Temporal Trends and Determinants of Cervical Cancer Screening Before, During, and After the COVID-19 Pandemic in Cameroon

Background: Cervical cancer ranks among the highest causes of mortality in females in Cameroon. Although there are effective screening tools, namely Pap age and HPV tests, women, especially in rural or underserved populations, do not have access to screening utilization. Vulnerability in addressing socio-environmental and healthcare access disparities perpetuates prevention and early detection. Methodology: A descriptive, cross-sectional study was undertaken from January 2018 into December 2024, in five regions of Cameroon: the Centre, South, North, Far North, and Littoral regions. A total of 3,751 women ages 25-65 years agreed to participate and were interviewed with semi-structured questionnaires, as well as health care workers, service providers, and health professionals. The data collected, captured access to screening services, perceived socio-economic and environmental barriers, and actual use of cytological and HPV tests. Results: Participants reported a low screening uptake (78.6% of women screened never). Reporting non-use of services was significantly related to living in rural locations (OR=0.55, p=0.001), low education attainment (OR=1 for none, OR=1.45 for higher education, p=0.003), and lower social coverage (OR=1 for uninsured, OR = 2.30 for insured, p=0.001). The top barriers to accessing services reported by participants were cost, distance to services, and poor information providing (all p=0.001). Less than 10% of health facilities surveyed had the capacity to provide screening services based on technical platforms: no Integrated Health Centers were documented as being equipped, only 1 of 25 Sub-divisional Medical Centers had the capacity to care for screening, and only 3 of 5 district hospitals were functional in care. Conclusion: Barriers such as socio-environmental inequalities, poor infrastructure, and inadequate personnel inhibit the early diagnosis of cervical cancer in Cameroon. Strategies focused on strengthening technical capacity, training staff, and increasing community awareness are essential to improving the uptake of screening and reducing mortality.