Aklilu H. Hailegebireal ^1* Habtamu Mellie Bizuayehu ² Biruk B. Wolde ³ Lire L. Tirore ⁴ Beshada Z. Woldegeorgis ⁵ Gizachew A. Kassie ⁶ Yordanos S. Asgedom ⁷

• ¹ School of Public Health, College of Medicine and Health Sciences, Wachemo University, Hosanna, Ethiopia, Hosanna, Ethiopia
• ² School of Public Health, Faculty of Medicine, the University of Queensland, Brisbane, Australia, Brisbane, Australia
• ³ Department of Public Health, College of Medicine and Health Sciences, Mizan Tepi University, Mizan, Ethiopia, Mizan-Tepi, Ethiopia
• ⁴ College of Medicine and Health Sciences, School of Public Health, Department of Health Informatics, Wachemo University, Hosanna, Ethiopia, Hosanna, Ethiopia
• ⁵ Department of Internal Medicine, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia, Soddo, Ethiopia
• ⁶ Department of Epidemiology and Biostatistics, College of Health Sciences and Medicine, Wolaita Sodo University, Ethiopia, soddo, Ethiopia
• ⁷ Department of Epidemiology, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia, Soddo, Ethiopia

Background: Despite a higher rate of breast cancer in sub-Saharan Africa (SSA), efforts to treat the disease through breast cancer screening are suboptimal, resulting in late diagnosis of breast cancer and poor outcomes. Several studies have been conducted in SSA countries about screening uptake, yet they addressed country or sub-country level data and did not consider both individual and beyond-individual factors related to screening. Hence, pooled prevalence as well as multilevel correlates of screening in the region is sparse, which have been addressed by this study using the most recent data among women with SSA.Methods: This study was conducted using the Demographic Health Survey data from 2013-2022) from six countries, and a total weighted sample of 95,248 women was examined. STATA version 16 was used for the data analysis. Multilevel mixed-effects logistic regression was performed and significant predictors were reported using adjusted odds ratios (aOR) with 95% confidence intervals (95% CI).The overall weighted prevalence of clinical breast cancer screening was 14.23% (95% CI: 13.97-14.75), with Namibia and Tanzania having the highest (24.5%) and lowest (5.19%) screening rates, respectively. Higher breast cancer screening uptake was observed among women of advanced age (35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49) [aOR=1.78; 95% CI: 1.60, 1.98], had higher educational levels [aOR=1.84; 95% CI: 1.66, 2.03], cohabited [aOR=1.37; 95% CI: 1.21, 1.55], in the richest wealth quintile [aOR=2.27; 95% CI: 1.95, 2.64], urban residents [aOR= 1.21; 95%CI: 1.10, 1.33], multiparous [aOR=1.47; 95% CI: 1.30, 1.68], visited health facilities [aOR=1.64; 95% CI: 1.52, 1.76], and read newspapers [aOR= 1.78; 95%CI: 1.60, 2.15].The prevalence of clinical breast cancer screening was low (14%). Strengthening awareness campaigns, improving healthcare infrastructure, health education, universal health coverage, and screening programme access, with a focus on rural areas, women who lack formal education, and low socioeconomic status, are critical to increasing breast cancer screening rates and equity. Scale-up local and regional collaborations and the involvement of media agencies in the implementation of screening programs, advocacy, dissemination of information, and integration of screening programs with their routine care, can boost the screening.