Abstract
BackgroundCervical cancer is the most prevalent gynaecologic cancer in Nigeria. Despite being largely preventable through screening, cervical cancer is the second leading cause of cancer morbidity and mortality in Nigeria. To reduce the burden of cervical cancer in Nigeria, female health workers (FHWs) are expected to play an influential role in leading screening uptake and promoting access to cervical cancer education and screening.AimThe aim of this systematic review is to assess the factors influencing cervical cancer screening (CCS) practice among FHWs in Nigeria.MethodsWe conducted a systematic literature search across six (6) electronic databases namely MEDLINE, Embase, Scopus, African Index Medicus, CINAHL, and Web of Science between May 2020 and October 2020. Reference list and grey literature search were conducted to complement database search. Four reviewers screened 3171 citations against the inclusion criteria and critically appraised the quality of eligible studies. Narrative synthesis was used in summarising data from included studies.ResultsOverall, 15 studies met the inclusion criteria and were all quantitative cross‐sectional studies. Included studies sampled a total of 3392 FHWs in Nigeria. FHWs had a high level of knowledge and positive attitude towards CCS. However, CCS uptake was poor. Predominant barriers to CCS uptake were the cost of screening, fear of positive results, lack of test awareness, reluctance to screen, low‐risk perception, and lack of time. In contrast, being married, increasing age, awareness of screening methods, and physician recommendation were the most documented facilitators.ConclusionThis study revealed that a complex interplay of socioeconomic, structural, and individual factors influences CCS among FHWs in Nigeria. Therefore, implementing holistic interventions targeting both health system factors such as cost of screening and infrastructure and individual factors such as low‐risk perception and fear of positive result affecting FHWs in Nigeria is critical to reducing the burden of cervical cancer.
Highlights
Cervical cancer represents a significant threat to reducing global health inequalities and achieving sustainable development goals
An estimated 570 000 cervical cancer cases and 311 000 deaths from the disease occurred in 2018.2 It is frightening to note that over 85% of cervical cancer incidence and mortality occur in low and middle-income countries (LMICs) including Nigeria where organised population cervical cancer screening (CCS) programmes are inadequate and treatment options limited.[3,4]
By identifying and synthesising results from available primary studies, this review provides robust evidence that can inform policy and programme initiatives directed at factors influencing CCS among female health workers (FHWs) in Nigeria
Summary
Cervical cancer represents a significant threat to reducing global health inequalities and achieving sustainable development goals This disease is the commonest gynaecological cancer affecting women especially in low and middle-income countries (LMICs).[1] Despite being largely preventable, an estimated 570 000 cervical cancer cases and 311 000 deaths from the disease occurred in 2018.2 It is frightening to note that over 85% of cervical cancer incidence and mortality occur in LMICs including Nigeria where organised population cervical cancer screening (CCS) programmes are inadequate and treatment options limited.[3,4] In contrast, high-income countries have witnessed almost 70% decrease in cervical cancer burden over the last 50 years upon the introduction of organised CCS programmes.[5] Such disparities between countries demonstrate stark inequalities in healthcare resources and enduring socioeconomic barriers especially in LMICs.[6,7].
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