Current Cervical Cancer Status in Resource-Limited Somalia: a Systematic Review of Burden, Screening Findings, and Knowledge Gaps.

introductionCervical cancer is the second most frequent cancer among Somali women, with approximately 1,055 diagnoses and 812 deaths annually; however, evidence to guide control efforts is scarce. This systematic review synthesizes the burden, screening findings, and knowledge gaps to inform policy and practice in Somalia’s resource-limited settings.

methodsFollowing PRISMA 2020, we searched PubMed, Scopus, Embase, ScienceDirect, DOAJ, Cochrane Library, and Google Scholar without date limits for English, peer-reviewed studies from Somalia reporting prevalence, incidence, knowledge, screening, and prevention. Two reviewers independently extracted the data and performed the JBI critical appraisal for cross-sectional studies. Given the heterogeneity, we conducted a narrative synthesis.

resultsSeven cross-sectional studies (2019–2024) with 3,797 participants from Mogadishu, Hargeisa, and Bosaso were included in this review. Across facility-based studies, cervical cancer accounted for 6.7% of all cancers and 13.3% of female cancers, while screening positivity among women attending screening services ranged up to 15.7%. The prevalence of cervical cancer ranged from 6.7% to 15.7%. Among 189 women sampled in Mogadishu (clinic-based), 31.7% were HPV DNA-positive, including 19.6% high-risk types (HPV16 13.8%, HPV18 5.3%); these findings may not represent national HPV prevalence. Among healthcare professionals, 73% had good theoretical knowledge; however, only 24% had treated a cervical-cancer patient, 22% reported receiving specific training, and only 2% of female providers had undergone Pap testing. Women’s awareness varied widely (43.7–97.7%), and misconceptions were common. In one facility-based screening study, VIA positivity was 7.6% compared with 5.1% for Pap smear (p = 0.004). Among women who were VIA-positive and underwent confirmatory assessment, 73.9% had CIN on colposcopy/biopsy; however, biopsy-confirmed CIN2+/cancer outcomes by each test and verification pathways were not fully reported, limiting direct comparison of diagnostic performance.

conclusionsSomalia faces a high burden of cervical cancer and HPV infection, compounded by limited screening coverage, training gaps among providers, and misinformation among women about HPV vaccination. Priority actions include establishing a national cancer registry, expanding HPV vaccination, scaling context-appropriate screening (VIA and HPV testing), delivering targeted public education, and strengthening provider training especially for female frontline staff using culturally sensitive approaches to improve uptake and outcomes.