Determinants and Socioeconomic Inequalities in Breast and Cervical Cancer Screening in Tajikistan: Evidence From the 2023 Demographic and Health Survey.
This study examined the determinants of breast and cervical cancer screening and quantified socioeconomic inequalities in service use.
We analyzed data from women age 15-49 years from the 2023 Tajikistan Demographic and Health Survey. The outcomes were self-reported ever having received a clinical breast examination for breast cancer and ever having been tested for cervical cancer. The prevalence was estimated using weighted descriptive statistics and Rao-Scott chi-square tests. Determinants were examined with multivariable logistic regression, reporting adjusted odds ratios (AORs), and 95% confidence intervals. Socioeconomic inequality was assessed using concentration curves and concentration indices, accounting for the complex survey design.
The final sample size was 9,824. Breast and cervical cancer screening prevalence was 6.2% and 9.3%, respectively. Uptake increased with age (25-34 years: breast AOR = 2.68; cervical AOR = 2.41; 35-49 years: breast AOR = 3.54; cervical AOR = 3.27, v 15-24 years) and with household wealth (richest v poorest, cervical AOR = 1.95). Higher screening odds were associated with parity, recent health care visits, contraceptive use, and media exposure, whereas lower odds were associated with nonmotorized transport use. The prevalence was greater in urban areas. Concentration indices showed significant pro-rich inequality for both screening services (breast = 0.05; cervical = 0.05; P < .001).
Strategies prioritizing integrating screening into reproductive and primary care, expanding outreach to poorer households, ensuring financial protection, and delivering community-based services in rural areas, alongside monitoring equity indicators, are critical to advancing universal access to breast and cervical cancer screening in Tajikistan.
We analyzed data from women age 15-49 years from the 2023 Tajikistan Demographic and Health Survey. The outcomes were self-reported ever having received a clinical breast examination for breast cancer and ever having been tested for cervical cancer. The prevalence was estimated using weighted descriptive statistics and Rao-Scott chi-square tests. Determinants were examined with multivariable logistic regression, reporting adjusted odds ratios (AORs), and 95% confidence intervals. Socioeconomic inequality was assessed using concentration curves and concentration indices, accounting for the complex survey design.
The final sample size was 9,824. Breast and cervical cancer screening prevalence was 6.2% and 9.3%, respectively. Uptake increased with age (25-34 years: breast AOR = 2.68; cervical AOR = 2.41; 35-49 years: breast AOR = 3.54; cervical AOR = 3.27, v 15-24 years) and with household wealth (richest v poorest, cervical AOR = 1.95). Higher screening odds were associated with parity, recent health care visits, contraceptive use, and media exposure, whereas lower odds were associated with nonmotorized transport use. The prevalence was greater in urban areas. Concentration indices showed significant pro-rich inequality for both screening services (breast = 0.05; cervical = 0.05; P < .001).
Strategies prioritizing integrating screening into reproductive and primary care, expanding outreach to poorer households, ensuring financial protection, and delivering community-based services in rural areas, alongside monitoring equity indicators, are critical to advancing universal access to breast and cervical cancer screening in Tajikistan.
Authors
Gupta Gupta, Sarker Sarker, Haider Haider, Mazumder Mazumder, Gupta Gupta, Chakraborty Chakraborty
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