Demand for Cervical Cancer Screening in Tigray Region of Ethiopia in 2018: A Community-Based Cross-Sectional Study

Figures & data

Table 1 Bivariate Analysis of Demographic Characteristics Versus Demand of Participants for Cervical Cancer Screening in Tigray, Ethiopia, 2019 (n=1,000)

		Demand		Total (%)	p-value
		Yes (%)	No (%)
Age-group, years	20–30	76 (36.5)	132 (63.5)	208 (20.8)	0.001
	31–40	259 (51.7)	242 (48.3)	501 (50.1)
	41–50	113 (53.1)	100 (46.9)	213 (21.3)
	51–60	32 (41.0)	46 (59.0)	78 (7.8)
Religion	Orthodox	462 (49.0)	480 (51.0)	942 (94.2)	0.008
	Muslim	18 (31.0)	40 (7.69)	58 (5.8)
Marital status	Married	332 (51.9)	308 (48.1)	640 (64.0)	0.632
	Divorced	128 (50.6)	125 (49.4)	253 (25.3)
	Unmarried	60 (56.1)	47 (43.9)	107 (10.7)
Education	None	70 (31.2)	154 (68.8)	224 (22.4)	<0.001
	Primary	130 (43.5)	169 (56.5)	299 (29.9)
	Secondary	197 (57.3)	147 (42.7)	344 (34.4)
	Tertiary	83 (62.4)	50 (37.6)	133 (13.3)
Occupation	Civil servant	75 (68.8)	34 (31.2)	109 (10.9)	<0.001
	Merchant	88 (44.7)	109 (55.3)	197 (19.7)
	Housewife	209 (52.4)	190 (47.6)	399 (39.9)
	Daily work	54 (29.5)	129 (70.5)	183 (18.3)
	Privately employed	54 (48.2)	58 (51.8)	112 (11.2)

Table 2 Bivariate Analysis of Reproductive Health Variables Versus Demand for Cervical Cancer Screening in Tigray, Ethiopia, 2019 (n=1,000)

		Demand		Total (%)	p-value
		Yes (%)	No (%)
Contraceptive use	Yes	285 (51.4)	269 (48.6)	554 (55.4)	0.015
	No	195 (43.7)	251 (56.3)	446 (44.6)
Pregnancies had	One to four	370 (48.4)	395 (51.6)	765 (76.5)	0.848
	Five or more	80 (47.6)	88 (52.4)	168 (16.8)
	None	30 (44.8)	37 (55.2)	67 (6.7)
Number of children	One to four	380 (48.4)	405 (51.6)	785 (78.5)	0.603
	Five or more	59 (49.2)	61 (50.8)	120 (12.0)
	None	41 (43.2)	54 (56.8)	95 (9.5)
Abortions	One or more	104 (58.4)	74 (41.6)	178 (17.8)	0.002
	None	376 (45.7)	446 (54.3)	822 (82.2)

Table 3 Bivariate Analysis of Cervical Cancer Risk Factors versus Demand for Cervical Cancer Screening in Tigray, Ethiopia, 2019 (n=1,000)

		Demand		Total (%)	p-value
		Yes (%)	No (%)
Age at first sex	≤20 years	402 (46.4)	465 (53.6)	867 (86.7)	0.008
	≥21 years	78 (58.6)	55 (41.4)	133 (13.3)
Lifetime sexual partner(s)	One	277 (47.1)	311 (52.9)	588 (58.8)	0.500
	Two or more	203 (49.27)	209 (50.73)	412 (41.2)
Smoking	Yes	28 (40.0)	42 (60.0)	70 (7.0)	0.165
	No	452 (48.6)	478 (51.4)	930 (93.0)
Alcohol use	Always	38 (55.1)	31 (44.9)	69 (6.9)	0.188
	Sometimes	299 (49.1)	310 (50.9)	609 (60.9)
	Never	143 (44.4)	179 (55.6)	322 (32.2)
Corticosteroid use	Yes	47 (56.6)	36 (43.4)	83 (8.3)	0.100
	No	433 (47.2)	484 (52.8)	917 (91.7)
History of sexually transmitted infection	Yes	110 (62.15)	67 (37.8)	177 (17.7)	0
	No	370 (44.96)	453 (55.04)	823 (82.3)

Table 4 Distribution of Measures of Variation in Demand for Cervical Cancer Screening in Tigray, Ethiopia, 2019 (n=1,000)

Variability and Model Test	Model I (null)	Model II	Model III
Variance	0.7709658	0.4467945	0.219282
ICC	0.1898541	0.1195705	0.0624886
PCV (%)	Reference	0.42047429	0.71557493
Model selection
LR	−640.36628	−413.34727	−406.35585
AIC	1,284.733	864.6945	864.7117
BIC	1,294.548	957.9419	992.3133
Model-fit diagnostics
VIF	Mean VIF		1.71
LROC	Area under ROC curve		0.9039

Abbreviations: AIC, Akaike information criterion; BIC, Bayesian information criterion; ICC, intraclass-correlation coefficient; LR, likelihood ratio; LROC, log of receiver-operating characteristic; PCV, proportional change in variance; VIF, variance-inflation factor.

Table 5 Multilevel mutivariable Logistic Regression Analysis of Individual and Community Variable by Demand for Cervical Cancer Screening in Tigray, Ethiopia, 2019 (n=1,000)

Individual			Demand		AOR (95% CI)
			Yes (%)	No (%)	Model II	Model III
Age-group, years	20–30		76 (36.5)	132 (63.5)	1	1
	31–40		259 (51.7)	242 (48.3)	2.43 (1.48, 4.00) ***	2.33 (0.42, 3.83) **
	41–50		113 (53.1)	100 (46.9)	3.10 (1.69, 5.70)***	3.02 (1.64, 5.55)***
	51–60		32 (41.0)	46 (59.0)	1.59 (0.70, 3.63)	1.53 (0.67, 3.47)
Religion	Orthodox		462 (49.0)	480 (51.0)	1	1
	Muslim		18 (31.0)	40 (7.69)	0.36 (0.15, 0.83)*	0.33 (0.14, 0.78)*
Education	None		70 (31.2)	154 (68.8)	1	1
	Primary		130 (43.5)	169 (56.5)	1.43 (0.84, 2.41)	1.42 (0.84, 2.39)
	Secondary		197 (57.3)	147 (42.7)	2.07 (1.22, 3.51) **	2.01 (1.19, 3.39)* *
	Tertiary		83 (62.4)	50 (37.6)	2.80 (1.42, 5.52) **	2.81 (1.43, 5.51)**
Occupation	Civil servant		75 (68.8)	34 (31.2)	1	1
	Merchant		88 (44.7)	109 (55.3)	0.55 (0.27, 1.11)	0.60 (0.29, 1.22)
	Housewife		209 (52.4)	190 (47.6)	0.75 (0.38, 1.45)	0.77 (0.39, 1.49)
	Daily work		54 (29.5)	129 (70.5)	0.29 (0.13, 0.63) **	0.32 (0.14, 0.69) **
	Privately employed		54 (48.2)	58 (51.8)	0.54 (0.24, 1.20)	0.58 (0.26, 1.29)
Contraceptive use	Yes		285 (51.4)	269 (48.6)	1.35 (0.90, 2.00)	1.27 (0.85, 1.89)
	No		195 (43.7)	251 (56.3)	1	1
Abortion(s)	One or more		104 (58.4)	74 (41.6)	1.48 (0.92, 2.38)	1.38 (0.86, 2.23)
	None		376 (45.7)	446 (54.3)	1	1
Age at first sex	≤20 years		402 (46.4)	465 (53.6)	1.10 (0.63, 1.93)	1.11 (0.63, 1.95)
	≥21 years		78 (58.6)	55 (41.4)	1	1
History of sexually transmitted infection	Yes		110 (62.2)	67 (37.8)	1.80 (1.11, 2.94)*	1.71 (1.05, 2.79)*
	No		370 (44.9)	453 (55)	1	1
Knowledge of cervical cancer	Knowledgeable		258 (87.7)	36 (12.2)	9.7 (6.13, 15.33)***	9.2 (5.79, 14.7)***
	Less knowledgeable		222 (31.4)	484 (68.5)	1	1
Attitude regarding cervical cancer	SupportPositive		297 (85.1)	52 (14.9)	8.7 (5.79, 13.09)***	8.3 (5.53, 12.5)***
	Lesspositive		183 (28.1)	468 (71.9)	1	1
Community
Type of district	Urban					1.04 (0.59, 1.82)
	Rural					1
Mean family size among clusters						1.16 (0.67, 2.01)
Mean score of community awareness among clusters						1.25 (1.05, 1.48)**
Ratio of households to HEW across clusters						0.99 (0.99, 1.00)
Ratio of health professionals to population/1,000 across clusters						0.95 (0.88, 1.03)
Ratio of population to health institutions across clusters						0.99 (0.99, 0.99)*
Literacy of zonal average across clusters						0.98 (0.96, 1.00)

Notes: *p<0.05; **p<0.01; ***p<0.001.

Abbreviation: HEW, health-extension worker.