Background
Theoretical foundation
Methods
The aim of the study
Study design and settings
Sampling
Data collection procedure
Country | Type of survey | Survey years | Observation (N) |
---|---|---|---|
Albania | Standard DHS | 2017–18 | 15,306 |
Bolivia | Standard DHS | 2008 | 40,479 |
Burkina Faso | Standard DHS | 2010 | 112,661 |
Colombia | Standard DHS | 2015–16 | 11,804 |
Cote d’Ivoire | Standard DHS | 2011–12 | 26,939 |
Dominican Republic | Standard DHS | 2013 | 17,480 |
Egypt | Standard DHS | 2014 | 9209 |
Equatorial Guinea | Standard DHS | 2014–15 | 2561 |
Honduras | Standard DHS | 2011–12 | 46,592 |
India | Standard DHS | 2015–16 | 1,289,652 |
Jordan | Standard DHS | 2012 | 40,386 |
Kenya | Standard DHS | 2014 | 36,540 |
Lesotho | Standard DHS | 2014 | 11,575 |
Namibia | Standard DHS | 2013 | 16,953 |
Philippines | Standard DHS | 2013 | 71,280 |
Tajikistan | Standard DHS | 2012 | 20,449 |
Tanzania | Standard DHS | 2011–12 | 10,869 |
Zimbabwe | Standard DHS | 2015 | 21,677 |
Total | 2008–2018 | 1,801,987 |
Outcome variables
Explanatory variables
Estimation strategies
Measuring and decomposing wealth-related inequalities
Results
Background characteristics of study participants
Characteristics | Number of observation | Women’s knowledge of cervical cancer | Utilisation of cervical cancer screening services | ||||
---|---|---|---|---|---|---|---|
n (%) | n (%) | 95% CI | P-value1 | n (%) | 95% CI | P-value1 | |
Age group | |||||||
< 26 years | 203,472 (11.75) | 63,232 (31.08) | (30.88–31.28) | 47,559 (26.02) | (25.82–26.22) | ||
26–35 years | 629,486 (36.36) | 217,696 (34.58) | (34.47–34.70) | < 0.001 | 175,494 (29.62) | (29.50–29.74) | < 0.001 |
36–45 years | 674,297 (38.95) | 241,054 (35.75) | (35.63–35.86) | 199,553 (31.06) | (30.95–31.17) | ||
46 or more | 223,878 (12.93) | 79,957 (35.71) | (35.52–35.91) | 67,803 (32.00) | (31.80–32.20) | ||
Educational level | |||||||
no education | 752,174 (41.05) | 203,970 (26.74) | (26.81–27.01) | 148,425 (22.19) | (22.09–22.29) | ||
primary | 399,246 (21.79) | 140,437 (39.40) | (39.24–39.56) | < 0.001 | 116,728 (35.72) | (35.55–35.88) | < 0.001 |
secondary | 570,867 (31.15) | 208,976 (39.93) | (39.80–40.06) | 182,532 (34.21) | (34.08–34.33) | ||
higher | 110,019 (6.00) | 45,628 (47.35) | (47.05–47.65) | 42,724 (42.64) | (42.33–42.94) | ||
Household head | |||||||
male | 1,527,282 (85.17) | 558,890 (36.70) | (36.62–36.77) | < 0.001 | 414,864 (28.81) | (28.73–28.88) | < 0.001 |
female | 265,922 (14.83) | 104,376 (39.75) | (39.56–39.94) | 79,670 (31.34) | (31.16–31.52) | ||
Household size | |||||||
< 5 members | 534,170 (29.64) | 189,376 (38.17) | (38.04–38.30) | 16,4587 (32.61) | (32.48–32.74) | ||
5–7 members | 858,427 (47.63) | 318,362 (36.53) | (36.43–36.63) | < 0.001 | 239,802 (29.20) | (29.10–29.30) | < 0.001 |
≥ 8 members | 409,815 (22.74) | 156,481 (36.45) | (36.30–36.59) | 90,147 (24.46) | (24.32–24.60) | ||
Currently breastfeeding | |||||||
no | 1,341,835 (78.97) | 463,050 (35.19) | (35.11–35.27) | < 0.001 | 403,083 (31.13) | (31.05–31.21) | < 0.001 |
yes | 357,415 (21.03) | 119,168 (31.63) | (31.47–31.78) | 77,186 (23.82) | (23.67–23.96) | ||
Currently amenorrheic | |||||||
no | 1,569,088 (91.70) | 539,226 (34.69) | (34.61–34.76) | 460,973 (30.57) | (30.49–30.64) | < 0.001 | |
yes | 141,967 (8.30) | 51,881 (35.14) | (34.89–35.39) | 0.312 | 29,434 (24.23) | (23.99–24.47) | |
Currently abstaining | |||||||
no | 1,595,179 (93.23) | 553,764 (34.71) | (34.64–34.79) | < 0.001 | 465,436 (30.40) | (30.32–30.47) | < 0.001 |
yes | 115,876 (6.77) | 40,415 (34.88) | (34.60–35.15) | 24,971 (25.40) | (25.13–25.67) | ||
Marital status | |||||||
married | 1,529,410 (88.82) | 517,451 (33.83) | (33.76–33.91) | < 0.001 | 408,194 (28.19) | (45.00–45.46) | < 0.001 |
others | 192,514 (11.18) | 83,854 (43.56) | (43.34–43.78) | 82,213 (45.23) | (28.12–28.27) | ||
Employment status | |||||||
no | 333,605 (51.07) | 149,712 (44.88) | (44.71–45.05) | < 0.001 | 110,798 (36.11) | (35.94–36.28) | 0.174 |
yes | 319,666 (48.93) | 165,495 (51.77) | (51.60–51.94) | 93,590 (36.83) | (36.64–37.01) | ||
Access to health facility | |||||||
no problem | 437,869 (25.77) | 136,530 (31.18) | (31.04–31.32) | 148,406 (32.60) | (32.46–32.73) | < 0.001 | |
some problem | 672,322 (39.57) | 262,319 (39.02) | (38.90–39.13) | < 0.001 | 179,888 (29.45) | (29.33–29.56) | |
extreme problem | 588,996 (34.66) | 186,316 (31.63) | (31.51–31.75) | 151,967 (27.49) | (27.37–27.61) | ||
Health insurance coverage | |||||||
no | 1,372,070 (79.75) | 467,290 (34.06) | (33.98–34.14) | < 0.001 | 359,259 (27.86) | (27.78–27.94) | < 0.001 |
yes | 348,436 (20.25) | 147,864 (42.44) | (42.27–42.60) | 114,053 (33.28) | (33.12–33.44) | ||
Mass media exposure | |||||||
no | 704,804 (39.94) | 214,934 (30.50) | (30.39–30.60) | < 0.001 | 120,414 (19.33) | (19.24–19.43) | < 0.001 |
yes | 1,059,673 (60.06) | 439,673 (41.49) | (41.40–41.59) | 363,979 (35.13) | (35.04–35.23) | ||
Wealth Index | |||||||
poorest (Q1) | 410,984 (22.92) | 104,745 (25.49) | (25.35–25.62) | < 0.001 | 70,699 (18.76) | (18.64–18.89) | |
poorer (Q2) | 385,984 (21.52) | 123,850 (32.09) | (31.94–32.23) | 88,121 (24.39) | (24.25–24.53) | < 0.001 | |
middle (Q3) | 364,113 (20.31) | 139,510 (38.32) | (38.16–38.47) | 104,965 (30.52) | (30.36–30.67) | ||
richer (Q4) | 341,052 (19.02) | 149,721 (43.90) | (43.73–44.07) | 114,233 (35.07) | (34.90–35.23) | ||
richest (Q5) | 299,854 (16.64) | 148,328 (48.68) | (44.52–55.29) | 116,516 (40.19) | (35.16–42.92) | ||
Place of residence | |||||||
urban | 600,094 (33.30) | 271,061 (45.17) | (45.04–45.30) | < 0.001 | 206,979 (36.11) | (35.99–36.23) | < 0.001 |
rural | 1,201,893 (66.70) | 395,695 (32.92) | (32.84–33.01) | 287,558 (25.65) | (25.56–25.73) | ||
Total | 1,801,987 (100.00) | 666,789 (36.99) | (36.92–37.06) | 494,537 (29.19) | (29.12–29.25) |
Countries | Utilisation of CCS services, % | Degree of inequalities | Sources | ||||
---|---|---|---|---|---|---|---|
Poorest (Q1) | Richest (Q5) | RPD | RPR | (Q5-Q1) / Q5 | Conc.I | ||
Present study findings (18 RCCs) | 18.76 | 40.19 | 21.43 | 2.14 | 0.53 | 0.298 | Present study |
Austria | 68.40 | 91.80 | 23.40 | 1.34 | 0.25 | 0.315 | [36] |
Australia | 50.40 | 62.10 | 11.70 | 1.23 | 0.19 | 0.126 | [55] |
Brazil | 55.40 | 88.40 | 33.00 | 1.60 | 0.37 | 0.296 | [36] |
Denmark | 45.00 | 78.00 | 33.00 | 1.73 | 0.42 | 0.098 | [56] |
France | 42.50 | 80.10 | 37.60 | 1.88 | 0.47 | 0.269 | [36] |
Finland | 49.90 | 74.10 | 24.20 | 1.48 | 0.33 | 0.122 | [36] |
Germany | 68.30 | 80.50 | 12.20 | 1.18 | 0.15 | 0.139 | [36] |
Greece | 31.40 | 62.40 | 31.00 | 1.99 | 0.50 | 0.266 | [36] |
Hungary | 38.60 | 78.30 | 39.70 | 2.03 | 0.51 | 0.285 | [36] |
Italy | 72.10 | 69.90 | −2.20 | 0.97 | −0.03 | 0.061 | [36] |
Ireland | 19.90 | 45.50 | 25.60 | 2.29 | 0.56 | 0.220 | [36] |
Luxembourg | 79.20 | 88.90 | 9.70 | 1.12 | 0.11 | 0.243 | [36] |
Mexico | 57.30 | 69.60 | 12.30 | 1.21 | 0.18 | 0.119 | [36] |
Netherlands | 46.40 | 65.90 | 19.50 | 1.42 | 0.30 | 0.151 | [36] |
Paraguay | 32.40 | 71.00 | 38.60 | 2.19 | 0.54 | 0.314 | [36] |
Portugal | 18.70 | 71.30 | 52.60 | 3.81 | 0.74 | 0.318 | [36] |
Russia | 60.50 | 77.00 | 16.50 | 1.27 | 0.21 | 0.142 | [36] |
Spain | 44.00 | 72.30 | 28.30 | 1.64 | 0.39 | 0.207 | [36] |
Slovenia | 62.50 | 78.40 | 15.90 | 1.25 | 0.20 | 0.273 | [36] |
Sweden | 62.50 | 75.80 | 13.30 | 1.21 | 0.18 | 0.177 | [36] |
Slovakia | 47.00 | 70.10 | 23.10 | 1.49 | 0.33 | 0.208 | [36] |
Uruguay | 48.10 | 75.50 | 27.40 | 1.57 | 0.36 | 0.246 | [36] |
UK | 56.80 | 63.40 | 6.60 | 1.12 | 0.10 | 0.069 | [36] |
Distribution of participants’ knowledge and utilisation of CCS services (for RQ 1)
Factors influencing women’s knowledge and utilisation of CC screening services (for RQ 2)
Variables | 1OR (95% CI) | Elast. | Erreygers’sConc.I | RC to the Erreygers’s Conc.I, % (95% CI) |
---|---|---|---|---|
Knowledge of cervical cancer | ||||
Age (years) | 1.03** (1.01, 1.05) | 0.49 | 0.71 | 25.62*** (10.12, 30.59) |
Schooling (years) | 1.08* (1.05, 1.11) | 0.32 | 0.36 | 15.07*** (10.26, 19.57) |
Household head (= male) | 0.76*** (0.74, 0.77) | − 0.24 | 0.01 | −2.24*** (−3.10, −1.59) |
Household size | 0.99 (0.99, 1.00) | − 0.01 | − 0.25 | 8.59 (− 2.36, 25.65) |
Currently breastfeeding (= yes) | 1.03*** (1.01, 1.05) | 0.02 | 0.11 | 6.51 (− 0.25, 12.69) |
Currently amenorrhea (= yes) | 1.23*** (1.19, 1.27) | 0.02 | − 0.06 | − 1.37*** (− 2.37, − 1.05) |
Currently abstaining (= yes) | 0.93** (0.90, 0.96) | − 0.01 | − 0.03 | 0.32 (− 0.24, 2.38) |
Marital status (= married) | 1.02* (1.00, 1.04) | 0.01 | − 0.01 | − 0.08 (− 1.21, 0.09) |
Currently working status (= yes) | 1.39*** (1.37, 1.41) | 0.15 | 0.06 | 15.21*** (11.23, 59.45) |
Access to health facility (= yes) | 1.55*** (1.52, 1.58) | 0.33 | −0.24 | − 10.00** (− 12.65, −4.89) |
Health insurance coverage (= yes) | 0.66*** (0.65, 0.67) | − 0.08 | 0.04 | −6.94*** (− 9.58, − 4.29) |
Mass media exposure (= no) | 0.84*** (0.83, 0.85) | −0.15 | − 0.26 | 15.26** (5.16, 23.36) |
Place of residence (= urban) | 1.13*** (1.11, 1.15) | 0.09 | −0.49 | −9.76** (− 12.59, −5.69) |
Wealth score | 1.26*** (1.25, 1.27) | 0.64 | 0.61 | 24.00* (3.68, 55.23) |
Total | 80.20** (60.55, 89.65) | |||
Utilisation of cervical cancer screening | ||||
Age (years) | 1.03** (1.02, 1.05) | 0.79 | 0.51 | 29.00*** (10.20, 39.51) |
Schooling (years) | 0.99* (0.98, 0.99) | −0.08 | 0.36 | 17.00** (12.59, 51.16) |
Household head (= male) | 1.12*** (1.10, 1.15) | 0.12 | 0.01 | 3.33 (−2.36, 6.23) |
Household size | 0.98* (0.97, 0.98) | −0.11 | −0.25 | 1.29 (−1.20, 2.31) |
Currently breastfeeding (= yes) | 1.16*** (1.14, 1.19) | −0.03 | − 0.12 | 9.51*** (2.59, 12.59) |
Currently amenorrhea (= yes) | 0.96** (0.93, 0.99) | −0.01 | − 0.06 | 0.63 (−2.16, 2.13) |
Currently abstaining (= yes) | 0.79*** (0.76, 0.82) | −0.01 | − 0.03 | 2.04* (0.59, 4.57) |
Marital status (= married) | 2.11*** (2.07, 2.15) | 0.09 | −0.02 | −8.23*** (−12.46, −5.80) |
Currently working status (= no) | 0.86*** (0.85, 0.88) | − 0.05 | 0.061 | − 14.16*** (−19.23, − 8.47) |
Access to health facility (= no) | 0.73*** (0.72, 0.74) | −0.18 | − 0.24 | 11.22* (2.36, 19.49) |
Health insurance coverage (= yes) | 1.58*** (1.55, 1.61) | 0.07 | 0.04 | 8.08* (1.26, 9.45) |
Mass media exposure (= no) | 0.43*** (0.39, 0.47) | −0.70 | −0.26 | 6.72** (1.56, 16.81) |
Place of residence (= urban) | 0.91** (0.89, 0.93) | 0.09 | −0.49 | −9.76*** (−15.62, −6.85) |
Wealth score | 1.99*** (1.09, 2.11) | 0.14 | 0.62 | 27.00** (14.56, 45.65) |
Total | 83.69*** (75.85, 95.54) |