Uptake and Determinants of Cervical Cancer Screening in Rural Communities of Rivers State, Nigeria

Abstract

Background: Cervical cancer remains a leading cause of cancer-related death among women in sub-Saharan Africa, yet screening uptake in rural Nigeria is critically low. This study determined the uptake and determinants of cervical cancer screening among women in rural communities of Rivers State, Nigeria. Methods: A community-based, analytic, cross-sectional study was conducted among 800 women aged 25–49 years selected from four rural LGAs using multi-stage sampling. A validated questionnaire (S-CVI = 0.92; Cronbach's α = 0.89) assessed sociodemographic, obstetric, knowledge, and health system factors. Uptake was defined as ever having undergone a Pap smear or VIA. Data were analysed using SPSS version 27.0. Multivariable logistic regression identified determinants, with robust standard errors accounting for clustering. Model stability was assessed using EPV = 4.0 and Firth penalised likelihood. Results: The mean age of the women was 34.6 ± 7.2 years. 585 (73.1%) of the women were married. Screening uptake was 5.4% (43/800; 95% CI: 4.0–7.2%). Pap smear was the predominant method (67.4%; n = 29), followed by VIA only (25.6%; n = 11) and both (7.0%; n = 3). Independent determinants included tertiary education (AOR = 7.12), secondary education (AOR = 3.28), higher income (AOR = 5.87), prior awareness (AOR = 4.91), good knowledge (AOR = 5.34), distance ≤5 km (AOR = 2.89), no husband's permission required (AOR = 2.22), and age 45–49 years (AOR = 3.02). The model showed excellent discrimination (AUROC = 0.862). Common reasons for non-screening included lack of knowledge (48.2%), no perceived need (31.4%), distance (28.3%), fear of pain (19.6%), cost (14.8%), and husband's refusal (11.8%). Sensitivity analysis using Pap smear alone (3.6% uptake) yielded consistent findings. Conclusion: Cervical cancer screening uptake in rural Rivers State is very low at 5.4%, far below the WHO elimination target of 70% coverage. Multi-level interventions addressing education, awareness, distance, cost, spousal engagement, and health system strengthening are needed to accelerate cervical cancer elimination in southern Nigeria.