Jonas M Ndeke

The relationship between rural residence and cervical cancer screening in three sub-Saharan countries with different national screening policies

Purpose To compare cervical cancer screening prevalence between urban and rural women aged 30–49 years in three sub-Saharan African countries chosen by their country-specific screening strategy (Burkina Faso, which has a systematic population-based cervical cancer screening programme in place; Tanzania, where opportunistic screening options only are implemented; and Ghana, which has implemented neither one). Methods We used the most recent Demographic and Health Surveys data from Burkina Faso, Ghana and Tanzania. We restricted our analysis to women aged 30–49 eligible for cervical cancer screening and categorised them by their place of residence as urban or rural. We calculated screening proportions using country-specific survey weights to estimate the absolute prevalence difference in cervical cancer screening between urban/rural residents. Results Rural participants represented 69.5% in Burkina Faso, 64.6% in Tanzania and 42.8% in Ghana. Burkina Faso women reported higher cervical cancer screening prevalence at 19.9%, and Ghana participants reported the lowest at 7.4%. Compared with urban participants, rural women screened less across countries, with an absolute prevalence difference in screening wider in Tanzania at 13.1% (95% CI 10.6% to 15.7%), followed by Burkina Faso at 11.1% (95% CI 7.7% to 14.6%) and narrower in Ghana at 5.9% (95% CI 4.1% to 7.7%). Conclusion We found a consistently low screening uptake and a screening prevalence gap disfavouring rural women from these three sub-Saharan African countries, with the narrowest urban/rural gap in Ghana and the widest in Tanzania, which has a large opportunistic cervical cancer screening programme. Our findings offer no indication of a potential benefit of having a systematic screening programme as a tool that can mitigate the screening gap between urban and rural populations. Further screening uptake studies, including more countries, are needed on this topic, which should account for the existing country-specific non-screening related factors in the healthcare system that may influence cervical cancer screening uptake.