Abstract
<title>Abstract</title> <p>Background: Malawi and Zambia rank highly in cervical cancer burden globally. Despite establishing programs and interventions, cervical cancer screening remains low in the two countries. There is limited evidence on the national prevalence and predictors of cervical cancer screening in both countries. This study assessed the prevalence and factors associated with cervical cancer screening among women aged 15–49 in Malawi and Zambia, using nationally representative data. Methods: We conducted a secondary analysis of data from the 2024 Malawi and Zambia Demographic Health Surveys (DHS), including 17,981 women from Malawi and 11,609 women from Zambia aged 15–49 years. The outcome variable, cervical cancer screening, was assessed using participants’ self-reported history of being screened by a healthcare professional. Descriptive statistics, including frequencies and percentages, were used to summarise participants’ characteristics and estimate the weighted prevalence of cervical cancer screening. Both univariable and multivariable logistic regression analyses were performed to identify the factors associated with cervical cancer screening. Results: The weighted prevalence of cervical cancer screening was 29.7% (95% CI: 28.6, 30.7) in Malawi and 31.6% (95% CI: 30.5, 32.8) in Zambia. In both countries, screening prevalence was highest among women aged 40–49 years (43.4% in Malawi and 47.1% in Zambia), those in formal employment (35.9% and 45.0%, respectively), women living with HIV (WLHIV) (71.5% and 82.1%, respectively), and mobile phone owners (33.2% and 36.5%, respectively). In the multivariable analyses, women aged 40–49 years (aOR = 2.31, 95% CI: 1.89, 2.82) and those in the richest wealth quintile (aOR = 1.52, 95% CI: 1.26, 1.84) had higher odds of cervical cancer screening in Malawi. In Zambia, health insurance coverage (aOR = 1.54, 95% CI: 1.30, 1.83) and modern contraceptive use (aOR = 1.18, 95% CI: 1.06, 1.31) were associated with increased odds of screening. Conversely, HIV-negative women (aOR = 0.20, 95% CI: 0.17, 0.24) and smokers (aOR = 0.43, 95% CI: 0.25, 0.72) in Malawi, as well as Muslim women in Zambia (aOR = 0.34, 95% CI: 0.14, 0.82), had lower odds of undergoing cervical cancer screening. Conclusion: Cervical cancer screening uptake remains low in Malawi and Zambia, with less than one-third of women of reproductive age reporting having ever been screened. Older age, higher socioeconomic status, health insurance coverage, and modern contraceptive use were associated with increased screening uptake, while smoking and certain sociodemographic factors were associated with lower uptake. Targeted interventions addressing these disparities are needed to improve screening coverage and accelerate progress toward cervical cancer elimination.</p>