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.