Factors associated with and socioeconomic inequalities in breast and cervical cancer screening among women aged 15–64 years in Botswana

Abstract

Background The most commonly diagnosed cancers among women are breast and cervical cancers, with cervical cancer being a relatively bigger problem in low and middle income countries (LMICs) than breast cancer. Methods The main aim of this study was to asses factors associated with and socioeconomic inequalities in breast and cervical cancer screening among women aged 15–64 years in Botswana. This study is part of the broad study on Chronic Non-Communicable Diseases in Botswana conducted (NCD survey) in 2016. The NCD survey was conducted across 3 cities and towns, 15 urban villages and 15 rural areas of Botswana. The survey collected information on several NCDs and risk factors including cervical and breast cancer screening. The survey adopted a multistage sampling design and a sample of 1178 participants (males and females) aged 15 years and above was selected in both urban and rural areas of Botswana. For this study, a sub-sample of 813 women aged 15–64 years was selected and included in the analysis. The inequality analysis was conducted using decomposition analysis using ADePT software version 6. Logistic regression models were used to show the association between socioeconomic variables and cervical and breast cancer screening using SPSS version 25. All comparisons were considered statistically significant at 5%. Results Overall, 6% and 62% of women reported that they were screened for breast and cervical cancer, respectively. Women in the poorest (AOR = 0.16, 95% CI = 0.06–0.45) and poorer (AOR = 0.37, 95% CI = 0.14–0.96) wealth quintiles were less likely to report cervical cancer screening compared to women in the richest wealth quintile. Similarly, for breast cancer, the odds of screening were found to be low among women in the poorest (AOR = 0.39, 95% CI = 0.06–0.68) and the poorer (AOR = 0.45, 95% CI = 0.13–0.81)) wealth quintiles. Concentration indices (CI) showed that cervical (CI = 0.2443) and breast cancer (CI = 0.3975) screening were more concentrated among women with high SES than women with low SES. Wealth status was observed to be the leading contributor to socioeconomic inequality observed for both cervical and breast cancer screening. Conclusions Findings in this study indicate the need for concerted efforts to address the health care needs of the poor in order to reduce cervical and breast cancer screening inequalities.

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“…Attending education may give the respondents the chance to gain information directly from their education programs or indirectly from discussions with others. Consistent with previous studies ( Keetile et al, 2021 ; Negi et al, 2022 ; Subramanian et al, 2018 ), we showed that the less wealthy participants were less likely to report having NCDs screening compared to wealthier participants. This reemphasises the notion that individuals with the financial means overcome barriers to accessing care compared to those who are poor.…”

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“…This corresponded with a study that found that the variation of CCS uptake is disproportionately distributed among poor women globally and so is the burden of cervical cancer (26). In support, a study conducted in Botswana assessing factors associated with socioeconomic inequalities in breast and cervical cancer found that women in the poorest and poor wealth quantiles were less likely to undergo CCS compared to women in the richest wealth quantile (27). Thus, highlighting the impact that wealth status has on the ability of women to undergo CCS.…”

Explaining socioeconomic inequality in cervical cancer screening uptake in Malawi

“…On determinant analysis, this study does not identify a statistically significant association between religion, employment and the uptake of cervical cancer screening. It is interesting to note that despite the scale up of cervical cancer screening, geographical location also presents itself as a hindrance to the uptake of cervical cancer screening, as was the case in Botswana [ 62 ]. In this respect, the findings show that women in rural areas are less likely to undertake cervical cancer screening than women in urban areas, which corroborates what was found in Kenya [ 63 ].…”