Nursing

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Psychotherapy in Africa: experience of the group psycho-educational support programme at Ibadan - a preliminary report
(1995-11) Onibokun, A. C.; Ohaeri, J. U.; Campbell, O. B.; Adenipekun, A. A
Africa stem from the lack of an appropriate psychodynamic theory ori which to base the technique used. He suggested and experimented with the use of cosmologies (world view) native to the culture (e.g. - the Yoruba Ayanmo myth) in psychodynamic elaborations in therapy. Ohaeri (1989) believed that work along the lines suggested by Morakinyo (1982) be encouraged, but opined that the current socio-economic and cultural changes in Nigeria make it imperative to examine the need for formalized psychotherapy in the contemporary Nigeria. In view of the above coupled with the felt needs of the teaming number of oncology patients at the Cancer Registry of the University College Hospital (U.C.H.), Ibadan, the Lola Marinho Psycho-oncology Counselling Clinic (LMPOC2) was established in July 1992. The clinic now runs a formal psychotherapy programme. With the increased availability of modern methods for diagnosis and the treatment of cancer, our experience has shown that many more cases of cancer now report in hospitals in Nigeria, in particular, at the Radio-therapy Centre of the University College Hospital (U.C.H.), Ibadan, which is the only functioning radio-therapy centre in West Africa sub-region for now. This has offered us the opportunity to enquire into aspects of psycho-oncology. Our goals in this clinic are: 1. to assist the patients and heir family members in becoming more knowledgeable about the disease by providing them with all necessary information. 2. to give support by providing continuity of care. 3. to teach the patients and their family members the necessary skills to cope with the stress of living with cancer. It is an eight session progressive course, which we have developed and used for hundreds of patients at the Lola Marinho Psycho-oncology Counselling Clinic (LMPOC2). The programme is intended for people living with cancer who want to help themselves cope with and combat their disease. It is also meant for those who wish to conduct group teaching skills for people living with cancer and their family members. The paper deals with the efficacy of psychotherapy in improving the quality of life of oncology patients in Nigeria, judging from our experience with our clients at the Lola Marinho Psycho-oncology Counselling Clinic (LMPOC2) of the University College Hospital, Ibadan, Nigeria. The findings pose great challenges to all categories of health care providers, especially Nigerian psychologists
Commonly reported gynecological morbidities and health-seeking behaviours among reproductive age women in urban Nigeria
(1998-08) Uwnkwe, C. B. U.; Adoyomi, O. A.; Palayo, J.; Moronkola, O. A.; Onibokun, A.; Ogundiran, A.
The present study investigated the commonly reported gynecological morbidities by reproductive age women in some/urban areas of south western Nigeria. Specifically the study attempted to determine the proportion of the reproductive age women surveyed reported the symptoms associated with obstetrics and gynecological morbidity, the perceived causes of such obstetrics and gynecological morbidity in the women, whether such women sought treatment or consultation for specific symptoms, and in what kind of health facilities., The Ex post facto research design was adopted in the study. The subjects used for the study were randomly selected from four health facilities located in the Ibadan metropolis, south western Nigeria. The findings from the study revealed that 91% of the respondents have had cause to report their problem to either government hospital, primary health center, private hospital, a sub-center or traditional hospital. Also, 55% of the respondents had their medium of information about health programmes through the radio, while the remaining 45% had been adequately informed about health programmes through the other media like television, magazines, workshops or seminars. About 80% claimed that they had menstrual disorders of heavy or light irregular bleeding, painful menstruation or spotting between periods, while79.6% claimed to have anaemia indicated by feeling excessively weak, tired or breathless during household activities. Some 60.4% of the respondents claimed to have lower reproductive tract infections while 30.7% stated that they have acute pelvic inflammatory disease, which is the lower abdomen pain or vagina discharge with fever. Also, about 58.4% was the percentage of women who sought or consultation for specific symptoms in the private hospital while the rest used the network of health centers and sub-centers available in their areas under the primary health care system. The implication of this findings were highlighted and discussed
The efficacy of non-drug therapy in cancer pain management
(1999-08) Onibokun, A.
This study sort to examine the effects of cognitive-behavioural therapy (CBT) on pain intensity (PI), occurrence and control of negative thoughts in response to pain (OCNT) and quality of life (QOL) in breast cancer patients who were experiencing physical pain. A pretest post-test control group quasi- experimental research design was utilised. Ninety patients with breast cancer who were; experiencing physical pain were randomly assigned to three groups. Experimental group I received training in relaxation and guided imagery, white experimental group II had training in cognitive restructuring, in addition to relaxation and guided imagery. The control group received no CBT. The effects of CBT were tested on PI, OCNT and QOL, both among the three groups an between the two experimental groups, using Analysis of Variance and T-test, respectively. Subjects who received CBT experienced low PI than the control group. They perceived significantly fewer OCNT, and their health related QOL were better enhanced as compared with those who received no CBT. .The subjects in experimental group II who had an additional benefit of cognitive restructuring training experienced fewer OCNT than those in experimental group I. There was no significant difference in PI and QOL between experimental groups I and II. The results indicated that CBT plays a significant role in the control of cancer pain
Psychological management of negative thoughts in women who have had mastectomy
(2000) Onibokun, A.
The purpose of this study was to explore the effectiveness of cognitive restructuring technique in the control of negative thoughts in breast career patients during the grieving process post mastectomy. Thirty breast cancer patients, who met certain specified criteria, were recruited for this study after obtaining their consent, from the radiotherapy out-patient Department of the University College hospital, Ibadan. A pretest - posttest longitudinal research design was utilized. The subjects received training in cognitive restructuring technique as a coping skill, for a period of 4 weeks to help them adjust to mastectomy. Using Inventory of Negative thoughts, the effect of cognitive restructuring technique was tested on the control of negative thoughts by the patients. The findings revealed that there was a decrease in the occurrence of negative thoughts in the patients at the end of the training sessions. The study confirms that cognitive restructuring technique has a significant role to play in the control of negative thoughts of patients during the grieving process
Prevalence and Pattern of smoking behaviour among health workers in Ibadan
(2000) Onibokun, A.; Moronkola, O.A.
This study is a descriptive survey and utilized purposive and snowball sampling techniques. The modified version of Akinboye (1984). Smoking Behaviour Assessment scale was the instrument used for data collection. Some of the determinants of smoking behaviour reported by the respondents included: to relax, to avoid boredom; to cope with task, and to suppress frustration. Among their major complaints are tiredness, coughing, nervousness and loss of concentration. Out of the 50 respondents who volunteered to participate in this study, about 50 percent were willing to quit smoking and showed intention to enlist in any tobacco cessation or counselling programme. We also found out that religion may have significant influence in tobacco cessation programme for the respondents, as nearly all of them desired divine help. They also believed that they needed social support from their spouses and religious leaders to quit smoking. Based on the findings of this study, there is need for a national tobacco behaviour survey among Nigerians health workers and adolescents. There is also the need for the inauguration of tobacco cessation counselling programme in the country
Loss, death, grief and care givers
(Stirling-Horden Publishers, Ibadan, 2000) Onibokun, A.
Effective communication skills
(Vantage Publishers, Ibadan, 2000-06) Onibokun, A. C.
Integrating nursing into national cancer control programs: prevention and early detection - the Nigeria experience
(Wiley-Liss, 2002) Onibokun, A. C.
Cancer is a major killer disease in Nigeria; breast, cervical and prostate cancers being the commonest. Data from Globocan 2000 indicate an increasing rate in cancer morbidity and mortality in Nigeria. It is estimated that by the year 2010 about 500,000 cases will be diagnosed annually. Over 70% of the cancer patients present themselves in stages III and IV when only palliative therapy can be offered. In spite of the increasing rates in cancer prevalence in Nigeria, the importance placed on cancer as a health problem is somewhat very low, relative to other non- communicable diseases. The National Government does not allocate up to 6% of its National Annual budget to health. Currently, the government has not given the issue of cancer prevention and treatment the priority it deserves, as compared with HIV/AIDS, which has suddenly gained attention as a result of international efforts. The high rates of morbidity and mortality associated with cancer related diseases could be considerably reduced through effective cancer education, championed by community health nurses and targeted at prevention and early detection. Unfortunately, this approach has not got the attention it deserves. In a country where about 65% of the populace live in rural communities (where there is a high level of ignorance, inadequate manpower and health facilities) cancer outreach programs aimed at rural areas, can be enhanced. This can be achieved through a program that integrates nursing especially community nursing, into national cancer control. Currently, only limited attempts promoted by State Ministries of Health, NGOs and professional bodies, have attempted doing this with the focus on primary, secondary and tertiary prevention. This paper shall analyze, evaluate and discuss the efforts made so far in Nigeria as a basis to coming up with options and strategies for effectively using nurses, especially community health nurses, in the prevention and early detection of cancer
Stressors and counseling needs of undergraduate nursing students in Ibadan, Nigeria
(Slark incoporated, 2004-09) Omigbodun, O. O.; Onibokun, A. C.; Yusuf, B. O.; Odukogbe, A. A.; Omigbodun, A. O.
Existing evidence suggests that nursing students have high levels of stress and that counseling and other support services should be made available to them. However, the stressors and counseling needs of undergraduate nursing students in Nigeria have yet to be explored. This study used a questionnaire to investigate the: stressors, counseling deeds, and desired counseling facilities of undergraduate nursing students at the University of Ibadan. Common stressors included excessive school work; financial 'problems, inadequate recreational facilities, and overcrowded accommodations. There was an association between reporting inconsiderate, insensitive lecturers as stressors and evidence of psychological distress. Nearly 60% of the respondents felt counseling would help them, and most desired counseling for academics, finances, and relationships. Most (78%) of the respondents preferred an independent facility with trained counselors. Desired characteristics for the services included accessibility, affordability, confidentiality, and a friendly atmosphere. Educators and administrators should use this information to design counseling facilities for students
Knowledge and attitudes of terminally ill patients and their family to palliative care and hospice services in Nigeria
(2005-06) Adenipekun, A.; Onibokun, A.; Elumelu, T. N.; Soyannwo, O. A.
Bacground: A palliative care and Hospice service is a neglected aspect of medical discipline especially in a developing country like Nigeria. With the global increase in incidence of cancer and HIV/A IDS and 70% of them presenting late, coupled with limited resources, for effective symptom control, palliative care therefore remains the only option left to improve the quality of life of the patients. Objective: To assess the, knowledge and attitudes of patients and their relations to palliative care and hospice services {PC&H} and to fashion out appropriate services for the patients. Materials and methods: A total of 130 participants were studied using a questionnaire which comprised of three parts: Socio-demographic variables. Information about Knowledge and Attitudes towards PC&H. Results: Sixty nine were patients while 61 were family members. Ninety four [72.3%] had no knowledge of PC&H regardless of level of education and social status. 109 (84%) agreed that symptoms of the terminally ill patients should be treated to improve their quality of life and 75%. of the participants agreed that this will be better done in a Hospice. 106 183% | participants desire to have hospice established in every community, this again was regardless of tribe Conclusion: There is a gross lack of knowledge about PC&H in our community as evidenced among, the participants studied. However, there is a positive attitude towards PC&H suggesting a general acceptance, since there is presently no well established Hospice, in Nigeria; we recommend that government and Non-governmental organizations should assist in this area. A hospital based Hospice might be a starting point
Smoking behaviour and perceived health consequences of environmental tobacco smoke among university athletes in Nigeria
(2005-07) Moronkola, O. A.; Onibokun, A.
This study investigated tobacco smoking behaviour and the perceived health consequences of environmental tobacco smoke by university athletes in Nigeria and to determine whether the philosophy of the Nigerian Universities Games Association (NUGAJ, resting on the objective of development of the physical, emotional and mental ideals of students, is still in vogue. The descriptive survey research method was used to collect data, through the use of self-developed and validated questionnaire (of r=0.80 reliability) of randomly selected university athletes that participated in the 19th biennial NUGA Games 2002, held between 11 and 21 December 2002, at the University of Ibadan. Out of the 159 respondents, 61 (38.7%) were smokers - consisting of 51 (83.6%) male and 10 (16.4%) female athletes). The reasons given for smoking included the influence of friends, and for relaxation purposes. The response level on knowledge of items about health consequences of tobacco smoking ranged between 65.4% and. 91.8%, while the level of knowledge of the health consequences of environmental tobacco smoke ranged between 38.5% and 64.8%. With these findings, we suggest educational intervention programmes to empower athletes say ‘No’ to smoking and quit smoking. We also suggested the need for sports councils to call health professionals to put in place tobacco smoking cessation programmes, develop IEC materials on environmental tobacco smoke and peer education programmes targeting university athletes to ensure their wellness
Knowledge and behaviour of nurse/midwives in the prevention of vertical transmission of HIV in Owerri, Imo State, Nigeria: a cross-sectional study
(2007-10) Ndikom, C. M.; Onibokun, A.
Background: Mother-to-Child Transmission (MTCT) of HIV remains the main mode of acquisition of HIV in children. Transmission of HIV may occur during pregnancy, delivery or breastfeeding. Studies have shown that some specific interventions help to reduce the transmission of the virus to the baby. In order to target safe, rational and effective intervention to reduce MTCT of HIV, it is necessary to ensure that the nurse/midwife has knowledge of the strategies for the prevention of vertical transmission of HIV. Method: The cross-sectional design was utilized to determine the knowledge and behaviour of nurse/midwives in the prevention of vertical transmission of HIV in Owerri, Imo State, Nigeria. The study sample consisted of 155 nurse/midwives drawn from three selected hospitals through stratified random sampling method. Official permission was obtained from the institutions and consent from participants. Data was collected through the use of a self administered questionnaire. Information sought included respondents' demographic characteristics, knowledge about and behaviour of prevention of vertical transmission as well as factors influencing behaviour. Results: Findings revealed that nurse/midwives had moderate level of knowledge with mean score of 51.4%. The mean score on behaviour was 52.5%, major factors that influence behaviour in these settings were mainly fear of getting infected, irregular supply of resources like gloves, goggles, sharp boxes, and water supply was not regular also. Hypotheses tested revealed that there is a positive relationship between knowledge and behaviour (r = 0.583, p = 0.00). Knowledge level of nurse/ midwives who had educational exposure was not different from those who did not (t = 1.439, p = 0.152). There was a significant difference in the knowledge of nurse/midwives who had experience in managing pregnant women living with HIV/AIDS and those who did not (t = 2.142, p = 0.03). Also, there was a significant relationship between behaviour and availability of resources (r = 0.318, p = 0.000). Conclusion: The study revealed that the nurse/midwives though moderately knowledgeable still had gaps in certain areas. Their behaviours were fairly appropriate. There is need for improved knowledge through structured educational intervention. Resources needed for practice should always be made available and the environment should be much more conducive for practice
Issues in pain management and Nurses role
(Ibadan University Press, Ibadan, 2009) Onibokun, A.
As the healthcare professionals involved in giving bedside care round-the-clock, professional nurses are in a unique position to promote state-of-the-art pain management practices for the health care consumer. Nurses make judgments regarding administration of ordered medications, timing of patient care activities, and also enable patients to make knowledgeable decisions regarding management of their pain. Historically, health care professionals maintained strict control over pain medications in order to protect patients/'clients from deleterious effects of opioid medications, especially with concerns regarding addiction. However, as the health care consumers demanded a more active role in decision-making and as research has shown that fears of addiction were grossly exaggerated, pain rating and approaches to pain management are currently based on patients' self-reports and response to treatment. Potential deleterious effects of pain medications are now weighed against well researched negative effects of uncontrolled pain on patient's well-being, as well as patients' identified goals for pain relief The impetus for this chapter, is to examine the issues on pain management from a contemporary perspective and its implication for nurses role
Palliative care needs evaluation in untreated patients with hepatocellular carcinoma in Ibadan, Nigeria
(2010-04) Otegbayo, J. A.; Onibokun, A. C.; Aikpokpo, V. N.; Soyannwo, O. A.
AIM This study aimed to evaluate the physical, psychosocial and spiritual needs of untreated patients with hepatocellular carcinoma, in order to determine effective palliative care approach and therefore improve their quality of life when curative therapy is elusive. METHODS The modified Needs Evaluation Questionnaire (NEQ) on pain and psychological assessments, thoughts and feelings and spiritual concerns was administered to 205 consecutive patients with recently diagnosed hepatocellular carcinoma after informed consent. The questionnaire included questions on pain, psychological state of mind, interference of disease with life, family functioning, knowledge of the disease, sexual functions and spirituality, among others. Responses were collated and analysed using simple statistics. RESULTS Abdominal pain, abdominal swelling, and weight loss were the leading clinical features, occurring in 157 (77%), 143 (70%) and 91 (44%) patients respectively. Pain characteristics varied, with 179 (87%) having it at presentation. Most of the patients (116, 57%) used NSAIDs for pain relief. Less than half (98, 48%) wanted to know the cause of the cancer, while 157 (77%) wanted to know treatment options. The majority (189, 92%) were ignorant about anyone with a similar ailment. Sexual function was not perceived as a problem but some expressed fears about sex, feeling that their partners would not find them attractive. Self-esteem was high in almost all respondents. Most (177, 86%) felt God is a “doer” while 28 (14%) felt God is a “supporter” and 162 (79%) would like a therapist or religious leader to talk to them. CONCLUSION Pain was a major concern and spiritual support by religious leaders was desired. Self-esteem of patients should be preserved and reinforced. We recommend that palliative care and end-of-life issues should be made part of multidisciplinary care of cancer patients in our setting
Patterns of psychoactive substance use among two-wheel commercial riders in Maiduguri, Borno state, Nigeria
(2011) Aliyu, U.; Oladele, E. O.; Adejomo, P. O.; Onibokun, A. C.
When any psychoactive substance is taken before driving, lives of both passengers and other motorists operating on the highway are endangered. This survey study designed to determine the patterns of psychoactive substance use among two-wheel commercial riders in Maiduguri, Borno State, Nigeria. The population of this study was 4141 two-wheel commercial riders operating in Maiduguri, Borno State. Multi-stage sampling technique was used to select 18 substations from the sampling frame. However, only 297 respondents constituted the study sample. Data were collected with the help of research assistants using a questionnaire. Descriptive statistics were used to analyze the data generated. The results of the study reveal that the commonly used psychoactive substances were kola nyt, cigarette, alcohol and marijuana. Oral and sniffing were the routes used by the respondents. Seventy-five percent of the respondents used these substances daily, mostly kola nut (31.31%) and cigarette (24.24%) that were obtained within garage. Alcohol (8.41%) and marijuana (7.74%) were obtained outside the garage. Analysis of problems associated with psychoactive substance use in the last one year shows that road traffic accident was the highest (Z-value of 6), followed by work and social problems (Z—value of 5 and 4) respectively. It is recommended that an intervention studies be conducted by the government and Non-Governmental Organizations (NGOs) to give the two-wheel commercial riders information on the types, use and consequences of psychoactive substances. Finally, government should enforce laws against psychoactive substance use and provide high-tech tools to help law enforcement agencies to tract substance users
Health implications of harmful widowhood practices in Nigeria
(Mark Allen Healthcare Ltd, 2011-03) Oludayo, O. G.; Onibokun, A.
This article outlines an exploratory survey to determine the existence and extent of harmful widowhood practices among widows and the subsequent health implications of such practices. A detailed questionnaire was administered to 210 widows with a response of 95.24%. Findings indicated that 83.5% and 56.5% of respondents were subjected to staying indoors and wearing of black dresses respectively. Similarly, widows were commonly subjected to confiscation of husband's goods and accused of having a hand in the husband's death, with a prevalence of 20% and 18% respectively. A significant relationship also exists between these harmful widowhood practices and the respondents' health. Of the respondents, 40.5% experienced absent-mindedness, while 56% had anxiety about children's future and 13.5% already had high blood pressure. Little or no help was received from the government or non-governmental organizations. There is a need for policies from all sectors of society to help ensure widows' welfare
Factors influencing initiation of antenatal care in Ibadan, Nigeria
(2011-12) Oluwatosin, O. A.; Aluko, J. O.; Onibokun, A. C.
Objective: Late antenatal care (ANC) registration and irregular attendance have been implicated as factors preventing women from receiving the full benefits of effective ANC. Therefore, this study seeks to elicit the factors that impact pregnant women's timing of registration for ANC in a mission hospital, in Ibadan, Nigeria. Method: A cross-sectional study of 160 women attending the booking clinic over a 4-week period. A structured questionnaire was utilized to collect data on sociodemographic characteristics, index pregnancy, previous pregnancy and past obstetrical history. Result: Only 14 women (9.4%) booked at first trimester while 93 (62.4%) and 42 (28.2%) booked at second and third trimesters respectively. For previous and current pregnancies, the husband's instruction was the leading influence for booking, at 71 (45.8%) and 89 (57.4%) respectively. Knowledge of ANC timing, experience of loss of child and miscarriage were significant predictors of gestational age at booking. Conclusion: This study suggests the need for education at a pre-conceptual stage of the benefits of early initiation of ANC for women
Women’s health beliefs and breast cancer screening practices in Nigeria
(2012-06) Olowokere, A.; Onibokun, A. C.; Irinoye, O.
Receiving a diagnosis of breast cancer and coping with subsequent treatments can be highly threatening experiences that may influence women’s breast screening practices. It is therefore important to have a good understanding of women’s beliefs and behaviour where breast cancer may be concerned. This study examined the influence of women’s beliefs on breast screening practices (BSE) in four rural communities of Nigeria. Utilizing cross-sectional design, women’s beliefs were measured using the Health Belief Model (HBM) scale adapted to Nigerian cultural settings. Women’s perceived risk to breast cancer was found to be moderately high. Self-confidence and intention to participate in health-promoting behaviours were the significant variables that influenced the women’s practice of BSE (P = 0.000 and P = 0.021 respectively). The authors therefore recommend that community health nurses should promote activities geared towards mastery of BSE by promoting self -confidence in women through regular demonstration and reinforcement of health educational sessions at the primary health care level
Breast cancer knowledge and screening practices among women in selected rural communities of Nigeria
(Acadenic Journals, 2012-11) Olowokere, A. E.; Onibokun, A. C.; Oluwatosin, O. A.
Globally, the devastation that befalls women diagnosed of breast cancer remains inestimable. Early detection remains a major effective approach that should be employed to combat the disease. The issue of concern, however, is whether women in the rural underserved areas are aware of these early detection methods. This study was designed to assess rural women’s awareness and knowledge of breast cancer and their screening practices. The study was a descriptive cross-sectional study utilizing self developed structured questionnaire. Reliability of the instrument was determined and alpha correlation values range between 0.81 and 0.95 for the different components of the questionnaire. Data was processed using descriptive analysis and associations tested with Chi-square at 5% level of significance. The results of the findings showed that 52.7% of the women had adequate knowledge about breast cancer risk factors and symptoms. Regarding the women’s awareness about breast cancer screening methods, 52.8 and 51.7% of women have heard about Breast Self-Examination (BSE) and Clinical Breast Examination (CBE) respectively. However, few numbers of respondents (3.9%) were aware about mammography and these are people who did it for the purpose of diagnosing breast problem. Majority of the women (72.8%) did not practice BSE which is the most readily available screening method. Considering the lack of sophisticated diagnostic technology such as mammography for breast screening in the rural areas, BSE provided a unique opportunity for the women to be breast aware and to identify breast problems which may constitute danger to their health in the future. Health care professionals, most especially those at the primary health care level, should enhance the women’s skills to use this simple procedure effectively to promote their health
Breast and cervical cancers awareness and screening practices among rural women in Ona-ara Local government area, Ibadan, Nigeria
(2013-05) Ajayi, I. O.; Onibokun, A. C.; Soyannwo, O. A.
The level of awareness and screening practices for breast and cervical cancers among rural women was investigated. Three of the six rural wards in Ona-ara LGA were selected by balloting and the three largest communities in each of the wards were purposively selected for the study.Structured interview was conducted among 276 consenting women aged ≥18 years in the households. Data were analysed using descriptive statistics and Chi-square test. Mean age of respondents was 36.5+12.6 years. Only 52(18.8%) and 11(4.0%) mentioned they knew something about breast and cervical cancers respectively. Knowledge of risk factors, cause and screening methods was poor irrespective of demographics. Only 15/52 (28.8%) and 3/52 (5.8%) who knew something about breast cancer mentioned clinical and Breast Self-Examination (BSE) respectively as screening methods for breast cancer. Half, 28/52 (53.8%) have ever practiced BSE and 9(17.3%) had clinical examination of the breast which was done as part of antenatal care or physical examination. The 24 respondents who did not examine their breasts mentioned they did not know they should (54.2%), don’t have problems with their breasts (54.3%), don’t know how to do it (37.5%) and think health workers should do it (33.3%). Only 4/11(36.4%) of those who knew something about cervical cancer mentioned vaginal examination for cervical cancer screening and only one (0.1%) respondent mentioned Pap smear. The poor level of awareness and screening practices for breast and cervical cancers among women in these rural communities emphasizes the need for community-based educational campaigns and provision of screening facilities in rural areas