Residency-Based Inequalities in Cervical Cancer Screening in Sub-Saharan Africa

This study examined the contributions of factors associated with rural-urban disparities in cervical cancer screening uptake in sub-Saharan Africa using a decomposition analysis.

We used data from the recent Demographic and Health Surveys conducted in 14 sub-Saharan African countries. A weighted sample of 66,958 women aged 30-49 years was included in our analysis. We used a multivariate nonlinear decomposition model to examine the factors contributing to the rural-urban disparities in cervical cancer screening uptake. The results were presented as differences due to characteristics and coefficients, with their respective coefficients, percentages, and p-values.

The pooled uptake of cervical cancer screening across the 14 countries was 21.2% (95% confidence interval [CI]: 20.1-22.2) among urban women and 11.6% (95% CI: 10.9-12.3) among rural women. The decomposition analysis showed that the differences in women's characteristics explained 106.53% of the rural-urban disparity in cervical cancer screening uptake. Factors such as education level, parity, wealth index, and exposure to mass media accounted for most of this disparity. The coefficients component explained the remaining -6.53% of the disparity in cervical cancer screening uptake.

Our study has shown that disparities between rural and urban areas in cervical cancer screening uptake exist in sub-Saharan Africa, largely driven by educational level, parity, wealth index, and exposure to mass media. Public health strategies must therefore adopt a multifaceted approach: increasing rural access to cervical cancer screening services, tailoring interventions for less educated and socially disadvantaged women, addressing marital and cultural barriers, and using mass media to normalise and promote cervical cancer screening.