A total of 457 married women aged 18-60 years, who referred to health centers in Khorramabad city, were studied in terms of the screening status of cervical cancer and factors related to it. The mean age of the participants in the study was 36.1±9.9.  Most participants (35%) were in the age range of 30-39 years. The majority of the research participants had academic education (57.3%). Considering the occupational status, 59.3% of the research participants were housekeepers. About 88.2% and 11.8 % of the studied persons lived in urban and rural regions, respectively (Table 2).

About 4.4% of participants had a history of regular smoking. Three (3.3%) of the study participants reported a history of cervical cancer. The first-degree relatives' (mother and sister) history of cervical cancer was reported by 15 (3.3%) participants. The age of onset of menstruation was 13 years and over in 77.25% of participants. Of the total participants in the study, 63 (13.8%) had menopause and the age of menopause in the majority of them was 45-49 years.

Of the total persons under coverage, 78.1% reported having a history of pregnancy and childbirth. The age of the last pregnancy in women with a history of pregnancy was in most cases (30%) between 30 and 34 years. The majority of participants (39.4%) reported to be below 20 years of age at first marriage. About 66.7% of the participants reported having a history of taking a Pap smear test at least once. The age of the first Pap smear in those who had a history of Pap smear was 35 years and over in most cases (34.4%). The frequency of Pap smear was once in the majority of participants with a history of Pap smear test (28.9%). The majority of participants with a history of Pap smear (31.8%) underwent Pap smear screening annually (Table 1). The average number of Pap smears in the subjects was 3.48 times. The minimum number of Pap smears was 1 and the maximum was 16 times. The mean number of Pap smears performed by women under study was 3.48+3 times. The minimum and the maximum number of Pap smears was reported 1 and 16, respectively.

The frequency distribution comparison of cervical cancer screening status is shown in Table 2 by demographic characteristics of study participants. According to the results shown in this table, statistically significant differences between the age groups were found in frequency distribution of performing cervical cancer screening (pv<0.001). No statistically significant differences in frequency distribution of performing cervical cancer screening (pv=0.734) were observed between marital status groups.

Considering the relationship between the education level and performing cervical cancer screening in the study participants, only 38.1% of illiterate individuals and 48.4% of the individuals with guidance school education and lower had a history of screening for cervical cancer, while 74.7% of the individuals with academic education reported they had a history of Pap test at least once. According to the Chi-square test, this difference was statistically significant (pv<0.001). Moreover, the difference in the frequency distribution of performing cervical cancer screening was statistically significant between the occupational groups. The highest and the lowest rate of screening was observed in employees (76.4%) and self-employed women (62.1%), respectively. The difference in the frequency distribution of performing cervical cancer screening was also statistically significant in terms of the place of residence (Table 2). The difference in the frequency distribution of performing cervical cancer screening was statistically insignificant between the participants in terms of the first-degree relatives' history of cervical cancer (pv=0.595), self-previous history of cervical cancer (pv=0.212), and history of smoking (pv=0.43).

Hamedan, and 49.4% of women in Tabriz reported that they had a history of taking the test at least once [11-13]. Perhaps one of the reasons for the higher percentage of taking a Pap smear test in the present research compared to other studies is due to the implementation of Iran’s Package of Essential Noncommunicable Diseases (IraPEN) Program. This program was implemented widely in Iran over recent years. One component of IraPEN program is cervical cancer screening for high risk 30-59-year-women or those with suspicious clinical symptoms. These women are identified and presented to the predetermined centers for cervical cancer screening. The situation is similar in other developing countries as well such that in a study in Rwanda in 2017, only 13.3% of asymptomatic women were referred for screening [14]. In a study by Assoumou et al. in 2015, out of 27.9% of participants who had heard of Pap smear test, only 65.1% had taken the test. They reported that the most important reason for this low frequency is that the women lacked the knowledge about cervical cancer screening importance and necessity [15]. Of all women who took a Pap smear in the present study,

about 29% had taken the test only once, and only one-third of those who had taken the test had repeated it at standard intervals [10]. In a study in 2015 in Qom, Mohebi et al. found that 51.87% of participants had irregularly participated in cervical cancer screening programs [16]. In other countries, however, the results of repeating the Pap test at standard intervals were inconsistent. For example, 48.8% of women in a study by Assoumou et al. had taken the test once, 41.5% 2-3 times, and 9.8% more than three times [15]. Moreover, in their study in 2017 in the United States, Akinlotan et al. found that 46% of women did not have a history of performing cervical cancer screening over the past year [17]. However, unlike the present study, the majority of women in Chorley et al.’s study had participated in the screening program at least once [18]. Moreover, in a cross sectional study in the United States, Kasting et al. found that 84% of their research participants had taken a Pap test over the past 3 years [19]. The reason for the inconsistency with our study can be attributed to the participants’ high level of awareness and different socio-economic and cultural conditions of our country as compared to the above mentioned countries.  In this study, the age of the first Pap test in most cases was 25-29 years and the time period between marriage and the first Pap test was less than 3 years in the majority of cases, but about one-third (36%) of participants reported that the time period between their marriage and the first Pap test was more than 5 years. The mean age of the first Pap test and the time period between the marriage and the first test in Sharifi et al.’s study in Asadabad was 26.4±6.5 and 5.2±6.9 years, respectively [10]. The higher frequency of taking the test in younger women seems to be due to more referrals to comprehensive health centers to receive maternal and child services.  Cervical cancer screening status in this study varied based on the participants age, education level, occupation, and place of residence, and the highest frequency of taking a Pap smear test was observed in women with academic education. In a study by Gu et al. in 2013, the majority of women who were willing to undergo screening in the future were married and had academic education [20]. Usually, women with higher education acquire further information about health-related screening behaviors through various media, especially the Internet. In the present research, the highest screening frequency was related to the age group of 30-39 and above 40 years, which had a statistically significant difference with that of the 30-year-old women. The reason can be attributed to the issue that women in the older age group pay more attention to their health status and adopt health-related behaviors.  In our study the screening frequency was higher in employees compared to women in other jobs.

In another study in 2017, Mbachu et al. found that following education about screening, the rate of performing screening increased more in employees [21]. Moreover, in a study in 2013, Demirtas et al. found that 50% of employees had taken a Pap smear test over the past 6 months and the employees faced fewer barriers to taking the test [22]. Moreover, the findings of this study showed that the most important reasons for not taking or irregularly taking a Pap test were being unaware of the importance and necessity of taking the test, having no opportunity to take the test, not paying attention to their health, fear of pain when undergoing the test, etc. therefore, the level of awareness and subsequently the screening rate can be increased in the community's women with proper educational programming at different levels, namely comprehensive health centers. Low awareness of women about the necessity of taking a Pap smear test can indicate the fact that there is no comprehensive education program in our country to inform about cervical cancer and Pap smear test and the maternal health care system lacks this debate. The results from this study indicated the undesirable performance of the community's women regarding taking a Pap smear test and awareness about its necessity, and it must be improved through education and making women sensitive to the issue and the benefits of early detection of the disease.  As healthcare personnel are an important source of information for women, their role in raising the women's awareness level is thus evident. By minimizing the cost of a Pap smear test and even making it free of charge for low-income or middle-income groups, community health care providers seem to be able to make it possible for all segments of society to take the test. Among limitations of this study was gathering data from women who referred to healthcare centers to receive services and future researchers had better collect data from the community level. This will lead to a more appropriate analysis of health behaviors.

From this study, we concluded that parasitism is a major health problem for camels because parasites get food and shelter from the host and cause disease. This research shows the high prevalence rate of nematyhelminthes of different species. In this research area, people use camels for meat and draught purpose. This study shows the high attack of gastrointestinal nematyhelminthes on camels and their production is used as food by people. For this purpose, it is suggested that deworming should be done properly after regular intervals with safe hand low cost effective anthelmintic drugs (Albendazole, levamizole and Ivermectin).  Farmers should be educated through the trained team of the Camel Center to assess the aspects of camel health, management and breeding. Due to the high cost of anthelmintic drugs and checkup fees of veterinarians poor owners do not connect with them and destroy the health of animals which causes a huge earning loss.