|Spatial Evaluation of Prevalence, Pattern and Predictors of Cervical Cancer Screening in India|
||Nilima, A Puranik, S M Shreenidhi, and S N Rai
||Public Health, 178: 124-136; DOI: 10.1016/j.puhe.2019.09.008
||Objective: To investigate the social determinants of cervical cancer screening and report the locations vulnerable to poor utilization of cervical cancer screening services.
Study design: An ecological study with the data derived from fourth round of the National Family Health Survey conducted in India in the period 2015-2016.
Methods: The study focused on the percentage of women who have never undergone cervical cancer screening across 639 districts in India. Moran's I statistic was used to investigate the overall clustering of location. The Getis-Ord Gi* statistic was used for the detection of significant local clusters. Spatial error, spatial lag, spatial Durbin and spatial Durbin error models were compared, and the model with best fit was reported. ArcGIS, GeoDa and R software were used for the analysis.
Results: The existence of spatial autocorrelation (Moran's I = 0.61) necessitates the consideration of spatial component while studying the screening data. A significant clustering of districts with poor screening has been observed in the North-Central and North-Eastern regions of India. The geographic arrangement of the percentage of women who have undergone cervical cancer screening was associated with the percentage of women with poor wealth index (P < 0.001), not using a modern method of contraception (P < 0.001), residing in rural areas (P = 0.033) and never heard of sexually transmitted infection (P = 0.014). The range of percentage of women getting cervix screened for cancer was 0.5-68.4%, presenting the heterogeneity among the population elements.
Conclusion: A higher risk of poor cervical cancer screening is observed in the districts where most of the women have poor wealth index, reside in urban area, have never heard of sexually transmitted infection and do not use a modern method of contraception.
Keywords: Cervical cancer screening; India; NFHS-4; Spatial epidemiology; Spatial regression.