Barriers to early diagnosis of cervical cancer: a mixed-method study in Côte d'Ivoire, West Africa.
Barriers to early diagnosis of cervical cancer: a mixed-method study in Côte d'Ivoire, West Africa.
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DOI：
10.1186/s12905-023-02264-9
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发表时间：
2023-03-27
影响因子：
2.5
通讯作者：
Jaquet, Antoine
中科院分区：
文献类型：
--
作者：
Plaisy, Marie P.;Boni, Simon A.;Coffie, Patrick;Tanon, Aristophane;Innocent, Adoubi;Horo, Apollinaire;Dabis, Francois;Bekelynck, Anne;Jaquet, Antoine
关键词：
在许多发展中国家，宫颈癌是一个主要的公共卫生问题，通常与晚期疾病确诊时的低生存率有关。在科特迪瓦和其他宫颈癌发病率较高的发展中国家，在获得筛查服务的机会有限的情况下，人们对与晚期宫颈癌有关的因素知之甚少。2019年5月至7月，我们采用定量和定性相结合的方法进行了横断面研究。关于该病社会人口和病史的信息摘自科特迪瓦癌症登记处进行的一项快速病例确定研究，该研究纳入了2018年7月至2019年6月期间所有被诊断为宫颈癌的妇女。对这些妇女中的一部分(12名妇女)和6名医疗保健提供者进行了深入的半结构化访谈，以进一步了解早期宫颈癌诊断的障碍。通过Logistic回归模型估计与晚期III、IV期(根据FIGO分类)相关的因素。在治疗路径模型的指导下，使用主题分析技术分析定性数据，并用定量数据进行三角划分。总共包括95名患有宫颈癌的妇女[平均年龄 = 51(IQR42-59)]。其中，18.9%的人感染了艾滋病毒，只有9.5%的人获得了医疗保险。大多数(71.5%)被诊断为晚期宫颈癌。多因素分析显示，未感染艾滋病毒(AOR = 5.4；[1.6-17.8]，p = 0.006)和未投保(AOR = 13.1；[2.0-85.5]，p = 0.007)是晚期宫颈癌的独立危险因素。定性数据提出了可能与诊断时的晚期宫颈癌相关的其他因素，包括医疗保健提供者缺乏关于宫颈癌的患者信息，以及国家意识和筛查活动不足。在科特迪瓦面临获得系统宫颈癌筛查的挑战的背景下，获得医疗保险或综合保健计划似乎是宫颈癌早期诊断的关键决定因素。
Cervical cancer, a major public health problem in many developing countries, is usually associated with a poor survival related to an advanced disease at diagnosis. In Côte d’Ivoire and other developing countries with high cervical cancer prevalence, little is known about factors associated with advanced cervical cancer stages in a context of limited access to screening services. From May to July 2019, we conducted a cross-sectional study using a mixed, quantitative and qualitative method. Information on socio-demographic and history of the disease was extracted from a rapid case ascertainement study performed by the cancer registry of Côte d’Ivoire that enrolled all women diagnosed with cervical cancer between July 2018 and June 2019. In-depth semi-structured interviews were conducted among a subset of these women (12 women) and six healthcare providers to further capture barriers to early cervical cancer diagnosis. Factors associated with an advanced stage III, IV (according to FIGO classification) were estimated by a logistic regression model. Qualitative data were analyzed using a thematic analysis technique guided by the treatment pathway model and triangulated with quantitative data. In total, 95 women with cervical cancer [median age = 51 (IQR 42–59)] years, were included. Among them, 18.9% were living with HIV and only 9.5% were covered by a health insurance. The majority (71.5%) were diagnosed with advanced cervical cancer. Being HIV-uninfected (aOR = 5.4; [1.6–17.8], p = 0.006) and being uninsured (aOR = 13.1; [2.0-85.5], p = 0.007) were independently associated with advanced cervical cancer in multivariable analysis. Qualitative data raised additional factors potentially related to advanced cervical cancer stages at diagnosis, including the lack of patient information on cervical cancer by healthcare providers and inadequate national awareness and screening campaigns. In a context of challenges in access to systematic cervical cancer screening in Côte d’Ivoire, access to health insurance or integrated healthcare program appear to be key determinants of early diagnosis of cervical cancer.
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