Ezechi Oliver Chukwujekwu, Petterson Karen Odberg, Gbajabiamila Titilola A, Idigbe Ifeoma Eugenia, Kuyoro Olutunmike, Ujah Innocent Achaya Otobo, Ostergren Per Olof
Clinical Sciences Division, Nigerian Institute of Medical Research, Lagos, Nigeria.
BMC Health Serv Res. 2014 Mar 31;14:143. doi: 10.1186/1472-6963-14-143.
Increasingly evidence is emerging from south East Asia, southern and east Africa on the burden of default to follow up care after a positive cervical cancer screening/diagnosis, which impacts negatively on cervical cancer prevention and control. Unfortunately little or no information exists on the subject in the West Africa sub region. This study was designed to determine the proportion of and predictors and reasons for default from follow up care after positive cervical cancer screen.
Women who screen positive at community cervical cancer screening using direct visual inspection were followed up to determine the proportion of default and associated factors. Multivariate logistic regression was used to determine independent predictors of default.
One hundred and eight (16.1%) women who screened positive to direct visual inspection out of 673 were enrolled into the study. Fifty one (47.2%) out of the 108 women that screened positive defaulted from follow-up appointment. Women who were poorly educated (OR: 3.1, CI: 2.0 - 5.2), or lived more than 10 km from the clinic (OR: 2.0, CI: 1.0 - 4.1), or never screened for cervical cancer before (OR: 3.5, CI:3:1-8.4) were more likely to default from follow-up after screening positive for precancerous lesion of cervix . The main reasons for default were cost of transportation (48.6%) and time constraints (25.7%).
The rate of default was high (47.2%) as a result of unaffordable transportation cost and limited time to keep the scheduled appointment. A change from the present strategy that involves multiple visits to a "see and treat" strategy in which both testing and treatment are performed at a single visit is recommended.
东南亚、南部非洲和东部非洲越来越多的证据表明，宫颈癌筛查/诊断呈阳性后不进行后续护理的负担对宫颈癌的预防和控制产生了负面影响。不幸的是，西非次区域在这一主题上几乎没有相关信息。本研究旨在确定宫颈癌筛查呈阳性后不进行后续护理的比例、预测因素及原因。
对在社区宫颈癌筛查中使用直接目视检查呈阳性的女性进行随访，以确定不进行后续护理的比例及相关因素。采用多因素逻辑回归确定不进行后续护理的独立预测因素。
673名在直接目视检查中呈阳性的女性中有108名（16.1%）被纳入研究。108名筛查呈阳性的女性中有51名（47.2%）未按预约进行后续随访。受教育程度低（比值比：3.1，置信区间：2.0-5.2）、居住在距离诊所10公里以上（比值比：2.0，置信区间：1.0-4.1）或以前从未进行过宫颈癌筛查（比值比：3.5，置信区间：3.1-8.4）的女性在宫颈上皮内瘤变筛查呈阳性后更有可能不进行后续随访。不进行后续护理的主要原因是交通费用（48.6%）和时间限制（25.7%）。
由于交通费用过高和难以抽出时间赴约，不进行后续护理的比例很高（47.2%）。建议从目前需要多次就诊的策略转变为“即检即治”策略，即在单次就诊时同时进行检测和治疗。
