Abstract
BACKGROUND: Cervical cancer is preventable, yet it remains a leading cause of cancer death in women. About 90% of cases and 94% of deaths occur in low- and middle-income countries (LMICs). Limited access to screening drives high incidence and mortality. Screening is central to secondary prevention and global elimination efforts. OBJECTIVE: This study aimed to assess determinants of cervical cancer screening among women aged 30-49 years in low- and middle-income countries: a multilevel analysis. METHODS: A cross-sectional study used nationally representative data from 148,605 weighted women aged 30-49 years in 20 LMICs (2019-2024). Multilevel logistic regression identified factors associated with cervical cancer screening while accounting for cluster-level variation. Statistical significance was set at p < 0.05, with AORs and 95% CIs reported. Model fit and random effects were assessed using deviance, MOR, ICC, and PCV. RESULT: Overall cervical cancer screening uptake was 14.03% (95% CI: 13.63-14.45%), ranging from 0.92% in Mauritania to 42.98% in Zambia. Higher screening was associated with older age 40-49 years (AOR = 1.48; 95% CI: 1.41-1.54), occupation (AOR = 1.15; 95% CI: 1.10-1.21), contraceptive use (AOR = 1.38; 95% CI: 1.31-1.44), recent health-facility visit (AOR = 1.93; 95% CI: 1.84-2.02), prior abortion (AOR = 1.28; 95% CI: 1.22-1.34), female-headed households (AOR = 1.11; 95% CI: 1.05-1.18), high community education (AOR = 1.63; 95% CI: 1.49-1.79), and high media exposure (AOR = 2.54; 95% CI: 2.30-2.80). Lower uptake was observed among individuals in high-poverty communities (AOR = 0.63; 95% CI: 0.57-0.68), higher parity (1-4 birth) (AOR = 0.86; 95% CI: 0.78-0.94); (five or more births) (AOR=0.66 95% CI: 59-0.73), and those residing in rural areas (AOR = 0.89; 95% CI: 0.82-0.97). CONCLUSION: Cervical cancer screening uptake in LMICs is far below the WHO 2030 target, with wide country disparities. Socio-demographic factors, health-facility contact, and community education increase uptake, while poverty and geographic barriers reduce it. Integrating screening into routine reproductive and maternal care, strengthening community and media education, and addressing structural barriers to access are essential to improving coverage.