The barriers to cervical cancer screening for urban and rural populations in Rwanda

Abstract

BACKGROUND Cervical cancer is the leading cause of cancer mortality in Rwandan women. There is a limited understanding of the barriers that women face to obtain cervical cancer screening in Rwanda. It is important to understand the barriers in order to implement effective screening programs. The goal of this study is to describe the barriers to cervical cancer screening among women in Rwanda and how they differ among women in rural and urban areas. METHODS This cross-sectional study recruited women from June 1 to 9, 2022 at Muhima and Nyamata District Hospitals in Rwanda. Women were eligible for the study if they were ≥ of 18 years and spoke Kinyarwanda or English. Women completed a 15-minute survey which included questions on the participants demographics, knowledge of cervical cancer, cervical cancer screening history, and barriers to healthcare. Women were stratified by survey location (urban vs rural). Descriptive statistics were reported. RESULTS A total of 374 women completed the survey with 169 participants from Muhima and 205 from Nyamata. Most women were in a relationship and had a primary school or less education. The most common barriers to accessing general healthcare services was long wait times at the facility, (Muhima 26%; Nyamata 30%), low quality of care, (Muhima 15%; Nyamata 12%) and transportation costs (Muhima 13%; Nyamata 9.3%). However, women from Nyamata were significantly more likely to report distance to the health center as a barrier (p-value <0.001) and women from Muhima were significantly more likely to report transportation method as a barrier (p-value =0.004). The primary reason reported for not obtaining cervical cancer screening was that women did not know how or where to get tested (Muhima 57%; Nyamata 51%). CONCLUSION The most common barriers to cervical cancer screening in Rwanda were the quality of clinical care and issues with traveling to the clinic. Implementing a cervical cancer self-collection program could help eliminate many barriers that women face to obtain health services in Rwanda. More research is needed to better understand the acceptability of cervical cancer screening in Rwanda and how it could be integrated into the healthcare system.