Mahiti Gladys Reuben, Adam Jovinary, Luoga Pankras
Department of Development Studies, Muhimbili University of Health and Allied Sciences, Box 65001, Dar Es Salaam, Tanzania.
An independent researcher working in Tabata , Dar Es Salaam, Tanzania.
Arch Public Health. 2025 May 23;83(1):135. doi: 10.1186/s13690-025-01629-w.
In Tanzania, cervical cancer is the fourth leading cause of cancer-related deaths and the foremost type of cancer affecting women of reproductive age (15-49 years) and beyond. Cervical cancer is preventable and treatable, which underscores the importance of early screening. This study aimed to determine the prevalence and determinants of cervical cancer screening(CCS) among women of reproductive age (15-49) in Tanzania.
In this study we analysed secondary data of 15,254 women drawn from the 2022 Tanzanian Demographic and Health Survey (TDHS). Data were weighted using the individual weight for women (v005/1,000,000) according to DHS guidelines. The dependent variable was CCS status, while independent variables included demographic characteristics, socio-economic factors, and health system factors. Descriptive analysis was used to show the distribution of respondents in terms of frequency and percentage. Weighted binary logistic regression model was used to determine associations between the variables. In addition, multivariable logistic model was used to control confounders and assess possibility of interaction. A significance threshold of p-value < 0.05 at 95% confidence interval(CI) was applied to assess the significance of each variable.
The prevalence of women aged 15-49 years who have ever undergone CCS in Tanzania was 7% (95% CI: 6.58, 7.93). Despite the low proportion of women who have ever received screening, cervical screening was significantly more common among women aged 30-49 years (adjusted Odds Ratio (aOR) = 3.56, 95% CI = 2.75, 4.60), married (aOR = 1.44, 95% CI = 1.11, 1.87), separated individuals (aOR = 1.64, 95% CI = 1.20, 2.24), smokers (aOR = 11.75, 95% CI = 1.93, 71.60), living with HIV (aOR = 5.72, 95% CI = 4.33, 7.56), and those who listened to the radio at least once a week (aOR = 1.46, 95% CI = 1.20, 1.78). Conversely, women who were less likely to be screened for CCS were typically characterised by residing in rural areas (aOR = 0.66, 95% CI = 0.53, 0.82), having informal education (aOR = 0.43, 95% CI = 0.30, 0.60), from low economic backgrounds (aOR = 0.49, 95% CI = 0.37, 0.66), unemployed (aOR = 0.78, 95% CI = 0.65, 0.952), never using contraception (aOR = 0.82, 95% CI = 0.70, 0.97), never covered by health insurance (aOR = 0.58, 95% CI = 0.45, 0.74). These factors were significantly associated with the uptake of CCS services among women aged 15-49 years in Tanzania.
The study highlight that women aged 15-49 years who have ever undergone CCS in Tanzania is generally low at 7%, compared to the WHO recommendation of 70%. Women with no formal education or primary education, belonging to the poor wealth quintile, and having no access of listening to the radio at least once per week; had lower possibility of undergoing CCS compared to their counterparts. Tailored programs aimed at increasing cervical cancer screening should target all women in order to attain the WHO recommendation. Additionally, there is a need to enhance education and health insurance coverage among community members to increase women's accessibility to CCS services.
在坦桑尼亚，宫颈癌是癌症相关死亡的第四大主要原因，也是影响育龄期（15 - 49岁）及以上女性的首要癌症类型。宫颈癌是可预防和可治疗的，这凸显了早期筛查的重要性。本研究旨在确定坦桑尼亚育龄期（15 - 49岁）女性宫颈癌筛查（CCS）的患病率及其决定因素。
在本研究中，我们分析了从2022年坦桑尼亚人口与健康调查（TDHS）中抽取的15254名女性的二手数据。根据 DHS 指南，使用女性个体权重（v005/1,000,000）对数据进行加权。因变量是CCS状态，自变量包括人口统计学特征、社会经济因素和卫生系统因素。描述性分析用于按频率和百分比展示受访者的分布情况。加权二元逻辑回归模型用于确定变量之间的关联。此外，多变量逻辑模型用于控制混杂因素并评估相互作用的可能性。在95%置信区间（CI）下，应用p值<0.05的显著性阈值来评估每个变量的显著性。
坦桑尼亚15 - 49岁曾接受过CCS的女性患病率为7%（95%CI：6.58，7.93）。尽管接受筛查的女性比例较低，但在30 - 49岁的女性中，宫颈癌筛查显著更为常见（调整后的优势比（aOR）= 3.56，95%CI = 2.75，4.60），已婚女性（aOR = 1.44，95%CI = 1.11，1.87），分居者（aOR = 1.64，95%CI = 1.20，2.24），吸烟者（aOR = 11.75，95%CI = 1.93，71.60），感染艾滋病毒者（aOR = 5.72，95%CI = 4.33，7.56），以及每周至少听一次广播的女性（aOR = 1.46，95%CI = 1.20，1.78）。相反，不太可能接受CCS筛查的女性通常具有以下特征：居住在农村地区（aOR = 0.66，95%CI = 0.53，0.82），接受过非正规教育（aOR = 0.43，95%CI = 0.30，0.60），来自低经济背景（aOR = 0.49，95%CI = 0.37，0.66），失业（aOR = 0.78，95%CI = 0.65，0.952），从未使用过避孕措施（aOR = 0.82，95%CI = 0.70，0.97），从未参加过医疗保险（aOR = 0.58，95%CI = 0.45，0.74）。这些因素与坦桑尼亚15 - 49岁女性接受CCS服务的情况显著相关。
该研究强调，坦桑尼亚15 - 49岁曾接受过CCS的女性总体比例较低，为7%，而世界卫生组织的建议是70%。与同龄人相比，未接受过正规教育或仅接受过小学教育、属于贫困财富五分位数且每周至少没有一次收听广播机会的女性，接受CCS的可能性较低。旨在增加宫颈癌筛查的针对性项目应针对所有女性，以达到世界卫生组织的建议。此外，有必要加强社区成员的教育和医疗保险覆盖范围，以提高女性获得CCS服务的可及性。
