Social, demographic and healthcare factors associated with stage at diagnosis of cervical cancer: cross-sectional study in a tertiary hospital in Northern Uganda
Social, demographic and healthcare factors associated with stage at diagnosis of cervical cancer: cross-sectional study in a tertiary hospital in Northern Uganda
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DOI：
10.1136/bmjopen-2015-007690
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发表时间：
2016-01-01
期刊：
影响因子：
2.9
通讯作者：
Lyratzopoulos, Georgios
中科院分区：
文献类型：
--
作者：
Mwaka, Amos Deogratius;Garimoi, Christopher Orach;Lyratzopoulos, Georgios
目的：研究乌干达北方宫颈癌妇女的患者和初级保健因素以及诊断时的分期，目的是确定与晚期相关的因素，以便为提高低收入和中等收入国家宫颈癌生存率的政策提供信息。设计：基于医院的横断面研究。设置：冲突后地区的三级非营利私立医院。参与者：宫颈分泌物组织诊断有症状患者的护理。在166例患者中，149人被招募和analyzed.Primary结局：宫颈癌阶段在diagnosis.Results：大多数妇女被诊断为III期（45%）或IV期（21%）。在控制了年龄、婚姻状况、教育程度和亲生子女的数量后，有证据表明诊断时的晚期癌症与初级保健专业人员转诊前的癌症诊断之间存在关联（调整OR（AOR）=13.04：95%CI 3.59 ~ 47.3），经济困难妨碍及时寻求帮助（AOR=5.5：95%CI 1.58 ~ 20.64）。在调整年龄、婚姻状况和教育程度后，有5-9个亲生子女的妇女（AOR=0.27：95%CI 0.08 - 0.96）被诊断为晚期（定义为III/IV期）癌症的可能性较小。在这项试点研究中，有没有统计学证据之间的关联诊断阶段，和因素，如诊断年龄和婚姻状况。结论：这项研究是第一次尝试了解乌干达农村地区宫颈癌的描述性流行病学设置。了解个别患者因素、患者的行为特征和与诊断时晚期相关的医疗保健因素，对于有针对性的有效公共卫生干预措施至关重要，以促进及时就医、早期诊断和改善宫颈癌生存率。
Objective: To examine patient and primary healthcare factors and stage at diagnosis in women with cervical cancer in Northern Uganda with the intention to identify factors that are associated with advanced stages in order to inform policies to improve survival from cervical cancer in low income and middle income countries.Design: Cross-sectional hospital-based study.Setting: Tertiary, not-for-profit private hospital in postconflict region.Participants: Consecutive tissue-diagnosed symptomatic patients with cervical attending care. Of 166 patients, 149 were enrolled and analysed.Primary outcome: Cervical cancer stage at diagnosis.Results: Most women were diagnosed at stages III (45%) or IV (21%). After controlling for age, marital status, educational attainment and number of biological children, there was evidence for association between advanced stage at diagnosis and pre-referral diagnosis of cancer by primary healthcare professionals (adjusted OR (AOR)=13.04: 95% CI 3.59 to 47.3), and financial difficulties precluding prompt help seeking (AOR=5.5: 95% CI 1.58 to 20.64). After adjusting for age, marital status and educational attainment, women with 5-9 biological children (AOR=0.27: 95% CI 0.08 to 0.96) were less likely to be diagnosed with advanced stage (defined as stages III/IV) cancer. In this pilot study, there was no statistical evidence for associations between stage at diagnosis, and factors such as age at diagnosis and marital status.Conclusions: This study is a first attempt to understand the descriptive epidemiology of cervical cancer in rural Ugandan settings. Understanding individual patient factors, patients' behavioural characteristics and healthcare factors associated with advanced stage at diagnosis is essential for targeted effective public health interventions to promote prompt health seeking, diagnosis at early stage and improved survival from cervical cancer.