Cervical Cancer Screening Uptake in Africa: A Multi-Country Analysis of WHO STEPS Data, 2014–2019

Abstract

ABSTRACT Background Cervical cancer remains a significant global public health challenge, with the overwhelming majority of its burden borne by low- and middle-income countries. Globally, an estimated 660,000 new cases and 350,000 deaths occur each year, with more than 90% of cervical cancer–related mortality concentrated in resource-limited settings. In Africa, limited access to organized screening programs and early detection services continues to contribute to persistently high incidence and mortality rates, despite the preventable nature of the disease. Methods We conducted a cross-sectional analysis of WHO STEPwise (STEPS) survey data collected between 2014 and 2019 from 11 African countries. The analysis included 25,471 women aged 15 years and older. Weighted prevalence estimates were calculated, and multivariable logistic regression models were fitted to identify factors associated with ever having been screened for cervical cancer. Predicted probabilities were estimated and stratified by age and residence. Results The pooled prevalence of cervical cancer screening uptake was approximately 10.0%. Uptake was consistently higher among urban women than rural women across all age groups. In adjusted analyses, screening uptake increased strongly with age, peaking at 50–54 years (AOR = 8.21; 95% CI: 5.55–12.14). Higher education showed a clear positive gradient, with tertiary education associated with more than threefold higher odds compared with no education (AOR = 3.20; 95% CI: 2.65–3.86). Urban residence was associated with higher uptake (AOR = 1.22; 95% CI: 1.11–1.34). Substantial cross-country variation was observed, with higher odds in Botswana (AOR = 6.58; 95% CI: 5.51–7.86) and markedly lower odds in Benin (AOR = 0.08; 95% CI: 0.05–0.14). Hypertension was positively associated with screening uptake, while low fruit and vegetable intake were inversely associated. Conclusions Cervical cancer screening uptake in Africa remains critically low and unevenly distributed. Addressing age, educational, urban–rural, and country-level disparities is essential to achieving WHO elimination targets.