The economic burden of cervical cancer on women in Uganda: a cross-sectional study

Abstract

PURPOSEThere is limited research on how a cervical cancer diagnosis financially impacts women and their families in Uganda, including the burden of out-of-pocket costs. This is important to understand because, in addition to being economic providers, women are primary caregivers. The objective of this analysis is to describe the economic impact of cervical cancer treatment, including how this differs by socio-economic status (SES) in Uganda.METHODSWe conducted a cross-sectional study from September 19, 2022 to January 17, 2023. Women were recruited from the Uganda Cancer Institute and Jinja Regional Referral Hospital, and were eligible for this study if they were ≥ of 18 years and being treated for cervical cancer. Participants completed a 45-minute survey which included questions about their out-of-pocket costs, unpaid labor, and changes in their family’s economic situation. A wealth index was constructed from the participants ownership of household items to determine their SES. Descriptive statistics were reported.RESULTSOf the 338 participants who completed the survey, 183 were from the lower SES. Women from the lower SES were significantly more likely to be older, have ≤ primary school education, and have a more advanced stage of cervical cancer. Both groups of women reported paying out-of-pocket for cervical cancer care (higher SES 95.5%, lower SES 92.3%). Only 15/338 participants stopped treatment because they could not afford it. Women of a lower SES were significantly more likely to report borrowing money (p-value=0.004) and selling possessions to pay for cancer care (p-value=0.006). With regards to unpaid labor, women from both groups reported a decrease in the amount of time that they spent caring for their children since their cervical cancer diagnosis.CONCLUSIONRegardless of their SES, women in Uganda incur out-of-pocket costs related to their cervical cancer treatment. However, there are inequities as women from the lower SES groups were more likely to borrow funds to afford treatment. Alternative payment models and further financial support could help alleviate the financial burden of cervical cancer of care on women and families in Uganda.