Adherence to cervical cancer follow-up screening and lesion recurrence in sub-Saharan Africa: a systematic review and meta-analysis

Timely follow-up after screening and treatment is essential for effective cervical cancer prevention. However, adherence remains markedly low across many low-resource settings, where missed follow-up and high recurrence rates undermine the effectiveness of screening programs. As a result, cervical cancer persists as the fourth leading cause of cancer mortality among women worldwide, with sub-Saharan Africa bearing a disproportionate burden due to geographic, structural, and health-system inequities. To estimate the pooled adherence to cervical cancer follow-up screening among women treated for precancerous cervical lesions following a positive screening result and to determine the one-year recurrence rate of cervical lesions in sub-Saharan Africa,2026. This systematic review and meta-analysis followed JBI methodological guidelines and was reported according to PRISMA standards. Relevant studies were identified through systematically searches of PubMed, EMBASE, CINAHL, Web of Science, and Scopus. Data were extracted using a standardized template, and analyses were conducted in STATA version 17. Study quality was appraised using Newcastle–Ottawa Scale. A Maximum Likelihood random-effects model was employed to pool prevalence estimates. Heterogeneity was assessed using the Cochrane Q test and I² statistic, and publication bias was evaluated using funnel plots and Egger’s test. Of 1325 records identified, 19 studies involving 14,448 women met the inclusion criteria and included in this review. The pooled adherence to cervical cancer follow-up screening among women with a positive screening result was 46.27% (95% CI: 37.29–55.26). The pooled one-year recurrence rate of cervical lesions after treatment was 15.89% (95% CI: 8.84–22.94%), increasing to 21.74% (95% CI: 7.86–35.62%) among women living with HIV. Counselling on the recommended follow-up schedule was consistently associated with improved adherence, whereas marital status showed inconsistent associations across studies. A commonly reported barrier to follow-up was women’s low perceived risk of cervical cancer. Adherence to cervical cancer follow-up screening in sub-Saharan Africa remains suboptimal. Counselling was consistently associated with improved adherence, whereas low perceived risk was a major barrier. Approximately one in six women experienced recurrence after treatment, increasing to one in five among women living with HIV. Strengthening follow-up systems through multicomponent interventions, including counselling, telephone reminders, community health worker engagement, and couple-centered approaches, may improve adherence and support cervical cancer prevention.