Individual need and health system factors associated with cervical cancer screening uptake among women of child-bearing age in Mangochi district, Malawi: a facility-based cross-sectional study

Abstract

Background Cervical cancer screening (CCS) uptake remains low in poor countries. Limited studies have assessed individual need and health system factors which facilitate/impede use of healthcare services, including CCS uptake. Thus, we examined associations between these factors and CCS uptake among women of child-bearing age (WCBA) in Mangochi, Malawi. Methods A cross-sectional study, sampling 482 women (18–49 years) using a multi-stage sampling method was conducted in five health facilities (HFs). Data were collected from June-July, 2019. Chi-squared or Fisher’s exact tests were used to compare the distribution of CCS uptake according to different independent groups. Results The proportion of WCBA who did CCS was significantly higher among HIV + women than those who were HIV- and with unknown HIV status, respectively [27.3% (33/121) vs 8.5% (30/353) vs 0% (0/8), χ2 = 29.18, df = 2, p < 0.001]. Significantly higher among those who had ever heard of cervical cancer (CC) than those who had not [23.0% (60/261) vs 1.4% (3/221), χ2 = 49.28, df = 1, p < 0.001]. Significantly higher among those who heard of CC from HFs than those who heard through radios, friends/family and other sources, respectively [31.2% (44/141) vs 16.7% (7/42) vs 9.3% (5/54) vs 16.7% (4/24), χ2 = 12.62, df = 3, p = 0.006]. Significantly higher among those with positive beliefs towards CCS than those with negative beliefs [19.2% (53/276) vs 4.9% (10/206), χ2 = 21.37, df = 1 p < 0.001]. Significantly higher among those recommended for CCS by health workers (HWs) than those not recommended [19.6% (53/270) vs 4.7% (10/212), χ2 = 23.24, df = 1, p < 0.001]. Significantly higher among those willing to be screened by male HWs than those unwilling [14.4% (60/418) vs 4.7% (3/64), χ2 = 4.57, df = 1, p = 0.033]. Fisher’s exact test showed that CCS uptake among WCBA varied significantly by level of knowledge of CC signs/symptoms, with 66.7% (12/18) and 19.8% (48/243) among those with high-level and low-level knowledge screened, respectively (p < 0.001). Conclusions HIV status, ever heard of CC, sources of information, knowledge of CC signs/symptoms, beliefs, recommendations by HWs for CCS, willingness to be screened by male HWs were associated with CCS uptake. These should be prioritized to improve CCS uptake among WCBA.