Moodley Jennifer, Constant Deborah, Mwaka Amos Deogratius, Scott Suzanne Emilie, Walter Fiona Mary
Women's Health Research Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town, 7925, South Africa.
Cancer Research Initiative, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town, 7925, South Africa.
Ecancermedicalscience. 2021 Jan 14;15:1171. doi: 10.3332/ecancer.2021.1171. eCollection 2021.
Breast and cervical cancers are leading causes of cancer morbidity and mortality in sub-Saharan Africa. Most women present with advanced-stage disease and have poor outcomes. This study aimed to describe anticipated help-seeking behaviour for possible breast and cervical cancer symptoms, barriers to accessing health care and factors associated with less timely anticipated help-seeking in urban and rural settings in Uganda and South Africa (SA).
We conducted a cross-sectional community-based survey between August and December 2018. Data were collected from one randomly selected woman per household using the African Women Awareness of CANcer breast and cervical cancer tool. Anticipated help-seeking behaviour was dichotomised into waiting <1week or ≥1 week to seek care. Multivariable analysis identified factors associated with anticipated help-seeking behaviour.
One thousand, seven hundred fifty-eight women participated (Uganda 873, SA 885, median age 34, interquartile ranges 26-47). Most would discuss symptoms with someone close to them (87.7% for breast, 83.0% for cervical symptoms). The majority anticipated seeking care from a health facility in <1 week: 86.1% and 88.0%, respectively, for breast and cervical symptoms. 38.7% of women expected to encounter at least 1 barrier when seeking care. Lack of money for transport or clinic costs was the most common barrier (24.6% of participants). For both cancers and in both countries, women who reported more barriers were significantly less likely to anticipate seeking timely care. In SA, rural location was also associated with longer anticipated time to seek care, adjusted prevalence ratio (aPR) 2.92, 95% confidence interval (CI) 1.48-5.76 and aPR 2.42, 95% CI 1.08-5.45 for breast and cervical cancer, respectively.
Interventions that improve community level cancer knowledge and highlight the importance of prompt help-seeking for possible symptoms are important to promote timely care seeking. In addition, addressing financial barriers by reducing transport and clinic costs and tackling geographical inequities in access to care could support women in seeking timely care for possible symptoms.
乳腺癌和宫颈癌是撒哈拉以南非洲地区癌症发病和死亡的主要原因。大多数女性就诊时已处于疾病晚期，预后较差。本研究旨在描述在乌干达和南非（SA）的城市和农村地区，针对可能出现的乳腺癌和宫颈癌症状预计的求助行为、获得医疗保健的障碍以及与预期求助不及时相关的因素。
我们在2018年8月至12月期间进行了一项基于社区的横断面调查。使用非洲妇女癌症认知乳腺癌和宫颈癌工具，从每户中随机选取一名女性收集数据。预期求助行为被分为等待<1周或≥1周后寻求治疗。多变量分析确定了与预期求助行为相关的因素。
1758名女性参与了研究（乌干达873名，南非885名，中位年龄34岁，四分位间距26 - 47岁）。大多数人会与身边亲近的人讨论症状（乳腺癌症状为87.7%，宫颈癌症状为83.0%）。大多数人预计会在<1周内前往医疗机构就诊：乳腺癌症状和宫颈癌症状分别为86.1%和88.0%。38.7%的女性预计在寻求治疗时至少会遇到1个障碍。交通或诊所费用缺钱是最常见的障碍（24.6%的参与者）。对于这两种癌症以及两个国家，报告遇到更多障碍的女性预计寻求及时治疗的可能性显著降低。在南非，农村地区也与更长的预期就诊时间相关，乳腺癌和宫颈癌的调整患病率比（aPR）分别为2.92，95%置信区间（CI）1.48 - 5.76和aPR 2.42，95% CI 1.08 - 5.45。
提高社区层面癌症知识并强调针对可能症状及时求助的重要性的干预措施，对于促进及时就医至关重要。此外，通过降低交通和诊所费用来消除经济障碍以及解决获得医疗服务方面的地理不平等问题，可以帮助女性针对可能的症状及时就医。
