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Table 2 Studies reporting barriers to Cervical cancer screening in low- and middle-income countries

From: Barriers to uptake of cervical cancer screening services in low-and-middle-income countries: a systematic review

Author, Country, Year

Study design

Population

Sample size

Age (years)

Screening method

Barriers

Quality rating

Africa

 Getahun T et al. Ethiopia, 2020 [13]

Mixed methods

Cross-sectional and IDIs

Rural and urban women, Cervical cancer screening service providers

821, 10 in-depth interviews

median age 39 years (range 30–49)

Not specified

Individual, Social, Health system

High

 Megersa BS et al. Ethiopia, 2020 [14]

Qualitative

IDIs and FGDs

Women who had participated in HPV self-sampling, sample collectors, community health care workers

47 (25 -FGDs, 22-in

IDIs).

mean age 36 years

HPV self-sampling

Individual, Social, Cultural/ traditional/ religious

High

 Ampofo AG et al. Ghana, 2020 [15]

Quantitative

Cross-sectional survey

Women of reproductive age

200

15–50

VIA, pap smear

Individual, Social, Cultural/traditional/religious, Health system

High

 Calys-Tagoe BNL et al. Ghana, 2020 [9]

Quantitative

Secondary data analysis

Women

2711

Mainly ≥50 years

Pap smear

Individual, Cultural/traditional/religious, Structural

Medium

 Stewart K et al. Nigeria, 2020 [10]

Quantitative

Secondary data analysis

Women who had received cervical screening

621

Not specified

VIA/VILI, and pap smear

Structural

High

 Harries J et al. South Africa, 2020 [16]

Qualitative

semi-structured interviews

Women with potential breast or Cervical cancer symptoms in urban and rural areas

18

mean age 34.5 years (range 22–58)

Not specified

Individual, Social, Health system, Structural

High

 Nyamambi E et al. Zimbabwe, 2020 [17]

Quantitative

Cross-sectional

Sexually active women

156

15–50

VIA

Individual, Cultural/traditional/ religious, Health system, Structural

High

 Getachew et al. Ethiopia, 2019 [18]

Mixed methods

Cross sectional

and FGDs

Women of reproductive age attending primary health centres

520

mean age 27.7 years (range 20–49)

Not specified

Individual, Health system, Structural

High

 Nigussie T et al. Ethiopia, 2019 [19]

Quantitative

Cross sectional

Women from a rural community

737

mean age 36.6 years (range 30–49)

VIA

Individual, Health system

High

 Solomon K et al. Ethiopia, 2019 [20]

Quantitative

Cross sectional

HIV positive women attending ARV clinics

475

18 + years

VIA

Individual, Cultural/traditional/ religious

Medium

 Williams MS et al. Ghana, 2019 [21]

Quantitative

Cross-sectional

Women

288

mean age 32.4 years (range 19–64)

Pap smear

Individual, Cultural/traditional/ religious

High

 Adewumi K et al. Kenya, 2019 [22]

Quantitative

Cross-sectional

Women, community health volunteers

604

not specified

self-collected vaginal swabs for HPV

Social, Cultural/ traditional/religious, Structural

High

 Oketch SY et al. Kenya, 2019 [23]

Qualitative

IDIs

Women in Cervical cancer screening campaign

120

mean age 36.1 years

HPV self-sampling

Individual, Social, Structural

High

 Lieber M et al. South Africa, 2019 [24]

Mixed method

IDIs, FGDs observations, chart reviews

Women patients and healthcare providers

12 patients, 3 healthcare providers

Not specified

VIA

Individual, Health system

Medium

 Shiferaw S et al. Ethiopia, 2018 [25]

Mixed method, Cross-sectional and qualitative IDIs

HIV-positive women attending heath facilities

581

mean age 35 years (range 21–65)

Not specified

Individual, Cultural/traditional/ religious, Health system, Structural

High

 Kangmennaang J et al. Kenya, 2018 [26]

Quantitative

Cross-sectional survey, secondary analysis of survey data

Women of reproductive age

14,741

mean age 30 years (range 15–49)

Not specified

Individual, Social, Cultural/ traditional/religious, Structural

High

 Ng’ang’a A et al. Kenya, 2018 [27]

Quantitative

Nested case-control study in a cross-sectional survey

Women

1180

30–49

Not specified

Individual, Structural

High

 Maree JE & Kampinda-Banda M. Malawi, 2020 [28]

Quantitative

Cross-sectional

Women, convenient sample in rural district

282

mean age 36.1 years (range 30–45)

VIA

Individual, Health system

High

 Keneema M et al. Uganda, 2018 [29]

Quantitative

Cross-sectional

Women attending antenatal clinic

100

25–49

not specified

Individual, Cultural/traditional/ religious, Health system, Structural

Medium

 Vhuromu EN et al. South Africa, 2018 [30]

Quantitative

Cross-sectional

Women attending health clinics

500

20–59

pap-smear

Individual, Cultural/ traditional/religious, Health system

Medium

 Kokuro Ml. Ghana, 2017

Thesis [31]

Quantitative

Cross-sectional

Women attending reproductive health services

369

18 years+

Not specified

Individual, Social, Cultural/traditional/religious, Structural

High

 Bishwajit G & Kpoghomou M, Kenya, 2017 [32]

Quantitative

Cross-sectional secondary data analysis

Women

11,138

mean age 29.6 years

range (15–49)

Not specified

Structural

High

 Lunsford NB et al. Kenya, 2017 [33]

Qualitative

FGDs

Women, married men with partners 25–49

100

(10 focus groups)

Women 25–49, men ≥18

Pap versus VIA/VILI

Individual, Social, Cultural/Traditional/religious, Health systems, Structural

High

 Tiruneh FN et al. Kenya, 2017 [34]

Quantitative

Cross-sectional

Married women

6498

15–49

Pap- smear, urine sampling

Social, Structural

High

 Filade TE et al. Nigeria, 2017 [35]

Qualitative

FGDs and IDIs

Pregnant women in antenatal care,

Healthcare workers

82 pregnant women, 13 Healthcare workers

pregnant women, mean age 28.9 years

HPV DNA based tests

Individual, Cultural/traditional/religious, Health system, Structural

High

 Momberg M. et al. South Africa, 2017 [36]

Qualitative

FGDs

Women, first time colposcopy clinic attendees

27

mean age 34 years (range 18–49)

pap smear & colposcopy

Individual, Social

High

 Malambo N. & Erikson S. Swaziland, 2018 [37]

Qualitative

Women, healthcare workers

20 women, 7 healthcare workers

19–49

Not specified

Individual, Health system

Medium

 Mitchell SM et al. Uganda, 2017 [38]

Quantitative

Cross-sectional

HIV+ women attending a routine care

87

30–69

Not specified

Individual, Health system

High

 Koneru A et al. Tanzania, 2017 [39]

Quantitative

Cross-sectional

HIV+ women

399

19 years+

VIA and colposcopy

Individual, Health system

High

 Modibbo IF et al. Nigeria, 2016 [40]

Qualitative

FGDs

Muslim and Christian women purposively sampled

49

18 years+

mean age 33 years

Not specified

Individual, Social, Cultural/traditional/ religious, Health systems

High

 Hweissa NAb et al. Libya, 2016 [41]

Qualitative

IDIs

Healthcare workers from public and private sectors

16

Not specified

Pap smear

Individual, Cultural/traditional/religious, Health system, Structural

High

 Adepoju EG et al. Nigeria, 2016 [42]

Quantitative

Cross-sectional

Women

287

age 51.6 years (SD 14.3)

Pap smear, colposcopy

Individual

Low

 Ndejjo R et al. Uganda, 2016 [43]

Quantitative

Cross sectional

Women from predominantly rural districts

900

25–49

Not specified

Individual, Social, Health systems, Structural

High

 Hasahya OT et al. Uganda, 2016 [44]

Qualitative

FGDs

Women of whose daughters had received HPV vaccination.

36

25–49

Not specified

Individual, Social, Health system, Structural

High

 Ghidei et al. Ethiopia and Tanzania, 2015 Research report [45]

Descriptive

Cross sectional

Women

23

19–45

VIA

Individual, Cultural/traditional/ religious

Low

 Compaore SC. et al. Burkina Faso, 2015 [46]

Quantitative

Cross-sectional

Women

351

Not specified

VIA, VILI

Individual, Structural

Medium

 Munthali CM. et al. Malawi, 2015 [47]

Qualitative interviews

Healthcare workers, cervical screening service providers, District coordinators

53

Not specified

VIA

Individual, Cultural/traditional/religious, Health system, Structural

High

 Learmonth D. et al. South Africa, 2015 [48]

Qualitative

FGDs

Women of low socioeconomic status

15

25–51

Not specified

Individual, Social, Cultural/traditional/ religious, Health system, Structural

High

 Ebu NI et al. Ghana, 2014 [49]

Quantitative

Cross-sectional

Women

392

10–74

Pap smear

Individual, Social, Cultural/traditional/ religious, Health system, Structural

High

 Omondi Aduda DS & Mkhize N. Kenya, 2014 [50]

Qualitative

FGDs

Women screened for syphilis and Cervical cancer

Not specified

not specified

Not specified

Individual, Health system, Structural

High

 Kibicho et al. Kenya, 2014

Thesis [51]

Quantitative

Cross -sectional

Women of reproductive age in a gynaecology ward

138

mean age 31.6 years (Range 18–49)

Pap smear, coloscopy, VIA/VILI test

Individual, Cultural/traditional/religious, Health system, Structural

High

 Abdulkadir IR. Ethiopia, 2013 Thesis [52]

Quantitative

cross-sectional

Female university students

392

Mean age 23.3 years (range 18–52

Pap smear

Individual, Cultural/traditional/religious, Health system, Structural

High

 Atuhaire L. Uganda, 2013

Thesis [53]

Qualitative

Exploratory and descriptive

Women accessing maternal and child health services

25

18–64

all screening

Individual, Health system

High

 Mwaka AD et al. Uganda, 2013 [54]

Qualitative

Healthcare workers

15

Not specified

Not specified

Individual, Cultural/traditional/religious, Health system, Structural

High

 Paul et al. Peru, Uganda, Vietnam, 2013 [55]

Qualitative

Women, Healthcare workers, village health team

109

not specified

VIA

Individual, Social, Health system, Structural

High

 Ngugi et al. Kenya, 2012 [56]

Qualitative

IDIs

Women

50

Not specified

Not specified

Individual, Social, Cultural/traditional/religious, Health system, Structural

High

 Hyacinth et al. Nigeria, 2012 [57]

Quantitative

Cross sectional

Women in their workplace

388

18–65

Pap smear

Individual, Health system

High

 Mupepi SC et al. Zimbabwe, 2011 [58]

Quantitative

cross-sectional

Sexually active women

 

12–84

Pap smear

Individual, Social, Cultural/traditional/religious, Health system, Structural

High

Asia

 Andersen JG et al. Nepal, 2020 [59]

Qualitative

FGDs and IDIs

Women, female community health volunteers

48

30–60

Not specified

Individual, Social, Cultural/traditional, Health system, Structural

High

 Spagnoletti BRM et al. Indonesia, 2019 [60]

Qualitative

FGDs and semi-structured interviews

Married women and men

56 women, 30 men

women 22–57, men 35–45

VIA and pap smear

Individual, Social, Health system, Structural

High

 Gu et al. China, 2018 [61]

Qualitative

Semi-structured interviews

Women at risk for cervical cancer in a prior study

27

25–50

pap smear test

Individual, Health system, Structural

High

 Ashtarian H et al. Iran, 2017 [62]

Quantitative Cross-sectional

Women attending health centres

355

mean age 34.08 years

pap-smear

Individual, Health system

High

 Osth J. Sri Lanka, 2015 Thesis [63]

Quantitative

Cross-sectional

Male and female undergraduate students

326

18–30

Pap smear, cytological screening

Individual

High

 Jia Y. et al. China, 2013 [64]

Quantitative Cross-sectional

Women

5929

25–65

Pap smear, VIA, colposcopy

Individual, Cultural/traditional/religious

High

 Baskaran P. et al. Malaysia, 2013 [65]

Quantitative Cross-sectional

Women attending outpatient care

369

mean age 37.5 years (range 21–65)

Pap smear

Individual, Cultural/traditional/religious, Health system

High

 Gan et al. Malaysia, 2013 [66]

Quantitative

Cross-sectional

women from 1000 households

959

mean age 45.2 years (range 20–64)

Pap smear

Individual, Social

High

 Demirtas B & Acikgoz I. Turkey, 2013 [67]

Quantitative

Cross-sectional

women registering at a gynaecology outpatient clinic

256

21–62

Pap Smear

Individual

High

 Guvenc et al. Turkey, 2013 [68]

Quasi-experimental

Women

294

21+

Pap smear

Individual

 

 Reis et al. Turkey, 2012 [69]

Qualitative

Women at gynaecology and obstetrics outpatient clinics

387

Not specified

Pap Smear

Individual

Medium

 Gu et al. China, 2012 [70]

Quantitative Cross-sectional

Women

167

25–50

Not specified

Individual

High

 Abdullah et al. Malaysia, 2011 [71]

Quantitative Cross-sectional

Female secondary school teachers

403

not specified

Pap smear

Individual, Health system

Medium

 Gu et al. China, 2010 [72]

Quantitative Cross-sectional

Women

184

25–50

Not specified

Individual, Health system

Medium

 Abdullah & Su, Malaysia, 2010 [73]

Qualitative Semi-structured interviews

Policy makers, healthcare workers

11

37–57

Pap smear

Individual, Health system

 

 Al-Naggar RA, Isa ZM. Malaysia, 2010 [74]

Quantitative Cross-sectional survey

female Malaysian university students

287

18 years+

Pap smear

Individual, Cultural/traditional/religious, Health system

Medium

 Park SJ, & Park Wl. Korea, 2010 [11]

Quantitative

Secondary analysis

Women aged 21+, no hysterectomy, eligible for Pap smears

2590

21 years+

Pap smear

Individual, Structural

High

North America

 Gottschlich A et al. Guatemala, 2020 [12]

Quantitative Secondary data analysis

screened and unscreened women

15,317

25–49

Pap smear

Individual, Social, Structural

High

 Bien-Aimé et al. Haiti, 2020 Thesis [75]

Quantitative

Cross sectional

women in five urban areas

200

25 years+

Pap smear, Colposcopy, VIA, HPV test

Individual, Social

Medium

 Lyons KD et al. Honduras, 2020 [76]

Quantitative

Cross sectional

Rural women

874

Not specified

HPV PCR and pap smear

Individual, Structural

Medium

 Chary AN & Rohloff PJ. Guatemala, 2014 [77]

Qualitative Semi-structured interviews

NGO service provider staff

36

Not specified

VIA

Health system

 

South America

 Barret BW et al. Peru, 2020 [78]

Quantitative

Cross sectional

Rural women

619

18–65

HPV testing, VIA or pap smear

Structural

Medium

 Collins JH et al. Peru 2019 [79]

Quantitative

Cross sectional

Rural women

121 women

mean age 42 years (range 21–76)

not specified

Individual, Structural

High

 Nugus P et al. Ecuador, 2018 [80]

Qualitative

FGDs and semi structured interviews

Women who had participated in a community-based Cervical cancer screening program

28

24–69

Pap smear

Individual, Social, Cultural/traditional/religious, Health system, Structural

High

 Albuquerque et al. Brazil, 2014 [81]

Quantitative

Cross sectional

Rural and urban women

493

Mean age 35.4 years (range15–69)

Pap smear

Individual, Health system, Structural

High

 Stormo et al. Bolivia, 2012 [82]

Qualitative

Descriptive survey

Healthcare workers

42

Not specified

VIA, cryotherapy

Individual, Social, Cultural/traditional/religious, Health system

Medium

 Paz-Soldán VA, et al. Peru,2012 [83]

Qualitative semi-structured interviews

Policy makers and healthcare workers

30

Not specified

Not specified

Health system, Structural

High

 Paolino M & Arrossi Sl. Argentina, 2011 [84]

Quantitative

Women attending hospital

200

18+

Pap smear

Individual, Health system, Structural

High

Oceania

 Townsend JS et al. US Affiliated Pacific Island Jurisdictions (USAPIJ), 2014 [85]

Quantitative

cross-sectional

Healthcare workers

72

not specified

HPV testing, Pap smear

Health system, Structural

High

Europe

 Valerianova Z. et al. Bulgaria, 2010 [86]

Qualitative

Healthcare workers

 

23–65

Not specified

Individual, Health system

Medium

 Rada C. et al. Romania, 2010 [87]

Quantitative Cross sectional

Men, women

1902

15–82

Pap smear

Individual, Social

Low

  1. FGDs Focus group discussions, IDI In-depth interviews, VIA Visual inspection with acetic acid, VILI Visual inspection with Lugol’s iodine, HPV Human papillomavirus