Factors associated with advanced stage at diagnosis of cervical cancer in Addis Ababa, Ethiopia: a population-based study

Abstract

ObjectiveTo describe the patterns and factors associated with advanced stage at diagnosis of cervical cancer among Addis Ababa residents, Ethiopia.DesignA population-based cross-sectional study.SettingSeven major hospitals or diagnostic facilities in Addis Ababa, Ethiopia.ParticipantsAll histopathology-confirmed patients with incident cervical cancer diagnosed from 1 January 2017 to 30 June 2018 among Addis Ababa residents.Outcome measuresThe proportion of patients with cervical cancer diagnosed at early stage (stage I/II) and advanced stage (stage III/IV) of the disease according to International Federation of Gynaecology and Obstetrics staging criteria, and adjusted prevalence ratio (APR) for factors associated with advanced-stage diagnosis using a Poisson regression with robust variance model.ResultsThe mean age of the study participants was 52.9 (±13.3) years. Nearly two-thirds (60.4%, 95% CI: 53.8% to 66.5%) of patients with cervical cancer were diagnosed at an advanced stage. Advanced stage at diagnosis was significantly associated with paying medical bill out of pocket (APR=1.44, 95% CI: 1.08 to 1.91), diagnostic interval >90 days (APR=1.31, 95% CI: 1.04 to 1.71), practicing religion as a remedy or not taking immediate action following symptom recognition (APR=1.25, 95% CI: 1.08 to 1.91) and visiting more than three different health facilities prior to diagnostic confirmation (APR=1.24, 95% CI: 1.07 to 1.51).ConclusionsOur findings of the high proportion of advanced-stage diagnosis of cervical cancer in Addis Ababa and its strong associations with out-of-pocket medical bill, seeking care out of conventional medicine settings and multiple visits to healthcare facilities before diagnostic confirmations underscore the need for public policies to improve the affordability of cancer care and enhance community awareness about the severity of the disease and referral system, in addition to expanding cervical cancer screening.

Prevalence of late-stage presentation and associated factors of cervical cancer patients in Tikur Anbesa Specialized Hospital, Ethiopia: institutional based cross-sectional study

“…In this study, about 57% cervical cancer patients presented with late stage. The current prevalence was lower than the studies conducted in Addis Ababa [ 4 ], Ghana [ 18 ], Tanzania [ 8 ], Nigeria [ 19 ] and Malaysia [ 20 ] with the prevalence’s of 60.4, 65.97, 63.9, 71.8 and 60% respectively. But it is higher than the studies conducted in Morocco [ 21 ], India [ 9 ], England [ 22 ] and Mexico [ 23 ] with their prevalence’s of 39.9, 45.4, 28 and 17.8% respectively.…”

“…On the study conducted in Addia Ababa, the median health-seeking and diagnostic intervals of women with cervical malignancy were ten and ninety-seven days respectively with 75% of delayed diagnostic confirmation. Nearly 60% of patients with cervical cancer were diagnosed at late stage with the significant factors of out-of-pocket medical bill, looking for care out of conventional health care areas and several visits to health settings before diagnostic confirmations [ 4 – 6 ].…”

Prevalence and determinants of late-stage presentation among cervical cancer patients, a systematic review and meta-analysis

“…The 25 studies [ 26 – 50 ] included 53,233 participants. Most of the included studies were cross-sectional studies and the sample size ranged from 50 [ 33 ] to 13624 [ 50 ]. Most studies were conducted in Ethiopia.…”

Association between waiting time for radiotherapy initiation and disease progression among women with cervical cancer in Addis Ababa, Ethiopia

“…Source of medical expense coverage was categorized as patients who were entitled with free medical service or insured and those who pay out of their pocket. 16 HIV status and tumor histologic type was dichotomized as positive or negative and squamous cell carcinoma (SCC) or adenocarcinoma, respectively. 17 Multivariable mixed effects logistic regression model was used to determine the association between waiting period for radiotherapy initiation and tumor progression to higher stage, expressed as adjusted odds ratio (aOR).…”

“…Educational status was dichotomized as literate or illiterate. Source of medical expense coverage was categorized as patients who were entitled with free medical service or insured and those who pay out of their pocket 16 . HIV status and tumor histologic type was dichotomized as positive or negative and squamous cell carcinoma (SCC) or adenocarcinoma, respectively 17 …”