ArticleBMJ open2023
Socioeconomic inequalities in cervical precancer screening among women in Ethiopia, Malawi, Rwanda, Tanzania, Zambia and Zimbabwe: analysis of Population-Based HIV Impact Assessment surveys.
Article in BMJ open, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.
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Who cites it
8 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Sociodemographic inequalities in the uptake of prenatal HIV testing in Ethiopia: Systematic review and meta-analysis.PloS one · 2024Pooled it
- Prior Cervical Cancer Screening, Social Determinants of Health, and HIV Status Among Patients at the Cancer Disease Hospital, Zambia.Research square · 2026Article
- Factors associated with cervical cancer screening in the South African demographic and health survey.Cancer causes & control : CCC · 2026Article
- Impact of the 2013 WHO guidelines for screening and treatment of cervical pre-cancerous lesions on women's screening uptake, by HIV-status, in Eastern and Southern Africa: a regression discontinuity design analysis.Reproductive health · 2026Article
- Factors associated with cervical cancer screening: results from cross-sectional surveys in Kenya and Malawi.BMC public health · 2025Article
- Client perspectives and satisfaction with integrating facility and community-based HPV self-sampling for cervical cancer screening with family planning: a mixed method study.BMC public health · 2025Article
- Wealth-related inequalities of women's cervical cancer screening in 11 Sub-Saharan African countries: evidence from a pooled decomposition analysis.Scientific reports · 2025Article
- High unmet needs for cervical cancer screening among women living with HIV in six African countries: A population-based study.International journal of STD & AIDS · 2025Article
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Abstract
objectivesWe examined age, residence, education and wealth inequalities and their combinations on cervical precancer screening probabilities for women. We hypothesised that inequalities in screening favoured women who were older, lived in urban areas, were more educated and wealthier.
designCross-sectional study using Population-Based HIV Impact Assessment data.
settingEthiopia, Malawi, Rwanda, Tanzania, Zambia and Zimbabwe. Differences in screening rates were analysed using multivariable logistic regressions, controlling for age, residence, education and wealth. Inequalities in screening probability were estimated using marginal effects models.
participantsWomen aged 25-49 years, reporting screening. OUTCOME MEASURES: Self-reported screening rates, and their inequalities in percentage points, with differences of 20%+ defined as high inequality, 5%-20% as medium, 0%-5% as low.
resultsThe sample size of participants ranged from 5882 in Ethiopia to 9186 in Tanzania. The screening rates were low in the surveyed countries, ranging from 3.5% (95% CI 3.1% to 4.0%) in Rwanda to 17.1% (95% CI 15.8% to 18.5%) and 17.4% (95% CI 16.1% to 18.8%) in Zambia and Zimbabwe. Inequalities in screening rates were low based on covariates. Combining the inequalities led to significant inequalities in screening probabilities between women living in rural areas aged 25-34 years, with a primary education level, from the lowest wealth quintile, and women living in urban areas aged 35-49 years, with the highest education level, from the highest wealth quintile, ranging from 4.4% in Rwanda to 44.6% in Zimbabwe.
conclusionsCervical precancer screening rates were inequitable and low. No country surveyed achieved one-third of the WHO's target of screening 70% of eligible women by 2030. Combining inequalities led to high inequalities, preventing women who were younger, lived in rural areas, were uneducated, and from the lowest wealth quintile from screening. Governments should include and monitor equity in their cervical precancer screening programmes.
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