Assessment of the screening uptake and health facility related facilitators, and barriers for cervical cancer screening uptake at primary health care facilities in southeast Oromia, Ethiopia
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Date
2024-11
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Addis Ababa University
Abstract
Background: Cervical cancer is the second most common cancer-causing morbidity and mortality
among women in Ethiopia, yet screening uptake is low despite recommended decentralized approaches
and awareness initiatives. The opportunistic screening strategy faces significant health facility barriers,
including access issues, financial constraints, and inadequate provider training. These obstacles impede
women's participation in screening programs. Consequently, many miss opportunities for early detection
and treatment, negatively impacting health outcomes. Therefore, to maximize the uptake and meet the
purpose of efforts to enhance cervical cancer screening uptake, it is necessary to know more about
health facility related barriers and facilitators for cervical cancer screening uptake.
Objectives: To assess cervical cancer screening uptake and health facility related facilitators, and
barriers for cervical cancer screening uptake at primary health care facilities in Ethiopia, 2024.
Methods: An explanatory sequential mixed study approach of qualitative interviews (n=16) and cross
sectional study among 629 women was conducted from January to September 2024 at six health care
facilities in southeast Oromia. Systematic random sampling was employed to recruit survey participants
from the selected health facilities while purposive sampling was used for key informant interviews.
Descriptive statistics were used to summarize the quantitative data and multivariable logistic regression
was employed to identified health facility related facilitators, and barriers for cervical cancer screening
uptake. Qualitative data were analyzed using thematic analysis approach through preparing themes and
subthemes to change raw data to categorized form.
Results: Cervical cancer screening uptake among women in this study population was 15.6% (95% CI
12.9, 18.6). TV/Radio was the main source of information about cervical cancer and its screening. age
group of 40-44 years (AOR= 3.34; 95% CI (1.27, 8.78)), completed college and above (AOR=4.14, 95%
CI (1.1, 15.8)), income level of >7800 (AOR = 8.3; 95% CI (1.86, 35.54)), received CC counseling
(AOR=6.52, 95% CI (3.1, 14.1)) and good knowledge (AOR = 6.53; 95% CI (3.2, 13.34)) were
significantly associated with cervical cancer screening uptake. The qualitative findings identified feeling
healthy, embarrassment, lack of recommendation by HCP, service interruption, availability of
traditional treatment as barriers for cervical cancer screening uptake. Furthermore, availability of
trained HCP, availability of equipment, and information dissemination through mass media, spousal
support, and availability of female provider mentioned as facilitators for CC screening uptake.
Conclusions and recommendation: Cervical cancer screening uptake among eligible women was
significantly lower in the study area. Age group, women education level, knowledge of women, income
level, and availability of CC counselling were factors associated with screening uptake. Furthermore
lack of recommendation by HCP and lack of resources including screening room and number of
provider were identified as health system related barriers. Therefore, it is necessary to execute planned
health education and awareness development at health facilities, particularly in primary health care, in
order to increase the adoption of cervical cancer screening services. Additionally, all women who attend
the health center for any service should get counselling regarding the advantages of CC screening
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Keywords
Cervical cancer screening, health facility barriers, health system facilitators, primary health facilities, Ethiopia.