Proportion and Determinants of Cervical Cancer Knowledge Among Female Sex Workers in Kilimanjaro: A Community-Based Cross-Sectional Study guided by the Socioecological Model

Background

Cervical cancer remains a significant public health issue in Tanzania, with high morbidity and mortality rates largely driven by limited awareness and access to preventive services. Female sex workers (FSWs) are particularly vulnerable due to their increased exposure to HPV through multiple sexual partners. This study aimed to assess the level of cervical cancer knowledge and associated factors among FSWs in Kilimanjaro region.

Methods

A community-based cross-sectional study was conducted among 351 FSWs aged 25-49 years in hotspot areas of Kilimanjaro region between June and July 2024. Respondent-driven sampling (RDS) was employed. Data were collected using an interviewer-administered questionnaire. Statistical analysis was performed with SPSS version 27.0, and Poisson regression with robust error variance was used to assess associations. Variables with a p-value less than 0.05 in the multivariate analysis were considered statistically significant.

Results

The mean age of study participants was 36.11±5.24 years, with 49.3% aged 25–34 years. The majority (66.1%) resided in urban areas. About 52.1% had attained primary education and only 2.6% had a college or university education. Additionally, 69.5% had at least two children, and 49.9% were separated or divorced.

Among the 351 FSWs studied, 89.0% were aware of cervical cancer. However, only 19.9% had a high level of knowledge about the disease and its prevention, with only 31.2%, 27.8% and 34.5% demonstrating high knowledge of risk factors, symptoms and signs, and preventive measures, respectively. Key factors significantly associated with cervical cancer knowledge included residence (APR:1.17, 95% CI:1.12-1.35), age at sexual debut (APR: 1.15, 95% CI: 1.05-1.26), and (APR: 1.18, 95% CI: 1.09-1.27), age at starting sex work (APR: 1.38, 95% CI: 1.12-1.69) and alcohol consumption (APR: 1.08, 95% CI: 1.002-1.16).

Conclusion

Despite high awareness of cervical cancer among FSWs, comprehensive knowledge about its risk factors, symptoms, and prevention remains low. These findings highlight the urgent need for targeted educational interventions that consider differences in residence, age at sexual debut, age at starting commercial sex, and alcohol consumption.