Anangwe Nelson, Steimgrimson Jon, Cu-Uvin Susan
School of Public Health, Moi University, Eldoret, 4606 - 30100, Kenya.
School of Public Health, Brown University, 121 S Main St, Providence, RI, 02903, USA.
BMC Cancer. 2025 Feb 5;25(1):203. doi: 10.1186/s12885-025-13563-9.
Cervical cancer cases are increasing in sub-Saharan Africa, particularly in Kenya, exacerbated by inadequate histopathology resources, posing a significant barrier to timely diagnosis and treatment. There has been little research on the availability and evolution of histopathology resources for diagnosing cervical cancer over the years. This retrospective study evaluated this evolution at Moi Teaching and Referral Hospital in Kenya between 2018 and 2022.
We used a mixed-methods approach. An in-depth interview was conducted with one of MTRH's pathology laboratory staff to assess the equipment, personnel, and quality control trends between 2018 and 2022. A thematic analysis was conducted in NVivo. We also retrospectively conducted a comprehensive inventory review of laboratory resources from 2018 to 2022 via purposive sampling. Microsoft Excel and Stata version 17 were utilized for descriptive statistical analysis. Turnaround time (TAT) was assessed against the UK's National Health Service Cervical Screening Program guidelines.
The number of histopathology laboratory personnel at MTRH increased from 2018 to 2022, during which the facility included two pathologists, one records person, and one office administrator. Cervical cancer biopsy samples processed by the histopathology lab increased from 225 in 2018 to 674 in 2022. However, the histopathology personnel-to-population ratio decreased from 1.5 pathologists and 2.7 histo-technicians per 100,000 in 2018 to 1.4 pathologists and 1.8 histo-technicians per 100,000 in 2022. Despite this decrease, lab equipment, automatic tissue processors and embedding machines were added, and an average 14-day turnaround time was maintained for cervical cancer pathology reports.
Our study highlights a growing burden of cervical cancer with biopsy samples processed by the MTRH histopathology laboratory, increasing from 225 in 2018 to 674 in 2022. Despite challenges such as a declining staff-to-patient ratio and limited resources, the lab maintained a commendable 14-day turnaround time, supporting timely cervical cancer diagnoses. These findings emphasize the need for continued investment in pathology resources and personnel to enhance diagnostic capacity and address the rising incidence of cervical cancer in Kenya and similar low-resource settings. The decline in the personnel-to-patient ratio underscores challenges in diagnosis, emphasizing the need to address workforce and infrastructure gaps to improve patient care within similar low-resource settings.
撒哈拉以南非洲地区的宫颈癌病例正在增加，尤其是在肯尼亚，组织病理学资源不足加剧了这一情况，这对及时诊断和治疗构成了重大障碍。多年来，关于用于诊断宫颈癌的组织病理学资源的可用性和演变情况的研究很少。这项回顾性研究评估了肯尼亚莫伊教学与转诊医院在2018年至2022年期间的这一演变情况。
我们采用了混合方法。对莫伊教学与转诊医院病理实验室的一名工作人员进行了深入访谈，以评估2018年至2022年期间的设备、人员和质量控制趋势。在NVivo中进行了主题分析。我们还通过目的抽样对2018年至2022年的实验室资源进行了回顾性全面清查。使用Microsoft Excel和Stata 17版本进行描述性统计分析。根据英国国家医疗服务体系宫颈癌筛查计划指南评估周转时间（TAT）。
2018年至2022年期间，莫伊教学与转诊医院组织病理学实验室的人员数量有所增加，在此期间该机构有两名病理学家、一名记录人员和一名办公室管理人员。组织病理学实验室处理的宫颈癌活检样本从2018年的225例增加到2022年的674例。然而，组织病理学人员与人口的比例从2018年每10万人中有1.5名病理学家和2.7名组织技术人员下降到2022年每10万人中有1.4名病理学家和1.8名组织技术人员。尽管有所下降，但实验室增加了设备、自动组织处理机和包埋机，并且宫颈癌病理报告的平均周转时间保持在14天。
我们的研究突出了莫伊教学与转诊医院组织病理学实验室处理的活检样本所显示的宫颈癌负担不断增加，从2018年的225例增加到2022年的674例。尽管存在诸如人员与患者比例下降和资源有限等挑战，但该实验室仍保持了值得称赞的14天周转时间，支持了宫颈癌的及时诊断。这些发现强调需要继续投资于病理资源和人员，以提高诊断能力并应对肯尼亚及类似资源匮乏地区宫颈癌发病率上升的问题。人员与患者比例的下降凸显了诊断方面的挑战，强调需要解决劳动力和基础设施差距，以改善类似资源匮乏地区的患者护理。
