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. 2025 Apr 10;15(1):12289.
doi: 10.1038/s41598-025-96347-2.

Wealth-related inequalities of women's cervical cancer screening in 11 Sub-Saharan African countries: evidence from a pooled decomposition analysis

Beminate Lemma Seifu  1 , Yohannes Mekuria Negussie  2 , Angwach Abrham Asnake  3 , Hiwot Atlaye Asebe  4 , Bezawit Melak Fente  5 , Zufan Alamrie Asmare  6 , Mamaru Melkam  7 , Meklit Melaku Bezie  8 , Alemayehu Kasu Gebrehana  9 , Sintayehu Simie Tsega  10
Affiliations

Wealth-related inequalities of women's cervical cancer screening in 11 Sub-Saharan African countries: evidence from a pooled decomposition analysis

Beminate Lemma Seifu et al. Sci Rep. .

Abstract

Cervical cancer is a preventable disease and ranks as the fourth most common cancer, as well as a major cause of cancer deaths among women globally. Despite initiatives by the World Health Organization to reduce cervical cancer incidence through vaccination, screening, and treatment, significant inequalities in healthcare access persist, particularly in low-income regions where economic and infrastructural barriers hinder access to screening services. Therefore, this study aimed to examine wealth-related inequalities in cervical cancer screening among women in Sub-Saharan African countries. The study analyzed 138,605 weighted samples of reproductive-aged women from DHS data spanning 2015 to 2023 across SSA countries. To assess socioeconomic-related inequality in cervical cancer screening uptake, the Erreygers normalized concentration index and its concentration curve were utilized. Additionally, a decomposition analysis was conducted to identify factors contributing to this inequality. The weighted Erreygers normalized concentration index was 0.25 with a standard error of 0.0078 (P value < 0.0001), indicating a statistically significant pro-rich distribution of wealth-related inequalities in cervical cancer screening uptake among reproductive-aged women. The decomposition analysis identified media exposure (20%), wealth index (15.58%), educational status (6.23%), and place of residence (2.18%) significantly contribute to screening inequalities. To address cervical cancer screening disparities in SSA, targeted strategies such as awareness campaigns for low-income groups, free screening services, mobile units in rural areas, and health literacy programs are recommended. Training community health workers and policy advocacy are also crucial. Comprehensive interventions should enhance media outreach, health education, and healthcare accessibility in both urban and rural areas to ensure equitable screening rates.

Keywords: Cervical cancer; Concentration index; Decomposition analysis; Socioeconomic-related inequality; Sub-Saharan Africa.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests. Ethical approval and consent to participate: The study doesn’t involve the collection of information from subjects. Consent to participate is not applicable. Since the study is a secondary data analysis based on DHS data.

Figures

Fig. 1
Fig. 1
Pooled prevalence of cervical cancer screening among women of reproductive age in SSA.
Fig. 2
Fig. 2
Coverage of cervical cancer screening by age group among women of reproductive age in SSA.
Fig. 3
Fig. 3
Coverage of cervical cancer screening by wealth quintiles among women of reproductive age in SSA.
Fig. 4
Fig. 4
Coverage of cervical cancer screening by place of residence among women of reproductive age in SSA.
Fig. 5
Fig. 5
Coverage of cervical cancer screening by educational level among women of reproductive age in SSA.
Fig. 6
Fig. 6
Coverage of cervical cancer screening by perceived distance to health facility among women of reproductive age in SSA.
Fig. 7
Fig. 7
Concentration curve for cervical cancer screening in SSA.
See this image and copyright information in PMC

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