Determinants of Cervical Cancer Screening Uptake among Women Seeking Services at Harare Central Hospital in Zimbabwe

Abstract

Introduction: Cervical cancer is the fourth most common cancer affecting women worldwide. Of the estimated more than 270 000 deaths from cervical cancer every year, more than 85% of these deaths occur in less developed regions. In Zimbabwe, 2270 new cases of cervical cancer and 1451 deaths occur annually. The high mortality rate from cervical cancer globally (52%) could be reduced by effective screening and treatment programmes. However, in Zimbabwe cervical cancer screening coverage remains very low, at 7.2% .The aim of the study was to determine the factors associated with cervical cancer screening uptake among women seeking services at Harare Central Hospital in Zimbabwe. Methods: This was a cross-sectional descriptive study of 326 women of child-bearing age (18–49 years) seeking services at Harare Central Hospital, Zimbabwe. Data on socio-demographic status (age, level of education, residence, marital status, religion, employment status, and income level), awareness and knowledge of cervical cancer, perceptions on severity and susceptibility to the disease, health seeking behaviors and perceived barriers was collected using an interviewer-administered structured questionnaire. Statistical significance of differences in proportions were determined by chi-square analyses while binary logistic regression analyses were used to identify predictors of self-reported uptake of the service. Results: Of the 326 women interviewed, only 33.3% (102) had done cervical cancer screening. There was a strong positive association between age (p < 0.0001), marital status, (p= 0.004), employment status (p= 0.030) and income levels (p = 0.034) hormonal contraceptive use (p<0.001), awareness about cervical cancer (p= 0.002) with the uptake of the service. Perceived susceptibility to cervical cancer was also an important determinant for being screened for cervical cancer (P <0.0003). Furthermore, those who said they visit a health provider more than twice a year (OR: 0.6.8, 95% CI: 0.33, 1.2, p= 0.009) and those who said they do not normally use cash to pay for healthcare (OR: 1.89, 95% CI: 1.01, 3.53; p= 0.048) had a higher likelihood of being screened. Conclusion: Awareness and knowledge, perception of higher susceptibility and frequent visits to a healthcare provider and not using cash to pay cash for health care services are significant determinants for cervical cancer screening uptake. Increasing knowledge, enhancing health education and giving more attention to women in lower socioeconomic groups may significantly improve uptake of cervical cancer screening in such settings.