Investigator

Alem Gebremariam

Adigrat University

AGAlem Gebremariam
Papers(2)
Barriers to early dia…Factors associated wi…
Collaborators(2)
Eva Johanna Kantelhar…Nebiyu Dereje
Institutions(3)
Adigrat UniversityMartin-Luther-Univers…Africa Centres for Di…

Papers

Barriers to early diagnosis and treatment of cervical cancer in Addis Ababa, Ethiopia: qualitative study

Objective Cervical cancer remains the most diagnosed and deadly cancer among women in low and middle income countries, including Ethiopia, although it can be controlled if detected and treated early. However, research on contextual barriers to early diagnosis and treatment of cervical cancer is limited in Ethiopia. This study aimed to describe the lived experience of the patients and to explore the barriers to early diagnosis and treatment of cervical cancer. Design We conducted a phenomenological qualitative study, which was part of a larger mixed-methods study. Setting Tikur Anbesa Specialised Comprehensive Hospital, Addis Ababa, Ethiopia. Participants 24 purposively selected patients with diagnostic delay and 16 patients with treatment delay were interviewed using an in-depth interview guide (IDI). Results Two broad themes and seven sub-themes to explain the barriers to early diagnosis and treatment of cervical cancer emerged. These themes and sub-themes include patient related barriers (inadequate knowledge, visits to traditional healers and practice of religious rituals as a solution for illness, poor adherence to the treatments and fear of side effects, and financial hardships) and provider related barriers (limited access to diagnostic and treatment infrastructure, inadequate training of healthcare providers and poor quality of care). Conclusions The findings of the study underscore the need to reinforce awareness among patients and the community, scale up the screening, diagnostic and treatment infrastructure, and advocate for quality of care in the healthcare facilities in Ethiopia to promote early diagnosis and treatment of cervical cancer.

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

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.

2Papers
2Collaborators