Bulamba Robert M, Kyasanku Emmanuel, Nalugoda Fred, Daama Alex, Nkale James, Miller Amanda Pearl, Byansi William, Namutundu Juliana, Kigozi Godfrey, Nalwoga Grace Kigozi, Balwanaki Chris, Watya Stephen, Ekström Anna Mia, Mugamba Stephen, Ndejjo Rawlance, Nakigozi Gertrude
Department of Epidemiology and Biostatistics, Africa Medical and Behavioral Sciences Organization (AMBSO), Kampala, Uganda.
Department of Epidemiology and Biostatistics, San Diego State University, San Diego, California, United States of America.
PLoS One. 2025 Sep 3;20(9):e0317641. doi: 10.1371/journal.pone.0317641. eCollection 2025.
Uganda has the highest prevalence and incidence of cervical cancer in the East African region, with 80% of women diagnosed at advanced stage when survival is minimal. Literature on uptake of cervical cancer screening is limited in Uganda and thus womens' knowledge and uptake of cervical cancer screening in the general population remains unknown. This study examined this gap of knowledge among women aged 25-65 years, across rural, urban and semi urban communities in a Ugandan district to inform design of targeted future cervical cancer screening programs in the country.
This descriptive cross-sectional study was conducted in Wakiso district, Uganda in May 2024 among 783 eligible women. Face-to-face interviews were conducted. Uptake of cervical cancer screening (outcome of interest) was dichotomously (yes/no) assessed. Knowledge of cervical cancer disease was assessed using the AWACAN validated tool, knowledge of cervical cancer screening was assessed using a set of ten (10) questions adapted from previous studies elsewhere, and all were measured on a Likert scale. Univariate, bivariate, and multivariable Poisson regression models with robust variance were performed using Stata software version 17.
Respondents' median age was 31 years (IQR 27-39 years). Majority (89.5%, 701/783) had heard of cervical cancer, and 90.6% (635/701) were aware of screening. Median knowledge score on signs and symptoms, risk factors and cervical cancer screening was 8.0 (IQR = 5-10), 8.0 (IQR = 5-11) and 7.0 (IQR = 4-10) respectively, and 54.3% had high knowledge about cervical cancer screening. Uptake of cervical cancer screening was 33.4%. Living in urban areas (aPR = 1.41, 95% CI: 1.05-1.88), being the ages 40-49 years (aPR = 1.76, 95% CI: 1.36-2.27), 50 years and above (APR = 2.16, 95% CI: 1.53-3.04), smoking (aPR = 1.39, 95% CI: 1.05-1.86), partner involvement (aPR = 2.61, 95% CI: 2.12-3.21), high knowledge about cervical cancer screening (aPR = 3.29, 95% CI: 2.35-4.60), and living with HIV (aPR = 1.66, 95% CI: 1.66-2.13) were significantly associated with higher uptake of cervical cancer screening among women in this setting.
Knowledge of cervical cancer screening was high, but the uptake of cervical cancer screening was lower than the recommended population coverage by WHO and Uganda national guidelines. There is need to improve accessibility to cervical cancer screening, increase nationwide cervical cancer awareness campaigns focusing on high-risk age groups and design targeted, tailored, culturally and socially sensitive interventions for young women aged 25-39 years to improve cervical cancer screening in Uganda.
乌干达是东非地区宫颈癌患病率和发病率最高的国家，80%的女性在确诊时已处于晚期，生存率极低。乌干达关于宫颈癌筛查接受情况的文献有限，因此普通人群中女性对宫颈癌筛查的知识和接受情况仍然未知。本研究调查了乌干达一个地区农村、城市和半城市社区中25至65岁女性的这一知识差距，以为该国未来有针对性的宫颈癌筛查项目设计提供参考。
2024年5月在乌干达瓦基索区对783名符合条件的女性进行了这项描述性横断面研究。进行了面对面访谈。对宫颈癌筛查的接受情况（感兴趣的结果）进行二分法（是/否）评估。使用经过AWACAN验证的工具评估对宫颈癌疾病的了解，使用从其他地方先前研究改编的一组十个问题评估对宫颈癌筛查的了解，所有这些都采用李克特量表进行测量。使用Stata软件17版进行单变量、双变量和多变量泊松回归模型，并采用稳健方差。
受访者的中位年龄为31岁（四分位间距27 - 39岁）。大多数（89.5%，701/783）听说过宫颈癌，90.6%（635/701）知道筛查。关于体征和症状、危险因素以及宫颈癌筛查的中位知识得分分别为8.0（四分位间距 = 5 - 10）、8.0（四分位间距 = 5 - 11）和7.0（四分位间距 = 4 - 10），54.3%的人对宫颈癌筛查有较高的知识水平。宫颈癌筛查的接受率为33.4%。居住在城市地区（调整后风险比 = 1.41，95%置信区间：1.05 - 1.88）、年龄在40 - 49岁（调整后风险比 = 1.76，95%置信区间：1.36 - 2.27）、50岁及以上（调整后风险比 = 2.16，95%置信区间：1.53 - 3.04）、吸烟（调整后风险比 = 1.39，95%置信区间：1.05 - 1.86）、伴侣参与（调整后风险比 = 2.61，95%置信区间：2.12 - 3.21）、对宫颈癌筛查有较高的知识水平（调整后风险比 = 3.29，95%置信区间：2.35 - 4.60）以及感染艾滋病毒（调整后风险比 = 1.66，95%置信区间：1.66 - 2.13）与该环境下女性更高的宫颈癌筛查接受率显著相关。
对宫颈癌筛查的知识水平较高，但宫颈癌筛查的接受率低于世界卫生组织和乌干达国家指南建议的人群覆盖率。有必要提高宫颈癌筛查的可及性，在全国范围内开展针对高危年龄组的宫颈癌宣传活动，并为25至39岁的年轻女性设计有针对性、量身定制、具有文化和社会敏感性的干预措施，以改善乌干达的宫颈癌筛查情况。
