Cervical cancer screening uptake, associated barriers and facilitators: a systematic review and meta-analysis

Abstract

Background: Botswana has a high burden of cervical cancer, mainly due to limited screening uptake and a high HIV prevalence. This systematic review and meta-analysis explore the barriers, facilitators, and cervical cancer screening uptake among women in the country. Methods: We identified relevant papers through PubMed/Medline, Scopus, Web of Science, and Google Scholar from 01 January 2013 to 21 November 2022 using predefined inclusion and exclusion criteria. The selection, assessment, and data extraction process was conducted in duplicate by two researchers. We adopted a fixed effects model to pool evidence on the screening uptake. Results: A total of 673 studies were extracted from the four databases from which we remained with nine papers for systematic review, with a total sample size of 3398. The pooled proportion of screening uptake was 0.40 (95% CI; 0.33, 0.47). All selected studies reported on the facilitators while seven studies reported barriers to cervical cancer screening uptake on four levels (individual, institutional, community, and policy levels). Conclusions: The pooled proportion of cervical cancer screening uptake was 40%, which is low, considering the national target to screen 70% of eligible women. The most frequently reported barriers were the low level of knowledge and awareness, misconceptions about screening, and delays in receipt of screening results (in some cases no delivery of results). Reported facilitators included high socio-economic status, having health care insurance, and having a personal health care provider. This work will inform interventions for specific groups of women, which will ultimately reduce the burden of cervical cancer in Botswana.