Awareness and Knowledge about Cervical Cancer prevention methods among Tunisian women


Cervical cancer prevention
anti-HPV vaccine


Objectives: Epidemiological and biological arguments put papillomavirus infection (HPV) as a determining factor in the etiology of cervical cancer. The main aim of this study is to assess the knowledge, attitudes, and practices related to HPV prevention and cervical cancer screening among women living in the city of Sousse, Tunisia.


Methods: Five hundred self-administered questionnaires were distributed to randomly selected women in the general population. These questionnaires were administrated through direct interview of patients visiting the outpatient clinics in “Farhat Hached Hospital” and in the waiting area of the National Health Insurance Fund – CNAM from May to June 2016.


Results: Four hundred fifty-two participants took part in this study. The knowledge of the sexually transmitted infection as an etiological agent for cervical cancer was expressed by only 175 (38,7%)women and the correct recommended frequency for the Pap smear test by 176 (38,9%) of the respondents. Among all the participants, 125 (27,7%) had already received the Pap smear test at least once in a lifetime. Despite that, 363 (80,3%) of the respondents were interested in the anti-HPV vaccine for themselves, 387 (86%) for their daughters and 405 (90%) by the introduction of the vaccine in the national program of vaccination. 


Conclusion: The knowledge of HPV infection and cervical cancer among Tunisian women was found to be low to moderate and the anti-HPV infection was found to be moderate to high. These results are concordant with the results of other studies conducted in other MENA countries.


Khodakarami N, Clifford GM, Yavari P, et al. Human papillomavirus infection in women with and without cervical cancer in Tehran, Iran. Int J Cancer. 2012;131(2):E156-161. doi:10.1002/ijc.26488.

El-Kak F. Sexuality and sexual health: constructs and expressions in the extended Middle East and North Africa. Vaccine. 2013;31 Suppl 6. doi:10.1016/j.vaccine.2012.10.120.

Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. - PubMed - NCBI. Accessed June 4, 2015.

Global cancer statistics. - PubMed - NCBI. Accessed June 4, 2015.

Vaccarella S, Bruni L, Seoud M. Burden of human papillomavirus infections and related diseases in the extended Middle East and North Africa region. Vaccine. 2013;31 Suppl 6. doi:10.1016/j.vaccine.2012.06.098.

Seoud M. Burden of human papillomavirus-related cervical disease in the extended middle East and north Africa-a comprehensive literature review. J Low Genit Tract Dis. 2012;16(2):106-120. doi:10.1097/LGT.0b013e31823a0108.

Fisher WA, Laniado H, Shoval H, Hakim M, Bornstein J. Barriers to human papillomavirus vaccine acceptability in Israel. Vaccine. 2013;31 Suppl 8:I53-57. doi:10.1016/j.vaccine.2013.06.107.

Kim JJ, Sharma M, O’Shea M, et al. Model-Based Impact and Cost-Effectiveness of Cervical Cancer Prevention in the Extended Middle East and North Africa (EMENA). Compr Control HPV Infect Relat Dis Ext Middle East North Africa Reg. 2013;31, Supple(0):G65-G77. doi:10.1016/j.vaccine.2012.06.096.

Seoud M, Vaccarella S, El-Kak F, et al. Extended Middle East and North Africa: Summary Recommendations for the Prevention of Human Papillomavirus Infections and Related Cancers Including Cervical Cancer. Compr Control HPV Infect Relat Dis Ext Middle East North Africa Reg. 2013;31, Supple(0):G78-G79. doi:10.1016/j.vaccine.2012.11.078.

Hammas-Hlaili W, Marzouk-Aissi W, Fadhlaoui A, Bougatef S, Ben Alaya-Bouafif N, Ben Romdhane H. Dépistage du cancer du col de l’utérus en Tunisie : connaissances et pratiques. Rev Epidemiol Sante Publique. 2012;60:S104. doi:10.1016/j.respe.2012.06.223.

Tonguc E, Gungor T, Var T, Kavak E, Yucel M, Uzunlar O. Knowledge about HPV, relation between HPV and cervix cancer and acceptance of HPV vaccine in women in eastern region of Turkey. J Gynecol Oncol. 2013;24(1). doi:10.3802/jgo.2013.24.1.7.