University of Pretoria, School of Health Systems and Public Health, Pretoria, South Africa.
Parirenyatwa Group of Hospitals, Radiotherapy Centre, Harare, Zimbabwe.
BMC Public Health. 2019 Apr 24;19(1):428. doi: 10.1186/s12889-019-6749-6.
Cervical cancer is the most commonly diagnosed cancer among women in Zimbabwe; however; access to screening and treatment services remain challenged. The objective of this study was to investigate socio-demographic inequities in cervical cancer screening and utilization of treatment among women in Harare, Zimbabwe.
Two cross sectional surveys were conducted in Harare with a total sample of 277 women aged at least 25 years. In the community survey, stratified random sampling was conducted to select 143 healthy women in Glen View, Cranborne, Highlands and Hopely communities of Harare to present high, medium, low density suburbs and rural areas respectively. In the patient survey, 134 histologically confirmed cervical cancer patients were also randomly selected at Harare hospital, Parirenyatwa Hospital and Island Hospice during their routine visits or while in hospital admission. All consenting participants were interviewed using a validated structured questionnaire programmed in Surveytogo software in an android tablet. Data was analyzed using STATA version 14 to yield descriptive statistics, bivariate and multivariate logistic regression outcomes for the study.
Women who reported ever screening for cervical cancer were only 29%. Cervical cancer screening was less likely in women affiliated to major religions (p < 0.05) and those who never visited health facilities or doctors or visited once in previous 6 months (p < 0.05). Ninety-two (69%) of selected patients were on treatment. Women with cervical cancer affiliated to protestant churches were 68 times [95% CI: 1.22 to 381] more likely to utilize treatment and care services compared to those in other religions (p = 0.040). Province of residence, education, occupation, marital status, income (personal and household), wealth, medical aid status, having a regular doctor, frequency of visiting health facilities, sources of cervical cancer information and knowledge of treatability of cervical cancer were not associated with cervical cancer screening and treatment respectively.
This study revealed few variations in the participation of women in cervical cancer screening and treatment explained only by religious affiliations and usage of health facilities. Strengthening of health education in communities including churches and universal healthcare coverage are recommended strategies to improve uptake of screening and treatment of cervical cancer.
宫颈癌是津巴布韦女性中最常见的癌症类型；然而，获得筛查和治疗服务仍然存在挑战。本研究的目的是调查哈拉雷妇女在宫颈癌筛查和治疗利用方面的社会人口不公平现象。
在哈拉雷进行了两项横断面调查，总样本量为 277 名年龄至少 25 岁的女性。在社区调查中，采用分层随机抽样方法，从格伦维尤、克朗伯恩、高地和霍普利社区中选择 143 名健康女性，分别代表高、中、低密度郊区和农村地区。在患者调查中，在哈拉雷医院、帕里伦耶塔瓦医院和岛屿临终关怀医院，在常规就诊或住院期间，随机选择了 134 名经组织学证实的宫颈癌患者。所有同意参与的参与者都使用 Surveytogo 软件在安卓平板电脑上的经过验证的结构化问卷进行了访谈。使用 STATA 版本 14 进行数据分析，得出研究的描述性统计数据、双变量和多变量逻辑回归结果。
仅 29%的女性报告曾接受过宫颈癌筛查。与主要宗教信仰的女性（p<0.05）以及从未去过医疗机构或医生或在过去 6 个月内仅去过一次的女性（p<0.05）相比，宫颈癌筛查的可能性较小。选择的 92 名（69%）患者正在接受治疗。与其他宗教信仰的女性相比，隶属于新教教堂的宫颈癌女性更有可能接受治疗和护理服务，是其 68 倍[95%CI：1.22 至 381]（p=0.040）。居住地、教育、职业、婚姻状况、个人和家庭收入、财富、医疗补助状况、有固定医生、就诊频率、宫颈癌信息来源和宫颈癌可治疗性知识与宫颈癌筛查和治疗无关联。
本研究显示，女性参与宫颈癌筛查和治疗的情况差异不大，仅由宗教信仰和对医疗机构的使用情况来解释。建议加强社区健康教育，包括教堂，并普及全民医疗保健，以提高宫颈癌筛查和治疗的参与率。
