Mengistie Berihun Agegn, Melese Mihret, Gebiru Ashebir Mamay, Getnet Mihret, Getahun Amare Belete, Tassew Worku Chekol, Tilahun Mikias Mered, Bizuneh Yosef Belay, Negash Habtu Kifle, Baykemagn Nebebe Demis, Asmamaw Desale B, Yirsaw Amlaku Nigusie, Abuhay Alemken Eyayu, Bitew Desalegn Anmut
Department of General Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
Department of Human Physiology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
PLoS One. 2025 Jul 21;20(7):e0328103. doi: 10.1371/journal.pone.0328103. eCollection 2025.
Cervical cancer is the fourth most prevalent type of cancer in women globally. Early detection and treatment of precancerous cervical lesions and human papillomavirus (HPV) infection are strongly advised to decrease the incidence of cervical cancer and death. Cervical cancer is a major public health concern in low- and middle-income nations, where screening and treatment options are constrained. Thus, the main objective of this umbrella review was to determine the pooled uptake of cervical cancer screening and its determinants in Africa.
This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The protocol for this umbrella review was registered on the International Prospective Register of Systematic Reviews (PROSPERO) with reference number CRD42024518297. We conduct a systematic and comprehensive search by using Google Scholar, PubMed, Scopus, Hinari, and Science Direct, from January 1, 2014, to September 20, 2024. The data were extracted using Microsoft Excel spreadsheet. The methodological quality of the included studies was examined using A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2). The statistical analysis was carried out using STATA version 17, which includes descriptive analysis, forest plots for prevalence, funnel plot, and an Egger test to examine publication bias. A random-effects model was used to determine the pooled effect estimate. Publication bias was checked by using the funnel plot and Egger's tests.
This umbrella review included 11 systematic reviews and meta-analysis studies across Africa with a total of 143,327 study participants. The overall prevalence of cervical cancer screening practice in Africa was 20.94% (95% CI: 15.84%-26.04%). Women's level of knowledge (AOR: 3.22, 95% CI: 1.64-6.33), positive attitude toward CCS (AOR: 2.48, 95% CI: 2.18-2.81), perceived vulnerability to cervical cancer (AOR = 3.57, 95% CI: 2.75, 4.63), and history of STIs (AOR = 4.89, 95% CI: 3.14, 7.62) were significantly associated with cervical cancer screening practice. In conclusion, the combined estimate of cervical cancer screening use in Africa remains much lower (20.94%) than the World Health Organization (WHO) recommendations target (70%). It indicates that there is a large gap that requires being addressed in collaboration to reduce the burden of cervical cancer and its morbidity and mortality across the continent. Therefore, healthcare professionals, policymakers, and other stakeholders shall implement effective strategies such as empowering women, improving the knowledge and attitude towards cervical cancer screening, advocacy, and expanding screening programs to all eligible women to increase utilization of cervical cancer screening.
宫颈癌是全球女性中第四大常见癌症类型。强烈建议对宫颈癌前病变和人乳头瘤病毒（HPV）感染进行早期检测和治疗，以降低宫颈癌的发病率和死亡率。在筛查和治疗选择受限的低收入和中等收入国家，宫颈癌是一个主要的公共卫生问题。因此，本系统性综述的主要目的是确定非洲宫颈癌筛查的综合接受情况及其决定因素。
本研究遵循系统评价和荟萃分析的首选报告项目（PRISMA）指南。本系统性综述的方案已在国际前瞻性系统评价注册库（PROSPERO）上注册，注册号为CRD42024518297。我们于2014年1月1日至2024年9月20日通过谷歌学术、PubMed、Scopus、Hinari和科学Direct进行了系统全面的检索。数据使用Microsoft Excel电子表格提取。使用评估系统评价的测量工具2（AMSTAR 2）检查纳入研究的方法学质量。使用STATA 17版进行统计分析，包括描述性分析、患病率森林图、漏斗图以及用于检验发表偏倚的Egger检验。采用随机效应模型确定合并效应估计值。通过漏斗图和Egger检验检查发表偏倚。
本系统性综述纳入了非洲的11项系统评价和荟萃分析研究，共有143327名研究参与者。非洲宫颈癌筛查实践的总体患病率为20.94%（95%CI：15.84%-26.04%）。女性的知识水平（调整后比值比[AOR]：3.22，95%CI：1.64-6.33）、对宫颈癌筛查的积极态度（AOR：2.48，95%CI：2.18-2.81）、感知到的患宫颈癌易感性（AOR = 3.57，95%CI：2.75，4.63）以及性传播感染史（AOR = 4.89，95%CI：3.14，7.62）与宫颈癌筛查实践显著相关。总之，非洲宫颈癌筛查使用的综合估计值（20.94%）仍远低于世界卫生组织（WHO）的建议目标（70%）。这表明存在很大差距，需要各方合作加以解决，以减轻整个非洲大陆的宫颈癌负担及其发病率和死亡率。因此，医疗保健专业人员、政策制定者和其他利益相关者应实施有效的策略，如增强妇女权能、提高对宫颈癌筛查的认识和态度、开展宣传以及将筛查项目扩大到所有符合条件的妇女，以提高宫颈癌筛查的利用率。
