Determinants of access and utilization of cervical cancer treatment and palliative care services in Harare, Zimbabwe

Abstract

Background Cervical cancer treatment and care services have remained largely centralized in Zimbabwe thereby entrenching inequities to access amongst patients. The objective of this study was to investigate the determinants of access to treatment and care among women with cervical cancer in Harare, Zimbabwe. Methods A sequential explanatory mixed methods design was used. In phase 1, three surveys (namely community, patient and health worker) were conducted with sample sizes of 143, 134 and 78 participants respectively. Validated structured questionnaires programmed in Android tablet with SurveytoGo software were used for data collection during the surveys. Univariate, bivariate and multivariate logistic regression analyzes were conducted using STATA® version 14 to generate descriptive statistics and identify determinants of access to cervical cancer treatment and care. In phase 2, 16 in-depth interviews, 20 key informant interviews and 6 focus groups were conducted to explain quantitative data. Participants were purposively selected and saturation principle was used to guide sample sizes. Manually generated thematic codes were processed in Dedoose software to produce final outputs for qualitative study. Results Knowledge of causes ( p = 0.046), perceptions of adequacy of specialists ( p < 0.001), locus of control ( p = 0.009), service satisfaction ( p = 0.022) and walking as a means of reaching nearest health facilities ( p < 0.001) were associated with treatment or perceptions of access by healthy women. Perceptions of access to treatment amongst health workers were associated with their basic training institution ( p = 0.046), health service quality perceptions ( p = 0.035) and electricity supply status in their respective health facilities ( p = 0.036).Qualitative findings revealed health system, societal and individual factors as barriers to accessing treatment and palliative care. Conclusions There are numerous prevailing multi-dimensional barriers to accessing cervical cancer treatment and palliative care in a low –income setting. The findings of this study revealed that heath system and societal factors were more important than individual level factors. Multi-sectoral approaches are recommended to address all the multifaceted barriers in order to improve cervical cancer treatment and palliative care access for better outcomes in resource-limited contexts.

Gaps and opportunities for cervical cancer prevention, diagnosis, treatment and care: evidence from midterm review of the Zimbabwe cervical Cancer prevention and control strategy (2016–2020)

“…This leads to heavy out of pocket expenses and delays women to start treatment as they have to seek for these investigations in private laboratories which are expensive. On the other hand lack of access to blood investigations delays or prevents some patients from required surgery or other definitive treatments [ 17 , 18 ].…”

Perceptions of key informants on the provision of cervical cancer prevention and control programme in Uganda: implication for cervical cancer policy

“…The lack of community awareness about cervical cancer screening and negative attitudes by some health workers were cited as barriers to screening access. Lack of awareness in the community and negative attitudes by health workers were reported as a barrier to accessing cervical cancer prevention and control services [73]. Access of treatment by patients with advanced cervical cancer were cited as problematic since there is no capacity to provide treatment nor capacity to provide patients with transport within Northern Uganda.…”

“…However, the lack of transport and money for living expenses while at UCI, leads many women to not access treatment. Barrier to accessing treatment related to transport cost have been reported in a study conducted in Zimbabwe [73]. Furthermore, there is a weak referral follow up system which is unable to track referred patients to the next level of care facilities.…”

Learning Curve, Survival Curve

“…Lack of access to diapers and to transport are barriers to accessing cervical cancer care. 11,12 Muniamma, however, continued to come regularly to collect her palliative medicines. We would also send her with some cooking oil and lentils to supplement the diet of rice and red chilies.…”