Health facility assessments of cervical cancer prevention, early diagnosis, and treatment services in Gulu, Uganda

Abstract

Background Cervical cancer is ranked globally in the top three cancers for women younger than 45 years, with the average age of death at 59 years of age. The highest burden of disease is in low-to-middle income countries (LMICs), responsible for 90% of the 311,000 cervical cancer deaths in 2018. This growing health disparity is due to the lack of quality screening and treatment programs, low human papillomavirus (HPV) vaccination rates, and high human immunodeficiency virus (HIV) co-infection rates. To address these gaps in care, we need to develop a clear understanding of the resources and capabilities of LMICs’ health care facilities to provide prevention, early diagnosis through screening, and treatment for cervical cancer. Objectives This project aimed to assess baseline available cervical cancer prevention, early diagnosis, and treatment resources, at facilities designated as Health Center III or above, in Gulu, Uganda. Methods We adapted the World Health Organization’s Harmonized Health Facility Assessment for our own HFA and grading scale, deploying it in October 2021 for a cross-sectional analysis of 21 health facilities in Gulu. Results Grading of Health Center IIIs (n = 16) concluded that 37% had “excellent” or “good” resources available, and 63% of facilities had “poor” or “fair” resources available. Grading of Health Center IVs and above (n = 5) concluded that 60% of facilities had “excellent” or “good” resources, and 40% had “fair” resources available. Discussion The analysis of health facilities in Gulu demonstrated subpar resources available for cervical cancer prevention, early diagnosis, and treatment. Focused efforts are needed to expand health centers’ resources and capability to address rising cervical cancer rates and related health disparities in LMICs. The development process for this project’s HFA can be applied to global cervical cancer programming to determine gaps in resources and indicate areas to target improved health equity.

Magnitude and trends in cervical cancer at Mbarara Regional Referral Hospital in South Western Uganda: Retrospective analysis of data from 2017–2022

“…It is important to review more recent data and understand the current trends in disease burden. With cervical cancer screening coverage in Uganda standing below 10% over the years [9], cervical cancer mortality might likely worsen due to delayed access to effective care and treatment [10]. Therefore, this study describes the magnitude and trends in the proportion of cervical cancer relative to other gynaecological malignancies between 2017 and 2022 and describes the histological types and stage distribution at diagnosis over the same period at Mbarara Regional Referral Hospital in South-western Uganda.…”

High Rate of Loss to Follow-Up Among Patients Undergoing Treatment for Premalignant Cervical Lesions at Mbarara Regional Referral Hospital, Southwestern Uganda: A Retrospective Cohort Study

“…This approach has been adopted by the Uganda Ministry of Health, using mainly visual inspection methods for cervical cancer screening [ 8 ]. The screening program in Uganda is however challenged by a number of factors including low staffing and poor infrastructure [ 9 ]. As a result, few women are screened, with many of them presenting with late-stage cancer at diagnosis [ 10 ].…”

High rate of loss to follow-up among patients undergoing treatment for premalignant cervical lesions at Mbarara Regional Referral Hospital, South Western Uganda; a retrospective cohort study

“…This approach has been adapted by the Uganda ministry of health, using mainly visual inspection methods for cervical cancer screening(8). The screening program in Uganda is however challenged by a number of factors including low sta ng and poor infrastructure (9). As a result, few women are screened, with many of them presenting with latestage cancer at diagnosis (10).…”