Lubeya Mwansa Ketty, Sinyani Angela, Mukosha Moses, Lindsay Brianna, Mumbula Enock Mulowa, Agbakwuru Chinedu, Daka Bwalya, Nowak Rebecca G, Ehoche Akipu, Mulundu Gina
Department of Obstetrics and Gynaecology, School of Medicine, University of Zambia, Lusaka, Zambia.
Women and Newborn Hospital, University Teaching Hospitals, Lusaka, Zambia.
Cancer Control. 2024 Jan-Dec;31:10732748241307361. doi: 10.1177/10732748241307361.
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.
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.
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.
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.
尽管赞比亚实施了世界卫生组织（WHO）的宫颈癌预防三大支柱目标——90-70-90预防、筛查和治疗，但宫颈癌每年仍夺去2000人的生命，是女性中最常见的癌症，尤其是感染艾滋病毒的女性（HIV感染者）。我们的研究描述了2021年赞比亚全国宫颈癌筛查和治疗的情况。
该研究采用两阶段整群抽样方法，纳入了赞比亚十个省份15岁及以上的参与者。使用结构化问卷收集了人口统计学特征、生殖史、性行为和宫颈癌预防方面的数据，并从生物样本中诊断出是否感染艾滋病毒。15至49岁的女性有资格纳入分析。主要关注的结果是女性是否自我报告接受过宫颈癌筛查。使用SAS proc surveyfreq程序计算分类变量的社会人口统计学特征，得出原始估计值和加权估计值。使用每条记录的刀切重抽样权重生成加权估计值及其方差。
在8801名接受调查的女性中，22.2%报告接受过宫颈癌筛查，大多数年龄在35至49岁之间。与艾滋病毒阴性女性相比，感染艾滋病毒的女性接受宫颈癌筛查的可能性更高（调整后的优势比[aOR]=3.92，95%置信区间[CI]：3.10，4.95）；与年轻女性相比，25至34岁（aOR=1.76，95%CI：1.42，2.21）或35至49岁（aOR=2.65，95%CI：2.11，3.33）的女性接受宫颈癌筛查的可能性更高；与未生育过的女性相比，生育1至4次（aOR=2.16，95%CI：1.54，3.02）或5次以上（aOR=1.98，95%CI：1.37，2.87）的女性接受宫颈癌筛查的可能性更高。婚姻状况、感染艾滋病毒情况、教育程度和生育次数是与筛查显著相关的其他因素。
与世界卫生组织70%的目标相比，我们报告的宫颈癌筛查接受率较低。世界卫生组织呼吁加强战略和努力以增加宫颈癌筛查和治疗，这既及时又紧迫。因此，对所有女性持续开展宣传和健康教育是关键。
