encouraging women to take leadership roles in their communities and participate in decision-making processes is important for fostering inclusive governance. Offering training programs in leadership, public speaking, and advocacy skills can prepare women for these roles.

f. Community Support and Networks:

Fostering community groups and networks that support women’s initiatives provides a valuable platform for sharing experiences and resources. Establishing mentorship programs that connect younger women with successful role models can inspire and guide the next generation.

g. Awareness and Advocacy:

Conducting awareness campaigns to challenge stereotypes and promote gender equality is vital for changing societal attitudes. Engaging men and boys in discussions about gender roles and the importance of women’s empowerment is also crucial for creating a supportive environment.

h. Access to Technology:

Providing training in digital literacy and ensuring access to technology will help women engage in the digital economy. Utilizing technology to disseminate information and resources can further empower women in various aspects of their lives.

i. Support Services:

Establishing safe spaces where women can access counseling, legal aid, and support services is essential for their well-being. Creating programs that address gender-based violence and provide resources for survivors can help mitigate its impact on women.

j. Monitoring and Evaluation:

Implementing systems to assess the effectiveness of empowerment programs allows for adjustments based on feedback. Using data to inform policy decisions ensures that women’s needs are prioritized in program planning and implementation.

Acknowledgments

The authors wish to express their gratitude to Mr. Bayola Boniface for facilitating the logistics of this study, which was self-funded. We also extend our appreciation to the medical team at Khar-Hai District Hospital for their invaluable assistance during the screening exercise

References

1. World Bank. "Cameroon Overview." Accessed September 1, 2024. https://www.worldbank.org/en/country/cameroon/overview#:~:text=Because%20its%20poverty%20reduction%20rate,56%20%25%20of%20the%20poor%20live.
   View at Publisher | View at Google Scholar
2. ReliefWeb. "Cameroon: Humanitarian Needs Overview 2023." March 2023. Accessed September 1, 2024. https://reliefweb.int/report/cameroon/cameroon-humanitarian-needs-overview-2023-march-2023#:~:text=An%20estimated%2037.5%20per%20cent,per%20cent%20in%20some%20regions.
   View at Publisher | View at Google Scholar
3. World Bank. "Cameroon Overview." Accessed September 1, 2024. https://www.worldbank.org/en/country/cameroon/overview#:~:text=Because%20its%20poverty%20reduction%20rate,56%20%25%20of%20the%20poor%20live.
   View at Publisher | View at Google Scholar
4. ReliefWeb. "Cameroon: Humanitarian Needs Overview 2023." March 2023. Accessed September 1, 2024. https://reliefweb.int/report/cameroon/cameroon-humanitarian-needs-overview-2023-march-2023#:~:text=An%20estimated%2037.5%20per%20cent,per%20cent%20in%20some%20regions.
   View at Publisher | View at Google Scholar
5. The Borgen Project. "Facts About Poverty in Cameroon." Accessed September 1, 2024. https://borgenproject.org/facts-about-poverty-in-cameroon/.
   View at Publisher | View at Google Scholar
6. ReliefWeb. "Cameroon: Humanitarian Needs Overview 2023." March 2023. Accessed September 1, 2024. https://reliefweb.int/report/cameroon/cameroon-humanitarian-needs-overview-2023-march-2023#:~:text=An%20estimated%2037.5%20per%20cent,per%20cent%20in%20some%20regions.
   View at Publisher | View at Google Scholar
7. “Tendances, profil et déterminants de la pauvreté au Cameroun entre 2001 et 2014”, Rapport quatrième enquête camerounaise auprès des ménages, Institut National de la Statistique, December 2015.
   View at Publisher | View at Google Scholar
8. Issa Saibou, “Effets économiques et sociaux des attaques de Boko Haram dans l’Extrême-Nord du Cameroun”, Kaliao, special edition November 2014, p. 156;
   View at Publisher | View at Google Scholar
9. Machikou Nadine, Claude Mbowou, “Economie politique de la violence dans l’Extrême-Nord”, Rapport national Cameroun, United Nations Development Programme (UNDP), October 2015].
   View at Publisher | View at Google Scholar
10. Crisis Group. "Cameroon." Accessed September 1, 2024. https://www.crisisgroup.org/central-africa/Cameroon.
    View at Publisher | View at Google Scholar
11. National Institute of Statistics (NIS). Enquête par grappes à indicateurs multiples (MICS5), 2014, Rapport Final. Yaoundé, Cameroun: Institut National de la Statistique; 2015.
    View at Publisher | View at Google Scholar
12. National Institute of Statistics (NIS). Quatrième Enquête Camerounaise auprès des Ménages: ECAM 4. Yaoundé, Cameroun: Institut National de la Statistique; 2014.
    View at Publisher | View at Google Scholar
13. Far North Region (Cameroon). Wikipedia. https://en.wikipedia.org/wiki/Far_North_Region_(Cameroon).
    View at Publisher | View at Google Scholar
14. A. Bouchardeau,Monographie hydrologique du Logone, (Paris:Orstom) 1968; V. Bénech et al., Hydrologie et physico-chimie des eaux d'inondation de la plain d'inondation du Nord-Cameroun (in series: Cahiers Orstom: série hydrologique) 1982 and E. Naah, Restauration hydro-technique de la plaine du Yaéré, (Projet Waza Logone, Yaoundé) 1993
    View at Publisher | View at Google Scholar
15. NIS (National Institute of Statistics). Quatrième Enquête Camerounaise auprès des Ménages: ECAM 4. Yaoundé, Cameroun: Institut National de la Statistique; 2014
    View at Publisher | View at Google Scholar
16. “Tendances, profil et déterminants de la pauvreté au Cameroun entre 2001 et 2014”, Rapport quatrième enquête camerounaise auprès des ménages, Institut National de la Statistique, December 2015.
    View at Publisher | View at Google Scholar
17. The United Nations Children’s Fund. Cholera Epidemiology and Response Factsheet—Cameroon. The United Nations Children’s Fund; Cameroon, Central Africa: 2013.
    View at Publisher | View at Google Scholar
18. Gorham TJ, Yoo J, Garabed R, Mouhaman A, Lee J. Water Access, Sanitation, and Hygiene Conditions and Health Outcomes among Two Settlement Types in Rural Far North Cameroon. Int J Environ Res Public Health. 2017 Apr; 14(4):441
    View at Publisher | View at Google Scholar
19. WHO/UNICEF Joint Monitoring Program. Estimates on the Use of Water Sources and Sanitation Facilities. WHO/UNICEF Joint Monitoring Program; Cameroon, Central Africa: 2015.
    View at Publisher | View at Google Scholar
20. UNHCR. Far North Cameroon Emergency. https://reporting.unhcr.org/operational/situations/far-north-cameroon-emergency. Accessed September 1, 2024.
    View at Publisher | View at Google Scholar
21. Abanda, F. H. (2012). Renewable energy sources in Cameroon: Potentials, benefits and enabling environment. Renewable and Sustainable Energy Reviews, 16(7), 4557-4562.
    View at Publisher | View at Google Scholar
22. Diboma, B. S., & Tatietse, T. T. (2013). Power interruption costs to industries in Cameroon. Energy policy, 62, 582-592.
    View at Publisher | View at Google Scholar
23. Far North Region (Cameroon). Wikipedia. https://en.wikipedia.org/wiki/Far_North_Region_(Cameroon). Accessed September 1, 2024.
    View at Publisher | View at Google Scholar
24. OCHA, in collaboration with humanitarian partners. Report covering the period up to June 30, 2023. https://www.unocha.org/. Accessed September 1, 2024.
    View at Publisher | View at Google Scholar
25. Dongmo AL et Lhoste P 2009 Nord Cameroun: pour une utilisation concertée des ressources entre pasteurs sédentarisés et agroéleveurs. Grain de sel, 46 - 47 : 20 - 21.
    View at Publisher | View at Google Scholar
26. International Federation of Red Cross and Red Crescent Societies. Cameroon Floods in Far North Region: Final Report DREF Operation No. MDRCM029. 2023.
    View at Publisher | View at Google Scholar
27. World Food Programme (WFP) Cameroon. Cameroon Flooding Impact Factsheet: Far North Region, September-October 2022. Published November 15, 2022.
    View at Publisher | View at Google Scholar
28. UNICEF. The impact of Boko haram and armed conflict on schooling in Cameroon’s far north education sector rapid needs assessment: far north, Cameroon. 2015;(February).
    View at Publisher | View at Google Scholar
29. Nouetchognou J. Boko Haram Insurgency: Health and Social Implications for Cameroon. Denis & Lenora Foretia Foundation | Catalyzing Africa's Economic Transformation. Available at: [https://www.foretiafoundation.org/]. Accessed September 1, 2024
    View at Publisher | View at Google Scholar
30. Tassang, A., Fru, C. N., Brady, M. R., Cho, F. N., Thierry, T., Paulette, N. F., Gracious, T., & Renald, T. (2021). Knowledge and Risk Factors of Cervical Cancer among Women in Towns of Fako Division, Cameroon. Journal of Advances in Medicine and Medical Research, 33(16), 81-91.
    View at Publisher | View at Google Scholar
31. Zattler, J. 2015. "Did Structural Adjustment Programmes Assist African Development?" E-International Relations. Accessed October 8, 2024. https://www.e-ir.info/2015/01/13/did-structural-adjustment-programmes-assist-african-development/.
    View at Publisher | View at Google Scholar
32. Thomson, M., Kentikelenis, A., and Stubbs, T. 2017. "Structural Adjustment Programmes Adversely Affect Vulnerable Populations: A Systematic-Narrative Review of Their Effect on Child and Maternal Health." Public Health Reviews 38: Article 13.
    View at Publisher | View at Google Scholar
33. CamerounWeb. "After 18 Years of Creation, Gov't School Pupils Still Study Under Trees." Last modified October 2014. https://www.camerounweb.com/CameroonHomePage/NewsArchive/After-18-years-of-creation-govt-school-pupils-still-study-under-trees-313104.
    View at Publisher | View at Google Scholar
34. Price, A. J., Ndom, P., Atenguena, E., Mambou Nouemssi, J. P., & Ryder, R. W. (2012). Cancer care challenges in developing countries. Cancer, 118(14), 3627-3635.
    View at Publisher | View at Google Scholar
35. Broberg, G., Wang, J., Östberg, A. L., Adolfsson, A., Nemes, S., Sparén, P., & Strander, B. (2018). Socio-economic and demographic determinants affecting participation in the Swedish cervical screening program: a population-based case-control study. PLoS One, 13(1), e0190171.
    View at Publisher | View at Google Scholar
36. Khan, M. J., Partridge, E. E., Wang, S. S., Schiffman, M., & Atypical Squamous Cells of Undetermined Significance/Low‐Grade Squamous Intraepithelial Lesion Triage Study (ALTS) Group. (2005). Socioeconomic status and the risk of cervical intraepithelial neoplasia grade 3 among oncogenic human papillomavirus DNA‐positive women with equivocal or mildly abnormal cytology. Cancer, 104(1), 61-70.
    View at Publisher | View at Google Scholar
37. Liu, T., Li, S., Ratcliffe, J., & Chen, G. (2017). Assessing knowledge and attitudes towards cervical cancer screening among rural women in Eastern China. International journal of environmental research and public health, 14(9), 967.
    View at Publisher | View at Google Scholar
38. Abudukadeer, A., Azam, S., Mutailipu, A. Z., Qun, L., Guilin, G., & Mijiti, S. (2015). Knowledge and attitude of Uyghur women in Xinjiang province of China related to the prevention and early detection of cervical cancer. World journal of surgical oncology, 13, 1-7.
    View at Publisher | View at Google Scholar
39. Biała M, Inglot M KBK of young P women of human papillomavirus (HPV) infection and cervical cancer prevention. MS 2015;18(1):34–37.
    View at Publisher | View at Google Scholar
40. Louie, K. S., De Sanjose, S., Diaz, M., Castellsagué, X., Herrero, R., Meijer, C. J., ... & Bosch, F. X. (2009). Early age at first sexual intercourse and early pregnancy are risk factors for cervical cancer in developing countries. British journal of cancer, 100(7), 1191-1197.
    View at Publisher | View at Google Scholar
41. Lemayehu H, Damen H. Patient side cost and its predictors for cervical cancer in Ethiopia: a cross sectional hospital based study. BMC Cancer. 2013;13:69.
    View at Publisher | View at Google Scholar
42. Parikh, S., Brennan, P., & Boffetta, P. (2003). Meta‐analysis of social inequality and the risk of cervical cancer. International journal of cancer, 105(5), 687-691.
    View at Publisher | View at Google Scholar
43. Sachs Jeffrey D. The end of poverty: economic possibilities for our time. New York: Penguin Books; 2005. p. 288–90]
    View at Publisher | View at Google Scholar
44. Fru, C. N., Tassang, A., Cho, F. N., Tassang, T., & Fru, P. N. (2020). Socio-economic Determinants Influencing Cervical Cancer Screening in Buea: A Cross-Sectional Study. International Journal of Tropical Disease & Health, 41(11), 14-22.
    View at Publisher | View at Google Scholar
45. Yohannes Tekalegn et al. High parity is associated with increased risk of cervical cancer: Systematic review and meta-analysis of case–control studies Womens Health (Lond). 2022; 18: 17455065221075904,
    View at Publisher | View at Google Scholar
46. Louise a. Brinton et al. Parity as a Risk Factor for Cervical ancer. American Journal of Epidemiology, Volume 130, Issue 3, September 1989, Pages 486–496.
    View at Publisher | View at Google Scholar
47. Hawkes, D., & Fennell, J. Educational inequalities in cervical cancer screening: a systematic review. BMC Public Health, 19(1), 2019. 1-14.
    View at Publisher | View at Google Scholar
48. Fisher, B. J., & McDonald, A. J. The role of health literacy in cervical cancer screening: A systematic review. Journal of Women's Health, 29(2) 2020. 250-259.
    View at Publisher | View at Google Scholar
49. Schoenfeld, E. M., & Hoh, L. Barriers to cervical cancer screening among women: a qualitative study. Journal of Health Disparities Research and Practice, 9(1), 2016. 15-27.
    View at Publisher | View at Google Scholar
50. Aldrich, M. C., et al. Geographic disparities in cervical cancer screening and outcomes in the United States: a review. Journal of Women's Health, 24(10) 2015, 814-821.
    View at Publisher | View at Google Scholar
51. Castañeda, H., et al. Neighborhood effects on cervical cancer screening in low-income and minority women. American Journal of Public Health, 106(7), 1217-2016. 1223.
    View at Publisher | View at Google Scholar
52. Arrossi, S., & Paolino, M. Impact of a community-based intervention on cervical cancer screening uptake in Argentina: a randomized controlled trial. BMC Public Health, 11, 43. 2011.
    View at Publisher | View at Google Scholar
53. World Health Organization (WHO). (2014). Global Strategy to Accelerate the Elimination of Cervical Cancer as a Public Health Problem.
    View at Publisher | View at Google Scholar
54. Kahesa, C., et al. "Determinants of cervical cancer screening among women in low- and middle-income countries: a systematic review." BMC Women's Health 2017.
    View at Publisher | View at Google Scholar
55. Mabeya, H., et al. "Factors influencing the uptake of cervical cancer screening in a low-resource setting." Pan African Medical Journal 2016.
    View at Publisher | View at Google Scholar
56. Nabugoda, M., et al. "Sexual behavior and cervical cancer screening uptake among women in Uganda: A community-based study." BMC Women's Health, 20, 45,2020.
    View at Publisher | View at Google Scholar
57. Bello, A. R., & Afolabi, M. O. "Awareness of cervical cancer and screening among women in Nigeria: a systematic review." Journal of Cancer Education, 31(4), 2016. 628-635.
    View at Publisher | View at Google Scholar
58. C. Neh Fru, Tassang Andrew, F. Nchang Cho, T. Tassang and P. Ngum Fru. Socio-economic Determinants Influencing Cervical Cancer Screening in Buea: A Cross-Sectional Study. International Journal of Tropical Disease & Health 41(11): 14-22, 2020; Article no. IJTDH.59891
    View at Publisher | View at Google Scholar
59. Sankaranarayanan, R., et al. "Cancer Survival in Africa, Asia, the Caribbean, and Central America: A Population-Based Study." The Lancet Oncology, 11(2), 141-148. 2010.
    View at Publisher | View at Google Scholar
60. Katz, L. M., et al. "Unemployment and Health: A Review." American Journal of Public Health, 109(4), 556-561,2019.
    View at Publisher | View at Google Scholar
61. Graham, S., et al. "Reproductive Factors and Risk of Cervical Cancer." Cancer Epidemiology, Biomarkers & Prevention, 3(3), 1994. 203-210.
    View at Publisher | View at Google Scholar
62. Wright, T. C., et al. (2006). "The Role of Sexual Behavior in the Epidemiology of Cervical Cancer." Gynecologic Oncology, 102(3), 307-313.
    View at Publisher | View at Google Scholar
63. Celestina Neh Fru and Andrew Tassang. Knowledge And Risk Factors For Cervical Cancer In Doukoula, Extreme North Of Cameroon. IQRJ: Volume 003, Issue 03, Mar 2024
    View at Publisher | View at Google Scholar
64. Brinton, L. A., et al. "Sexual and Reproductive Factors in Relation to the Risk of Cervical Cancer." International Journal of Cancer, 92(5), 720-726,2001.
    View at Publisher | View at Google Scholar