Abstract
<title>Abstract</title> <p>Background Cervical cancer remains a major public health challenge in Cameroon. Cervical cancer screening uptake remains low in both urban and rural populations. The COVID-19 pandemic further disrupted preventive healthcare services and may have exacerbated existing sociocultural and structural barriers to screening. This study aimed to evaluate the temporal trends of HPV infection and cytopathological profiles, and to identify the sociodemographic, anthropological, urban-rural, and COVID-19-related determinants associated with non-participation in cervical cancer screening in Cameroon. Methods A cross-sectional study was conducted among 3,751 women aged 25–65 years recruited from urban and rural health facilities in Cameroon between 2016 and 2024. Sociodemographic, anthropological, behavioral, and COVID-19-related data were collected using structured questionnaires. Cervical samples underwent cytopathological examination according to the Bethesda system and HPV molecular testing for genotype identification. Temporal trends were analyzed across three periods: before COVID-19 (2016–2019), during COVID-19 (2020–2021), and after COVID-19 (2022–2024). Multivariate logistic regression and multiple correspondence analysis were performed to identify determinants associated with screening non-participation. Results The screening rate decreased between 2019 (38.6%) and 2020 (21.4% due to COVID-19) and increased to 34.8% in 2024. The screening uptake by urban women was higher than that of rural women (31.2% vs 14.8%; p < 0.001). The prevalence of human papillomavirus (HPV) declined between 2016 (51.1%) and 2024 (30.4%); however, the predominant strains of HPV were HPV-16 (28.7%) and HPV-18 (19.5%). The rate of low-grade squamous intraepithelial lesion (LSIL) was 9.0% and high-grade squamous intraepithelial lesions (HSIL) was 4.0%. Non-participation in screening was associated with being a rural resident (adjusted odds ratio [aOR] = 2.25), lack of health insurance (aOR = 2.88), fear of gynecological examination (aOR = 3.21), preference for traditional medicine (aOR = 2.53) and fear of COVID-19 (aOR = 2.62); for all factors, p < 0.001. Conclusion In Cameroon, barriers to screening for cervical cancer are influenced by interconnected factors which include sociocultural, structural, geographical, and COVID-19-related factors. Rural women are at a significantly higher risk of experiencing a lack of access to healthcare as well as the effects of sociocultural constraints.</p>