Socioeconomic and contextual determinants of cervical cancer screening uptake in West Africa: a multilevel analysis of recent DHS data from five countries

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Résumé

Background
Cervical cancer remains a leading cause of cancer-related morbidity and mortality among women in sub-Saharan Africa, despite effective screening methods. This study examined individual- and household-level predictors of ever having been screened for cervical cancer in 5 West African countries and residual between-cluster variation using multilevel models, based on recent nationally representative data.

Methods
We analyzed Demographic and Health Survey (DHS) data from Burkina Faso (2021), Côte d’Ivoire (2021), Ghana (2022), Mali (2023–2024) and Senegal (2023). The sample included women aged 15–49 years with complete information on ever-screening for cervical cancer. Two-level logistic random-intercept models (women nested within clusters) were fitted to estimate adjusted odds ratios (aORs) with 95% confidence intervals (CIs) and residual between-cluster variation through the intraclass correlation coefficient (ICC). A sensitivity analysis was restricted to women aged 30–49 years.

Results
Ever-screening prevalence ranged from 4.6% in Mali to 14.6% in Burkina Faso. Ever-screening uptake increased markedly with age in all 5 countries, with women aged 45–49 having higher odds than adolescents aged 15–19 (aOR, 2.84 in Burkina Faso; aOR, 14.11 in Ghana). Secondary or higher education was associated with greater ever-screening uptake in all countries, with the strongest associations in Côte d’Ivoire (aOR, 2.21) and Mali (aOR, 1.86). Household wealth was associated with ever-screening in Côte d’Ivoire, Ghana, Mali and Senegal, with aORs ranging from 2.26 to 2.87 among women in the richest quintile compared with the poorest. Health insurance coverage was positively associated in all 5 countries. ICCs ranged from 32.6% (95% CI, 28.8–36.7) in Mali to 41.0% (95% CI, 34.6–47.9) in Ghana, indicating substantial residual between-cluster variation that persisted after adjustment.

Conclusion
Ever-screening for cervical cancer in West Africa was associated with socioeconomic position, financial protection, and health system access. A substantial part of the residual variation operated at the cluster level, Increasing equitable ever-screening uptake will require interventions that reduce indirect costs, decentralize screening services, and integrate prevention within routine reproductive healthcare.

Mots-clés

Uterine cervical neoplasms; Early detection of cancer; Socioeconomic factors; Health services accessibility; Multilevel analysis