Individual and community-level determinants of cervical cancer screening in Zimbabwe: a multilevel analysis of a nationwide survey

Cervical cancer screening that has proven to reduce the burden of cervical cancer elsewhere, but remains low in Zimbabwe, a country with the highest disease burden in Sub-Saharan Africa. The ministry of health’s 2018-target was to screen 25% of the women aged 25–59 years though cross-sectional district-based studies have indicated sub-optimal screening. The main objective of the study was to establish the determinants of cervical cancer screening in Zimbabwe using multi-level modelling to take into account individual, household, and community factors simultaneously. We used data from the 2015 Zimbabwe Demographic and Health Survey including 9955 women aged 15–49 years nested within 400 communities. We used two-step multi-level multivariable regression analyses. Few (13.44%) women had ever screened for cervical cancer. We observed higher odds of ever been screened among women; aged 31–49 years (OR = 2.01; 95% CI 1.72–2.34), working (OR = 1.35; 95% CI 1.17–1.55), with health insurance (OR = 1.95; 95% CI 1.63–2.34 ), who ever used modern contraceptives (OR = 1.51 ; 95% CI 1.22–1.86), with exposure to multiple media (OR = 1.27; 95% CI 1.03–1.58), and residing in communities with high proportion of women with; favorable attitude towards wife beating (OR = 1.21; 95% CI1.04-1.41), and with a non-poor wealth index distribution (OR = 1.54; 95% CI 1.14–2.05). The study findings point at the co-existence of individual and community factors in shaping decision to screen and call for policies that address inequities in access to resources as well as disempowering cultural attitudes.