Background: Cervical cancer (CC) remains a significant public health concern affecting women globally, with an estimated 604,000 new cases and 342,000 deaths reported in 2020. It ranks as the fourth most prevalent cancer and the fourth leading cause of cancer-related mortality among women.

Methods: A cross-sectional study was conducted at the Gynecology Clinic of Edward Francis Small Teaching Hospital (EFSTH). Participants were selected through a single-stage cluster sampling technique. The sample size was calculated using Epi Info version 7.2.5, and data were entered, cleaned, and analyzed using SPSS version 20. Statistical significance was set at p < 0.05.

Results: A total of 362 reproductive-age women participated. The majority 336 (92.8%) exhibited poor knowledge of cervical cancer. While 290 (80%) of the respondents had a positive attitude toward prevention, 292 (80.7%) demonstrated poor practice, as they had never undergone screening. Only 70 (19.3%) had been screened at least once. Educational status (p = 0.00, V = 0.4) and religion (p = 0.04, V = 0.1) were associated with good knowledge levels. Additional associations were observed between sociodemographic variables and attitudes or practices, although screening uptake remained generally low.

Conclusion: There is a clear disparity between the positive attitude toward cervical cancer prevention and the actual preventive practices among women in The Gambia. Strengthening education and improving access to screening are essential to reduce the burden of cervical cancer in The Gambia.

Keywords: attitude, cervical cancer, knowledge, practice, prevention, screening, The Gambia

Cervical cancer (CC) remains a significant public health concern, particularly in low- and middle-income countries (LMICs). Globally, it is the fourth most common cancer and the fourth leading cause of cancer-related deaths in women, accounting for approximately 604,000 new cases and 342,000 deaths in 2020.^1,2 Over 90% of these cases and deaths occurred in LMICs, largely due to inadequate access to prevention, screening, and treatment services.¹ In The Gambia, the burden is especially high. According to the 2021 HPV and related cancers fact sheet, an estimated 286 women are diagnosed with CC annually, and 199 succumb to the disease. CC is the leading cancer among Gambian women, particularly those aged 15 to 44 years.³

The crude incidence rate of CC in The Gambia was reported at 23.5 per 100,000 women in 2021, with a mortality rate of 16.3 per 100,000.³ The age-standardized incidence rate was 42.9 per 100,000 women, and the cumulative lifetime risk of developing CC was estimated at 3.9%.^1,3,4 Alarmingly, only 9% of Gambian women were screened between 2014 and 2019, with just 11% ever having been screened as of 2019.⁴ Several risk factors contribute to the development of CC, including behavioral (e.g., smoking, obesity), sexual and reproductive factors (e.g., early marriage, early coitarche, multiple sexual partners, use of oral contraceptives), infections such as HPV, herpes simplex virus, and HIV, as well as poor dietary habits and genetic predispositions.^5–8

HPV is identified as the primary etiological agent in nearly all cervical malignancies, making it the only human cancer with a well-established cause.¹⁰ Though CC is largely preventable and treatable, it remains a leading cause of cancer deaths in LMICs due to limited awareness and access to early detection services.Common symptoms in the symptomatic phase include pelvic pain, dyspareunia, abnormal vaginal bleeding, and foul-smelling discharge.⁹ In contrast to many high-income countries, where robust screening programs and HPV vaccination have drastically reduced CC incidence,¹¹ The Gambia continues to struggle with late-stage presentations and poor outcomes.

The Gambian strategic plan for CC prevention and control (2016–2020) introduced HPV vaccines—Gardasil, Gardasil 9, and Cervarix—for girls aged 9–13 through school-based and community outreach programs, aiming for 90% coverage by 2020.¹² For secondary prevention, cytology-based screening targets women aged 20 to 80 years. However, as of 2021, there were no guidelines for early symptom detection at the primary healthcare level, although a structured referral pathway exists.¹² Available screening modalities include Papanicolaou (Pap) smears, HPV DNA tests, and visual inspection with acetic acid (VIA).¹² Nevertheless, awareness and uptake remain low, hindering the effectiveness of these interventions.^13–15 Most Gambian CC cases present at advanced stages, when treatment options are limited and more costly.¹⁶

Management options in The Gambia include pathology services, cancer surgery, and chemotherapy, but radiotherapy remains unavailable.⁴ Studies within and outside the country reveal a general lack of awareness regarding HPV, CC screening, and vaccination.^{10,13,16–20} This lack of awareness, especially among reproductive-aged women, may contribute to delayed presentation and poor outcomes.

This study was conducted among women of reproductive age (15–49 years) at Edward Francis Small Teaching Hospital (EFSTH), Banjul, to assess their knowledge, attitude, and practice regarding cervical cancer prevention. The findings aim to inform targeted interventions, raise awareness, and enhance the uptake of available preventive services in The Gambia.

Study design

A cross-sectional study was conducted at the Gynecology Clinic of Edward Francis Small Teaching Hospital (EFSTH), Banjul, from 14th November 2022 to 20th January 2023. Data were collected using an interviewer-administered structured questionnaire targeting women of reproductive age (15–49 years) attending the clinic during the study period.

Study population and setting

The study included all women aged 15–49 years attending EFSTH’s gynecology clinic, either for first-time or follow-up consultations. EFSTH, located in Banjul, is The Gambia’s national referral hospital and serves as the country’s main cervical cancer screening center.

Eligibility criteria

Inclusion: Women aged 15–49 years who visited the clinic during the study period.
Exclusion: Women with known mental illness, critically ill individuals, and those who declined participation after being informed of the study’s objectives.

Sample size and sampling technique

A sample size of 362 was calculated using Epi Info™ version 7.2.5.0 based on a hypothetical clinic population of 6,061 women (average monthly attendance from January to October 2022), at a 95% confidence level and 5% margin of error. Participants were selected using single-stage cluster sampling, a probability-based method.

Data collection

A structured questionnaire adapted from a similar study (49) was used. It was written in English and covered socio-demographics, knowledge of cervical cancer symptoms and risk factors, awareness of prevention and treatment services, attitudes and practices regarding screening, and barriers to screening. Reliability was evaluated using Cronbach’s alpha.

Pretesting and quality control

Pretesting was conducted with 18 women (5% of the sample) one week prior to data collection to ensure clarity and consistency. These responses were excluded from the final analysis. Reliability was considered acceptable at Cronbach’s alpha > 0.7.

Operational definitions

1. Cervical cancer: Uncontrolled cell growth at the cervix.²¹
2. Cancer screening: Procedures aimed at detecting abnormal cervical cells.²¹
3. Knowledge: Assessed via “Yes/No” questions; correct answers scored 1, incorrect scored 0. Scores were classified as good (80–100%), satisfactory (50–79%), or poor (<50%).¹³
4. Attitude: Measured using a 5-point Likert scale (1 = strongly disagree, 5 = strongly agree). Scores above the mean indicated a positive attitude; below the mean indicated negative attitude.¹⁵
5. Practice: Defined as good if the respondent had ever been screened, and poor if never screened.²¹

Data processing and analysis

Data were entered and analyzed using SPSS version 20. Descriptive statistics (frequencies, percentages, means, and standard deviations) summarized sample characteristics. Associations between socio-demographic variables and outcomes (knowledge, attitude, and practice) were tested using Chi-square tests (significance at p ≤ 0.05), with Phi and Cramer’s V used for effect size measurement. Microsoft Excel was used to generate graphs and charts for selected variables.

Ethical considerations

Ethical approval was obtained from the EFSTH Research and Publication Committee. Written informed consent was secured from each participant following explanation of the study’s aim. Confidentiality and anonymity were ensured, and participants were informed of their right to withdraw at any time without consequence.

Socio-demographic characteristics of respondents

A total of 362 women participated (mean age 31.2 ± 8.29 years, range 16–49); 34.0% were aged 36–49. Most were Muslims (92.5%), married (79.6%), and urban residents (95.0%). Educational levels varied: 45.3% had high school education, 18.8% had a diploma/degree, and 27.9% had no formal education. Most had 0–3 children (79.6%). Employment included self-employed (34.0%), housewives (28.2%), and private employees (13.2%) (Table 1).

Knowledge of cervical cancer, its screening, and treatment

"Overall, the majority of respondents (92.8%) demonstrated poor knowledge of cervical cancer, with only 0.6% exhibiting good knowledge." This emphasizes the poor knowledge clearly. Awareness of HPV as a cause was low (6.4%), and most were unaware of risk factors, symptoms, and prevention methods. While 60.5% had heard of screening, few knew the methods (8.3%) or recommended intervals (12.2%). Awareness of HPV vaccination (6.4%) and treatment options (15.5%) was also limited, highlighting significant gaps in knowledge (Table 2).

Attitude towards cervical cancer prevention

Respondents were assessed using eight questions, yielding a mean score of 6.1 (± SD 1.94). Those scoring below the mean (72; 20.0%) were considered to have a negative attitude, while the majority (290; 80.0%) had a positive attitude. Most respondents (193; 53.3%) strongly agreed that cervical cancer is a major health problem in The Gambia. A large proportion (280; 77.3%) strongly agreed that screening is vital for prevention. Additionally, 73.2% strongly agreed that any woman, including themselves, could develop cervical cancer, and 96.4% were willing to undergo screening (Table 3).

Practice of cervical cancer screening

A significant majority 292(80.7%) of respondents had never been screened for cervical cancer. While 163(45.0%) had undergone screening for other reproductive health issues such as HIV and STIs, only 70(19.3%) had ever been screened for cervical cancer. Among those screened, most did so at public health facilities, and the screening was mainly prompted by a doctor’s recommendation, followed by self-initiation and community or peer influence (Table 4).

Barriers to cervical cancer screening

The main reasons mentioned by the respondents as to why they have not been screened for cervical cancer were lack of information 212 (58.6%), never been told to screen 256(70.7%), the anticipation of a painful procedure 10 (2.8%) and not knowing where to screen 8 (2.2%) (Figure 1).

Factors associated with knowledge of cervical cancer screening

Educational status and religion were significantly associated with knowledge of cervical cancer screening, with education showing a moderate (Cramer's V = 0.4) and religion a weak (Cramer's V = 0.1) relationship (p < 0.05) (Table 5).

Factors associated with the attitude towards cervical cancer screening

The study found significant associations (p < 0.05) between women’s attitudes toward cervical cancer screening and age, education, marital status, number of children, and occupation. Age and education showed weak associations (V = 0.2), marital status and number of children had moderate associations (V = 0.3), while occupation had the strongest association (V = 0.4) (Table 6).

Factors associated with practice towards cervical cancer screening

Age, marital status, number of children, and occupation were significantly associated with cervical cancer screening practices (p < 0.05). Marital status showed a weak association (V = 0.2), while the others had moderate associations (V = 0.3), indicating that socio-demographic factors influence screening practices (Table 7).

Relationship between attitude and practice and level of knowledge of cervical cancer

Knowledge of cervical cancer was significantly associated with women’s attitude (p = 0.03, V = 0.14) and practice (p = 0.01, V = 0.20), though the relationships were weak. This suggests that knowledge influences attitude and practice, but not strongly (Table 8).

Cervical cancer continues to be a major public health issue globally, especially in low- and middle-income countries where access to preventive services is limited. In The Gambia, cervical cancer is the leading cause of cancer-related deaths among women, highlighting the urgency of implementing effective prevention strategies.³ Understanding the knowledge, attitude, and practice (KAP) of women regarding cervical cancer prevention is essential to reducing morbidity and mortality. This study, conducted among women of reproductive age attending the gynecology clinic at Edward Francis Small Teaching Hospital (EFSTH), offers critical insights into the current state of cervical cancer awareness and prevention in the country.

As shown in Table 2, only 7.2% of respondents had adequate knowledge of cervical cancer, revealing a substantial gap. This result is consistent with studies from similar low-resource settings. For instance, a study in India reported that 11% of women had sufficient knowledge of cervical cancer,²² while only 4.8% of women were knowledgeable in a Nigerian study.²³ These findings underscore the widespread lack of awareness and the need for intensified educational campaigns. Alarmingly, as indicated in Table 2, 93.6% of respondents in this study did not know that Human Papillomavirus (HPV) is the primary cause of cervical cancer. This mirrors findings in Northwest Ethiopia, where many women were similarly unaware of the link between HPV and cervical cancer.²⁴ Since HPV is preventable through vaccination and screening, this lack of knowledge could negatively affect the uptake of preventive measures.

In terms of perceived risk factors, the most frequently cited by participants were multiple sexual partners (16.9%), cigarette smoking (14.9%), early marriage (13.3%), and early sexual initiation (12.2%)—as presented in Table 2. These perceptions align with studies conducted in Bangladesh²⁵ and Ethiopia,²¹ where similar risk factors were identified. While the percentages may be relatively low, they reflect a foundational awareness that could be strengthened through targeted health education initiatives. Socio-cultural differences and exposure to health information likely account for variations in awareness across regions.

The attitude of respondents toward cervical cancer prevention was notably positive. As shown in Table 3, a large majority (80%) expressed favorable attitudes, with 77.3% agreeing that screening is essential for prevention. Furthermore, Table 3 shows that 96.4% indicated a willingness to undergo screening if the procedure was free and painless. These encouraging results are in line with findings from Nigeria, Southern Ethiopia, Zambia, and Zimbabwe,^21,26–30 suggesting that women are generally open to screening when barriers are minimized. This willingness presents a valuable opportunity for public health authorities to design accessible and acceptable screening services.

Despite the positive attitudes, Table 4 shows that only 19.3% of respondents had undergone cervical cancer screening. This figure, while higher than the 5.8% reported in Zimbabwe and similar to low rates in Southern Ethiopia,^21,28 remains inadequate. The discrepancy between attitude and practice suggests that external barriers may prevent women from acting on their intentions. These include systemic and informational obstacles that hinder access to screening services.

Key barriers identified by respondents included a lack of information (58.6%), never being advised to undergo screening (70.7%), fear of pain during the procedure (2.8%), and lack of knowledge about where to access screening (2.2%)—as detailed in Figure 1. These barriers are consistent with those reported in studies from India, Nigeria, Ghana, and Uganda.^31–34 Addressing these issues requires a multifaceted approach that includes community outreach, healthcare provider training, and improved service delivery infrastructure.

Figure 1 Distribution of respondent’s barriers to cervical cancer screening, EFSTH November 2022 to January 2023. n=362.

Note: Percent exceeds 100% because of multiple responses.

Socio-demographic factors were found to be significantly associated with KAP toward cervical cancer prevention. As shown in Table 5, educational level and religion were associated with knowledge, with women who attained higher education showing better understanding—similar to findings from other studies.^22,23 Attitude was influenced by age, educational status, marital status, number of children, and occupation, also reflected in Table 6. These associations have also been reported in earlier research, where older women and those with formal education or employment tended to have more positive health attitudes.^21,29 Practice was significantly associated with age, marital status, number of children, and occupation—again as demonstrated in Table 7—suggesting that social responsibilities and life experiences may influence women’s health-seeking behaviors.

In summary, this study highlights significant gaps in knowledge and practice regarding cervical cancer prevention, despite positive attitudes. Public health interventions should focus on enhancing awareness of HPV and the benefits of early screening. Efforts should also aim to eliminate structural and informational barriers to screening. Strengthening community education, improving communication from healthcare providers, and integrating screening into routine gynecological care are essential next steps to reduce the burden of cervical cancer in The Gambia.^35–63

In conclusion, while there is a positive attitude toward cervical cancer prevention among women in The Gambia, the lack of adequate knowledge and low practice rates indicate the need for urgent public health interventions. By addressing the socio-demographic factors influencing knowledge, attitude, and practice, and improving access to information and screening services, it is possible to enhance cervical cancer prevention in The Gambia and reduce the burden of this preventable disease. Future studies should explore the underlying reasons for the low practice rates and examine the effectiveness of different intervention strategies in increasing screening uptake.

None.

Study limitations

This study was limited to women of reproductive age attending the Gynecology Clinic at Edward Francis Small Teaching Hospital, which may not fully represent the broader population of women aged 15 years and above in The Gambia (estimated at 670,131 in 2021) who are at risk for cervical cancer. Additionally, its limited geographic and temporal scope may not capture regional or seasonal differences in awareness and screening behavior.

Availability of data and material: The datasets generated and/or analyzed during this study are available and can be shared on reasonable request. The corresponding author can be contacted for the data if required.

Author contributions

PMO collected the data and wrote the first draft of the manuscript. TO supervised data collection, guided the data analysis, and oversaw the compilation of the final output. MA critically reviewed the draft and provided editorial corrections.

None.

The authors declare no conflict of interest.

1. World Health Organization (WHO). Cervical cancer fact sheet. 2022.
2. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality Worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209-249.
3. Information center on HPV and cancer. Gambia human papilloma virus and related cancers fact sheet. The Catalan Institute of Oncology (ICO) and the International Agency for Research on Cancer (IARC). 2021.
4. World Health Organization (WHO). Cervical cancer Gambia 2021 country profile. 2021.
5. Monteiro JC, Tsutsumi MY, de Carvalho DO, et al. Prevalence, diversity, and risk factors for cervical HPV infection in women screened for cervical cancer in Belem, Para, Northern Brazil. Pathogens. 2022;11(9):960.
6. Li J, Liu G, Luo J, et al. Cervical cancer prognosis and related risk factors for patients with cervical cancer: a long-term retrospective cohort study. Sci Rep. 2022;12(1):13994.
7. Giglio AG, de Brito Rangel J, Cardozo CL, et al. Incidence and risk factors associated with the development of metastatic spinal cord compression due to bone metastasis in women with cervical cancer. Eur Spine J. 2022;31(11):3139-3145.
8. Sadia H, Shahwani IM, Bana KFM. Risk factors of cervical cancer and role of primary healthcare providers regarding PAP smears counseling: Case control study. Pak J Med Sci. 2022;38(4Pt II):998-1003.
9. Eze JN, Emeka-Irem EN, Edegbe FO. A six-year study of the clinical presentation of cervical cancer and the management challenges encountered at a state teaching hospital in southeast Nigeria. Clin Med Insights Oncol. 2013;7:151-158.
10. Anene-Okeke CG, Aluh DO, Okorie UH. Knowledge, attitudes and practice of cervical cancer prevention among student health professionals in Nigeria. APJCC. 2019.
11. Heena H, Durrani S, AlFayyad I, et al. Knowledge, attitudes, and practices towards cervical cancer and screening amongst female healthcare professionals: a cross-sectional study. J Oncol. 2019;2019:5423130.
12. World Health Organization (WHO). Strategic plan for the prevention and control of cervical cancer in the Gambia. 2016.
13. Gebisa T, Bala ET, Deriba BS. Knowledge, attitude, and practice toward cervical cancer screening among women attending health facilities in central Ethiopia. Cancer Control. 2022;29:10732748221076680.
14. Miles TT, Riley-Powell AR, Lee GO, et al. Knowledge, attitudes, and practices of cervical cancer prevention and pap smears in two low-income communities in Lima, Peru. BMC Women's Health. 2021;21(1):168.
15. Zibako P, Tsikai N, Manyame S, et al. Knowledge, attitude and practice towards cervical cancer prevention among mothers of girls aged between 9 and 14 years: a cross sectional survey in Zimbabwe. BMC Women's Health. 2021;21(1):426.
16. Agboola AMD, Bello OO. The determinants of knowledge of cervical cancer, attitude towards screening and practice of cervical cancer prevention amongst antenatal attendees in Ibadan, Southwest Nigeria. Ecancermedicalscience. 2021;15:1225.
17. Cham B. Knowledge, practice and acceptability of cervical cancer screening among midwives in the Gambia. Women's Health Science Journal. 2018;2(3).
18. Keita M. Factors influencing the uptake of cervical cancer prevention services among women of reproductive age (15-49) residing in the greater Banjul Area, The Gambia [Master's dissertation]. Curtin University, Australia; 2015.
19. Burhan M, Rahman NAA, Haque M. Knowledge and attitude regarding cervical cancer and its prevention among young female adults in Kuantan, Malaysia. J Educ Health Promot. 2021;10:332.
20. Ghosh S, Mallya SD, Shetty RS, et al. Knowledge, attitude and practices towards cervical cancer and its screening among women from tribal population: a community-based study from Southern India. J Racial Ethn Health Disparities. 2021;8(1):88-93.
21. Tekle T, Wolka E, Nega B, et al. Knowledge, attitude and practice towards cervical cancer screening among women and associated factors in hospitals of Wolaita Zone, Southern Ethiopia. Cancer Manag Res. 2020;12:993-1005.
22. Bansal AB, Pakhare AP, Kapoor N, et al. Knowledge, attitude, and practices related to cervical cancer among adult women: A hospital-based cross-sectional study. J Nat Sci Biol Med. 2015;6(2):324-328.
23. Hauwa I, Oluwasanu MM, John-Akinola Y, et al. Knowledge of cervical cancer and barriers to screening among women in a city in Northern Nigeria. J Public Health (Berl). 2022;30:1923-1933.
24. Mengesha A, Messele A, Beletew B. Knowledge and attitude towards cervical cancer among reproductive age group women in Gondar town, North West Ethiopia. BMC Public Health. 2020;20(1):209.
25. Farzana S, Saha S, Sayem A, et al. Knowledge about risk factors of carcinoma cervix among the women attending for VIA test in a selected hospital. J Nat Sci Biol Med. 2019;6(2):324-328.
26. Oluwole EO, Mohammed AS, Akinyinka MR, et al. Cervical cancer awareness and screening uptake among rural women in Lagos, Nigeria. J Community Med Prim Heal Care. 2017;29(1):81-88.
27. Ndikom CM, Ofi BA, Folashade O. Willingness to utilize cervical cancer screening services among, antenatal clinic attendees in selected hospitals in Ibadan, Nigeria. J Women’s Health. 2014;3(3):1-5.
28. Nyamambi E, Murendo C, Sibanda N, et al. Knowledge, attitudes and barriers of cervical cancer screening among women in Chegutu rural district of Zimbabwe. Cogent Social Sciences. 2020;6(1):1766784.
29. Okunowo AA, Daramola ES, Soibi-harry AP, et al. Women’s knowledge of cervical cancer and uptake of Pap smear testing and the factors influencing it in a Nigerian tertiary hospital. J Cancer Res Pract. 2018;5(3):105-111.
30. Awosan KJ, Hassan M, Ibrahim BM. Knowledge of cervical cancer and uptake of pap smear test and human papillomavirus vaccination among gynecologic clinic attendees in Sokoto. Int J Sci Study. 2018;6(5):52-58.
31. Mafiana JJ, Dhital S, Halabia M, et al. Barriers to uptake of cervical cancer screening among women in Nigeria: a systematic review. Afr Health Sci. 2022;22(2):295-309.
32. Ubah C, Nwaneri AC, Anarado AN, et al. Perceived barriers to cervical cancer screening uptake among women of an urban community in South-Eastern Nigeria. Asian Pac J Cancer Prev. 2022;23(6):1959-1965.
33. Devarapalli P, Labani S, Nagarjuna N, et al. Barriers affecting uptake of cervical cancer screening in low and middle income countries: A systematic review. Indian J Cancer. 2018;55(4):318-326.
34. Black E, Hyslop F, Richmond R. Barriers and facilitators to uptake of cervical cancer screening among women in Uganda: a systematic review. BMC Womens Health. 2019;19(1):108.
35. S Department of State National Cancer Institute. HPV and Cancer. 2022.
36. Cohen PA, Jhingran A, Oaknin A, et al. Cervical cancer. Lancet. 2019;393(10167):169-182.
37. Uyeda M. Cervical cancer: definition, prevention and treatment. Science World Journal of Cancer Science and Therapy. 2019;1(1):1-7.
38. Devine C, Viswanathan C, Faria S, et al. Imaging and staging of cervical cancer. Semin Ultrasound CT MR. 2019;40(4):280-286.
39. Aimagambetova G, Chan CK, Ukybassova T, et al. Cervical cancer screening and prevention in Kazakhstan and Central Asia. J Med Screen. 2021;28(1):48-50.
40. Shinkfi-Bagudu Z, Tittenbrun Z, Johnson S. Cervical cancer elimination in Africa: Where are we now and where do we need to be? Union for International Cancer Control and African Cancer Registry Network. 2022.
41. Arbyn M, Weiderpass E, Bruni L, et al. Estimates of incidence and mortality of cervical cancer in 2018: a worldwide analysis. Lancet Global Health. 2020;8(2):e191-e203.
42. American Cancer Society. Cervical cancer: risk factors, prevention and screening. 2022.
43. Moudatsou M, Vouyiouka P, Karagianni-Hatziskou E, et al. Knowledge and use of cervical cancer prevention services among social work and nursing University students. Healthcare (Basel). 2022;10(6):1140.
44. Sam OJ. Assessing knowledge, attitude, and practices of women of reproductive age (15-49) towards cervical cancer screening in Adyel Division, Adyel Ward, Lira City West Division, Lira City. J Biomed Biosensors. 2022;2(2):11-30.
45. Hirani S, Khan S, Akram S, et al. Knowledge, awareness, and practices of cervical cancer, its risk factors, screening, and prevention among women in Karachi, Pakistan. Eur J Cancer Prev. 2021;30(1):97-102.
46. Allanson ER, Schmeler KM. Cervical cancer prevention in low- and middle-income countries. Clin Obstet Gynecol. 2021;64(3):501-518.
47. Alholm Z, Monk BJ, Ting J, et al. Patient characteristics, treatment patterns, and clinical outcomes among patients with previously treated recurrent or metastatic cervical cancer: A community oncology-based analysis. Gynecol Oncol. 2021;161(2):422-428.
48. Abe A, Yuasa M, Imai Y, et al. Extreme leanness, lower skeletal muscle quality, and loss of muscle mass during treatment are predictors of poor prognosis in cervical cancer treated with concurrent chemoradiation therapy. Int J Clin Oncol. 2022;27(5):983-991.
49. Merz J, Bossart M, Bamberg F, et al. Revised FIGO staging for cervical cancer - a new role for MRI. RoFo. 2020;192(10):937-944.
50. Soares LC, Junior JCD, de Souza RJ, et al. Critical analysis of the FIGO 2018 cervical cancer staging. J Turk Ger Gynecol Assoc. 2022;23(4):325-326.
51. Andrei C, Rodica G, Aurelia B, et al. Post-intervention KAP study on the knowledge, attitudes, and practices on cervical cancer prevention in the Republic of Moldova. UNFPA. 2022.
52. Turdo YQ, Ruffieux Y, Boshomane TMG, et al. Cancer treatment and survival among cervical cancer patients living with or without HIV in South Africa. Gynecol Oncol Rep. 2022;43:101069.
53. Whop LJ, Cunningham J, Garvey G, et al. Towards global elimination of cervical cancer in all groups of women. Lancet Oncol. 2019;20(5):e238.
54. Zhao S, Chen H, Zhao FH. [Global guidelines for cervical cancer and precancerous lesions treatment: a systematic review]. Zhonghua Yi Xue Za Zhi. 2022;102(22):1666-1676.
55. Cetina-Perez L, Castro-Eguiluz D. Consensus report on the prevention, diagnosis, and treatment of cervical cancer - a perspective from the immune system toward immunotherapy. Rev Invest Clin. 2020;72(4):185-187.
56. Ebu NI, Mupepi SC, Siakwa MP, et al. Knowledge, practice, and barriers toward cervical cancer screening in Elmina, Southern Ghana. Int J Womens Health. 2015;7:31-39.
57. Mabelele MM, Materu J, Ng'ida FD, et al. Knowledge towards cervical cancer prevention and screening practices among women who attended reproductive and child health clinic at Magu district hospital, Lake Zone Tanzania: a cross-sectional study. BMC Cancer. 2018;18(1):565.
58. Ramathuba DU, Ngambi D, Khoza LB, et al. Knowledge, attitudes and practices regarding cervical cancer prevention at Thulamela Municipality of Vhembe District in Limpopo Province. Afr J Prim Health Care Fam Med. 2016;8(2):e1-e7.
59. Jedy-Agba E, Joko WY, Liu B, et al. Trends in cervical cancer incidence in Sub-Saharan Africa. Br J Cancer. 2020;123(1):148-154.
60. Stelzle D, Tanaka LF, Lee KK, et al. Estimates of the global burden of cervical cancer associated with HIV. Lancet Glob Health. 2021;9(2):e161-e169.
61. World Health Organization. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach, 2nd ed. 2016.
62. Bhatla N, Berek JS, Fredes MC, et al. Revised FIGO staging for carcinoma of the cervix uteri. Int J Gynecol Obstet. 2019;145(1):129-135.
63. Kabelenga E, Mwanakasale V, Siziya S. Knowledge, Attitude and Practices towards cervical cancer screening among female medical students at the Copperbelt University School of Medicine, Zambia. 2018;5(3).