尽管在降低全球孕产妇死亡率方面取得了显著进展,宫颈癌已被确定为孕产妇发病率和死亡率的主要原因,特别是在撒哈拉以南非洲国家。一直以来,宫颈癌筛查服务的使用可有效降低宫颈癌的发病率和死亡率。尽管如此,在埃塞俄比亚进行的研究有限,以评估宫颈癌筛查的摄取及其预测因素,这些研究显示了不一致和不确定的发现。因此,本研究进行了系统评价和荟萃分析,以评估埃塞俄比亚符合条件的女性的宫颈癌筛查汇总利用情况及其预测因素.
像PubMed这样的数据库,WebofScience,Scopus,CINAHL,Psychinfo,谷歌学者,科学直接,对Cochrane图书馆进行了系统搜索。包括所有报告埃塞俄比亚宫颈癌筛查利用和/或其预测因素的观察性研究。两位作者使用标准化的数据提取格式独立提取所有必要的数据。患病率研究的质量评估标准改编自纽卡斯尔渥太华质量评估量表。采用CochraneQ检验统计量和I2检验评估研究的异质性。使用随机效应分析模型以95%置信区间(CI)估计宫颈癌筛查利用的合并患病率及其相关因素。从850篇潜在相关文章中,本研究纳入了25项研究,共有18,067名符合条件的女性.汇总的全国宫颈癌筛查利用率为14.79%(95%CI:11.75,17.83)。宫颈癌筛查的使用率最高(18.59%)在南方民族和民族地区(SNNPR)。最低的是阿姆哈拉地区(13.62%)。亚组分析显示,合并宫颈癌筛查在HIV阳性妇女中最高(20.71%)。这项荟萃分析还显示,女性没有接受正规教育会使宫颈癌筛查利用率降低67%[POR=0.33,95%CI:0.23,0.46]。对宫颈筛查有良好知识的女性[POR=3.01,95CI:2.2.6,4.00],感知对宫颈癌的易感性[POR=4.9,95%CI:3.67,6.54],宫颈癌的严重程度[POR=6.57,95%CI:3.99,10.8]和有性传播感染(STIs)病史的患者[POR=5.39,95%CI:1.41,20.58]更有可能利用宫颈癌筛查.此外,宫颈癌筛查利用的主要障碍是认为自己是健康的(48.97%)和缺乏宫颈癌筛查信息(34.34%)。
这项荟萃分析发现,符合条件的妇女中宫颈癌筛查的比例远低于WHO的建议。在埃塞俄比亚,只有七分之一的妇女使用了宫颈癌筛查。根据女性的地理区域和特征,宫颈癌筛查存在显着差异。教育状况,对宫颈癌筛查的知识,对宫颈癌的易感性和严重程度以及性传播感染史的感知显着增加了筛查实践的接受。因此,妇女赋权,提高对宫颈癌筛查的知识,增强对癌症的感知易感性和严重程度以及确定女性既往史是改善宫颈癌筛查实践的重要策略.
Despite a remarkable progress in the reduction of global rate of maternal mortality, cervical cancer has been identified as the leading cause of maternal morbidity and mortality, particularly in sub-Saharan African countries. The uptake of cervical cancer screening service has been consistently shown to be effective in reducing the incidence rate and mortality from cervical cancer. Despite this, there are limited studies in Ethiopia that were conducted to assess the uptake of cervical cancer screening and its predictors, and these studies showed inconsistent and inconclusive findings. Therefore, this systematic
review and meta-analysis was conducted to estimate the pooled cervical cancer screening utilization and its predictors among eligible women in Ethiopia.
Databases like PubMed, Web of Science, SCOPUS, CINAHL, Psychinfo, Google Scholar, Science Direct, and the Cochrane Library were systematically searched. All observational studies reporting cervical cancer screening utilization and/ or its predictors in Ethiopia were included. Two authors independently extracted all necessary data using a standardized data extraction format. Quality assessment criteria for prevalence studies were adapted from the Newcastle Ottawa quality assessment scale. The Cochrane Q test statistics and I2 test were used to assess the heterogeneity of studies. A random effects model of analysis was used to estimate the pooled prevalence of cervical cancer screening utilization and factors associated with it with the 95% confidence intervals (CIs). From 850 potentially relevant articles, twenty-five studies with a total of 18,067 eligible women were included in this study. The pooled national cervical cancer screening utilization was 14.79% (95% CI: 11.75, 17.83). The highest utilization of cervical cancer screening (18.59%) was observed in Southern Nations Nationalities and Peoples\' region (SNNPR), and lowest was in Amhara region (13.62%). The sub-group analysis showed that the pooled cervical cancer screening was highest among HIV positive women (20.71%). This meta-analysis also showed that absence of women\'s formal education reduces cervical cancer screening utilization by 67% [POR = 0.33, 95% CI: 0.23, 0.46]. Women who had good knowledge towards cervical screening [POR = 3.01, 95%CI: 2.2.6, 4.00], perceived susceptibility to cervical cancer [POR = 4.9, 95% CI: 3.67, 6.54], severity to cervical cancer [POR = 6.57, 95% CI: 3.99, 10.8] and those with a history of sexually transmitted infections (STIs) [POR = 5.39, 95% CI: 1.41, 20.58] were more likely to utilize cervical cancer screening. Additionally, the major barriers of cervical cancer screening utilization were considering oneself as healthy (48.97%) and lack of information on cervical cancer screening (34.34%).
This meta-analysis found that the percentage of cervical cancer screening among eligible women was much lower than the WHO recommendations. Only one in every seven women utilized cervical cancer screening in Ethiopia. There were significant variations in the cervical cancer screening based on geographical regions and characteristics of women. Educational status, knowledge towards cervical cancer screening, perceived susceptibility and severity to cervical cancer and history of STIs significantly increased the uptake of screening practice. Therefore, women empowerment, improving knowledge towards cervical cancer screening, enhancing perceived susceptibility and severity to cancer and identifying previous history of women are essential strategies to improve cervical cancer screening practice.