Barriers to Cervical Cancer Screening in Rural Communities of Rivers State, Nigeria
Nduye Christie Tobin Briggs *
Department of Community Medicine, Faculty of Clinical Sciences, Rivers State University, Port Harcourt, Nigeria.
Obeleye Tom-George
School of Public Health, University of Port Harcourt, Rivers State, Nigeria.
*Author to whom correspondence should be addressed.
Abstract
Background: Cervical cancer remains a leading cause of cancer‑related mortality among women in Sub‑Saharan Africa, yet screening coverage remains critically low, particularly in rural Nigeria. This study assessed the barriers to cervical cancer screening and identified predictors of non‑uptake among women aged 25–65 years in rural communities of Rivers State, Nigeria.
Methods: A community‑based analytic cross‑sectional study was conducted from April to September 2025 among 589 women selected through multistage sampling. A structured, interviewer‑administered questionnaire adapted from a validated tool was used. Data were analysed using SPSS version 27.0. Descriptive statistics, bivariate analysis, and multivariable binary logistic regression with the enter method were used. Statistical significance was set at p < 0.05. Model diagnostics included the Hosmer‑Lemeshow test, Nagelkerke R², Area Under the Receiver Operating Characteristic curve (AUROC), and sensitivity analysis.
Results: The mean age was 41.3 ± 11.7 years; 61.3% were aged 35–54 years. Only 52 women (8.8%) had ever been screened for cervical cancer. The most common individual barrier was lack of knowledge (86.6%), followed by fear of pain or results (65.2%). Husband's disapproval (58.5%) was the leading socio‑cultural barrier, while cost (76.2%) and distance >5 km to a health facility (71.5%) were the predominant health system barriers. Independent predictors of never being screened were no formal education (AOR = 9.84, 95% CI: 3.21–30.15), farming/fishing occupation (AOR = 5.76, 95% CI: 2.10–15.80), monthly income <₦30,000 (AOR = 8.42, 95% CI: 2.98–23.82), never having heard of cervical cancer (AOR = 14.53, 95% CI: 4.87–43.36), and distance >5 km to facility (AOR = 3.21, 95% CI: 1.56–6.60). The model demonstrated excellent discrimination (AUROC = 0.86) and good fit (Hosmer‑Lemeshow p = 0.621).
Conclusion: Cervical cancer screening uptake among rural women in Rivers State is extremely low (8.8%). Multilevel barriers, including knowledge deficits, fear, husband's disapproval, cost, distance, low education, and poverty, strongly predicted non‑screening. Targeted community‑based education, male engagement initiatives, mobile screening services, and subsidised care are urgently needed to address these barriers and improve screening coverage in this underserved population.
Keywords: Cervical cancer screening, Barriers, Screening uptake, Rural women, Socio-cultural factors.