Disparities and determinants of testing for early detection of cervical cancer among Nepalese women: evidence from a population-based survey.

ABSTRACT

BACKGROUND: Cervical cancer (CC) presents a considerable challenge in South Asia, notably in Nepal, where screening remains limited. Past research in Nepal lacked national representation and a thorough exploration of factors influencing CC screening, such as educational and socioeconomic disparities. This study aims to measure these gaps and identify associated factors in testing for early detection of CC among Nepalese women. METHODS: Data from the 2019 Nepal Noncommunicable Disease Risk Factors survey (WHO-STEPwise approach to noncommunicable risk factor surveillance), involving 2,332 women aged 30-69 years, were used. Respondents were asked if they had undergone CC testing through VIA, Pap smear, or HPV test ever or in the past five years. The slope index of inequality (SII) and relative concentration index (RCI) were used to measure socioeconomic and education-based disparities in CC test uptake. RESULTS: Only 7.1% (95% CI 5.1-9.9) Nepalese women had ever undergone CC testing, while 5.1% (95% CI 3.4-7.5) tested within the last five years. The ever uptake of CC testing was 5.1 percentage points higher (SII 5.1, 95% CI -0.1 to 10.2) among women from richest compared to poorest households. Education-based disparities were particularly pronounced, with a 13.9 percentage point difference between highly educated urban residents and their uneducated counterparts (SII 13.9, 95% CI 5.8 to 21.9). CONCLUSIONS: Less than one in ten women in Nepal had a CC testing, primarily favoring higher educated and wealthier individuals. IMPACT Targeted early detection and CC screening interventions are necessary to address these disparities and improve access and uptake.