Healthcare utilisation, cancer screening and potential barriers to accessing cancer care in rural South West Nigeria: a cross-sectional study.
Healthcare utilisation, cancer screening and potential barriers to accessing cancer care in rural South West Nigeria: a cross-sectional study.
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DOI：
10.1136/bmjopen-2020-040352
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发表时间：
2021-07-26
期刊：
影响因子：
2.9
通讯作者：
Du M
中科院分区：
文献类型：
--
作者：
Sharma A;Alatise OI;O'Connell K;Ogunleye SG;Aderounmu AA;Samson ML;Wuraola F;Olasehinde O;Kingham TP;Du M
预计到2030年，撒哈拉以南非洲的癌症负担将翻一番;获得癌症管理的医疗服务是该地区的优先事项。在尼日利亚，国家癌症控制计划的目标是确保到2022年所有尼日利亚人的合格人群中有50%以上的癌症筛查。我们描述了医疗保健利用，癌症筛查活动和潜在的障碍，以获得癌症护理在一个欠研究的农村社区为基础的成年人口在西南尼日利亚。2018年4月，我们对位于尼日利亚西南部奥逊州伊巴丹以东约130公里、距离拉各斯250公里的社区成年人（>18岁）进行了一项横断面研究。参与者用当地方言完成了一次面对面的调查。我们使用问卷调查来评估人口统计学、健康状况、收入、医疗支出、医生就诊和癌症筛查史。我们招募了346名患者：中位年龄为52岁，75%为女性。在整个队列中，4%的人有医疗保险。46%的人报告去年有重大医疗费用。符合条件的参与者很少进行癌症筛查活动：1.5%的人报告进行了宫颈癌筛查，3.3%的人进行了乳房X光检查，5%的人进行了结肠镜检查。在收入较低和教育水平较低的人群中，癌症筛查评估的频率较低。使用包括个人收入、保险状况和教育的多变量logistic回归模型，较高的个人收入与更多的癌症筛查活动相关（OR 2.7，95%CI 1.3至5.7，p<0.01）。尽管如此，大多数人都与初级保健医生有联系（去年为52%），超过70%的人可以收听广播和电视，这表明存在扩大社区筛查干预和提高认识的机会。尽管全国癌症病例有所增加，但我们强调尼日利亚社区成年人口中癌症筛查和全民医疗保健覆盖率的不足。根据政府资源的可用性，增加金融风险保护、提高认识和有针对性的资源分配可能有助于扩大尼日利亚的获得。
Cancer burden is predicted to double by 2030 in sub-Saharan Africa; access to healthcare services for cancer management is a priority in the region. In Nigeria, National Cancer Control Plan aims to ensure >50% cancer screening of eligible populations by 2022 for all Nigerians. We describe healthcare utilisation, cancer screening activities and potential barriers to accessing cancer care within an understudied rural community-based adult population in South West Nigeria. In April 2018, we conducted a cross-sectional study of community-based adults (>18 years) ~130 km east of Ibadan, 250 km from Lagos in Osun State, South West Nigeria. Participants completed a face-to-face survey in local dialect. We used a questionnaire to assess demographics, health status, income, medical expenditures, doctor visits and cancer screening history. We enrolled 346 individuals: with median age of 52 years and 75% women. Of the entire cohort, 4% had medical insurance. 46% reported a major medical cost in the last year. Cancer screening activities were infrequent in eligible participants: 1.5% reported having had cervical cancer screening, 3.3% mammogram and 5% colonoscopy screening. Cancer screening assessment was less frequent in those with less income and lower education levels. Using a multivariable logistic regression model including personal income, insurance status and education, higher personal income was associated with more cancer screening activity (OR 2.7, 95% CI 1.3 to 5.7, p<0.01). Despite this, most individuals had contact with a primary healthcare doctor (52% in the last year), and over 70% access to radio and TV suggesting the opportunity to expand community-based screening interventions and awareness exists. Despite national increases in cancer cases, we highlight a deficiency in cancer screening and universal healthcare coverage within a community-based adult Nigerian population. Subject to availability of governmental resources, increasing financial risk protection, awareness and targeted resource allocation may help expand access in Nigeria.
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