title: Cervical cancer screening and HPV vaccine acceptability among rural and urban women in Kilimanjaro Region, Tanzania.
abstract: OBJECTIVE
  To determine cervical cancer screening coverage and the knowledge, attitudes and barriers toward screening tests among women in rural and urban areas of Tanzania, as well as explore how they view the acceptability of the HPV vaccine and potential barriers to vaccination.
  
  
  METHODS
  A cross-sectional study using interview-administered questionnaires was conducted using multistage random sampling within urban and rural areas in Kilimanjaro Region, Tanzania.
  
  
  METHODS
  Women aged 18-55 were asked to participate in the survey. The overall response rate was 97.5%, with a final sample of 303 rural and 272 urban dwelling women.
  
  
  METHODS
  Descriptive and simple test statistics were used to compare across rural and urban strata. Multivariate logistic regression models were used to estimate ORs and 95% CIs.
  
  
  RESULTS
  Most women (82%) reported they had heard of cervical cancer, while self-reported cervical cancer screening among women was very low (6%). In urban areas, factors associated with screening were: older age (OR=4.14, 95% CI 1.86 to 9.24 for ages 40-49, and OR=8.38, 95% CI 2.10 to 33.4 for >50 years), having health insurance (OR=4.15, 95% CI 1.52 to 11.4), and having knowledge about cervical cancer (OR=5.81, 95% CI 1.58 to 21.4). In contrast, among women residing in rural areas, only condom use (OR=6.44, 95% CI 1.12 to 37.1) was associated with screening. Women from both rural and urban areas had low vaccine-related knowledge; however, most indicated they would be highly accepting if it were readily available (93%).
  
  
  CONCLUSIONS
  The current proportion of women screened for cervical cancer is very low in Kilimanjaro Region, and our study has identified several modifiable factors that could be addressed to increase screening rates. Although best implemented concurrently, the availability of prophylactic vaccination for girls may provide an effective means of prevention if they are unable to access screening in the future.
authors.affiliation: Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada.
authors.forename: Melissa S
authors.initials: MS
authors.lastname: Cunningham
authors.affiliation: Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada.
authors.forename: Emily
authors.initials: E
authors.lastname: Skrastins
authors.affiliation: Faculty of Medicine, Queen's University, Kingston, Ontario, Canada.
authors.forename: Ryan
authors.initials: R
authors.lastname: Fitzpatrick
authors.affiliation: Faculty of Medicine, Queen's University, Kingston, Ontario, Canada.
authors.forename: Priya
authors.initials: P
authors.lastname: Jindal
authors.affiliation: Kilimanjaro Christian Medical Center, Moshi, Tanzania, Africa.
authors.forename: Olola
authors.initials: O
authors.lastname: Oneko
authors.affiliation: Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada Faculty of Medicine, Queen's University, Kingston, Ontario, Canada.
authors.forename: Karen
authors.initials: K
authors.lastname: Yeates
authors.affiliation: Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen's University, Kingston, Canada.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Booth
authors.affiliation: Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada Faculty of Medicine, Queen's University, Kingston, Ontario, Canada.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Carpenter
authors.affiliation: Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen's University, Kingston, Canada.
authors.forename: Kristan J
authors.initials: KJ
authors.lastname: Aronson
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D017280:Condoms; D003430:Cross-Sectional Studies; D003625:Data Collection; D055088:Early Detection of Cancer; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D008403:Mass Screening; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000175:diagnosis*; D053918:Papillomavirus Vaccines; D010342:Patient Acceptance of Health Care; D012424:Rural Population; D011795:Surveys and Questionnaires; D013636:Tanzania; D014505:Urban Population; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000517:prevention & control*; D014611:Vaccination; D055815:Young Adult
chemical_list: D053918:Papillomavirus Vaccines
keywords: Acceptability; Africa; Cervical Cancer; HPV; Vaccine