Utilization of Cervical Cancer Screening and Its Associated Factors among Women aged 25-49 Years in Kaloleni Sub-County, Kilifi County

Abstract

Cervical cancer continues to pose a significant public health challenge worldwide. In Kenya, cervical cancer is the second most common cancer among women, with an incidence rate of 32.8 per 100,000 and mortality of 21.4 per 100,000 in 2022, yet national screening coverage remains 17% despite free services in public facilities(KDHS, 2022). This facility-based, mixed-methods cross-sectional study assessed cervical cancer screening utilization and associated factors among 217 women aged 25–49 years attending five health facilities in Kaloleni Sub-County, Kilifi County, between June and August 2025. Guided by Andersen’s Behavioral Model of Health Services Utilization, data collection involved interviewer-administered questionnaires, key informant interviews with 20 healthcare workers, and health facility assessments. Only 23.0% of women reported ever being screened. The analysis identified several significant associations: women unaware of cervical cancer (OR = 0.078, 95% CI [0.023, 0.262], p < 0.001), and unawareness of screening existence yielded an OR of 0.069 (95% CI [0.024, 0.201], p < 0.001). Knowledge gaps further influenced uptake, with those who didn’t know the cervical cancer symptoms associated with an OR of 0.083 (95% CI [0.038, 0.18], p < 0.001). Employed women (OR = 2.121, 95% CI [1.007, 4.218], p = 0.030) and those with health insurance (OR = 2.123, 95% CI [1.067, 4.220], p = 0.030) showed higher uptake. Husbands’ approval an OR of 0.238 (95% CI [0.117,0.487], p < 0.001). Health facility factors, such as service promotion, an OR of 0.105 (95% CI [0.048,0.228], p < 0.001), and staff training adequacy, an OR of 0.094 (95% CI [0.045,0.198], p < 0.001). Qualitative findings identified fear, low perceived susceptibility, spousal opposition, and facility-level barriers such as supply shortages as key deterrents. These findings highlight the importance of targeted awareness campaigns, staff training, and facility improvements to increase screening utilization.