Individual-level and community-level determinants of cervical cancer screening among Kenyan women: a multilevel analysis of a Nationwide survey
Individual-level and community-level determinants of cervical cancer screening among Kenyan women: a multilevel analysis of a Nationwide survey
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DOI：
10.1186/s12905-017-0469-9
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发表时间：
2017-11-15
影响因子：
2.5
通讯作者：
Chuang, Ying-Chih
中科院分区：
文献类型：
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作者：
Tiruneh, Fentanesh Nibret;Chuang, Kun-Yang;Chuang, Ying-Chih
背景资料：在撒哈拉以南非洲地区，关于宫颈癌筛查决定因素的研究主要集中在宫颈癌筛查的个人特征上。因此，在这项研究中，我们包括个人和社区层面的指标，以检查肯尼亚妇女宫颈癌筛查的决定因素。方法：我们分析了2014年肯尼亚人口与健康调查的数据。我们的分析集中在9016已婚育龄妇女（15-49岁）。我们进行了多层次分析，使用广义线性混合模型与对数二项函数，同时分析个人和社区层面的因素与宫颈癌screen.Results：约72.1%的妇女（n = 6498）知道宫颈癌的关联。在这些妇女中，只有19.4%接受过宫颈癌筛查[58.24%接受巴氏试验，41.76%接受目视检查]。我们的多因素分析结果表明，35-49岁妇女的宫颈癌筛查率高于15-24岁妇女。居住在中部、尼扬扎和内罗毕地区的妇女的患病率也高于居住在沿海地区的妇女。宫颈癌筛查在那些接触媒体、家庭财富指数较高、有工作、有保险、12个月内去过卫生机构的妇女中更为普遍。有性自主权的女性的巴氏试验史的患病率比没有性自主权的女性高19%。在性自主和受过高等教育的女性比例较高的社区中，巴氏试验史的患病率也较高。结论：政策应强调增加性别平等、改善社区层面的教育、为妇女提供就业机会以及增加全民健康保险覆盖范围。这些协调中心可以确保公平获得保健服务，并进一步提高肯尼亚宫颈癌筛查的普及率。
Background: Studies on the determinants of cervical cancer screening in sub-Saharan Africa have focused mostly on individual-level characteristics of cervical cancer screening. Therefore, in this study, we included both individual-and community-level indicators to examine the determinants of cervical cancer screening among Kenyan women.Methods: We analyzed data from the 2014 Kenya Demographic and Health Surveys. Our analysis focused on 9016 married women of reproductive age (15-49 years). We conducted multilevel analyses using generalized linear mixed models with the log-binomial function to simultaneously analyze the association of individual-and community-level factors with cervical cancer screening.Results: About 72.1% of women (n = 6498) knew about cervical cancer. Of these women, only 19.4% had undergone cervical cancer screening [58.24% Papanicolaou (Pap) test and 41.76% visual inspection]. Our multivariate analysis results indicated that the prevalence of cervical cancer screening was higher among women aged 35-49 years than women aged 15-24 years. The prevalence was also higher among women residing in the Central, Nyanza, and Nairobi regions than women residing in the Coastal region. Cervical cancer screening was more prevalent among women who had media exposure, had higher household wealth index, were employed, were insured, and had visit a health facility in 12 months than did their counterparts. The prevalence of Pap test history was 19% higher among women who had sexual autonomy than women who did not have sexual autonomy. The prevalence of Pap test history was also higher among communities comprised of higher proportions of women with sexual autonomy and higher education.Conclusions: Policies should emphasize increasing gender equality, improving education at the community level, providing employment opportunities for women, and increasing universal health insurance coverage. These focal points can ensure equity in access to health care services and further increase the prevalence of cervical cancer screening in Kenya.