Lifetime prevalence of cervical cancer screening in 55 low- and middle-income countries

Julia M Lemp, Jan-Walter De Neve, Hermann Bussmann, Simiao Chen, Jennifer Manne-Goehler, Michaela Theilmann, Maja-Emilia Marcus, Cara Ebert, Charlotte Probst, Lindiwe Tsabedze-Sibanyoni, Lela Sturua, Joseph M Kibachio, Sahar Saeedi Moghaddam, Joao S Martins, Dismand Houinato, Corine Houehanou, Mongal S Gurung, Gladwell Gathecha, Farshad Farzadfar, Scott Dryden-PetersonJustine I. Davies, Rifat Atun, Sebastian Vollmer, Till Bärnighausen, Pascal Geldsetzer

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)
252 Downloads (Pure)


Importance: 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.

Objective: To determine lifetime cervical cancer screening prevalence in LMICs and its variation across and within world regions and countries.

Design, Setting, and Participants: 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.

Exposures: World region, country; countries' economic, social, and health system characteristics; and individuals' sociodemographic characteristics.

Main Outcomes and Measures: Self-report of having ever had a screening test for cervical cancer.

Results: 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.

Conclusions and Relevance: 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.

Original languageEnglish
Pages (from-to)1532-1542
Number of pages11
JournalJAMA The Journal of the American Medical Association
Issue number15
Publication statusPublished - 20 Oct 2020

Bibliographical note

Funding Information:
Funding/Support: Dr Tsabedze-Sibanyoni reported receiving grants from the WHO and nonfinancial support from Eswatini Ministry of Health during the conduct of the study. Dr Bärnighausen was supported by the Alexander von Humboldt Foundation through the Alexander von Humboldt Professor award, funded by the Federal Ministry of Education and Research; the German Research Foundation; the Wellcome Trust; and by grants R01-HD084233 from the National Institute of Child Health and Human Development, P01-AG041710 from the National Institute on Aging, R01-AI124389 and R01-AI112339 from the National Institute of Allergy and Infectious Diseases, and D43-TW009775 from the Fogarty International Center, all of the of National Institutes of Health. Dr Geldsetzer was supported by grant KL2TR003143 from the National Center for Advancing Translational Sciences of the National Institutes of Health. Dr De Neve was supported by the Alexander von Humboldt Foundation. Dr Manne-Goehler was supported by grant T32 AI007433 from the National Institute of Allergy and Infectious Diseases. This study uses data from multiple STEPS surveys (as specified in the Table), which were implemented by the respective Ministry of Health with the support of the WHO. This study uses data from WHO’s Study on Global Ageing and Adult Health (SAGE). SAGE is supported by the US National Institute on Aging through Interagency Agreements OGHA 04034785; YA1323-08-CN-0020; Y1-AG-1005-0, and through research grants R01-AG034479 and R21-AG034263. This study is also based on data from Eurostat, European Health Survey 2014.

Publisher Copyright:
© 2020 American Medical Association. All rights reserved.

Copyright 2020 Elsevier B.V., All rights reserved.

ASJC Scopus subject areas

  • General Medicine


Dive into the research topics of 'Lifetime prevalence of cervical cancer screening in 55 low- and middle-income countries'. Together they form a unique fingerprint.

Cite this