title: Underutilization of cervical cancer prevention services in low and middle income countries: a review of contributing factors.
abstract: This review aims at identifying barriers to utilization of cervical cancer prevention services in low- and middle-income countries. An electronic search was conducted using the following key words, HPV vaccination, screening, barriers, utilization and low and middle income/developed countries. Using the Garrard (1999) Matrix method approach, a modified matrix was designed and used as a data collection tool and data related to each category listed on the tool were entered into a matrix containing columns reflecting the categories. Constant comparative analysis was used to identify thematic categories. 31 articles published between 2001 and 2014 were yielded from the search. Analysis of the contents of the articles showed that the underutilization of cervical cancer screening services in low and middle-income countries is the result of barriers in accessing and utilizing of the prevention services. Though not mutually exclusive, the barriers were categorized in three categories; individual, community and health system related. Individual barriers include lack of awareness and knowledge about risk factors and prevention of cervical cancer. Age, marital status, diffidence, social economic status, cultural and religious belief of the women also determine the women's' willingness to utilize the services. In some communities there is stigma attached to discussing reproductive health issues and this limits the young women's awareness of cervical cancer and its prevention. Understanding individual, community and health system barriers that hinder women's utilization of cervical cancer prevention services is very crucial in designing effective cervical cancer control programs in low- and middle-income countries.
authors.affiliation: School of Public Health and Family Medicine Health, University of Malawi, Mahatma Gandhi Road, Private Bag 360, Chichiri, Blantyre 3, Malawi.
authors.forename: Fresier
authors.initials: F
authors.lastname: Chidyaonga-Maseko
authors.affiliation: Prime Health Consulting and Services, Prime Health Consulting and Services A47/5/240, Malingunde Road. P.O. Box 1926, Lilongwe, Malawi.
authors.forename: Maureen Leah
authors.initials: ML
authors.lastname: Chirwa
authors.affiliation: School of Public Health and Family Medicine Health, University of Malawi, Mahatma Gandhi Road, Private Bag 360, Chichiri, Blantyre 3, Malawi.
authors.forename: Adamson Sinjani
authors.initials: AS
authors.lastname: Muula
mesh_terms: D003906:Developing Countries; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D030361:Papillomavirus Infections / Q000517:prevention & control; D053918:Papillomavirus Vaccines / Q000008:administration & dosage*; D012307:Risk Factors; D012959:Socioeconomic Factors; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*
chemical_list: D053918:Papillomavirus Vaccines
keywords: Cervical cancer; low and middle income countries; prevention