Excel data extraction.

BackgroundCervical cancer is the fourth most prevalent type of cancer in women globally. Early detection and treatment of precancerous cervical lesions and human papillomavirus (HPV) infection are strongly advised to decrease the incidence of cervical cancer and death. Cervical cancer is a major public health concern in low- and middle-income nations, where screening and treatment options are constrained. Thus, the main objective of this umbrella review was to determine the pooled uptake of cervical cancer screening and its determinants in Africa.MethodsThis study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The protocol for this umbrella review was registered on the International Prospective Register of Systematic Reviews (PROSPERO) with reference number CRD42024518297. We conduct a systematic and comprehensive search by using Google Scholar, PubMed, Scopus, Hinari, and Science Direct, from January 1, 2014, to September 20, 2024. The data were extracted using Microsoft Excel spreadsheet. The methodological quality of the included studies was examined using A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2). The statistical analysis was carried out using STATA version 17, which includes descriptive analysis, forest plots for prevalence, funnel plot, and an Egger test to examine publication bias. A random-effects model was used to determine the pooled effect estimate. Publication bias was checked by using the funnel plot and Egger’s tests.ResultsThis umbrella review included 11 systematic reviews and meta-analysis studies across Africa with a total of 143,327 study participants. The overall prevalence of cervical cancer screening practice in Africa was 20.94% (95% CI: 15.84%–26.04%). Women’s level of knowledge (AOR: 3.22, 95% CI: 1.64–6.33), positive attitude toward CCS (AOR: 2.48, 95% CI: 2.18–2.81), perceived vulnerability to cervical cancer (AOR = 3.57, 95% CI: 2.75, 4.63), and history of STIs (AOR = 4.89, 95% CI: 3.14, 7.62) were significantly associated with cervical cancer screening practice. In conclusion, the combined estimate of cervical cancer screening use in Africa remains much lower (20.94%) than the World Health Organization (WHO) recommendations target (70%). It indicates that there is a large gap that requires being addressed in collaboration to reduce the burden of cervical cancer and its morbidity and mortality across the continent. Therefore, healthcare professionals, policymakers, and other stakeholders shall implement effective strategies such as empowering women, improving the knowledge and attitude towards cervical cancer screening, advocacy, and expanding screening programs to all eligible women to increase utilization of cervical cancer screening.

背景：宫颈癌（Cervical cancer）是全球女性群体中第四大高发恶性肿瘤。学界强烈建议通过早期发现并治疗宫颈上皮内瘤变（precancerous cervical lesions）与人乳头瘤病毒（human papillomavirus, HPV）感染，以降低宫颈癌的发病率与死亡率。在筛查与治疗手段受限的中低收入国家，宫颈癌是一项重大公共卫生挑战。因此，本伞状综述（umbrella review）的核心目标是明确非洲地区宫颈癌筛查的合并普及率及其影响因素。

方法：本研究遵循系统评价与荟萃分析首选报告条目（Preferred Reporting Items for Systematic Reviews and Meta-Analyses, PRISMA）规范。本伞状综述的研究方案已在国际系统评价前瞻注册库（International Prospective Register of Systematic Reviews, PROSPERO）注册，注册编号为CRD42024518297。本研究于2014年1月1日至2024年9月20日期间，通过Google Scholar、PubMed、Scopus、Hinari及Science Direct数据库开展系统性全面检索。研究数据通过Microsoft Excel电子表格进行提取。采用系统评价方法学质量评价工具2（A Measurement Tool to Assess Systematic Reviews 2, AMSTAR 2）对纳入研究的方法学质量进行评估。统计分析采用STATA 17版本软件完成，涵盖描述性分析、患病率森林图、漏斗图及Egger检验以评估发表偏倚。本研究采用随机效应模型计算合并效应量，并通过漏斗图与Egger检验验证发表偏倚。

结果：本伞状综述共纳入非洲地区11项系统评价与荟萃分析研究，涉及研究对象总计143327例。非洲地区宫颈癌筛查的总体普及率为20.94%（95%置信区间：15.84%~26.04%）。女性的认知水平（调整后优势比（Adjusted Odds Ratio, AOR）：3.22，95%置信区间：1.64~6.33）、对宫颈癌筛查（Cervical Cancer Screening, CCS）的积极态度（AOR：2.48，95%置信区间：2.18~2.81）、对宫颈癌易感性的认知（AOR=3.57，95%置信区间：2.75~4.63）以及性传播感染（Sexually Transmitted Infections, STIs）病史，均与宫颈癌筛查行为存在显著关联。

结论：综上，非洲地区宫颈癌筛查的合并使用率仅为20.94%，远低于世界卫生组织（World Health Organization, WHO）推荐的70%目标值。这表明非洲地区宫颈癌防控仍存在巨大缺口，需各方协同应对，以降低全大洲的宫颈癌疾病负担与病死率。因此，医疗工作者、政策制定者及其他利益相关方应落实有效干预策略，包括赋予女性权益、提升公众对宫颈癌筛查的认知与态度、开展宣传推广，并将筛查项目覆盖所有符合条件的女性，以提高宫颈癌筛查的使用率。