Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
Department of Nursing, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
BMJ Open. 2022 Jul 29;12(7):e058026. doi: 10.1136/bmjopen-2021-058026.
We investigated the association between women's healthcare decision making and cervical cancer screening uptake in sub-Saharan Africa.
Secondary data from the Demographic and Health Surveys of six countries in sub-Saharan Africa were used. We employed multilevel binary logistic regression modelling.
Sub-Saharan Africa.
Women aged 15-49 years in Benin (n=5282), Côte d'Ivoire (n=1925), Cameroon (n=7558), Kenya (n=6696), Namibia (n=1990) and Zimbabwe (n=5006).
Cervical cancer screening uptake.
The overall prevalence of cervical cancer screening across the six sub-Saharan African countries was 13.4%. Compared with women whose healthcare decisions were made solely by husbands/partners/someone else, the likelihood of cervical cancer screening uptake was significantly higher among women who took healthcare decisions in consultation with their husbands/partners (aOR=1.38; 95% CI 1.19 to 1.59), but highest among those who made healthcare decisions alone (aOR=1.66; 95% CI 1.44 to 1.91). Women aged between 40 and 45 years (aOR=5.18; 95% CI 3.15 to 8.52), those with higher education (aOR=2.13; 95% CI 1.57 to 2.88), those who had ever heard of cervical cancer (aOR=32.74; 95% CI 20.02 to 53.55), read newspaper or magazine at least once a week (aOR=2.11; 95% CI 1.83 to 2.44), listened to the radio at least once a week (aOR=1.35; 95% CI1.18 to 1.52) and those in households with richest wealth index (aOR=1.55; 95% CI 1.20 to 2.00) had significantly higher odds of screening for cervical cancer compared to their counterparts.
Women who are able to make autonomous healthcare decisions and those who practice shared decision making are more likely to uptake cervical cancer screening. Therefore, policy interventions should focus on empowering women to be able to take autonomous healthcare decisions or shared decision making while targeting subpopulations (ie, multiparous and rural-dwelling women, as well as those in other religious affiliations aside from Christianity) that are less likely to uptake cervical cancer screening. Also, the radio and print media could be leveraged in raising awareness about cervical cancer screening to accelerate cervical cancer screening uptake in sub-Saharan Africa.
我们研究了撒哈拉以南非洲女性的医疗保健决策与宫颈癌筛查参与之间的关系。
利用撒哈拉以南非洲六个国家的人口与健康调查的二级数据。我们采用了多层次二元逻辑回归模型。
撒哈拉以南非洲。
贝宁（n=5282）、科特迪瓦（n=1925）、喀麦隆（n=7558）、肯尼亚（n=6696）、纳米比亚（n=1990）和津巴布韦（n=5006）15-49 岁的女性。
宫颈癌筛查参与率。
在撒哈拉以南非洲的六个国家中，宫颈癌筛查的总体流行率为 13.4%。与医疗保健决策仅由丈夫/伴侣/他人做出的女性相比，与丈夫/伴侣协商做出医疗保健决策的女性进行宫颈癌筛查的可能性显著更高（aOR=1.38；95%CI 1.19 至 1.59），而独自做出医疗保健决策的女性则最高（aOR=1.66；95%CI 1.44 至 1.91）。40-45 岁的女性（aOR=5.18；95%CI 3.15 至 8.52）、受过高等教育的女性（aOR=2.13；95%CI 1.57 至 2.88）、听说过宫颈癌的女性（aOR=32.74；95%CI 20.02 至 53.55）、每周至少阅读一次报纸或杂志的女性（aOR=2.11；95%CI 1.83 至 2.44）、每周至少听一次广播的女性（aOR=1.35；95%CI1.18 至 1.52）和来自最富裕财富指数家庭的女性（aOR=1.55；95%CI 1.20 至 2.00）与对照组相比，进行宫颈癌筛查的几率显著更高。
能够做出自主医疗保健决策的女性和共同做出决策的女性更有可能接受宫颈癌筛查。因此，政策干预应侧重于增强女性做出自主医疗保健决策或共同决策的能力，同时针对不太可能接受宫颈癌筛查的亚人群（即多产妇和农村居民，以及除基督教以外的其他宗教信仰者）。此外，还可以利用广播和印刷媒体提高对宫颈癌筛查的认识，以加速撒哈拉以南非洲的宫颈癌筛查。
