Cervical cancer screening “see and treat approach”: real-life uptake after invitation and associated factors at health facilities in Gondar, Northwest Ethiopia

Abstract

Background Although cervical cancer is a preventable disease, screening coverage in Ethiopia is far below the target. There is limited evidence on uptake among the general population in Ethiopia. Thus, this study was conducted to assess uptake and associated factors with the cervical cancer screening “see and treat approach” among eligible women in public health facilities in Gondar town, Northwest Ethiopia. Method A facility-based, cross-sectional study was conducted. The total sample size was 493. A consecutive sampling method was applied. Participants were informed about and invited to cervical cancer screening using visual inspection with acetic acid. Crude and adjusted odds ratios were calculated to determine statistical association with socio-demographic variables. Multivariable logistic regression was used to determine factors of cervical cancer screening uptake. Result Out of 464 women advised for screening, 76 (16.4, 95% CI [13, 19.8%]) attended the screening. Primary education and above (AOR = 5.3, 95% CI [2.20, 13.0]), knowledge about the disease (AOR = 8.4, 95% CI [3.33, 21.21]), perceived susceptibility (AOR = 6.5, 95% CI [2.72, 15.51]), fewer perceived barriers (AOR = 6.4, 95% CI [2.30, 17.80]), cues to action (AOR = 4.6, 95% CI [1.86, 11.32]), perceived self-efficacy (AOR = 5, 95% CI [2.14, 11.73]), and previous recommendation for screening (AOR = 2.7, 95% CI [1.15, 6.51]) were significantly associated with screening uptake. Conclusion The actual uptake of screening offered in this study was high relative to only 3% national screening coverage. There is a need to implement active invitation for screening with special focus on less-educated women. Repeated invitation may facilitate future screening uptake.

Characteristics of Women Seeking Cervical Cancer Cytology Screening in a Private Health Facility

“…About one-third of our participants reported self-initiating the cervical cancer screening, which is similar to a facility-based study that was conducted in Addis Ababa in 2019 and found self-initiated cervical cancer screening to be 33.3% [ 17 ]. Health literacy, based on education and access to understandable health information, has been shown as one of the key factors for increasing the self-initiation of screening [ 6 , 8 , 9 , 10 , 11 , 12 , 13 ]. What is more, awareness is very important for self-initiated cervical screening.…”

“…C. Especially due to the related costs and perceived benefits of the private sector, such as shorter waiting times, it can be assumed that the clientele of both sectors differs. Existing studies on cervical cancer screening often focus on public health facilities or it is not identifiable whether the included health facilities are public or private [ 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 ].…”

Women’s sexual autonomy as a determinant of cervical cancer screening uptake in Addis Ababa, Ethiopia: a case–control study

“…The incidence and mortality of CC have been reduced in countries through organized screening programmes [ 10 , 11 ]. In developing countries, including Ethiopia, the CC screening rate is low, ranging between 1 and 23% [ 12 – 14 ]. Recently, in Ethiopia, CC screening centres are being established to provide screening services for all eligible women.…”

“…In Kenya, higher uptake for the Pap test was found among women who had sexual autonomy when compared with their counterparts [ 26 ]. Low educational level, poor knowledge towards cervical cancer and screening, long distance to screening site, fear of positive result, embarrassment was some of the barriers of cervical cancer screening uptake in Ethiopia [ 12 – 15 , 17 – 19 ]. Besides, data from other countries showing that greater sexual autonomy increase uptake [ 26 ].…”

“…A decline was noted [ 27 ]. In Ethiopia, studies addressed the socio-demographic, reproductive, clinical and health care-related determinants of CC screening uptake [ 12 – 14 , 17 – 19 , 30 ]. However, none of these studies examined the association between women’s autonomy and CC screening uptake.…”