Barriers to early diagnosis of invasive cervical cancer among patients receiving treatment at Kenyatta National Hospital, Nairobi Kenya
Korir, Anne Rugutt
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Although cancer still remains a major health problem, early diagnosis and improved therapeutic interventions of cervical cancer in developed countries are quite different from what is observed in the developing countries; Kenya included. In resource constrained environments, limited access to oncology facilities, coupled with the stigma associated with cancer has much influence on the disease reporting and management. While the biological factors associated with early diagnosis and proper management have been documented, there is need to clearly define the role of individual, social, cultural and economic factors as determinants of early diagnosis of cervical cancer. The main objective of the study was to determine the barriers to early diagnosis among cervical cancer patients. Kenyatta National Hospital was chosen because it is the only national referral hospital in Kenya with radiotherapy machine used in treatment of cancer patients. Given that the cost of treatment is lower than the private hospitals, it attracts a large number of patients as referrals from the forty seven counties in the country. This was a descriptive survey using researcher-administered structured questionnaires to obtain data from a sample of 320 cervical cancer patients in Kenyatta National Hospital‟s radiotherapy clinic and among in-patients. To corroborate the findings from the patients, key informant schedule was administered to 30 healthcare personnel who interact closely with these patients to seek their views on reasons for late diagnosis. The data was analyzed using SPSS version 16.1 and presented in frequencies, graphs and tables. Chi square was used to test association among variables and significance level was set at 0.05. Individual patient‟s attitudes of the disease and health seeking behaviour were analyzed and correlated with the measurable outcomes which include; time lapse to disease diagnosis, age, socio-economic status, cultural factors, health facility-related factors and reaction time by health personnel. The findings have been correlated with time of onset of disease to diagnosis and treatment. The findings of this study established that general lack of knowledge on cervical cancer (75.3%) was significantly associated with late diagnosis (Chi-square=9.27 (1, N= 320; p=0.0023). A preponderance 266 (83.1%) had no knowledge on screening tests prior to diagnosis while only 54 (16.9%) were aware of Pap smear test. Similarly education level (² = 20.62 (3, N=316, P<.0001) was significantly association with late diagnosis of cervical cancer. Logistic regression analyses showed that higher education attainment was associated with 0.58 lower odds of late diagnosis of cervical cancer. Other social factors like age at diagnosis, locality, marital status and religion did not show any significant association with either early or late diagnosis.This study recommends that well organized cancer awareness and screening programmes be established while considering aspects of accessibility and affordability. Strengthening healthcare and referral systems, as well as continuing education of existing healthcare providers is recommended.