Individual and community-level determinants of cervical cancer screening in Zimbabwe: a multi-level analyses of a nationwide survey.

BACKGROUND: Despite the benefits of cervical cancer (CC) screening to reduce the disease burden, uptake remains limited in developing countries. This study aims to assess the individual and community-level determinants of cervical cancer screening among women of reproductive age in Zimbabwe. METHODS: We analyzed data collected from 400 communities from the 2015 Zimbabwe Demographic and Health Survey with a sample size of 9955 women aged 15-49 years. The descriptive statistics and multi-level regression models adjusted for potential covariates were performed to examine the association between individual, household and community-level factors and the uptake of cervical cancer screening in women. RESULTS: The mean (SD) age of women in Zimbabwe using cervical cancer screening was 27.9 (9.9) years. A relatively small proportion of women, i.e., only 13.4% had ever screened for cervical cancer, with higher screening rates observed in the following sub-groups: middle aged women 31-49 years (odds ratio (OR) = 2.01; 95% confidence intervals (CI) 1.72-2.34), and currently working (OR = 1.35; 95% CI 1.17-1.55), those with health insurance (OR = 1.95; 95% CI 1.63-2.34), used modern contraceptives (OR = 1.51; 95% CI 1.22-1.86), exposed to multiple media (OR = 1.27; 95% CI 1.03-1.58), those living in communities that had a high predominance of women with favorable attitude towards Intimate Partner Violence (IPV) against women (OR = 1.21; 95% CI 1.04-1.41) and a non-poor wealth index (OR = 1.54; 95% CI 1.14-2.05). CONCLUSIONS: Our data shows a significantly low prevalence of cervical cancer screening among reproductive age women in Zimbabwe. To increase the uptake of cervical cancer screening, there is an urgent need both to implement behavioral interventions targeted at women from low socio-economic groups and to advocate for universal health coverage that includes financial risk protection to help all women realize their right to health.

Factors associated with HPV vaccination uptake in Uganda: a multi-level analysis.

BACKGROUND: The cervical cancer burden in Uganda is high amidst low uptake of HPV vaccination. Identification of individual and community factors associated with HPV vaccination are imperative for directed interventions. Conversely, in most Low and Middle Income Countries (LMICs) including Uganda this problem has not been sufficiently studied as the influence of individual and contextual determinants remains undetermined in spite of their substantial effect on HPV vaccine uptake. The aim of the study was to identify individual (school attendance status, age of girls, ethnicity, and amount of media exposure) and community (socioeconomic disadvantages) factors associated with HPV vaccination. METHODS: Based on a modified conceptual framework for health care utilization, hierarchical modelling was used to study 6093 girls, aged 10-14 years (level 1), nested within 686 communities (level 2) in Uganda by analyzing data from the 2016 Uganda Demographic and Health Survey. RESULTS: Majority (78%) of the girls had not been vaccinated. A number of both individual and community factors were significantly associated with HPV vaccination. The Odds of HPV vaccination were higher among girls age; 11, 13, and 14 compared to girls age 10 years, attending school compared to girls not attending school, who were; foreigners, Iteso, Karamajong, Banyoro, Basoga, and other tribe compared to Baganda, living in families with 1-8 members compared to those living in families with 9 or more members and middle social economic status compared to poor wealth quintile. CONCLUSIONS: Both individual and community factors show a noticeable effect on HPV vaccination. If higher vaccination rates are to be achieved in Uganda, these factors should be addressed. Strategies aimed at reaching younger girls, street children, out of school girls, and girls with lower SES should be embraced in order to achieve high vaccination uptake.

Individual and intimate-partner factors associated with cervical cancer screening in Central Uganda.

Intimate-partner factors have a significant effect on the uptake of services that affect maternal reproductive health outcomes. There is limited research on intimate-partner factors associated with cervical cancer screening. Therefore, this article examines the intimate-partner correlates of cervical cancer screening among married women in Central Uganda. We conducted a cross-sectional survey in Wakiso and Nakasongola districts in Central Uganda. A total of 656 married women aged 25-49 participated in the study. Frequency distributions for descriptive statistics and Pearson chi-squared tests were done to identify the association of selected individual explanatory variables and intimate-partner factors with cervical cancer screening. Finally, multivariable complementary log-log regressions were used to estimate intimate-partner factors associated with women's cervical cancer screening uptake in Central Uganda. About 2 in 10 (20%) of the participants had been screened for cervical cancer. The following characteristics when examined separately in relation to the uptake of cervical cancer screening service and were significant: woman's age, education attainment, occupation, wealth index, parity, male partner's age, and male partner's emotional support. After adjusting for independent factors, cervical cancer screening was significantly associated with women who had; attained secondary (AOR = 2.19; CI 1.18-4.06) compared to none/ primary education, and received partner's emotional support (AOR = 30.06; CI 13.44-67.20) compared to those who did not receive partner's emotional support. In Central Uganda, cervical cancer screening among married women was significantly associated with women's education, and partner's emotional support. These factors point to the importance of intimate-partner factors. Therefore, more effort should be directed at encouraging men's participation. This should be supplemented with empowering women through education to increase uptake of screening services.

Predictors of cervical cancer screening uptake in two districts of Central Uganda.

Uganda's cervical cancer age standardized incidence rate is four times the global estimate. Although Uganda's ministry of health recommends screening for women aged 25-49 years, the screening remains low even in the most developed region (Central Uganda) of the country. This study examined the demographic, social, and economic predictors of cervical cancer screening in Central Uganda with the aim of informing targeted interventions to improve screening. The cross-sectional survey was conducted in Wakiso and Nakasongola districts in Central Uganda. A total of 845 women age 25-49 years participated in the study. Data were analyzed at bivariate and multivariate levels to examine the predictors of CC (cervical cancer) screening. Only 1 in 5 women (20.6%) had ever screened for cervical cancer. Our multivariate logistic regression model indicated that wealth index, source of information, and knowledge about CC and CC screening were significantly associated with cervical cancer screening. The odds of cervical cancer screening were higher among rich women compared with poor women [AOR = 1.93 (95%CI: 1.06-3.42), p = 0.031)], receiving information from health providers compared with radios [AOR = 4.14 (95%CI: 2.65-6.48), p<0.001, and being more knowledgeable compared with being less knowledgeable about CC and CC screening [AOR = 2.46 (95%CI: 1.49-3.37), p<0.001)]. Overall cervical cancer screening uptake in central Uganda was found to be low. The findings of the study indicate that women from a wealthy background, who had been sensitized by health workers and with high knowledge about CC and CC screening had higher odds of having ever screened compared with their counterparts. Efforts to increase uptake of screening must address disparities in access to resources and knowledge.