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Citation Information

Type Thesis or Dissertation - Master of Public Health
Title Barriers to early diagnosis of invasive cervical cancer among patients receiving treatment at Kenyatta National Hospital, Nairobi Kenya
Author(s)
Publication (Day/Month/Year) 2014
Abstract
Although cancer still remains a major health problem, early diagnosis and improved
therapeutic interventions of cervical cancer in developed countries are quite different
from what is observed in the developing countries; Kenya included. In resource
constrained environments, limited access to oncology facilities, coupled with the stigma
associated with cancer has much influence on the disease reporting and management.
While the biological factors associated with early diagnosis and proper management have
been documented, there is need to clearly define the role of individual, social, cultural
and economic factors as determinants of early diagnosis of cervical cancer. The main
objective of the study was to determine the barriers to early diagnosis among cervical
cancer patients. Kenyatta National Hospital was chosen because it is the only national
referral hospital in Kenya with radiotherapy machine used in treatment of cancer
patients. Given that the cost of treatment is lower than the private hospitals, it attracts a
large number of patients as referrals from the forty seven counties in the country. This
was a descriptive survey using researcher-administered structured questionnaires to
obtain data from a sample of 320 cervical cancer patients in Kenyatta National Hospital‟s
radiotherapy clinic and among in-patients. To corroborate the findings from the patients,
key informant schedule was administered to 30 healthcare personnel who interact closely
with these patients to seek their views on reasons for late diagnosis. The data was
analyzed using SPSS version 16.1 and presented in frequencies, graphs and tables. Chi
square was used to test association among variables and significance level was set at
0.05. Individual patient‟s attitudes of the disease and health seeking behaviour were
analyzed and correlated with the measurable outcomes which include; time lapse to
disease diagnosis, age, socio-economic status, cultural factors, health facility-related
factors and reaction time by health personnel. The findings have been correlated with
time of onset of disease to diagnosis and treatment. The findings of this study established
that general lack of knowledge on cervical cancer (75.3%) was significantly associated
with late diagnosis (Chi-square=9.27 (1, N= 320; p=0.0023). A preponderance 266
(83.1%) had no knowledge on screening tests prior to diagnosis while only 54 (16.9%)
were aware of Pap smear test. Similarly education level ( ² = 20.62 (3, N=316, P<.0001)
was significantly association with late diagnosis of cervical cancer. Logistic regression
analyses showed that higher education attainment was associated with 0.58 lower odds of
late diagnosis of cervical cancer. Other social factors like age at diagnosis, locality,
marital status and religion did not show any significant association with either early or
late diagnosis.This study recommends that well organized cancer awareness and
screening programmes be established while considering aspects of accessibility and
affordability. Strengthening healthcare and referral systems, as well as continuing
education of existing healthcare providers is recommended.

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