Cervical cancer screening uptake in East Africa: a systematic review and meta-analysis of observational studies

Abstract

Background: Cervical cancer is the second most common cancer and the leading cause of cancer-related deaths among women of reproductive age globally. In East Africa, cervical cancer presents a substantial public health challenge. Although previous studies have attempted to assess its prevalence and determine the associated factors, their findings have often been inconsistent and inconclusive. To address this gap, we conducted this systematic review and meta-analysis, aiming to provide clearer insights into the prevalence and determinants of cervical cancer screening in the region.

Method: The review protocol was registered in PROSPERO under the reference number CRD42024563102. We systematically searched of multiple databases, including PubMed, Hinari, Embase, Scopus, Epistimonikos, African Journals Online, ScienceDirect, and Google Scholar. We included observational studies published between January 1, 2019, and September 2, 2024. The search results were retrieved and organized using Rayyan software. The data analysis was done using Stata version 17 software. The heterogeneity and publication bias were assessed prior to pooling the estimates.

Result: A total of 12,700 women included from 24 articles. The overall estimated pooled prevalence of cervical cancer screening was 19.22% (95% CI 14.69, 23.74). Age 40–49 years (AOR = 2.58; 95% CI: 1.41, 4.73), government employment (AOR = 1.55; 95% CI: 0.61, 3.93), marriage (AOR = 0.82, 95% CI: 0.15, 4.46), divorce (AOR = 2.32, 95% CI: 0.13, 43.54), parity of more than four (AOR = 1.4; 95% CI: 0.5, 3.93), good knowledge (AOR = 4.31; 95% CI: 2.72, 6.83), high perceived severity (AOR = 1.63; 95% CI: 0.63, 4.22), high perceived benefit (AOR = 1.73; 95% CI: 0.98, 3.05), low perceived barriers (AOR = 2.25; 95% CI: 0.77, 6.60), modern contraceptives use (AOR = 1.18; 95% CI: 0.52, 2.65), know someone with cervical cancer (AOR = 2.12; 95% CI: 0.70, 6.40), and favorable attitude (AOR = 2.63; 95% CI: 1.66, 4.17) were significantly associated with cervical cancer screening utilization.

Conclusion: Cervical cancer screening uptake remains low in East Africa due to factors like demographics, knowledge, attitudes, and personal connections to the disease. Empowering women and enhancing their knowledge, attitudes, and perceptions are essential strategies to improve screening practices.

Keywords: Cervical cancer; East africa; Screening uptake; Systematic review and meta-analysis.

Fig. 1

PRISMA flow diagram for cervical cancer screening utilization and its predictors

Fig. 2

Pooled cervical cancer screening uptake in East Africa

Fig. 3

Galbraith plot showing the utilization of cervical cancer screening in East Africa

Fig. 4

Test of publication bias for proportion studies by using funnel plot

Fig. 5

Test of publication bias for proportion studies after trim and fill showed using funnel plot

Fig. 6

Sensitivity analysis of included studies

Fig. 7

the pooled odds ratio of the association between age (40-49) and cervical cancer screening utilization in east Africa

Fig. 8

the pooled odds ratio of the association between government employment and cervical cancer screening utilization in east Africa

Fig. 9

the pooled odds ratio of the association between marriage and cervical cancer screening utilization in east Africa

Fig. 10

the pooled odds ratio of the association between divorce and cervical cancer screening utilization in east Africa

Fig. 11

the pooled odds ratio of the association between parity and cervical cancer screening utilization in east Africa

Fig. 12

the pooled odds ratio of the association between knowledge and cervical cancer screening utilization in east Africa

Fig. 13

the pooled odds ratio of the association between perceived severity and cervical cancer screening utilization in east Africa

Fig. 14

the pooled odds ratio of the association between perceived benefits and cervical cancer screening utilization in east Africa

Fig. 15

the pooled odds ratio of the association between perceived barrier and cervical cancer screening utilization in east Africa

Fig. 16

the pooled odds ratio of the association between contraceptive use and cervical cancer screening utilization in east Africa

Fig. 17

the pooled odds ratio of the association between know someone with cervical cancer and cervical cancer screening utilization in east Africa

Fig. 18

the pooled odds ratio of the association between attitude and cervical cancer screening utilization in east Africa