Introduction
Rationale
Cervical cancer is the most common type of cancer. It is caused by the human papillomavirus (HPV), which is transmitted through sexual intercourse.1 Today, there are more than 150 distinct HPV varieties known, especially in those between the ages of 22 and 25.2 About 50% of cervical cancer cases have been related to HPV 16 and 18, known to be high-risk HPV types.3 Despite the fact that it contributes to the morbidity and death of these women, it is one of the most treatable and preventable types of cancer, as long as it is identified early and successfully controlled.4 Other risk factors include early initiation of sexual activity, multiple sexual partners, prolonged oral contraceptive use, immunological suppression and smoking.5
According to research, there are 24.6 million patients with cancer worldwide. In 2020, there were 604 000 new cases of cervical cancer and 342 000 deaths of the estimated new cases.6 7 The incidence, mortality and prevalence of cervical cancer worldwide were 7.9%, 7.5% and 9%, respectively, according to a WHO report of 2015. The vast majority (90%) of these cases occur in developing countries.6 There were 715 000 new cases of cancer and 542 000 cancer-related deaths in Africa.8 Compared with women in high-income countries, women in low-income and middle-income countries had a 35% higher average lifetime risk of cervical cancer.9
In developing nations, cervical cancer is more common in women over 50 years of age, but it is also becoming more prevalent in women between the ages of 15 and 49.10 In sub-Saharan Africa, the prevalence was 27.6%, the death rate was 23.2% and the incidence rate was 25.2%. In Ethiopia, the rates of cervical cancer incidence, death and prevalence of cervical cancer were 17.3%, 16.5%, and 18.2% respectively.11 Twenty-three percent of Ethiopian women are expected to develop cervical cancer per 100 000 persons each year.12
According to reports, cervical cancer is diagnosed in Ethiopian adult women, second only to breast cancer.13–15 There are 20.9 million women in Ethiopia who are 15 or older and at risk of developing cervical cancer. Before the 2009 introduction of the Addis Tesfa Initiative, Ethiopia had no regular access to cervical cancer screening and treatment for precancerous cervical lesions.16 Once it has progressed to invasive cervical cancer, the cost of cervical cancer is remarkably high. Cervical cancer screening is done only 23% of the time in most developing nations, according to different reports.9 17 18 One of the key elements of health promotion efforts that can reduce morbidity and mortality by more than 80% is cervical cancer screening. However, in Ethiopia, the prevalence of cervical cancer screening is 0.6% for all women aged 18–69 years, 1.6% in urban areas and 0.4% in rural areas.3 19
Together with rapid therapy for early cervical lesions, visual inspection with acetic acid (VIA) provides a rapid and affordable screening technique. It has an average sensitivity and specificity. The test can be performed by nurses or health professionals and the findings are immediate. In many low-resource where it is difficult to maintain high-quality cytology programmes, VIA is practical.20 A large-cluster randomised controlled trial conducted in rural India found that a single HPV screening can reduce cervical cancer mortality and new cases by 50%.21 To eliminate cervical cancer in women worldwide by 2030, the WHO created a global strategy. To address these issues, 90% of women should receive the full HPV vaccine before the age of 15, 70% of women between the ages of 15 and 45 should be screened and 90% of those who are found to have the disease will receive treatment and care.4
Our country, Ethiopia, also adopted the WHO’s guideline that women aged 30 and older begin cervical cancer screening at least one to 3 years of age using a see-and-treat strategy. However, regardless of age, it is recommended that sexually active and HIV-positive women undergo a screening every 3 years (from the time of HIV diagnosis). An activity to increase knowledge about cervical cancer prevention, affect social norms and encourage behaviour change among targeted individuals or subpopulations to prevent cervical cancer is the behavioural change communication intervention.22
According to the theory of planned behaviour (TPB), attitudes towards behaviour, subjective norms and perceived behavioural control have an indirect influence on a person’s behaviour in addition to direct influences from intention.23 According to a meta-analysis, the TPB explained 27% of the variance in behaviour across a wide range of actions and 39% of the variance in intentions.24 TPB is useful in predicting the intention of cervical cancer screening intention, according to evidence.25–29 Despite the efforts made, the results of a study conducted in different parts of Ethiopia revealed that cervical cancer screening programmes were not widely used.30–33 Some of the reasons people did not use the screening service included a low level of intention, lack of understanding, a negative attitude towards cervical cancer screening and an incorrect understanding of the severity of the disease.22 34–36 It will be feasible to considerably lower the incidence and mortality of cervical cancer by increasing the level of intention towards cervical cancer screening. This systematic review and meta-analysis is therefore designed to evaluate the intention of all eligible Ethiopian women to accept cervical cancer screening, as well as its predictors.
Objectives
Primary objective
To determine the pooled prevalence of intention to screen for cervical cancer and its predictors among women of reproductive age in Ethiopia.
Secondary objectives
Identify relevant grey and peer-reviewed literature describing intention to screen for cervical cancer and its predictors among women of reproductive age in Ethiopia.
Assess the level of intention for cervical cancer screening among women of reproductive age in Ethiopia.
Identify the factors associated with women's intention to screen for cervical cancer in Ethiopia as described in the literature.
Collect key findings and recommendations on the intention to screen for cervical cancer from studies conducted in Ethiopia between 1 January 2014 and 31 December 2023.