Acta Scientific Women's Health (ASWH)(ISSN: 2582-3205)

Research Article Volume 2 Issue 11

Knowledge, Attitude, and Practice of Cervical Cancer Screening and Associated Factors Among Reproductive Aged Women in Ethiopia: A Meta-Analysis and Systematic Review

Yoseph Merkeb Alamneh1*, Alehegn Aderaw Alamneh2 and Abtie Abebaw Shiferaw3

1Department of Biomedical Sciences, School of Medicine, Debre Markos University, Debre, Markos, Ethiopia
2Department of Human Nutrition and Food Sciences, College of Health Sciences, Debre, Markos, University, Ethiopia
3Department of Medical Laboratory, College of Health Science, Debre Markos University, Debre, Markos, Ethiopia

*Corresponding Author: Yoseph Merkeb Alamneh, Department of Biomedical Sciences, School of Medicine, Debre Markos University, Debre, Markos, Ethiopia.

Received: June 03, 2020; Published: October 07, 2020



Background: Cervical cancer is the leading cause of cancer deaths, accounting for 9% of female cancer deaths. In addition, more than 85% of cervical cancer related deaths are found in low and middle-income countries. Women’s knowledge and attitude are barriers for the uptake of cervical cancer screening service in Ethiopia. Studies conducted on knowledge, attitude, and practice of cervical cancer screening and associated factors among reproductive age women are inconsistent. Therefore, this systematic review and meta-analysis aimed to estimate the national level of knowledge, attitude, and practice of cervical cancer screening and associated factors among women aged 15 - 49 years in Ethiopia.

Methods: An international database such as PubMed, EMBASE, Scopus, Google Scholar, Science Direct Cochrane library, and Grey literature databases were searched an extensively. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 guideline were pursued for this review. The quality of each study was assessed using Newcastle-Ottawa quality assessment tool. Stata version 14 was used to analyze the data. We have used a random effects model to estimate the pooled prevalence and odds ratio with 95% CI. The possible heterogeneity between studies was assessed using I-squared (I2) test statistic. Egger’s test was used to assess the publication bias.

Result: Eighteen studies with a total of 9,897 women were included in this meta-analysis. The pooled national level of knowledge, attitude and practice towards cervical cancer screening among 15 - 49 years old aged women in Ethiopia was 40.37% (95% CI: 30.09, 50.66), 58.87% (95% CI: 42.69, 75.05) and 14.02% (95% CI: 9.67, 18.37) respectively. Being uneducated (OR: 3.10, 95% CI: 2.09, 4.62), Women who had good knowledge (OR: 5.87, 95% CI: 2.57, 13.40), Women who had positive attitude (OR: 4.20, 95% CI: 2.86, 6.16) and not being married (OR: 3.34, 95% CI: 1.09, 10.22) were the major factors of cervical cancer screening practice.

Conclusions and Recommendation: This review showed that the level of knowledge, attitude, and practice of cervical cancer screening among reproductive-age women in Ethiopia was relatively lower. Educational status, knowledge, attitude and marital status were statistically significant factors for cervical cancer screening practice. Hence, the health care provider needs to scale up health education and awareness creation about cervical cancer screening and early detection and prevention of cervical cancer.

Keywords: Knowledge; Attitude; Cervical Cancer Screening Practice; Ethiopia



  1. Ferlay J. “Cancer incidence, mortality and prevalence worldwide”. GLOBOCAN2002 (2004).
  2. Getahun F., et al. “Comprehensive knowledge about cervical cancer is low among women in Northwest Ethiopia”. BMC Cancer1 (2013): 2.
  3. Eke N., et al. “Knowledge of Cervical Cancer and its Screening Amongst Female Workers In Nnewi, Nigeria”. Afrimedic Journal1 (2010): 31-36.
  4. Bruni L., et al. “ICO information centre on HPV and cancer (HPV Information Centre)”. Human papillomavirus and related diseases in the world Summary Report 4.8 (2015).
  5. Parkhurst JO and Vulimiri M. “Cervical cancer and the global health agenda: insights from multiple policy-analysis frameworks”. Global Public Health10 (2013): 1093-1108.
  6. Organization WH. Annual technical report: 2013: department of reproductive health and research, including UNDP/UNFPA/WHO/World Bank Special Programme of Research Training in Human Reproduction (HRP). In: World Health Organization (2014).
  7. Smith RA., et al. “Cancer screening in the United States, 2011: A review of current American Cancer Society guidelines and issues in cancer screening”. CA: A Cancer Journal for Clinicians 1 (2011): 8-30.
  8. Emanuel GO., et al. “Awareness and Practice of Cervical Cancer Screening among Women Accessing Care in a Rural Tertiary Hospital in Nigeria”. Clinical Medicine and Research 4 (2015): 120.
  9. Goodwin TM., et al. “Current diagnosis and treatment obstetrics and gynecology”. In: McGraw-Hill Medical (2012).
  10. Lataifeh I., et al. “A survey of the knowledge and attitude of Jordanian obstetricians and gynaecologists to cervical cancer screening”. Journal of Obstetrics and Gynaecology8 (2009): 757-760.
  11. Loutfi A and Pickering J. “The distribution of cancer specimens from two pathology centres in Ethiopia”. Ethiopian Medical Journal1 (1992): 13-17.
  12. Kress CM., et al. “Knowledge, attitudes, and practices regarding cervical cancer and screening among Ethiopian health care workers”. International Journal of Women's Health 7 (2015): 765.
  13. Gakidou E., et al. “Coverage of cervical cancer screening in 57 countries: low average levels and large inequalities”. PLoS Medicine6 (2008): e132.
  14. Waktola EA., et al. “HPV and burden of cervical cancer in east Africa”. Gynecologic Oncology3 (2005): S201-S202.
  15. Bayu H., et al. “Cervical cancer screening service uptake and associated factors among age eligible women in Mekelle Zone, Northern Ethiopia, 2015: a community based study using health belief model”. PloS One3 (2016): e0149908. 353.
  16. ETHIOPIA Location and Size: Geography – OSU.
  17. Liberati A., et al. “The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration”. PLoS Medicine7 (2009): e1000100.
  18. Moher D., et al. “The inclusion of reports of randomised trials published in languages other than English in systematic reviews”. Health Technology Assessment41 (2003): 1-90.
  19. Munn Z., et al. “The development of a critical appraisal tool for use in systematic reviews addressing questions of prevalence”. International Journal of Health Policy and Management3 (2014): 123.
  20. Modesti PA., et al. “Panethnic differences in blood pressure in Europe: a systematic review and meta-analysis”. PloS One1 (2016): e0147601.
  21. Rücker G., et al. “Undue reliance on I 2 in assessing heterogeneity may mislead’. BMC Medical Research Methodology1 (2008): 79.
  22. Nyaga VN., et al. “Metaprop: a Stata command to perform meta-analysis of binomial data”. Archives of Public Health 1 (2014): 39.
  23. Borenstein M., et al. “A basic introduction to fixed‐effect and random‐effects models for meta‐analysis”. Research Synthesis Methods2 (2010): 97-111.
  24. Moher D., et al. “Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement”. Systematic Reviews1 (2015): 1.
  25. Begg CB and Mazumdar M. “Operating characteristics of a rank correlation test for publication bias”. Biometrics (1994): 1088-1101.
  26. Egger M., et al. “Bias in meta-analysis detected by a simple, graphical test”. BMJ 315 (1997): 629-634.
  27. Mingo AM., et al. “Cervical cancer awareness and screening in Botswana”. International Journal of Gynecologic Cancer4 (2012): 638-644.
  28. Ali-Risasi C., et al. “Knowledge, attitude and practice about cancer of the uterine cervix among women living in Kinshasa, the Democratic Republic of Congo”. BMC Women's Health1 (2014): 30.
  29. Hong Y., et al. “HPV and cervical cancer related knowledge, awareness and testing behaviors in a community sample of female sex workers in China”. BMC Public Health1 (2013): 696.
  30. Hoque ME. “Cervical cancer awareness and preventive behaviour among female university students in South Africa”. Asian Pacific Journal of Cancer Prevention 1 (2010): 127-130.
  31. Gichangi P., et al. “Knowledge and practice about cervical cancer and Pap smear testing among patients at Kenyatta National 393 Hospital, Nairobi, Kenya”. International Journal of Gynecologic Cancer6 (2003): 827-833.
  32. John J. “The knowledge, attitude, practice and perceived barriers towards screening for premalignant cervical lesions among women aged 18years and above, in Songea urban, Ruvuma”. Muhimbili University of Health and Allied Sciences (2011).
  33. Al-Naggar RA., et al. “Knowledge and barriers towards cervical cancer screening among young women in Malaysia”. Asian Pacific Journal of Cancer Prevention 4 (2010): 867-873.
  34. Lyimo FS and Beran TN. “Demographic, knowledge, attitudinal, and accessibility factors associated with uptake of cervical cancer screening among women in a rural district of Tanzania: three public policy implications”. BMC Public Health1 (2012): 22.
  35. Al Meer F., et al. “Knowledge, attitude and practices regarding cervical cancer and screening among women visiting primary health care in Qatar”. (2011).
  36. Anantharaman V., et al. “A cross-sectional study on knowledge, attitude, and practice on cervical cancer and screening among female health care providers of Chennai corporation, 2013”. Journal of Academy of Medical Sciences 4 (2012): 124.
  37. Obiechina N and Mbamara S. “Knowledge attitude and practice of cervical cancer screening among sexually active women in Onitsha, southeast Nigeria”. Nigerian Journal of Medicine: Journal of the National Association of Resident Doctors of Nigeria4 (2009): 384-387.
  38. Bansal AB., et al. “Knowledge, attitude, and practices related to cervical cancer among adult women: A hospital-based cross-sectional study”. Journal of Natural Science, Biology, and Medicine2 (2015): 324.
  39. Sichanh C., et al. “Knowledge, awareness and attitudes about cervical cancer among women attending or not an HIV treatment center in Lao PDR”. BMC Cancer1 (2014): 161.
  40. Nganwai P., et al. “Knowledge, attitudes and practices vis-a-vis cervical cancer among registered nurses at the Faculty of Medicine, Khon Kaen University, Thailand”. Asian Pacific Journal of Cancer Prevention 1 (2008): 15-18.
  41. HADI N and Azimirad A. Knowledge attitude and practice of women in Shiraz about cervical cancer and Pap smear 2009. (2010).
  42. Al Sairafi M and Mohamed FA. “Knowledge, attitudes, and practice related to cervical cancer screening among Kuwaiti women”. Medical Principles and Practice1 (2009): 35-42.
  43. Hoque E and Hoque M. “Knowledge of and attitude towards cervical cancer among female university students in South Africa”. Southern African Journal of Epidemiology and Infection1 (2009): 21-24.
  44. Tsegaye S., et al. “Knowledge and attitude towards cervical cancer screening and associated factors among female Hawassa university college of medicine and health sciences students”. MOJ Public Health3 (2018): 151-158.
  45. Varadheswari T., et al. “A study on the prevalence and KAP regarding cervical cancer among women attending a tertiary care hospital in Perambalur”. International Journal of Preventive Medicine Research3 (2015): 71-78.


Citation: Yoseph Merkeb Alamneh., et al. “Knowledge, Attitude, and Practice of Cervical Cancer Screening and Associated Factors Among Reproductive Aged Women in Ethiopia: A Meta-Analysis and Systematic Review". Acta Scientific Women's Health 2.11 (2020): 06-15.


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