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Improving cervical cancer continuum of care towards elimination in Ethiopia: a scoping review

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Abstract

Background

Cervical cancer is the second-leading cause of death among all cancers in Ethiopia. Ethiopia plans to eliminate cervical cancer as a public health problem by 2030, following the World Health Organization's call for action. A scoping review was conducted on the status of the cervical cancer continuum towards elimination in Ethiopia.

Methods

We searched articles in PubMed, Scopus, and Google Scholar. All studies conducted on cervical cancer in Ethiopia, from first date of publication to March 15, 2023, type of article, or language of publication, were included. However, conference abstracts, commentaries, and letters to the editors were excluded. We used EndNote X9 software to merge articles from different databases and automatically remove duplicates. Screening of titles, abstracts, and full texts was performed independently by two co-authors. The cancer care continuum was employed as a framework to guide data synthesis and present the findings.

Results

Of the 569 retrieved articles, 159 were included in the review. They found that most of the articles focused on knowledge, attitude, and practice. However, there were few studies on health-seeking behavior, perception and acceptability of cervical cancer services, as well as the availability and readiness of a screening program. The review identified inadequate knowledge, attitude, and perception about cervical cancer, and highlighted that screening for cervical cancer is not widely utilized in Ethiopia. Knowledge, attitude, education status, and income were repeatedly reported as precursors influencing cervical cancer screening. Most studies concluded that there is a high prevalence of precancerous lesions and cervical cancer, as well as high mortality rates or short survival times. The review also identified significant heterogeneity in findings across time and geographic settings within each component of the cancer care continuum.

Conclusions

Overall, there is inadequate knowledge, perception, health-seeking behavior, screening, and treatment services, indicating that the country is falling behind its targets in eliminating cervical cancer, despite the availability of effective interventions and tools. We argue that implementation research is necessary to identify implementation issues, challenges, and strategies to scale up both primary and secondary prevention services. By doing so, Ethiopia can address cervical cancer as a public health problem and work towards its elimination.

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Data availability

All the generated data are available within this manuscript.

Abbreviations

HIV:

Human immunodeficiency virus

HPV:

Human papilloma virus

SNNPR:

Southern Nation Nationalities People Region

US$:

United States Dollar

VIA:

Visual inspection with acetic acid

WHO:

World Health Organization

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Authors and Affiliations

  1. School of Public Health, The University of Queensland, Brisbane, Australia

    Aklilu Endalamaw & Yibeltal Assefa

  2. College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia

    Aklilu Endalamaw, Habtamu Alganeh & Muluken Azage

  3. College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia

    Asmamaw Atnafu, Adane Nigusie & Destaw Fetene Teshome

  4. Centre for Applied Health Economics, School of Medicine, Griffith University, Brisbane, Australia

    Daniel Erku

  5. Menzies Health Institute Queensland, Griffith University, Brisbane, Australia

    Daniel Erku

  6. International Institute of Primary Health Care, Addis Ababa, Ethiopia

    Eskinder Wolka & Anteneh Zewdie

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  1. Aklilu Endalamaw
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  2. Habtamu Alganeh
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  4. Asmamaw Atnafu
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  7. Adane Nigusie
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  9. Destaw Fetene Teshome
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  10. Yibeltal Assefa
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Contributions

AE and YA conceptualised the study design, retrieved relevant articles, screening and data extraction, analysed, interpreted the results, and drafted the manuscript. HA contributed to selection of articles and data extraction. MA, AA, DE and EW contributed to the research aim and manuscript draft, and critically revised the drafted manuscript. AN, AZ and DFT contributed to critically revised the drafted manuscript. All authors read and approved the final manuscript.

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Correspondence to Aklilu Endalamaw.

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Endalamaw, A., Alganeh, H., Azage, M. et al. Improving cervical cancer continuum of care towards elimination in Ethiopia: a scoping review. Cancer Causes Control 35, 549–559 (2024). https://doi.org/10.1007/s10552-023-01813-9

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