Population-Based Study on Adherence to Cervical Cancer Screening: Frequency and Determinants in Two Low-Income Neighborhoods of Franceville, Gabon

Background

With 570,000 new cases and 311,000 deaths annually, cervical cancer is the 4th most common cancer among women, predominantly affecting sub-Saharan Africa (84% of cases). This study evaluates adherence to screening and its determinants in two disadvantaged neighborhoods of Franceville, Gabon.

Materials and Methods

This prospective and cross-sectional study was conducted from August to October 2025. It utilized weighted population data from demographic and health surveys. Information on sociodemographic, economic, behavioral, and medical factors, as well as knowledge about cervical cancer screening, was collected. After descriptive statistical analysis of the data, bivariate and multivariate analyses were performed using R software. Results were considered significant at a p-value of ≤ 0.05 within a 95% confidence interval.

Results

The study included 400 women aged 18 to 65 living in low-income neighborhoods, among whom 120 had previously participated in cervical cancer screening, resulting in a screening adherence prevalence of 30% (95% CI: [0.26–0.35]). This prevalence varied by neighborhood, with 34.5% in Ombélé (95% CI: [0.28–0.42]) and 25.5% in Ongouénié (95% CI: [0.2–0.32]). Multivariate analysis revealed several factors influencing screening adherence: women in Ongouénié had a lower likelihood of being screened (OR = 0.62) compared to those in Ombélé. Women aged 35 to 44 and those who were married or in stable unions had higher screening rates (adjusted OR = 1.78 and adjusted OR = 3.21, respectively), while widows had a lower likelihood (adjusted OR = 0.29). Education was a key factor, with women having secondary and higher education being 1.65 and 4.89 times more likely to be screened, respectively. Additionally, women working in the formal sector had a higher probability of participating in screening (adjusted OR = 3.15), while those with five or more children had a significantly lower probability (adjusted OR = 0.28).

Conclusion

The results of this study confirm insufficient adherence to cervical cancer screening programs in two low-income neighborhoods of Franceville. They also identify key socioeconomic, behavioral, and medical determinants influencing this practice, providing insights for improving local prevention and management strategies.