Self-Reported Cervical Cancer Screening Uptake Among Women of Reproductive Age in Zambia: Evidence from the 2021 Zambia Population-Based HIV Impact Assessment (ZAMPHIA) Survey

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Abstract

Background

Despite Zambia implementing the World Health Organisation's (WHO) tri-pillar cervical cancer prevention goals 90-70-90 Prevent, Screen, and Treat, cervical cancer claims 2000 lives annually and reigns as the most common cancer among women, especially those living with HIV (WLHIV). Our study describes the national uptake of screening and treatment from the ZAMPHIA 2021 survey.

Methods

Utilising a two-stage cluster sampling approach, the study included participants aged 15 years and older across Zambia’s ten provinces. Data were collected on demographic traits, reproductive history, sexual behaviour, and cervical cancer prevention using a structured questionnaire, and HIV was diagnosed from biological samples. Women aged 15-49 were eligible for inclusion in the analysis. The primary outcome of interest was whether a woman self-reported being screened for cervical cancer. Sociodemographic characteristics were calculated for categorical variables using the SAS proc surveyfreq procedure, producing both raw and weighted estimates. The weighted estimates and their variance were generated using jackknife replicate weights for each record.

Results

Of the 8801 surveyed women, 22.2% reported undergoing cervical cancer screening, the majority being aged between 35-49 years. Cervical cancer screening uptake was more likely among compared to HIV negative counterparts (aOR = 3.92, 95% CI: 3.10, 4.95), those aged 25-34 years (aOR = 1.76, 95% CI: 1.42, 2.21) or 35-49 years (aOR = 2.65, 95% CI: 2.11, 3.33) than younger and those with 1-4 (aOR = 2.16, 95% CI: 1.54, 3.02) or more than 5 live births (aOR = 1.98, 95% CI: 1.37, 2.87) than none. Marital status, WLHIV, education, and parity were other factors significantly associated with screening.

Conclusion

We report low cervical cancer screening uptake compared to the 70% target of WHO. The WHO’s call for bolstered strategies and efforts to increase cervical cancer screening and treatment is timely and urgent. Therefore, ongoing messaging and health education among all women is key.

Related collections

Most cited references 35

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The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.

Erik von Elm, Douglas G. Altman, Matthias Egger … (2008)

Much of biomedical research is observational. The reporting of such research is often inadequate, which hampers the assessment of its strengths and weaknesses and of a study's generalizability. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Initiative developed recommendations on what should be included in an accurate and complete report of an observational study. We defined the scope of the recommendations to cover three main study designs: cohort, case-control, and cross-sectional studies. We convened a 2-day workshop in September 2004, with methodologists, researchers, and journal editors to draft a checklist of items. This list was subsequently revised during several meetings of the coordinating group and in e-mail discussions with the larger group of STROBE contributors, taking into account empirical evidence and methodological considerations. The workshop and the subsequent iterative process of consultation and revision resulted in a checklist of 22 items (the STROBE Statement) that relate to the title, abstract, introduction, methods, results, and discussion sections of articles. Eighteen items are common to all three study designs and four are specific for cohort, case-control, or cross-sectional studies. A detailed Explanation and Elaboration document is published separately and is freely available on the web sites of PLoS Medicine, Annals of Internal Medicine, and Epidemiology. We hope that the STROBE Statement will contribute to improving the quality of reporting of observational studies.

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The global burden of women’s cancers: a grand challenge in global health

Groesbeck P. Parham, Natasha Kassami, Lesong Conteh … (2017)

Every year, more than 2 million women worldwide are diagnosed with breast or cervical cancer, yet where a woman lives, her socioeconomic status, and agency largely determines whether she will develop one of these cancers and will ultimately survive. In regions with scarce resources, fragile or fragmented health systems, cancer contributes to the cycle of poverty. Proven and cost-effective interventions are available for both these common cancers, yet for so many women access to these is beyond reach. These inequities highlight the urgent need in low-income and middle-income countries for sustainable investments in the entire continuum of cancer control, from prevention to palliative care, and in the development of high-quality population-based cancer registries. In this first paper of the Series on health, equity, and women's cancers, we describe the burden of breast and cervical cancer, with an emphasis on global and regional trends in incidence, mortality, and survival, and the consequences, especially in socioeconomically disadvantaged women in different settings.

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Is Open Access

Estimates of the global burden of cervical cancer associated with HIV

Dominik Stelzle, Luana F Tanaka, Kuan Lee … (2020)

Summary Background HIV enhances human papillomavirus (HPV)-induced carcinogenesis. However, the contribution of HIV to cervical cancer burden at a population level has not been quantified. We aimed to investigate cervical cancer risk among women living with HIV and to estimate the global cervical cancer burden associated with HIV. Methods We did a systematic literature search and meta-analysis of five databases (PubMed, Embase, Global Health [CABI.org], Web of Science, and Global Index Medicus) to identify studies analysing the association between HIV infection and cervical cancer. We estimated the pooled risk of cervical cancer among women living with HIV across four continents (Africa, Asia, Europe, and North America). The risk ratio (RR) was combined with country-specific UNAIDS estimates of HIV prevalence and GLOBOCAN 2018 estimates of cervical cancer to calculate the proportion of women living with HIV among women with cervical cancer and population attributable fractions and age-standardised incidence rates (ASIRs) of HIV-attributable cervical cancer. Findings 24 studies met our inclusion criteria, which included 236 127 women living with HIV. The pooled risk of cervical cancer was increased in women living with HIV (RR 6·07, 95% CI 4·40–8·37). Globally, 5·8% (95% CI 4·6–7·3) of new cervical cancer cases in 2018 (33 000 new cases, 95% CI 26 000–42 000) were diagnosed in women living with HIV and 4·9% (95% CI 3·6–6·4) were attributable to HIV infection (28 000 new cases, 20 000–36 000). The most affected regions were southern Africa and eastern Africa. In southern Africa, 63·8% (95% CI 58·9–68·1) of women with cervical cancer (9200 new cases, 95% CI 8500–9800) were living with HIV, as were 27·4% (23·7–31·7) of women in eastern Africa (14 000 new cases, 12 000–17 000). ASIRs of HIV-attributable cervical cancer were more than 20 per 100 000 in six countries, all in southern Africa and eastern Africa. Interpretation Women living with HIV have a significantly increased risk of cervical cancer. HPV vaccination and cervical cancer screening for women living with HIV are especially important for countries in southern Africa and eastern Africa, where a substantial HIV-attributable cervical cancer burden has added to the existing cervical cancer burden. Funding WHO, US Agency for International Development, and US President's Emergency Plan for AIDS Relief.

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Author and article information

Journal

Journal ID (nlm-ta): Cancer Control

Journal ID (iso-abbrev): Cancer Control

Journal ID (hwp): spccx

Journal ID (publisher-id): CCX

Title: Cancer Control : Journal of the Moffitt Cancer Center

Publisher: SAGE Publications (Sage CA: Los Angeles, CA )

ISSN (Print): 1073-2748

ISSN (Electronic): 1526-2359

Publication date (Electronic): 22 December 2024

Publication date Collection: Jan-Dec 2024

Volume: 31

Electronic Location Identifier: 10732748241307361

Affiliations

[1 ]Department of Obstetrics and Gynaecology, School of Medicine, Ringgold 119183, universityUniversity of Zambia; , Lusaka, Zambia

[2 ]Women and Newborn Hospital, universityUniversity Teaching Hospitals; , Lusaka, Zambia

[3 ]universityYoung Emerging Scientists Zambia; , Lusaka, Zambia

[4 ]Department of Pathology and Microbiology, School of Medicine, Ringgold 119183, universityUniversity of Zambia; , Lusaka, Zambia

[5 ]Department of Pharmacy, School of Health Sciences, Ringgold 119183, universityUniversity of Zambia; , Lusaka, Zambia

[6 ]Center for International Health Education and Biosecurity, Ringgold 51576, universityUniversity of Maryland School of Medicine; , Baltimore, MD, USA

Author notes

[*]Mwansa Ketty Lubeya, Department of Obstetrics and Gynaecology, School of Medicine, University of Zambia, Box 50110, Ridgeway Campus, Nationalist Road, Lusaka 10101, Zambia. Email: ketty.lubeya@ 123456unza.zm

Author information

Mwansa Ketty Lubeya https://orcid.org/0000-0002-8526-3410

Article

Publisher ID: 10.1177_10732748241307361

DOI: 10.1177/10732748241307361

PMC ID: 11664511

PubMed ID: 39710618

SO-VID: b0e46e60-9d68-4d35-b8ad-6789be422f60

License:

This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

History

Date received : 31 July 2024

Date revision received : 30 October 2024

Date accepted : 26 November 2024

Funding

Funded by: President’s Emergency Plan for AIDS Relief;

Award ID: #U2GGH002172

Custom metadata

typesetter ts10

cover-date January-December 2024

Keywords: cervical cancer,hiv,hpv,zambia,cervical cancer screening,hpv vaccination,multiparity,zamphia

Data availability:

Keywords: cervical cancer, hiv, hpv, zambia, cervical cancer screening, hpv vaccination, multiparity, zamphia