Resource-constrained countries (RCCs) have the highest burden of cervical cancer (CC) in the world. Nonetheless, although CC can be prevented through screening for precancerous lesions, only a small proportion of women utilise screening services in RCCs. The objective of this study was to examine the magnitude of inequalities of women’s knowledge and utilisation of cervical cancer screening (CCS) services in RCCs. A total of 1,802,413 sample observations from 18 RCC’s latest national-level Demographic and Health Surveys (2008 to 2017–18) were analysed to assess wealth-related inequalities in terms of women’s knowledge and utilisation of CCS services. Regression-based decomposition analyses were applied in order to compute the contribution to the inequality disparities of the explanatory variables for women’s knowledge and utilisation of CCS services. Overall, approximately 37% of women had knowledge regarding CCS services, of which, 25% belonged to the poorest quintile and approximately 49% from the richest. Twenty-nine percent of women utilised CCS services, ranging from 11% in Tajikistan, 15% in Cote d’Ivoire, 17% in Tanzania, 19% in Zimbabwe and 20% in Kenya to 96% in Colombia. Decomposition analyses determined that factors that reduced inequalities in women’s knowledge of CCS services were male-headed households (− 2.24%; 95% CI: − 3.10%, − 1.59%; P < 0.01), currently experiencing amenorrhea (− 1.37%; 95% CI: − 2.37%, − 1.05%; P < 0.05), having no problems accessing medical assistance (− 10.00%; 95% CI: − 12.65%, − 4.89%; P < 0.05), being insured (− 6.94%; 95% CI: − 9.58%, − 4.29%; P < 0.01) and having an urban place of residence (− 9.76%; 95% CI: − 12.59%, − 5.69%; P < 0.01). Similarly, factors that diminished inequality in the utilisation of CCS services were being married (− 8.23%;95% CI: − 12.46%, − 5.80%; P < 0.01), being unemployed (− 14.16%; 95% CI: − 19.23%, − 8.47%; P < 0.01) and living in urban communities (− 9.76%; 95% CI: − 15.62%, − 5.80%; P < 0.01). Women’s knowledge and utilisation of CCS services in RCCs are unequally distributed. Significant inequalities were identified among socioeconomically deprived women in the majority of countries. There is an urgent need for culturally appropriate community-based awareness and access programs to improve the uptake of CCS services in RCCs.

中文翻译：

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在18个资源有限的国家中，与女性有关的宫颈癌筛查和服务利用知识方面的与财富相关的不平等现象：汇总分解分析的证据。

资源受限的国家（RCC）在世界上宫颈癌（CC）的负担最大。虽然如此，尽管可以通过筛查癌前病变来预防CC，但是只有一小部分妇女在RCC中使用筛查服务。这项研究的目的是检验女性知识不平等的程度以及在农村信用社中使用宫颈癌筛查（CCS）服务的情况。从18个RCC最新的国家级人口与健康调查（2008年至2017–18年）中，总共进行了1,802,413个样本观察结果的分析，以评估与财富相关的不平等现象，涉及妇女的知识和对CCS服务的利用。应用了基于回归的分解分析，以计算解释变量对女性知识和使用CCS服务的不平等差距的贡献。总体而言，约37％的妇女了解CCS服务，其中25％属于最贫穷的五分之一，约49％来自最富有的五分之一。29％的妇女使用了CCS服务，从塔吉克斯坦的11％，科特迪瓦的15％，坦桑尼亚的17％，津巴布韦的19％，肯尼亚的20％到哥伦比亚的96％。分解分析确定，减少女性对CCS服务的不平等程度的因素是男户主家庭（-2.24％； 95％CI：-3.10％，-1.59％； P <0.01），目前正闭经（-1.37％； 95） ％CI：-2.37％，-1.05％； P <0.05），在获得医疗救助方面没有问题（− 10.00％; 95％CI：− 12.65％，− 4.89％; P <0.05），被保险（− 6.94％; 95％CI：− 9.58％，− 4.29％; P <0.01 ）并具有城市居住地（-9.76％; 95％CI：-12.59％，-5.69％; P <0.01）。同样，减少结婚CCS服务使用不平等的因素是结婚（− 8.23％; 95％CI：− 12.46％，− 5.80％; P <0.01），失业（− 14.16％; 95％CI：− 19.23 ％，-8.47％； P <0.01）和生活在城市社区中（-9.76％； 95％CI：-15.62％，-5.80％； P <0.01）。妇女在农村信用社中的知识和对CCS服务的利用不均衡。在大多数国家中，被社会经济剥夺的妇女中发现了严重的不平等现象。