Cervical precancer screening coverage, barriers to uptake, and linkage to care: a survey in Blantyre city and Chiradzulu district
Study design
Cross-sectional survey using household sampling
Background
Cervical cancer remains a major public health challenge in Malawi, which continues to report among the highest cervical cancer incidence and mortality rates worldwide. To support the scale-up of cervical cancer prevention services, a population-based survey was conducted in 2025 in Blantyre City and Chiradzulu District in the Southern Region of Malawi.
Objectives
- Assess cervical cancer screening coverage among women aged 25-49 years in Blantyre and Chiradzulu districts during the survey period (June 2025);
- Identify factors influencing screening uptake and barriers to participation;
- Assess screening results and linkage to follow-up care and treatment among women who have been screened;
- Assess knowledge and perceptions related to HPV, cervical cancer and cervical cancer prevention.
Our role
Study design and implementation
Partners
- Malawi Ministry of Health
Methodology
A cross-sectional household survey was conducted using roof-based sampling. All eligible women aged 25-49 in sampled households years were invited to participate. Data were collected through structured with screening histories verified against entries in participants’ health passports. Survey weights were applied to generate population-representative estimates.
A total of 1,675 women completed the survey across three study strata: Blantyre City, Chiradzulu MSF catchment area, and Chiradzulu non-MSF catchment area. Demographic characteristics showed clear urban-rural gradients in literacy, education, employment, and household income. HIV testing coverage was nearly universal among respondents, with higher HIV prevalence observed in Chiradzulu compared with Blantyre.
Key Findings
- Cervical cancer screening coverage increased substantially compared with the 2019 survey, rising from 40.2% to 59.1% in Blantyre, from 38.9% to 76.4% in the Chiradzulu MSF catchment area, and from 25.4% to 55.4% in the Chiradzulu non-MSF catchment area (participant self-report).
- Coverage based on health passport verification remained considerably lower (36.3–52.6%) than coverage based on participant self-report (55.4 - 76.4%), highlighting potential gaps in documentation and/or recall of previous screening.
- Screening coverage was consistently higher among women living with HIV (80.4–88.8%) than among HIV-negative women (47.9 - 73.8%) across all strata, with the highest coverage observed among women living with HIV in the Chiradzulu MSF catchment area (88.8%, 95% CI 82.0 - 93.3).
- Knowledge and acceptability of cervical cancer screening were high across all strata, with more than 90% of women agreeing that screening can prevent cervical cancer.
- HPV testing coverage remained low (1.9 - 13.8%) compared with VIA screening (54.7-73.7%).
- Despite these improvements, challenges remain in ensuring timely result delivery following HPV self-sampling and linkage to treatment.7 %).
