Predictors of cervical cancer prevention practices among women in Uganda
The uptake of cervical cancer (CC) preventive measures that have proven to be effective in averting the disease burden elsewhere is low in Uganda; a country with high CC burden. Identification of factors associated with comprehensive knowledge about the disease and uptake of preventive measures is important for design and implementation of appropriate interventions. In Uganda, these factors have not been adequately investigated. The main objective of the study was to establish predictors of uptake of CC preventive measures in Uganda. Secondary data from 2016 Uganda Demographic and Health Survey were analyzed to assess the predictors of Human Papilloma Virus (HPV) vaccination among 6,093 girls age 10 – 14 years nested within 686 villages/ cells in Uganda. Primary data for 845 women age 25–49 years and 503 girls age 10-17 years were collected through a cross-sectional survey from Central Uganda; a region where cervical prevention interventions are relatively accessible. Data were analyzed using STATA 16.0 software at univariate level using frequencies, bivariate level using chi squared tests and at multivariate level using; binary logistic, complementary log-log and hierarchical multivariate regression analyses. The majority of the girls had not been vaccinated in Uganda (78%) and Central Uganda (60.6 %). Only 1 in 5 (20%) of the women had ever screened for cervical cancer in Central Uganda. In Uganda, the likelihood of having been vaccinated against HPV was higher among girls who were; age 11, 12 and 13 compared to 10 years, schooling, living in households with <9 members, and in the middle compared to the poorest wealth quintile. In Central Uganda, the likelihood of having been vaccinated against HPV was higher among girls who were; resident in urban compared to rural areas, schooling, second birth order, in rich compared to the poor wealth quintile, and daughters to mothers age 30-39 compared to 25-29 years. The likelihood of having high knowledge about cervical cancer and its prevention in central Uganda was higher among women who were; age 30-34 and 45-49 compared to ≤ 29 years, had attained secondary and above education compared to non-educated, in the middle and rich compared to poor wealth index, and farmers compared to professionals. The likelihood of having ever screened was higher among women who; were in the rich compared to poor wealth quintile, had attained secondary and post-secondary education compared to non-educated, were married to farmers compared to non-employed, and women who had received compared to those who didn’t receive spousal screening emotional support. Age, social economic status, male partner support, and knowledge about the disease were the most important predictors of cervical cancer prevention uptake. Strategies aimed at reaching younger, out of school girls, and those in the poor wealth quintile should be adapted and implemented to enhance vaccination uptake. Health workers should integrate cervical cancer screening in their health education interventions, encourage men’s participation through community education, and women should be empowered through education to increase uptake of cancer screening in Uganda.