Abstract
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 Cronbachs 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, SD 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. Keywords: Uptake, Cervical cancer, screening, Female sex workers, Behavioural, Kilimanjaro, health belief model, uptake
Competing Interest Statement
The authors have declared no competing interest.
Funding Statement
This study was in part funded by the German Federal Ministry of Education and Research 01KA2220B. This research was funded in part by the Science for Africa Foundation to the Developing Excellence in Leadership, Training, and Science in Africa (DELTAS Africa) program [Del-22-008] with support from Welcome Trust and the UK Foreign, Commonwealth & Development Office and is part of the EDCPT2 program supported by the European Union.
Author Declarations
I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.
Yes
The details of the IRB/oversight body that provided approval or exemption for the research described are given below:
Ethical approval was obtained from Kilimanjaro Christian Medical University College (PG02/2024), the principal investigator's institution. Approval was also obtained from all local ethics committees to ensure the study adhered to regional and institutional guidelines. All participants were anonymously identified to maintain confidentiality and privacy.
I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.
Yes
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Footnotes
The following Modifications have been made in this Manuscript: 1. The closing statement of the background section that previously read: "Therefore, This Study aims to investigate the uptake and behavioural determinants of cervical cancer screening uptake among Female Sex Workers in Kilimankaro Region in the Health Belief Model Perspective" has been modified to: "In The Health Belief Model Perspective, this study aims to investigate the uptake and behavioural determinants of cervical cancer screening among Female Sex Workers in Kilimanjaro Region." 2. Removed Duplicate of the Theoretical Framework. The figure already exists in the document. The separate attachment of the same figure was removed to avoid confusion. The retained Framework has also been edited.
Data Availability
All data produced in the present study are available upon reasonable request to the authors.
