Extent and Predictors of Delays in Diagnosis of Cervical Cancer in Addis Ababa, Ethiopia: A Population-Based Prospective Study

PURPOSE A substantial proportion of cervical cancers are diagnosed at advanced stage in Ethiopia. Therefore, the aim of this study was to determine the extent and predictors of delays in cervical cancer diagnosis in Addis Ababa. PATIENTS AND METHODS We prospectively recruited 231 patients with cervical cancer diagnosed from January 1, 2017, to June 30, 2018, in 7 health facilities in Addis Ababa, representing 99% of all cervical cancers recorded in the Addis Ababa population-based cancer registry. A structured questionnaire on patients’ experience was administered face to face by trained interviewers. Health-seeking intervals > 90 days (date from recognition of symptoms to medical consultation) and diagnostic intervals > 30 days (dates from medical consultation to diagnostic confirmation) were categorized as delayed. Factors associated with these delays were assessed using multivariable binary logistic regression models. RESULTS The median health-seeking and diagnostic intervals for patients with cervical cancer in Addis Ababa were 10 and 97 days, respectively. Approximately one quarter of the patients were delayed in seeking medical consultation, and three fourths of the patients had delayed diagnostic confirmation. Factors associated with health-seeking delays included poor cervical cancer awareness, practicing of religious rituals, and waiting for additional symptoms before visiting a health facility. Factors associated with diagnostic delays included first contact with primary health care units and visits to ≥ 4 different health facilities before diagnosis. CONCLUSION A considerable proportion of patients with cervical cancer in Addis Ababa have delays in seeking medical care and diagnostic conformation. These findings reinforce the need for programs to enhance awareness about cervical cancer signs and symptoms and the importance of early diagnosis in the community and among health care providers.

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Factors associated with advanced stage at diagnosis of cervical cancer in Addis Ababa, Ethiopia: a population-based study

BMJ Open ◽

10.1136/bmjopen-2020-040645 ◽

2020 ◽

Vol 10 (10) ◽

pp. e040645

Author(s):

Nebiyu Dereje ◽

Alem Gebremariam ◽

Adamu Addissie ◽

Alemayehu Worku ◽

Mathewos Assefa ◽

...

Keyword(s):

Cervical Cancer ◽

Conventional Medicine ◽

Early Stage ◽

Addis Ababa ◽

Population Based ◽

Advanced Stage ◽

Stage At Diagnosis ◽

Factors Associated ◽

Medical Bill ◽

Stage Stage

ObjectiveTo describe the patterns and factors associated with advanced stage at diagnosis of cervical cancer among Addis Ababa residents, Ethiopia.DesignA population-based cross-sectional study.SettingSeven major hospitals or diagnostic facilities in Addis Ababa, Ethiopia.ParticipantsAll histopathology-confirmed patients with incident cervical cancer diagnosed from 1 January 2017 to 30 June 2018 among Addis Ababa residents.Outcome measuresThe proportion of patients with cervical cancer diagnosed at early stage (stage I/II) and advanced stage (stage III/IV) of the disease according to International Federation of Gynaecology and Obstetrics staging criteria, and adjusted prevalence ratio (APR) for factors associated with advanced-stage diagnosis using a Poisson regression with robust variance model.ResultsThe mean age of the study participants was 52.9 (±13.3) years. Nearly two-thirds (60.4%, 95% CI: 53.8% to 66.5%) of patients with cervical cancer were diagnosed at an advanced stage. Advanced stage at diagnosis was significantly associated with paying medical bill out of pocket (APR=1.44, 95% CI: 1.08 to 1.91), diagnostic interval >90 days (APR=1.31, 95% CI: 1.04 to 1.71), practicing religion as a remedy or not taking immediate action following symptom recognition (APR=1.25, 95% CI: 1.08 to 1.91) and visiting more than three different health facilities prior to diagnostic confirmation (APR=1.24, 95% CI: 1.07 to 1.51).ConclusionsOur findings of the high proportion of advanced-stage diagnosis of cervical cancer in Addis Ababa and its strong associations with out-of-pocket medical bill, seeking care out of conventional medicine settings and multiple visits to healthcare facilities before diagnostic confirmations underscore the need for public policies to improve the affordability of cancer care and enhance community awareness about the severity of the disease and referral system, in addition to expanding cervical cancer screening.

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Spatiotemporal modelling and mapping of cervical cancer incidence among HIV positive women in South Africa: a nationwide study

International Journal of Health Geographics ◽

10.1186/s12942-021-00283-z ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Dhokotera Tafadzwa ◽

Riou Julien ◽

Bartels Lina ◽

Rohner Eliane ◽

Chammartin Frederique ◽

...

Keyword(s):

South Africa ◽

Health Care ◽

Cervical Cancer ◽

South African ◽

Access To Health Care ◽

Health Facilities ◽

Hiv Positive ◽

The South ◽

Hiv Positive Women ◽

Access To Health

Abstract Background Disparities in invasive cervical cancer (ICC) incidence exist globally, particularly in HIV positive women who are at elevated risk compared to HIV negative women. We aimed to determine the spatial, temporal, and spatiotemporal incidence of ICC and the potential risk factors among HIV positive women in South Africa. Methods We included ICC cases in women diagnosed with HIV from the South African HIV cancer match study during 2004–2014. We used the Thembisa model, a mathematical model of the South African HIV epidemic to estimate women diagnosed with HIV per municipality, age group and calendar year. We fitted Bayesian hierarchical models, using a reparameterization of the Besag-York-Mollié to capture spatial autocorrelation, to estimate the spatiotemporal distribution of ICC incidence among women diagnosed with HIV. We also examined the association of deprivation, access to health (using the number of health facilities per municipality) and urbanicity with ICC incidence. We corrected our estimates to account for ICC case underascertainment, missing data and data errors. Results We included 17,821 ICC cases and demonstrated a decreasing trend in ICC incidence, from 306 to 312 in 2004 and from 160 to 191 in 2014 per 100,000 person-years across all municipalities and corrections. The spatial relative rate (RR) ranged from 0.27 to 4.43 in the model without any covariates. In the model adjusting for covariates, the most affluent municipalities had a RR of 3.18 (95% Credible Interval 1.82, 5.57) compared to the least affluent ones, and municipalities with better access to health care had a RR of 1.52 (1.03, 2.27) compared to municipalities with worse access to health. Conclusions The results show an increased incidence of cervical cancer in affluent municipalities and in those with more health facilities. This is likely driven by better access to health care in more affluent areas. More efforts should be made to ensure equitable access to health services, including mitigating physical barriers, such as transportation to health centres and strengthening of screening programmes.

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Cervical cancer survivors and health care use: A Danish population-based register study

Gynecologic Oncology ◽

10.1016/j.ygyno.2021.02.003 ◽

2021 ◽

Vol 161 (2) ◽

pp. 565-572

Author(s):

Malene Skorstengaard ◽

Maria Eiholm Frederiksen ◽

Miguel Vázquez-Prada Baillet ◽

Anna-Belle Beau ◽

Pernille Tine Jensen ◽

...

Keyword(s):

Health Care ◽

Cervical Cancer ◽

Cancer Survivors ◽

Population Based ◽

Health Care Use ◽

Danish Population

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Trends in and determinants of visiting private health facilities for maternal and child health care in Nepal: Comparison of three Nepal Demographic Health Surveys, 2006, 2011, and 2016.

10.21203/rs.3.rs-40846/v1 ◽

2020 ◽

Author(s):

Ramesh Prasad Adhikari ◽

Manisha Laxmi Shrestha ◽

Emily N. Satinsky ◽

Nawaraj Upadhaya

Keyword(s):

Health Care ◽

Child Health ◽

Maternal And Child Health ◽

Health Surveys ◽

Wealth Quintile ◽

Health Facilities ◽

Child Health Care ◽

Health Seeking ◽

And Child Health ◽

Over Time

Abstract Background: Maternal and child health care services are available in both public and private facilities in Nepal. No study has yet looked at trends in maternal and child health service use over time in Nepal. This paper assesses trends in and determinants of visiting private health facilities for maternal and child health needs using nationally representative data from the last three successive Nepal Demographic Health Surveys (NDHS). Methods: Data from the NDHS conducted in 2006, 2011, and 2016 were used. Maternal and child health-seeking was established using data on place of antenatal care (ANC), place of delivery, and place of treatment for child diarrhoea and fever/cough. Logistic regression models were fitted to identify trends in and determinants of health-seeking at private facilities. Results: The results indicate an increase in the use of private facilities for maternal and child health care over time. Across the three survey waves, women from the highest wealth quintile had the highest odds of accessing ANC services at private health facilities (AOR=6.0, CI= 3.78 -9.52 in 2006; AOR=5.6, CI= 3.51 – 8.81 in 2011; AOR=3.0, CI= 1.53 -5.91 in 2016). Women from the highest wealth quintile (AOR=8.3 CI= 3.97 – 17.42 in 2006; AOR=7.3, CI= 3.91 – 13.54 in 2011; AOR=3.3, CI= 1.54 – 7.09 in 2016) and women with more years of schooling (AOR=1.1, CI= 1.07 – 1.16 in 2006; AOR=1.1, CI= 1.04 – 1.14 in 2011; AOR=1.2, CI= 1.17 -1.27 in 2016) were more likely to deliver in private health facilities. Likewise, children belonging to the highest wealth quintile (AOR=6.4, CI= 1.59 – 25.85 in 2006; AOR=8.0, CI= 2.43 – 26.54 in 2016) were more likely to receive diarrhoea treatment in private health facilities.Conclusions: Women are increasingly visiting private health facilities for maternal and child health care in Nepal. Household wealth quintile, and the mother’s years of schooling were the major determinants for selecting private health facilities for these services. These trends indicate the importance of collaboration between private and public health facilities in Nepal to foster a public private partnership approach in the Nepalese health care sector.

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Interval cancer audit and disclosure in cervical screening programmes: An international survey

Journal of Medical Screening ◽

10.1177/09691413211062344 ◽

2021 ◽

pp. 096914132110623

Author(s):

Patricia Fitzpatrick ◽

Therese Mooney ◽

Helen Byrne ◽

Orla Healy ◽

Noirin Russell ◽

...

Keyword(s):

Cervical Cancer ◽

Cancer Detection ◽

Cervical Screening ◽

Interval Cancer ◽

Population Based ◽

Audit Process ◽

Detection Rates ◽

Legal Cases ◽

Cervical Cancers ◽

International Comparative

Background Legal cases involving the National Cervical Screening Programme in Ireland following non-disclosure of an interval cervical cancer audit prompted this first international comparative survey of interval cervical cancer audit. Methods A survey of 22 international population-based cervical screening programmes was conducted, to determine if they undertook audit of invasive cervical cancers. Those countries/regions that perform reviews were asked (i) how the audit was undertaken, including how the reviews were performed and how they controlled for retrospective bias, (ii) how women are informed of the audit process and how their consent is obtained, and (iii) how audit results were disclosed to patients. Results Seventeen countries/regions invited completed the survey (77%); 65% (11/17) have an audit process for interval cervical cancers. Five perform individual patient reviews; three perform programme-wide review, with calculation of interval cancer detection rates; one routinely performs programme-wide review with calculation of interval cancer detection rates and offers individual reviews, and one routinely performs local hospital-level reviews. In the remaining country/region, hospital laboratories audit cancers, with a national audit process for all cervical cancers. Varying methodologies for retrospective cytology review were employed; four include control samples, with a ratio varying from 1:1 to 1:2. Three conduct a blinded review. Most countries/regions do not discuss interval cancer audit with participants and 3/11 (27.3%) inform women when a cervical cancer audit takes place. Disclosure is limited and variable. Conclusion The responses suggest that there is no consistent approach to audit of interval cervical cancers or to disclosure of audit results.

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Service Level Factors Associated with Cervical Screening in Aboriginal and Torres Strait Islander Primary Health Care Centres in Australia

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16193630 ◽

2019 ◽

Vol 16 (19) ◽

pp. 3630 ◽

Cited By ~ 1

Author(s):

Abbey Diaz ◽

Brenda Vo ◽

Peter D. Baade ◽

Veronica Matthews ◽

Barbara Nattabi ◽

...

Keyword(s):

Health Care ◽

Cervical Cancer ◽

Primary Health Care ◽

Torres Strait Islander ◽

Cervical Screening ◽

Service Level ◽

Factors Associated ◽

Primary Health ◽

Screening Coverage ◽

Torres Strait

Aboriginal and Torres Strait Islander women have significantly higher cervical cancer incidence and mortality than other Australian women. In this study, we assessed the documented delivery of cervical screening for women attending Indigenous Primary Health Care (PHC) centres across Australia and identified service-level factors associated with between-centre variation in screening coverage. We analysed 3801 clinical audit records for PHC clients aged 20–64 years from 135 Indigenous PHC centres participating in the Audit for Best Practice in Chronic Disease (ABCD) continuous quality improvement (CQI) program across five Australian states/territories during 2005 to 2014. Multilevel logistic regression models were used to identify service-level factors associated with screening, while accounting for differences in client-level factors. There was substantial variation in the proportion of clients who had a documented cervical screen in the previous two years across the participating PHC centres (median 50%, interquartile range (IQR): 29–67%), persisting over years and audit cycle. Centre-level factors explained 40% of the variation; client-level factors did not reduce the between-centre variation. Screening coverage was associated with longer time enrolled in the CQI program and very remote location. Indigenous PHC centres play an important role in providing cervical screening to Aboriginal and Torres Strait Islander women. Thus, their leadership is essential to ensure that Australia’s public health commitment to the elimination of cervical cancer includes Aboriginal and Torres Strait Islander women. A sustained commitment to CQI may improve PHC centres delivery of cervical screening; however, factors that may impact on service delivery, such as organisational, geographical and environmental factors, warrant further investigation.

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