Prevalence of cervical human papillomavirus infection among women in Ghana: a systematic review and meta-analysis

Abstract

Background

Cervical cancer remains a significant public health challenge, particularly in low and middle-income countries, where the burden is disproportionately high. Human papillomavirus (HPV) is the principal cause of cervical cancer, yet evidence on the national prevalence of HPV infection in Ghana remains fragmented and inconsistent across studies. As Ghana prepares to scale up HPV vaccination and expand HPV-based screening, a comprehensive synthesis of HPV prevalence is essential to inform policy and guide prevention strategies. Through this systematic review and meta-analysis, we sought to estimate the pooled prevalence of any HPV infection and high-risk HPV genotypes among women in Ghana.

Methods

A systematic search of published studies reporting cervical HPV prevalence among Ghanaian women was conducted. Eligible studies included cross-sectional, retrospective and cohort designs. Data were extracted on study characteristics, population type, sample size and HPV outcomes. Random-effects models were used to generate pooled prevalence estimates for any HPV, high-risk HPV and low-risk HPV types. Heterogeneity and potential publication bias were assessed using I² statistics and funnel plots.

Results

Seventeen studies with a combined sample of more than 8,000 women were included. The pooled prevalence of any HPV infection was 31% (95% CI: 25–38%). The pooled prevalence of high-risk HPV infection was 28% (95% CI: 22–33%), while low-risk HPV infection had a pooled prevalence of 12% (95% CI: 4–20%). Substantial heterogeneity was observed across all analyses (I² > 90%). Funnel plots suggested possible publication bias for any HPV and low-risk HPV, while studies reporting high-risk HPV infection demonstrated a more symmetrical distribution. The estimate for low‑risk HPV prevalence was based on a limited number of studies and should be interpreted as exploratory.

Conclusion

HPV infection is highly prevalent among women in the studied regions, with high-risk HPV types constituting a substantial proportion of infections. These findings underscore the urgent need to strengthen national cervical cancer prevention strategies through widespread HPV vaccination, improved access to HPV-based screening and targeted interventions for high-risk groups. Establishing baseline HPV prevalence is critical for evaluating the impact of ongoing and future prevention programmes in Ghana. Findings are based on studies predominantly conducted in southern Ghana and may not fully represent the national population. Prospective Register of Systematic Reviews (PROSPERO); Registration ID: CRD42024605015.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-026-28037-1.

Introduction

Globally, the burden of cancer continues to rise and cervical cancer remains a major public health concern. It is the fourth most common cancer affecting women, with over 660,000 new cases and 350,000 deaths reported in 2022 [1]. The global distribution of cervical cancer is markedly uneven, with the majority of cases occurring in low and middle-income countries, particularly in sub-Saharan Africa [2]. In 2022, sub-Saharan Africa accounted for over a hundred thousand new cases, including substantial numbers in West, East, Northern, Southern and Middle Africa [3]. This contradicts the World Health Organisation’s (WHO) strategy to eliminate cervical cancer by reducing the annual incidence rate to below 4 cases per 100,000 women [2]. In Ghana, recent estimates indicate 3,000 new cervical cancer diagnoses annually, with a significant proportion (83%) resulting in death [4]. These regional disparities are driven by inequalities in access to vaccination, screening and treatment services, along with the influence of other determinants such as Human Immunodeficiency virus (HIV) prevalence, gender inequality and socioeconomic barriers [5].

Human papillomavirus (HPV) is the primary cause of cervical cancer and one of the most common sexually transmitted infections worldwide [2]. It is estimated that most women will acquire an HPV infection by middle age [6]. With more than 200 identified types, HPV affects both men and women [7]. Several HPV genotypes have been classified according to their carcinogenic potential, with certain high-risk types strongly linked to the development of cervical precancer and invasive cervical cancer [8]. Understanding the burden and distribution of HPV genotypes is therefore essential for designing effective public health strategies.

Prevention efforts such as HPV vaccination and screening for precancerous lesions form the foundation of cervical cancer control [9]. Although Pap smear cytology has been used widely, limitations in sensitivity have contributed to the increasing adoption of HPV DNA testing, which offers higher sensitivity for detecting high-risk infections [10]. Knowledge of local HPV prevalence and genotype patterns is crucial for guiding screening policies, selecting appropriate diagnostic methods and informing HPV vaccination strategies [8].

In Ghana, several studies have examined HPV prevalence across different regions and population groups [8, 11–13]. However, many of these studies have been limited by small sample sizes, restricted geographical coverage or differences in testing methods. These variations have produced inconsistent prevalence estimates, making it difficult to develop a clear national picture of HPV epidemiology. Importantly, no comprehensive synthesis currently exists that pools available data to generate national-level estimates of overall HPV prevalence and the prevalence of high-risk HPV genotypes among Ghanaian women. As the country prepares for the scale-up of HPV vaccination and to expand HPV-based screening [14], establishing baseline prevalence estimates is essential for monitoring programme impact and guiding future interventions.

This systematic review and meta-analysis aim to address these gaps by synthesising the available evidence on cervical HPV infection among women in Ghana. By generating pooled estimates of overall HPV prevalence and prevalence of both high-risk and low-risk HPV genotypes, this review provides essential evidence to strengthen cervical cancer prevention and control efforts. The findings of this review are expected to support evidence-based policy and enhance the effectiveness of vaccination and screening programmes nationwide.

Method

Study design

This study employed a systematic review and meta-analysis to synthesise existing quantitative research, including cross-sectional and cohort studies on the prevalence of cervical HPV infection among Ghanaian women. Case–control studies were excluded because their sampling is conditional on disease or exposure status and therefore does not yield representative prevalence estimates. Specifically, studies that recruited participants on the basis of cervical cancer diagnosis or HIV status were excluded from the quantitative synthesis to avoid inflation of pooled prevalence estimates. The review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 guidelines and was registered prospectively in the International Prospective Register of Systematic Reviews (PROSPERO; Registration ID: CRD42024605015) [15].

The review question was structured using the PICO framework as follows [16]:

• Population (P): Ghanaian women.

• Intervention/Exposure (I): Not applicable.

• Comparison (C): Not applicable.

• Outcome (O): HPV detected by polymerase chain reaction (PCR), hybrid capture or any recognised genotyping methodology.

Search strategy

A comprehensive search was conducted across four electronic databases: MEDLINE (via PubMed), EMBASE, Web of Science and CINAHL from database inception to 1st October 2024. Search terms included combinations of “HPV”, “prevalence”, “cervical HPV”, “Ghana”, “cervical cancer” and “women”. Additional studies were identified through manual screening of reference lists of relevant reviews and included articles (supplementary Table 1). Classification of HPV genotypes into high‑risk and low‑risk categories was based on explicit genotype information reported in individual studies. Studies were classified as contributing to the high‑risk HPV analysis only when assays clearly identified recognized high‑risk genotypes (e.g. HPV 16, HPV18 and other types explicitly defined as high‑risk according to established classifications.

Eligibility criteria

Studies were eligible for inclusion if they:

1. Were conducted in Ghana and involved Ghanaian women.

2. Used a quantitative study design (cross-sectional, retrospective or cohort).

3. Reported sample size and the number of HPV-positive participants.

4. Presented data on cervical HPV infection, including HPV genotypes when available.

5. Provided measurable HPV outcomes using recognised laboratory detection methods.

Studies were excluded if they:

1. Were conducted outside Ghana.

2. Focused exclusively on high-risk populations such as women living with HIV, pregnant women, commercial sex workers or individuals diagnosed with cervical cancer or cervical intraepithelial lesions.

3. Were published before the year 2000, as such studies may not reflect the current epidemiological pattern.

4. Lacked extractable quantitative data on HPV prevalence.

Study selection process

All identified records were imported into the Rayyan reference management system [17] and duplicates were removed. Two reviewers independently screened titles and abstracts to assess relevance. Full texts of potentially eligible studies were retrieved and evaluated against the inclusion criteria. Any disagreements between reviewers were resolved through discussion or consultation with the wider research team.

Data extraction

Data were extracted independently by two reviewers using a standardized form. Extracted information included study characteristics (title, first author, year of publication and study design), population details (sample size, participant age, study location and region), laboratory methods used for HPV detection and genotyping, and outcome data (number of HPV-positive participants, number of high-risk and low-risk HPV and prevalence of specific high-risk genotypes). For cohort and interventional studies, only baseline prevalence data were included in the extraction.

Risk of bias assessment

The methodological quality and risk of bias of all included studies were assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Prevalence Studies [18]. This assessment considered factors such as sampling methods, measurement reliability and completeness of outcome reporting.

Data synthesis and statistical analysis

A narrative synthesis was used to describe study characteristics, population features and methodological variations. For the quantitative synthesis, a random-effects meta-analysis was conducted to generate pooled prevalence estimates with 95% confidence intervals for any HPV infection. To stabilize variances and account for the bounded nature of prevalence data, individual study estimates were transformed prior to pooling using the Freeman–Tukey double arcsine transformation. Studies were weighted using inverse-variance weighting, such that studies with greater precision contributed more to the pooled estimates. Between study variance was estimated using restricted maximum likelihood (REML). Pooled estimates and corresponding 95% confidence intervals were back-transformed to the original proportion scale for presentation. Statistical heterogeneity was quantified using the I² statistic.

Given the high levels of statistical heterogeneity observed across outcomes (I² > 90%), additional analyses were undertaken to explore potential sources of heterogeneity. Prespecified sensitivity analyses were conducted by excluding studies assessed as having moderate risk of bias. In addition, subgroup analyses were performed by population type (community-based versus clinic-based samples). These analyses were conducted using random-effects models consistent with the primary analysis to assess the robustness of pooled estimates and to examine whether effect sizes differed systematically across subgroups.

Publication bias was assessed through visual inspection of funnel plots and formally evaluated using Egger’s regression test. No statistical adjustment for funnel plot asymmetry, such as trim-and-fill methods, was undertaken. Formal adjustment methods are unreliable when the number of included studies is small and when substantial between-study heterogeneity is present, conditions that applied to several outcomes in this review. All statistical analyses were conducted using Stata (version 19.5; StataCorp, College Station, TX, USA).

Results

Characteristics of included studies

A total of 6,419 abstracts were identified from the selected databases comprising Ovid EMBASE (87), CINAHL and Medline (6,177), Web of Science (111) and Google Scholar (44) (Fig. 1). Out of the identified abstracts, 515 were duplicates, which were removed before screening commenced. From the 5,904 records screened, 5,878 were excluded, and 20 out of the remaining 26 full-text reports were reviewed. The 6 full-text reports were excluded because they could not be retrieved (Supplementary Table 2). The 20 full-text papers retrieved were assessed for eligibility, and 3 were excluded based on the following reasons: one paper focused on HPV genotype variance rather than the targeted outcome, one investigated HPV persistence rather than the target outcome, and the last one reported the same result and population as an earlier published study by the same authors. A total of 17 articles which reported the prevalence of HPV remained for meta-analysis and synthesis as indicated in Table 1.

Fig. 1.

Adapted PRISMA flowchart

Table 1.

Characteristics of included studies (n = 17)

Study	Year	City/town	Region	Population	Age group	Study type	Number of people studied	Number positive for any HPV	Number positive for high- risk HPV	Number positive for low- risk HPV	HPV genotypes
Effah et al. [13]	2024	Nzulezo	Western	Women in the community	>=25	Cross-sectional	100	39	39	-	HPV 16, 18, and other types
Atiase et al. [11]	2024	Korle-Bu	Greater Accra	Women with diabetes mellitus attending the clinic	>=21	Cross-sectional	198	43	43	-	HPV 16, 18, and other types
Tekpor et al. [12]	2024	Accra	Greater Accra	Kayayei women	>=18	Cross-sectional	63	20	20	-	-
Effah et al. [21]	2023	-	Greater Accra, Volta, Central	Catholic nuns	-	Cross-sectional	105	25	25	-	HPV 16, 18
Effah et al. [22]	2023	Battor	Volta	Archived cervical-vaginal specimens of women who attended the cervical cancer prevention and training centre, Battor	>=25	Retrospective	226	82	82	-	-
Effah et al. [20]	2023	Battor	Volta	Women attending the ANC and PNC clinic	-	Cross-sectional	107	24	24	-	-
Dei-Adomakoh et al. [24]	2023	Korle-Bu	Greater Accra	Women with SCD attending a routine visit	>=20	Cross-sectional	168	48	48	-	-
Effah et al. [23]	2023	Battor	Volta	Women visiting the clinic and on outreaches	>=21	Cross-sectional	236	42	42	-	-
Donkoh et al. [25]	2022	Kumasi	Ashanti	Women attending for medical services at various hospitals in Kumasi	18–93	Cross-sectional	500	186	115	29	HPV 52, 56, 35, 18, 58, 68, 51, 39, 45, 16, 59, 33, 31, 42, 43, 66, 6/11 and 44.
Effah et al. [26]	2022	Battor	Volta	Women attending the clinic	-	Cross-sectional	3451	449	-	-	-
Acheampong et al. [19]	2021	Nsawam	Eastern	Incarcerated women	19–97	Cross-sectional	84	40	40	-	HPV 16, 18, and other types
Awua et al. [27]	2020	Akuse	Eastern	Women accessing clinical care in the hospital and women in the community	15–65	Cross-sectional	230	33	16.6	9.9	16, 35, 40, 45, 58, 18, 66
Krings et al. [28]	2019	North Tongu	Volta	Women in the North Tongu district	18–65	Cross-sectional	1943	903	628	405	HPV 16, 52, 35, 59, 56
Stuart et al. [29]	2019	Cape Coast	Central	Women attending the Cape Coast Teaching Hospital	-	Mixed method	76	32	-	-	-
Agyemang-Yeboah et al. [30]	2018	Kumasi, Accra	Ashanti, Greater Accra	Women who reported to cervical centres with various gynaecological or obstetric complaints	>=20	Cross-sectional	317	138	111	54	HPV 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68, 6/11, 42, 43, 44
Awua et al. [31]	2017	Akuse	Eastern	Women in the community	15–65	Cross-sectional	226	124	-	-	HPV 16, 18,33,35, 58, 59, 40
Domfeh et al. [32]	2008	Korle-Bu	Greater Accra	Women attending the clinic	19–57	Cross-sectional	75	8	-	-	-

- means not reported

Abbreviations: ANC Antenatal clinic, PNC Postnatal care, SCD Sickle cell disease

Using the JBI Critical Appraisal Checklist for Prevalence Studies [18], 15 studies (88%) were rated as low risk of bias and 3 (12%) as moderate risk (Table 2). The most common methodological limitations were unclear sampling method.

Table 2.

Risk of bias assessment (n = 17)

Study ID	First Author	Year	Appropriate Sample Frame? (Yes/No/Unclear)	Appropriate Sampling Method? (Yes/No/Unclear)	Adequate Sample Size? (Yes/No/Unclear)	Subjects & Setting Described? (Yes/No/Unclear)	Sufficient Data Coverage? (Yes/No/Unclear)	Valid HPV Identification Method? (Yes/No/Unclear)	Reliable & Consistent Measurement? (Yes/No/Unclear)	Appropriate Statistical Analysis? (Yes/No/Unclear)	Adequate Response Rate? (Yes/No/Unclear)	Overall Risk of Bias (Low/Moderate/High)
1	Effah et al. [13]	2024	yes	yes	yes	yes	yes	yes	yes	yes	yes	low
2	Atiase et al. [11]	2024	yes	yes	yes	yes	yes	yes	yes	yes	yes	low
3	Tekpor et al. [12]	2024	yes	no	yes	yes	yes	yes	yes	yes	yes	moderate
4	Effah et al. [21]	2023	yes	yes	yes	yes	yes	yes	yes	yes	yes	low
5	Effah et al. [22]	2023	yes	yes	yes	yes	yes	yes	yes	yes	yes	low
6	Effah et al. [20]	2023	yes	yes	yes	yes	yes	yes	yes	yes	yes	low
7	Dei-Adomakoh et al. [24]	2023	yes	yes	yes	yes	yes	yes	yes	yes	yes	low
8	Effah et al. [23]	2023	yes	yes	yes	yes	yes	yes	yes	yes	yes	low
9	Donkoh et al. [25]	2022	yes	yes	yes	yes	yes	yes	yes	yes	yes	low
10	Effah et al. [26]	2022	yes	yes	yes	yes	yes	yes	yes	yes	yes	low
11	Acheampong et al. [19]	2021	yes	yes	yes	yes	yes	yes	yes	yes	yes	low
12	Awua et al. [27]	2020	yes	unclear	yes	yes	yes	yes	yes	yes	no	moderate
13	Krings et al. [28]	2019	yes	yes	yes	yes	yes	yes	yes	yes	yes	low
14	Stuart et al. [29]	2019	yes	yes	yes	yes	yes	yes	yes	yes	yes	low
15	Agyemang-Yeboah et al. [30]	2018	yes	yes	yes	yes	yes	yes	yes	yes	yes	low
16	Awua et al. [31]	2017	yes	yes	yes	yes	yes	yes	yes	yes	yes	low
17	Domfeh et al. [32]	2008	yes	yes	yes	yes	yes	yes	yes	yes	yes	low

The characteristics of the 17 studies included in the systematic review and meta-analysis have been summarised in Table 1. The studies were conducted from the year 2000 and beyond and included a total of 8,105 participants. The studies were conducted in the Volta, Greater Accra, Central, Ashanti, Eastern and Western regions of Ghana [11, 12, 26–32, 13, 19–25]. Studies were population-based, with the majority being cross-sectional. Participants’ age groups ranged from 15 to 97 years. The total number of reported HPV positive cases was 2,236. The majority of the studies reported on high-risk HPV-positives. Only a few reported on low-risk HPV-positives. Considerable variation was observed across studies in sample size, population characteristics and diagnostic approaches.

The prevalence of any HPV infection across studies ranged from 13% to 54% (Fig. 2). The random-effects meta-analysis yielded a pooled prevalence of 31% (95% CI: 25%–38%). Heterogeneity in overall HPV prevalence was substantial (I² = 97.92%). Thirteen studies reported prevalence estimates for high-risk HPV types (Fig. 3). Reported prevalence ranged from 5% to 45%, with a pooled prevalence estimate of 28% (95% CI: 22%–33%). Heterogeneity was high (I² = 93.72%), although lower than that observed for overall HPV prevalence Only three studies reported prevalence estimates for low-risk HPV infection (Fig. 4). Observed prevalence ranged from 6% to 21%, resulting in a pooled prevalence of 12% (95% CI: 4%–20%). Heterogeneity was very high (I² = 97.75%) with wide confidence interval reflects. Given the small number of contributing studies and wide confidence interval, this estimate should be interpreted cautiously and considered exploratory.

Fig. 2.

Forest plot of the prevalence of any HPV infection among women in Ghana

Fig. 3.

Forest plot of the prevalence of high-risk HPV infection among women in Ghana

Fig. 4.

Forest plot of the prevalence of low-risk HPV infection among women in Ghana

Funnel plots were constructed to assess potential publication bias for the three HPV outcomes (Figs. 5A–C). The funnel plot for any HPV infection showed noticeable asymmetry, with greater dispersion of smaller studies and an uneven distribution of points around the pooled estimate (Fig. 5A). The funnel plot for high-risk HPV appeared comparatively more symmetric, with most studies clustering around the pooled estimate and less pronounced dispersion, although some variability among smaller studies remained evident (Fig. 5B). For low-risk HPV, the funnel plot showed marked asymmetry, with few studies contributing data and a wide spread of points around the pooled estimate (Fig. 5C). Egger’s test showed no evidence of small-study effects for overall HPV prevalence (β = 2.44, SE = 2.29, p = 0.29) or low-risk HPV prevalence (β =2.25, SE = 10.82, p = 0.84). For high-risk HPV prevalence, there was borderline evidence of small-study effects (β = 3.68, SE = 1.92, p = 0.055). Visual inspection of the funnel plots was broadly consistent with these findings. Sensitivity analyses excluding studies with moderate risk of bias yielded pooled estimates that were broadly consistent in direction and magnitude with the primary analyses, although heterogeneity remained substantial (Supplementary Fig. 1–5). Subgroup analyses by population type indicated differences in pooled estimates between community‑based and clinic‑based studies, suggesting that study setting and underlying population characteristics contribute to the observed heterogeneity.

Fig. 5.

Funnel plot assessing publication bias

Subgroup analyses were conducted to examine differences in HPV prevalence by study setting (community‑based versus clinic‑based) (Supplementary Fig. 5). The pooled prevalence of HPV was lower among (clinic‑based studies: 26% (95% CI: 18%–34%) compared to community‑based studies: 41% (95% CI: 32%–50%)). Heterogeneity remained high within both subgroups (clinic‑based: I² = 96.33%; community‑based: I² = 90.83%). The test for subgroup differences showed a borderline statistically significant difference (p = 0.05).

Discussion

Summary of main findings

This systematic review and meta-analysis brought together data from 17 studies conducted across six of the sixteen regions of Ghana, involving more than 8,000 women from both community and clinical settings [11–13, 19–32]. The pooled prevalence of any HPV infection was 31%, while the prevalence of high-risk HPV infection was 28%, and low-risk HPV infection was 12%. These findings point to a substantial burden of HPV infection in Ghana, with high-risk strains accounting for the majority of HPV infections detected. Considerable heterogeneity was observed across all pooled estimates, reflecting differences in study populations, diagnostic assays, sampling techniques and geographic variation. Funnel plots indicated possible publication bias for any HPV and low-risk HPV, while the high-risk HPV studies showed a more symmetrical pattern, suggesting a lower risk of bias in that subset.

Comparison with the literature

The high prevalence of HPV observed in this review aligns with patterns reported across sub-Saharan Africa, where HPV rates remain among the highest globally [33]. Previous regional estimates suggest HPV prevalence between 25% and 40% in many West and Central African countries, which is consistent with the pooled prevalence found in Ghana [34, 35]. The high-risk HPV prevalence of 28% is substantially higher than global averages, where the prevalence of high-risk HPV among women with normal cytology is estimated at approximately 11–12% [6, 36]. However, it mirrors findings from studies across West Africa, where high-risk HPV types (16, 18, 31, 33, and 45) are reported more frequently than in many other regions [33, 34]. This difference may reflect variation in sexual behaviour, access to healthcare, HPV screening uptake and the availability of HPV vaccination programmes across sub-Saharan African countries and Western and other developed countries [37]. The notable heterogeneity observed in this review is also consistent with global HPV literature, where prevalence is known to vary considerably between community-based and facility-based studies and between rural and urban populations [2, 38, 39].

The observed differences in HPV prevalence between clinic‑based and community‑based studies may reflect underlying differences in population characteristics, healthcare seeking behaviour and risk profiles. Clinic‑based populations are more likely to include individuals seeking care for symptoms or screening, which may result in higher observed prevalence. In contrast, community‑based studies may better reflect the general population, although they may also include individuals with lower healthcare access. These findings highlight the importance of considering study setting when interpreting HPV prevalence estimates. They also suggest that clinic‑based estimates may overestimate population‑level prevalence, while community‑based data may provide more representative estimates for public health planning. However, given the substantial heterogeneity observed within subgroups, these findings should be interpreted with caution.

The high levels of heterogeneity observed across studies (I² > 90%) are likely to reflect a combination of methodological and contextual differences rather than chance alone. Several factors may contribute to this variability. First, differences in HPV detection methods, such as polymerase chain reaction (PCR) based assays versus hybrid capture techniques, may influence sensitivity and specificity, leading to variation in reported prevalence estimates. Second, variation in sample collection methods, including clinician‑collected versus self‑collected specimens, may affect detection rates, with some evidence suggesting higher or more variable detection in self‑sampling contexts. Third, differences in study populations and settings, including community‑based versus clinic‑based samples, may reflect underlying differences in risk profiles, healthcare‑seeking behaviour, and access to screening services. Additionally, variability in demographic characteristics, urban versus rural contexts and study design may further contribute to observed heterogeneity. Due to the limited number of studies and inconsistent reporting of these variables across studies, formal meta‑regression analysis was not performed, as such analyses may yield unreliable estimates under these conditions. Nevertheless, the identified factors provide plausible explanations for the observed variability and should be considered when interpreting the pooled estimates.

Strengths and limitations

A major strength of this review is the inclusion of a large number of studies from a broad range of settings across Ghana, enabling a comprehensive synthesis of HPV prevalence in the country. The substantial overall sample size enhances the reliability of pooled estimates, and the disaggregation of any HPV infection offers a more nuanced understanding of circulating HPV types. Another strength lies in the systematic methodology employed, including random-effects modelling and assessment of publication bias.

Despite these strengths, some limitations are acknowledged. The pooled HPV prevalence estimates in our review came from studies conducted across only six of the sixteen regions in Ghana. These six regions fall largely within the southern belt of the country. In the absence of published prevalence estimates from the middle and upper belt of the country, care must be taken in informing nationwide HPV risk reduction programmes with pooled estimates from this review. The extremely high heterogeneity observed across analyses indicates substantial methodological and population differences between studies, which may limit comparability. Rather than indicating a lack of association, the heterogeneity likely reflects genuine contextual differences across study settings. Future primary studies using more standardised outcome measures and reporting would facilitate more precise estimation and improved exploration of heterogeneity. Diagnostic variability was present, as studies employed different HPV detection techniques with differing sensitivities and specificities. Several studies focused on high-risk populations such as incarcerated women or women attending specialised clinics, which may result in overestimation of population-wide prevalence. Although these populations were not selected based on known high‑risk clinical status, they may differ from the general population in terms of health seeking behaviour, exposure risk and access to healthcare. Inclusion of these groups may therefore influence the pooled prevalence estimates. As a result, findings should be interpreted with caution, particularly with regard to their generalisability to the wider population. Additionally, some studies did not report complete data for high-risk or low-risk HPV types. Evidence of publication bias in the funnel plots, particularly for any HPV and low-risk HPV, further suggests that smaller or non-significant studies may be underrepresented. However, formal methods to adjust for publication bias were not applied, particularly for low‑risk HPV, where the small number of available studies limits the reliability of such approaches. Consequently, pooled prevalence estimates, especially for low‑risk HPV, should be interpreted with caution. As such, direct comparisons between the prevalence of low‑risk and high‑risk HPV should be avoided. Additional population‑based studies are needed to strengthen the evidence base and improve the precision of prevalence estimates. Age is a well‑established determinant of HPV prevalence. However, variation in age reporting across studies limited the feasibility of age‑based subgroup analyses. Some studies reported wide age ranges, while others did not provide age information or age‑specific prevalence estimates. As a result, the potential influence of age on pooled prevalence estimates could not be formally assessed and should be considered a limitation of this review. Future studies should report age‑stratified prevalence estimates using standardised age categories to facilitate more refined synthesis.

Clinical implications

The substantial burden of HPV infection identified in this review highlights significant implications for cervical cancer prevention and control in Ghana. The high prevalence of high-risk HPV, the types most closely associated with cervical cancer development, underscores the urgency of expanding HPV vaccination programmes nationwide. Enhancing access to HPV DNA-based screening is crucial, as these methods offer superior sensitivity compared with cytology [40] and are more suitable for low-resource settings [41]. Public health interventions must prioritise improved awareness of HPV transmission, HPV-cervical cancer association, screening benefits and vaccination among women and adolescents. Strengthening laboratory infrastructure for molecular detection and genotyping is also essential to support effective screening and surveillance systems. Given the elevated HPV burden observed among high-risk groups in particular, targeted outreach and screening for vulnerable populations, including women living with HIV and women with chronic health conditions, may be especially beneficial.

Conclusion

This systematic review and meta-analysis show a notably high prevalence of HPV infection in Ghana, with one-third of women carrying any HPV type and nearly one-third infected with high-risk oncogenic types. The findings highlight the critical importance of scaling up HPV vaccination, increasing access to robust and sensitive screening methods, and implementing targeted public health interventions to reduce the burden of HPV-related disease among women in Ghana. Although heterogeneity between studies was considerably high, the consistent pattern of high prevalence across the studied regions and populations underscores the urgent need for strengthened cervical cancer prevention strategies in Ghana and supports efforts aligned with the WHO global initiative to eliminate cervical cancer as a public health problem.

Abbreviations

HPV

Human papillomavirus

PROSPERO

Prospective Register of Systematic Reviews

WHO

World Health Organisation

GLOBOCAN

Global Cancer Observatory

HIV

Human immunodeficiency virus

DNA

Deoxyribonucleic acid

PRISMA

Preferred Reporting Items for Systematic reviews and Meta-Analyses

MOH

Ministry of Health

PCR

Polymerase chain reaction

JBI

Joanna Briggs Institute

Authors’ contributions

**YN** : conceptualisation (lead), data curation (lead), methodology (lead), analysis, writing – original draft (lead). **JOL** : conceptualisation (lead), methodology (lead), writing – review and editing (supporting). **BON** : methodology (supporting), screening (lead), writing – original draft (supporting). **PKAAD** : methodology (supporting), screening (lead), writing – review and editing (supporting). **MI** : methodology (supporting), writing – review and editing (supporting).

Funding

The study was not funded.

Data availability

All data analysed in this study are derived from previously published articles, which are cited within the manuscript. Extracted data used for the meta-analysis are available from the corresponding author upon reasonable request.

Declarations

Ethics approval and consent to participate

Ethical approval and informed consent were not required for this study because it is a systematic review and meta-analysis based exclusively on previously published, publicly available data.

Consent for publication

Not applicable. This study does not contain any individual person’s data.

Competing interests

The authors declare no competing interests.