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Christensen AJ, Mwayi J, Mbabazi J, Juncker M, Kallestrup P, Kraef C. Fighting cervical cancer in Africa: a cross-sectional study on prevalence and risk factors for precancerous lesions in rural Uganda. Public Health 2023; 225:87-95. [PMID: 37922591 DOI: 10.1016/j.puhe.2023.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 09/06/2023] [Accepted: 09/26/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE To identify risk factors for precancerous cervical lesions and factors associated with treatment delay among women in the rural Busoga Region, Uganda. STUDY DESIGN A retrospective cross-sectional study from a regional cervical cancer screening program and from cervical cancer patients enrolled in a region-wide palliative care program. METHODS Logistic regression analysis was conducted to assess risk factors for screening positive for precancerous lesions. In a separate analysis, factors associated with treatment delay were assessed among women enrolled in the palliative care program. RESULTS Three thousand nine hundred forty-six women were included from the screening program and 334 from the palliative care program. In total, 7.6% of screening participants had precancerous lesions. Within Busoga Region, the highest positivity rate was found in Bugweri and Namayingo Districts. Abnormal vaginal bleeding (adjusted odds ratio [aOR] 1.60; 95% confidence interval [CI] 1.15-2.21; p = 0.005) and older age at first menstrual period (aOR 1.08; 95% CI 1.01-1.16; p = 0.03) were associated with having a precancerous lesion. Among palliative care patients, a history of previous contact with the health care system was associated with a delay in enrolment (≥12 months from first symptom presentation until commencement in palliative care; aOR 5.23; 95% CI 1.16-36.54; p = 0.047). CONCLUSIONS The results underline an unmet need for broad-scale cervical cancer screening focusing on all women in the reproductive age. Abnormal bleeding was the only substantial risk factor for precancerous lesions, indicating that specific algorithms to identify high-risk populations may not be applicable in this population. Increased awareness, resources, and funding are still necessary to achieve global cervical cancer elimination.
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Affiliation(s)
| | - J Mwayi
- Rays of Hope Hospice Jinja, Uganda
| | | | | | - P Kallestrup
- Department of Public Health, Aarhus University, Denmark; Danish Non-Communicable-Disease Alliance, Denmark
| | - C Kraef
- Department of Infectious Diseases, Rigshospitalet Copenhagen, Denmark; Heidelberg Institute of Global Health, University of Heidelberg, Germany; Centre of Excellence for Health, Immunity and Infections (CHIP), Copenhagen University Hospital - Rigshospitalet, Denmark
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Ooko F, Mothiba T, Van Bogaert P, Wens J. Access to palliative care in patients with advanced cancer of the uterine cervix in the low- and middle-income countries: a systematic review. BMC Palliat Care 2023; 22:140. [PMID: 37726748 PMCID: PMC10510249 DOI: 10.1186/s12904-023-01263-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 09/12/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Women with advanced uterine cervical cancer suffer from a combination of moderate to severe physical, psychological, social, and spiritual distress due to their disease and are in need of palliative care to improve their quality of life. Approximately 85% of the women live in the low- and middle-income countries. Whether these women and their families access palliative care is not known. OBJECTIVES To understand the geographic accessibility, availability, financial accessibility, and acceptability of palliative care by patients with advanced cervical cancer and their families. METHODS We conducted a Systematic review following PRISMA guidelines in CINAHL, Cochrane Central Register of Controlled Trials, MEDLINE, PsychINFO, PubMed and Scopus for the core concepts: palliative care, access, advanced uterine cervical cancer. Eligible articles were published in English, contained original data on experiences of patients and/or caregivers including symptoms management, and discussed available resources, communication, satisfaction, and healthcare utilization. RESULTS Overall there was limited access to palliative care with the few available facilities located in cities, far from the rural areas where most women lived. Pervasive poverty was common with poor affordability of healthcare, travelling, accommodation, and subsistence expenses. Misconceptions and poor knowledge of the disease, cultural beliefs and attitudes, and other health system insufficiencies also presented challenges for access. CONCLUSION Concerted effort should be made to improve availability of palliative care facilities. Health education to address misconceptions and other cognitive barriers that limit access among cervical cancer patients and their families should be urgently undertaken in the LMICs.
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Affiliation(s)
- Francis Ooko
- Faculty of Health Sciences, University of Limpopo, Private Bag X1106, Sovenga, 0727, South Africa.
| | - Tebogo Mothiba
- Faculty of Health Sciences, University of Limpopo, Private Bag X1106, Sovenga, 0727, South Africa
| | - Peter Van Bogaert
- Faculty of Medicine and Health Sciences, University of Antwerp, Prinsstraat 13, Antwerp, 2000, Belgium
| | - Johan Wens
- Faculty of Medicine and Health Sciences, University of Antwerp, Prinsstraat 13, Antwerp, 2000, Belgium
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Mwamba M, Lombe DC, Msadabwe S, Bond V, Simwinga M, Sentoogo Ssemata A, Muhumuza R, Seeley J, Mwaka AD, Aggarwal A. A Narrative Synthesis of Literature on the Barriers to Timely Diagnosis and Treatment of Cancer in Sub-Saharan Africa. Clin Oncol (R Coll Radiol) 2023; 35:e537-e548. [PMID: 37302880 DOI: 10.1016/j.clon.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 02/13/2023] [Accepted: 05/22/2023] [Indexed: 06/13/2023]
Abstract
Poor cancer survival outcomes in sub-Saharan Africa (SSA) have been linked to delays in diagnosis and treatment. Here we present a detailed overview of the qualitative literature evaluating the barriers to receiving timely diagnosis and treatment of cancer in SSA. The PubMed, EMBASE, CINAHL, PsycINFO databases were searched to identify qualitative studies reporting on barriers to timely diagnosis of cancer in SSA published between 1995 and 2020. A systematic review methodology was applied, including quality assessment and narrative data synthesis. We identified 39 studies, of which 24 focused on breast or cervical cancer. Only one study focused on prostate cancer and one on lung cancer. When exploring factors contributing to delays, six key themes emerged from the data. The first theme was health service barriers, which included: (i) inadequate numbers of trained specialists; (ii) limited knowledge of cancer among healthcare providers; (iii) poor co-ordination of care; (iv) inadequately resourced health facilities; (v) negative attitudes of healthcare providers towards patients; (vi) high cost of diagnostic and treatment services. The second key theme was patient preference for complementary and alternative medicine; the third was the limited understanding of cancer among the population. The fourth barrier was a patient's personal and family obligations; the fifth was the perceived impact of cancer and its treatment on sexuality, body image and relationships. Finally, the sixth was the stigma and discrimination faced by patients following a diagnosis of cancer. In conclusion, health system, patient level and societal factors all influence the likelihood of timely diagnosis and treatment for cancer in SSA. The results provide a focus for targeting health system interventions, particular with regards to awareness and understanding of cancer in the region.
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Affiliation(s)
- M Mwamba
- Zambart, School of Public Health, Ridgeway Campus, University of Zambia, Lusaka, Zambia.
| | - D C Lombe
- Regional Cancer Treatment Services MidCentral District Health Board, New Zealand
| | - S Msadabwe
- Cancer Diseases Hospital, Lusaka, Zambia
| | - V Bond
- Zambart, School of Public Health, Ridgeway Campus, University of Zambia, Lusaka, Zambia; London School of Hygiene & Tropical Medicine (LSHTM), London, UK
| | - M Simwinga
- Zambart, School of Public Health, Ridgeway Campus, University of Zambia, Lusaka, Zambia
| | - A Sentoogo Ssemata
- The Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine (MRC/UVRI & LSHTM), Uganda Research Unit, Entebbe, Uganda
| | - R Muhumuza
- The Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine (MRC/UVRI & LSHTM), Uganda Research Unit, Entebbe, Uganda
| | - J Seeley
- The Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine (MRC/UVRI & LSHTM), Uganda Research Unit, Entebbe, Uganda
| | - A D Mwaka
- Department of Medicine, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - A Aggarwal
- London School of Hygiene & Tropical Medicine (LSHTM), London, UK; Institute of Cancer Policy, King's College London, London, UK
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Mwaka AD, Achan J, Orach CG. Traditional health practices: A qualitative inquiry among traditional health practitioners in northern Uganda on becoming a healer, perceived causes of illnesses, and diagnostic approaches. PLoS One 2023; 18:e0282491. [PMID: 37093797 PMCID: PMC10124846 DOI: 10.1371/journal.pone.0282491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 02/15/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND The practice of traditional and complementary medicine is increasing in most low-and middle-income countries especially for chronic communicable and non-communicable diseases. In this study, we aimed to understand how people gain healing power and become traditional health practitioners (THPs), perceived causes of illnesses, and how THPs diagnose illnesses. METHODS This was a cross-sectional qualitative interview-based study. We used semi-structured in-depth guides to collect data from THPs identified through the Acoli cultural institutions and snowball sampling technique. The study team visited the THPs and interviewed them in their homes. Some THPs allowed the study team to visit them more than once and as well observe their healing practices and medicines. Thematic analysis approach was used to analyze the data. Atlas.ti version 9.2 was used to support data analysis. RESULTS Twenty two THPs aged 39-80 years were included in the study. Most of the respondents were male, and married. We identified three main themes: (i) how people gain healing power and become traditional health practitioners; (ii) perceived causes of illnesses; and (iii) how illnesses are diagnosed. The majority of respondents reported that most people become THPs through: inheriting healing power from their parents or grandparents; transfer of healing powers from senior healers; instructions during visions and dreams; and, acquiring healing power during spirits possessions. Perceived causes of illnesses included: fate and natural causes, spirits attacks, curses by elders, witchcraft, contagion and infections, poor hygiene, heredity, and malevolent actions. THPs diagnose illnesses through various approaches including consultations with spirits, observing patterns of occurrences and events, evaluation of symptoms and signs of illnesses, use of bones from animals/birds and other objects to diagnose illnesses, performing diagnostic rituals, and using biomedical laboratory testing in health facilities. CONCLUSION Healing knowledge and powers are acquired in particular ways that can be traced to appraise authenticity of healers during registration and licensing to ensure safety of patients. Understanding perspectives of the THPS on causes of illnesses and how diagnoses are made potentially informs strategies for integration and or collaboration between the national biomedical health system and traditional health practices.
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Affiliation(s)
- Amos Deogratius Mwaka
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- Faculty of Medicine, Department of Medicine, Gulu University, Gulu, Uganda
| | - Jennifer Achan
- School of Public Health, College of Health Sciences, Msakerere University, Kampala, Uganda
| | - Christopher Garimoi Orach
- School of Public Health, College of Health Sciences, Msakerere University, Kampala, Uganda
- Department of Community Health & Behavioral Sciences, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
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Reis BS, Nogueira CM, Meneses ADFP, Mellado BH, Candido Dos Reis FJ. Experiences of women with advanced cervical cancer before starting the treatment: Systematic review of qualitative studies. Int J Gynaecol Obstet 2023; 161:8-16. [PMID: 36183310 DOI: 10.1002/ijgo.14491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 09/26/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Advanced stage and high mortality are characteristics of cervical cancer in developing countries. Comprehension of the diagnosis itinerary is one of the main strategies to control the disease impact. OBJECTIVES To identify reasons for the delay in diagnosing symptomatic cervical cancer according to the patient's perspectives reported in qualitative studies. We searched four databases (PubMed, Embase, CINAHL, and Web of Science). SELECTION CRITERIA We included qualitative studies of women with advanced cervical cancer that explored their experiences before treatment. We excluded unoriginal, non-qualitative, and duplicated studies. DATA COLLECTION AND ANALYSIS We selected 39 articles for a full-text reading and included 15 in the present review. We chose the Consolidated Criteria for Reporting Qualitative Research (COREQ) for quality assessment and The Model of Pathways to Treatment to guide the codifying process. MAIN RESULTS Four main themes emerged from the synthesis: (1) Health-seeking motivators; (2) Obstacles to seeking medical care; (3) Diagnosis delay; and (4) Coping with the disease. These themes were derived from patients' personal knowledge and beliefs, social relationships, socioeconomic status, and healthcare system characteristics. CONCLUSIONS Individual behavior, social factors, and healthcare organization contribute to the delay in diagnosing advanced cervical cancer.
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Affiliation(s)
- Bruna Sena Reis
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of Sao Paulo, Sao Paulo, Brazil
| | - Cristiane Matos Nogueira
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of Sao Paulo, Sao Paulo, Brazil
| | | | - Bruna Helena Mellado
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of Sao Paulo, Sao Paulo, Brazil
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Gutusa F, Roets L. Early cervical cancer screening: The influence of culture and religion. Afr J Prim Health Care Fam Med 2023; 15:e1-e6. [PMID: 36744462 PMCID: PMC9900302 DOI: 10.4102/phcfm.v15i1.3776] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 10/28/2022] [Accepted: 11/01/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Screening for cervical cancer at an early stage is essential for providing women with a better chance of receiving effective treatment for both precancers and cancer. Delaying screening until cancer has advanced can be detrimental, resulting in late presentation of cervical cancer and, as a result, cancer metastasis. AIM The purpose of this study was to assess the extent to which culture and religion influence early cervical cancer screening in women. SETTING The research was conducted in one of the rural districts in Manicaland Province of Zimbabwe. METHODS A qualitative exploratory and contextual design was utilised, and data were gathered by means of semistructured interviews. At 17 semistructured interviews, data saturation was reached and further data collection terminated. Data were thematically analysed. RESULTS Five themes that described participants' perceptions on culture and religion as barriers to early cervical cancer screening emerged from the data. These included a lack of knowledge, stigmatisation, cultural beliefs and values, religion and a lack of resources. These all negatively affected participants' motivation to seek early screening services. CONCLUSION According to the study findings, culture and religion constitute impediments to early cervical cancer screening for rural women. Interventions that encourage screening, such as targeted health education and health promotion materials, must consider cultural and religious views if behaviour change in diverse groups is to be accomplished.Contribution: The study has the potential to inform Zimbabwean health policy and contribute to prospective interventions or health education that encourage women to attend early cancer screening.
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Affiliation(s)
- Fungai Gutusa
- Department of Health Studies, College of Human Sciences, University of South Africa, Pretoria, South Africa
| | - Lizeth Roets
- Department of Health Studies, College of Human Sciences, University of South Africa, Pretoria, South Africa
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Ayangba Asakitogum D, Aziato L, Akorfa Ohene L. Ghanaian Women Beliefs on the Causes, Prevention and Treatment of Cervical Cancer: A Qualitative Study. (Journal Targeted: European Journal of Cancer Care). INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2023. [DOI: 10.1016/j.ijans.2023.100538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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Mekonnen AG, Gebeyehu BT, Woldearegay M. Experience of patients with breast cancer with traditional treatment and healers' understanding of causes and manifestations of breast cancer in North Shewa zone, Ethiopia: a phenomenological study. BMJ Open 2022; 12:e063726. [PMID: 36456000 PMCID: PMC9716934 DOI: 10.1136/bmjopen-2022-063726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES Despite a high number of traditional healers (THs) who treat patients with cancer in Ethiopia, there is limited evidence that explored the lived experience of patients with breast cancer (BC) with traditional treatment and healers' understanding of the causes and manifestations of BC. DESIGN A phenomenological study design was employed. SETTING This study was conducted in the North Shewa zone in Ethiopia. PARTICIPANTS Eight in-depth interviews were conducted; four of which were with patients with BC and four with THs. Semistructured interviewing techniques were used to collect data from the two groups of respondents. All interviews were audio-recorded. The recorded data were transcribed verbatim. Coding and marking were then performed to make the raw data sortable. The marked codes were then summarised and categorised into themes. RESULTS In this study, some of THs were unaware of the main risk factors or causes of BC. They did not mention the lifestyle risk factors of BC such as smoking cigarettes, consuming alcohol and eating habits. The most common clinical manifestations noted by THs were lumps at the breast, discharge from the nipples and weakness. All of the THs got their knowledge of BC treatment from their families and through experience. Regarding the lived experience of treatment, some patients with BC perceived that traditional medicines were safer and more effective than modern treatments and they eventually referred themselves to the THs. CONCLUSIONS Although THs were unaware of the causes of BC, they were familiar with basic signs and symptoms of the disease. Patients with BC referred themselves to the THs because they preferred traditional therapies to modern ones. In order to better satisfy the unmet needs of Ethiopian women with BC, due consideration should be given to traditional treatments.
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Affiliation(s)
- Alemayehu Gonie Mekonnen
- School of Nursing and Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Belete Tewabe Gebeyehu
- Department of Chemistry, College of Natural and Computational Sciences, Debre Berhan University, Debre Berhan, Amhara, Ethiopia
| | - Mesfin Woldearegay
- Department of Biology, College of Natural and Computational Science, Debre Berhan University, Debre Berhan, Amhara, Ethiopia
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Mwaka AD, Achan J, Adoch W, Wabinga H. From their own perspectives: a qualitative study exploring the perceptions of traditional health practitioners in northern Uganda regarding cancers, their causes and treatments. BMC FAMILY PRACTICE 2021; 22:155. [PMID: 34275446 PMCID: PMC8287672 DOI: 10.1186/s12875-021-01505-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 07/01/2021] [Indexed: 12/13/2022]
Abstract
Background Many cancer patients in the low- and middle-income countries seek care with traditional health practitioners (THPs) and use traditional and complementary medicines (T&CMs) for treatment of cancers. Little is known about the perceptions and influence of THPs on cancer patients’ help-seeking and treatment decisions. We aimed to explore perceptions of THPs regarding cancers, cancer causes, and preferred treatments for cancers, in order to identify aspects that can inform interventions to improve cancer outcomes in Uganda. Methods We conducted this ethnographic study in northern Uganda. In-depth interviews were conducted at the respondents’ homes in quiet, open places, and in the absence of none- respondents. Interviews were audio-recorded and transcribed verbatim within a week of the interviews. Thematic qualitative analysis approaches were used to identify themes and subthemes. Results We included 21 respondents in the study; most were male (16/21), married, with median age of 59 years (range 39 – 80). Most respondents perceived cancer as a new and challenging disease, while one respondent thought of cancer as a result of an imbalance within the body. Most confessed unawareness of the causes of cancers, but believed that cancer could result from the interplay of a number of factors including poor diets, ingestions of chemical agents, and assaults by the spirits of the dead. Some reported that cancers (especially of women’s genital tracts) were sexually transmitted, or caused by accumulation of dirt. Only few healers treated cancers. Most respondents reported that they referred cancer patients to biomedical facilities, sometimes after they have first used their medicines. Most respondents hoped that collaborative research with scientists could help them identify potent T&CMs that cure cancers. Conclusion Traditional health practitioners require training on cancer causes, symptoms and signs, and the necessity for prompt initiation of effective treatments in order to improve cancer outcomes. The predisposition of the majority of respondents to refer cancer patients to biomedical services sets a fertile ground for meaningful cooperation between biomedical and traditional health practices. The national health system in the low- and middle-income countries could formally recognize traditional health practices as a component of the national healthcare system, and encourage the two to practice side by side. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01505-w.
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Affiliation(s)
- Amos Deogratius Mwaka
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda.
| | - Jennifer Achan
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Winnie Adoch
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Henry Wabinga
- Kampala Cancer Registry, Department of Pathology, School of Biomedical Sciences, Makerere University, Kampala, Uganda
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Friebel-Klingner TM, Luckett R, Bazzett-Matabele L, Ralefala TB, Monare B, Nassali MN, Ramogola-Masire D, Bvochora M, Mitra N, Wiebe D, Rebbeck TR, McCarthy AM, Grover S. Clinical and sociodemographic factors associated with late stage cervical cancer diagnosis in Botswana. BMC Womens Health 2021; 21:267. [PMID: 34229672 PMCID: PMC8259023 DOI: 10.1186/s12905-021-01402-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 06/22/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Cervical cancer is the leading cause of female cancer mortality in Botswana with the majority of cervical cancer patients presenting with late-stage disease. The identification of factors associated with late-stage disease could reduce the cervical cancer burden. This study aims to identify potential patient level clinical and sociodemographic factors associated with a late-stage diagnosis of cervical cancer in Botswana in order to help inform future interventions at the community and individual levels to decrease cervical cancer morbidity and mortality. RESULTS There were 984 women diagnosed with cervical cancer from January 2015 to March 2020 at two tertiary hospitals in Gaborone, Botswana. Four hundred forty women (44.7%) presented with late-stage cervical cancer, and 674 women (69.7%) were living with HIV. The mean age at diagnosis was 50.5 years. The association between late-stage (III/IV) cervical cancer at diagnosis and patient clinical and sociodemographic factors was evaluated using multivariable logistic regression with multiple imputation. Women who reported undergoing cervical cancer screening had lower odds of late-stage disease at diagnosis (OR: 0.63, 95% CI 0.47-0.84) compared to those who did not report screening. Women who had never been married had increased odds of late-stage disease at diagnosis (OR: 1.35, 95% CI 1.02-1.86) compared to women who had been married. Women with abnormal vaginal bleeding had higher odds of late-stage disease at diagnosis (OR: 2.32, 95% CI 1.70-3.16) compared to those without abnormal vaginal bleeding. HIV was not associated with a diagnosis of late-stage cervical cancer. Rural women who consulted a traditional healer had increased odds of late-stage disease at diagnosis compared to rural women who had never consulted a traditional healer (OR: 1.61, 95% CI 1.02-2.55). CONCLUSION Increasing education and awareness among women, regardless of their HIV status, and among providers, including traditional healers, about the benefits of cervical cancer screening and about the importance of seeking prompt medical care for abnormal vaginal bleeding, while also developing support systems for unmarried women, may help reduce cervical cancer morbidity and mortality in Botswana.
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Affiliation(s)
- Tara M Friebel-Klingner
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
| | - Rebecca Luckett
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Botswana, Gaborone, Botswana
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Obstetrics and Gynecology, Princess Marina Hospital, Gaborone, Botswana
| | - Lisa Bazzett-Matabele
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Botswana, Gaborone, Botswana
- Department of Obstetrics and Gynecology, Yale University, New Haven, CT, USA
| | - Tlotlo B Ralefala
- Department of Oncology, Princess Marina Hospital, Gaborone, Botswana
| | - Barati Monare
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
| | - Mercy Nkuba Nassali
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Doreen Ramogola-Masire
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Memory Bvochora
- Department of Oncology, Princess Marina Hospital, Gaborone, Botswana
| | - Nandita Mitra
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Douglas Wiebe
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
| | - Timothy R Rebbeck
- Dana-Farber Cancer Institute and Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Anne Marie McCarthy
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Surbhi Grover
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana.
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA.
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McCutchan G, Weiss B, Quinn-Scoggins H, Dao A, Downs T, Deng Y, Ho H, Trung L, Emery J, Brain K. Psychosocial influences on help-seeking behaviour for cancer in low-income and lower middle-income countries: a mixed-methods systematic review. BMJ Glob Health 2021; 6:bmjgh-2020-004213. [PMID: 33531348 PMCID: PMC7868297 DOI: 10.1136/bmjgh-2020-004213] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/09/2020] [Accepted: 01/06/2021] [Indexed: 12/14/2022] Open
Abstract
Introduction Starting cancer treatment early can improve outcomes. Psychosocial factors influencing patients’ medical help-seeking decisions may be particularly important in low and lower middle-income countries (LMIC) where cancer outcomes are poor. Comprehensive review evidence is needed to understand the psychosocial influences on medical help-seeking for cancer symptoms, attendance for diagnosis and starting cancer treatment. Methods Mixed-methods systematic review registered on PROSPERO (CRD42018099057). Peer-reviewed databases were searched until April 2020 for studies assessing patient-related barriers and facilitators to medical help-seeking for cancer symptoms, diagnosis and treatment in adults (18+ years) living in LMICs. Quality of included studies was assessed using the Critical Appraisal Skills Programme tool. Data were synthesised using meta-analytic techniques, meta-ethnography or narrative synthesis as appropriate. Results Of 3963 studies identified, 64 were included. In quantitative studies, use of traditional, complementary and alternative medicine (TCAM) was associated with 3.60 higher odds of prolonged medical help-seeking (95% CI 2.06 to 5.14). Qualitative studies suggested that use of TCAM was a key barrier to medical help-seeking in LMICs, and was influenced by causal beliefs, cultural norms and a preference to avoid biomedical treatment. Women face particular barriers, such as needing family permission for help-seeking, and higher stigma for cancer treatment. Additional psychosocial barriers included: shame and stigma associated with cancer such as fear of social rejection (eg, divorce/disownment); limited knowledge of cancer and associated symptoms; and financial and access barriers associated with travel and appointments. Conclusion Due to variable quality of studies, future evaluations would benefit from using validated measures and robust study designs. The use of TCAM and gender influences appear to be important barriers to help-seeking in LMIC. Cancer awareness campaigns developed with LMIC communities need to address cultural influences on medical help-seeking behaviour.
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Affiliation(s)
- Grace McCutchan
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK .,Wales Cancer Research Centre, Cardiff University, Cardiff, UK
| | - Bahr Weiss
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee, USA
| | - Harriet Quinn-Scoggins
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK.,PRIME Centre Wales, Cardiff University, Cardiff, UK
| | - Anh Dao
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee, USA
| | - Tom Downs
- Department of Acute Medicine, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, Gwynedd, UK
| | - Yunfeng Deng
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee, USA
| | - Ha Ho
- Center for Research, Information and Services in Psychology, Vietnam National University, Hanoi, Vietnam
| | - Lam Trung
- Danang Psychiatric Hospital, Da Nang, Vietnam
| | - Jon Emery
- Department of General Practice and Centre for Cancer Research, University of Melbourne, Melbourne, Victoria, Australia
| | - Kate Brain
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
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Koh M, Goh YN. Willingness to pay for traditional, complementary and alternative medicine (TCAM) among Malaysian adults. INTERNATIONAL JOURNAL OF PHARMACEUTICAL AND HEALTHCARE MARKETING 2021. [DOI: 10.1108/ijphm-09-2019-0066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Health plays a crucial role in the daily lives and supporting health is the important role of medicine. With the availability of traditional, complementary and alternative medicine (TCAM), the demands and willingness to pay among users are increasing. Hence, this study aims to determine the psychological factors influencing the willingness to pay for TCAM among Malaysian adults.
Design/methodology/approach
In total, 300 completed self-administered questionnaires were collected from Malaysian adults using a purposive sampling method through intercepts at public health-care facilities. A structural equation modelling approach using partial least square was used to test the hypotheses.
Findings
The findings show that attitude, subjective norms, perceived price and knowledge have a significant impact on willingness to pay for TCAM. Surprisingly, there was no relationship found between perceived behavioural control and health consciousness on willingness to pay for TCAM.
Originality/value
The findings of this study are expected to provide better insights into TCAM use among Malaysian adults. The results are also important to encourage health-care institutions and practitioners to educate the general public on the safety of TCAM to ensure more health benefits to the users.
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Mwaka AD, Walter FM, Scott S, Harries J, Wabinga H, Moodley J. Symptom appraisal, help-seeking and perceived barriers to healthcare seeking in Uganda: an exploratory study among women with potential symptoms of breast and cervical cancer. BMJ Open 2021; 11:e041365. [PMID: 33550241 PMCID: PMC7925866 DOI: 10.1136/bmjopen-2020-041365] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 12/30/2020] [Accepted: 01/19/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE We assessed the process of recognising abnormal bodily changes, interpretations and attributions, and help-seeking behaviour among community-based Ugandan women with possible symptoms of breast and cervical cancer, in order to inform health interventions aiming to promote timely detection and diagnosis of cancer. DESIGN Qualitative in-depth interviews. SETTING Rural and urban communities in Uganda. PARTICIPANTS Women who participated in the African Women Awareness of CANcer cross-sectional survey who disclosed potential breast and cervical cancer symptoms were eligible; recruitment was purposive. Interviews were conducted in women's homes, lasted between 40 and 90 min, were audio-recorded, transcribed verbatim and translated to English. Thematic analysis was used to identify themes and subthemes, underpinned by the conceptual framework of the Model of Pathways to Treatment. RESULTS 23 women were interviewed: 10 had potential symptoms of breast cancer and 13 of cervical cancer. Themes regarding symptom appraisal and help-seeking included the: (1) detection and interpretation of abnormal bodily sensations; (2) lay consultations regarding bodily changes; (3) iterative process of inferring and attributing illnesses to the bodily changes; (4) restricted disclosure of symptoms to lay people due to concerns about privacy and fear of stigmatisation; (5) help-seeking from multiple sources including both traditional and biomedical health practitioners, and (6) multiple perceived barriers to help-seeking including long waiting times, lack of medicines, absenteeism of healthcare professionals, and lack of money for transport and medical bills. CONCLUSION Women with potential symptoms of breast and cervical cancer undergo complex processes of symptom interpretation, attributing symptoms or inferring illness, and lay consultations before undertaking help-seeking and management. Increasing community understanding of breast and cervical cancer symptoms, and tackling perceived barriers to health-seeking, could lead to prompt and appropriate symptom appraisal and help-seeking, and contribute to improving cancer outcomes.
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Affiliation(s)
- Amos Deogratius Mwaka
- Department of Medicine, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Fiona M Walter
- The Primary Care Unit, Department of Public Health and Primary Care, Cambridge University, Cambridge, UK
- University of Melbourne, Centre for Cancer Research, Faculty of Medicine, Dentistry & Health Sciences, Melbourne, Victoria, Australia
| | - Suzanne Scott
- Centre for Oral, Clinical and TranslationalSciences, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK
| | - Jane Harries
- Women's Health Research Unit, University of Cape Town School of Public Health & Family Medicine, Faculty of Health Sciences, Cape Town, South Africa
| | - Henry Wabinga
- Department of Medicine, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Jennifer Moodley
- Women's Health Research Unit, University of Cape Town School of Public Health & Family Medicine, Faculty of Health Sciences, Cape Town, South Africa
- Cancer Research Initiative, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- South African Medical Research Council Gynaecology Cancer Research Centre, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Stein E, Pulle J, Zimmerman M, Otim I, Atala J, Rwebembera J, Oyella LM, Harik N, Okello E, Sable C, Beaton A. Previous Traditional Medicine Use for Sore Throat among Children Evaluated for Rheumatic Fever in Northern Uganda. Am J Trop Med Hyg 2020; 104:842-847. [PMID: 33319727 PMCID: PMC7941849 DOI: 10.4269/ajtmh.20-0288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 11/01/2020] [Indexed: 11/07/2022] Open
Abstract
Timely diagnosis of group A streptococcal (GAS) sore throat coupled with appropriate antibiotic treatment is necessary to prevent serious post-streptococcal complications, including rheumatic fever (RF) and rheumatic heart disease (RHD). Traditional medicine (TM) is a known common adjunct to formal medical care in sub-Saharan Africa. A better understanding of health-seeking behavior for sore throat both within and outside the formal medical system is critical to improving primary prevention efforts of RF and RHD. A prospective mixed-methods study on the use of TM for sore throat was embedded within a larger epidemiological study of RF in Northern Uganda. Children presenting with symptoms of RF were interviewed about recent TM use as well as health services use for sore throat. One hundred children with a median age of 10 years (interquartile range: 6.8-13 years) completed the TM interview with their parent/guardian as part of a research study of RF. Seventeen, or 17%, accessed a TM provider for sore throat as part of the current illness, and 70% accessed TM for sore throat in the past (73% current or past use). Of the 20 parents who witnessed the TM visit, 100% reported use of crude tonsillectomy. Penicillin was the most frequently prescribed medication by TM providers in 52% of participants who were seen by a TM provider. The use of TM among children presenting with symptoms of sore throat in northern Uganda is common and frequently used in tandem with diagnostic services offered through the formal healthcare system. Engagement with TM practitioners may provide an important avenue for designing effective primary prevention and management strategies of RF and reduce the global burden of RHD.
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Affiliation(s)
- Elizabeth Stein
- University of Washington School of Medicine, Seattle, Washington
- Children’s National Heart Institute, Children’s National Hospital, Washington, District of Columbia
| | - Jafesi Pulle
- Uganda Heart Institute, Mulago National Referral Hospital, Kampala, Uganda
| | | | - Isaac Otim
- Uganda Heart Institute, Mulago National Referral Hospital, Kampala, Uganda
| | - Jenifer Atala
- Uganda Heart Institute, Mulago National Referral Hospital, Kampala, Uganda
| | - Joselyn Rwebembera
- Uganda Heart Institute, Mulago National Referral Hospital, Kampala, Uganda
| | - Linda Mary Oyella
- Uganda Heart Institute, Mulago National Referral Hospital, Kampala, Uganda
| | - Nada Harik
- Division of Infectious Diseases, Children’s National Hospital, Washington, District of Columbia
| | - Emmy Okello
- Uganda Heart Institute, Mulago National Referral Hospital, Kampala, Uganda
| | - Craig Sable
- Children’s National Heart Institute, Children’s National Hospital, Washington, District of Columbia
| | - Andrea Beaton
- Cincinnati Children’s Hospital Medical Center, University of Cincinnati Medical School, Cincinnati, Ohio
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Harries J, Scott SE, Walter FM, Mwaka AD, Moodley J. Women's appraisal, interpretation and help-seeking for possible symptoms of breast and cervical cancer in South Africa: a qualitative study. BMC Womens Health 2020; 20:251. [PMID: 33187501 PMCID: PMC7666481 DOI: 10.1186/s12905-020-01120-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 11/05/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In South Africa, breast cancer is the most commonly diagnosed cancer and cervical cancer the leading cause of cancer mortality. Most cancers are diagnosed at a late-stage and following symptomatic presentation. The overall purpose of the study was to inform interventions aimed at improving timely diagnosis of breast and cervical cancer. METHODS In-depth interviews were conducted with women with potential breast or cervical cancer symptoms from urban and rural South Africa. Participants were recruited from a community-based cross-sectional study on breast and cervical cancer awareness. Data were analysed using a thematic analysis approach. RESULTS Eighteen women were interviewed (10 urban, 8 rural): the median age was 34.5 years (range 22-58). Most were unemployed, and five were HIV positive. Themes included impact and attribution of bodily changes; influence of social networks and health messaging in help-seeking; management of symptoms and help-seeking barriers. Breast changes were often attributed to manual activities or possible cancer. Women were often unsure how to interpret vaginal symptoms, attributing them to HIV, hormonal contraceptives, or partner infidelity. Concerns about cancer were based on health information from the radio, social networks, or from primary care providers. Prompt care seeking was triggered by impact of symptoms on personal lives. Rural women, especially with possible symptoms of cervical cancer, experienced challenges during help-seeking including judgmental attitudes of clinic staff. Most participants were skeptical of traditional medicine. CONCLUSIONS This is the first study exploring interpretation of possible breast and cervical cancer symptoms at a community level in South Africa. The process of interpreting bodily changes, symptom attribution and help-seeking is complex and influenced by women's everyday life experiences. Timely diagnosis interventions should not only include cancer symptom awareness but also address individual, structural and health systems related barriers to care.
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Affiliation(s)
- Jane Harries
- Women's Health Research Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
| | - Suzanne E Scott
- Centre for Oral, Clinical and Translational Sciences, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK
| | - Fiona M Walter
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Amos D Mwaka
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Jennifer Moodley
- Women's Health Research Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Cancer Research Initiative, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa
- SAMRC Gynaecology Cancer Research Centre, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa
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Availability, Costs and Stock-Outs of Essential NCD Drugs in Three Rural Rwandan Districts. Ann Glob Health 2020; 86:123. [PMID: 33024709 PMCID: PMC7518082 DOI: 10.5334/aogh.2729] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: To reduce the non-communicable diseases (NCDs) burden, the World Health Organization has set a target to reach 80% availability of the affordable essential medicines required to treat NCDs by 2025. Objectives: This study described the availability, costs, and stock-outs of essential NCD drugs in three rural Rwandan districts. Methods: We retrospectively assessed 54 NCD drugs listed for district hospitals or health centers in the Rwanda national essential medicines list. Data were collected from three district hospitals and 17 health centers that host NCD clinics. We extracted data on drug availability, quantity dispensed, costs, stock-outs, and the replenishing supplier for these drugs between January 1 and December 31, 2017. Results: Overall, 71% of essential medicines for health centers and 78% of essential medicines for district hospitals were available at facilities. Only 15% of health centers experienced a stock-out of beclomethasone, while 77% experienced at least one stock-out of amlodipine and metformin. The median length of stock-out ranged from nine to 72 days, and 78% of the stock-outs across all health centers were replenished by a Non-Governmental Organization (NGO) partner. Except for enoxaparin and metformin, all district hospitals experienced at least one stock-out of each drug. The median length of stock-out ranged from 3.5 to 228 days, and 82% of the stock-outs across all district hospitals were replenished by the Rwandan Ministry of Health (RMOH). The least expensive drug was digoxin ($0.02, Interquartile range (IQR): 0.01, 0.10), while the most expensive was beclomethasone ($9.35, IQR: 3.00, 13.20). Conclusions: This study shows the viability of drug-supported NCD care in rural settings of sub-Saharan Africa. Stock-outs are a challenge; our study emphasizes the importance of the MOH/NGO partnerships in this context. Medicine costs are also challenging, though, in these districts, drugs are more affordable through community-based health insurance, government, and NGO partner subsidies.
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Jatho A, Tran BT, Cambia JM, Nanyingi M, Mugisha NM. Cancer Risk Studies and Priority Areas for Cancer Risk Appraisal in Uganda. Ann Glob Health 2020; 86:78. [PMID: 32704483 PMCID: PMC7350938 DOI: 10.5334/aogh.2873] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background Research into aetiologies and prevention of the commonest cancers and implementation of primary and secondary prevention can reduce cancer risk and improve quality of life. Moreover, monitoring the prevalence of cancer risk factors in a specific population helps guide cancer prevention and early detection efforts and national cancer control programming. Objective This article aims to provide the scope and findings of cancer risk studies conducted in Uganda to guide researchers, health-care professionals, and policymakers. Methods Between November 2019 to January 2020, we searched peer-reviewed published articles in Pubmed, EMBASE and Cochrane Library (Cochrane central register of controlled trials-CENTRAL). We followed the recommendation of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses - the PRISMA. The primary focus was to identify cancer risk and prevention studies conducted in Uganda and published in peer-reviewed journals from January 2000 and January 2020. We used key Boolean search terms with their associated database strings. Results We identified 416 articles, screened 269 non-duplicate articles and obtained 77 full-text articles for review. Out of the 77 studies, we identified one (1%) randomized trial, two (2.5%) retrospective cohort studies and 14 (18%) case-control studies, 46 (60%) cross-sectional studies, five (6.4%) ecological studies, three panel studies (4%) and six (8%) qualitative studies. Cervical cancer was the most studied type of cancer in Uganda (23.4%, n = 18 studies), followed by lymphomas - both Hodgkin and Non-Hodgkin sub-types (20.7%), n = 16 studies) and breast cancer (15.6%, n = 12 studies). In lymphoma studies, Burkitt lymphoma was the most studied type of lymphoma (76%, n = 13 studies). The studies concentrated on specific cancer risk awareness, risk perceptions, attitudes, uptake of screening, uptake of human papillomavirus vaccination, the prevalence of some of the known cancer risk factors and obstacles to accessing screening services. Conclusion The unmet need for comprehensive cancer risk and prevention studies is enormous in Uganda. Future studies need to comprehensively investigate the known and putative cancer risk factors and prioritize the application of the higher-hierarchy evidence-generating epidemiological studies to guide planning of the national cancer control program.
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Affiliation(s)
- Alfred Jatho
- Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, KR
- Uganda Cancer Institute, Kampala, UG
| | - Binh Thang Tran
- Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, KR
- Institute of Research and Development, Duy Tan University, Da Nang, VN
| | - Jansen Marcos Cambia
- Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, KR
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Tusubira AK, Akiteng AR, Nakirya BD, Nalwoga R, Ssinabulya I, Nalwadda CK, Schwartz JI. Accessing medicines for non-communicable diseases: Patients and health care workers' experiences at public and private health facilities in Uganda. PLoS One 2020; 15:e0235696. [PMID: 32634164 PMCID: PMC7340292 DOI: 10.1371/journal.pone.0235696] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 06/20/2020] [Indexed: 12/15/2022] Open
Abstract
Background Non-communicable diseases (NCDs) are increasingly prevalent in low- and middle-income countries. Successful management requires consistent access to appropriate medicines. Availability of NCD medicines is generally low, especially in the public sector, however, little is known about other factors affecting access. We explored barriers and facilitators of access to medicines for diabetes and hypertension at public and private health facilities in Uganda. Methods We conducted a qualitative descriptive study at six public hospitals and five private health facilities in different regions of Uganda. Data collection included 36 in-depth interviews and 14 focus group discussions (n = 128) among purposively selected adult outpatients with diabetes and/or hypertension and 26 key informant interviews with healthcare workers and patient association leaders. Transcripts were coded and emerging themes identified using the Framework method. Results Four main themes emerged: Stocking of medicines and supplies, Financial factors, Individual behaviour and attitudes, and Service delivery at health facilities. Stocking of medicines and supplies mainly presented barriers to access at public facilities including frequent stockouts, failure to stock certain medicines and low quality brands often rejected by patients. Financial factors, especially high cost of medicines and limited insurance coverage, were barriers in private facilities. Free service provision was a facilitator at public facilities. Patients’ confusion resulting from mixed messages and their preference for herbal treatments were cross-sector barriers. While flexibility in NCD service provision was a facilitator at private facilities, provider burnout and limited operating hours were barriers in public facilities. Patient-driven associations exist at some public facilities and help mitigate inadequate medicine stock. Conclusion Access to NCD medicines in Uganda is influenced by both health system and patient factors. Some factors are sector-specific, while others cross-cutting between public and private sectors. Due to commonalities in barriers, potential strategies for overcoming them may include patient-driven associations, public-private partnerships, and multi-modal health education platforms.
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Affiliation(s)
- Andrew K. Tusubira
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
- * E-mail:
| | - Ann R. Akiteng
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
| | - Brenda D. Nakirya
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
| | - Ritah Nalwoga
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
| | - Isaac Ssinabulya
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
- Uganda Heart Institute, Mulago National Referral Hospital, Kampala, Uganda
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Christine K. Nalwadda
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
- Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences Makerere University, Kampala, Uganda
| | - Jeremy I. Schwartz
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
- Section of General Internal Medicine, Yale University School of Medicine, New Haven, CT, United States of America
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Wong LP, Wong PF, Megat Hashim MMAA, Han L, Lin Y, Hu Z, Zhao Q, Zimet GD. Multidimensional social and cultural norms influencing HPV vaccine hesitancy in Asia. Hum Vaccin Immunother 2020; 16:1611-1622. [PMID: 32429731 PMCID: PMC7482900 DOI: 10.1080/21645515.2020.1756670] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 04/11/2020] [Indexed: 12/27/2022] Open
Abstract
HPV vaccine hesitancy in Asia is unique compared to Western countries due to multidimensional social-cultural norms that influence beliefs regarding vaccination. Reviews on HPV vaccine hesitancy in Asia lack of in-depth discussion regarding the traditional and social-cultural norms dimensions. This paper puts forward opinions in which culture, normative beliefs, and religion influence HPV vaccine hesitancy in Asian countries. Issues surrounding HPV hesitancy among parents, young adult women, adult women, men and the sexual and gender minority people in Asian countries were highlighted. The shortage of HPV vaccine supply would soon be reduced as some Asian countries are on the way to producing the HPV vaccine which production is currently dominated by Western European countries. The culture of favoring imported Western products among many in Asia and in addition to long-existing fake vaccine crisis pose a challenge for the newly emerging HPV vaccine produced in Asia. Some recommendations, research gaps, and future research needs were discussed.
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Affiliation(s)
- Li Ping Wong
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Pooi-Fong Wong
- Department of Pharmacology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Liyuan Han
- Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, Zhejiang, China
| | - Yulan Lin
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou, Fujian Province, China
- Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Zhijian Hu
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou, Fujian Province, China
- Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Qinjian Zhao
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, Xiamen, Fujian Province, China
| | - Gregory D. Zimet
- Department of Pediatrics, School of Medicine, Indiana University, Indianapolis, IN, U.S
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Mwaka AD, Abbo C, Kinengyere AA. Traditional and Complementary Medicine Use Among Adult Cancer Patients Undergoing Conventional Treatment in Sub-Saharan Africa: A Scoping Review on the Use, Safety and Risks. Cancer Manag Res 2020; 12:3699-3712. [PMID: 32547206 PMCID: PMC7246319 DOI: 10.2147/cmar.s251975] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 04/29/2020] [Indexed: 12/30/2022] Open
Abstract
Background Use of traditional and complementary medicine (T&CM) is very common among patients in sub-Saharan Africa (SSA). However, there are limited data on concurrent use of T&CM with conventional cancer therapies. In this scoping review, we sought to describe the (i) prevalence of use, (ii) types of medicine, (iii) reasons for taking T&CM, (iv) current knowledge on safety and risks, (v) characteristics of adult cancer patients who use T&CM, and (vi) perceived treatment outcomes among cancer patients undergoing conventional cancer treatment in SSA. Methods We conducted a systematic literature search for articles published in the English language in three scientific databases (PubMed, Embase and Web of Science). We used a scoping review approach to map relevant literature on T&CM use among cancer patients undergoing conventional cancer treatments. We assessed 96 articles based on titles and abstracts, and 23 articles based on full text. Twelve articles fulfilled preset eligibility criteria. Results More than half of the included articles were from only two countries in SSA: Nigeria and Uganda. Median prevalence of use of T&CM was 60.0% (range: 14.1-79.0%). Median percent disclosure of use of T&CM to attending healthcare professionals was low at 32% (range: 15.3-85.7%). The most common reasons for non-disclosure were: the doctor did not ask, the doctor would rebuke them for using T&CM, and the doctors do not know much about T&CM and so there is no need to share the issue of use with them. T&CM used by cancer patients included herbs, healing prayers and massage. Reported reasons for use of T&CM in 8 of 12 articles included the wish to get rid of cancer symptoms, especially pain, cure cancer, improve physical and psychological well-being, treat toxicity of conventional cancer therapies and improve immunity. There were limited data on safety and risk profiles of T&CM among cancer patients in SSA. Conclusion Use of traditional and complementary medicines is common among cancer patients undergoing conventional cancer treatments. Healthcare professionals caring for cancer patients ought to inquire and communicate effectively regarding the use of T&CM in order to minimize the risks of side effects from concurrent use of T&CM and biomedicines.
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Affiliation(s)
- Amos Deogratius Mwaka
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Catherine Abbo
- Department of Psychiatry, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Alison Annet Kinengyere
- Albert Cook Medical Library, College of Health Sciences, Makerere University, Kampala, Uganda
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Using Media to Promote Public Awareness of Early Detection of Kaposi's Sarcoma in Africa. JOURNAL OF ONCOLOGY 2020; 2020:3254820. [PMID: 32280342 PMCID: PMC7115145 DOI: 10.1155/2020/3254820] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 01/20/2020] [Accepted: 02/06/2020] [Indexed: 01/17/2023]
Abstract
Background Despite its hallmark cutaneous presentation, most Kaposi's sarcoma (KS) in Africa is diagnosed too late for effective treatment. Early diagnosis will only be achievable if patients with KS present earlier for care. We hypothesized that public awareness about KS can be enhanced through exposure to common media. Methods We developed educational messages regarding early detection of KS for the general African public portraying a three-part theme: “Look” (regularly examine one's skin/mouth), “Show” (bring to the attention of a healthcare provider any skin/mouth changes), and “Test” (ask for a biopsy for definitive diagnosis). We packaged the messages in three common media forms (comic strips, radio, and video) and tested their effect on increasing KS awareness among adults attending markets in Uganda. Participants were randomized to a single exposure to one of the media and evaluated for change in KS-related knowledge and attitudes. Results Among 420 participants, media exposure resulted in increased ability to identify KS (from 0.95% pretest to 46% posttest); awareness that anyone is at risk for KS (29% to 50%); belief that they may be at risk (63% to 76%); and knowledge that definitive diagnosis requires biopsy (23% to 51%) (all p < 0.001). Most participants (96%) found the media culturally appropriate. Conclusion Exposure to media featuring a theme of “Look,” “Show,” and “Test” resulted in changes in knowledge and attitudes concerning KS among the general public in Uganda. High incidence and poor survival of KS in Africa are an impetus to further evaluate these media, which are freely available online.
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James PB, Wardle J, Steel A, Adams J. Ebola survivors' healthcare-seeking experiences and preferences of conventional, complementary and traditional medicine use: A qualitative exploratory study in Sierra Leone. Complement Ther Clin Pract 2020; 39:101127. [PMID: 32379665 DOI: 10.1016/j.ctcp.2020.101127] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 02/27/2020] [Accepted: 02/28/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND and Purpose: This study explores Ebola survivors' healthcare-seeking experiences within the context of Sierra Leone's free healthcare initiative (FHCI) and comprehensive package for Ebola survivors (CPES) program while also exploring the enablers and barriers to their use of informal healthcare. MATERIALS AND METHODS We employed an inductive, exploratory qualitative approach using focus group discussion with 41 adults Ebola survivors in the four administrative regions of Sierra Leone. RESULTS Biomedical care was the first choice of treatment option for most survivors immediately following post-ETC discharge. Survivors' healthcare-seeking experience varies before and after their inclusion into FHCI and the establishment of the CPES program. Personal and health system factors influenced survivors' decision to seek multiple healthcare approaches, especially T&CM. CONCLUSION Our findings suggest the determinants of Ebola survivors' healthcare-seeking experiences should be considered when developing and implementing programs aimed at improving the current health status of Ebola survivors in Sierra Leone.
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Affiliation(s)
- Peter Bai James
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Ultimo, NSW, 2007, Sydney, Australia; Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Sierra Leone.
| | - Jon Wardle
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Ultimo, NSW, 2007, Sydney, Australia; National Centre for Naturopathic Medicine, Southern Cross University, Lismore, NSW, 2480, Australia
| | - Amie Steel
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Ultimo, NSW, 2007, Sydney, Australia
| | - Jon Adams
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Ultimo, NSW, 2007, Sydney, Australia
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Tapera O, Dreyer G, Kadzatsa W, Nyakabau AM, Stray-Pedersen B, Sjh H. Health system constraints affecting treatment and care among women with cervical cancer in Harare, Zimbabwe. BMC Health Serv Res 2019; 19:829. [PMID: 31718646 PMCID: PMC6852958 DOI: 10.1186/s12913-019-4697-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 10/30/2019] [Indexed: 11/21/2022] Open
Abstract
Background Cervical cancer is a major cause of morbidity and mortality among women yet access to treatment and care remains a huge challenge in Zimbabwe. The objective of this study was to investigate health system constraints affecting engagement into treatment and care by women with cervical cancer in Harare, Zimbabwe. Methods A sequential explanatory mixed methods design was used for this study. Phase 1 comprised of two surveys namely: patient and health worker surveys with sample sizes of 134 and 78 participants respectively. Validated structured questionnaires programmed in Android tablet with SurveytoGo software were used for data collection during the surveys. Univariate analyses were conducted using STATA® version 14 to generate descriptive statistics. In phase 2, 16 in-depth interviews, 20 key informant interviews and 6 focus groups were conducted to explain survey results. Participants were purposively selected and sample sizes were informed by saturation principle. Participants in phase 1 and 2 were different. English transcripts were manually coded line by line in Dedoose software using the thematic codes that had been established from the survey data. The final codes were used to support and explain the survey data at the interpretation stages. Results Health system constraints identified in surveys were: limited or lack of training for health workers, weakness of surveillance system for cervical cancer, limited access to treatment and care, inadequate health workers, reliance of patients on out-of-pocket funding for treatment services, lack of back-up for major equipment. Qualitative inquiry revealed the following barriers to treatment and care: high costs of treatment and care, lack of knowledge about cervical cancer and bad attitudes of health workers, few screening and treating centres located mostly in urban areas, lack of clear referral system resulting in bureaucratic processes, and limited screening and treating capacities in health facilities due to lack of resources. Conclusion The results of this study show that health system and its organization present barriers to access of cervical cancer treatment and care among women. Strong political will, mobilization of resources both domestically and from partners in addition to sound policies are imperative to address key health system challenges.
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Affiliation(s)
- O Tapera
- School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa.
| | - G Dreyer
- Gynaecologic Oncology, Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa
| | - W Kadzatsa
- Parirenyatwa Group of Hospitals, Radiotherapy Centre, Harare, Zimbabwe
| | - A M Nyakabau
- Parirenyatwa Group of Hospitals, Radiotherapy Centre, Harare, Zimbabwe
| | - B Stray-Pedersen
- Institute of Clinical Medicine, University in Oslo and Womens' Clinic, Oslo University Hospital, Oslo, Norway
| | - Hendricks Sjh
- Faculty of Dentistry and Oral Health Hospital, Sefako Makgatho Health Sciences University, Pretoria, South Africa.,Faculty of Health Sciences, University of Fort Hare, East London, South Africa
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Mwaka AD, Tusabe G, Garimoi CO, Vohra S, Ibingira C. Integration of traditional and complementary medicine into medical school curricula: a survey among medical students in Makerere University, Uganda. BMJ Open 2019; 9:e030316. [PMID: 31488487 PMCID: PMC6731838 DOI: 10.1136/bmjopen-2019-030316] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To describe the disposition and sociodemographic characteristics of medical students associated with inclusion of traditional and complementary medicine in medical school curricula in Uganda. DESIGN A cross-sectional study conducted during May 2017. A pretested questionnaire was used to collect data. Disposition to include principles of traditional and complementary medicine into medical school curricula was determined as proportion and associated factors determined through multivariate logistic regression. PARTICIPANTS AND SETTING Medical students in their second to fifth years at the College of Health Sciences, Makerere University, Uganda. Makerere University is the oldest public university in the East African region. RESULTS 393 of 395 participants responded. About 60% (192/325) of participants recommended inclusion of traditional and complementary medicine principles into medical school curricula in Uganda. The disposition to include traditional and complementary medicine into medical school curricula was not associated with sex, age group or region of origin of the students. However, compared with the second year students, the third (OR 0.34; 95% CI 0.17 to 0.66) and fifth (OR 0.39; 95% CI 0.16 to 0.93) year students were significantly less likely to recommend inclusion of traditional and complementary medicine into the medical school curricula. Participants who hold positive attributes and believe in effectiveness of traditional and complementary medicine were statistically significantly more likely to recommend inclusion into the medical school curricula in Uganda. CONCLUSIONS Inclusion of principles of traditional and complementary medicine into medical school curricula to increase knowledge, inform practice and research, and moderate attitudes of physicians towards traditional medicine practice is acceptable by medical students at Makerere University. These findings can inform review of medical schools' curricula in Uganda.
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Affiliation(s)
- Amos Deogratius Mwaka
- Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Gersave Tusabe
- Department of Philosophy, Makerere University College of Humanities and Social Sciences, Kampala, Uganda
| | - Christopher Orach Garimoi
- Department of Community Health and Behavioural Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | - Sunita Vohra
- Departments of Paediatrics, Medicine, and Psychiatry, University of Alberta, Edmonton, Alberta, Canada
| | - Charles Ibingira
- Department of Anatomy, Makerere University College of Health Sciences, Kampala, Uganda
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Tapera O, Dreyer G, Kadzatsa W, Nyakabau AM, Stray-Pedersen B, Sjh H. Cervical cancer knowledge, attitudes, beliefs and practices of women aged at least 25 years in Harare, Zimbabwe. BMC WOMENS HEALTH 2019; 19:91. [PMID: 31286937 PMCID: PMC6615311 DOI: 10.1186/s12905-019-0790-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 06/26/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Cervical cancer is the most common cancer and a major cause of morbidity and mortality among women in Zimbabwe yet it is preventable, early detectable and highly curable. The objective of this study was to investigate knowledge, attitudes, beliefs and practices towards cervical cancer, its prevention and treatment in Harare, Zimbabwe. METHODS Sequential explanatory mixed methods approach consisting of analytical cross sectional survey and a qualitative inquiry was used. Study population consisted of women with cervical cancer, health workers and other stakeholders who are involved in cancer control programmes. Patient survey data were collected using validated structured questionnaire in Surveytogo software in an android tablet. Qualitative study used key informant interviews to understand survey findings better. Data analyses for the survey involved univariate and multivariate analyses using STATA version 14. For qualitative study, themes in transcripts were coded and analyzed using Dedoose software to generate evidence for the study. RESULTS Participants reported different levels of knowledge of causes (23%), risk factors (71%), prevention (72%), screening (73%) and treatment (80%) of cervical cancer. Knowledge of causes of cervical cancer were negatively associated with: being aged 45 or more years (OR = 0.02; p = 0.004), having no household income (OR = 0.02;p = 0.007), household income <US$600 per month (OR = 0.02; p = 0.015), middle class wealth (OR = 0.01;p = 0.032), watching TV daily (OR = 0.01;p = 0.007) and 1-6 times per week (OR = 0.02; p = 0.045). Knowledge of causes of cervical cancer were also positively associated with listening to radio daily (OR = 394, CI: 11.02-1406) (p = 0.001) and 1-6 times a week (OR = 100, CI: 2.95-3364) (p = 0.010). Knowledge of prevention was only positively associated with listening to the radio daily (OR = 77, CI: 1.89-3114) (p = 0.022) and 1-6 times a week (OR = 174, CI: 2.42-1255) (p = 0.018). Major drivers of lack of knowledge for cervical cancer were: limited awareness programmes, lack of knowledge among health workers, donor prioritization of infectious diseases, infancy of cervical cancer interventions, negative attitudes towards cervical cancer and misconceptions. CONCLUSIONS This study revealed that knowledge of causes and prevention of cervical cancer was associated with frequent radio listenership. Strengthening of health education through the packaging of messages targeting the wider society using different delivery channels is thus recommended.
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Affiliation(s)
- O Tapera
- School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa.
| | - G Dreyer
- Gynaecologic Oncology, Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa
| | - W Kadzatsa
- Radiotherapy Centre, Parirenyatwa Group of Hospitals, Harare, Zimbabwe
| | - A M Nyakabau
- Radiotherapy Centre, Parirenyatwa Group of Hospitals, Harare, Zimbabwe
| | - B Stray-Pedersen
- Institute of Clinical Medicine, University in Oslo and Womens' Clinic, Oslo University, Oslo, Norway
| | - Hendricks Sjh
- Faculty of Dentistry and Oral Health Hospital, Sefako Makgatho Health Sciences University, Pretoria, South Africa.,Faculty of Health Sciences, University of Fort Hare, East London, South Africa
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Mwaka AD, Tusabe G, Orach Garimoi C, Vohra S. Turning a blind eye and a deaf ear to traditional and complementary medicine practice does not make it go away: a qualitative study exploring perceptions and attitudes of stakeholders towards the integration of traditional and complementary medicine into medical school curriculum in Uganda. BMC MEDICAL EDUCATION 2018; 18:310. [PMID: 30563506 PMCID: PMC6299601 DOI: 10.1186/s12909-018-1419-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 12/03/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND A substantial proportion of healthcare professionals have inadequate understanding of traditional and complementary medicine and often consider their use inappropriate. METHODS We conducted a qualitative study to understand the perceptions and attitudes of medical students, medical school faculty and traditional and complementary medicine practitioners. In-depth interviews and focus group discussions were used to collect data. Thematic approach was used in data analysis to identify emerging themes and sub themes. Data analysis was supported with use of Atlas.ti v6.1.1. RESULTS The majority of participants commended the inclusion of traditional and complementary medicine principles into medical school curricula. The main reasons advanced were that: patients are already using these medicines and doctors need to understand them; doctors would be more accommodating to use and not rebuke patients, thereby minimizing delays in care due to pursuit of alternative therapies; promote patient safety; foster therapeutic alliance and adherence to therapy; uphold patients' right to self-determination; lead to discovery of new drugs from traditional medicines; and set ground for regulation of practices and quality control. However, participants anticipated operational and ethical challenges that include inadequate number of faculty to teach the subject, congested curricula, increased costs in research and development to produce evidence-base data, obstruction by pharmaceutical companies, inaccessibility to and depletion of medicinal plants, and potential conflicts due to diversity in culture and values. A substantial minority of participants thought traditional medicine need not be taught in medical schools because there is lack of scientific evidence on efficacy, safety, and side effects profiles. These shortfalls could make the determination of benefits (beneficence) and harm (maleficence) difficult, as well as compromise the ability of physicians to adequately disclose benefits and harms to patients and family, thereby undermining the process of informed consent and patient autonomy. CONCLUSIONS Training medical students in principles of traditional and complementary medicine is considered reasonable, feasible, and acceptable; and could lead to improvement in health outcomes. There are anticipated challenges to implementing a hybrid medical school curricula, but these are surmountable and need not delay introducing traditional and complementary medicine principles into medical school curricula in Uganda.
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Affiliation(s)
- Amos Deogratius Mwaka
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
- Cancer Awareness and Early Detection Coalition (CAEDCO), Kampala, Uganda
| | - Gervase Tusabe
- Department of Philosophy, School of Liberal and Performing Arts, College of Humanities and Social Sciences, Makerere University, Kampala, Uganda
| | - Christopher Orach Garimoi
- Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Sunita Vohra
- Departments of Paediatrics, Medicine, and Psychiatry, University of Alberta, Edmonton, Canada
- Faculty of Medicine & Dentistry, Integrative Health Institute, University of Alberta, Edmonton, Canada
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James PB, Wardle J, Steel A, Adams J. Traditional, complementary and alternative medicine use in Sub-Saharan Africa: a systematic review. BMJ Glob Health 2018; 3:e000895. [PMID: 30483405 PMCID: PMC6231111 DOI: 10.1136/bmjgh-2018-000895] [Citation(s) in RCA: 171] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 08/26/2018] [Accepted: 08/27/2018] [Indexed: 12/31/2022] Open
Abstract
Background The WHO estimates that a considerable number of people in Sub-Saharan Africa (SSA) rely on traditional, complementary and alternative medicine (TCAM) to meet their primary healthcare needs, yet there remains a dearth of research evidence on the overall picture of TCAM utilisation in the region. Methods We conducted a literature search of original articles examining TCAM use in SSA between 1 January 2006 and 28 February 2017, employing Medline, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Scopus, ProQuest, PubMed, Embase and African Journals Online databases. A critical appraisal of relevant articles reporting a quantitative or mixed-method design was undertaken. Results Despite the heterogeneity and general low quality of the identified literature, the review highlights a relatively high use of TCAM alone or in combination with orthodox medicine, in both general population and in specific health conditions in SSA. TCAM users compared with non-TCAM users are more likely to be of low socioeconomic and educational status, while there were inconsistencies in age, sex, spatial location and religious affiliation between TCAM users and non-TCAM users. Most TCAM users (55.8%–100%) in SSA fail to disclose TCAM use to their healthcare providers, with the main reasons for non-disclosure being fear of receiving improper care, healthcare providers’ negative attitude and a lack of enquiry about TCAM use from healthcare providers. Conclusion TCAM use in SSA is significant, although most studies emerge from a few countries. Factors associated with TCAM use in SSA are similar to those observed in other regions, but further research may be required to further elucidate challenges and opportunities related to TCAM use specific to SSA.
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Affiliation(s)
- Peter Bai James
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
- Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Jon Wardle
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Amie Steel
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
- Office of Research, Endeavour College of Natural Health, Brisbane, Queensland, Australia
| | - Jon Adams
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
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Atim P, Ochola E, Ssendagire S, Rutebemberwa E. Health Seeking Behaviours among Caretakers of Children with Nodding Syndrome in Pader District - Northern Uganda: A Mixed Methods Study. PLoS One 2016; 11:e0159549. [PMID: 27471850 PMCID: PMC4966934 DOI: 10.1371/journal.pone.0159549] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 07/04/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Nodding syndrome is a neurological disorder which had affected about 3000 children with over 170 deaths in northern Uganda by 2012. With limited data on health seeking, the study aimed to assess the health seeking behavior and associated factors among caretakers of children with nodding syndrome in Pader district. METHODS A mixed methods cross sectional study was conducted in July 2013 among 249 caretakers of children with nodding syndrome in three sub-counties of Pader. Respondents were consecutively interviewed using semi-structured questionnaires. Eleven key informants were additionally interviewed. We determined the associations of various factors with health care seeking and obtained adjusted odds ratios and 95% confidence intervals using logistic regression model. Quantitative data was analysed using Stata version 12 while qualitative data was analysed manually and quotes reported. RESULTS Most caretakers, 78.3% (195/249) sought care first from a health facility, 12.9% (32/249) visited traditional healers and 8.8% (22/249) self-medicated. Of those who sought care from a health facility, 50% sought care after a month. Factors associated with improved care seeking included: Time taken to reach care 1-3 hours; adjusted odds ratio = 6.4 (95% CI = 2.96-14.03), time spent in care above five years; adjusted odds ratio = 12.0 (95% CI: 1.24-117.73) and changed care seeking place; adjusted odds ratio = 17.2 (95% CI: 3.64-81.67). CONCLUSION/ RECOMMENDATION Caretakers sought care from multiple places. One in five caretakers still sought care outside a formal health facility. Many respondents who sought care first from health facilities went late, at least one month after symptoms onset. Factors associated with health seeking included distance, duration in treatment and not having changing care provider. There is need for massive sensitization of community to enhance prompt care seeking. More research is needed to elucidate the cause, thus finding the treatment for nodding syndrome, to prevent "wandering in hope".
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Affiliation(s)
- Pamela Atim
- Department of Health Policy, Planning and Management, Makerere University School of Public Health, Kampala, Uganda
- Department of Public Health, Gulu University Faculty of Medicine, Gulu, Uganda
| | - Emmanuel Ochola
- Department of Public Health, Gulu University Faculty of Medicine, Gulu, Uganda
- Department of HIV, Research and Documentation, St. Mary's Hospital Lacor, Gulu, Uganda
| | - Stephen Ssendagire
- Department of Health Policy, Planning and Management, Makerere University School of Public Health, Kampala, Uganda
| | - Elizeus Rutebemberwa
- Department of Health Policy, Planning and Management, Makerere University School of Public Health, Kampala, Uganda
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Hasahya OT, Berggren V, Sematimba D, Nabirye RC, Kumakech E. Beliefs, perceptions and health-seeking behaviours in relation to cervical cancer: a qualitative study among women in Uganda following completion of an HPV vaccination campaign. Glob Health Action 2016; 9:29336. [PMID: 26895145 PMCID: PMC4759844 DOI: 10.3402/gha.v9.29336] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 12/08/2015] [Accepted: 12/21/2015] [Indexed: 01/12/2023] Open
Abstract
Background Cervical cancer remains a leading cause of morbidity and mortality in Uganda. Despite earlier information campaigns to introduce human papilloma virus (HPV) vaccination, which also targeted cervical cancer, misinterpretation and misunderstanding of the subject remain high. Women in Uganda present with cervical cancer at an advanced stage due to poor health-seeking behaviours, with an associated high mortality rate. This project explored beliefs, attitudes, perceptions, and health-seeking behaviours in relation to cervical cancer among women in Uganda after an HPV vaccination project had been rolled out. Design A qualitative study design was used, with six focus group discussions (FGDs) that included 36 women, aged 25–49 years, with no previous history of cervical cancer symptoms or diagnosis. The women were interviewed in February and March 2013. The transcribed data was analysed using content analysis. Results Three themes emerged: feeling unprotected and unsafe, misbelief and wondering about cervical cancer, and fear of the testing procedure. Participating women had heard of cervical cancer but preferred to wait to access cervical cancer screening until symptom debut. Conclusions There are still barriers to cervical cancer screening among women in Uganda, where there is a need for culture-specific, sensitive information and interventions to address the issues of improving the cervical cancer screening uptake among these women. Societal context needs to be taken into account when implementing community-based health education.
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Affiliation(s)
- Olivia Topister Hasahya
- Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden.,Gynecological, Breast and Sarcoma Cancer, Department of Oncology, Karolinska University Hospital, Solna, Sweden;
| | - Vanja Berggren
- Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden.,Faculty of Health Sciences, Lund University, Lund, Sweden
| | - Douglas Sematimba
- Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden.,Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Edward Kumakech
- Makerere University College of Health Sciences, Kampala, Uganda
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Broccoli MC, Calvello EJB, Skog AP, Wachira B, Wallis LA. Perceptions of emergency care in Kenyan communities lacking access to formalised emergency medical systems: a qualitative study. BMJ Open 2015; 5:e009208. [PMID: 26586324 PMCID: PMC4654277 DOI: 10.1136/bmjopen-2015-009208] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 09/10/2015] [Accepted: 10/27/2015] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES We undertook this study in Kenya to understand the community's emergency care needs and barriers they face when trying to access care, and to seek community members' thoughts regarding high impact solutions to expand access to essential emergency services. DESIGN We used a qualitative research methodology to conduct 59 focus groups with 528 total Kenyan community member participants. Data were coded, aggregated and analysed using the content analysis approach. SETTING Participants were uniformly selected from all eight of the historical Kenyan provinces (Central, Coast, Eastern, Nairobi, North Eastern, Nyanza, Rift Valley and Western), with equal rural and urban community representation. RESULTS Socioeconomic and cultural factors play a major role both in seeking and reaching emergency care. Community members in Kenya experience a wide range of medical emergencies, and seem to understand their time-critical nature. They rely on one another for assistance in the face of substantial barriers to care-a lack of: system structure, resources, transportation, trained healthcare providers and initial care at the scene. CONCLUSIONS Access to emergency care in Kenya can be improved by encouraging recognition and initial treatment of emergent illness in the community, strengthening the pre-hospital care system, improving emergency care delivery at health facilities and creating new policies at a national level. These community-generated solutions likely have a wider applicability in the region.
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Affiliation(s)
- Morgan C Broccoli
- Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
| | - Emilie J B Calvello
- Department of Emergency Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Alexander P Skog
- University of Maryland, School of Medicine, Baltimore, Maryland, USA
| | - Benjamin Wachira
- Accident and Emergency Department, The Aga Khan University Hospital, Nairobi, Kenya
| | - Lee A Wallis
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
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Mwaka AD, Okello ES, Abbo C, Odwong FO, Olango W, Etolu JW, Oriyabuzu R, Lagoro DK, Mutamba BB, Idro R, Opar BT, Aceng JR, Lukwago A, Neema S. Is the glass half full or half empty? A qualitative exploration on treatment practices and perceived barriers to biomedical care for patients with nodding syndrome in post-conflict northern Uganda. BMC Res Notes 2015; 8:386. [PMID: 26318338 PMCID: PMC4552991 DOI: 10.1186/s13104-015-1323-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 08/11/2015] [Indexed: 12/03/2022] Open
Abstract
Background Nodding syndrome has increasingly become an issue of public health concern internationally. The etiology of the disorder is still unknown and there are yet no curative treatments. We explored perceptions about treatment practices and barriers to health seeking for nodding syndrome in Pader and Kitgum districts in northern Uganda in order to provide data necessary for informing policy on treatment adherence and rehabilitations. Methods We used focus group discussions and individual interviews to gain deep insights into help-seeking and treatment practices for nodding syndrome. Purposive sampling was used to identify information-rich participants that included village health teams, community members not directly affected with nodding syndrome, district leaders, healthcare professionals, and caregivers of children affected with nodding syndrome. We used qualitative content analysis to analyze data and presented findings under distinct categories and themes. Results Caregivers and communities sought care from multiple sources including biomedical facilities, traditional healers, traditional rituals from shrines, and spiritual healing. Nodding syndrome affected children reportedly have showed no enduring improvement with traditional medicines, traditional rituals, and prayers. A substantial minority of participants reported minimal improvements in symptoms of convulsions with use of western medicines. Challenges involved in health seeking included; (1) health system factors e.g. long distances to facilities, frequent unavailability of medicines, few healthcare providers, and long waiting times; (2) contextual and societal challenges e.g. lack of money for transport and medical bills, overburdening nature of the illness that does not allow time for other activities, and practical difficulties involved in transporting the physically deformed and mentally retarded children to the health facilities. Conclusions Help-seeking for nodding syndrome is pluralistic and include use of traditional and biomedical practices. Western medicines admittedly showed at least short term control on nodding syndrome symptoms, especially convulsions and led in a few cases to regain of functional abilities. However, multiple barriers hinder health seeking and interfere with adherence to biomedical treatments. Regarding cure, there are hitherto no treatments participants perceive cure nodding syndrome.
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Affiliation(s)
- Amos Deogratius Mwaka
- Department of Medicine, Mulago Hospital and the School of Medicine, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda.
| | - Elialilia S Okello
- Department of Psychiatry, Mulago Hospital and the School of Medicine, College of Healthcare Sciences, Makerere University, Kampala, Uganda.
| | - Catherine Abbo
- Department of Psychiatry, Mulago Hospital and the School of Medicine, College of Healthcare Sciences, Makerere University, Kampala, Uganda.
| | | | | | | | - Rachel Oriyabuzu
- Department of Psychiatry, Mulago Hospital and the School of Medicine, College of Healthcare Sciences, Makerere University, Kampala, Uganda.
| | | | - Byamah Brian Mutamba
- Department of Psychiatry, Mulago Hospital and the School of Medicine, College of Healthcare Sciences, Makerere University, Kampala, Uganda. .,Butabika National Mental Referral Hospital, Kampala, Uganda.
| | - Richard Idro
- Department of Paediatrics and Child Health, Mulago Hospital and the School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda. .,Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.
| | | | | | | | - Stella Neema
- Department of Sociology and Anthropology, Makerere University, Kampala, Uganda.
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Pattison N. Reflecting on patient experiences, behaviours and subsequent effects on cancer care and outcomes. Eur J Cancer Care (Engl) 2015; 24:457-60. [DOI: 10.1111/ecc.12341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2015] [Indexed: 11/28/2022]
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