Mutyaba Twaha, Faxelid Elisabeth, Mirembe Florence, Weiderpass Elisabete
Department of Obstetrics and Gynaecology, Makerere University Medical School, P.O.Box 7072, Kampala, Uganda.
Reprod Health. 2007 Jun 26;4:4. doi: 10.1186/1742-4755-4-4.
Cervical cancer is the most common female cancer in Uganda. Over 80% of women diagnosed or referred with cervical cancer in Mulago national referral and teaching hospital have advanced disease. Plans are underway for systematic screening programmes based on visual inspection, as Pap smear screening is not feasible for this low resource country. Effectiveness of population screening programmes requires high uptake and for cervical cancer, minimal loss to follow up. Uganda has poor indicators of reproductive health (RH) services uptake; 10% postnatal care attendance, 23% contraceptive prevalence, and 38% skilled attendance at delivery. For antenatal attendance, attendance to one visit is 90%, but less than 50% for completion of care, i.e. three or more visits.
We conducted a qualitative study using eight focus group discussions with a total of 82 participants (16 men, 46 women and 20 health workers). We aimed to better understand factors that influence usage of available reproductive health care services and how they would relate to cervical cancer screening, as well as identify feasible interventions to improve cervical cancer screening uptake.
Barriers identified after framework analysis included ignorance about cervical cancer, cultural constructs/beliefs about the illness, economic factors, domestic gender power relations, alternative authoritative sources of reproductive health knowledge, and unfriendly health care services. We discuss how these findings may inform future planned screening programmes in the Ugandan context.
Knowledge about cervical cancer among Ugandan women is very low. For an effective cervical cancer-screening programme, awareness about cervical cancer needs to be increased. Health planners need to note the power of the various authoritative sources of reproductive health knowledge such as paternal aunts (Sengas) and involve them in the awareness campaign. Cultural and economic issues dictate the perceived reluctance by men to participate in women's reproductive health issues; men in this community are, however, potential willing partners if appropriately informed. Health planners should address the loss of confidence in current health care units, as well as consider use of other cervical cancer screening delivery systems such as mobile clinics/camps.
宫颈癌是乌干达最常见的女性癌症。在穆拉戈国家转诊和教学医院，超过80%被诊断或转诊为宫颈癌的女性患有晚期疾病。由于巴氏涂片筛查对这个资源匮乏的国家不可行，基于肉眼检查的系统筛查计划正在筹备中。人群筛查计划的有效性需要高参与率，对于宫颈癌筛查而言，还需要尽量减少失访情况。乌干达生殖健康（RH）服务的参与指标较差；产后护理的参与率为10%，避孕普及率为23%，分娩时熟练助产服务的使用率为38%。产前检查方面，就诊一次的比例为90%，但完成全程护理（即三次或更多次就诊）的比例不到50%。
我们进行了一项定性研究，采用了8次焦点小组讨论，共有82名参与者（16名男性、46名女性和20名卫生工作者）。我们旨在更好地了解影响现有生殖健康护理服务使用的因素以及这些因素与宫颈癌筛查的关系，同时确定可行的干预措施以提高宫颈癌筛查的参与率。
框架分析后确定的障碍包括对宫颈癌的无知、关于该疾病的文化观念/信仰、经济因素、家庭性别权力关系、生殖健康知识的其他权威来源以及不友好的医疗服务。我们讨论了这些发现如何为乌干达未来计划的筛查计划提供信息。
乌干达女性对宫颈癌的了解非常少。为了实施有效的宫颈癌筛查计划，需要提高对宫颈癌的认识。卫生规划者需要注意诸如父系姑姑（Sengas）等各种生殖健康知识权威来源的影响力，并让他们参与宣传活动。文化和经济问题导致男性参与女性生殖健康问题的意愿较低；然而，如果得到适当的信息，这个社区的男性有可能成为愿意合作的伙伴。卫生规划者应解决当前医疗单位失去信任的问题，并考虑使用其他宫颈癌筛查服务提供系统，如流动诊所/营地。
