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

Introduction: Breast cancer remains an important public health problem with high mortality in low-income countries like Tanzania. This is because of the low uptake of screening for breast cancer, an intervention that could be cost-effective and significant in reducing mortality and poor prognosis in such a setting. This is a population-based survey to uncover the spatial distribution and determinants of low uptake of breast cancer screening among women of reproductive age in Tanzania. Methods: This analytical cross-sectional study utilized data from 2022 Tanzania Demographic and Health Survey and Malaria Indicator Survey (TDHS-MIS). A total of 15254 women aged 15–49 years were included in the analysis. The outcome variable was the uptake of breast cancer screening, coded as “1” for the women who reported a doctor or other healthcare provider examined their breasts to check for cancer, and “0” otherwise. Descriptive and geospatial analyses were conducted to assess patterns of screening uptake across regions. To identify associated factors, a mixed-effect multilevel logistic regression analysis was performed using Stata version 17. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported, and a significance level of p