Infrastructural Challenges Lead to Delay of Curative Radiotherapy in Nigeria
Infrastructural Challenges Lead to Delay of Curative Radiotherapy in Nigeria
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DOI：
10.1200/jgo.19.00286
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发表时间：
2020-01-01
影响因子：
4.5
通讯作者：
Olopade, Olufunmilayo, I
中科院分区：
文献类型：
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作者：
Leng, Jim;Ntekim, Atara, I;Olopade, Olufunmilayo, I
在低收入和中等收入国家，癌症发病率呈指数增长。根据国际原子能机构的数据，放射治疗可用性和需求的最大差距是在尼日利亚，那里的每台机器估计为2570万人提供服务。本研究旨在描述放射治疗的障碍，并确定干预领域。METHODS这是一项横断面研究，于2017年6月至2017年8月在尼日利亚伊巴丹大学学院医院进行。通过问卷调查（N = 186）收集与放疗相关的人口统计学、社会文化和基础设施因素。有序逻辑回归被用来确定导致转诊延迟和治疗延迟的因素。患者来自尼日利亚36个州中的20个。中位年龄为50岁（范围：19-79岁）。接受治疗的最常见癌症是乳腺癌（37.5%）、宫颈癌（16.3%）、头颈部癌（11.9%）和前列腺癌（10.9%）。在有序逻辑回归分析中，社会文化因素，包括无力支付（优势比[OR]，1.99; P = .034），一个坏的医院经验（OR，7.05; P = .001），和旅行时间（OR，1.36; P = .001），增加了转诊延迟放疗的几率。与此相反，治疗开始的时间和社会文化因素，包括年龄，教育和无力支付之间没有显着的关系。非结构性障碍，包括机器故障（OR，2.92; P = .001），工人罢工（OR，2.64; P = .001），停电（OR，2.81; P = .022），增加了治疗延迟的几率。然而，工作人员和设备故障使患者无法及时接受放射治疗。未来必须实施旨在解决尼日利亚机器维护、卫生保健工作者满意度和电网老化问题的政策，以加强卫生保健系统，为癌症患者提供护理。
PURPOSEIn low- and middle-income countries, there has been an exponential increase in cancer incidence. According to the International Atomic Energy Agency, the biggest gap in radiotherapy availability and need is in Nigeria, where each machine serves an estimated 25.7 million people. This study aimed to characterize the barriers to radiotherapy and to identify areas for intervention.METHODSThis was a cross-sectional study conducted at the University College Hospital in Ibadan, Nigeria, from June 2017 to August 2017. Demographic, sociocultural, and infrastructural factors relating to radiotherapy were collected through a questionnaire (N = 186). Ordinal logistic regression was used to identify the factors leading to delays in referral and delays in treatment initiation.RESULTSPatients traveled from 20 of Nigeria's 36 states. The median age was 50 years (range, 19-79 years). The most common cancers treated were breast (37.5%), cervical (16.3%), head and neck (11.9%), and prostate (10.9%). In ordinal logistic regression, sociocultural factors, including the inability to pay (odds ratio [OR], 1.99; P = .034), a bad hospital experience (OR, 7.05; P = .001), and travel time (OR, 1.36; P = .001), increased the odds of referral delay to radiotherapy. In contrast, there was no significant relationship between time to treatment initiation and sociocultural factors including age, education, and inability to pay. Infrastructural barriers, including machine breakdown (OR, 2.92; P = .001), worker strikes (OR, 2.64; P = .001), and power outages (OR, 2.81; P = .022), increased the odds of treatment delay.CONCLUSIONAlthough delays caused by patient factors are reported extensively, patients overcame these barriers in the hopes of curative treatment. However, staff and equipment malfunctions prevented patients from receiving timely radiotherapy. Policies aimed at addressing machine maintenance, health care worker satisfaction, and the aging power grid in Nigeria must be implemented in the future to strengthen the health care system to care for patients with cancer.