Published in PLOS One on 2026-04-07, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Geofrey Emesu, Elizabeth Ekirapa Kiracho, Alfred Jatho, Joseph Kagaayi, Aggrey David Mukose, Annette Kyomuhangi, Aloysius Gonzaga Mubuuke
Source: PLOS One • DOI 10.1371/journal.pone.0335336
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Cervical cancer poses a severe public health burden in Uganda, which has one of the world’s highest incidence rates. Despite commitments to Universal Health Coverage (UHC), screening utilization remains critically low and inequitable. This study assessed vertical equity in the awareness and utilization of cervical cancer screening services among women in Uganda, evaluating whether distribution aligns with differential need.
We conducted a cross-sectional analysis of the 2022 Uganda Demographic and Health Survey (UDHS), including 18,251 women aged 15–49. The primary outcomes were self-reported screening utilization and awareness. Socioeconomic status was measured using the DHS wealth index. Equity was assessed using concentration curves and indices (CIs), with a positive CI indicating pro-rich inequality. P.value of 0.05 (95% confidence interval) was used to test for significance of study findings.
We found significant pro-rich inequity in both screening utilization (CI = 0.125, p < 0.000) and awareness (CI = 0.178, p < 0.000), demonstrating that wealthier women had a disproportionate advantage. The pro-rich inequality in utilization was more pronounced in the urban (CI = 0.125) than rural (CI = 0.049) areas. Awareness was distributed almost equitably in rural areas (CI = −0.007, p = 0.165) but showed significant pro-rich inequality in urban settings (CI = 0.014, p < 0.016).
Uganda’s cervical cancer screening services demonstrate significant vertical inequity, disproportionately favoring wealthier and urban women rather than being allocated according to greater need. To achieve elimination goals, deliberate policies must prioritize resource allocation and awareness for the poorer and rural women who bear the highest burden.
Background
Cervical cancer represents a devastating and preventable public health burden across low- and middle-income countries, standing as the leading cause of gynecological cancer mortality globally and affecting 6.9% of all women [1]. Uganda faces an exceptionally severe crisis, bearing one of the world’s highest burdens. The nation ranks among the top ten globally for cervical cancer incidence, estimated at 28.8 per 100,000 women annually, and second in Eastern Africa. This translates to approximately 6,413 new cases and 4,301 deaths reported each year [2]. This profound loss of life starkly contradicts the World Health Organization’s core health system goals of equity, equality, and efficiency, highlighting a critical shortfall in achieving Universal Health Coverage —the global commitment ensuring all people access quality essential health services without enduring financial hardship.
In May 2018, the WHO launched a global effort to eliminate cervical cancer as a public health issue through a comprehensive strategy advocating for countries to meet the ‘90-70-90’ targets by 2030: vaccinating 90% of girls against HPV by age 15, screening 70% of women with high-performance tests by ages 35 and 45, and ensuring that 90% of women with cervical pre-cancer or invasive cancer have access to treatment [3]. However progress has been slow or almost stagnated for most countries in Sub-Saharan Africa and by 2021, 133 countries reported slightly over 10% of women of reproductive age screened within the past 5 years [4]).
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider financing & policy desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Geofrey Emesu, Elizabeth Ekirapa Kiracho, Alfred Jatho, Joseph Kagaayi, Aggrey David Mukose, Annette Kyomuhangi, Aloysius Gonzaga Mubuuke. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
Explore connected evidence
- Evidence brief: Spatial autocorrelation and determinants of low uptake of breast cancer screening among women of reproductive age: A mixed-effect multilevel analysis of Tanzanian population-based survey
- Evidence brief: Factors influencing breast cancer screening among reproductive age women in Lesotho: Analysis of the 2023-24 demographic and health survey using the Andersen Behavioral Model
- Evidence brief: Determinants of cervical cancer screening among women aged 30 to 49 years in 20 low- and middle-income countries: A multilevel analysis
