Spatial variation and associated factors of cervical cancer screening uptake among women aged 25 – 49 years in Sub-Saharan Africa, 2017-2023

Abstract

Background- Cervical cancer is the fourth most common cancer among women globally and the third most common cancer in developing countries. The Sub-Saharan African countries constitute almost 85% of the global burden of cervical cancer. It is a late-onset disease with an incubation period of up to 20 year. This makes it a preventable disease with early screening and treatment of precancerous lesions. However, the uptake of cervical cancer screening is very low in this region. The Spatial variation in cervical cancer screening has not been assessed in previous studies, and there is limited evidence on associated factors. Objective- To assess the spatial variation and associated factors of cervical cancer screening uptake among women aged 25 – 49 years in Sub-Saharan Africa, 2017-2023. Method- A community-based cross-sectional study was conducted in 10 Sub-Saharan African countries from 2017 to 2023. A weighted sample of 75,360 participants was analyzed. Spatial analysis was conducted on ArcGIS 10.7 to detect global spatial autocorrelation and identify hotspot areas with a high proportion of cervical screening non-uptake, and spatial scan analysis was done to identify the geographical location of clusters with a high rate of cervical cancer screening non-uptake. To identify associated factors of cervical cancer screening uptake, spatial multilevel logistic regression was performed in R version 4.3. Result- Cervical cancer screening uptake among 25-49-year-old women in the SSA region was 11.6% (95% CI: 11.3%–11.7%). The screening non-uptake was clustered (Global Moran’s I = 0.62). And the hot spots were located in most parts of Madagascar, Mauritania, Benin and Cote d'Ivoire. On spatial scan analysis, the primary window was located in Madagascar and Mozambique. Age, education, employment status, wealth, marital status, sex of household head, media exposure, parity, HIV testing, sexually transmitted infections, health insurance, modern contraceptive use, early sexual initiation, multiple sexual partners, healthcare visit in the last one year, and sub-region of SSA were statistically significant factors associated with cervical cancer screening uptake. Conclusion and recommendation- Cervical cancer screening uptake in the sub-Saharan Africa (SSA) region is low compared to the World Health Organization (WHO) target. It varies geographically in the Sub-Saharan Africa (SSA) region. Therefore, spatially targeted interventions should be implemented by stakeholders in the SSA region to enhance cervical cancer screening uptake. Individual and community-level factors were identified as associated with cervical cancer screening uptake.