Background Cervical cancer is the leading cause of disability and mortality among women in Africa. Despite a significant correlation between HIV/AIDS and cervical cancer, there is unacceptably low coverage of the uptake of cervical cancer screening among human immunodeficiency virus-positive women in Sub-Saharan Africa. Individual primary studies are limited in explaining the patterns of uptake of cervical cancer screening. This review therefore considers the uptake of cervical cancer screening and its barriers among human immunodeficiency virus-positive women in Sub-Saharan Africa. Methods We systematically searched articles published until December 31, 2019, from the PubMed, Cochrane Library, POP LINE, Google Scholar, African Journals Online and JURN databases. The quality of the included articles was assessed by using the Newcastle‒Ottawa Scale, and the coverage of uptake of cervical cancer screening was pooled after checking for heterogeneity and publication bias. The random effect model was used, and subgroup analysis estimates were performed by country. Results Twenty-one studies comprising 20,672 human immunodeficiency virus-positive women were included. Applying a random effect model, the overall cervical cancer screening uptake among this group of women in Sub-Saharan Africa was estimated to be 30% (95% CI: 19, 41, I2 = 100%). The main barriers to uptake of cervical screening include poor knowledge about cervical cancer and screening, low risk perception of cervical cancer, fear of test result and fear of screening as painful, lack of access to screening services, high cost of screening service, and poor partner attitude and acceptance of the service. The perception of an additional burden of having a cervical cancer diagnosis was found to be a unique barrier among this population of women. Conclusion The unacceptably low coverage of uptake of cervical cancer screening would indicate that the need to scale up the opportunities to these groups of women as well. This review revealed that in addition to structural and health care system barriers, sociocultural and personal barriers are powerful barriers in HIV-positive women. For these cohorts of population, a particular obstacle was discovered to be perception of an additional burden of having cervical cancer.

An episiotomy is one of the most commonly performed obstetrics surgeries indicated in emergencies during the second stage of labor like fetal distress, dystocia, and tight perineum. As a result, this systematic review and meta-analysis aimed to assess the prevalence of episiotomy practice and associated factors in Ethiopia. Ten cross-sectional studies with a total population of 3718 were included in this study. The search was done using online databases like PubMed, HINARI, Web of Science, other gray, and online repositories of Universities. All the included papers were extracted and appraised using the standard extraction sheet format of JOANNA Briggs Institute. The Cochran Q-test and I2 statistics test were used to test the heterogeneity of studies. To detect the publication bias of the included studies, a funnel plot and Egger’s test were used. The pooled prevalence of episiotomy practice and the odds ratio with a 95% confidence interval were presented using forest plots. The overall pooled prevalence of episiotomy practice was 45.11% (95% CI; 37.04–53.18; I2 = 96.3%). Prolonged second stage of labor (OR: 4.79, 95% CI: 3.03, 7.57), face presentation (OR: 4.26, 95% CI: 1.21, 15.07), birth weight > 4000 g (OR: 6.71, 95% CI: 3.14–14.33), instrumental delivery (OR: 4.26, 95% CI 2.95, 6.14), and primiparity (OR: 3.70, 95% CI: 1.90, 7.2) were factors associated with episiotomy practice. The overall prevalence of episiotomy practice was higher in Ethiopia compared to studies conducted in other countries. The prolonged second stage of labor, face presentation, birth weight > 4000 g, instrumental delivery, and primiparity of women were the factors associated with episiotomy practice. Therefore, efforts should be made to prevent routine episiotomy practice through creating awareness, adjusting national guidelines, affecting the World Health Organization episiotomy policy, and monitoring the activities of the health care facilities in executing the protocols.

Background Cervical cancer is a leading cause of disability and mortality among women in Africa. Despite significant correlation between HIV/AIDS and cervical cancer, unacceptably low coverage of uptake of cervical cancer screening among Human Immunodeficiency Virus-positive women in Sub-Saharan Africa. Individual primary studies are limited in explaining the patterns of uptake of cervical cancer screening. Hence, this review considers the uptake of cervical cancer screening and its barriers among Human Immunodeficiency Virus-positive women in Sub-Saharan Africa. Methods We systematically searched articles published up to December 31st, 2019 from databases of PubMed, Cochrane Library, POP LINE, Google Scholar, African Journals Online and JURN. Quality of included articles was assessed by using the Newcastle-Ottawa Scale and the coverage of uptake of cervical cancer screening was pooled after checking for heterogeneity and publication bias. The random effect model was used and sub-group analysis estimate was done by countries. Results Twenty-one studies comprised of 20,672 Human Immunodeficiency Virus-Positive women were included. Applying random effect model, the overall cervical cancer screening uptake among this group of women in Sub Saharan Africa was estimated to be 30% (95% CI: 19, 41, I2 = 100%). The main barriers to uptake of cervical screening to include: poor knowledge about cervical cancer and screening, low risk perception of cervical cancer, fear of test result and fear of screening as painful, lack of access to screening services, high cost of screening service, and poor partner attitude and acceptance of the service. The perception of an additional burden of having a cervical cancer diagnosis was found to be a unique barrier among this population of women. Conclusion The review revealed that cervical cancer screening uptake is low due to poor knowledge about cervical cancer and screening, low risk perception of cervical cancer, Fear of test result and fear of screening, lack of access to screening services, high cost of screening services and poor partner attitude and acceptance of the service. Besides the above, perception of an additional burden of having a cervical cancer was found to be a unique barrier for these group of population.

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