DETERMINANTS OF CERVICAL CANCER SCREENING IN THE KILIMANJARO REGION OF TANZANIA
Skrastins, Emily F. E.
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Background: Cervical cancer is a leading cause of death in Tanzanian women, with annual age-standardized mortality of 38 per 100,000. While organized screening programs have minimized cervical cancer rates in the developed world, a national prevention program has not yet been instituted in Tanzania. Though screening is available at clinics in the Kilimanjaro region, uptake of these services is reported to be low. The objectives of this thesis were: 1) to describe the knowledge, attitudes and practices of cervical cancer screening in rural and urban Kilimanjaro women, 2) to determine the main barriers preventing women from being screened, and 3) to identify important determinants of screening status and screening acceptability in the population. Methods: A cross-sectional survey was administered to 312 rural and 280 urban women in the region over June-July 2012. The sample was obtained through a multistage random sampling strategy. Descriptive statistics were performed to address Objectives 1 and 2, while multivariate logistic regression models were created using generalized estimating equations to address Objective 3. Results: Awareness of cervical cancer in the sample was high, but women had less knowledge of screening tests for the disease. The proportion of ever-screened women was significantly lower in the rural (4%) than in the urban (8%) sample. The most common barrier in never-screened women was not knowing that screening existed, followed by anticipated cost of the procedure. Travel distance was a more frequent concern in rural women. Older age, being married, cervical cancer knowledge and healthcare access factors were significantly associated with screening status in urban women, while only older age and condom use were associated in rural women. Personal beliefs about risk were associated with screening acceptability in never-screened women. Willingness to be screened was low in urban women with high socioeconomic status. Conclusions: Participation in cervical screening is extremely low in the Kilimanjaro region due to both access-related and personal barriers. While Tanzania awaits a national screening program, the identified determinants may inform regional screening and education initiatives aimed at increasing screening coverage in the Kilimanjaro area.