Understanding the Role of Place in Breast and Cervical Cancer Screening in Kenya and Ghana

Non-communicable diseases, including cancers, are considered major health challenges in the twenty-first century and pose a disproportionate burden on many low-to-middle-income countries (LMICs). For instance, it is estimated that nearly 2000 lives are lost daily to cancer in Africa, and about 1,109,209 new cancer cases and 711,429 cancer-related deaths were reported in 2020. Without a focus on equity and prioritization of cancer from policymakers and stakeholders, cancer prevalence and mortality rates are likely to increase in Africa. In the context of LMICs, especially in sub-Saharan Africa (SSA), several structural and political challenges persist regarding the secondary prevention of cancer through timely screening, diagnosis, and treatment. Using multilevel analysis, this chapter examines the role of place in influencing the utilization of breast and cervical cancer screening in Kenya and Ghana. The results indicate that location-based variables, such as urbanity, wealth, finances, and distance, are barriers to screening. Non-location factors, such as age, education, employment, and contextual norms, were associated with breast cancer (BC) and cervical cancer (CC) screening in Kenya and Ghana. For instance, rural poor women in Kenya (OR = 0.65, 95% CI [0.46–0.93]) and Ghana (OR = 0.77, 95% CI [0.62–0.95]) were less likely to screen for BC compared to the urban poor. Similarly, rural poor women (OR = 0.63, 95% CI [0.43–0.94]) were less likely to screen for CC, whereas the urban rich (OR = 1.53, 95% CI [1.06–2.21]) were more likely to screen for CC compared to the urban poor respectively. Understanding the spatiality and role of place in cancer screening for secondary prevention in SSA is essential to enable researchers and policymakers to examine how the characteristics of individuals concentrated in places, their collective opportunities, and the socio-cultural and historical features of places where they live and play, affect their access to these essential health care services.