Female Sex Workers and Cervical Cancer Screening in Kilimanjaro Region: Uptake and Behavioural Determinants. A Community-Based Cross-Sectional Study Using the Health Belief Model

  1. Gumbo D. Silas
  2. Innocent H. Uggh
  3. Bernard Njau
  4. Esther Majaliwa
  5. Patricia Swai
  6. Alma Redson
  7. Gaudensia Olomi
  8. John E. Mtenga
  9. Prisca Marandu
  10. Leah Mmari
  11. Happiness Kilamwai
  12. Bariki Mchome
  13. Blandina T. Mmbaga
  14. Alex Mremi
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Abstract

Objective

Cervical cancer is the 4th most leading cause of cancer-related deaths among women globally. Despite its significance, the uptake and behavioural determinants of screening among female sex workers (FSWs) in Tanzania remain poorly understood. This study aimed to address this gap among this risky population.

Design

A community-based cross-sectional study design.

Setting

This hotspot-based study was conducted at the community level, in two councils within Kilimanjaro Region, Tanzania.

Participants

This study involved 351 FSWs aged 25-49 years, enrolled between May and December 2024, with no history of total hysterectomy. Data was collected using an interviewer-administered questionnaire using the Respondent-Driven Sampling (RDS) technique with 0.75-0.92 Cronbach’s Alpha values for internal consistency of item questions. Analysis was carried out using SPSS version 27.0. Binary logistic regression was performed, with variables having a p-value less than 0.05 in multivariate analysis considered statistically significant.

Main outcome measures

Cervical cancer screening uptake.

Results

Out of 351 FSWs enrolled, the mean age was (36.11±5.24) years, with most living in urban areas 232(66.1%) and having completed primary education 183(52.1%). Only 17 (4.8%) had ever been screened for cervical cancer in their lifetime with the highest screening rates observed among those aged 45-49 years 3(12.5%), and those residing in urban areas 13(5.6%).

After adjusting for the modifying factors, perceived severity (AOR: 3.25, 95%CI: 1.16-9.07), perceived benefits (AOR: 3.61, 95%CI: 1.10-11.84), self-efficacy (AOR: 3.59, 95%CI: 1.18-10.96), and cues to action (AOR:3.61, 95%CI:1.28-10.15) were significantly associated with the uptake of cervical cancer screening among this population.

Conclusion

The uptake of cervical cancer screening among FSWs in Kilimanjaro region was extremely low. To address this challenge, targeted interventions that address key behavioural determinants, such as perceived severity, perceived benefits, self-efficacy, and cues to action, are highly recommended for this population.

Article Summary

Strengths and Limitations of this study

  • This was the first study in Tanzania focusing on FSWs, a high-risk and often underserved population.

  • This study serves as a baseline for future studies and offers critical data to inform national policies, public health strategies and programs for cervical cancer prevention tailored to vulnerable groups.

  • The use of the Health Belief Model (HBM) in this study, provides a structured understanding of behavioural determinants of cervical cancer screening uptake among this population.

  • The use of Respondent-driven sampling (RDS) techniques in this study reduces sampling bias and provides robust data, thereby enhancing the reliability of the findings.

  • However, the reliance on self-reported information for certain aspects of this study may have impacted on the accuracy of our findings due to potential recall and social desirability biases. Therefore, future studies should consider using more objective measures to minimize these biases.

Article activity feed

  1. Version published to 10.1101/2025.05.01.25326792v2 on medRxiv
  2. Version published to 10.1101/2025.05.01.25326792v1 on medRxiv