Original Research

Rural Zulu women’s knowledge of and attitudes towards Pap smears and adherence to cervical screening

Michelle A.L. Godfrey, Sithokozile Mathenjwa, Nasim Mayat
African Journal of Primary Health Care & Family Medicine | Vol 11, No 1 | a1994 | DOI: https://doi.org/10.4102/phcfm.v11i1.1994 | © 2019 Michelle Ann Louise Godfrey, Sithokozile Mathenjwa, Nasim Mayat | This work is licensed under CC Attribution 4.0
Submitted: 19 November 2018 | Published: 03 October 2019

About the author(s)

Michelle A.L. Godfrey, Lower Umfolozi District War Memorial Hospital, Empangeni, KwaZulu-Natal, South Africa; and, Department of Gynaecological Oncology, Queen Alexandra Hospital, Portsmouth, United Kingdom
Sithokozile Mathenjwa, Lower Umfolozi District War Memorial Hospital, Empangeni, KwaZulu-Natal, South Africa
Nasim Mayat, Lower Umfolozi District War Memorial Hospital, Empangeni, KwaZulu-Natal, South Africa


Background: Cervical cancer is the most common form of cancer in black women in South Africa and has almost a 60% mortality rate. However, adherence to cervical screening programmes of black women living in rural South Africa is not universal.

Aim: The aim of this study was to gain a better understanding of rural Zulu women’s knowledge of and attitudes towards Pap smear tests, and their reasons for participation or non-compliance with cervical screening.

Setting: This study was conducted at the gynaecology and antenatal clinics in a secondary referral hospital in rural KwaZulu-Natal.

Methods: A hospital-based cross-sectional study was undertaken in the form of a semi-structured patient questionnaire survey with open and closed questions. The responses to the open-ended questions were manually analysed by the authors using a thematic approach. Outcome measures included whether the woman had a previous Pap smear, her understanding of the cervical screening programme and causes of cervical cancer.

Results: This study included a total analysis of 234 responses. The mean age was 29 years (s.d. = 8.3 years). Overall, 32.5% of women had previously had a Pap smear. Among the responders, 33.3% were human immunodeficiency virus (HIV)-positive and 53.0% were HIV-negative. Only 19.2% of women understood that a Pap smear was related to screening for cervical cancer.

Conclusions: This study illustrated a poor understanding of cervical screening, which may result in the low level of uptake of Pap smear reported; this is particularly concerning in HIV-positive women, who are at higher risk of developing cervical cancer. Urgent and extensive public health campaigning is required within rural South Africa to improve cervical screening uptake and decrease cervical cancer mortality.


cervical pap smear; cervical screening; human immunodeficiency virus; cervical cancer; human papillomavirus; Zulu women; South Africa


Total abstract views: 2741
Total article views: 5237


Crossref Citations

1. Barriers and Facilitators Factors to Uptake of Cervical Cancer Screening Among Women in Low- and Middle-income Countries: A Narrative Review
Sarah Ahmed Al-Oseely, Rosliza Abdul Manaf, Suriani Ismail
Malaysian Journal of Medicine and Health Sciences  vol: 19  issue: 4  first page: 354  year: 2023  
doi: 10.47836/mjmhs.19.4.48