Determinants of delay in seeking medical care among women with invasive cervical cancer in Western Kenya

Abstract

ABSTRACT Cervical cancer is a disease with tremendous public health significance. It is the leading cause of cancer morbidity and mortality among women in Kenya. Although curable through regular screening and treatment of precancerous lesions, its incidence is on the rise in Eastern Africa and many women are presenting with advanced disease leading to low survival rates. In Western Kenya, it is the most common type of cancer affecting women. Patient delay accounts for a large proportion of those who present with advanced disease in developing countries. Reducing the time from onset of first symptoms to diagnosis will effectively improve quality of life and prognosis of cervical cancer patients. This cross-sectional study was conducted to explore the process of symptom appraisal and determine socioeconomic, psychosocial, and cultural and health system factors that contribute to patient delay in seeking medical care for cervical cancer among women in two county referral hospitals in rural Kenya. In the setting where the study was carried out, the prevalence of HIV/AIDS is relatively high. There were 274 respondents who participated in the study. Face to face interviews using a pretested structured questionnaire and medical records review were carried out. Data was collected from all those who met the inclusion criteria and had given their informed consent with the option of voluntary withdrawal from the study at any stage. Descriptive and inferential statistics were analyzed using Statistical Packages for Social Sciences version 21 (SPSS Inc, USA). Chi square test and logistic regression was used to derive relationships between variables; results were considered significant with p value ≤0.05. Outcome measures were a description of determinants of late presentation and diagnosis of cervical cancer. The findings indicate that 55% of patients waited more than three months before seeking medical care mainly because they did not appraise the symptoms as serious warranting medical attention. This was despite majority (85%) of them having good access to medical facilities. Psychosocial factors such as beliefs and perceptions held by the patients about initial symptoms and availability of social support networks were the most significant predictors of delay in seeking medical care. Age of patient, education level, employment status, access to insurance, beliefs about traditional medicine, knowledge of cervical cancer and preventative health orientation of the respondents also contributed to delay in seeking care. In conclusion, there is need to raise awareness about cancer to empower both the public and health workers to recognize its signs and symptoms early and seek treatment. There is a need for the patients to be economically empowered in order to access available cancer care. They could be encouraged to enroll in the National Health Insurance Fund in order to benefit from its various cancer treatment packages.