ERA, UNAIDS, Geneve, Switzerland
Faculty of Medicine, University of Geneva, Geneve, Switzerland.
BMJ Open. 2023 Jun 20;13(6):e067948. doi: 10.1136/bmjopen-2022-067948.
We examined age, residence, education and wealth inequalities and their combinations on cervical precancer screening probabilities for women. We hypothesised that inequalities in screening favoured women who were older, lived in urban areas, were more educated and wealthier.
Cross-sectional study using Population-Based HIV Impact Assessment data.
Ethiopia, Malawi, Rwanda, Tanzania, Zambia and Zimbabwe. Differences in screening rates were analysed using multivariable logistic regressions, controlling for age, residence, education and wealth. Inequalities in screening probability were estimated using marginal effects models.
Women aged 25-49 years, reporting screening.
Self-reported screening rates, and their inequalities in percentage points, with differences of 20%+ defined as high inequality, 5%-20% as medium, 0%-5% as low.
The sample size of participants ranged from 5882 in Ethiopia to 9186 in Tanzania. The screening rates were low in the surveyed countries, ranging from 3.5% (95% CI 3.1% to 4.0%) in Rwanda to 17.1% (95% CI 15.8% to 18.5%) and 17.4% (95% CI 16.1% to 18.8%) in Zambia and Zimbabwe. Inequalities in screening rates were low based on covariates. Combining the inequalities led to significant inequalities in screening probabilities between women living in rural areas aged 25-34 years, with a primary education level, from the lowest wealth quintile, and women living in urban areas aged 35-49 years, with the highest education level, from the highest wealth quintile, ranging from 4.4% in Rwanda to 44.6% in Zimbabwe.
Cervical precancer screening rates were inequitable and low. No country surveyed achieved one-third of the WHO's target of screening 70% of eligible women by 2030. Combining inequalities led to high inequalities, preventing women who were younger, lived in rural areas, were uneducated, and from the lowest wealth quintile from screening. Governments should include and monitor equity in their cervical precancer screening programmes.
本研究旨在探讨年龄、居住地、教育程度和财富不平等及其组合对女性宫颈癌前筛查概率的影响。我们假设，筛查的不平等有利于年龄较大、居住在城市地区、教育程度较高和财富较多的女性。
使用基于人群的艾滋病毒影响评估数据进行横断面研究。
埃塞俄比亚、马拉维、卢旺达、坦桑尼亚、赞比亚和津巴布韦。使用多变量逻辑回归分析控制年龄、居住地、教育程度和财富后，分析了筛查率的差异。使用边际效应模型估计了筛查概率的不平等。
年龄在 25-49 岁之间、报告接受过筛查的女性。
自我报告的筛查率及其百分比差异，差异超过 20%定义为高度不平等，5%-20%为中度不平等，0%-5%为低度不平等。
研究对象的样本量范围从埃塞俄比亚的 5882 人到坦桑尼亚的 9186 人。在所调查的国家中，筛查率较低，范围从卢旺达的 3.5%（95%CI，3.1%-4.0%）到赞比亚和津巴布韦的 17.1%（95%CI，15.8%-18.5%）和 17.4%（95%CI，16.1%-18.8%）。根据协变量，筛查率的不平等程度较低。将不平等因素结合起来，导致居住在农村地区、年龄在 25-34 岁之间、受教育程度较低、来自最低财富五分位数的女性与居住在城市地区、年龄在 35-49 岁之间、受教育程度较高、来自最高财富五分位数的女性之间在筛查概率方面存在显著的不平等，差异范围从卢旺达的 4.4%到津巴布韦的 44.6%。
宫颈癌前筛查率不平等且较低。在所调查的国家中，没有一个国家达到世卫组织到 2030 年为 70%符合条件的妇女提供筛查的目标的三分之一。将不平等因素结合起来，导致较年轻、居住在农村地区、未受教育和来自最低财富五分位数的女性无法进行筛查，造成了高度的不平等。政府应该在宫颈癌前筛查项目中纳入并监测公平性。
