Wealth-related inequalities of women’s knowledge of cervical cancer screening and service utilisation in 18 resource-constrained countries: evidence from a pooled decomposition analysis
Abstract Introduction Resource-constrained countries (RCCs) have the highest burden of cervical cancer (CC) in the world. Nonetheless, although CC can be prevented through screening for precancerous lesions, only a small proportion of women utilise screening services in RCCs. The objective of this s...
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| Format: | Article |
| Language: | English |
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BMC
2020-03-01
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| Series: | International Journal for Equity in Health |
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| Online Access: | http://link.springer.com/article/10.1186/s12939-020-01159-7 |
| _version_ | 1818295262469160960 |
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| author | Rashidul Alam Mahumud Syed Afroz Keramat Gail M Ormsby Marufa Sultana Lal B. Rawal Khorshed Alam Jeff Gow Andre M. N. Renzaho |
| author_facet | Rashidul Alam Mahumud Syed Afroz Keramat Gail M Ormsby Marufa Sultana Lal B. Rawal Khorshed Alam Jeff Gow Andre M. N. Renzaho |
| author_sort | Rashidul Alam Mahumud |
| collection | DOAJ |
| description | Abstract Introduction Resource-constrained countries (RCCs) have the highest burden of cervical cancer (CC) in the world. Nonetheless, although CC can be prevented through screening for precancerous lesions, only a small proportion of women utilise screening services in RCCs. The objective of this study was to examine the magnitude of inequalities of women’s knowledge and utilisation of cervical cancer screening (CCS) services in RCCs. Methods A total of 1,802,413 sample observations from 18 RCC’s latest national-level Demographic and Health Surveys (2008 to 2017–18) were analysed to assess wealth-related inequalities in terms of women’s knowledge and utilisation of CCS services. Regression-based decomposition analyses were applied in order to compute the contribution to the inequality disparities of the explanatory variables for women’s knowledge and utilisation of CCS services. Results Overall, approximately 37% of women had knowledge regarding CCS services, of which, 25% belonged to the poorest quintile and approximately 49% from the richest. Twenty-nine percent of women utilised CCS services, ranging from 11% in Tajikistan, 15% in Cote d’Ivoire, 17% in Tanzania, 19% in Zimbabwe and 20% in Kenya to 96% in Colombia. Decomposition analyses determined that factors that reduced inequalities in women’s knowledge of CCS services were male-headed households (− 2.24%; 95% CI: − 3.10%, − 1.59%; P < 0.01), currently experiencing amenorrhea (− 1.37%; 95% CI: − 2.37%, − 1.05%; P < 0.05), having no problems accessing medical assistance (− 10.00%; 95% CI: − 12.65%, − 4.89%; P < 0.05), being insured (− 6.94%; 95% CI: − 9.58%, − 4.29%; P < 0.01) and having an urban place of residence (− 9.76%; 95% CI: − 12.59%, − 5.69%; P < 0.01). Similarly, factors that diminished inequality in the utilisation of CCS services were being married (− 8.23%;95% CI: − 12.46%, − 5.80%; P < 0.01), being unemployed (− 14.16%; 95% CI: − 19.23%, − 8.47%; P < 0.01) and living in urban communities (− 9.76%; 95% CI: − 15.62%, − 5.80%; P < 0.01). Conclusions Women’s knowledge and utilisation of CCS services in RCCs are unequally distributed. Significant inequalities were identified among socioeconomically deprived women in the majority of countries. There is an urgent need for culturally appropriate community-based awareness and access programs to improve the uptake of CCS services in RCCs. |
| first_indexed | 2024-12-13T03:44:51Z |
| format | Article |
| id | doaj.art-1ef7bf271b6d4543bff49f459b7ec9a5 |
| institution | Directory Open Access Journal |
| issn | 1475-9276 |
| language | English |
| last_indexed | 2024-12-13T03:44:51Z |
| publishDate | 2020-03-01 |
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| series | International Journal for Equity in Health |
| spelling | doaj.art-1ef7bf271b6d4543bff49f459b7ec9a52022-12-22T00:00:50ZengBMCInternational Journal for Equity in Health1475-92762020-03-0119111510.1186/s12939-020-01159-7Wealth-related inequalities of women’s knowledge of cervical cancer screening and service utilisation in 18 resource-constrained countries: evidence from a pooled decomposition analysisRashidul Alam Mahumud0Syed Afroz Keramat1Gail M Ormsby2Marufa Sultana3Lal B. Rawal4Khorshed Alam5Jeff Gow6Andre M. N. Renzaho7School of Social Sciences, Western Sydney UniversityEconomics Discipline, Social Science School, Khulna UniversityProfessional Studies, Faculty of Business, Education, Law and Arts, University of southern QueenslandNutrition and Clinical Services Division, International Centre for Diarrheal Disease ResearchSchool of Health Medical and Allied Sciences, CQUniversity SydneyHealth Economics and Policy Research, Centre for Health, Informatics and Economic Research, University of Southern QueenslandHealth Economics and Policy Research, Centre for Health, Informatics and Economic Research, University of Southern QueenslandSchool of Social Sciences, Western Sydney UniversityAbstract Introduction Resource-constrained countries (RCCs) have the highest burden of cervical cancer (CC) in the world. Nonetheless, although CC can be prevented through screening for precancerous lesions, only a small proportion of women utilise screening services in RCCs. The objective of this study was to examine the magnitude of inequalities of women’s knowledge and utilisation of cervical cancer screening (CCS) services in RCCs. Methods A total of 1,802,413 sample observations from 18 RCC’s latest national-level Demographic and Health Surveys (2008 to 2017–18) were analysed to assess wealth-related inequalities in terms of women’s knowledge and utilisation of CCS services. Regression-based decomposition analyses were applied in order to compute the contribution to the inequality disparities of the explanatory variables for women’s knowledge and utilisation of CCS services. Results Overall, approximately 37% of women had knowledge regarding CCS services, of which, 25% belonged to the poorest quintile and approximately 49% from the richest. Twenty-nine percent of women utilised CCS services, ranging from 11% in Tajikistan, 15% in Cote d’Ivoire, 17% in Tanzania, 19% in Zimbabwe and 20% in Kenya to 96% in Colombia. Decomposition analyses determined that factors that reduced inequalities in women’s knowledge of CCS services were male-headed households (− 2.24%; 95% CI: − 3.10%, − 1.59%; P < 0.01), currently experiencing amenorrhea (− 1.37%; 95% CI: − 2.37%, − 1.05%; P < 0.05), having no problems accessing medical assistance (− 10.00%; 95% CI: − 12.65%, − 4.89%; P < 0.05), being insured (− 6.94%; 95% CI: − 9.58%, − 4.29%; P < 0.01) and having an urban place of residence (− 9.76%; 95% CI: − 12.59%, − 5.69%; P < 0.01). Similarly, factors that diminished inequality in the utilisation of CCS services were being married (− 8.23%;95% CI: − 12.46%, − 5.80%; P < 0.01), being unemployed (− 14.16%; 95% CI: − 19.23%, − 8.47%; P < 0.01) and living in urban communities (− 9.76%; 95% CI: − 15.62%, − 5.80%; P < 0.01). Conclusions Women’s knowledge and utilisation of CCS services in RCCs are unequally distributed. Significant inequalities were identified among socioeconomically deprived women in the majority of countries. There is an urgent need for culturally appropriate community-based awareness and access programs to improve the uptake of CCS services in RCCs.http://link.springer.com/article/10.1186/s12939-020-01159-7Cervical cancer screening servicesDecomposition analysesResource-constrained countriesKnowledgeUtilisation |
| spellingShingle | Rashidul Alam Mahumud Syed Afroz Keramat Gail M Ormsby Marufa Sultana Lal B. Rawal Khorshed Alam Jeff Gow Andre M. N. Renzaho Wealth-related inequalities of women’s knowledge of cervical cancer screening and service utilisation in 18 resource-constrained countries: evidence from a pooled decomposition analysis International Journal for Equity in Health Cervical cancer screening services Decomposition analyses Resource-constrained countries Knowledge Utilisation |
| title | Wealth-related inequalities of women’s knowledge of cervical cancer screening and service utilisation in 18 resource-constrained countries: evidence from a pooled decomposition analysis |
| title_full | Wealth-related inequalities of women’s knowledge of cervical cancer screening and service utilisation in 18 resource-constrained countries: evidence from a pooled decomposition analysis |
| title_fullStr | Wealth-related inequalities of women’s knowledge of cervical cancer screening and service utilisation in 18 resource-constrained countries: evidence from a pooled decomposition analysis |
| title_full_unstemmed | Wealth-related inequalities of women’s knowledge of cervical cancer screening and service utilisation in 18 resource-constrained countries: evidence from a pooled decomposition analysis |
| title_short | Wealth-related inequalities of women’s knowledge of cervical cancer screening and service utilisation in 18 resource-constrained countries: evidence from a pooled decomposition analysis |
| title_sort | wealth related inequalities of women s knowledge of cervical cancer screening and service utilisation in 18 resource constrained countries evidence from a pooled decomposition analysis |
| topic | Cervical cancer screening services Decomposition analyses Resource-constrained countries Knowledge Utilisation |
| url | http://link.springer.com/article/10.1186/s12939-020-01159-7 |
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