title: Barriers to utilisation of cervical cancer screening in Sub Sahara Africa: a systematic review.
abstract: BACKGROUND
  Cervical cancer is the commonest cause of cancer-related death in Sub Sahara Africa (SSA). Both primary and secondary preventive services are available but utilisation remain low. This systematic review aims to summarise reported barriers preventing women from utilising cervical cancer screening services in SSA.
  
  
  METHODS
  Electronic searches on MEDLINE, EMBASE, PsycINFO, BIOSIS preview, Global Health, PubMed, Cochrane library, CINAHL, ISI Web of Knowledge and Google scholar and quality assessment of the included studies were performed. A meta-analysis was applied to identify major themes.
  
  
  RESULTS
  Eight studies exploring reasons women did not utilise cervical cancer screening were included. Women in SSA reported similar barriers despite cultural and language diversity in the region. Women reported fear of screening procedure and negative outcome, low level of awareness of services, embarrassment and possible violation of privacy, lack of spousal support, societal stigmatisation, cost of accessing services and health service factors like proximity to facility, facility navigation, waiting time and health care personnel attitude.
  
  
  CONCLUSIONS
  Strategies for improving uptake and utilisation of cervical screening in SSA should focus on improving cervical health education, addressing cultural beliefs and practices and improving spousal support and empowering women, as well as addressing physical access problem, costs and improving staff attitude.
authors: Faculty of Medical Science, Anglia Ruskin University, Cambridge Campus, UK.
authors: J N W
authors: JN
authors: Lim
authors: National Health Service, UK.
authors: A A
authors: AA
authors: Ojo
mesh_terms: D017954:Africa South of the Sahara; D001291:Attitude of Health Personnel; D003144:Communication Barriers; D003365:Costs and Cost Analysis; D003469:Culture; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005239:Fear; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006796:Household Work; D006801:Humans; D007398:Interpersonal Relations; D010342:Patient Acceptance of Health Care / Q000523:psychology; D010353:Patient Education as Topic; D012649:Self Concept; D012752:Shame; D018454:Spouses / Q000523:psychology; D013240:Stereotyping; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control* / Q000523:psychology
keywords: Sub Sahara Africa; barriers; cervical cancer screening; systematic review