review · Public Health
A systematic review and meta-analysis examining cervical cancer screening across Sub-Saharan Africa revealed an overall uptake rate of just 12.87 percent among 36,374 women evaluated across twenty-nine studies. Low participation in screening is linked to several distinct determinants. Knowledge regarding cervical cancer serves as a major driver, raising the odds of screening participation by nearly five times. Additional key predictors associated with screening uptake include educational attainment, patient age, HIV status, use of contraceptives, perceived personal susceptibility, and awareness regarding where screening services are located. Given that screening rates remain low across the region, public health outreach initiatives and targeted health promotion programmes addressing these specific knowledge and access barriers are needed to boost participation.
Cervical cancer is a critical health challenge, yet fewer than thirteen percent of women in Sub-Saharan Africa undergo screening. Identifying the primary drivers of screening attendance, particularly awareness and education, provides health bodies with clear targets for intervention. Addressing these barriers can directly inform preventative campaigns to reach underserved populations and ultimately reduce the disease burden across the region.
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The objective of this study is to estimate the pooled uptake of cervical cancer screening and identify its predictors in Sub-Saharan Africa. Systematic review and meta-analysis. We searched PubMed, EMBASE, CINAHL, African Journals OnLine, Web of Science and Scopus electronic databases from January 2000 to 2019. All observational studies published in the English language that reported cervical cancer uptake and/or predictors in Sub-Saharan Africa were initially screened. We assessed methodological quality using the Newcastle-Ottawa Scale. An inverse variance-weighted random-effects model meta-analysis was performed to estimate the pooled uptake and odds ratio (OR) of predictors with a 95% confidence interval (CI). The I2 test statistic was used to check between-study heterogeneity, and the Egger's regression statistical test was used to check publication bias. We initially screened 3537 citations and subsequently 29 studies were selected for this review, which included a total of 36,374 women. The uptake of cervical cancer screening in Sub-Saharan Africa was 12.87% (95% CI: 10.20, 15.54; I2 = 98.5%). A meta-analysis of seven studies showed that knowledge about cervical cancer increased screening uptake by nearly five times (OR: 4.81; 95% CI: 3.06, 7.54). Other predictors of cervical screening uptake include educational level, age, Human Immune deficiency Virus (HIV) status, contraceptive use, perceived susceptibility and awareness about screening locations. Cervical screening uptake is low in Sub-Saharan Africa as a result of several factors. Health outreach and promotion programmes to target these identified predictors are required.
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DOI: 10.1016/j.puhe.2021.04.014
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