Predictors of Cervical Cancer Screening Among Kenyan Women: Results of a Nested Case-control Study in a Nationally Representative Survey

Background: Cervical cancer is a major public health concern in Kenya. It is the leading cause of cancer morbidity and mortality among women. Although screening is an effective prevention method, uptake is low among eligible women. Little is known about predictors of cervical cancer screening uptake. This study explored relationship between uptake of cervical cancer screening, socio-demographic, behavioral and biological risk factors.

Methods: Nested case-control study within STEPS survey, a population-based cross-sectional household survey conducted between April and June 2015.Cases were women who had undergone cervical cancer screening and controls were unscreened women. Study participants were women eligible for cervical cancer screening (30-49 years). Variables included socio-demographic; behavioral risk factors such as physical activity, tobacco and alcohol use diet and biological factors like diabetes and hypertension. Outcome of interest was cervical cancer screening. Data analysis was done using STATA version 14. Logistic regression model was used to assess relationship between cervical cancer screening and socio-demographic, behavioral and biological risk factors.

Results: Of 1180 women interviewed, 16.4% (n = 194) had been screened for cervical cancer. Of unscreened women (n = 986), 67.9% were aware of cervical cancer screening. Higher screening rates were observed in more educated women (25.2%), highest income quintile (29.6%) and living in urban areas (23%) than in women with no formal education (3.2%), poorest (3.6%) and living in rural areas (13.8%). Younger women (35-39) and those with low High-density lipoprotein (HDL) were less likely to be screened [OR = 0.56; 95% CI = (0.34, 0.93); p-value = 0.025] and [OR = 0.51; 95% CI = (0.29, 0.91); p = value 0.023] respectively. Self-employed women, those in the fourth wealth quintile, binge drinkers, high sugar consumption and insufficient physical activity were more likely to be screened [OR 2.55 (1.12, 5.81) p value 0.026], [OR 3.56 (1.37, 9.28) p value 0.009], [OR 5.94 (1.52, 23.15) p value 0.010], [OR 2.99 (1.51, 5.89) p value 0.002] and [OR 2.79 (1.37, 5.68) p value 0.005] respectively.

Conclusion: Uptake of cervical cancer screening is low despite high awareness. Strategies to improve cervical cancer screening in Kenya should be implemented with messages targeting persons with both risky and non-risky lifestyles especially younger women with no formal education living in rural areas.