Uptake of cervical cancer screening service and associated factors among age-eligible women in Ethiopia: systematic review and meta-analysis

Towards 90-70-90 targets: Individual and community level factors associated with cervical cancer screening among women of reproductive age in Tanzania: A multi-level analysis based on 2022 Tanzania demographic and health survey

INTRODUCTION

Cervical cancer is a major public health problem worldwide, and is mainly caused by human papillomaviruses. More than 90% of cervical cancer cases can be prevented by using a human papilloma vaccine and screening. Despite the ongoing global cervical cancer screening target, uptake remains unacceptably low in sub-Saharan Africa such as Tanzania. Although cervical cancer is the leading cause of mortality in Tanzania, evidence on the individual- and community-level factors associated with cervical cancer screening among women of reproductive age is scarce. Therefore, this study aimed to determine the individual- and community-level factors associated with cervical cancer screening among women of reproductive age in Tanzania.

METHODS

This study used data from the 2022 Tanzania Demographic and Health Survey (TDHS). A weighted sample of 15,140 women of reproductive age was included in this study. Given the effect of clustering and binary nature of the outcome variable, we used a multilevel binary logistic regression model. The adjusted odds ratio (AOR) with 95% Confidence Interval (CI) was statistically significant. Moreover, the model with the lowest deviance best suited the data.

RESULTS

The overall uptake of cervical cancer screening among Tanzanian women was 7.28% (95% confidence interval [CI]: 6.87%, 7.70%). Women's age (25-34, 35-49), women with primary, secondary, and higher educational levels, being employed, a high household wealth index, visiting health facilities in the last 12 months, owning mobile phones, urban residence, and southern highlands, Southern, and Zanzibar administrative zones, were significantly associated with cervical cancer screening.

CONCLUSION

Cervical cancer screening among women in Tanzania was low. Low uptake underscores the need for increased focus on addressing the coverage of the 2030 Sustainable Development Goals (SDGs). The study would help policymakers create programs that consider education, employment, visiting health facilities, mobile phones, wealth, residence, and administrative zones, which would make women undergo cervical cancer screening. Pointing to women living with low cervical cancer screening could help increase their uptake and achieve the targets of the national and World Health Organization.

Cervical Cancer Screening Practice and Associated Factors Among School Teachers in Bahir Dar City, North West Ethiopia: A Cross-Sectional Study

Background and Aims

Despite its prioritization by the World Health Organization, improving access to cervical cancer screening remains a challenge in Ethiopia. Educated individuals, particularly teachers, are viewed as key influencers in promoting healthy lifestyles among youth and can significantly contribute to cervical cancer prevention. However, there is a notable gap in research regarding cervical cancer screening practices among female educators in the studied region. This study aimed to assess the cervical cancer screening practices and associated factors among female school teachers in Bahir Dar, Ethiopia, 2024.

Methods

A school-based cross-sectional study was conducted from May 27 to June 28, 2024, involving 561 female school teachers in Bahir Dar City, using a stratified multistage sampling method. Data were gathered through a pretested structured questionnaire, entered in Epi-data version-4.6, and analyzed with SPSS version-23. Bi-variable and multivariable binary logistic regression analyses were performed, considering variables with p values < 0.05 as statistically significant. Multicollinearity was assessed, and the Hosmer-Lemeshow test evaluated the model's fit.

Results

The proportion of female school teachers practicing cervical cancer screening was 14.6% (95% CI: 11.57%-17.66%). Significant factors associated with screening included having more than one lifetime sexual partner (AOR = 2.96, 95% CI: 1.48-4.92), a history of gynecological examinations (AOR = 2.59, 95% CI: 1.28-5.23), a fair understanding of cervical cancer (AOR = 2.16, 95% CI: 1.12-4.17), a positive attitude toward screening (AOR = 3.23, 95% CI: 1.65-6.33), and a high perceived susceptibility to cervical cancer (AOR = 2.57, 95% CI: 1.34-4.93).

Conclusions

Cervical cancer screening rates among female school teachers in Bahir Dar City fall short of the HSTP-II target. Independent predictors of screening include having multiple sexual partners, a history of gynecological exams, knowledge of cervical cancer, attitudes toward screening, and perceived susceptibility. To improve these rates, initiatives should focus on raising awareness and fostering positive attitudes among teachers about cervical cancer and health-seeking behavior.

Integrated cervical cancer screening uptake and associated factors among women attending primary care services at public health centres in Addis Ababa, Ethiopia: a multicentre cross-sectional study

Background

Cervical cancer (CC) is a major health problem in Ethiopia. Integrated healthcare approaches have been suggested as a way to increase access to and utilisation of screening services. Limited data exists on integrated CC screening (CCS) uptake at the primary care facilities where most women access healthcare. This study aimed to determine integrated CCS uptake and associated factors among women attending primary care services at health centres (HCs) in Addis Ababa, Ethiopia.

Methods

A multicentred cross-sectional study design was conducted among 1366 women attending primary care services at HCs in Addis Ababa. A systematic random sampling method was used to reach the study participants. Sexually active women aged 30-49 years attending primary care services in HCs were included in the study. A multivariable logistic regression model, with Stata/MP V.17.0 software, was used to identify the factors associated with integrated CCS service utilisation at a p value<0.05. Findings were presented using adjusted OR (AORs) with 95% CI.

Result

Only 15.6% (95% CI: 13.7 to 17.6) of women used the CCS that was integrated into the primary care services that they initially sought. Being single (AOR: 4.10; 95% CI: 2.19 to 7.68), divorced (AOR: 2.33; 95% CI: 1.04 to 5.21), attending college and above (AOR: 5.86; 95% CI: 2.32 to 14.79), being in the richest wealth index (AOR: 2.76; 95% CI: 1.46 to 5.22), husband's sexual behaviour (AOR: 6.8; 95% CI: 4.09 to 11.21), having a favourable attitude towards CCS (AOR: 2.24; 95% CI: 1.52 to 3.29) and visiting postnatal clinic (AOR: 8.06; 95% CI: 2.33 to 27.8) were associated with utilisation of CCS services, while preference of a specific gender of healthcare provider (HCP) (AOR: 0.04; 95% CI: 0.02 to 0.13) was associated with non-utilisation of CCS.

Conclusion

The study found low integrated CCS uptake among women in Addis Ababa, influenced by factors like marital status, education, wealth, husband's sexual behaviour, attitude towards CCS, postnatal clinic visits and preferred gender of HCPs. Taking these factors into consideration by stakeholders could promote CCS utilisation.

Service-Delivery Models to Increase the Uptake of Non-Communicable Disease Screening in South-Central Ethiopia: A Difference-In-Differences Analysis

BACKGROUND

Screening for non-communicable diseases (NCDs) is a critical step for early detection and the prevention of consequent morbidity and mortality. To facilitate NCD screening, the Ethiopian Ministry of Health has developed screening guidelines. However, like other low- and middle-income countries, interventions to increase the uptake of NCD-screening services in Ethiopia remain ineffective. Thus, this study aimed to determine the effectiveness of service delivery models to increase NCD-screening service uptake in south-central Ethiopia.

METHOD

A health-facility-based quasi-experimental study design was employed to determine the effectiveness of providing a multiple-NCD-screening service in addition to social- and behavioral-change communication (SBCC) intervention to increase the uptake of NCD-screening services. The interviewer-administered structured questionnaire was adapted from previously published research and used to collect data during the baseline and end-line survey periods. A difference-in-differences analysis was used to determine the effectiveness of the intervention.

RESULTS

Compared with routine care, the availability of a multiple-NCD-screening service, together with SBCC intervention, was found to significantly increase the uptake of cervical cancer screening, clinical breast examination, blood pressure measurement, and blood glucose-measurement services, by 18, 9, 44 and 23 percent points, respectively. However, the availability of a multiple-NCD-screening service without SBCC intervention increased clinical breast-examination service uptake by 9% point and blood glucose-measurement service uptake by 18% point without increasing the uptake of cervical cancer-screening or blood pressure-measurement services.

CONCLUSION

The integration of multiple-NCD-screening services accompanied by SBCC intervention that promotes them is an important approach for improving the uptake of NCD-screening services.

Determinants of cervical cancer screening among women of childbearing age in four sub-Saharan African countries: insights from large population surveys

BACKGROUND

Cervical cancer is the most common cause of cancer-related mortality among women in Africa. Cervical cancer screening in women is associated with decreased incidence and mortality of cervical cancer. There is a dearth of recent data regarding the prevalence and associated factors of cervical cancer screening in sub-Saharan Africa. Therefore, this study is intended to determine the prevalence and associated factors impacting cervical cancer screening among women in four sub-Saharan African countries.

METHODS

Data from the recent demographic and health surveys of four countries in sub-Saharan Africa conducted between 2022 and 2023. Multilevel mixed-effects logistic regression was used to determine the factors associated with the outcome variable. Variables with a p-value < 0.05 were declared statistically significant.

RESULTS

The prevalence of cervical cancer screening among women of childbearing age in four sub-Saharan African countries was 8.90% (95% CI: 8.67%, 9.13%). At the individual level, being older, educated, non-breastfeeding, employed, wealthier, sexually active, using contraceptives, having media exposure, visiting healthcare facilities in the last 12 months, and residing in urban areas were associated with higher odds of cervical cancer screening. At the community level, being from communities with a high level of literacy and media exposure increases the odds of cervical cancer screening among women in sub-Saharan Africa.

CONCLUSION

The prevalence of cervical cancer screening among childbearing-age women was found to be low. To improve cervical cancer screening practices among women of childbearing age, it is therefore advised to support women's empowerment, mass media campaigns, and regular visits to healthcare facilities.

Cervical cancer screening utilization and associated factors among women living with HIV in Ethiopia, 2024: systematic review and meta-analysis

BACKGROUND

Cervical cancer is a significant global health challenge, with the majority of cases and deaths occurring in low-resource regions like sub-Saharan Africa including Ethiopia. Women living with HIV (WLHIV) in this area face a six-fold higher risk of cervical cancer compared to women living without HIV Both the availability of screening services and their utilization remain low, particularly among WLHIV, hindering efforts to reduce the cervical cancer burden in this vulnerable population.

OBJECTIVE

This study aimed to synthesize the current research on the prevalence of cervical cancer screening utilization and the associated factors among women living with HIV in Ethiopia.

METHOD

We conducted a comprehensive systematic review and meta-analysis, searching databases such as Google Scholar, PubMed, and the Cochrane Library for relevant studies published from 2015 up to 2023 and the search period for these relevant articles was from April 1 up to April 30, 2024. Data from included studies was extracted, organized in Excel, and then analyzed using STATA 17. The overall effect across all studies was calculated using a random-effect model. Potential publication bias and heterogeneity in the results between studies were assessed using Egger's test, forest plot, and I² statistic, respectively.

RESULT

According to the systematic review and meta-analysis, the overall prevalence of cervical cancer screening utilization among women living with HIV in Ethiopia was 24% (17 - 32%). Several factors were independently associated with cervical cancer screening utilization, including age (40-49) years (OR = 3.95, 95% CI: 3.307-4.595), age (18-29) years (OR = 5.021, 95% CI: 1.563-9.479), education level greater than college (OR = 3.293, 95% CI: 1.835-4.751), having good knowledge (OR = 3.421, 95% CI: 2.928-3.915), early initiation of sexual intercourse (OR = 3.421, 95% CI: 2.928-3.915), awareness of cervical cancer (OR = 3.551, 95% CI: 2.945-4.157), having information about cancer (OR = 3.671, 95% CI: 2.606-4.736), CD4 count less than 500 cell/mm3 (OR = 4.001, 95% CI: 1.463-6.539), government employee (OR = 5.921, 95% CI: 1.767-10.076), and perceived susceptibility (OR = 2.950, 95% CI: 2.405-3.496).

CONCLUSION

This systematic review and meta-analysis show that the pooled prevalence of cervical cancer screening rates among Women living with HIV in Ethiopia is notably low, at only 24%. Factors influencing service utilization include age, education level, knowledge about cervical cancer, early sexual initiation, awareness of the disease itself, and HIV-related conditions. To enhance screening rates, interventions must target these factors and address systemic healthcare deficiencies.

Prevalence of human papillomaviruses in self-collected samples among women attending antenatal care in Ethiopia: a cross-sectional study

Cervical cancer is the second most commonly diagnosed cancer in women in Ethiopia. However, data are limited on the prevalence of human papillomavirus (HPV) genotypes. Self-sampled vaginal lavages were obtained consecutively from 783 women attending 7 health facilities across Ethiopia. Genotype prevalence was assessed by Multiplex-Papillomavirus-Genotyping which detects and individually identifies 51 genotypes and 3 subtypes. Genotype-specific prevalence was described and associations with known risk factors were analysed. The overall HPV prevalence (age range 18-45) was 33.1% (95% confidence interval (CI) 29.8-36.4). The prevalence of HPV was different in the rural and urban population with 17.6% (95%CI 11.6-23.7) and 36.8% (95%CI 33.1-40.6) (p < 0.001 chi-square test), respectively. The most common high-risk types were HPV 16 (6.6%), followed by HPV 52 (4.3%), 51 and 39 (both 2.9%). Urban women compared to rural women had a higher risk of being HPV positive (odds ratio 2.36 (95% CI 1.47-3.79; p < 0.001). Age at sexual debut ≤15 years and polygamous husband (in urban women) also increased the risk of being HPV positive nearly two-fold. The high prevalence of hr-HPV in Ethiopian women in the reproductive age group shows the need for screening programs. The nonavalent HPV vaccine covers the most prevalent hr-HPV genotypes as found in this study and can therefore be used effectively. Since antenatal care is the best-utilised health service, implementing self-sampled vaginal lavage could be an opportunity for screening in this age group. Screening algorithms and triage still need to be defined to avoid over-treatment in these women.

Male support for cervical cancer screening in Debre Berhan City Ethiopia a community based cross sectional survey

Male partner involvement strongly influences a woman's decision to undergo cervical cancer screening. Women of low socioeconomic status are disproportionately affected by cervical cancer. Women living in low-and middle-income countries often encounter resistance from their partners regarding participation in cervical cancer screening. The lack of men's support for sexual and reproductive health programs, including cervical cancer screening, creates a barrier to women's utilization of health services. To assess Ethiopian men's awareness, knowledge, perceptions, and attitudes toward cervical cancer screening and their support to their female partners during screening. A community-based cross-sectional survey was conducted from June 20, 2023, to August 04, 2023. A multistage sampling procedure was used to recruit 614 male survey participants. Descriptive statistics were used to summarize sociodemographic data. Univariate and multivariate regression analyses were performed to measure the associations between the dependent and independent variables. A p-value of less than 0.05 was considered statistically significant. In this survey, 58.5% (359) of participants supported their partners for cervical cancer screening. More than half 55.9% (343) of the participants had an awareness of cervical cancer disease and 47.2% (290) participants knew the risk factors associated with the development of cervical cancer. In addition to that, 66.8% (410) of men have a positive attitude towards screening and encourage their wives to get screened if they notice symptoms of cervical cancer. Regarding the perceptions of cervical cancer, 37.0% (227) of male participants believed that their female partners were at risk of developing the disease, while 38.3% (235) of men believed that cervical cancer screening was only necessary if the woman showed symptoms. Completion of higher education (AOR = 3.75, 95% CI 1.60-8.79, p = 0.002), living with other people (AOR = 0.09, 95% CI 0.03-0.29, p < 0.0001), not being tested for HIV (AOR = 0.26, 95% CI 0.10-0.74, p = 0.011), and having information about cervical cancer (AOR = 3.33, 95% CI 1.36-8.15, p = 0.009) were statistically significantly associated with men's support for their partners in cervical cancer screening. Men's awareness, knowledge, and perceptions of cervical cancer screening were low. On the other hand, men have a positive attitude towards screening and encourage their wives to get screened if they notice symptoms of cervical cancer. This survey will serve as a basis for the development of further strategies and action plans to promote and support male participation in cervical cancer screening in Ethiopia. This can be achieved through the development of strategic plans, including public campaigns, raising awareness among social and community leaders, involving non-governmental organizations focusing on women's health, and community education.

Factors associated with human papillomavirus infections among women living with HIV in public health facilities in Western Oromia, Ethiopia

BACKGROUND

Human Papillomavirus infection (HPV) is among the most common sexually transmitted infections with the highest incidence and prevalence worldwide. HPV has been established as the main cause of cervical cancer and remains a public health problem globally. In Western Oromia, Ethiopia cervical screening remains a major issue because of limited resources, and shortage of HPV testing technology. As a result, the prevalence of HPV and associated factors remain unknown among HIV-positive women. This study aimed to assess the prevalence of HPV and associated factors among women living with HIV attending Antiretroviral Therapy (ART) services in public health facilities of East Wollega and West Showa Zones, Ethiopia, 2022.

METHOD

Using a cross-sectional study design, a total of 415 women ≥ 18 years old were enrolled using systematic random sampling from five public health facilities. Cervical specimens were collected by a trained nurse from April 01 2022, to May 30, 2022, and tested at Nekemte Public Health Research and Referral Molecular Biology, a certified/accredited laboratory for HPV-DNA Polymerase Chain Reaction by expertise using Abbott m2000rt-PCR assays. Finally, Epi data version 4.6 was used for data entry and SPSS version 24.0 were used for data cleaning and analysis, and frequencies and prevalence of HPV were computed. Variables were identified using the multivariable model and statistically significant associations of variables were determined based on the adjusted odds ratio (AOR) with its 95% CI and P-value < 0.05 to determine the strength of association.

RESULT

The prevalence of HPV was 30.4% [95% CI: 26.0, 34.9]. Of HPV-infected women, 11.9% were positive for HPV-16, 9.5% for HPV-18, and 65.9% were positive for other hr-HPV . The odds of HPV infection among women aged beyond 48 years are 2.85 times the odds of HPV among people who were aged 18-27(AOR = 2.85, 95% CI: 1.16, 5.58). The odds of HPV infection among women who had three or more sexual partners is 4.12 times the odds of HPV infection among women with a single sexual partner(AOR = 4.12, 95% CI: 2.34-8.62). The odds of HPV infection among women who didn't use condom during sexual intercourse are 4.73 times the odds of HPV among women who used condom during sexual intercourse. (AOR = 4.73, 95% CI: 1.98-9.33). The odds of HPV infection among women who had history of is 4.52 times the odds of HPV infection among women with no history of abortion. [AOR = 4.52, 95% CI: 2.04, 6.89] The odds of HPV infection among women with history of Sexually Transmitted Infection (STI) 3.62 times the odds of HPV among women with no history of STI (AOR = 3.62, 95%CI: 1.75, 5.83). The odd of HPV among women with abnormal vaginal discharge is 3.31 times the odds of the disease among women with normal vaginal discharge [AOR = 3.31, 95% CI: 2.87,7.35).

CONCLUSION AND RECOMMENDATION

The prevalence of HPV infection among HIV-infected women was high in the study area. Given the above-associated factors, we recommend that the stakeholders integrate HPV prevention strategies into HIV /AIDS services. Furthermore, the study has provided essential information about the HIV link with hr-HPV infections, which may explain the high prevalence among HIV-infected women. This can contribute to policy development and planning of prevention strategies incorporating HPV infection prevention especially among youth and HIV-infected people.

Parental willingness to vaccinate their daughters against human papilloma virus and its associated factors in Woldia town, Northeast Ethiopia

Background

The cells of the cervical epithelial wall are the source of the malignant tumor caused by the human papilloma virus (HPV) known as cervical cancer. In 2018, Ethiopia implemented the HPV vaccine specifically targeting girls aged 9-14 years. This vaccination initiative serves as an effective preventive measure against cervical cancer, provided that parents express a positive inclination to have their daughters vaccinated as part of the program.

Objective

The aim of the study was to assess parental willingness to vaccinate their daughters against human papillomavirus and its associated factors in Woldia town, Northeast Ethiopia.

Methods

A community-based cross-sectional study was conducted among 414 parents of daughters aged 9-14 years between 10 and 25 January 2023. Respondents were selected by a systematic sampling method and a face-to-face interview was conducted to collect data. Data were entered into Epi Data version 4.6 and exported to SPSS version 25 for analysis. Multivariable analyses were used to examine the association between dependent and independent variables. The adjusted odds ratio (AOR), 95% confidence interval (CI), and p-value <0.05 were used to determine statistical significance.

Results

A total of 410 study participants with a response rate of 99% were included in the study, and approximately 72.9% (95% CI: 68.3-77.2) of them were willing to vaccinate their daughters. This study found that parents with a family history of cervical cancer screening (AOR = 3.27, 95%; CI = 1.38-7.74), secondary and above educational status (AOR = 2.72, 95% CI = 1.29-5.73), good knowledge of the human papilloma virus vaccination (AOR = 3.00, 95% CI = 1.70-5.28), and favorable attitude toward the human papilloma virus vaccine (AOR = 4.40, 95% CI = 2.45-7.88) were significantly associated with parental willingness to vaccinate their daughters against human papilloma virus.

Recommendation

In this study, most parents were willing to vaccinate their daughters against human papilloma virus. The significant determinants of parental willingness to their daughter's human papilloma virus vaccination were family history of cervical cancer screening, level of education, and knowledge and attitude toward the human papilloma virus vaccine. Therefore, health information regarding the human papillomavirus vaccination with an emphasis on raising community awareness should be designed.

Uptake of cervical cancer screening and associated factors among HIV positive women attending adult art clinic at public hospitals in Addis Ababa, Ethiopia, 2022

BACKGROUND

Cervical cancer is the second most common malignancy in Ethiopia and first in some African countries. It is six times more likely to occur in positive cases of the human immunodeficiency virus than in the general population. If diagnosed and treated early enough, cervical cancer is both treatable and preventable. However, among Ethiopian women who test positive for HIV, the uptake of cervical cancer screening is low. Its determinant factors were not well studied in the study area. Hence, this study was aimed at filling this information gap.

OBJECTIVE

To assess uptake of cervical cancer screening services and associated factors among HIV-positive women attending an adult antiretroviral treatment clinic at public hospitals in Addis Ababa, Ethiopia, June 1-30, 2022.

METHODS

A cross-sectional investigation was carried out in a hospital. 407 participants in all were chosen using the systematic sampling technique. A pretested interviewer-administered questionnaire was used to collect the data from respondents. The data were entered into Epi data version 4.6 and exported to SPSS version 25 for analysis. Bivariable and multivariable logistic regression analysis was employed. Adjusted odds ratio with its 95% confidence interval and p value < 0.05 were used to estimate the strength and significance of the association.

RESULT

Among a total of 407 respondents, 238 (58.5%), 95% CI (53.5-63.3), HIV-positive women were screened at least once in the last five years. In multivariable analysis, age > 45 years old (AOR = 0.18, 95% CI: 0.053-0.644), number of children (3 children) (AOR = 0.19, 95% CI:0.036-0.979), perception of being susceptible to cervical cancer (AOR = 6.39, 95% CI: 1.79-22.74), knowledge of cervical cancer and its screening (AOR = 19.34, 95% CI: 7.87-47.75), and positive attitude towards cervical cancer screening (AOR = 8.06, 95% CI:3.62-17.91) were significantly associated factors with the uptake of cervical cancer screening.

CONCLUSION AND RECOMMENDATION

in this study, Age > 45 years, having less than three children, feeling susceptible, knowing about cervical cancer and screening, and having a positive attitude toward cervical cancer screening were significant factor of uptake of cervical cancer screening service. There is a need to strengthen the policy and health education on safe sexual practices and healthy lifestyles through information dissemination and communication to scale up screening service utilization.

Effectiveness of couple education and counseling on uptake of cervical cancer screening among women in Southern Ethiopia: a cluster randomized trial

Cervical cancer is a major public health problem worldwide. Women die of the disease due to low early screening practices and its detection at advanced stages particularly in developing countries. Therefore, this study aimed to determine the effectiveness of couple education and counseling on the uptake of cervical screening among women. The study employed random allocation of 16 clusters into two study arms. A total of 288 women participated in the study. Structured home-based education and counseling were provided to the intervention group, while the control group received standard of care. Surveys were completed at baseline and end line. This study demonstrated that the proportion of women who had been aware of cervical cancer and screening grew from 22.9 to 100%, participants' mean knowledge scores showed improvement from 3.18 to 11.99, and cervical screening uptake increased from 2.1% to 72.5% in the intervention group (p < 0.001). Also, the difference in differences of screening uptake between the study groups was statistically significant (p = 0.021).The study shows the effectiveness of the intervention package in improving the uptake of cervical screening in the study setting. Therefore, we recommend that creating awareness, increasing knowledge, and improving women's perceptions through structured home-based couple education and counseling is important to improve cervical screening uptake among the target women.

Adherence to Treatment and Follow-Up of Precancerous Cervical Lesions in Ethiopia

BACKGROUND

In Ethiopia, both incidence and mortality of cervical cancer are relatively high. Screening services, which were implemented during the past few years, are currently being expanded. The World Health Organization recommends patients with a positive VIA (visual inspection with acetic acid) result should immediately receive treatment followed by rescreening after 1 year as precancerous lesions can reoccur or become residential despite treatment.

MATERIALS AND METHODS

Screening logbooks dating between 2017 and 2020 were retrospectively reviewed in 14 health facilities of Addis Ababa and Oromia region. Data for 741 women with a VIA-positive result were extracted and those women were asked to participate in a questionnaire-based phone interview to gain insights about adherence to treatment and follow-up. Data were analyzed using descriptive methods and then fitted into 2 generalized linear models to test variables for an influence on adherence to follow up.

RESULTS

Around 13 800 women had received a VIA screening, of which approximately 820 (5.9%) were VIA positive. While over 90% of women with a positive screen received treatment, only about half of the treated patients returned for a follow-up examination. After treatment, 31 women had a VIA-positive re-screen. We found that educational status, age over 40, no/incorrect follow-up appointment, health facility-related barriers, and use of reminders are important drivers of adherence to follow up.

CONCLUSION

Our results revealed that adherence to treatment after VIA positive screening is relatively high whereas adherence to follow up recommendations still needs improvement. Reminders like appointment cards and phone calls can effectively reduce the loss of follow-up.

Utilization of cervical cancer screening and determinant factors among female nurses in selected public hospitals in Addis Ababa, Ethiopia

BACKGROUND

Cervical cancer is one of the top cause of death among childbearing women globally and public health issue for underdeveloped nations.It is the world's second most prevalent cancer among women. In 2018, 311,000 women died due to cervical cancer.Approximately 80 % of these deaths occurred in developing countries.However, there has been insufficient research on cervical cancer screening utilisation among Ethiopian nurses, despite the fact that nurses promote women's health and play a key role in cervical cancer education. As a result, evaluating utilization of cervical cancer screening among nurses is critical for program effectiveness.

OBJECTIVE

To assess the magnitude of utilization of cervical cancer screening and determinant factors among female Nurses in selected public hospitals in Addis Ababa, Ethiopia.

METHODOLOGY

An institutional-based cross-sectional study design was employed from October 1 to November 30, 2022. Data was collected using an interviewer-administered questionnaire. The data was entered into Epi data version 3.1 and then exported to SPSS version 22 for data management and analysis. Bivariate and multi-variable logistic regressions were employed to identify the predictor variables. Statistical significance was considered at P < 0.05 with adjusted odds ratio calculated at 95 % CI.

RESULT

The magnitude of utilization of cervical cancer screening among nurses working in selected public hospitals in Addis Ababa was 18.5 % (95 % CI: 14.2, 23.1). Having work experience > 8 years (AOR = 16.78; 95 % CI: 4.82, 58.44), history of STI (AOR = 53.72; 95 % CI: 14.18, 203.45) and having multiple sexual partners (AOR = 12.74; 95 % CI: 4.15, 39.11) were significantly associated with utilization of cervical cancer screening among female nurses.

CONCLUSION

The overall cervical cancer screening rate among female nurses was low compared to the WHO strategy for cervical cancer elimination, which asks for 70 % of women worldwide to be checked for cervical illnesses regularly by 2030. According to the study findings, respondents' work experience, STI history, and having multiple sexual partners influenced their utilization of cervical cancer screening among nurses. To boost the utilization of screening services, female nurses should place a strong emphasis on maintaining screening awareness through education and knowledge sharing.Finally, we recommend future researchers to do comparative study design to draw any scientific and credible conclusions.

Barriers Associated with Adherence to Cervical Cancer Screening Among Women Living with HIV in Nkhatabay District, Malawi: A Mixed-Methods Study

Background

Cervical cancer (CC) incidence among Women Living with HIV (WLHIV) is high compared to the general population of women. As such, the Malawi National CC guideline recommends yearly screening among WLHIV. However, only 15.9% of WLHIV were screened nationally using Visual Inspection with Acetic Acid (VIA) by 2015 and there is no data regarding adherence and barriers to yearly screening. This study assessed adherence levels and associated barriers to yearly Cervical Cancer screening (CCS) among WLHIV.

Methods

A cross-sectional concurrent mixed-method study was conducted at Nkhatabay District Hospital (NBDH) and Chintheche Rural Hospital (CRH) in Malawi. A sample of 205 WLHIV participated in quantitative strand and in-depth interviews were conducted with 10 health care workers and 10 WLHIV. Quantitative data were analysed using STATA version 16. Pearson's chi-square test and Multivariate logistic regression analysis were performed. P value was set at 0.05. Qualitative data were analysed deductively following six steps of thematic analysis.

Results

Only 5.4% (n=11) of the participants had been screened as required. Women aged ≥45 had 4 times the odds of being screened for CC compared to ≤30 (OR 4.18, 95% CI 0.65-26.8). WLHIV on ART > 10 years had more than 5 times the odds of being screened (OR 5.9, 95% CI 1.08-33.19) compared with those on ART <3 years. Use of male service providers (p =< 0.001), fear of the VIA procedure (p = <0.001) and lack of interest (p = <0.015) were significant barriers to adherence. Qualitative findings revealed a lack of knowledge regarding CCS protocol and the use of male providers.

Conclusion

WLHIV face many challenges in accessing CCS and adherence to yearly CCS is very low. There is urgent need for targeted community awareness, scaling up of HPV tests and incorporation of CCS into routine integrated outreach services.

Assessment of knowledge and perceptions of human papillomavirus vaccine and its determinants among women who have eligible daughters in Debre Berhan City, Ethiopia: a cross-sectional study

Introduction

Globally, cervical cancer(CC) is the second most commonly diagnosed cancer and the fourth leading cause of cancer-related deaths in women. Human papillomavirus (HPV) infection is the leading cause of CC. Persistent infection with HPV accounts for 90% of all CC cases. The human papillomavirus vaccine has the great potential to prevent HPV-related infections for millions of women and men. The current study aimed to assess knowledge and perceptions towards the HPV vaccine and its determinants among women who have eligible daughters in Debre Berhan City, Ethiopia.

Methods

A cross-sectional study was conducted from April 2, 2023, to May 15, 2023. A multistage sampling procedure was used to recruit 607 women participants. Descriptive statistics were used to summarize socio-demographic data. Univariable and multivariable binary logistic regression analyses were performed to measure the associations between the dependent and independent variables. A p-value of <0.05 was considered statistically significant.

Results

More than three-fourths of the participants, 479 individuals (80%) were currently married, and 243(40.1%) had a diploma or higher education level. Of 456(75.12) participants reported, they had information about cervical cancer. For 449(73.9%) of the participants, television was the main evidence. The majority of 352(59.99%) participants knew the HPV vaccine could be offered to a female child aged 9-14 years old. Only 215(35.4%) participants think the HPV vaccine was safe and effective. Women who had a degree and above educational level were about 9 times more likely to have good knowledge about the HPV vaccine than study participants who did not read and write (AOR=9.21; 95% CI=2.82-12.16; p=0.004). Women who did not have information about the HPV vaccine before this study were about 80% less likely to have a positive perception of the HPV vaccine than participants who had earlier information about the HPV vaccine (AOR=0.8; 95%CI=0.63-0.49; P=003).

Conclusion

Women had poor knowledge and perceptions about the HPV vaccine. Maternal marital status, age, and having information about the HPV vaccine were the only predictors of women's knowledge of the HPV vaccine.

Improving cervical cancer continuum of care towards elimination in Ethiopia: a scoping review

BACKGROUND

Cervical cancer is the second-leading cause of death among all cancers in Ethiopia. Ethiopia plans to eliminate cervical cancer as a public health problem by 2030, following the World Health Organization's call for action. A scoping review was conducted on the status of the cervical cancer continuum towards elimination in Ethiopia.

METHODS

We searched articles in PubMed, Scopus, and Google Scholar. All studies conducted on cervical cancer in Ethiopia, from first date of publication to March 15, 2023, type of article, or language of publication, were included. However, conference abstracts, commentaries, and letters to the editors were excluded. We used EndNote X9 software to merge articles from different databases and automatically remove duplicates. Screening of titles, abstracts, and full texts was performed independently by two co-authors. The cancer care continuum was employed as a framework to guide data synthesis and present the findings.

RESULTS

Of the 569 retrieved articles, 159 were included in the review. They found that most of the articles focused on knowledge, attitude, and practice. However, there were few studies on health-seeking behavior, perception and acceptability of cervical cancer services, as well as the availability and readiness of a screening program. The review identified inadequate knowledge, attitude, and perception about cervical cancer, and highlighted that screening for cervical cancer is not widely utilized in Ethiopia. Knowledge, attitude, education status, and income were repeatedly reported as precursors influencing cervical cancer screening. Most studies concluded that there is a high prevalence of precancerous lesions and cervical cancer, as well as high mortality rates or short survival times. The review also identified significant heterogeneity in findings across time and geographic settings within each component of the cancer care continuum.

CONCLUSIONS

Overall, there is inadequate knowledge, perception, health-seeking behavior, screening, and treatment services, indicating that the country is falling behind its targets in eliminating cervical cancer, despite the availability of effective interventions and tools. We argue that implementation research is necessary to identify implementation issues, challenges, and strategies to scale up both primary and secondary prevention services. By doing so, Ethiopia can address cervical cancer as a public health problem and work towards its elimination.

Utilization and associated factors of cervical cancer screening service among eligible women attending maternal health services at Adare General Hospital, Hawassa city, Southern Ethiopia

This particular study aimed to assess the magnitude of cervical cancer screening service utilization and associated factors among eligible women attending maternal health services at Adare General Hospital, Hawassa city, Southern Ethiopia, 2022. Institution-based cross-sectional study was conducted using a systematic random sampling technique among 299 eligible women from March 1- to April 30, 2022. Data was collected through face-to-face interviews using a pretested structured questionnaire. Data was also entered into Epi-data version 3.1 and exported to SPSS version 25.0 for analysis. Both bivariable and multi-variable logistic regression model was fitted and the presence of association was declared at a p value of less than 0.05. The strenth of association was determined using adjusted odd ratios together with a 95% confidence interval. Among interviewed women, 19.8% (95% CI 15.5%, 24.0%) of them had screened for cervical cancer at least once within the past five years. Place of residence (AOR = 0.37; 95% CI 0.14-0.96), modern contraception use (AOR = 2.49; 95% CI 1.04-5.96), discussion about cervical cancer with healthcare providers (AOR = 2.34; 95% CI 1.08-5.07), and comprehensive knowledge about cervical cancer (AOR = 0.25; 95% CI 0.10-0.62) were independently associated with cervical cancer screening service utilization. The study depicted relatively low utilization of cervical cancer screening services. The women were more likely to utilize the service if they are dwellers of urban residences, used modern contraception, had discussion about cervical cancer with healthcare providers, and had good comprehensive knowledge about cervical cancer. Thus, women living in rural areas should get more emphasis on cervical cancer prevention strategies, and improving consistent discussion about cervical cancer with clients visiting for maternal health services by healthcare providers in health facilities also be recommended.

Factors influencing the uptake and utilization of cervical cancer screening services among women attending public health centers in Addis Ababa, Ethiopia: mixed methods study

BACKGROUND

Cervical cancer is the second cause of cancer deaths among Ethiopian women. Despite multifaceted government efforts, the uptake and utilization of cervical cancer screening remain very low. This study aimed to assess factors influencing the uptake and utilization of cervical cancer screening at public health centers in Addis Ababa.

METHODS

A convergent parallel mixed-method study was employed to collect data through eight focus group discussions with 66 women purposively recruited from outpatient clinics, and cross-sectional face-to-face exit interviews with 80 women attending cervical cancer clinics in four high-patient volume health centers. The group interviews were tape-recorded, transcribed in Amharic, translated into English, and a thematic analysis approach was used in the analysis. Exit interview data were collected using a structured questionnaire in the Open Data Kit tool on an android tablet. STATA version 17 was used for descriptive and inferential data analyses. Statistical significance was set at p < 0.05.

RESULTS

The majority of focus group discussion participants had lack of knowledge of cervical cancer and its screening services. The major barriers to the uptake of screening were inadequate public awareness, fear of the procedure, embarrassment, provider's gender, lack of male partner support, and childcare. Women aged 40 years and above were 13.9 times more likely to utilize cervical cancer screening than those under 30 years (AOR = 13.85; 95% CI: 1.40, 136.74). There was a strong preference for a female provider (AOR = 7.07; 95% CI: 1.53, 32.75) among women screened after attending antiretroviral therapy clinics and those screened due to abnormal vaginal bleeding than women referred from family planning clinics (AOR = 6.87; 95% CI: 1.02, 46.44). Safety of screening was negatively associated with women aged 30-39 (AOR = 0.045; 95% CI: 0.003, 0.696), and those who attended primary education, and secondary education and above, (AOR = 0.016; 95% CI: 0.001, 0.262), and (AOR = 0.054; 95% CI: 0.004, 0.724), respectively.

CONCLUSIONS

The study identified low public awareness, inadequate provider preference, safety concerns, and poor male partner support for cervical cancer screening. We recommend the decision-makers enhance public messages, maintain provider choices, ensure safety, and engage males to improve the uptake and utilization of cervical cancer screening.

Cervical Cancer Screening Utilization and Barriers to Uptake in Ethiopia: An Umbrella Review

BACKGROUND

Cervical cancer (CCa) is the second most common type of cancer and a leading cause of death among adult women in Ethiopia. However, at the moment, there is a lack of evidence that can be generalizable as a whole to the country regarding the uptake of cervical cancer screening.

OBJECTIVE

The aim of this review was to assess the pooled estimated uptake of CCa and to identify the major barriers to cervical cancer screening (CCS) uptake among adult women in Ethiopia.

METHOD

The review protocol was registered at the International Prospective Register of Systematic Reviews (PROSPERO) with a registration number of CRD42022353954. The data were searched electronically using Google Scholar, PubMed, Medline, and Web of Science search engines. The heterogeneity of the literature was assessed using Cochran's (Q) test and Higgin's and Thomson's (I2) statistic. The Rosenthal approach, Fail-safe N method, Egger's test with a P-value <0.05, and funnel plot symmetry were used to detect publication bias. Random effect analysis was used to find out the pooled effect size. The Stata 17 software was used to perform analysis.

RESULT

The pooled estimated uptake of CCS was 13.08% (POR 13.08; 95% CI: 10.24, 15.93; I2 = 81.93%). Common factors associated with uptake of CCS were adequacy of knowledge (POR = 3.48; 95% CI: 2.74, 4.23; I2 = 0%), attitudes of women (POR = 3.51; 95% CI: 2.96, 4.07; I2 = 0%), and perceived susceptibility (POR = 4.03; CI: 2.68, 5.39; I2 = 46.38%). A slightly high degree of overlap of studies was observed.

CONCLUSION AND RECOMMENDATION

The pooled estimated CCS is low. Factors like adequacy of knowledge of CCa, attitudes of women, and perception of susceptibility among women showed a significant association with cervical cancer screening uptake. Creating a platform where women can get adequate and focused information about cervical cancer and screening is crucial.

Mothers' intention to vaccinate their daughters against human papillomavirus in NorthWest Ethiopia, using the theory of planned behavior

Human papillomavirus (HPV) is the second most common cause of cancer worldwide among females. HPV vaccination is highly protective against HPV infection and can reduce 56% of HPV infections. Therefore, the study aims to assess mothers' intention to vaccinate their daughters aged 9-14 years old against human papillomavirus in Debre Tabor town, Northwest Ethiopia, using the theory of planned behavior. A community-based cross-sectional study design was employed using the theory of planned behavior from November 1 to 30, 2022, in Northwest Ethiopia. A total sample of 449 study participants was enrolled. The study participants were selected using a multi-stage random sampling technique. Data was collected using an interview-administered questionnaire. The data was entered into EPI data version 4.6 and then, exported to SPSS version 23 for analysis. Those variables with a p-value <.05 with 95% CI were considered significant predictors. Mothers' positive intention to vaccinate their daughters aged 9-14 years against HPV was 67.5%. Attitude, perceived behavioral control, and subjective norm were significant predictors with (AOR = 10.09, 95% CI = 6.23-16.32), (AOR = 4.12, 95% CI = 2.71-6.26), and (AOR = 16.397, 95% CI = 9.69-27.748), respectively. Only two-thirds of mothers have a positive intention to vaccinate their daughters against human papillomavirus. Attitude, perceived behavioral control, and subjective norm were predictors. Therefore, it is better to do community mobilization toward the advantage of HPV vaccination.

Cervical cancer screening uptake and associated factors among Women Living with Human Immunodeficiency Virus in public hospitals, eastern Ethiopia

Background

Cervical cancer, the second leading cancer in Ethiopia women, is six times higher among women infected with the Human Immune Virus 1-infected women. Its screening provides protective advantages, and is linked to a decrease in the incidence of invasive cervical cancer and mortality. Although cancer screening has great advantages for early treatment and prevention of further complications, cervical cancer screening uptake is low among women in developing countries. Cervical cancer screening uptake among Women Living with Human Immunodeficiency Virus (WLHIV) is not well known in Eastern Ethiopia. Thus, we aimed to assess cervical cancer screening uptake and its associated factors among WLHIV in public hospitals in Harar, eastern Ethiopia.

Methods

An institution-based cross-sectional study was carried out on 412 randomly selected HIV-positive women from March 20 to April 20, 2022. The results of the study were presented descriptively in percentages and analytically in odds ratio. Bivariate and multivariable logistic regression analyses were used to determine the presence and degree of association between dependent and independent variables. In the multivariable logistic analysis, a p-value of 0.05, and an adjusted odds ratio with a 95% confidence interval were considered to determine independent predictors for the uptake of cervical cancer screening.

Results

Cervical cancer screening uptake among WLHIV was 57.5% (95% CI: 52.5, 62.9%). The uptake of cervical cancer screening was significantly associated with age between 20-29 years (AOR = 7.33; 95% CI: 1.98, 27.1), 40-49 years (AOR = 4.37; 95% CI: 1.48, 12.89), tertiary level of education (AOR = 0.197; 95% CI: 0.041, 0.946), good knowledge (AOR = 3.591; 95% CI: 2.123, 6.073), and monthly income of 2501(45.52 $) and above Ethiopian Birr (AOR = 0.389; 95% CI: 0.158, 0.959).

Conclusions

More than half of the participants had undergone cervical cancer screening. Age, marital status, educational status, monthly income, and awareness of cancer screening uptake were all factors related to cervical cancer screening. To maximize uptake, it is necessary to create specific counseling and education programs that target HIV-positive women.

Communicable and Non-communicable Diseases Diagnosis and Treatment Service Availability at Primary Health Care Units During COVID-19 Outbreak in Ethiopia

Background

Non-communicable diseases (NCDs) pose a substantial global health challenge, resulting in an annual death toll of over 15 million individuals aged 30 to 69. Ethiopia, categorized as COVID-19 vulnerable, grapples with NCD treatment challenges. This study aims to assess disease service availability at primary health units in Ethiopia during the pandemic.

Methods

A facility-based cross-sectional study was conducted from October to December 2021 across regions, encompassing 452 facilities: 92 health centers, 16 primary hospitals, 344 health posts, and 43 districts. Facility selection, based on consultation with regional health bureaus, included high, medium, and low performing establishments. The study employed the WHO tool for COVID-19 capacity assessment and evaluated services for various diseases using descriptive analysis.

Results

Results reveal service disruptions in the past year: hospitals (55.6%), health centers (21.7%), districts (30.2%), and health posts (17.4%). Main reasons were equipment shortages (42%), lack of skilled personnel (24%), and insufficient infection prevention supplies (18.8%). While tuberculosis treatment was fully available in 23% of health posts and malaria services in 65.7%, some health centers lacked HIV/AIDS, cardiovascular, mental health, and cervical cancer services. Most communicable and non-communicable disease diagnoses and treatments were fully accessible at primary hospitals, except for cervical cancer (56.3%) and mental health (62.5%) services.

Conclusion

Significant gaps exist in expected services at primary health units. Improving disease care accessibility necessitates strengthening the supply chain, resource management, capacity building, and monitoring systems.

Characteristics of Women Seeking Cervical Cancer Cytology Screening in a Private Health Facility

Background and Objectives: Over 80% of cervical cancer cases in sub-Saharan Africa are detected at late stages, predominantly due to the lack or inaccessibility of prevention services. Public health facilities in Ethiopia offer free cervical cancer screening for eligible women. Besides the public health facilities, private providers also offer a variety of screening services at the patients' expense. As the overall cervical cancer screening uptake in Ethiopia is still far below the 90% WHO target, coordination between all actors of the health system is key. This includes a close cooperation between the public and private sectors to combine the advantages of both to the benefit of all patients as well as media campaigns and community involvement to promote the self-initiation of screening. Materials and Methods: To gain insights into the utilization of cervical cancer screening in the private health sector, we conducted an institution-based cross-sectional study at Arsho medical laboratories in Addis Ababa. Every woman who came there for cervical cancer screening between 1 May and 30 June 2020 was asked to participate in a questionnaire-based, face-to-face interview about their socio-demographic background, cervical cancer screening experience and self-initiation of screening. A total of 274 women participated in the interviews. We further assessed the reproductive status of the patients, their risk factors for cervical cancer, source of information about the screening and barriers to cervical cancer screening. Results: The ages of the participants ranged between 20-49 years. The majority (over 70%) were married. A total of 37.6% reported self-initiating the screening. More than three-quarters of all interviewed women reported mostly using the private health care sector for all kinds of health services. Conclusions: While the Ethiopian government efforts on scaling up cervical cancer screening focus mainly on public health facilities, the private sector often does not get as much attention from policy makers. Efforts should be made to extend the government's interest in cervical cancer screening and implementation research to the private healthcare sector.

Factors influencing the prevalence of cervical cancer screening in Malaysia: a nationwide survey

BACKGROUND

In 2020, cervical cancer ranked fourth in terms of both frequency of diagnosis and the leading cause of cancer-related deaths among women globally. Among Malaysian women, it was the third most prevalent form of cancer. Published data on nationally representative cervical cancer screening in Malaysia have been limited. Therefore, this study aimed to determine the prevalence of receiving a Pap smear test in the past three years, its relationship with socio-demographic factors and physical activity.

METHODS

Using a subset of survey data from the National Health and Morbidity Survey (NHMS) 2019, a secondary data analysis was performed. Trained research assistants collected data through face-to-face method using a mobile tablet questionnaire system application. Logistic regression analysis was performed to examine the relationship between sociodemographic factors, physical activity, and cervical cancer screening. The analyses were conducted using STATA version 14 (Stata Corp, College Station, Texas, USA), accounting for sample weighs and complex sampling design.

RESULTS

The analysis included 5,650 female respondents, representing an estimated 10.3 million Malaysian female adults aged 18 and above. Overall, 35.2% (95%CI 33.2, 37.4) respondents had a Pap smear test within the past three years. Respondents who were physically active were 1.41 times more likely to have a Pap smear test. Similarly, respondents aged 35-59 (OR 1.84; 95%CI 1.46, 2.34) and those living in rural localities (OR 1.38; 95%CI 1.13, 1.70) had higher odds of receiving a Pap smear test. Compared to married respondents, single respondents (OR 0.04; 95%CI 0.02, 0.07) and widowed/divorcee respondents (OR 0.72; 95%CI 0.56, 0.82) were less likely to receive a Pap smear test. Educated respondents were more likely to have had a Pap smear test.

CONCLUSIONS

The overall prevalence of cervical cancer screening in Malaysia remains low (35.2%). Efforts should be made to strengthen health promotion programs and policies in increasing awareness on the significance of cervical cancer screening. These initiatives should specifically target younger women, single women, and widowed/divorced individuals. The higher cervical screening uptake among rural women should be studied further, and the enabling factors in the rural setup should be emulated in urban areas whenever possible.

Socioeconomic inequalities in cervical precancer screening among women in Ethiopia, Malawi, Rwanda, Tanzania, Zambia and Zimbabwe: analysis of Population-Based HIV Impact Assessment surveys

OBJECTIVES

We examined age, residence, education and wealth inequalities and their combinations on cervical precancer screening probabilities for women. We hypothesised that inequalities in screening favoured women who were older, lived in urban areas, were more educated and wealthier.

DESIGN

Cross-sectional study using Population-Based HIV Impact Assessment data.

SETTING

Ethiopia, Malawi, Rwanda, Tanzania, Zambia and Zimbabwe. Differences in screening rates were analysed using multivariable logistic regressions, controlling for age, residence, education and wealth. Inequalities in screening probability were estimated using marginal effects models.

PARTICIPANTS

Women aged 25-49 years, reporting screening.

OUTCOME MEASURES

Self-reported screening rates, and their inequalities in percentage points, with differences of 20%+ defined as high inequality, 5%-20% as medium, 0%-5% as low.

RESULTS

The sample size of participants ranged from 5882 in Ethiopia to 9186 in Tanzania. The screening rates were low in the surveyed countries, ranging from 3.5% (95% CI 3.1% to 4.0%) in Rwanda to 17.1% (95% CI 15.8% to 18.5%) and 17.4% (95% CI 16.1% to 18.8%) in Zambia and Zimbabwe. Inequalities in screening rates were low based on covariates. Combining the inequalities led to significant inequalities in screening probabilities between women living in rural areas aged 25-34 years, with a primary education level, from the lowest wealth quintile, and women living in urban areas aged 35-49 years, with the highest education level, from the highest wealth quintile, ranging from 4.4% in Rwanda to 44.6% in Zimbabwe.

CONCLUSIONS

Cervical precancer screening rates were inequitable and low. No country surveyed achieved one-third of the WHO's target of screening 70% of eligible women by 2030. Combining inequalities led to high inequalities, preventing women who were younger, lived in rural areas, were uneducated, and from the lowest wealth quintile from screening. Governments should include and monitor equity in their cervical precancer screening programmes.

The trend of change in cervical tumor size and time to death of hospitalized patients in northwestern Ethiopia during 2018-2022: Retrospective study design

Background and Aims

Cervical cancer is the fourth most common cause of cancer-related death in the world. The objective of this study was to determine factors that affect the longitudinal change of tumor size and the time to death of outpat.

Methods

A retrospective follow-up study was carried out among 322 randomly selected patients with cervical cancer at the University of Gondar Referral Hospital from May 15, 2018 to May 15, 2022. Data were extracted from the patient's chart from all patients' data records. Kaplan-Meier estimator, log-rank test, the Cox proportional-hazard model, and the joint model for the two response variables simultaneously were used.

Results

Among 322 outpatients with cervical cancer, 148 (46%) of them were human immunodeficiency virus (HIV) positive and 107 (33.3%) of them died. The results of joint and separate models show that there is an association between survival and the longitudinal data in the analysis; it indicates that there is a dependency between longitudinal terms of cervical tumor size and time-to-death events. A unit centimeter square rise in tumor size, corresponding to an exp(0.8502) = 2.34 times, significantly raised the mortality risk.

Conclusion

The study showed that HIV, stage of cancer, treatment, weight, history of abortion, oral contraceptive use, smoking status, and visit time were statistically significant factors for the two outcomes jointly.

Implications

As a result, adequate health services and adequate resource allocations are critical for cervical cancer control and prevention programs. Therefore, the government should provide adequate funding and well-trained health professionals to hospitals to sustain screening programs with appropriate coverage of cervical cancer patient treatments.

Cervical Cancer Screening Practice Among Women: A Community Based Cross-Sectional Study Design

Early detection of cervical cancer through screening practice in developing countries is still low. The study is aimed to determine cervical cancer screening practice and associated factors among women of age 25 to 59 years old. Community-based study design was employed and systematic sampling was used to get 458 samples. The data were entered into Epi info version 7.2.1.0 and exported to SPSS version 20 for cleaning and analysis. Binary and Multivariable Logistic regression was used and adjusted odds ratio with 95% CI at P-value <.05 was reported as significant value. Cervical screening practice among the study participants was 15.5%. Women's age 40 to 49 (AOR = 2.95, 95% CI = 0.94, 9.28), educational status (AOR = 4.19, 95% CI = 1.31, 13.37), employed women (AOR = 2.59, 95% CI = 1.01, 6.68), parity above 4 (AOR = 3.09, CI = 1.03, 9.31), sexual partners 2 to 3 (AOR = 5.32, CI = 2.33, 12.14), good knowledge about cervical cancer (AOR = 3.88; 95% CI = 1.83, 8.23) and positive attitude toward cervical cancer (AOR = 5.92, CI = 2.53, 13.87) were independently associated with cervical cancer screening practices. The study revealed that the utilization of cervical cancer screening was very low. Educational status, Women's age, number of sexual partners, knowledge, and attitude were significantly associated with cervical cancer screening practice. Therefore, intervention programs intended at improving cervical cancer screening practice among women should focus on the significant factors.

Cervical cancer in Ethiopia: a review of the literature

BACKGROUND

Cervical cancer is one of the most common malignancies affecting women worldwide with large geographic variations in prevalence and mortality rates. It is one of the leading causes of cancer-related deaths in Ethiopia, where vaccination and screening are less implemented. However, there is a scarcity of literature in the field. Therefore, the objective of this review was to describe current developments in cervical cancer in the Ethiopian context. The main topics presented were the burden of cervical cancer, knowledge of women about the disease, the genotype distribution of Human papillomavirus (HPV), vaccination, and screening practices in Ethiopia.

METHODS

Published literature in the English language on the above topics until May 2021 were retrieved from PubMed/Medline, SCOPUS, Google Scholar, and the Google database using relevant searching terms. Combinations of the following terms were considered to retrieve literature; < Cervical cancer, uterine cervical neoplasms, papillomavirus infections, papillomavirus vaccines, knowledge about cervical cancer, genotype distribution of HPV and Ethiopia > . The main findings were described thematically.

RESULTS

Cervical cancer is the second most common and the second most deadly cancer in Ethiopia, The incidence and prevalence of the disease is increasing from time to time because of the growth and aging of the population, as well as an increasing prevalence of well-established risk factors. Knowledge and awareness about cervical cancer is quite poor among Ethiopian women. According to a recent report (2021), the prevalence of previous screening practices among Ethiopian women was at 14%. Although HPV 16 is constantly reported as the common genotype identified from different grade cervical lesions in Ethiopia, studies reported different HPV genotype distributions across the country. According to a recent finding, the most common HPV types identified from cervical lesions in the country were HPV-16, HPV-52, HPV-35, HPV-18, and HPV-56. Ethiopia started vaccinating school girls using Gardasil-4™ in 2018 although the coverage is insignificant. Recently emerging reports are in favor of gender-neutral vaccination strategies with moderate coverage that was found superior and would rapidly eradicate high-risk HPVs than vaccinating only girls.

CONCLUSIONS

Cervical cancer continues to be a major public health problem affecting thousands of women in Ethiopia. As the disease is purely preventable, classic cervical cancer prevention strategies that include HPV vaccination using a broad genotype coverage, screening using a high precision test, and treating cervical precancerous lesions in the earliest possible time could prevent most cervical cancer cases in Ethiopia. The provision of a focused health education supported by educational materials would increase the knowledge of women about cervical cancer in general and the uptake of cervical cancer prevention and screening services in particular.

Cervical cancer screening in women living with HIV attending primary care clinics in a health district, South Africa: a descriptive cross-sectional study

Introduction

globally, cervical cancer remains a public health problem. It is ranked the fourth most common cause of women's cancer. In South Africa, it was the second most common cancer diagnosed in 2012. The disease progresses rapidly in women living with Human Immunodeficiency Virus (HIV), due to immune suppression. The purpose was to evaluate cervical cancer screening in HIV-positive women attending primary health care (PHC) clinics in Ekurhuleni Health District (EHD), South Africa. Aim and Objectives: the study aim was to evaluate cervical cancer screening in HIV-positive women attending PHC clinics for routine care in Ekurhuleni Health District, Gauteng Province, South Africa. Objectives were to describe the cervical cancer screening uptake of HIV-positive women on antiretroviral therapy (ART) who remained in care and were screened, determine the length of time or period from starting ART to the first cervical cancer screening, and describe associations among screening, age, and the period from starting ART.

Methods

this was a retrospective descriptive cross-sectional study design. A review of clinic records was conducted on women living with HIV and on antiretroviral therapy for at least four years. The study period was from March to September 2020. After a clustered randomization of clinics, 550 records were systematically selected. Stata version 16.1 was used for analysis.

Results

the median age was 34, ranged 23-68, with the interquartile range (IQR) of 29-42 years. Nearly a third (32.9%, n= 181) had cervical cancer screening documented. Those with both an ART start date and first screening were 83% (n= 151). The median for ART duration was 5 years and ranged from 4-8 years. The median time to first screening was 43 weeks with an IQR of 16-67 weeks. Women aged 35-44 years or above 45 were more likely to be screened (AOR 3.2, CI: 1.0-9.8, p= 0.05) and (AOR 5.3, CI: 1.7-16.9, p= 0.01), respectively.

Conclusion

there was suboptimal uptake and delay in initiating screening in women living with HIV. Nevertheless, the older women were, more likely to be screened. This study suggests poor adherence to policy and highlights the need for accelerated staff training on cervical cancer policy.

Trends and Determinants in Uptake of Cervical Cancer Screening in Spain: An Analysis of National Surveys from 2017 and 2020

Cervical cancer rates have declined in industrialized nations as a result of cytology screening programs. However, there are still sizeable differences in screening adherence in Spain. This study aimed to identify the prevalence of cervical cancer screening among women in Spain, to analyze trends in that prevalence from 2017 and 2020 and to identify socio-demographic, health, and lifestyle factors related with adherence to this screening test. We conducted a cross-sectional study of 13,619 women aged 25−65 who participated in the 2017 Spanish National Health Survey and the 2020 European Health Survey for Spain. We used logistic regression to examine the relationship between socio-demographic, health and lifestyle factors and cervical cancer adherence. The prevalence of adherence was 73.18%. Additionally, there was a significant decrease in cervical cancer screening uptake from 2017 and 2020 among women aged 25−44 years (2017: 77.80%, 2020: 75.20%, p = 0.02), but an increase in the age group of 45−65 years (2017: 68.93%, 2020: 72.39%, p < 0.01) and in foreigners (2017: 64.29%, 2020: 72.29%, p < 0.01). Screening for cervical cancer is related with age, educational level, social class, insurance status, visits to the family doctor, alcohol consumption and free time physical exercise.

Utilization of cervical cancer screening service and associated factors among women of reproductive age group in Ilu Abba Bor zone, southwestern Ethiopia, 2019: Cross-sectional study

Introduction:

Cervical cancer is one of the severest risks to women’s life. It is the main reason for more than half million of morbidity and 266,000 deaths worldwide annually.

Objective:

The aim of this study was to assess the level of cervical cancer screening service utilization and associated factors among women of the reproductive age group coming for health care service to public health facilities of Ilu Abba Bor zone, southwestern Ethiopia, 2019.

Methods:

An institutional-based cross-sectional study design was employed from 1 May to 30 May 2019. Participants were selected by systematic random sampling technique. Data were collected using a pretested questionnaire and entered into Epi data 3.1 and exported to SPSS version 23 for analysis. Multivariable logistic regression was used to observe the factors associated with cervical cancer screening utilization service. An adjusted odds ratio with a 95% confidence interval was used. Variables with a p-value of <0.05 were considered to be statistically significant.

Results:

From a total of 259 women involved in the study, about 19 (7.3%) of the study participants had been screened for cervical cancer at least once in the past 3 years during the study period. Educational status: primary (grade 1–8) (adjusted odds ratio = 3; 95% confidence interval = (1.15–7.91)), secondary (grade 9–12) (adjusted odds ratio = 4.21; 95% confidence interval = (1.04–7.46)), and tertiary (grade 12+) (adjusted odds ratio = 6.01; 95% confidence interval = (3.01–11.35)), nulliparous (adjusted odds ratio = 0.256; 95% confidence interval = (0.105–0.642)), and looking for information about cervical cancer (adjusted odds ratio = 3.4; 95% confidence interval = (1.8–6.2)) were significant factors associated with utilization of cervical cancer screening service.

Conclusion:

The study revealed that there was low cervical cancer screening service utilization in the study area. Educational status, parity, and looking for cervical cancer information were independently associated with cervical cancer screening utilization service. There is need to improve women’s education, dissemination of information about importance of cervical cancer screening, and focus on nulliparous women to have good practice of cervical cancer screening.

Cervical cancer screening in a population of black South African women with high HIV prevalence: A cross-sectional study

Cervical cancer is largely preventable through early detection, but screening uptake remains low among black women in South Africa. The purpose of this study was to determine the prevalence and factors associated with cervical cancer screening in the past 10 years among black African women in primary health care (PHC) clinics, in Gauteng Province, South Africa. This was a cross-sectional study involving 672 consecutively recruited black women at cervical cancer screening programs in PHC clinics between 2017 and 2020. An interviewer-administered questionnaire covered socio-demographics, HIV status, sexual history, cervical cancer risk factors knowledge, and screening behaviours in the past 10 years. The mean age of participants was 38 years. More than half (63%) were aged 30-49 years. Most completed high school education (75%), were unemployed (61%), single (60%), and HIV positive (48%). Only 285 (42.4%) of participants reported screening for cervical cancer in the past 10 years. Of participants that reported receiving information on screening, 27.6% (n = 176) and 13.97% (n = 89) did so from healthcare facilities and community platforms respectively. Participants aged 30 years or more were more likely to report for cervical cancer screening as compared to other categories in the past 10 years. The study found low cervical cancer screening prevalence. This calls for health education campaigns and prevention strategies that would target individual patients' contexts and stages of behavioral change. Such strategies must also consider socio-demographic and clinical correlates of cervical cancer screening and promote better integration into PHC services in South Africa.

A cross-sectional assessment of symptom burden among patients with advanced cervical cancer

Background

The increasing burden of chronic non-communicable diseases in developing countries is driving attention to palliative care services. Identification of disease-specific symptoms of concern and their prevalence will guide designing, monitoring, and evaluating palliative care programmes. This study assessed the burden of symptoms and problems among patients with advanced cervical cancer.

Methods

This research followed a cross-sectional study design to quantitatively review the symptom burden among patients diagnosed with advanced cervical cancer attending treatment at Tikur Anbessa Specialised Hospital, Addis Ababa, Ethiopia from January to July 2019. Symptoms were assessed using a patient-reported, seven-day recall Integrated Palliative Care Outcome Scale (IPOS) version III. Frequency, median and mean scores with a standard deviation were used in the descriptive analysis whereas t-test and one-way analysis of variance were used for comparisons.

Results

There were 385 patients with advanced cervical cancer, stage IIB-IVB, successfully interviewed. The median age was 50 years, the majority were illiterate (63.1%) and in marital union (62.3%). Over 50% of the patients experienced pain, weakness, poor appetite, constipation, limited mobility, and dry mouth. The burdens of emotional symptoms such as patient anxiety, family anxiety, and patient depression were also prevalent at 79.7%, 82.3%, and 47.0%, respectively. Patients who are illiterate, at a higher stage of the disease, not currently in marriage, and who received palliative radiotherapy bear a higher symptom burden.

Conclusion

Patients with advanced cervical cancer bear a high symptom burden. Early initiation of palliative care is recommended to alleviate the concerning symptoms, and to improve patients’ quality of life.

Women's Satisfaction with Cervical Cancer Screening Services and Associated Factors in Maternal Health Clinics of Jimma Town Public Health Facilities, Southwest Ethiopia

Background

Despite the existence of proven interventions for cervical cancer, low coverage and uptake of existing screening and treatment services remains the main challenge to prevention and control of cervical cancer in developing countries. This study aimed to assess women’s satisfaction with cervical cancer screening services and factors associated with it in public health facilities of Jimma town, Southwest Ethiopia.

Methods

A facility-based cross-sectional study was conducted from March 20 to May 20, 2020. All women aged between 30 and 49 years who visited health facilities during the data collection period were interviewed consecutively. Composite variables were computed from existing data for satisfaction, knowledge, and attitude. A 95% confidence interval was constructed for all outcome variables and multivariate logistic regression was used to identify predictors of satisfaction.

Results

Out of 205 interviewed women, 41% (95% CI: 34–47) were satisfied with cervical cancer screening services. One-hundred and seventeen (57%, 95% CI: 50–64) women had good comprehensive knowledge of cervical cancer screening and 121 (59%, 95% CI: 52–66) had favorable attitude. Satisfaction with cervical cancer screening service was statistically associated with occupational status, religion, perceived length of waiting time to see a provider, and knowledge of cervical cancer.

Conclusion

Satisfaction with cervical cancer screening services was low in public health facilities of Jimma town. Slightly more than half of women had good knowledge and favorable attitude regarding cervical cancer screening. Among the clinical factors, only perceived length of waiting time to see a provider and women’s knowledge of cervical cancer were statistically associated with satisfaction with screening services. Therefore, efforts should be made to improve level of satisfaction, knowledge and attitude of women toward cervical cancer and screening services.

Histone Deacetylation Regulated by KDM1A to Suppress DACT1 in Proliferation and Migration of Cervical Cancer

Objective

Increased expression of KDM1A and decreased expression of DACT1 in cervical cancer cells were noticed in a previous study. This study is aimed at exploring the mechanism behind the KDM1A regulation on DACT1 in cervical cancer cells.

Methods

The expression profile of KDM1A and DACT1 in cervical cancer tissues was searched in TCGA database. In vitro experiments verified the effect of KDM1A and DACT1 on proliferation and migration ability of cervical cancer cell lines after cell transfection. The interaction of KDM1A with HDAC1 was identified by coimmunoprecipitation (Co-IP). The expression levels of KDM1A and DACT1 in cervical cancer cell lines were determined by qRT-PCR and western blot.

Results

TCGA database showed that cervical cancer tissues had elevated expression of KDM1A and decreased expression of DACT1, which was consistent with the observation in cervical cancer cell lines. KDM1A was found to negatively regulate DACT1 through histone deacetylation. Meanwhile, the downregulation of KDM1A or overexpression of DACT1 could suppress the cell proliferation and migration ability in HeLa and SiHa cells. Cotransfection of KDM1A and DACT1 overexpression could reverse the increased cell proliferation and migration ability induced by KDM1A overexpression.

Conclusion

KDM1A can downregulate DACT1 expression through histone deacetylation and therefore suppress the proliferation and migration of cervical cancer cells.