Rana Tika, Chan Dorothy Ngo Sheung, Law Bernard Man Hin, Choi Kai Chow, Shrestha Sunil, So Winnie Kwok Wei
The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
Department of Research and Academics, Kathmandu Cancer Center, Tathali, Bhaktapur, Bagmati Province, Nepal.
PLoS One. 2025 Jun 24;20(6):e0321627. doi: 10.1371/journal.pone.0321627. eCollection 2025.
Globally, cervical cancer is the fourth most common cancer among women, and more than 90% of all cervical cancer-related deaths worldwide are recorded in resource-limited countries. The present review investigated the uptake rate of cervical cancer screening and identified the factors associated with screening service utilisation in the female populations of least developed countries (LDCs).
Five electronic databases (EMBASE, Ovid MEDLINE, CINAHL, Cochrane Library, and PubMed) and grey literature were searched for relevant literature using the keywords of the included studies. Both qualitative and quantitative studies were included. Three reviewers performed critical appraisals using the Mixed Methods Appraisal Tool. Meta-analysis was performed to pool the quantitative results from comparable studies.
A total of twenty-five studies were included in the review. The cervical cancer screening uptake rate in LDCs ranged from 4% to 21%. Multiple factors were associated with screening service utilisation among women in the LDCs, namely socio-demographic characteristics, including employment status (odds ratio (OR): 2.72; 95% CI: 1.97-3.76; p < 0.001); knowledge of cervical cancer and its screening (OR: 3.39; 95% CI: 2.00-5.75; p < 0.001); sexual and reproductive health-related factors such as parity status (OR: 2.73; 95% CI: 1.61-4.64; p = 0.002); healthcare providers' recommendations (OR: 5.32; 95% CI: 2.44-11.58; p < 0.001); perceived risk of developing cervical cancer (OR: 3.76; 95% CI: 2.62-5.38; p < 0.001); use of media for cervical cancer screening promotion, including radio; cultural factors; and myths and misconceptions about cervical cancer and its screening.
The uptake of cervical cancer screening among eligible women in the LDCs was notably low. The governments of these countries are advised to invest and allocate additional resources to advance policies and develop cervical cancer prevention programmes that are accessible, affordable, and acceptable.
在全球范围内，宫颈癌是女性中第四大常见癌症，全球超过90%的宫颈癌相关死亡病例记录在资源有限的国家。本综述调查了宫颈癌筛查的接受率，并确定了最不发达国家（LDCs）女性人群中与筛查服务利用相关的因素。
使用纳入研究的关键词在五个电子数据库（EMBASE、Ovid MEDLINE、CINAHL、Cochrane图书馆和PubMed）以及灰色文献中搜索相关文献。纳入了定性和定量研究。三位评审员使用混合方法评估工具进行批判性评估。进行荟萃分析以汇总可比研究的定量结果。
本综述共纳入25项研究。最不发达国家的宫颈癌筛查接受率在4%至21%之间。多个因素与最不发达国家女性的筛查服务利用相关，即社会人口学特征，包括就业状况（优势比（OR）：2.72；95%置信区间：1.97 - 3.76；p < 0.001）；对宫颈癌及其筛查的了解（OR：3.39；95%置信区间：2.00 - 5.75；p < 0.001）；性与生殖健康相关因素，如生育状况（OR：2.73；95%置信区间：1.61 - 4.64；p = 0.002）；医疗保健提供者的建议（OR：5.32；95%置信区间：2.44 - 11.58；p < 0.001）；患宫颈癌的感知风险（OR：3.76；95%置信区间：2.62 - 5.38；p < 0.001）；使用媒体（包括广播）促进宫颈癌筛查；文化因素；以及对宫颈癌及其筛查的误解和错误观念。
最不发达国家符合条件的女性中宫颈癌筛查的接受率显著较低。建议这些国家的政府投入并分配额外资源，以推进政策并制定可及、可负担且可接受的宫颈癌预防计划。
