Burden and predictors of cervical cancer mortality in Sub-Saharan Africa: a systematic review and meta-analysis

Cervical cancer remains a major public health concern, particularly in Sub-Saharan Africa, where limited access to vaccination, screening, and treatment contributes to high mortality. Identifying mortality patterns and key risk factors is essential for designing effective interventions. This systematic review and meta-analysis aimed to estimate cervical cancer-related mortality and identify its common predictors among women in the region. The study followed PRISMA guidelines and was registered in PROSPERO (CRD42025639606). A systematic search of Medline/PubMed, Scopus, Web of Science, HINARI, and Google Scholar identified observational studies published up to 15 August 2024 reporting cervical cancer-related mortality and predictors in Sub-Saharan Africa. Six authors independently screened titles and abstracts, while all eight reviewed full texts for eligibility; discrepancies were resolved through discussion. Study quality was assessed using a modified version of the Newcastle–Ottawa Scale. Heterogeneity was evaluated with I² and Cochran’s Q test, and random-effects models were applied when substantial heterogeneity existed. Subgroup analyses and meta-regression explored potential sources of variability. From 1760, articles, 23 studies including 10,040 participants were included. The pooled prevalence of cervical cancer-related mortality was 56% (95% CI: 0.48–0.64). Significant predictors included advanced age (> 60 years; OR = 1.12), rural residence (OR = 1.38), hormonal contraceptive use (OR = 1.23), history of abortion (OR = 1.33), substance use (OR = 1.21), comorbidities (OR = 1.20), anemia (OR = 1.47), HIV infection (OR = 1.17), advanced disease stage (OR = 1.76), adenocarcinoma histology (OR = 1.30), single treatment modality (OR = 1.44), and single chemotherapy cycle (OR = 1.28). The burden of cervical cancer mortality in Sub-Saharan Africa remains high, affecting over half of women with the disease, particularly those with advanced age, rural residence, comorbidities, and advanced disease stage. Targeted interventions for these high-risk groups and comprehensive treatment strategies are essential to reduce mortality and improve survival. Not applicable.