Determinants of Cervical Cancer Screening among Female Health Professionals in Harar Town, Eastern Ethiopia: A Cross-Sectional Study.

Background: Cervical cancer screening is a key to detect the pre-cervical cancer earlier, but it is almost not utilized in all developing countries and most cases were diagnosed at late stage of cervical cancer. The current screening level has no much effect to control cervical cancer unless addressing female health workers since they are a role model to the public. Objective: The study was conducted to assess the utilizations of cervical cancer screening and associated factors among female Health workers in Arba Minch town and Zuria woreda public health facilities in 2016/17. Methods: A facility based cross-sectional study design was conducted in Arba Minch town and Zuria district, among selected female health professions using computer generated technique of simple random sampling. The data was collected by means of self-administered questionnaires and ethical issue had been given more emphasized during data collection time. Data was entered using EPI info version 7.2.0.1 and analyzed by SPSS version 20. The associations of explanatory and outcome variables were assessed by binary logistic regression and those variables with p value of less than 0.25 were included in multivariate analysis and Statistical significant was considered with odd ratio, 95% of confidence interval and p value of <0.05. Result: About 281 of the respondents were correctly completed the questionnaire of the total respondents, only 27 (9.6%) have had cervical screening within the past three years. There was an association between service year utilization of cervical cancer screening (AOR=4.99, 95% CI: 1.36-18.10), knowledge of cervical cancer screening and utilization of cervical cancer screening (AOR 1.78, 95% CI: 1.05-3.02). Conclusion: The level of utilization of screening was low in female health workers, service year and knowledge were associated with the utilization of cervical screening. Sustaining awareness creation and sensitization of screening should be given emphasis broadly for female’s health workers to increase the number of utilization in health workers.

Cancer of the cervix is the second most common cancer among women worldwide, with about over 660 000 new cases and approximately ninety-four percent of the 350 000 cervical cancer-related death happened in low- and middle-income countries. Effective screening initiatives are particularly crucial in preventing cervical cancer in women. Therefore, the purpose of this systematic literature review was to investigate the pooled prevalence of Ethiopian female healthcare professionals' cervical cancer screening utilization. Published articles were searched from different major international databases (PubMed, Cochrane Library, Scopus, Web of Science, Since Direct, Google Scholar). Direct Google searches were used for additional sources mainly for gray and preprint studies. This review included studies that reported either the use of cervical cancer screening or cervical cancer screening predictors in Ethiopia. All published and unpublished studies through May/2024 and reported in the English language were retrieved to assess eligibility for inclusion in this review. The Newcastle-Ottawa Scale quality assessment tool was used to assess the quality of the included studies and Egger's test was used to assess the publication bias. In order to calculate the pooled prevalence of cervical cancer screening, 2,919 female healthcare professionals participated in the review. Articles were published from 2015 to 2024. The pooled Utilization of cervical cancer screening in Ethiopia, as determined by a meta-analysis of ten articles was 13.59% (95% CI: 7.53, 19.65). The estimated/pooled cervical cancer screening utilization was found to be lower than the World Health Organization recommendations as the estimator revealed in the meta-analysis. The low utilization of Cervical Cancer (CCa)screening practice despite they are healthcare professionals is a significant concern that can impact the broader efforts to combat cervical cancer. Based on the this reviews the authors recommend regular monitoring and evaluation of the CCa screening habits of healthcare professionals and the effectiveness of implemented interventions. It is necessary to explore the factors that enable or hinder CCa screening and address the issue through qualitative or mixed-method studies.

Aim:Screening for early detection and treatment of cervical cancer is a cornerstone of prevention. The purpose of this study was to assess the awareness in women about the utilization of cervical cancer screening services in Vhembe District, South Africa.Methods:This cross-sectional study involved a random selection of 500 women aged 20-59 years in Vhembe District, Limpopo Province, South Africa. Data was collectedviaa self-structured questionnaire on the demographic variables, provision, utilization and awareness of cervical cancer screening services.Results:The majority of the participants agreed to have cervical cancer screening services in their clinics (79.2%), and never had a Pap smear (58.6%). Most women would not go for cervical cancer screening, mainly because of a lack of facilities (30.0%), fear of pain (24.4%), and embarrassment (15.2%). Most participants indicated that Pap smear test meant scraping the cervix to detect abnormal cancerous cells (39.2%) and 34.2% did not know a Pap smear. Majority of the participants indicated Pap smears should be done every 10 years (65.8%); Pap smears could detect cervical cancer earlier (66.8%), and had heard about cervical cancer (71.6%). The majority of the participants considered cervical cancer as a serious problem to warrant considerable attention (59.4%); and some perceived cervical cancer as transmittable through multiple sexual partners (22.2%). The majority of the participants were aware of a vaccine against cervical cancer for girls at school (69.0%), and it was indicated that government should use health education to encourage women to attend cervical screening services (51.6%).Conclusion:Despite the free availability of cervical cancer screening services and awareness, the utilization of cervical cancer screening services is low. There is a need to intensify cervical screening health talks and campaigns, and to provide alternative accessible options for screening services for women in rural areas.

To identify the determinants of cervical cancer (CC) screening among underserved rural women in Zimbabwe. Community-based cross-sectional survey. 840 rural women (25-65 years). A structured, pretested questionnaire was used to collect data on sociodemographic characteristics and factors influencing screening. The outcome was defined as self-reported ever screening for CC. Multivariable logistic regression was used to examine the association between CC screening and independent variables. Of the 840 women included, 33% had a history of screening. Women 25-45 years (adjusted odds ratio (aOR): 0.43; 95% CI: 0.30-0.61) and without medical insurance (aOR: 0.66; 95% CI: 0.45-0.97) had reduced odds of CC screening. Conversely, women who had seen or heard messages on CC screening (aOR: 1.48; 95% CI: 1.03-2.13), were living with HIV (aOR: 1.87; 95% CI: 1.22-2.87) reported recent antibiotic use (aOR: 4.50; 95% CI: 1.47-13.79) and had malaria in the last 6 months (aOR: 2.45; 95% CI: 1.02-5.86) had increased odds of CC screening. There is a need for intensified efforts to improve CC screening uptake, particularly in underserved rural areas with suboptimal screening rates and high CC burden. Strategies should include widespread tailored awareness messaging targeting younger women, women living with HIV, and women without medical insurance.

Despite the high incidence of cervical cancer, the screening coverage is low in developing countries, including Ethiopia. This study aimed to assess the pooled prevalence of cervical cancer screening and its determinants among female health workers in Ethiopia. All published literatures were searched using extensive international databases such as PubMed, Web of Science, Science Direct, Google Scholar, HINARI, Scopus, and Cochrane Library. The pooled prevalence of cervical cancer screening and the effect size of its determinants were illustrated using forest plots, and a DerSimonian-Laird random effect model with 95% Confidence Interval (CI). The pooled prevalence of cervical cancer screening among female health workers in Ethiopia was 17.4% (95% CI: 13.4, 21.3). Being trained in cervical cancer screening (AOR = 1.75, 95% CI: 1.05, 2.44), good knowledge about cervical cancer screening (AOR = 1.31, 95% CI: 1.02, 1.61), having multiple sexual partners (AOR = 2.06, 95% CI: 1.11, 301), and having a history of sexually transmitted infection (STI) (AOR = 2.96, 95% CI: 1.44, 4.47) were the main pooled predictors of cervical cancer screening utilization among female health workers in Ethiopia. Only one in every six female health workers was screened for cervical cancer in Ethiopia. Training in cervical cancer screening, knowledge of cervical cancer screening, multiple sexual partners, and STIs were the main determinants of cervical cancer screening utilization. Improving the health professionals' knowledge on cervical cancer screening through providing training on cervical cancer screening would be needed to increase the level of cervical cancer screening.

Women living with HIV are more prone to develop cervical cancer since they have a compromised immune system; hence, they need to be screened continuously in an attempt to identify and prevent it. Despite Lesotho's high HIV prevalence (25.6%), cervical cancer screening coverage and its determinants among women living with HIV remain insufficiently characterized. This study aimed to quantify the rate and determinants of cervical cancer screening among women living with HIV using the 2023/24 Lesotho DHS data. Cross-sectional analysis was performed using the Lesotho DHS Individual Women's Recode file. A weighted sample of 611 HIV-positive women aged 25years and older participated in the study, as this age group is eligible for cervical cancer screening. Individual and community-level factors were determined using multilevel mixed-effects logistic regression. The level of significance was determined by the 95% confidence interval and a p value less than 0.05 for associations. The total prevalence of cervical cancer screening among women living with HIV was 85.4%. Women aged 40-44years (adjusted odds ratio [AOR] 4.14; 95% confidence interval [CI] 1.53-11.18) and those who had a clinical breast exam (AOR 5.53; 95% CI 2.54-12.05) were more likely to undergo cervical cancer screening, whereas low parity (AOR 0.19; 95% CI 0.05-0.78) and rural residence (AOR 0.50; 95% CI 0.25-0.99) were associated with lower odds of screening. Adoption of cervical cancer screening among women living with HIV in Lesotho is high, with most screened women receiving normal results. Screening uptake varied by demographics, being higher among older women and those who had breast examinations, while lower among women with low parity and rural residents. Integration of breast and cervical cancer screening, rural outreach targeting, and health education for low-parity women can increase coverage and equity.

BackgroundCervical cancer is a major public health problem affecting women worldwide. It is the second cause of mortality among women in Ethiopia. Early Cervical cancer screening has a tremendous impact on reducing morbidity and mortality related to cervical cancer infection. Therefore, this study aimed to assess cervical cancer screening utilization and associated factors among women attending Antenatal Care at Asella referral and teaching hospital, Arsi Zone, south-central Ethiopia.MethodThis study employed a facility-based cross-sectional study among 457 Antenatal Care mothers from December 2020 to February 2021. Data collection was performed using interviewer-administered structured questionnaires. Data were entered into EpiInfo Version 7 and transferred to SPSS V.21 for analysis. A logistic regression model was used to determine the factors associated with cervical cancer screening utilization and an adjusted odds ratio with a 95% confidence interval at p-value < 0.05 was computed to determine the level of statistical significance.ResultThe magnitude of cervical cancer screening utilization was found to be 7.2%(95% CI: 5.2, 10.6). Educational status of secondary and above (AOR = 2.92; 95%CI = 1.078–7.94), getting screened for any reproductive healthcare services(AOR = 4.95; 95%CI = 2.24–10.94), having multiple sexual partners(AOR = 4.55; 95%CI = 1.83–11.35), and satisfactory knowledge of cervical cancer screening(AOR = 3.89; 95%CI = 1.74–8.56) were significantly associated factors with cervical cancer screening utilization.ConclusionUtilization of cervical cancer screening was low among women attending Antenatal care at Asella Referral and Teaching hospital, Southcentral Ethiopia. Educational status, history of multiple sexual partners, getting screened for any reproductive healthcare services, and knowledge of cervical cancer screening were significant factors associated with the utilization of cervical cancer screening. Hence, to improve the utilization of Cervical cancer screening, there should be the implementation of programmed health education and awareness creation on the benefits of screening as well as the promotion of reproductive healthcare services at health facilities.

BackgroundCervical cancer screening is the primary goal in 90-70-90 targets to reduce cervical cancer incidence and mortality by identifying and treating women with precancerous lesions. Although several studies have been conducted in Sub-Saharan African (SSA) countries on cervical cancer screening, their coverage was limited to the regional or national level, and/or did not address individual- and community-level determinants, with existing evidence gaps to the wider SSA region using the most recent data. Hence, this study aimed to assess the pooled prevalence and multilevel correlates of cervical cancer screening among women with SSA.MethodsThis study was conducted using the Demographic Health Survey data (2015–2022) from 11 countries, and a total weighted sample of 124,787 women was considered in the analysis. Using multilevel mixed-effects logistic regression, the influence of each factor on cervical cancer screening uptake was investigated, and significant predictors were reported using the adjusted odds ratio (aOR) with their respective 95% confidence intervals (95% CI).ResultsThe overall weighted prevalence of cervical cancer screening was 10.29 (95% CI: 7.77, 11.26), with the highest and lowest screening rates detected in Namibia and Benin at 39.3% (95% CI: 38.05, 40.54) and 0.5% (95% CI: 0.36, 0.69), respectively. Higher cervical screening uptake was observed among women aged 35–49 [aOR = 4.11; 95% CI: 3.69, 4.58] compared to 15–24 years, attending higher education [aOR = 2.71; 95% CI: 2.35, 3.23] than no formal education, being in the richest wealth quintile [aOR = 1.45; 95% CI: 1.26, 1.67], having a recent visit to a health facility [aOR = 1.83; 95% CI: 1.71, 1.95], using contraception [aOR = 1.54; 95% CI: 1.45, 1.64], recent sexual activity [aOR = 3.59; 95% CI: 2.97, 4.34], and listening to the radio [aOR = 1.78; 95%CI: 1.60, 2.15].ConclusionThe overall prevalence of cervical cancer screening in SSA countries was found to be low; only one in every ten women has been screened. Strengthening universal health coverage, and promoting screening programs with an emphasis on rural areas and low socioeconomic status are key to improving screening rates and equity. Additionally, integrating cervical cancer screening with existing reproductive health programs, e.g. contraceptive service would be important.

BackgroundCervical cancer screening is the method of early detection of cervical cancer before occurrence to decrease mortality and morbidity of the women. When women screened at least once in their lifetime for cervical cancer, their risk of cancer could be decreased by 25–36%. Despite this advantage the coverage of cervical cancer screening remains below 2% across country level. Therefore, this study aimed to assess cervical cancer screening utilization and associated factors among women 30–65 years in north shoa Ethiopia. MethodCommunity-based cross-sectional study was conducted using stratified cluster sampling technique among 855 women in March 2021. Data were collected using pretested and semi-structured interviewer administered questionnaire. Adjusted odds ratio with a 95% confidence interval was used to report the association between predictors and the outcome variable. ResultCervical cancer screening utilization was found to be 21.2% (95% CI = 18.5–23.9).Being HIV positive [AOR = 16.49 (95% CI: 9.20–29.54)], knowing someone who had ever been screened for cervical cancer [AOR = 5.46 (95% CI: 2.53–11.79)], having good knowledge about cervical cancer screening [AOR = 3.8 (95% CI: 2.21–6.56)], women found in fourth quintile wealth index [AOR = 3.31 (95% CI: 1.13–9.70)] and having low perceived barriers for cervical cancer screening [AOR = 2.58 (95% CI: 1.43–4.64] were found to be significantly associated with cervical cancer screening utilization. ConclusionThe study revealed the utilization of cervical cancer screening among women 30–65 years is low. Health education program and other multi-disciplinary approaches should be done to increase cervical cancer screening utilization.

BackgroundDespite the benefits of cervical cancer (CC) screening to reduce the disease burden, uptake remains limited in developing countries. This study aims to assess the individual and community-level determinants of cervical cancer screening among women of reproductive age in Zimbabwe.MethodsWe analyzed data collected from 400 communities from the 2015 Zimbabwe Demographic and Health Survey with a sample size of 9955 women aged 15–49 years. The descriptive statistics and multi-level regression models adjusted for potential covariates were performed to examine the association between individual, household and community-level factors and the uptake of cervical cancer screening in women.ResultsThe mean (SD) age of women in Zimbabwe using cervical cancer screening was 27.9 (9.9) years. A relatively small proportion of women, i.e., only 13.4% had ever screened for cervical cancer, with higher screening rates observed in the following sub-groups: middle aged women 31–49 years (odds ratio (OR) = 2.01; 95% confidence intervals (CI) 1.72–2.34), and currently working (OR = 1.35; 95% CI 1.17–1.55), those with health insurance (OR = 1.95; 95% CI 1.63–2.34), used modern contraceptives (OR = 1.51; 95% CI 1.22–1.86), exposed to multiple media (OR = 1.27; 95% CI 1.03–1.58), those living in communities that had a high predominance of women with favorable attitude towards Intimate Partner Violence (IPV) against women (OR = 1.21; 95% CI 1.04–1.41) and a non-poor wealth index (OR = 1.54; 95% CI 1.14–2.05).ConclusionsOur data shows a significantly low prevalence of cervical cancer screening among reproductive age women in Zimbabwe. To increase the uptake of cervical cancer screening, there is an urgent need both to implement behavioral interventions targeted at women from low socio-economic groups and to advocate for universal health coverage that includes financial risk protection to help all women realize their right to health.

BackgroundDespite a remarkable progress in the reduction of global rate of maternal mortality, cervical cancer has been identified as the leading cause of maternal morbidity and mortality, particularly in sub-Saharan African countries. The uptake of cervical cancer screening service has been consistently shown to be effective in reducing the incidence rate and mortality from cervical cancer. Despite this, there are limited studies in Ethiopia that were conducted to assess the uptake of cervical cancer screening and its predictors, and these studies showed inconsistent and inconclusive findings. Therefore, this systematic review and meta-analysis was conducted to estimate the pooled cervical cancer screening utilization and its predictors among eligible women in Ethiopia.Methods and findingsDatabases like PubMed, Web of Science, SCOPUS, CINAHL, Psychinfo, Google Scholar, Science Direct, and the Cochrane Library were systematically searched. All observational studies reporting cervical cancer screening utilization and/ or its predictors in Ethiopia were included. Two authors independently extracted all necessary data using a standardized data extraction format. Quality assessment criteria for prevalence studies were adapted from the Newcastle Ottawa quality assessment scale. The Cochrane Q test statistics and I2 test were used to assess the heterogeneity of studies. A random effects model of analysis was used to estimate the pooled prevalence of cervical cancer screening utilization and factors associated with it with the 95% confidence intervals (CIs). From 850 potentially relevant articles, twenty-five studies with a total of 18,067 eligible women were included in this study. The pooled national cervical cancer screening utilization was 14.79% (95% CI: 11.75, 17.83). The highest utilization of cervical cancer screening (18.59%) was observed in Southern Nations Nationalities and Peoples’ region (SNNPR), and lowest was in Amhara region (13.62%). The sub-group analysis showed that the pooled cervical cancer screening was highest among HIV positive women (20.71%). This meta-analysis also showed that absence of women’s formal education reduces cervical cancer screening utilization by 67% [POR = 0.33, 95% CI: 0.23, 0.46]. Women who had good knowledge towards cervical screening [POR = 3.01, 95%CI: 2.2.6, 4.00], perceived susceptibility to cervical cancer [POR = 4.9, 95% CI: 3.67, 6.54], severity to cervical cancer [POR = 6.57, 95% CI: 3.99, 10.8] and those with a history of sexually transmitted infections (STIs) [POR = 5.39, 95% CI: 1.41, 20.58] were more likely to utilize cervical cancer screening. Additionally, the major barriers of cervical cancer screening utilization were considering oneself as healthy (48.97%) and lack of information on cervical cancer screening (34.34%).ConclusionsThis meta-analysis found that the percentage of cervical cancer screening among eligible women was much lower than the WHO recommendations. Only one in every seven women utilized cervical cancer screening in Ethiopia. There were significant variations in the cervical cancer screening based on geographical regions and characteristics of women. Educational status, knowledge towards cervical cancer screening, perceived susceptibility and severity to cervical cancer and history of STIs significantly increased the uptake of screening practice. Therefore, women empowerment, improving knowledge towards cervical cancer screening, enhancing perceived susceptibility and severity to cancer and identifying previous history of women are essential strategies to improve cervical cancer screening practice.

Despite a remarkable progress in the reduction of global rate of maternal mortality, cervical cancer has been identified as the leading cause of maternal morbidity and mortality, particularly in sub-Saharan African countries. The uptake of cervical cancer screening service has been consistently shown to be effective in reducing the incidence rate and mortality from cervical cancer. Despite this, there are limited studies in Ethiopia that were conducted to assess the uptake of cervical cancer screening and its predictors, and these studies showed inconsistent and inconclusive findings. Therefore, this systematic review and meta-analysis was conducted to estimate the pooled cervical cancer screening utilization and its predictors among eligible women in Ethiopia. Databases like PubMed, Web of Science, SCOPUS, CINAHL, Psychinfo, Google Scholar, Science Direct, and the Cochrane Library were systematically searched. All observational studies reporting cervical cancer screening utilization and/ or its predictors in Ethiopia were included. Two authors independently extracted all necessary data using a standardized data extraction format. Quality assessment criteria for prevalence studies were adapted from the Newcastle Ottawa quality assessment scale. The Cochrane Q test statistics and I2 test were used to assess the heterogeneity of studies. A random effects model of analysis was used to estimate the pooled prevalence of cervical cancer screening utilization and factors associated with it with the 95% confidence intervals (CIs). From 850 potentially relevant articles, twenty-five studies with a total of 18,067 eligible women were included in this study. The pooled national cervical cancer screening utilization was 14.79% (95% CI: 11.75, 17.83). The highest utilization of cervical cancer screening (18.59%) was observed in Southern Nations Nationalities and Peoples' region (SNNPR), and lowest was in Amhara region (13.62%). The sub-group analysis showed that the pooled cervical cancer screening was highest among HIV positive women (20.71%). This meta-analysis also showed that absence of women's formal education reduces cervical cancer screening utilization by 67% [POR = 0.33, 95% CI: 0.23, 0.46]. Women who had good knowledge towards cervical screening [POR = 3.01, 95%CI: 2.2.6, 4.00], perceived susceptibility to cervical cancer [POR = 4.9, 95% CI: 3.67, 6.54], severity to cervical cancer [POR = 6.57, 95% CI: 3.99, 10.8] and those with a history of sexually transmitted infections (STIs) [POR = 5.39, 95% CI: 1.41, 20.58] were more likely to utilize cervical cancer screening. Additionally, the major barriers of cervical cancer screening utilization were considering oneself as healthy (48.97%) and lack of information on cervical cancer screening (34.34%). This meta-analysis found that the percentage of cervical cancer screening among eligible women was much lower than the WHO recommendations. Only one in every seven women utilized cervical cancer screening in Ethiopia. There were significant variations in the cervical cancer screening based on geographical regions and characteristics of women. Educational status, knowledge towards cervical cancer screening, perceived susceptibility and severity to cervical cancer and history of STIs significantly increased the uptake of screening practice. Therefore, women empowerment, improving knowledge towards cervical cancer screening, enhancing perceived susceptibility and severity to cancer and identifying previous history of women are essential strategies to improve cervical cancer screening practice.

Background:Cervical cancer is the second most common cancer among women in the Philippines. Cervical cancer screening is an effective method to reduce incidence. However, screening utilization is limited. This study aims to assess human papillomavirus (HPV) and cervical cancer knowledge, perceptions, and screening utilization, and to investigate factors influencing screening utilization among rural women in the Philippines. Methods:This cross-sectional community-based study was conducted among 338 rural women aged 20–50 years, with a child under 5 years old registered in one of four public rural health centers in Tacao Island, Masbate Province in October 2017. A questionnaire administered via face-to-face interviews elicited information about demographic characteristics, knowledge, perceived susceptibility and perceived severity of HPV and cervical cancer, and cervical cancer screening utilization. Results:Mean age of participants was 32.5 years. Only 13.9% of participants had ever had cervical cancer screening. Although most women had heard of cervical cancer screening, their knowledge about the cause, risk factors, and preventive measures of HPV and cervical cancer was limited. Older age and higher education status were significantly associated with screening utilization. However, knowledge and perceived susceptibility and severity showed no association. The main reason for having screening was due to a health professional’s request or recommendation, and the reasons for not having screening were cost, not having symptoms, and fear of pain or discomfort and/or embarrassment during the procedure. Conclusions:Health education must increase knowledge about HPV and cervical cancer and screening among women, including the nature and progression of cervical cancer, benefits of screening, screening cost, and screening procedure. Health care providers have an important role in educating and motivating women to undergo screening.

Cervical cancer continues to be a global public health concern and a leading cause of cancer deaths among Nepalese women. In spite of the availability of screening and treatment services in Nepal, the utilization of screening has been low. This study investigated knowledge, attitude, preventive practices and utilization of cervical cancer screening among women in a semi-urban area of Pokhara Metropolitan City of Nepal. A community-based cross-sectional survey was carried out among 729 women 30-60 years of age, between April and June 2019. Participants were selected by systematic random sampling, and a door-to-door home visit was conducted for data collection. A pretested interviewer-administered Nepali questionnaire was used to collect information on sociodemographic variables, knowledge, attitude and preventive practices regarding cervical cancer screening. The mean age of the participants was 45.9 years (SD ±7.7); the majority were married (86.7%). Among the participants, 44.9% were ever screened for cervical cancer. However, only 10.4% of participants received timely repeated screening for cervical cancer. The median knowledge score achieved by participants was 2.0 [interquartile range (IQR) 1-4] on a scale of maximum score 36, the median attitude score was 31.0 (IQR 29-32) on a scale of 40 and the median preventive practice score was 3.0 (IQR 3-4) on a scale of five. This study showed low knowledge and low utilization of cervical cancer screening among women in Nepal. We recommend a community-based educational intervention to educate and empower women to increase knowledge and utilization of cervical cancer screening.

In Nepal, cervical cancer is the most common cancer among women despite the existing policies. This study intends to assess the implementation of cervical cancer prevention and screening through service utilization by women, knowledge and attitude among health professionals, and the perceptions of stakeholders in Nepal. This mixed-methods study was conducted in 2022 across five tertiary hospitals in Kathmandu, Nepal. The quantitative study comprised the health professionals and women attending gynecology outpatient clinics from the selected hospitals. The qualitative study comprised stakeholders including service providers and experts on cervical cancer from selected hospitals, civil societies, and the Ministry of Health and Population. The utilization of screening through pap smear among 657 women across five hospitals was 22.2% and HPV vaccination was 1.5%. The utilization of cervical cancer screening was associated with older age [adjusted odds ratio (AOR) = 1.09, CI: 1.07, 8.19], married (AOR = 3.024, CI: 1.12, 8.19), higher education (AOR = 3.024, CI:1.12, 8.42), oral contraceptives use (AOR = 2.49, CI: 1.36, 4.39), and ever heard of cervical cancer screening (AOR = 13.28, CI: 6.85, 25.73). Among 254 health professionals, the knowledge score was positively associated with them ever having a training [Standardized Beta (β) = 0.20, CI: 0.44, 2.43)] and having outreach activities in their hospital (β = 0.19 CI: 0.89, 9.53) regarding cervical cancer screening. The female as compared to male health professionals (β = 0.16, CI: 0.41, 8.16, P = 0.03) and having a cervical cancer screening guideline as compared to none (β = 0.19 CI: 0.89, 9.53, P = 0.026) were more likely to have a better attitude for screening. The qualitative findings among 23 stakeholders reflected implementation challenges in policy, supply, service delivery, providers, and community. This study showed low utilization of prevention and services by women and implementation gaps on cervical cancer prevention and screening services across five tertiary hospitals in Kathmandu, Nepal. The findings could help designing more focused interventions.