Factors Influencing the Uptake of Cervical Cancer Screening Services Among Women Aged Between 25 And 49 Years in Thika Sub-County.

Abstract

Cervical Cancer (CC) is ranked as fourth most prevalent cancer affecting women globally. Its incidence in sub-Saharan Africa averages 31.7 per 100,000 women, with Eastern Africa reaching 42.7, and some countries exceeding 50 per 100,000. These trends show rising rates over the past two decades. In Kenya, the annual incidence of cervical cancer is 19.7 per 100,000. It is the second most common cancer among Kenyan women after breast cancer. Cervical cancer screening (CCS) is essential because, when detected early, cervical cancer is highly preventable. Screening enables timely identification of precancerous lesions, which can be effectively treated to prevent progression. In low-income countries, screening is a more accessible and cost-effective preventive strategy compared to HPV vaccination, making it a practical option for reducing cervical cancer burden. Kenya issued its first cervical cancer screening guidelines in 2012–2013, yet only 14% of eligible women have been screened. This is way below the world health organization’s (WHO)70% target for Cervical cancer elimination by 2030. Objectives of this study included assessing the influence of knowledge, socio-demographic factors and health system factors on the uptake of cervical cancer screening services (CCSS). A cross-sectional study was conducted among 285 women in Thika Sub-County, selected through stratified random sampling across five wards. Simple random sampling was applied within each stratum. Data was collected using structured questionnaires, analyzed using SPSS 25, with descriptive statistics and chi-square tests explored associations. Most respondents were aged 25–30 years (45.1%), predominantly Christian (78.5%), married (55.1%) and had either a bachelor’s degree (40.6%) or vocational training (34.3%). Daily income was mostly below Kes 2,000, with 38.6% earning under KES 1,000. Education level (χ² = 21.659, p < 0.01), religion (χ² = 23.841, p < 0.01), and employment (χ² = 7.099, p = 0.029) were significantly associated with cervical cancer screening uptake. This study found out that only 11% were screened in the past year and 25% had been screened in the past three years demonstrating poor adherence to the national guidelines. Key barriers included fear and anxiety (72.6%), lack of awareness (56%), high hospital charges (11.5%), distance to facilities (10.2%), long waiting times (6.4%), and unfriendly health workers (5.3%). Over 80% of respondents agreed that cervical cancer is deadly, and 82.9% indicated that fear of the disease would motivate them to participate in awareness campaigns. Perceived risk, especially belief in the dangers of multiple sexual partners (r = 0.337, χ² = 35.117, p < 0.01) and the fatal nature of CC (r = 0.218, χ² = 19.601, p < 0.01) was significantly linked to cervical cancer screening uptake. Less than one-fifth (18.2%) of respondents had received cervical cancer sensitization from the Ministry of Health, and 59.4% had never received verbal information from healthcare providers. While 61.4% indicated that access to screening facilities would encourage them to get screened, over half (53.3%) reported a lack of adequate screening services in their area. Availability of screening programs (χ² = 49.172, p < 0.01) and provider-led sensitization (χ² = 52.143, p < 0.01) were strongly associated with cervical cancer screening uptake. Cervical Cancer Screening uptake remains low in Thika Sub-County, driven by fear, low awareness, and limited health system support. Strengthening health education, expanding access, and scaling up community-based screening programs are critical to improving screening rates and reducing Cervical Cancer burden.