Knowledge, Attitude, and Practice of Cervical Cancer Screening and Associated Factors Among Reproductive Aged Women in Ethiopia: A Meta-Analysis and Systematic Review

Abstract Background: Cervical cancer is the leading cause of cancer deaths, accounting for 9% of female cancer deaths. In addition, more than 85% of cervical cancer related deaths are found in low and middle-income countries. Women’s knowledge and attitude are barriers for the uptake of cervical cancer screening service in Ethiopia. Studies conducted on knowledge, attitude, and practice of cervical cancer screening and associated factors among reproductive age women are inconsistent. Therefore, this systematic review and meta-analysis aimed to estimate the national level of knowledge, attitude, and practice of cervical cancer screening and associated factors among women aged 15-49 years in Ethiopia.Methods: An international database such as PubMed, EMBASE, Scopus, Google Scholar, Science Direct Cochrane library, and Grey literature databases were searched an extensively. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 guideline were pursued for this review. The quality of each study was assessed using Newcastle- Ottawa quality assessment tool. Stata version 14 was used to analyze the data. We have used a random effects model to estimate the pooled prevalence and odds ratio with 95% CI. The possible heterogeneity between studies was assessed using I-squared (I2) test statistic. Egger’s test was used to assess the publication bias. Result: Eighteen studies with a total of 9, 897 women were included in this meta-analysis. The pooled national level of knowledge, attitude and practice towards cervical cancer screening among 15-49 years old aged women in Ethiopia was 40.37% (95% CI: 30.09,50.66), 58.87% (95% CI: 42.69,75.05) and 14.02% (95% CI: 9.67,18.37) respectively. Being uneducated (OR: 3.10, 95% CI: 2.09,4.62), Women who had good knowledge (OR: 5.87, 95% CI: 2.57,13.40), Women who had positive attitude (OR: 4.20, 95% CI: 2.86,6.16) and not being married (OR: 3.34, 95% CI: 1.09,10.22) were the major factors of cervical cancer screening practice. Conclusions and Recommendation: This review showed that the level of knowledge, attitude, and practice of cervical cancer screening among reproductive-age women in Ethiopia was relatively lower. Educational status, knowledge, attitude and marital status were statistically significant factors for cervical cancer screening practice. Hence, the health care provider needs to scale up health education and awareness creation about cervical cancer screening and early detection and prevention of cervical cancer.