Cervical cancer screening uptake in Sub-Saharan Africa: a systematic review and meta-analysis

Objectives: The objective of this study is to estimate the pooled uptake of cervical cancer screening and identify its predictors in Sub-Saharan Africa. Study design: Systematic review and meta-analysis. Methods: We searched PubMed, EMBASE, CINAHL, African Journals OnLine, Web of Science and Scopus electronic databases from January 2000 to 2019. All observational studies published in the English language that reported cervical cancer uptake and/or predictors in Sub-Saharan Africa were initially screened. We assessed methodological quality using the Newcastle-Ottawa Scale. An inverse variance-weighted random-effects model meta-analysis was performed to estimate the pooled uptake and odds ratio (OR) of predictors with a 95% confidence interval (CI). The I-2 test statistic was used to check between-study heterogeneity, and the Egger's regression statistical test was used to check publication bias. Results: We initially screened 3537 citations and subsequently 29 studies were selected for this review, which included a total of 36,374 women. The uptake of cervical cancer screening in Sub-Saharan Africa was 12.87% (95% CI: 10.20, 15.54; I-2 = 98.5%). A meta-analysis of seven studies showed that knowledge about cervical cancer increased screening uptake by nearly five times (OR: 4.81; 95% CI: 3.06, 7.54). Other predictors of cervical screening uptake include educational level, age, Human Immune deficiency Virus (HIV) status, contraceptive use, perceived susceptibility and awareness about screening locations. Conclusions: Cervical screening uptake is low in Sub-Saharan Africa as a result of several factors. Health outreach and promotion programmes to target these identified predictors are required. (C) 2021 The Author(s). Published by Elsevier Ltd on behalf of The Royal Society for Public Health.

Automated summary

This study aimed to estimate the pooled uptake of cervical cancer screening and identify its predictors in Sub-Saharan Africa through a systematic review and meta-analysis. The results indicated a low uptake of cervical cancer screening in the region, influenced by factors such as knowledge level, age, HIV status, and educational level. Targeted health promotion programs are required to improve cervical cancer screening uptake in Sub-Saharan Africa.