2nd Edition of Public Health World Conference (PHWC) 2026

Abstract

Cervical cancer remains a major public health challenge and a leading cause of cancer-related mortality among women in low- and middle-income countries, including Zambia. Despite being largely preventable through effective screening and early treatment, uptake of cervical cancer screening services remains low. This study aimed to examine the determinants of cervical cancer screening uptake among women of reproductive age in Zambia using nationally representative data.

This study utilised secondary data from the 2024 Zambia Demographic and Health Survey, a nationally representative cross-sectional survey. A total of 5,866 women aged 15–49 years were included in the analysis. The outcome variable was cervical cancer screening uptake, defined as ever having undergone a Pap smear test. Explanatory variables included individual-level factors such as age, education, marital status, occupation, wealth index, and health insurance coverage, as well as community-level factors including province and place of residence. Data were weighted to account for the complex survey design. Descriptive statistics, chi-square tests, and multivariable logistic regression analyses were conducted to identify factors associated with screening uptake. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported.

The findings showed that only 27.2% of women had ever undergone cervical cancer screening, indicating low uptake. Screening uptake increased significantly with age, with women aged 35–39 years nearly five times more likely to be screened compared to those aged 15–19 years (AOR = 4.96, 95% CI: 3.67–6.70). Women residing in rural areas were less likely to undergo screening compared to their urban counterparts (AOR = 0.70, 95% CI: 0.58–0.84). Socioeconomic inequalities were evident, as women from the richest households had higher odds of screening compared to those from the poorest households (AOR = 2.06, 95% CI: 1.49–2.86). Health insurance coverage was also associated with increased likelihood of screening (AOR = 1.31, 95% CI: 1.01–1.71). Additionally, significant regional variations were observed across provinces.

In conclusion, cervical cancer screening uptake in Zambia remains low and is influenced by demographic, socioeconomic, and geographic factors. Targeted interventions focusing on rural populations, younger women, and economically disadvantaged groups, alongside strengthening health systems and expanding access to screening services, are critical to improving uptake and reducing the burden of cervical cancer in Zambia.