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Factors associated with cervical cancer screening in the South African demographic and health survey
M G Singini1, F Sitas2,3, P Basu4
1Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town and Durban, South Africa. Mwiza.singini@mrc.ac.za.
Cancer Causes & Control : CCC
|July 1, 2026
Summary
Cervical cancer screening uptake is low in South Africa, especially for Black women. HIV testing and wealth are key factors influencing screening participation, highlighting the need for targeted interventions.
Area of Science:
- Public Health
- Epidemiology
- Gynecologic Oncology
Background:
- Cervical cancer is a significant health concern for women in South Africa.
- Papanicolaou (Pap) screening uptake remains suboptimal despite its importance.
- Limited research exists on factors influencing screening participation in this population.
Purpose of the Study:
- To examine the associations between cervical cancer screening uptake and sociodemographic characteristics.
- To investigate the influence of women's empowerment on screening participation.
- To explore the role of healthcare access and lifestyle behaviors in cervical screening uptake.
Main Methods:
- Cross-sectional analysis of a nationally representative dataset of 2789 women aged 25-49 years from the 2016 South African Demographic and Health Survey.
- Multivariable generalized linear regression models with Poisson distribution were used to estimate adjusted prevalence ratios (aPRs) and 95% confidence intervals (95% CIs).
- Factors were ordered by attributable fractions (AF) to determine their relative importance in influencing screening uptake.
Main Results:
- HIV testing (aPR=1.79, AF=41.7%) was the strongest positive determinant of cervical screening uptake.
- Being Black (aPR=0.75, AF=19.7%) and disempowerment (aPR=1.10, AF=5.5%) were associated with lower and higher screening uptake, respectively.
- Higher socioeconomic status (rich, aPR=1.34, AF=15.9%) and education (aPR=1.18, AF=8.9%) were also significant positive determinants.
Conclusions:
- Cervical cancer screening uptake remains suboptimal, particularly among Black women in South Africa.
- Interventions should focus on increasing HIV testing and addressing socioeconomic and empowerment disparities.
- Community-based programs and enhanced awareness campaigns are crucial for improving Pap smear uptake.
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