Individual and community-level determinants of cervical cancer screening among Kenyan women: a multilevel analysis of a Kenya demographic and health surveys 2022.
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BACKGROUND: Though studies reported factors determining cervical cancer screening, investigating community-level determinants was limited and not conclusive. This study included both individual- and community-level indicators to investigate factors affecting cervical cancer screening nationwide in Kenyan reproductive-age women. METHODS: The 2022 Kenyan Demography and Health Survey data was used for the study. A total of 16,716 reproductive-age women were included in the analysis. A multilevel analysis using generalized linear mixed models with the log-binomial function was applied to examine the association between individual- and community-level factors with cervical cancer screening. The goodness of a fit model was identified by using deviance, and the model with the lowest deviance was considered as the best-fitted model. Adjusted odds ratio (AOR) with its 95% confidence interval (CI) at p-value < 0.05 was used to declare significantly associated factors with women's cervical cancer screening. RESULTS: The pooled prevalence of cervical cancer screening in Kenya was 7.40% (95% CI: 7.02%, 7.78%). Women's age, marital status, educational status, wealth index, employment status, media exposure, parity, contraceptive use, visited health facility last 12 months, self-reported sexually transmitted disease, and geographical zone were significantly associated with cervical cancer screening. CONCLUSIONS: Policies should give emphasis to community-based education, health insurance coverage to overcome the financial burden of the community, create opportunities for women`s employment, strengthen media exposure to educate women, and increase the coverage of contraceptive use. Moreover, infrastructure accessibility and awareness creation on the benefits of facility visits and medical checkups could improve cervical cancer screening in Kenya.