Mwaka Amos Deogratius, Garimoi Christopher Orach, Were Edward Maloba, Roland Martin, Wabinga Henry, Lyratzopoulos Georgios
Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
Department of Community Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.
BMJ Open. 2016 Jan 21;6(1):e007690. doi: 10.1136/bmjopen-2015-007690.
To examine patient and primary healthcare factors and stage at diagnosis in women with cervical cancer in Northern Uganda with the intention to identify factors that are associated with advanced stages in order to inform policies to improve survival from cervical cancer in low income and middle income countries.
Cross-sectional hospital-based study.
Tertiary, not-for-profit private hospital in postconflict region.
Consecutive tissue-diagnosed symptomatic patients with cervical attending care. Of 166 patients, 149 were enrolled and analysed.
Cervical cancer stage at diagnosis.
Most women were diagnosed at stages III (45%) or IV (21%). After controlling for age, marital status, educational attainment and number of biological children, there was evidence for association between advanced stage at diagnosis and pre-referral diagnosis of cancer by primary healthcare professionals (adjusted OR (AOR)=13.04:95% CI 3.59 to 47.3), and financial difficulties precluding prompt help seeking (AOR=5.5:95% CI 1.58 to 20.64). After adjusting for age, marital status and educational attainment, women with 5-9 biological children (AOR=0.27:95% CI 0.08 to 0.96) were less likely to be diagnosed with advanced stage (defined as stages III/IV) cancer. In this pilot study, there was no statistical evidence for associations between stage at diagnosis, and factors such as age at diagnosis and marital status.
This study is a first attempt to understand the descriptive epidemiology of cervical cancer in rural Ugandan settings. Understanding individual patient factors, patients' behavioural characteristics and healthcare factors associated with advanced stage at diagnosis is essential for targeted effective public health interventions to promote prompt health seeking, diagnosis at early stage and improved survival from cervical cancer.
研究乌干达北部宫颈癌女性患者的个体因素、基层医疗保健因素及诊断时的分期，以确定与晚期相关的因素，从而为低收入和中等收入国家改善宫颈癌生存率的政策提供依据。
基于医院的横断面研究。
冲突后地区的三级非营利性私立医院。
连续的经组织诊断的有症状的宫颈癌就诊患者。166例患者中，149例被纳入研究并进行分析。
诊断时的宫颈癌分期。
大多数女性在III期（45%）或IV期（21%）被诊断。在控制年龄、婚姻状况、教育程度和亲生子女数量后，有证据表明诊断时的晚期与基层医疗保健专业人员在转诊前对癌症的诊断之间存在关联（调整后比值比（AOR）=13.04：95%置信区间3.59至47.3），以及因经济困难而无法及时寻求帮助（AOR=5.5：95%置信区间1.58至20.64）。在调整年龄、婚姻状况和教育程度后，有5至9个亲生子女的女性被诊断为晚期（定义为III/IV期）癌症的可能性较小（AOR=0.27：95%置信区间0.08至0.96）。在这项试点研究中，没有统计学证据表明诊断时的分期与诊断年龄和婚姻状况等因素之间存在关联。
本研究首次尝试了解乌干达农村地区宫颈癌的描述性流行病学。了解与诊断时的晚期相关的个体患者因素、患者行为特征和医疗保健因素，对于有针对性的有效公共卫生干预措施至关重要，这些措施可促进及时寻求医疗、早期诊断并提高宫颈癌生存率。
