https://orcid.org/0000-0002-0628-6164
Figures
Abstract
Background
Cervical cancer is the fourth most prevalent type of cancer in women globally. Early detection and treatment of precancerous cervical lesions and human papillomavirus (HPV) infection are strongly advised to decrease the incidence of cervical cancer and death. Cervical cancer is a major public health concern in low- and middle-income nations, where screening and treatment options are constrained. Thus, the main objective of this umbrella review was to determine the pooled uptake of cervical cancer screening and its determinants in Africa.
Methods
This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The protocol for this umbrella review was registered on the International Prospective Register of Systematic Reviews (PROSPERO) with reference number CRD42024518297. We conduct a systematic and comprehensive search by using Google Scholar, PubMed, Scopus, Hinari, and Science Direct, from January 1, 2014, to September 20, 2024. The data were extracted using Microsoft Excel spreadsheet. The methodological quality of the included studies was examined using A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2). The statistical analysis was carried out using STATA version 17, which includes descriptive analysis, forest plots for prevalence, funnel plot, and an Egger test to examine publication bias. A random-effects model was used to determine the pooled effect estimate. Publication bias was checked by using the funnel plot and Egger’s tests.
Results
This umbrella review included 11 systematic reviews and meta-analysis studies across Africa with a total of 143,327 study participants. The overall prevalence of cervical cancer screening practice in Africa was 20.94% (95% CI: 15.84%–26.04%). Women’s level of knowledge (AOR: 3.22, 95% CI: 1.64–6.33), positive attitude toward CCS (AOR: 2.48, 95% CI: 2.18–2.81), perceived vulnerability to cervical cancer (AOR = 3.57, 95% CI: 2.75, 4.63), and history of STIs (AOR = 4.89, 95% CI: 3.14, 7.62) were significantly associated with cervical cancer screening practice. In conclusion, the combined estimate of cervical cancer screening use in Africa remains much lower (20.94%) than the World Health Organization (WHO) recommendations target (70%). It indicates that there is a large gap that requires being addressed in collaboration to reduce the burden of cervical cancer and its morbidity and mortality across the continent. Therefore, healthcare professionals, policymakers, and other stakeholders shall implement effective strategies such as empowering women, improving the knowledge and attitude towards cervical cancer screening, advocacy, and expanding screening programs to all eligible women to increase utilization of cervical cancer screening.
Citation: Mengistie BA, Melese M, Gebiru AM, Getnet M, Getahun AB, Tassew WC, et al. (2025) Uptake of cervical cancer screening and its determinants in Africa: Umbrella review. PLoS One 20(7): e0328103. https://doi.org/10.1371/journal.pone.0328103
Editor: Worku Necho Asferie, Debre Tabor University, ETHIOPIA
Received: November 13, 2024; Accepted: June 25, 2025; Published: July 21, 2025
Copyright: © 2025 Mengistie et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All relevant data are within the paper and its Supporting Information files.
Funding: The author(s) received no specific funding for this work.
Competing interests: The authors have declared that no competing interests exist.
Abbreviations: AOR, Adjusted odds ratio; AMSTAR, A Measurement tool to Assess systematic reviews; CCS, Cervical cancer screening; CI, Confidence interval; HPV, Human papillomavirus; LMICs, Low-and middle-income countries; SSA, sub-Saharan Africa; STIS, Sexually transmitted infections; SRM, Systematic review and meta-analysis; WHO, World Health Organization.
Introduction
Cervical cancer affects mainly women and girls worldwide [1]. It’s the fourth most prevalent cancer in both incidence (6.8%) and mortality (8.1%) in women worldwide in 2022 [1]. Even though it’s a global public health problem, the incidence is higher in low- and middle-income countries [1,2]. In 2022, cervical carcinoma was estimated to cause 661,021 cases of new cancer and 348,189 mortalities globally [1]. It’s a rare cause of death in developed nations, while about 94% of the deaths from cervical cancer occurred in low- and middle-income nations [1,2]. The incidence and fatality rates for cervical cancer remain highest in Sub-Saharan Africa (SSA), Central America, and Southeast Asia [1,2]. Geographic variations in the cervical cancer burden are linked to disparities in access to HPV immunization, cervical cancer screening, and treatment services [1].
Human papillomavirus (HPV) infection causes nearly 99.7% of precancerous and malignant cervical lesions [3,4]. HPV subtypes 16 and 18, which account for approximately 70% of cervical cancer around the globe, are the most carcinogenic types [3]. Cervical cancer is caused by a persistent sexually transmitted infection of oncogenic HPV variants [4,5]. Additionally, there are several common risk factors that raise the likelihood of developing cervical cancer, including having multiple sexual partners, initiation of early sexual intercourse, having a compromised immunity, using oral contraception for an extended period of time (more than 5 years), having a large number of children (three or more), poor genital sanitation, tobacco use, and having sexually transmitted infections [6,7].
Worldwide, the uptake of cervical cancer screening (CCS) varies greatly [8]. High-income countries have higher rates, while low-income ones have lower rates. In 2019, the global adherence of CCS in women aged 20–69 years was 33.66% [8]. This rate was twice as higher in developed nations, at 75.66%, as compared to low-and middle-income countries (LMICs), which reported only 24.91% compliance. Similarly, CCS uptake is extremely low in Africa (5.28%) [8]. Consequently, the region of Sub-Saharan Africa (SSA) ranks as the highest regarding poor cervical cancer outcomes, such as higher mortality and lower survival rate, suggesting late diagnosis of cases, limited access for screening and treatment services, and the presence of additional risk factors, including a high burden of HIV and poor socioeconomic factors and extreme poverty [9,10]. In addition, A wide range of barriers, such as lack of knowledge and awareness of cervical cancer, cultural or traditional and religious factors, and health system barriers to screening, were identified across most LMICs [11].
The WHO has launched a Global Strategy to Accelerate Cervical Cancer Elimination that defines three important strategies: HPV vaccination, screening, and treatment [9]. In 2020, the WHO introduced the 90-70-90 a global strategy to eliminate cervical cancer. This plan targets 90% HPV vaccination of girls by the age of 15, 70% of women to be screened for cervical disease with a high-performance test at least twice by the age of 45. Finally, 90% of women diagnosed with precancerous cervical lesions treated and 90% of invasive cervical cancer managed by 2030 [9]. The primary objective of secondary prevention is to lower the incidence and mortality of cervical cancer by detecting and treating women who have precancerous lesions [9].
Cervical cancer grows slowly from HPV infection or precancerous lesions to advanced stages of malignancy. It can be prevented using screening, thereby allowing for early identification and an opportunity for therapy [12]. Screening for cervical cancer is one of the most effective cancer preventive techniques available today. If abnormal changes to cervical epithelial cells are identified and treated immediately, the likelihood of developing cervical cancer is lowered [13]. The American Cancer Society (ACS), the WHO, and the United States Preventive Services Task Force (USPSTF) suggest that all eligible women receive a screening for cervical cancer at least once every three years [14]. There are three types of cervical cancer screening methods [15]. HPV DNA testing is recommended as the primary screening technique for women older than 30 years. The second method is Visual Inspection with Acetic Acid (VIA) or Visual Inspection with Lugol’s (VILI), which is used when HPV testing is not yet available or when there is a risk of loss to follow-up. The third approach is the Pap smear, which should be performed in the following situations: 1) for women who are not qualified for VIA or VILI due to the non-visibility of the squamo-columnar junction and absence of HPV screening, 2) as the main test for women younger than 30 years, and 3) as a co-test with HPV for HIV-infected women [15,16]. In resource-limited areas, visual inspection of the cervix with acetic acid (VIA) followed by therapy (screen and treat) is an alternative approach to secondary prevention [9,16].
Although cervical cancer screening is proven to reduce cervical cancer incidence, many factors influence screening uptake [17]. The rate of screening uptake has been shown to vary by knowledge about cervical cancer and screening services, in addition to other factors, such as individual perception, beliefs, attitudes, culture, and partner attitude [18]. Numerous individuals or coordinated initiatives targeting both health practitioners and the community may encourage women to undergo CCS. Outreach visits, mobilization of communities, health education, and counseling services are all possible components of an efficient cervical cancer prevention and control program that ensures high screening uptake [19,20].
Despite cervical cancer screening being considered one of the most efficient approaches for reducing the incidence and mortality rate of cervical cancer, it’s less practiced in LMIC countries, including Africa [9]. So far, there are multiple systematic reviews and meta-analyses that have found an inconsistent prevalence of CCS uptake with significant heterogeneity across Africa, ranging from 5.47% [21] to 43% [22]. In addition, this umbrella review attempts to aggregate the overall estimate of CCS uptake and its determinants among different study populations. For instance: eligible-age group women, reproductive-age women, and women living with HIV. Therefore, the aim of this umbrella review was to summarize the heterogeneous findings of various systematic reviews and meta-analysis studies to generate conclusive findings. This comprehensive evidence will help HCPs, health managers, and policymakers in implementing evidence-based interventions to improve uptake of CCS, and it’s considered a cost-effective secondary preventive intervention for cervical cancer. Ultimately, it enables the detection and treatment of precancerous cervical lesions, improves survival rates, reduces morbidity and mortality from cervical cancer.
Methods and materials
Study protocol and search strategy
This umbrella review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) guideline [23] (S1 File). The study protocol was developed and registered on PROSPERO (reference number: CRD42024582302).
We conducted a comprehensive search on Google Scholar, PubMed, Hinari, Scopus, and ScienceDirect. on systematic review and meta-analysis studies of CCS uptake and its determinant factors undertaken in Africa. The search technique was based on the condition, context, and population (CoCo Pop) framework [24]. Publications were retrieved from prior studies meeting the eligibility criteria. A search strategy was developed for databases by combining keywords using Boolean operators (“AND” and “OR”). All systematic reviews and meta-analyses published between January 1, 2014, and September 20, 2024, were included. Finally, we used the following combination of searching terms: (“systematic review AND meta-analysis” OR “systematic reviews”) AND “uptake” OR “acceptance” OR “utilization” OR “cervical cancer screening” OR “early cervical cancer detection” AND “Africa” OR “Sub-Saharan Africa.” In addition, snowballing techniques were used to retrieve further studies from the citation list of papers identified in the available database (S2 File).
Eligibility criteria
We included all systematic reviews and meta-analyses studies that reported the prevalence and/or associated factors of cervical cancer screening in Africa. In addition, studies published in English after January 1, 2014, were included in this umbrella review. Whereas articles were excluded for the following reasons: the article did not report the outcome of interest, narrative reviews, primary studies, qualitative reviews, expert opinions, case reports, editorials, correspondence, abstracts, and methodological studies.
Data extraction and management
Two authors (BAM and MM) carried out data extraction from the included SRM studies using a standardized data abstraction form developed in an Excel spreadsheet. Based on the inclusion and exclusion criteria, all searched studies were transferred to Endnote X8, reference management software. Articles were screened and selected first based on their title and abstract, and then the full text was reviewed. In cases of dispute, discussions with additional reviewers were held to determine the final article selection to include in this umbrella review. Following the comprehensive searching, possibly eligible publications were imported into Endnote. Duplicate studies were deleted in cases where two or more papers shared similar features. Structured data extraction in a Microsoft Excel spreadsheet was designed and implemented. For each SRM study, the following data were extracted: identification data (first author’s last name and publication year), prevalence of CCS, factors associated with CCS uptake, adjusted odds ratio with 95% confidence intervals, number of primary studies included within each SRM study, study area, total sample size, publication bias assessment methods, risk bias assessment method, and scores (Table 2 and S3 File).
Measurement of outcome variable
The primary objective of this study was to determine the combined prevalence of cervical cancer screening uptake in Africa. The prevalence was calculated by dividing the number of women who screened for cervical cancer by the total number of women in the study and then multiplying by 100. The second objective of this umbrella review was to identify predictors of CCS uptake in Africa, which were evaluated using adjusted odds ratios from previous SRM studies.
Cervical cancer screening is the practice of checking women for precancerous or malignant cells on the cervix using diagnostic procedures including the Pap smear, HPV test, or visual inspection with acetic acid (VIA). These procedures involve taking cervical cells for microscopic analysis or diagnosing the presence of HPV, a virus associated with cervical cancer [9,25]. For the purposes of this analysis, any documented evidence of having screened and participated in mass or campaign examinations, clinic- or facility-based, or regular screenings a minimum of once in life is considered CC screening uptake [9,26].
Quality assessment
The quality of the included studies was evaluated by two authors (BAM and MM) independently using A Measurement Tool to Assess Systematic Reviews (AMSTAR 2) [27]. The tool consists of 16 components, comprising 9 non-critical and 7 critical subdomains. Critical domains include whether the protocol was registered prior to the beginning of the review, the scope of the literature search, the explanation for excluding specific studies, the risk of bias from the studies included in the review, the suitability of meta-analysis methods, performing the risk of bias account of when interpreting the review’s findings, and the evaluation of the existence and potential effects of publication bias [27]. The quality of included SRM studies in this umbrella review was classified as high, moderate, low, or critically low using the AMSTAR-2 tool. This umbrella review turned down articles with critically low-quality evidence [27] (Table 1).
Data synthesis and statistical analysis
Data were extracted using a Microsoft Excel spreadsheet and then exported to STATA 17 statistical software, where all statistical data analysis were performed. The extracted data were presented as texts, tables, and forest plots. The standard error of prevalence for each SRM study was calculated using a binomial distribution. The pooled prevalence of the SRM studies was examined for heterogeneity using the Higgins I-squared (I2) test. Heterogeneity among those included was characterized as low, moderate, or high based on I-square values of <25%, 50%−75%, and 75%, respectively [28].
A random-effects meta-analysis approach (Der Simonian and Laird’s method) was employed to estimate the pooled prevalence of CCS use in Africa. Subgroup analysis was performed across the country, continent, and study population to identify potential sources of study heterogeneity. Additionally, we conducted a leave-one-out sensitivity analysis to assess the impact of individual SRM studies on the pooled estimate. The pooled estimates across the continent were then displayed using forest plots and tables, along with their respective 95% confidence intervals. Graphically, publication bias was examined using a forest plot (23). Furthermore, the statistical significance of publication bias was tested using both Egger’s and Begg’s tests, and a p-value less than 0.05 was employed to confirm the existence of publication bias [29]. In the end, the pooled adjusted odds ratio (AOR) with 95% confidence intervals was displayed using forest plots.
Results
Literature searches
A total of 722 studies were retrieved through all searching databases, including Google Scholar; 118 duplicate records were removed, and the remaining 604 studies were eligible for further screening. However, the majority of studies (n = 547) were excluded by screening their titles and abstracts. Then, the remaining 57 full-text articles were examined for eligibility criteria, and 46 studies were dropped for different reasons, such as variation in the study context, insufficient data, not directly related to the outcome of interest, scoping reviews, and qualitative systematic reviews. Finally, 11 eligible SRM studies were included for the final quantitative meta-analysis [21,22,25,26,30–36] (Fig 1).
Characteristics of the included studies
In this umbrella review, 11 eligible SRM articles with a total of 143,327 participants were included. In terms of the distribution of the SRM studies across Africa, seven studies were conducted in Ethiopia, one in Botswana, and the remaining were conducted in the SSA context (Table 2).
Uptake of cervical cancer screening in Africa
This umbrella review comprised 11 systematic reviews and meta-analyses from previous studies looking at the overall prevalence of cervical cancer screening in Africa. Thus, the pooled prevalence of cervical cancer screening uptake in Africa was 20.94% (95% confidence interval: 15.84%−26.04%). The statistical test found significant heterogeneity among the included SRM studies (heterogeneity I2 = 99.88%, p-value = 0.000). As a result, a random-effects meta-analysis model was applied (Fig 2).
Heterogeneity and sub-group analysis
Sub-group analysis was carried out based on the region of Africa, which the study was conducted and the study population. Accordingly, the highest prevalence was found in SSA, 31.44% (95% CI: 18.02, 44.87), whereas the lowest prevalence was detected in East Africa, 14.97% (95% CI: 10.39, 19.54) (Fig 3).
In addition, a subgroup analysis was carried out based on the study population; relatively, a higher overall uptake of cervical cancer screening was found among women with HIV (23.37%; 95% CI: 16.42, 30.31) Despite conducting subgroup analysis based on the aforementioned factors, no significant improvement in heterogeneity in the pooled estimate of cervical cancer screening uptake (Fig 4).
Publication bias, trim and fill analysis
A funnel plot was used to visually check the presence of publication bias, while Egger’s test was employed to confirm it. In this review, the asymmetrical distribution of the funnel plot demonstrates an existence of publication bias among the studies used to estimate the pooled prevalence of cervical cancer screening among African women. Statistically, Egger’s (P-value = 0.000) and Begg’s tests (P-value = 0.0430) were statistically significant, indicating the presence of publication bias (Fig 5).
A non-parametric trim and fill statistical analysis was performed to determine the number of potentially missing studies to reduce and adjust for publication bias in the included studies. However, the trim and fill analysis revealed the absence of significant publication bias because the overall prevalence of observed studies was equal to the sum of observed and imputed studies (Table 3).
A leave-one-out sensitivity analysis
A leave-one-out sensitivity analysis using the random-effects model was performed to examine the effect of a single study on the estimated effect size. However, the findings show that a single study did not significantly affect the total effect size, and the point estimate of omitted study falls within the confidence interval of the overall estimate of CCS. This proved the reliability of the pooled estimate of cervical cancer screening in Africa (Fig 6).
Factors associated with cervical cancer screening in Africa
This umbrella review examined eight publications out of eleven studies that reported on determinants that influence cervical cancer screening uptake in Africa. The random-effects model revealed that women’s knowledge of cervical cancer screening, attitudes toward CCS, perceived vulnerability to cervical cancer, and history of sexually transmitted infections (STIs) were all significantly associated with cervical cancer screening in Africa.
Those who had knowledge about cervical cancer screening were 3.5 times more likely to utilize cervical cancer screening (AOR = 3.47, 95% CI: 3.01, 4.17) than those who had poor knowledge about it. The odds of cervical cancer screening were 3.56 times more likely in women with a favorable attitude towards CCS (AOR = 3.56, 95% CI: 3.04, 4.16) than in women who had an unfavorable attitude towards the screening program. The pooled adjusted odds ratio of the three studies also showed that women who perceived higher risk of cervical cancer (AOR = 3.57, 95% CI: 2.75, 4.63) were 3.57 times more likely to adopt CCS. Finally, having a history of STIs was the other contributing factor for cervical cancer screening in Africa. Thus, the likelihood of undergoing CCS was five times higher among women with a history of sexually transmitted infections (AOR = 4.89, 95% CI: 3.14, 7.62) than their counterparts (Fig 7).
Discussion
Secondary preventive measures, such as a high-coverage screening program, health promotion, and early detection of precancerous in treatment, are crucial for preventing cervical cancer, particularly in unvaccinated women and infected with HPV strains [16]. The prevalence of cervical cancer screening in resource-limited countries is significantly lower than that in developed countries [37]. Additionally, limited and inconsistent findings have been obtained regarding the use of cervical cancer screening services across Africa. Therefore, this umbrella review summarized prior meta-analysis studies on cervical cancer screening in Africa to generate comprehensive evidence.
In this umbrella review, the pooled prevalence of cervical cancer screening uptake in Africa was 20.94% (95% CI: 15.84%–26.04%). This finding was consistent with systematic review and meta-analysis studies conducted in 22% of LMICs [38], 18.2% in Arab countries [39], and 16% in Nepal [40]. However, the uptake of CCS in Africa was lower than systematic reviews and meta-analyses of studies that reported the prevalence of 46% among immigrant women in Europe [41] and 28% in Asia [42].
Additionally, the finding of this umbrella review was lower than a global adherence to CCS that reported a pooled prevalence of 33.66%, with the lowest and highest adherence to CCS in LMICs and high-income countries, 24.91% and 75.66%, respectively [43]. The disparity could be explained by variations in the study participants’ sociodemographic and financial situations. Thus, individuals who have a lower educational and socioeconomic background are less likely to adhere to preventative actions like cervical cancer screenings [43,44]. Moreover, variations in the countries’ healthcare policies, such as the structure of institutions and the availability of screening programs, might have had an important effect on the implementation of effective cervical cancer screening initiatives [44]. Thus, low- and middle-income countries, particularly African countries, faced constrained opportunity for healthcare services, a shortage of skilled health workers, inadequate funds and supplies, and long waiting times. These are common barriers that lower uptake of CCS [44]. Likewise, lack of awareness, fear of the screening procedure, and unfavorable perceptions towards cervical cancer screening highly contribute for lower utilization of CCS in Africa. In contrast, individuals in the high-income countries had access to secondary preventive measures such as high-quality screening methods (Pap smear, HPV self-sampling, artificial-assisted screening), higher health literacy, and favorable attitudes towards CCS, which all ultimately increase the uptake of CCS [44,45]. Due to the low coverage of cervical screening, there is a higher rate of cervical cancer cases and poor prognosis related to late diagnosis in developing countries. Therefore, improving access to CCS, community-based health education, involving community leaders and health extension workers to overcome cultural and social hurdles, involving partners, making sure screening services are affordable, and integrating the program with other services should be the prioritized initiatives to increase CCS utilization.
Regarding determinant factors, women’s knowledge was found to be significantly associated with the acceptance of CCS screening; that is, women who knew more about cervical cancer and screening programs were more likely to use the CCS. This finding was consistent with previous studies [40,46,47]. This could be explained by their increased awareness of the importance, benefits, and screening process, which leads to increased participation and early detection of cervical cancer.
Cervical cancer screening was substantially correlated with women’s attitudes toward CCS. As a result, women who had a favorable perception of CCS were more likely to get screened for cervical cancer than those who had a negative opinion. This result was in agreement with findings from low- and middle-income nations [11,48,49]. This could be because women with a good attitude have positive beliefs, motives, and views about the importance and benefits of regular screening, which in turn influence their screening practices. Cultural, social, and spiritual impediments, such as screening restrictions, fear of screening, shame, misunderstandings, and disapproval by partners or family members, all impede cervical cancer screening.
Women’s perceived vulnerability for developing cervical cancer was the other contributing factor for cervical cancer screening. Thus, a woman who perceived herself as more vulnerable to cervical cancer had a higher likelihood of being screened for cervical cancer. This conclusion was in agreement with other studies [50,51]. This is because the women could recognize the severity and far-reaching consequences of the disease, which motivated them to get screened on a regular basis. However, it’s crucial to increase the awareness, attitude, and practice of individuals as well as the community on the benefits of CCS and the severity of cervical cancer. It encourages undergoing screening, which enables detecting and treating the problem early and reducing the incidence of advanced-stage cervical cancer. Finally, women who had a history of STIs were five times more likely to undergo cervical cancer screening than those who did not have a history of STIs. This finding was consistent with primary studies conducted in Ethiopia [52–54] and a meta-analysis study conducted in Ethiopia [31,51]. This is due to the fact that women who have a history of sexually transmitted infections are more likely to visit healthcare facilities because they seek medical treatment and follow-up care for their illness. This allows health professionals to undergo cervical cancer screening for women as part of their comprehensive care for reproductive and sexual health.
Implication of the study
This umbrella review would be the pioneer to summarize preexisting multiple systematic reviews to generate comprehensive evidence on cervical cancer screening and its determinants in Africa. It highlights that the uptake of CCS is too far from the WHO target. Therefore, the findings of this review serve as baseline information for health professionals, health managers, researchers, and concerned non-governmental organizations to take evidence-based interventions to improve CCS in Africa. It also provides an insight for policymakers to realize this lower uptake of CCS, but the higher burden of cervical cancer in Africa. The finding suggests the need to draft and implement appropriate strategies that help to promote cervical cancer screening uptake. The government of each country needs to expand and advocate cervical cancer screening programs through facility- and community-based screening campaigns and convey information via various mass media. The above actions play an important role in early detection and treatment of precancerous cervical lesions and reduce the incidence of cervical cancer.
Strengths and limitations of the study
The authors of this umbrella review employed robust statistical approaches, including a random-effects model, to determine pooled prevalence and account for heterogeneity across studies. The model also examined for publication bias statistically and inspected funnel plots visually. However, this finding could be biased due to the significant variability of the included studies across Africa. This might be due to differences in the study area and the methodological quality of the original studies (sampling technique, sample size, and CCS uptake measurement) included in each systematic review and meta-analysis, which could alter the pooled estimate’s generalizability. Additionally, it’s better to explore barriers and facilitators of cervical cancer screening through qualitative systematic reviews or in-depth qualitative studies. This would be pivotal in exploring socio-cultural variables, health system variables, women’s knowledge, and perceptions towards CCS.
Conclusions
This umbrella review concludes that the pooled estimate of cervical cancer screening in Africa (20.94%) remains much lower than the WHO recommendations target (70%). In addition, women’s level of knowledge, attitude toward CCS, perceived susceptibility to cervical cancer, and history of STIs were significantly associated with the uptake of cervical cancer screening. Therefore, to improve cervical cancer screening uptake, healthcare professionals, policymakers, and healthcare stakeholders shall implement effective strategies such as empowering women, improving knowledge and attitude towards cervical cancer screening, and offering CCS for a woman with a history of STIs.
Acknowledgments
We would like to express our heartfelt gratitude to all of the authors of the primary and systematic reviews and meta-analyses included in this umbrella review.
References
- 1. Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024;74(3):229–63. pmid:38572751
- 2. Chidebe RC, Osayi A, Torode JS. The Global Fund, Cervical Cancer, and HPV Infections: What Can Low-and Middle-Income Countries Do to Accelerate Progress by 2030?. EClinicalMedicine. 2025;81.
- 3. Arbyn M, Weiderpass E, Bruni L, de Sanjosé S, Saraiya M, Ferlay J, et al. Estimates of incidence and mortality of cervical cancer in 2018: a worldwide analysis. Lancet Glob Health. 2020;8(2):e191–203. pmid:31812369
- 4. de Martel C, Plummer M, Vignat J, Franceschi S. Worldwide burden of cancer attributable to HPV by site, country and HPV type. Int J Cancer. 2017;141(4):664–70. pmid:28369882
- 5. Dryden-Peterson S, Bvochora-Nsingo M, Suneja G, Efstathiou JA, Grover S, Chiyapo S, et al. HIV Infection and Survival Among Women With Cervical Cancer. J Clin Oncol. 2016;34(31):3749–57. pmid:27573661
- 6. Geremew AB, Gelagay AA, Azale T. Uptake of pre cervical cancer screening service and associated factors among women aged 30-49 years in Finote Selam town Northwest Ethiopia. Int J Collab Res Intern Med Public Health. 2018;10(2):829–42.
- 7. Chapman Lambert CL. Factors influencing cervical cancer screening in women infected with HIV: a review of the literature. J Assoc Nurses AIDS Care. 2013;24(3):189–97. pmid:22999769
- 8. Zhang W, Gao K, Fowkes FJI, Adeloye D, Rudan I, Song P, et al. Associated factors and global adherence of cervical cancer screening in 2019: a systematic analysis and modelling study. Global Health. 2022;18(1):101. pmid:36494856
- 9.
World Health Organization. Global strategy to accelerate the elimination of cervical cancer as a public health problem. World Health Organization; 2020.
- 10. Buskwofie A, David-West G, Clare CA. A Review of Cervical Cancer: Incidence and Disparities. J Natl Med Assoc. 2020;112(2):229–32. pmid:32278478
- 11. Petersen Z, Jaca A, Ginindza TG, Maseko G, Takatshana S, Ndlovu P, et al. Barriers to uptake of cervical cancer screening services in low-and-middle-income countries: a systematic review. BMC Womens Health. 2022;22(1):486. pmid:36461001
- 12.
Sievers D, White H. Evidence series: cervical Cancer screening and prevention, and barriers to uptake. Washington, DC: Population Services International; 2016.
- 13. Stewart TS, Moodley J, Walter FM. Population risk factors for late-stage presentation of cervical cancer in sub-Saharan Africa. Cancer Epidemiol. 2018;53:81–92. pmid:29414636
- 14. Moyer VA, U.S. Preventive Services Task Force. Screening for cervical cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2012;156(12):880–91, W312. pmid:22711081
- 15.
World Health Organization. WHO guideline for screening and treatment of cervical pre-cancer lesions for cervical cancer prevention: use of dual-stain cytology to triage women after a positive test for human papillomavirus (HPV). World Health Organization; 2024.
- 16. Wilailak S, Kengsakul M, Kehoe S. Worldwide initiatives to eliminate cervical cancer. Int J Gynaecol Obstet. 2021;155(Suppl 1):102–6. pmid:34669201
- 17. Baskaran P, Subramanian P, Rahman RA, Ping WL, Mohd Taib NA, Rosli R. Perceived susceptibility, and cervical cancer screening benefits and barriers in malaysian women visiting outpatient clinics. Asian Pac J Cancer Prev. 2013;14(12):7693–9. pmid:24460355
- 18. Leung SS, Leung I. Cervical cancer screening: knowledge, health perception and attendance rate among Hong Kong Chinese women. Int J Women Health. 2010;221–8.
- 19. Everett T, Bryant A, Griffin MF, Martin-Hirsch PP, Forbes CA, Jepson RG. Interventions targeted at women to encourage the uptake of cervical screening. Cochrane Database Syst Rev. 2011;2011(5):CD002834. pmid:21563135
- 20. Musa J, Achenbach CJ, O’Dwyer LC, Evans CT, McHugh M, Hou L, et al. Effect of cervical cancer education and provider recommendation for screening on screening rates: A systematic review and meta-analysis. PLoS One. 2017;12(9):e0183924. pmid:28873092
- 21. Kassie AM, Abate BB, Kassaw MW, Aragie TG, Geleta BA, Shiferaw WS. Impact of knowledge and attitude on the utilization rate of cervical cancer screening tests among Ethiopian women: A systematic review and meta-analysis. PLoS One. 2020;15(12):e0239927.
- 22. Bogale AL, Teklehaymanot T, Haidar Ali J, Kassie GM. Knowledge, attitude and practice of cervical cancer screening among women infected with HIV in Africa: Systematic review and meta-analysis. PLoS One. 2021;16(4):e0249960. pmid:33831128
- 23. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. pmid:33782057
- 24. Munn Z, Moola S, Lisy K, Riitano D, Tufanaru C. Methodological guidance for systematic reviews of observational epidemiological studies reporting prevalence and cumulative incidence data. Int J Evid Based Healthc. 2015;13(3):147–53. pmid:26317388
- 25. Yirsaw AN, Nigusie A, Andualem F, Getachew E, Getachew D, Tareke AA, et al. Cervical cancer screening utilization and associated factors among women living with HIV in Ethiopia, 2024: systematic review and meta-analysis. BMC Womens Health. 2024;24(1):521. pmid:39300442
- 26. Mengesha MB, Chekole TT, Hidru HD. Uptake and barriers to cervical cancer screening among human immunodeficiency virus-positive women in Sub Saharan Africa: a systematic review and meta-analysis. BMC Womens Health. 2023;23(1):338.
- 27. Shea BJ, Reeves BC, Wells G, Thuku M, Hamel C, Moran J, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ. 2017;358:j4008. pmid:28935701
- 28. Huedo-Medina TB, Sánchez-Meca J, Marín-Martínez F, Botella J. Assessing heterogeneity in meta-analysis: Q statistic or I2 index? Psychol Methods. 2006;11(2):193–206. pmid:16784338
- 29. Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994;50(4):1088–101. pmid:7786990
- 30. Yimer NB, Mohammed MA, Solomon K, Tadese M, Grutzmacher S, Meikena HK. Cervical cancer screening uptake in Sub-Saharan Africa: a systematic review and meta-analysis. Public Health. 2021;195:105–11.
- 31. Desta M, Getaneh T, Yeserah B, Worku Y, Eshete T, Birhanu MY, et al. Cervical cancer screening utilization and predictors among eligible women in Ethiopia: A systematic review and meta-analysis. PLoS One. 2021;16(11):e0259339. pmid:34735507
- 32. Ayenew AA, Zewdu BF, Nigussie AA. Uptake of cervical cancer screening service and associated factors among age-eligible women in Ethiopia: systematic review and meta-analysis. Infect Agent Cancer. 2020;15(1):67. pmid:33292388
- 33.
Omolo B, Tladi P, Gabaitiri L, Makubate B. Cervical cancer screening uptake, associated barriers and facilitators: a systematic review and meta-analysis. 2023.
- 34. Dessalegn Mekonnen B. Cervical Cancer Screening Uptake and Associated Factors among HIV-Positive Women in Ethiopia: A Systematic Review and Meta-Analysis. Adv Prev Med. 2020;2020:7071925. pmid:32879739
- 35. Lakew G, Yirsaw AN, Berhie AY, Belayneh AG, Bogale SK, Andarge GA, et al. Cervical cancer screening practice and associated factors among female health care professionals in Ethiopia 2024: a systematic review and meta-analysis. BMC Cancer. 2024;24(1):986. pmid:39123161
- 36.
Alamneh YM, Alamneh AA, Shiferaw AA. Knowledge, attitude, and practice of cervical cancer screening and associated factors among reproductive aged women in Ethiopia: A meta-analysis and systematic review. 2020.
- 37. Simms KT, Steinberg J, Caruana M, Smith MA, Lew JB, Soerjomataram I, et al. Impact of scaled up human papillomavirus vaccination and cervical screening and the potential for global elimination of cervical cancer in 181 countries, 2020-99: a modelling study. Lancet Oncol. 2019;20(3):394–407.
- 38. Son DA, Hanh NTT. The prevalence of cervical cancer screening in low and middle-income countries: A literature review. Tạp chí Y học Cộng đồng. 2024;65(Tiếng Anh).
- 39. Ahmed HAA, Abbas MH, Hussein HA, Nasr RSF, Lashen AA, Khaled H, et al. Cervical cancer screening uptake in Arab countries: a systematic review with meta-analysis. BMC Cancer. 2024;24(1):1438. pmid:39574088
- 40. Shrestha AD, Andersen JG, Gyawali B, Shrestha A, Shrestha S, Neupane D, et al. Cervical cancer screening utilization, and associated factors, in Nepal: a systematic review and meta-analysis. Public Health. 2022;210:16–25. pmid:35863158
- 41. Rosato I, Dalla Zuanna T, Tricarico V, Barbiellini Amidei C, Canova C. Adherence to Cervical Cancer Screening Programs in Migrant Populations: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2023;20(3):2200. pmid:36767568
- 42.
Bhandari AK, Htay ZW, Parvin R, Murakami M, Matsuda T, Abe SK. Prevalence of Cervical Cancer Screening in Asia-A Systematic Review and Meta-Analysis. Available at SSRN 4774471.
- 43. Zhang W, Gao K, Fowkes FJ, Adeloye D, Rudan I, Song P, et al. Associated factors and global adherence of cervical cancer screening in 2019: a systematic analysis and modelling study. Global Health. 2022;18(1):101.
- 44. Farajimakin O. Barriers to Cervical Cancer Screening: A Systematic Review. Cureus. 2024;16(7):e65555. pmid:39192892
- 45. Rosato I, Dalla Zuanna T, Tricarico V, Barbiellini Amidei C, Canova C. Adherence to Cervical Cancer Screening Programs in Migrant Populations: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2023;20(3):2200. pmid:36767568
- 46. Enechukwu OH, Gusen MJ, Usman MI, Shamshudeen A, Abdulaziz A. Factors influencing the uptake of cervical cancer screening among women of reproductive age in Nigeria: A systematic review. J Public Health. 2023:1–10.
- 47. Mantula F, Toefy Y, Sewram V. Barriers to cervical cancer screening in Africa: a systematic review. BMC Public Health. 2024;24(1):525. pmid:38378542
- 48. Mafiana JJ, Dhital S, Halabia M, Wang X. Barriers to uptake of cervical cancer screening among women in Nigeria: a systematic review. Afr Health Sci. 2022;22(2):295–309. pmid:36407354
- 49. Ibrahim HA, Nahari MH, Alshahrani MA, Al-Thubaity DD, Elgzar WT, El Sayed HA, et al. Cervical cancer perceived risks and associated factors among women in Saudi Arabia: A cross-sectional study. Afr J Reprod Health. 2022;26(7s):13–22. pmid:37585006
- 50. Ibekwe CM, Hoque ME, Ntuli-Ngcobo B. Perceived benefits of cervical cancer screening among women attending Mahalapye District Hospital, Botswana. Asian Pac J Cancer Prev. 2010;11(4):1021–7. pmid:21133618
- 51. Ayenew AA, Zewdu BF, Nigussie AA. Uptake of cervical cancer screening service and associated factors among age-eligible women in Ethiopia: systematic review and meta-analysis. Infect Agent Cancer. 2020;15(1):67. pmid:33292388
- 52. Tesfaw K, Kindie W, Mulatu K, Bogale EK. Utilisation of cervical cancer screening and factors associated with screening utilisation among women aged 30-49 years in Mertule Mariam Town, East Gojjam Zone, Ethiopia, in 2021: a cross-sectional survey. BMJ Open. 2022;12(11):e067229. pmid:36414295
- 53. Aynalem BY, Anteneh KT, Enyew MM. Utilization of cervical cancer screening and associated factors among women in Debremarkos town, Amhara region, Northwest Ethiopia: Community based cross-sectional study. PLoS One. 2020;15(4):e0231307. pmid:32255807
- 54. Amado G, Weldegebreal F, Birhanu S, Dessie Y. Cervical cancer screening practices and its associated factors among females of reproductive age in Durame town, Southern Ethiopia. PLoS One. 2022;17(12):e0279870. pmid:36584208