# Current Cervical Cancer Status in Resource-Limited Somalia: a Systematic Review of Burden, Screening Findings, and Knowledge Gaps

## TL;DR

Cervical cancer is a major health issue in Somalia, with limited screening and knowledge, requiring urgent policy and training improvements.

## Contribution

This systematic review provides the first comprehensive synthesis of cervical cancer burden, screening findings, and knowledge gaps in resource-limited Somalia.

## Key findings

- Cervical cancer accounts for 6.7% of all cancers in Somalia, with screening positivity up to 15.7%.
- Only 24% of healthcare professionals in Somalia have treated a cervical cancer patient, and 2% of female providers have undergone Pap testing.
- HPV DNA positivity in Mogadishu was 31.7%, with 19.6% being high-risk types like HPV16 and HPV18.

## Abstract

Cervical cancer is the second most frequent cancer among Somali women, with approximately 1,055 diagnoses and 812 deaths annually; however, evidence to guide control efforts is scarce. This systematic review synthesizes the burden, screening findings, and knowledge gaps to inform policy and practice in Somalia’s resource-limited settings.

Following PRISMA 2020, we searched PubMed, Scopus, Embase, ScienceDirect, DOAJ, Cochrane Library, and Google Scholar without date limits for English, peer-reviewed studies from Somalia reporting prevalence, incidence, knowledge, screening, and prevention. Two reviewers independently extracted the data and performed the JBI critical appraisal for cross-sectional studies. Given the heterogeneity, we conducted a narrative synthesis.

Seven cross-sectional studies (2019–2024) with 3,797 participants from Mogadishu, Hargeisa, and Bosaso were included in this review. Across facility-based studies, cervical cancer accounted for 6.7% of all cancers and 13.3% of female cancers, while screening positivity among women attending screening services ranged up to 15.7%. The prevalence of cervical cancer ranged from 6.7% to 15.7%. Among 189 women sampled in Mogadishu (clinic-based), 31.7% were HPV DNA-positive, including 19.6% high-risk types (HPV16 13.8%, HPV18 5.3%); these findings may not represent national HPV prevalence. Among healthcare professionals, 73% had good theoretical knowledge; however, only 24% had treated a cervical-cancer patient, 22% reported receiving specific training, and only 2% of female providers had undergone Pap testing. Women’s awareness varied widely (43.7–97.7%), and misconceptions were common. In one facility-based screening study, VIA positivity was 7.6% compared with 5.1% for Pap smear (p = 0.004). Among women who were VIA-positive and underwent confirmatory assessment, 73.9% had CIN on colposcopy/biopsy; however, biopsy-confirmed CIN2+/cancer outcomes by each test and verification pathways were not fully reported, limiting direct comparison of diagnostic performance.

Somalia faces a high burden of cervical cancer and HPV infection, compounded by limited screening coverage, training gaps among providers, and misinformation among women about HPV vaccination. Priority actions include establishing a national cancer registry, expanding HPV vaccination, scaling context-appropriate screening (VIA and HPV testing), delivering targeted public education, and strengthening provider training especially for female frontline staff using culturally sensitive approaches to improve uptake and outcomes.

The online version contains supplementary material available at 10.1007/s44197-026-00526-x.