Coverage and Factors Associated with Cervical Cancer Screening: Results from a Population-Based WHO Steps Study in Ethiopia
Background: Cervix cancer is the most common cause of cancer deaths in Africa accounting for 10.4 deaths, which represents one in five of all cancer deaths in African women Munoz et al. Sub-Saharan Africa bears the highest global burden of this fatal yet entirely preventable disease. The problem is particularly severe in sub-Saharan Africa, where the age-adjusted incidence rate is 45 per 100,000 women with Ethiopia at 35.9 per 100,000 women. Data from the Addis Ababa population based cancer registry showed that breast and cervical cancers were the leading causes of cancer, comprising 22.6% and 10.8% respectively of all cases of cancers. Methods: Community-based Cross-sectional survey based on the World Health Organization (WHO) NCD Stepwise approach was done. The survey was conducted in the 9 regions and two city administrations (Addis Ababa and Dire Dawa) in Ethiopia. The target population for this survey included all men and 15-69 years old who consider Ethiopia to be their primary place of residence. A single population-proportion formula was used to determine the sample size design effect coefficient of 1.5, Z-score=1.96, proportion=35.2 and marginal error=0.04. A total of 513 EAs were covered nationwide. Thus, 5823 women were included in this study. A mix of sampling approach namely stratified, three-stage cluster sampling, simple random sampling and Kish method were employed to select the study settings and the study participants. Results: Cervical cancer screening rate in Ethiopia is extremely low (2.9%). When adjusted for demographic and residence confounders (age, location, income, education), cervical cancer screening is significantly associated with being at urban area (AOR=2.5, 95% CI: 1.1, 5.7), age 30-49 years (AOR=2.4, 95% CI: 1.2, 4.8), having annual household income of more than 30,000 ETB (AOR=7.1, 95% CI: 4.8, 10.4) and college and above level of education (OR=2.8, 95% CI: 1.1, 7.8). Conclusions: Cervical cancer screening rate in Ethiopia is extremely low as compared to the rates of other countries. This needs a mechanism to establish and strengthen the multi-sectoral response in general for the prevention and control of cervical cancer and increasing awareness of the community towards cervical cancer screening and strengthening the health system in particular.
