Skip to main content

Low level of knowledge about cervical cancer among Ethiopian women: a systematic review and meta-analysis

Abstract

Introduction

Cervical cancer is one of the leading causes of malignancies among women in Ethiopia. Knowing the disease could empower women to make an informed decision regarding participation with cervical cancer prevention strategies. There is scarcity of compiled data in the field. Therefore, this systematic review aimed to provide an overview of knowledge about cervical cancer among Ethiopian women.

Methods

We conducted a systematic review of peer-reviewed articles on the knowledge of cervical cancer. Articles were systematically searched using comprehensive search strings from PubMed/Medline, SCOPUS, and grey literature from Google Scholar. Two reviewers assessed study eligibility, extracted data, and the risk of bias independently. Meta-analysis was performed using STATA v 14 to pool the overall knowledge of the women about cervical cancer.

Results

We included 26 articles published between 2013 and 2020 covering a total of 14,549 participants. All the included articles had good methodological quality. The proportion of participants who had heard of cervical cancer varied from 4.6 to 87.7% with the pooled estimate at 56% (95% CI: 47–66). Similarly, the proportion of participants who knew that HPV is the main cause of cervical cancer lied between 0 and 49.7% with the pooled result at 21% (95% CI: 13–30). Likewise, the pooled prevalence to identify at least one risk factor, one symptom of cervical cancer and ever heard of cervical cancer screening was gauged at 52% (95% CI: 39–64), 43% (95% CI: 26–60), and 39% (95% CI: 24–55), respectively. The overall pooled prevalence of good knowledge about cervical cancer was at 43% (95% CI: 33–53). On top of this, the prevalence of previous screening practice among the participants was at 14% (95% CI: 9–20).

Conclusions

Knowledge about cervical cancer among Ethiopian women is quite poor. Therefore, health education to provide sufficient and unbiased information about HPV and cervical cancer in general is required to the public.

Background

Cervical cancer ranks the fourth most frequent cancer among women and is the 2nd most common female cancer in the age group between 15 to 44 years worldwide. Every year over 527,624 women are diagnosed with the case and about 265,672 die from the disease globally [1]. In Ethiopia women aged 15 years and older, who are at risk of developing cervical cancer, are close to 30 million. Based on the 2018 World Health Organization (WHO) report, of all form of cancers in Ethiopia, new cervical cancer cases and death shared 6294 (10.6%) and 4884 (11.6%), respectively [2]. Cervical cancer is the leading cause of cancer-related mortality among women and almost nine out of ten cervical cancer deaths disproportionately occur in developing countries [3,4,5,6,7,8,9].

More than 99% of cervical cancer is associated with genital infection with certain types (High-Risk) Human papillomavirus (HPV), which is the most common viral sexually transmitted infection (STI) globally [10, 11] that most women are experiencing soon after they become sexually active [12]. Persistent infection with HR-HPV is the primary cause of cervical cancer [13, 14]. There are identified factors that increase the risk of cervical cancer. Among them some are multiple numbers of sexual partners, early age at first sexual intercourse, presence of STIs, use of hormonal contraceptives for a long time, multiple parity, elderly age and smoking behavior [15]. Moreover, the health policy on cancer, capacity of the health system, socio-economic and cultural factors and awareness and knowledge about the disease was found linked with cervical cancer related morbidity and mortality [15, 16].

Cervical cancer is curable if detected at its early stage. Premature detection is valuable as early lesions develop slowly preceding cancer, typically over a period of 10 years [17]. These precursor lesions, are detectable by a variety of methods; to mention cytology (Pap smear), HPV-based tests and visual inspection with acetic acid (VIA) are common [18]. In the Ethiopian context, visual inspection of the cervix with acetic acid is routinely used and is giving promising results in terms of reducing morbidity and mortality [15].

Several evidences showed that, knowledge and awareness of cervical cancer among African women, in general, is very poor while mortality is very high [16]. Women’s knowledge of cervical cancer would impact the uptake of cervical cancer prevention activities, like avoiding risk factors, to get regular screening and vaccination. Hence, there is a need to have compiled data on women’s knowledge about cervical cancer as input for intervention which is otherwise quite limited in Ethiopia even if there are fragmented reports. Therefore, this review was conducted aimed at assessing the overall knowledge of Ethiopian women about cervical cancer.

Review question

This systematic review addresses the following question; how is the knowledge of Ethiopian women on cervical cancer?

Objective

The main aim of this review was to describe the knowledge and awareness of Ethiopian women on cervical cancer.

Methods

Protocol registration

Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guideline, the review protocol was registered at International Prospective Register of Systematic Reviews (PROSPERO) with a registration number of CRD42020219684.

Eligibility criteria

Studies were selected based on the following criterion: Study design: descriptive studies that reported the knowledge of women on cervical cancer. Participants: women of any age group from the general population. Studies that employed health professionals were not considered in this review as a significant proportion of health care workers are assumed to be knowledgeable about cervical cancer [19]. Setting: we included studies with the outcome of interest reported in Ethiopia. Language and publication: We included peer-reviewed published articles and unpublished preprints written in the English language.

Information sources and search strategy

This review was done following PRISMA [20]. A computerized systematic strategy was adopted to search for articles in PubMed/Medline and SCOPUS. The last search was conducted on 29 September 2020. Manual search from Google Scholar and Google databases was also carried out for grey literature. The search terms were developed in line with the Medical Subject Headings (MeSH) thesaurus using a combination of the big ideas (or ‘key terms’) which derived from the research question. The reference lists of retrieved articles were probed (forward and back ward searching) to identify articles that were not retrieved from databases manual search. The first two authors; AD and DM searched the articles independently.

The domains of the search terms were: ‘knowledge’, ‘awareness’, ‘cervical cancer’ ‘Ethiopia’. We combined these terms using the Boolean operator “OR”, and “AND” accordingly. The full search strategy for the two databases is annexed in Supplement 1.

Study selection

Studies that have reported the knowledge of Ethiopian women on cervical cancer were included regardless of their year of publication. Searched articles were directly imported and handled using EndNote X5 citation manager (Thomson Reuters, New York, USA). Based on the PRISMA procedure, duplicated articles were excluded and the titles and abstracts of the remaining papers were screened sequentially for inclusion in full-text evaluation by the first two authors. Differences between the reviewers were resolved through discussion.

Data collection process and data items

The extracted data items include name of the first author, publication year, mean/median age of the study participants, sample size, variables related to the knowledge of the study subjects about cervical cancer. The data were extracted from the included articles using piloted excel data extraction sheet developed by the first author.

Methodological quality appraisal of the included studies

The validity and methodological quality of all included studies were assessed using Joanna Briggs Institute Critical Appraisal Checklist for systematic review [21]. The tool consists of eight criteria that were checked as ‘yes’, ‘no’, ‘unclear’ or ‘not applicable’. After carefully evaluating the included articles against each criterion, studies were finally classified in to three groups; a study that fulfilled > 80% of the criteria was considered as ‘good quality’. Similarly a study that scored 50–80 and < 50% were rated as ‘fair’ and ‘poor’ quality, respectively. Fortunately, all the included studies scored > 80 and judged methodologically good.

Data synthesis

Descriptive statistics, such as: simple counts, ranges and percentages were used to present the synthesized data. A systematic narrative synthesis was provided in which summary results were presented using text and table. To pool the overall knowledge of the women about cervical cancer meta-analysis was performed using STATA v 14 (Stata Corp. College Station, TX, USA) using a random effect model. The heterogeneity of the included studies was assessed using the I2 test and I2 = > 50% considered as high heterogeneity among the results of the included studies.

Operational definition

Knowledge

The included studies used a series of different number of items to measure knowledge. The level of knowledge was measured using items related to risk factors, signs and symptoms, treatment options, and prevention methods and early detection measures of cervical cancer. Studies used the cumulative mean score of the participants about cervical cancer to measure their knowledge. Based on this, they labeled as poor knowledge for those who had scored less than the mean and good knowledge for those who had scored greater than or equal to the mean value.

Results

Search results

From the computerized systematically searched databases and other sources, a total of 116 articles were retrieved and sequentially screened for inclusion in the analysis as depicted in PRISMA flow chart (Fig. 1) [20]. Twenty-six articles met our inclusion criteria and were included in the systematic review and meta-analysis.

Fig. 1
figure1

The PRISMA flow diagram of literature selection

Characteristics of the included studies

The characteristic of the included studies is summarized in (Table 1). All included studies were published in the period of 2013 and 2020 and used a cross-sectional study design to describe the knowledge of women on cervical cancer. These articles used questionnaires adapted from previously published similar articles to generate data.

Table 1 Descriptive summary of studies included in the systematic review

Most of the studies were reported from the four regions of the country; Tigri, Amhara, Oromia and Southern Nations, Nationalities and Peoples regions (SNNP). Two articles [22, 23] from Addis Ababa and one article [24] was from Sidama regional state. The number of participants in each included article varied from 154 [25] to 1186 [26]. Overall, this review contains reports of 14,549 study participants. The reported age group and the mean age of the participants were variable. However, all participants were in the age group of 15–88 years and the mean age ranges between 20.5–38 years. The majorities of the participants were married and had no formal education. With regard to the HIV status of the study participants, two of the included studies employed all HIV-positive women [27, 28]. The other three studies, [24,25,26] reported the proportion of HIV positive women at 5.5%. 8.7 and 22%, respectively. The remaining articles had no information about the HIV status of the study participants.

Knowledge of women on cervical cancer

The pooled prevalence of women who had ever heard about cervical cancer in Ethiopia was 56% (95% CI: 47–66). Largely, mass-media (television/radio) mentioned as the main source of information about the disease. Sadly, the pooled proportion of knowing HPV as the main cause of cervical cancer was at 21% (95% CI: 13–30) which is very low. Similarly, the pooled prevalence of identifying at least one risk factor, one symptom of cervical cancer and ever heard of cervical cancer screening was at 52% (95% CI: 39–64), 43% (95% CI: 26–60) and 39%(95% CI:24–55), respectively. However, heterogeneity was very high (I2 = > 98%) and the result must be interpreted with caution (Table 2).

Table 2 Pooled estimates for some of the selected variables on knowledge about cervical cancer

Overall knowledge about cervical cancer

The reported good knowledge level of the participants about cervical cancer by the included studies ranges from 19.9% [29] to 82.5% [26] (Table 3). The pooled overall knowledge was at 43% (95% CI: 33–53) (Fig. 2).

Table 3 The proportion of good knowledge reported by the included studies about cervical in Ethiopia
Fig. 2
figure2

Frost plot showing the overall knowledge of cervical cancer in Ethiopia

On top of this, thirteen articles had reported about cervical cancer screening history of the study participants and the pooled prevalence of previous screening history was at 14% (95% CI: 9–20, I2 = 98.6%).

Discussion

The incidence and prevalence of cervical cancer are higher in the developing world due to several reasons such as lack of awareness regarding HPV infection, absence of organized cervical cancer education, screening and vaccination programs. Knowledge about the disease provides a vital prospect to undertake comprehensive prevention and control strategies in the community. Therefore, this particular review summarized articles containing information about the knowledge of Ethiopian women about cervical cancer as an entry point for the prevention and control of the disease.

In this review, about 56% (95% CI: 47–66) of women had ever heard about cervical cancer. Mass-media (television/radio) was the most frequently reported source of information about the disease. The proportion of good knowledge by the included studies ranges from 19.9% [29] to 82.5% [26] and the pooled overall good knowledge about cervical cancer gauged at 43% (95% CI: 33–53) which is considered as very low. Hence, education about HPV, cervical cancer and associated prevention methods must be strenghned and has to be integrated with sexual and reproductive health, antenatal health system in health facilities, universities and various associations. A similar review article by Perlman et al. showed that the levels of knowledge on cervical cancer and HPV were consistently low in Sub-Sharan Africa [30]. Similarly, a review by Cunningham and his colleague stated that there is a broad knowledge gap concerning HPV and cervical cancer among African women [31]. A low level of knowledge of cervical cancer among Indian women is also reported by Husain et al. [32]. In contrast, overall good knowledge of cervical cancer was reached as high as 78.6% in Saudi Arabia [33] which might be because of their better socio-economic status than Ethiopia.

In our review the pooled proportion of knowing HPV as the main cause of cervical cancer was at 21% (95% CI: 13–30). A global-based review by Klug and colleagues on knowledge about infection with HPV showed that the knowledge of the general public about HPV infection was poor and the proportion of participants who even had heard of the term HPV varied from 13 to 93% [34]. A similar review article in Iran by Taebi et al. corroborated with our report of a low level of knowledge about HPV [35]. Taken together, women’s knowledge was very low across different continents. Therefore, increasing the knowledge of women about HPV could empower them to make an informed decision regarding participation with cervical cancer prevention approaches [36].

The pooled prevalence of identifying at least one risk factor, one symptom of cervical cancer and ever heard of cervical cancer screening was at 52% (95% CI: 39–64), 43% (95% CI: 26–60) and 39%(95% CI:24–55), respectively. These figures imply that there is a relatively low level of information about cervical cancer among Ethiopian women. This review justifies an urgent need for government and non-government organizations, health-care providers and other stakeholders to join hands together to educate women, create massive social awareness to reduce the risk of having cervical cancer in the community [32, 33].

Avoiding or minimizing risk factors and early detection of precancerous cervical lesions are key to reduce the incidence and prevalence of cervical cancer. In this review the pooled proportion of women who knew that cervical cancer can be preventable was at 55% (95% CI: 46–63) (Table 2) which is suboptimal. Cervical cancer is potentially preventable hence there is a need to diversify strategies to reach women though different communication channels. Furthermore, approaches to increase uptake of screening practice and introduction of the latest point of care screening tools to the lowest level health tier system can have a profound impact in bringing awareness and raising their knowledge [37].

One of the prominent means of cervical cancer prevention is screening. In the present study, thirteen articles had reported about cervical cancer screening history of the study participants and the pooled prevalence of previous screening practice was at 14% (95% CI: 9–20, I2 = 98.6%). The reported poor knowledge (43%) about cervical cancer might be linked with this poor screening uptake. It has been reported that the knowledge of women on cervical cancer was a determinant factor for cervical cancer screening uptake [38]. Further, the majority of women in this review had no formal education. Literacy was also reported to be an independently associated factor with cervical cancer screening uptake [39]. According to a review by Desalegn et al, the pooled prevalence of cervical cancer screening uptake among HIV-positive women in Ethiopia was about 18% [38] which is slightly higher than our report. In Ethiopia, HIV-positive women had better priority for cervical cancer screening than the general public [40] which might explain the relativly higher screening uptake of this review. Although our review didn’t put attempt to find out factors that limit the uptake of cervical cancer screening in Ethiopia, Desalegn et al. review showed that educational status of women, knowledge of women on cervical cancer, and perceived susceptibility were significantly associated with cervical cancer screening uptake [38]. A similar review by Lim and colleagues aimed at identifying barriers to utilize cervical cancer screening in Sub Sahara Africa showed that low level of awareness about cervical cancer prevention services, embarrassment and possible violation of privacy, lack of spousal support, societal stigmatization, cost of accessing services and health service factors like proximity to the facility, facility navigation, waiting time and health care personnel attitude were the main factors the limit women to uptake screening [41].

Taken together, there is a need to improve the existing national strategies of cervical cancer screening [40] uptake. An effective screening and integrated sustainable education programs about the general picture of cervical cancer can help to increase public awareness and eventually can lead to a significant reduction in morbidity and mortality associated with the disease [42, 43].

Strength and limitations

To the best of our knowledge, this systematic review reported the latest summarized finding of knowledge of women on cervical cancer in the Ethiopian context. However, our finding should be interpreted with caution due to some drawbacks; all the studies were reported from the four regions and the Addis Ababa city administration. The absence of data from the rest of the regions in the country might bias the overall national estimate in to these regions. The other snare of this review is the presence of high heterogeneity between the included articles.

Conclusion

The result of this review showed that the overall knowledge about cervical cancer was found to be poor in Ethiopia that needs an improvement as the disease is increasing. This study urges the stake holder’s engagement in the battle like the provision of organized education at various levels from school to house to house using different mainstream Medias and associations.

Availability of data and materials

All the generated data in this review are included in the manuscript. The original data can be obtained from the principal investigator upon request.

Abbreviations

HPV:

Humanpapillom Virus

HIV:

Human Immunodeficiency virus

Pap:

Papaniculo test

VIA:

Visual Inspection with Acetic acid

WHO:

World Health Organization

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analysis

SNNP:

Southern Nations, Nationalities and Peoples regions

References

  1. 1.

    Bruni L, Barrionuevo-Rosas L, Albero G, Serrano B, Mena M, Gómez D et al. ICO/IARC information Centre on HPV and Cancer (HPV information Centre). Human Papillomavirus and Related Diseases in the World. Summary Report 2017. http://www.hpvcentre.net/statistics/reports/XWX.pdf. Accessed 13 April 2018.

  2. 2.

    World Health Organization. Ethiopia cancer fact sheet. 2018. http://gco.iarc.fr/today/data/factsheets/populations/231-ethiopia-fact-sheets.pdf. Accessed 3 Oct 2018.

  3. 3.

    Bruni L, Albero G, Serrano B, Mena M, Gómez D, Muñoz J, Bosch FX, de Sanjosé S. ICO/IARCInformation Centre on HPV and Cancer (HPV Information Centre). Human Papillomavirus and Related Diseases in the World. Summary Report 17 June 2019. Available at: https://hpvcentre.net/statistics/reports/XWX.pdf. Accessed 20 Dec 2020.

  4. 4.

    Melek A, Bayik A. Visual inspection with acetic acid in cervical Cancer screening. Cancer Nurs. 2011;34(2):158–63. https://doi.org/10.1097/NCC.0b013e3181efe69f.

    Article  Google Scholar 

  5. 5.

    Sharma G, Dua P, Agarwal SM. A Comprehensive Review of Dysregulated miRNAs Involved in Cervical Cancer. Curr Genomics. 2014;15(4):310–23. Epub 2014 Aug. https://doi.org/10.2174/1389202915666140528003249.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  6. 6.

    WHO. Cervical Cancer: Estimated Incidence, Mortality and Prevalence Worldwide in 2012. WHO. 2012. http://globocan.iarc.fr/old/FactSheets/cancers/cervix-new.asp. Accessed 30 Jan 2018.

  7. 7.

    Agency CS. Ethiopian demographic health survey; 2011.

    Google Scholar 

  8. 8.

    WHO. Human papillomavirus (HPV) and cervical cancer. In: WHO Media center. WHO. http://www.who.int/mediacentre/factsheets/fs380/en/. Accessed 1 Feb 2018.

  9. 9.

    WHO. Latest global cancer data. 2018. http://www.who.int/cancer/PRGlobocanFinal.pdf. Accessed 3 Oct 2018.

  10. 10.

    WHO. Guidelines for screening and treatment of precancerous lesions for cervical cancer prevention. Geneva, Switzerland: World Health Organization; 2013.

    Google Scholar 

  11. 11.

    Kambouris M, Chini V, Daskalaki A. HPV detection and genotyping using the Luminex xMAP technology. 2010. http://www.irma-international.org/viewtitle/40440/. Accessed 15 Nov 2018.

  12. 12.

    Maine D, Hurlburt S, Greeson D. Cervical Cancer prevention in the 21st century: cost is not the only issue. Am J Public Health. 2011;101(9):1549–55. https://doi.org/10.2105/AJPH.

    Article  PubMed  PubMed Central  Google Scholar 

  13. 13.

    Santos-Lopez G, Marquez-Dominguez L, Reyes-Leyva J, Vallejo-Ruiz V. General aspects of structure, classification and replication of human papillomavirus. Rev Med Inst Mex Seguro Soc. 2015;53(2):S166–71.

    PubMed  Google Scholar 

  14. 14.

    WHO. Human papillomavirus (HPV) and cervical cancer. 2016. http://www.who.int/mediacentre/factsheets/fs380/en/. Accessed 13 April 2018.

  15. 15.

    Ali F, Kuelker R, Wassie B. Understanding cervical cancer in the context of developing countries. Ann Trop Med Public Health. 2012;5(1):3–15. https://doi.org/10.4103/1755-6783.92871.

    Article  Google Scholar 

  16. 16.

    Anorlu RI. Cervical cancer: the sub-Saharan African perspective. Reprod Health Matters. 2008;16(32):41–9. https://doi.org/10.1016/s0968-8080(08)32415-x.

    Article  PubMed  Google Scholar 

  17. 17.

    Leto M, Santos Junior GF, Porro AM, Tomimori J. Human papillomavirus infection: etiopathogenesis, molecular biology and clinical manifestations. An Bras Dermatol. 2011;86(2):306–17.

    Article  Google Scholar 

  18. 18.

    García DA, Cid-Arregui A, Schmitt M, Castillo M, Briceño I, Aristizábal FA. Highly sensitive detection and genotyping of HPV by PCR multiplex and Luminex Technology in a Cohort of Colombian women with abnormal cytology. Open Virol J. 2011;5:70–9. https://doi.org/10.2174/1874357901105010070.

    Article  PubMed  PubMed Central  Google Scholar 

  19. 19.

    Dulla D, Daka D, Wakgari N. Knowledge about cervical cancer screening and its practice among female health care workers in southern Ethiopia: a cross-sectional study. Int J Women's Health. 2017;9:365.

    Article  Google Scholar 

  20. 20.

    Shamseer L, Moher D, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. Bmj. 2015;2(349):g7647. https://doi.org/10.1136/bmj.g7647.

  21. 21.

    JBI. Checklist for Analytical Cross Sectional Studies 2020. https://joannabriggs.org/sites/default/files/2020-08/Checklist_for_Analytical_Cross_Sectional_Studies.pdf. Accessed 30 Oct 2020.

  22. 22.

    Getachew S, Getachew E, Gizaw M, Ayele W, Addissie A, Kantelhardt EJ. Cervical cancer screening knowledge and barriers among women in Addis Ababa, Ethiopia. PLoS One. 2019;14(5). https://doi.org/10.1371/journal.pone.0216522.

  23. 23.

    Segni MT, Demissie HF, Tadesse DM, Amdemichael R, Mamo YT, Worku A. Level of knowledge and associated factor toward cervical Cancer among women age (21-64) years visiting health facilities in Gulele sub-city Addis Ababa Ethiopia. J Pancreas. 2017;18(1):44–8.

    Google Scholar 

  24. 24.

    Kasim J, Kalu A, Kamara B, Alema HB. Cervical Cancer Screening Service Utilization and Associated Factors among Women in the Shabadino District, Southern Ethiopia. J Cancer Epidemiol. 2020;3(6398394). https://doi.org/10.1155/2020/6398394.

  25. 25.

    Saleem A, Bekele A, Fitzpatrick MB, Mahmoud EA, Lin AW, Velasco HE, et al. Knowledge and awareness of cervical cancer in Southwestern Ethiopia is lacking: A descriptive analysis. PLoS One. 2019;14(11). https://doi.org/10.1371/journal.pone.0215117.

  26. 26.

    Bayu H, Berhe Y, Mulat A, Alemu A. Cervical cancer screening service uptake and associated factors among age eligible women in Mekelle zone, northern Ethiopia, 2015: a community based study using health belief model. PLoS One. 2016;11(3):e0149908.

    Article  Google Scholar 

  27. 27.

    Erku DA, Netere AK, Mersha AG, Abebe SA, Mekuria AB, Belachew SA. Comprehensive knowledge and uptake of cervical cancer screening is low among women living with HIV/AIDS in Northwest Ethiopia. Gynecol Oncol Res Pract. 2017;4(1):20.

    Article  Google Scholar 

  28. 28.

    Shiferaw N, Brooks MI, Salvador-Davila G, Lonsako S, Kassahun K, Ansel J, et al. Knowledge and awareness of cervical Cancer among HIV-infected women in Ethiopia. Obstet Gynecol Int. 2016;2016. https://doi.org/10.1155/2016/1274734.

  29. 29.

    Mengesha A, Messele A, Beletew B. Knowledge and attitude towards cervical cancer among reproductive age group women in Gondar town, North West Ethiopia. BMC Public Health. 2020;20(1):209.

    Article  Google Scholar 

  30. 30.

    Perlman S, Wamai RG, Bain PA, Welty T, Welty E, Ogembo JG. Knowledge and awareness of HPV vaccine and acceptability to vaccinate in sub-Saharan Africa: a systematic review. PLoS One. 2014;9(3):e90912. https://doi.org/10.1371/journal.pone.0090912.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  31. 31.

    Cunningham MS, Davison C, Aronson KJ. HPV vaccine acceptability in Africa: a systematic review. Prev Med. 2014;69:274–9.

    Article  Google Scholar 

  32. 32.

    Husain R, Ramya D, Pradeep M, Govindaraju S, Ramakrishnan V. Knowledge on human papillomavirus and cervical cancer awareness among women in South India. Saudi J Health Sci. 2019;8(2):81–7. https://doi.org/10.4103/sjhs.sjhs_69_18.

    Article  Google Scholar 

  33. 33.

    Malibari SS. Knowledge about cervical Cancer among women in Saudi Arabia. Egypt J Hosp Med. 2018;70(10):1823–5.

    Article  Google Scholar 

  34. 34.

    Klug SJ, Hukelmann M, Blettner M. Knowledge about infection with human papillomavirus: a systematic review. Prev Med. 2008;46(2):87–98. https://doi.org/10.1016/j.ypmed.2007.09.003.

    Article  PubMed  Google Scholar 

  35. 35.

    Taebi M, Riazi H, Keshavarz Z, Afrakhteh M. Knowledge and attitude toward human papillomavirus and HPV vaccination in Iranian population: a systematic review. Asian Pac J Cancer Prev. 2019;20(7):1945–9.

    Article  Google Scholar 

  36. 36.

    Patel H, Jeve YB, Sherman SM, Moss EL. Knowledge of human papillomavirus and the human papillomavirus vaccine in European adolescents: a systematic review. Sex Transm Infect. 2016;92(6):474–9.

    Article  Google Scholar 

  37. 37.

    Johnson LG, Armstrong A, Joyce CM, Teitelman AM, Buttenheim AM. Implementation strategies to improve cervical cancer prevention in sub-Saharan Africa: a systematic review. Implement Sci. 2018;13(1):28. https://doi.org/10.1186/s13012-018-0718-9.

    Article  PubMed  PubMed Central  Google Scholar 

  38. 38.

    Dessalegn MB. Cervical Cancer screening uptake and associated factors among HIV-positive women in Ethiopia: a systematic review and meta-analysis. Adv Prev Med. 2020;2020. https://doi.org/10.1155/2020/7071925.

  39. 39.

    Lindau ST, Tomori C, Lyons T, Langseth L, Bennett CL, Garcia P. The association of health literacy with cervical cancer prevention knowledge and health behaviors in a multiethnic cohort of women. Am J Obstet Gynecol. 2002;186(5):938–43. https://doi.org/10.1067/mob.2002.122091.

    Article  PubMed  Google Scholar 

  40. 40.

    Health FDRoEMo. Guideline for cervical Cancer prevention and control in Ethiopia. 2015. https://www.iccp-portal.org/system/files/plans/Guideline%20Eth%20Final.pdf. Accessed 3 Nov 2018.

  41. 41.

    Lim JNW, Ojo AA. Barriers to utilisation of cervical cancer screening in sub Sahara Africa: a systematic review. Eur J Cancer Care. 2017;26(1):e12444. https://doi.org/10.1111/ecc.12444.

    Article  Google Scholar 

  42. 42.

    Gönenç İM, Abbas MN, Çalbayram N, Yılmaz S. A review of knowledge and attitudes of young people on cervical cancer and HPV vaccination. J Public Health. 2020;28(1):97–103. https://doi.org/10.1007/s10389-018-01012-w.

    Article  Google Scholar 

  43. 43.

    Daniyal M, Akhtar N, Ahmad S, Fatima U, Akram M, Asif HM. Update knowledge on cervical cancer incidence and prevalence in Asia. Asian Pac J Cancer Prev. 2015;16(9):3617–20.

    Article  Google Scholar 

Download references

Acknowledgments

We would like to thank Bahir Dar and Addis Ababa Universities and CDT-Africa for the provided opportunity to undertake this review.

Funding

We have received no fund for this particular review.

Author information

Affiliations

Authors

Contributions

AD and TA conceived the review topic and objectives. AD, DM and YM participated in the study selection, data extraction and analysis. EM, TA and YM reviewed the manuscript critically for its scientific content. All authors reviewed and approved the manuscript.

Corresponding author

Correspondence to Awoke Derbie.

Ethics declarations

Ethics approval and consent to participate

Not applicable in this section.

Consent for publication

Not applicable in this section.

Competing interests

Authors declare that they have no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Additional file 1:

Search strategy.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Derbie, A., Mekonnen, D., Misgan, E. et al. Low level of knowledge about cervical cancer among Ethiopian women: a systematic review and meta-analysis. Infect Agents Cancer 16, 11 (2021). https://doi.org/10.1186/s13027-021-00350-x

Download citation

Keywords

  • Knowledge
  • Cervical cancer
  • Ethiopia