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      Uptake of cervical cancer screening service and associated factors among age-eligible women in Ethiopia: systematic review and meta-analysis

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          Abstract

          Background

          Cervical cancer is the leading cause of cancer deaths among women in developing countries. Since cervical cancer is a preventable disease, screening is an important control and prevention strategy, recommended by the World Health Organization (WHO) for all women aged 30 years and older, and even earlier for some high-risk women. Therefore the aim of this study was to assess the uptake of cervical cancer screening among age-eligible women in Ethiopia.

          Method

          Review identification was performed through the search of online databases PubMed, Google Scholar, HINARI, EMBASE, Science Direct, Cochrane library, African Journals, and other gray and online repository accessed studies were searched using different search engines. For critical appraisal of studies, Newcastle-Ottawa Quality Assessment Scale (NOS) was used. The analysis was conducted by using STATA 11 software. To test the heterogeneity of studies, the Cochran Q test and I 2 test statistics were used. To detect publication bias of the studies, the funnel plot and Egger’s test were used. The pooled prevalence of cervical cancer screening and the odds ratio (OR) with a 95% confidence interval were presented using forest plots.

          Result

          Twenty-four studies with a total of 14,582 age-eligible women were included in this meta-analysis. The pooled national level of cervical cancer screening among age-eligible women in Ethiopia was 13.46% (95%CI:11.06,15.86). Knowledge on cervical cancer and screening (OR = 4.01,95%CI:2.76,5.92), history of multiple sexual partners (OR = 5.01, 95%CI:2.61,9.61), women’s age (OR = 4.58, 95%CI:2.81,7.46), history of sexually transmitted disease (OR = 4.83,95%CI:3.02,7.73), Perceived susceptibility to cervical cancer (OR = 3.59, 95%CI:1.99,6.48), getting advice from health care providers (OR = 4.58, 95%CI:3.26, 6.43), women’s educational level (OR = 6.68,95%CI:4.61,9.68), women’s attitude towards cervical cancer and screening (OR = 3.42, 95%CI:2.88,4.06) were the determinant factors of cervical cancer screening uptake among age-eligible women in Ethiopia.

          Conclusion

          The pooled prevalence of cervical cancer screening was remarkably low among age-eligible women in Ethiopia. Thus, to increase the uptake of cervical cancer screening among age-eligible women regularly, it is better to create awareness programs for early detection and treatment of cervical cancer, and educational interventions that teach the step-by-step practice of cervical screening to increase women’s attitude for screening. Additionally, it is better to inform every woman is susceptible to cervical cancer, especially after starting sexual intercourse, and screening remains fundamental in the fight against cervical cancer before becoming invasive. Moreover, counseling and improving the confidence of women by health care providers to undergo screening is recommended.

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          Most cited references40

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          Global Cancer Statistics 2018: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries

          This article provides a status report on the global burden of cancer worldwide using the GLOBOCAN 2018 estimates of cancer incidence and mortality produced by the International Agency for Research on Cancer, with a focus on geographic variability across 20 world regions. There will be an estimated 18.1 million new cancer cases (17.0 million excluding nonmelanoma skin cancer) and 9.6 million cancer deaths (9.5 million excluding nonmelanoma skin cancer) in 2018. In both sexes combined, lung cancer is the most commonly diagnosed cancer (11.6% of the total cases) and the leading cause of cancer death (18.4% of the total cancer deaths), closely followed by female breast cancer (11.6%), prostate cancer (7.1%), and colorectal cancer (6.1%) for incidence and colorectal cancer (9.2%), stomach cancer (8.2%), and liver cancer (8.2%) for mortality. Lung cancer is the most frequent cancer and the leading cause of cancer death among males, followed by prostate and colorectal cancer (for incidence) and liver and stomach cancer (for mortality). Among females, breast cancer is the most commonly diagnosed cancer and the leading cause of cancer death, followed by colorectal and lung cancer (for incidence), and vice versa (for mortality); cervical cancer ranks fourth for both incidence and mortality. The most frequently diagnosed cancer and the leading cause of cancer death, however, substantially vary across countries and within each country depending on the degree of economic development and associated social and life style factors. It is noteworthy that high-quality cancer registry data, the basis for planning and implementing evidence-based cancer control programs, are not available in most low- and middle-income countries. The Global Initiative for Cancer Registry Development is an international partnership that supports better estimation, as well as the collection and use of local data, to prioritize and evaluate national cancer control efforts. CA: A Cancer Journal for Clinicians 2018;0:1-31. © 2018 American Cancer Society.
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            Inequities in the Global Health Workforce: The Greatest Impediment to Health in Sub-Saharan Africa

            Health systems played a key role in the dramatic rise in global life expectancy that occurred during the 20th century, and have continued to contribute enormously to the improvement of the health of most of the world’s population. The health workforce is the backbone of each health system, the lubricant that facilitates the smooth implementation of health action for sustainable socio-economic development. It has been proved beyond reasonable doubt that the density of the health workforce is directly correlated with positive health outcomes. In other words, health workers save lives and improve health. About 59 million people make up the health workforce of paid full-time health workers world-wide. However, enormous gaps remain between the potential of health systems and their actual performance, and there are far too many inequities in the distribution of health workers between countries and within countries. The Americas (mainly USA and Canada) are home to 14% of the world’s population, bear only 10% of the world’s disease burden, have 37% of the global health workforce and spend about 50% of the world’s financial resources for health. Conversely, sub-Saharan Africa, with about 11% of the world’s population bears over 24% of the global disease burden, is home to only 3% of the global health workforce, and spends less than 1% of the world’s financial resources on health. In most developing countries, the health workforce is concentrated in the major towns and cities, while rural areas can only boast of about 23% and 38% of the country’s doctors and nurses respectively. The imbalances exist not only in the total numbers and geographical distribution of health workers, but also in the skills mix of available health workers. WHO estimates that 57 countries world wide have a critical shortage of health workers, equivalent to a global deficit of about 2.4 million doctors, nurses and midwives. Thirty six of these countries are in sub-Saharan Africa. They would need to increase their health workforce by about 140% to achieve enough coverage for essential health interventions to make a positive difference in the health and life expectancy of their populations. The extent causes and consequences of the health workforce crisis in Sub-Saharan Africa, and the various factors that influence and are related to it are well known and described. Although there is no “magic bullet” solution to the problem, there are several documented, tested and tried best practices from various countries. The global health workforce crisis can be tackled if there is global responsibility, political will, financial commitment and public-private partnership for country-led and country-specific interventions that seek solutions beyond the health sector. Only when enough health workers can be trained, sustained and retained in sub-Saharan African countries will there be meaningful socio-economic development and the faintest hope of attaining the Millennium Development Goals in the sub-continent.
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              The burden of human papillomavirus infections and related diseases in sub-saharan Africa.

              Despite the scarcity of high quality cancer registries and lack of reliable mortality data, it is clear that human papillomavirus (HPV)-associated diseases, particularly cervical cancer, are major causes of morbidity and mortality in sub-Saharan Africa (SSA). Cervical cancer incidence rates in SSA are the highest in the world and the disease is the most common cause of cancer death among women in the region. The high incidence of cervical cancer is a consequence of the inability of most countries to either initiate or sustain cervical cancer prevention services. In addition, it appears that the prevalence of HPV in women with normal cytology is higher than in more developed areas of the world, at an average of 24%. There is, however, significant regional variation in SSA, with the highest incidence of HPV infection and cervical cancer found in Eastern and Western Africa. It is expected that, due to aging and growth of the population, but also to lack of access to appropriate prevention services and the concomitant human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) epidemic, cervical cancer incidence and mortality rates in SSA will rise over the next 20 years. HPV16 and 18 are the most common genotypes in cervical cancer in SSA, although other carcinogenic HPV types, such as HPV45 and 35, are also relatively more frequent compared with other world regions. Data on other HPV-related anogenital cancers including those of the vulva, vagina, anus, and penis, are limited. Genital warts are common and associated with HPV types 6 and 11. HIV infection increases incidence and prevalence of all HPV-associated diseases. Sociocultural determinants of HPV-related disease, as well as the impact of forces that result in social destabilization, demand further study. Strategies to reduce the excessive burden of HPV-related diseases in SSA include age-appropriate prophylactic HPV vaccination, cervical cancer prevention services for women of the reproductive ages, and control of HIV/AIDS. This article forms part of a regional report entitled "Comprehensive Control of HPV Infections and Related Diseases in the Sub-Saharan Africa Region" Vaccine Volume 31, Supplement 5, 2013. Updates of the progress in the field are presented in a separate monograph entitled "Comprehensive Control of HPV Infections and Related Diseases" Vaccine Volume 30, Supplement 5, 2012. Copyright © 2013. Published by Elsevier Ltd.
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                Author and article information

                Contributors
                amanuelbiruk0077@gmail.com
                biruk0077@gmail.com
                azezun705@gmail.com
                Journal
                Infect Agent Cancer
                Infect Agent Cancer
                Infectious Agents and Cancer
                BioMed Central (London )
                1750-9378
                13 November 2020
                13 November 2020
                2020
                : 15
                : 67
                Affiliations
                [1 ]GRID grid.442845.b, ISNI 0000 0004 0439 5951, Midwifery department, College of Medicine and Health Sciences, , Bahir Dar University, ; Bahir Dar, Ethiopia
                [2 ]GRID grid.442845.b, ISNI 0000 0004 0439 5951, College of Medicine and Health Sciences, Department of Orthopedics, , Bahir Dar University, ; Bahir Dar, Ethiopia
                Article
                334
                10.1186/s13027-020-00334-3
                7666476
                33292388
                75d242c6-99bf-4b89-8076-e64a739366ac
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 13 August 2020
                : 2 November 2020
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2020

                Oncology & Radiotherapy
                Oncology & Radiotherapy

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