Lifetime Prevalence of Cervical Cancer Screening in 55 Low- and Middle-Income Countries
The World Health Organization is developing a global strategy to eliminate cervical cancer, with goals for screening prevalence among women aged 30 through 49 years. However, evidence on prevalence levels of cervical cancer screening in low- and middle-income countries (LMICs) is sparse. To determin...
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| Vydáno v: | JAMA : the journal of the American Medical Association Ročník 324; číslo 15; s. 1532 |
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| Médium: | Journal Article |
| Jazyk: | angličtina |
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United States
20.10.2020
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| ISSN: | 1538-3598, 1538-3598 |
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| Abstract | The World Health Organization is developing a global strategy to eliminate cervical cancer, with goals for screening prevalence among women aged 30 through 49 years. However, evidence on prevalence levels of cervical cancer screening in low- and middle-income countries (LMICs) is sparse.
To determine lifetime cervical cancer screening prevalence in LMICs and its variation across and within world regions and countries.
Analysis of cross-sectional nationally representative household surveys carried out in 55 LMICs from 2005 through 2018. The median response rate across surveys was 93.8% (range, 64.0%-99.3%). The population-based sample consisted of 1 136 289 women aged 15 years or older, of whom 6885 (0.6%) had missing information for the survey question on cervical cancer screening.
World region, country; countries' economic, social, and health system characteristics; and individuals' sociodemographic characteristics.
Self-report of having ever had a screening test for cervical cancer.
Of the 1 129 404 women included in the analysis, 542 475 were aged 30 through 49 years. A country-level median of 43.6% (interquartile range [IQR], 13.9%-77.3%; range, 0.3%-97.4%) of women aged 30 through 49 years self-reported to have ever been screened, with countries in Latin America and the Caribbean having the highest prevalence (country-level median, 84.6%; IQR, 65.7%-91.1%; range, 11.7%-97.4%) and those in sub-Saharan Africa the lowest prevalence (country-level median, 16.9%; IQR, 3.7%-31.0%; range, 0.9%-50.8%). There was large variation in the self-reported lifetime prevalence of cervical cancer screening among countries within regions and among countries with similar levels of per capita gross domestic product and total health expenditure. Within countries, women who lived in rural areas, had low educational attainment, or had low household wealth were generally least likely to self-report ever having been screened.
In this cross-sectional study of data collected in 55 low- and middle-income countries from 2005 through 2018, there was wide variation between countries in the self-reported lifetime prevalence of cervical cancer screening. However, the median prevalence was only 44%, supporting the need to increase the rate of screening. |
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| AbstractList | The World Health Organization is developing a global strategy to eliminate cervical cancer, with goals for screening prevalence among women aged 30 through 49 years. However, evidence on prevalence levels of cervical cancer screening in low- and middle-income countries (LMICs) is sparse.ImportanceThe World Health Organization is developing a global strategy to eliminate cervical cancer, with goals for screening prevalence among women aged 30 through 49 years. However, evidence on prevalence levels of cervical cancer screening in low- and middle-income countries (LMICs) is sparse.To determine lifetime cervical cancer screening prevalence in LMICs and its variation across and within world regions and countries.ObjectiveTo determine lifetime cervical cancer screening prevalence in LMICs and its variation across and within world regions and countries.Analysis of cross-sectional nationally representative household surveys carried out in 55 LMICs from 2005 through 2018. The median response rate across surveys was 93.8% (range, 64.0%-99.3%). The population-based sample consisted of 1 136 289 women aged 15 years or older, of whom 6885 (0.6%) had missing information for the survey question on cervical cancer screening.Design, Setting, and ParticipantsAnalysis of cross-sectional nationally representative household surveys carried out in 55 LMICs from 2005 through 2018. The median response rate across surveys was 93.8% (range, 64.0%-99.3%). The population-based sample consisted of 1 136 289 women aged 15 years or older, of whom 6885 (0.6%) had missing information for the survey question on cervical cancer screening.World region, country; countries' economic, social, and health system characteristics; and individuals' sociodemographic characteristics.ExposuresWorld region, country; countries' economic, social, and health system characteristics; and individuals' sociodemographic characteristics.Self-report of having ever had a screening test for cervical cancer.Main Outcomes and MeasuresSelf-report of having ever had a screening test for cervical cancer.Of the 1 129 404 women included in the analysis, 542 475 were aged 30 through 49 years. A country-level median of 43.6% (interquartile range [IQR], 13.9%-77.3%; range, 0.3%-97.4%) of women aged 30 through 49 years self-reported to have ever been screened, with countries in Latin America and the Caribbean having the highest prevalence (country-level median, 84.6%; IQR, 65.7%-91.1%; range, 11.7%-97.4%) and those in sub-Saharan Africa the lowest prevalence (country-level median, 16.9%; IQR, 3.7%-31.0%; range, 0.9%-50.8%). There was large variation in the self-reported lifetime prevalence of cervical cancer screening among countries within regions and among countries with similar levels of per capita gross domestic product and total health expenditure. Within countries, women who lived in rural areas, had low educational attainment, or had low household wealth were generally least likely to self-report ever having been screened.ResultsOf the 1 129 404 women included in the analysis, 542 475 were aged 30 through 49 years. A country-level median of 43.6% (interquartile range [IQR], 13.9%-77.3%; range, 0.3%-97.4%) of women aged 30 through 49 years self-reported to have ever been screened, with countries in Latin America and the Caribbean having the highest prevalence (country-level median, 84.6%; IQR, 65.7%-91.1%; range, 11.7%-97.4%) and those in sub-Saharan Africa the lowest prevalence (country-level median, 16.9%; IQR, 3.7%-31.0%; range, 0.9%-50.8%). There was large variation in the self-reported lifetime prevalence of cervical cancer screening among countries within regions and among countries with similar levels of per capita gross domestic product and total health expenditure. Within countries, women who lived in rural areas, had low educational attainment, or had low household wealth were generally least likely to self-report ever having been screened.In this cross-sectional study of data collected in 55 low- and middle-income countries from 2005 through 2018, there was wide variation between countries in the self-reported lifetime prevalence of cervical cancer screening. However, the median prevalence was only 44%, supporting the need to increase the rate of screening.Conclusions and RelevanceIn this cross-sectional study of data collected in 55 low- and middle-income countries from 2005 through 2018, there was wide variation between countries in the self-reported lifetime prevalence of cervical cancer screening. However, the median prevalence was only 44%, supporting the need to increase the rate of screening. The World Health Organization is developing a global strategy to eliminate cervical cancer, with goals for screening prevalence among women aged 30 through 49 years. However, evidence on prevalence levels of cervical cancer screening in low- and middle-income countries (LMICs) is sparse. To determine lifetime cervical cancer screening prevalence in LMICs and its variation across and within world regions and countries. Analysis of cross-sectional nationally representative household surveys carried out in 55 LMICs from 2005 through 2018. The median response rate across surveys was 93.8% (range, 64.0%-99.3%). The population-based sample consisted of 1 136 289 women aged 15 years or older, of whom 6885 (0.6%) had missing information for the survey question on cervical cancer screening. World region, country; countries' economic, social, and health system characteristics; and individuals' sociodemographic characteristics. Self-report of having ever had a screening test for cervical cancer. Of the 1 129 404 women included in the analysis, 542 475 were aged 30 through 49 years. A country-level median of 43.6% (interquartile range [IQR], 13.9%-77.3%; range, 0.3%-97.4%) of women aged 30 through 49 years self-reported to have ever been screened, with countries in Latin America and the Caribbean having the highest prevalence (country-level median, 84.6%; IQR, 65.7%-91.1%; range, 11.7%-97.4%) and those in sub-Saharan Africa the lowest prevalence (country-level median, 16.9%; IQR, 3.7%-31.0%; range, 0.9%-50.8%). There was large variation in the self-reported lifetime prevalence of cervical cancer screening among countries within regions and among countries with similar levels of per capita gross domestic product and total health expenditure. Within countries, women who lived in rural areas, had low educational attainment, or had low household wealth were generally least likely to self-report ever having been screened. In this cross-sectional study of data collected in 55 low- and middle-income countries from 2005 through 2018, there was wide variation between countries in the self-reported lifetime prevalence of cervical cancer screening. However, the median prevalence was only 44%, supporting the need to increase the rate of screening. |
| Author | Atun, Rifat Chen, Simiao Theilmann, Michaela Sturua, Lela Manne-Goehler, Jennifer Lemp, Julia M Farzadfar, Farshad Davies, Justine I Houehanou, Corine Gurung, Mongal S Kibachio, Joseph M Bussmann, Hermann Gathecha, Gladwell Moghaddam, Sahar Saeedi Houinato, Dismand Marcus, Maja-Emilia Dryden-Peterson, Scott Tsabedze-Sibanyoni, Lindiwe Bärnighausen, Till De Neve, Jan-Walter Martins, Joao S Probst, Charlotte Ebert, Cara Vollmer, Sebastian Geldsetzer, Pascal |
| Author_xml | – sequence: 1 givenname: Julia M surname: Lemp fullname: Lemp, Julia M organization: Heidelberg Institute of Global Health (HIGH), Medical Faculty and University Hospital, University of Heidelberg, Heidelberg, Germany – sequence: 2 givenname: Jan-Walter surname: De Neve fullname: De Neve, Jan-Walter organization: Heidelberg Institute of Global Health (HIGH), Medical Faculty and University Hospital, University of Heidelberg, Heidelberg, Germany – sequence: 3 givenname: Hermann surname: Bussmann fullname: Bussmann, Hermann organization: Department of Applied Tumor Biology, Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany – sequence: 4 givenname: Simiao surname: Chen fullname: Chen, Simiao organization: Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing – sequence: 5 givenname: Jennifer surname: Manne-Goehler fullname: Manne-Goehler, Jennifer organization: Medical Practice Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Boston – sequence: 6 givenname: Michaela surname: Theilmann fullname: Theilmann, Michaela organization: Heidelberg Institute of Global Health (HIGH), Medical Faculty and University Hospital, University of Heidelberg, Heidelberg, Germany – sequence: 7 givenname: Maja-Emilia surname: Marcus fullname: Marcus, Maja-Emilia organization: Department of Economics and Centre for Modern Indian Studies, University of Goettingen, Göttingen, Germany – sequence: 8 givenname: Cara surname: Ebert fullname: Ebert, Cara organization: RWI-Leibniz Institute for Economic Research, Essen (Berlin office), Germany – sequence: 9 givenname: Charlotte surname: Probst fullname: Probst, Charlotte organization: Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada – sequence: 10 givenname: Lindiwe surname: Tsabedze-Sibanyoni fullname: Tsabedze-Sibanyoni, Lindiwe organization: Eswatini Ministry of Health, Mbabane, Eswatini – sequence: 11 givenname: Lela surname: Sturua fullname: Sturua, Lela organization: Non-Communicable Disease Department, National Center for Disease Control and Public Health, Tbilisi, Georgia – sequence: 12 givenname: Joseph M surname: Kibachio fullname: Kibachio, Joseph M organization: Institute of Global Health, Faculty of Medicine, University of Geneva (UNIGE), Geneva, Switzerland – sequence: 13 givenname: Sahar Saeedi surname: Moghaddam fullname: Moghaddam, Sahar Saeedi organization: Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran – sequence: 14 givenname: Joao S surname: Martins fullname: Martins, Joao S organization: Faculty of Medicine and Health Sciences, Universidade Nacional Timor Lorosa'e, Rua Jacinto Candido, Dili, Timor-Leste – sequence: 15 givenname: Dismand surname: Houinato fullname: Houinato, Dismand organization: Laboratory of Epidemiology of Chronic and Neurological Diseases, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin – sequence: 16 givenname: Corine surname: Houehanou fullname: Houehanou, Corine organization: Laboratory of Epidemiology of Chronic and Neurological Diseases, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin – sequence: 17 givenname: Mongal S surname: Gurung fullname: Gurung, Mongal S organization: Health Research and Epidemiology Unit, Ministry of Health, Thimphu, Bhutan – sequence: 18 givenname: Gladwell surname: Gathecha fullname: Gathecha, Gladwell organization: Division of Non-Communicable Diseases, Kenya Ministry of Health, Nairobi, Kenya – sequence: 19 givenname: Farshad surname: Farzadfar fullname: Farzadfar, Farshad organization: Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran – sequence: 20 givenname: Scott surname: Dryden-Peterson fullname: Dryden-Peterson, Scott organization: Botswana Harvard AIDS Institute, Gaborone, Botswana – sequence: 21 givenname: Justine I surname: Davies fullname: Davies, Justine I organization: Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom – sequence: 22 givenname: Rifat surname: Atun fullname: Atun, Rifat organization: Department of Global Health and Social Medicine at the Harvard Medical School, Boston, Massachusetts – sequence: 23 givenname: Sebastian surname: Vollmer fullname: Vollmer, Sebastian organization: Department of Economics and Centre for Modern Indian Studies, University of Goettingen, Göttingen, Germany – sequence: 24 givenname: Till surname: Bärnighausen fullname: Bärnighausen, Till organization: Africa Health Research Institute, Somkhele, South Africa – sequence: 25 givenname: Pascal surname: Geldsetzer fullname: Geldsetzer, Pascal organization: Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, California |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/33079153$$D View this record in MEDLINE/PubMed |
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| SubjectTerms | Adult Cross-Sectional Studies Developing Countries Early Detection of Cancer - statistics & numerical data Female Global Health Health Care Surveys Humans Middle Aged Patient Acceptance of Health Care - statistics & numerical data Self Report Uterine Cervical Neoplasms - diagnosis |
| Title | Lifetime Prevalence of Cervical Cancer Screening in 55 Low- and Middle-Income Countries |
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