Rural-urban variations in cervical cancer screening uptake among women in Ghana: Evidence from the 2022 Ghana Demographic and Health Survey

Background
Cervical cancer is the fourth most common cancer that affects women worldwide. Cervical cancer is preventable through early detection and treatment of precancerous lesions, yet there is poor uptake among women. In Ghana, there is a paucity of literature on rural-urban variations in cervical cancer screening uptake among women. We, therefore, assessed the rural-urban variations in cervical cancer screening uptake among women in Ghana.

Methods
This is a cross-sectional study that utilized data from the women’s file of the 2022 Ghana Demographic and Health Survey. The study was limited to 14,973 women who had complete data on the variables of interest. At 95% confidence interval and 5% significance level, a logistic regression model was conducted to ascertain the association between the dependent and independent variables, and results were presented in odds ratio. All analyses were conducted using STATA statistical software version 16.0.

Results
Out of the 14,973 participants, generally, the prevalence of cervical cancer screening uptake was 4.6%. Specifically, 6.3% of urban women and 3.0% of rural women had been screened for cervical cancer. Urban women who were widowed [AOR = 3.58, 95%CI = 2.29–5.60], from Northern region [AOR = 7.22, 95%CI = 3.42–15.25], had given birth to between 2 and 4 children [AOR = 1.54, 95%CI = 1.09–2.17] and had their first sexual intercourse at 10–14 years [AOR = 2.34, 95%CI = 1.20–4.56] had increased odds of cervical cancer screening. Also, urban women belonging to Moslem religion [AOR = 0.58, 95%CI = 0.42–0.80] and those who make joint decisions about their health with their partners [AOR = 0.60, 95%CI = 0.47–0.77] had decreased odds of cervical cancer screening uptake. On the other hand, rural women who had separated/divorced their partners [AOR = 2.21, 95%CI = 1.24–3.95], rural women from North East region [AOR = 2.91, 95%CI = 1.24–6.81] and had their first sexual intercourse at 20–24 years [AOR = 3.24, 95%CI = 1.23–8.55] had increased odds of cervical cancer screening uptake. All the remaining variables (aged [40–49 years], attained tertiary education, belonged to richest wealth quintile, had access to mass media, and enrolled in health insurance scheme) were same (had higher odds of cervical cancer screening uptake) for both rural-urban women in Ghana.

Conclusion
There are rural-urban variations in cervical cancer screening uptake among women in Ghana, in terms of prevalence [with urban women (6.3%) having slightly higher screening uptake than rural women (3.0%)] and determinants. Context-specific interventions aimed at improving cervical cancer screening uptake among women should focus on addressing rural-urban disparities in screening uptake and ensure possible scale-up of cervical cancer screening services, especially for the most vulnerable women.