Dereje Nebiyu, Addissie Adamu, Worku Alemayehu, Assefa Mathewos, Abraha Aynalem, Tigeneh Wondemagegnehu, Kantelhardt Eva Johanna, Jemal Ahmedin
School of Public Health, Wachemo University, Hosanna, Ethiopia.
Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.
JCO Glob Oncol. 2020 Feb;6:277-284. doi: 10.1200/JGO.19.00242.
A substantial proportion of cervical cancers are diagnosed at advanced stage in Ethiopia. Therefore, the aim of this study was to determine the extent and predictors of delays in cervical cancer diagnosis in Addis Ababa.
We prospectively recruited 231 patients with cervical cancer diagnosed from January 1, 2017, to June 30, 2018, in 7 health facilities in Addis Ababa, representing 99% of all cervical cancers recorded in the Addis Ababa population-based cancer registry. A structured questionnaire on patients' experience was administered face to face by trained interviewers. Health-seeking intervals > 90 days (date from recognition of symptoms to medical consultation) and diagnostic intervals > 30 days (dates from medical consultation to diagnostic confirmation) were categorized as delayed. Factors associated with these delays were assessed using multivariable binary logistic regression models.
The median health-seeking and diagnostic intervals for patients with cervical cancer in Addis Ababa were 10 and 97 days, respectively. Approximately one quarter of the patients were delayed in seeking medical consultation, and three fourths of the patients had delayed diagnostic confirmation. Factors associated with health-seeking delays included poor cervical cancer awareness, practicing of religious rituals, and waiting for additional symptoms before visiting a health facility. Factors associated with diagnostic delays included first contact with primary health care units and visits to ≥ 4 different health facilities before diagnosis.
A considerable proportion of patients with cervical cancer in Addis Ababa have delays in seeking medical care and diagnostic conformation. These findings reinforce the need for programs to enhance awareness about cervical cancer signs and symptoms and the importance of early diagnosis in the community and among health care providers.
在埃塞俄比亚，相当一部分宫颈癌在晚期才被诊断出来。因此，本研究的目的是确定亚的斯亚贝巴宫颈癌诊断延迟的程度及其预测因素。
我们前瞻性地招募了2017年1月1日至2018年6月30日期间在亚的斯亚贝巴7家医疗机构被诊断为宫颈癌的231名患者，这些患者占亚的斯亚贝巴基于人群的癌症登记处记录的所有宫颈癌患者的99%。由经过培训的访谈员面对面发放一份关于患者经历的结构化问卷。将寻求医疗间隔时间>90天（从症状出现到就医咨询的日期）和诊断间隔时间>30天（从就医咨询到诊断确认的日期）归类为延迟。使用多变量二元逻辑回归模型评估与这些延迟相关的因素。
亚的斯亚贝巴宫颈癌患者的中位寻求医疗间隔时间和诊断间隔时间分别为10天和97天。约四分之一的患者在寻求医疗咨询方面存在延迟，四分之三的患者诊断确认延迟。与寻求医疗延迟相关的因素包括宫颈癌知晓率低、进行宗教仪式以及在前往医疗机构就诊前等待出现更多症状。与诊断延迟相关的因素包括首次接触基层医疗单位以及在诊断前就诊于≥4家不同的医疗机构。
亚的斯亚贝巴相当一部分宫颈癌患者在寻求医疗护理和诊断确认方面存在延迟。这些发现强化了开展相关项目以提高社区和医疗服务提供者对宫颈癌体征和症状的认识以及早期诊断重要性的必要性。
