Utilization of breast cancer screening in Kenya: what are the determinants?

Factors Associated with the Uptake of HIV Testing in Canada: Evidence from a Nationally Representative Study

In this study, we explore the factors associated with the uptake of HIV testing at the national level in Canada. Using the 2015-16 Canadian Community Health Survey and applying logistic regression analysis, we examine the associations between HIV testing and factors identified by the Andersen's behavioral model of healthcare utilization. We find that a range of predisposing, enabling, and need factors are significantly associated with HIV testing. For example, compared to the oldest respondents (i.e. 55-64), their younger counterparts (i.e. 45-54, 35-44, and 25-34) are more likely to have been tested for HIV. Compared to those in Atlantic Canada, respondents in Quebec (OR = 1.96, p < .001), Ontario (OR = 1.44, p < .001), Prairies (OR = 1.37, p < .001), British Columbia (OR = 1.99, p < .001), and the Territories (OR = 2.22, p < .001) are all more likely to have been tested for HIV. Based on these findings, we provide several important suggestions for policymakers and future research.

Investigating Factors Influencing the National Cancer Screening Program among Older Individuals in Republic of Korea-Data from the Korea National Health and Nutrition Examination Survey VIII

This study aims to determine the influencing factors of the participation of older individuals aged 65 years and above in South Korea's National Cancer Screening Program (NCSP) using data from the eighth wave (2019-2021) of the Korea National Health and Nutrition Examination Survey (KNHANES VIII), and discuss potential problems and coping strategies. Variables were selected based on Andersen's healthcare utilization model. "Participation in the NSCP" was considered the dependent variable, with independent variables including sociodemographic characteristics (sex, marital status, residence, education level, income level, economic activity, medical coverage type, and private insurance), health conditions (subjective health status, hypertension, and diabetes), and health behaviors (physical activity, monthly alcohol consumption, and current smoking status). The analysis revealed that higher participation rates correlated with being married, having an education level beyond elementary school, being employed, subscribing to private insurance, perceiving oneself as having average or poor health, engaging in physical activity, and not smoking. Sex, residence, income, medical coverage type, hypertension, diabetes, and monthly alcohol consumption were found to be insignificantly correlated. These findings underscore the importance of tailored promotion and health education for older individuals to boost NCSP participation rates, which could ultimately elevate public health standards.

Perceived barriers and factors influencing uptake of breast cancer screening among women: a population-based cross-sectional study

Breast cancer (BC) screening plays a major role in the prevention of BC through early detection and timely treatment. This study aims to determine the level of uptake of BC screening and associated factors. A community-based analytical cross-sectional study was conducted in Dodoma City, Tanzania from July to December 2020. The study included women aged 8 years and above without a known history of breast cancer. Multivariable logistic regression was used to determine the socio-demographic factors associated with BC screening. P value < 0.05 was considered significant. A total of 354 study participants were included in the present study. The mean age of participants was 31.0 ± 11.8 years. The majority of study participants (67.5%, n = 239) were aware of BC screening. However, only (35.3%, n = 125) reported to have ever practised BC screening. Breast self-examination was the most (16.4%, n = 58) frequently used method for BC screening among study participants. Lack of knowledge of all methods of BC screening was the barrier that was perceived by the vast majority (60.2%, n = 213) of the study participants. Having low family income was the only predictor of failure to practice BC screening. In this study, most of the women were aware of BC, however, few of them had undergone breast cancer (BC) screening at the time of the interview. The study also found that the main barrier to BC screening was the lack of knowledge about BC among the study participants. Immediate measures are necessary to increase women's awareness of BC. Such as community sensitization on the importance of screening, can help improve the uptake of BC screening and the early detection of BC.

Barriers and enablers of breast cancer screening among women in East Africa: a systematic review

BACKGROUND

Breast cancer is among the most common cancers globally with a projected increase in incidence and mortality in low- and middle-income countries. The majority of the patients in East Africa present with advanced disease contributing to poor disease outcomes. Breast cancer screening enables earlier detection of the disease and therefore reduces the poor outcomes associated with the disease. This study aims to identify and synthesize the reported barriers and enablers of breast cancer screening among East African women.

METHODS

Medline, Embase, SCOPUS, and Cochrane library were searched for articles published on the subject from start to March 2022 using PRISMA guidelines. Also, forward citation, manual search of references and searching of relevant journals were done. A thematic synthesis was carried out on the "results/findings" sections of the identified qualitative papers followed by a multi-source synthesis with quantitative findings.

RESULTS

Of 4560 records identified, 51 were included in the review (5 qualitative and 46 quantitative), representing 33,523 women. Thematic synthesis identified two major themes - "Should I participate in breast cancer screening?" and "Is breast cancer screening worth it?". Knowledge of breast cancer and breast cancer screening among women was identified as the most influencing factor.

CONCLUSION

This review provides a rich description of factors influencing uptake of breast cancer screening among East African women. Findings from this review suggest that improving knowledge and awareness among both the public and providers may be the most effective strategy to improve breast cancer screening in Eastern Africa.

Prostate cancer screening uptake in Kenya: An analysis of the demographic and health survey

BACKGROUND

Prostate cancer (PCa) screening is a cost-effective strategy to promote early detection and treatment. Understanding the determinants of PCa screening uptake would help policy makers to identify high-risk populations and ensure the cost-effectiveness of health promotion interventions. This study aims to estimate the prevalence of PCa screening uptake and assess its associated factors among Kenyan men.

METHODS

The study relied on data from the 2014 Kenya Demographic and Health Survey. Both descriptive and inferential analyses were performed. Firth logistic regression was employed using the "firthlogit" command in STATA. The adjusted odds ratio and 95% confidence interval were presented.

RESULTS

Overall, the prevalence of PCa screening uptake was 4.4%. The odds of PCa screening uptake were high among men aged 50-54 [aOR= 2.08; CI= 1.23, 3.52], those who had health insurance coverage [aOR= 1.69; CI= 1.28, 2.23], those who read at least once in a week [aOR= 1.52; CI= 1.10, 2.10], and among those who watched TV at least once in a week [aOR= 1.73; CI= 1.18, 2.52]. Men who resided in the Eastern [aOR= 2.23; CI= 1.39, 3.60], Nyanza [aOR= 2.13; CI= 1.29, 3.53], and Nairobi [aOR= 1.97; CI= 1.01, 3.86] had a higher likelihood of getting screened for PCa.

CONCLUSION

In conclusion, the uptake of PCa screening in Kenya is low. To ensure the cost-effectiveness of health-promoting interventions that aim to improve PCa screening uptake in Kenya, men without health insurance coverage should be targeted and prioritized. Increasing literacy rate, sensitization via television, and increasing the insurance coverage in the country would significantly contribute to a higher uptake of PCa screening.

POLICY SUMMARY

To improve the uptake of PCa screening, there would be a need to implement a national advocacy campaign that will sensitize Kenyan men about the need to undergo PCa screening. This national advocacy campaign to increase the uptake of PCa screening in Kenya must leverage mass media platforms.

Understanding the association between unmet dental care needs and household food security status among older people in Ghana

The literature recognizes food insecurity as a barrier to access to health care services. However, we know very little about the association between food insecurity and unmet dental care needs among older people in Ghana. To address this void in the literature, this study uses a representative survey of adults aged 60 or older from three regions in Ghana to examine whether older people who experienced household food insecurity differently report unmet dental care needs in comparison to their counterparts without any food insecurity. We find that 40% of older adults reported unmet dental care needs. Results from logistic regression analysis show that older people who experienced severe household food insecurity were more likely to report unmet dental care needs, compared to those who did not experience any type of food insecurity, even after accounting for theoretically relevant variables (OR = 1.94, p < 0.05). Based on these findings, we discuss several implications for policymakers and directions for future research.

Influence of distance to health facilities on clinical breast cancer screening behaviour among women in five sub-Saharan African countries

BACKGROUND

Regular breast screening is one of the most effective ways to detect early signs of breast cancer but travel distance to cancer-diagnostic facilities can affect breast screening attendance. Yet, limited studies have examined the impact of distance to cancer-diagnostic facilities on clinical breast screening behaviour among women in sub-Saharan Africa (SSA). This study examined the influence of travel distance to a health facility on clinical breast screening behaviour in five SSA countries: Namibia, Burkina Faso, Cote D'Ivoire, Kenya, and Lesotho. The study further assessed variations in clinical breast screening behaviour across diverse socio-demographic characteristics of women.

METHODS

A sample of 45,945 women was drawn from the most recent Demographic and Health Surveys (DHS) for the included countries. The DHS uses 2-stage stratified cluster sampling to select nationally representative samples of women (15-49) and men (15-64) via a cross-sectional design. Proportions and binary logistic regression were used to examine associations between the women's socio-demographic characteristics and breast screening attendance.

RESULTS

The overall proportion of survey participants who underwent clinical breast cancer screening was 16.3%. Travel distance to a health facility had a significant (p < 0.001) impact on clinical breast screening behaviour as 18.5% of participants who self-reported distance as "not a big problem" attended clinical breast screening compared to 10.8% who self-reported distance as "a big problem". The study further found that various socio-demographic factors were significantly associated with breast cancer screening uptake, including age, education level, media exposure, wealth status, parity, contraceptive use, health insurance coverage, and marital status. The multivariate analysis controlling for other factors confirmed the strong association between distance to health facilities and screening uptake.

CONCLUSIONS

The study found that travel distance is a significant factor affecting clinical breast screening attendance among women in the selected SSA countries. Furthermore, the likelihood of breast screening attendance varied depending on different women's characteristics. It is crucial to prioritise breast screening interventions, particularly among the disadvantaged women identified in this study, to achieve maximum public health benefits.

Factors associated with awareness of breast cancer among women of reproductive age in Lesotho: a national population-based cross-sectional survey

BACKGROUND

Breast cancer is a leading cause of cancer mortality and a major public health problem. The growing number of breast cancer-related deaths has been largely attributed to a lack of awareness of the disease among women. Whilst there have been frequent campaigns promoting breast cancer awareness, evidence suggests that women still lack awareness. Therefore, this study assessed the prevalence and factors associated with the awareness of breast cancer among women of reproductive age in Lesotho.

METHODS

We used population-based cross-sectional data from the 2014 Lesotho Demographic and Health survey. A total of 6,620 women of reproductive age were included in the analysis. The outcome variable was awareness of breast cancer. Women who heard about breast cancer were considered to be aware of the disease. Multilevel binary logistic regression models were fitted to determine the factors associated with breast cancer awareness among women.

RESULTS

The level of awareness of breast cancer was 86.8% (95% CI: 85.5, 87.9). Women aged 45-49 years [adjusted odds ratio (AOR) = 2.87, 95% confidence interval (CI): 1.83, 4.48], married women [AOR = 1.51 (95% CI: 1.19, 1.93)], and women with higher educational level [AOR = 12.56, (95% CI: 4.35, 36.28)] were more likely to be aware of breast cancer. Additionally, women who listened to the radio at least once a week [AOR = 1.96, (95% CI: 1.63, 2.37)], those who read newspapers or magazines [AOR = 1.91 (95% CI: 1.48, 2.46)] and women in the wealthiest group [AOR = 2.55, (95% CI: 1.67, 3.89)] had higher odds of breast cancer awareness. However, women who were in rural areas were less likely [AOR = 0.63, (95% CI: 0.47, 0.84)] to be aware of breast cancer than those in urban areas.

CONCLUSION

The level of awareness of breast cancer among women of reproductive age in Lesotho was extremely low. We recommend that policymakers, clinicians, and public health practitioners should consider the factors identified in this study when designing and developing intervention programs to improve the awareness of breast cancer among women in Lesotho.

Factors Associated with Deworming Medication Utilization among Pregnant Women in Benin: Evidence from the Demographic and Health Survey

Deworming medication utilization is a useful strategy to reduce the burden of anemia among pregnant women. Yet, we know very little about the prevalence and correlates of deworming medication utilization among pregnant women in sub-Saharan Africa, including Benin. To address this void in the literature, we used the 2017–2018 Benin Demographic and Health Survey and applied logistic regression analysis to explore the demographic, socioeconomic, and healthcare factors associated with deworming medication utilization in Benin. We found that deworming medication coverage was 65% at the national level. We observed that women aged 35–49 years were less likely to use deworming medication compared to those aged 15–24 years (OR = 0.79, p < 0.01). Compared to Christian women, Muslim women (OR = 0.70, p < 0.01) and women of other religions (OR = 0.51, p < 0.01) were also less likely to use deworming medication. Moreover, women with lower levels of education and household wealth, as well as unemployed women, were less likely to use deworming medication in comparison to their educated, richer, and employed counterparts. Women who visited ANC fewer than eight times were also less likely to use deworming medication compared to their counterparts who did so eight times or more (OR = 0.65, p < 0.001). Based on these findings, we discussed several implications for policymakers.

Prevalence and associated factors of breast cancer screening among nuns in the Catholic Archdiocese of Nairobi

Introduction

breast cancer is a significant global challenge. The risk of breast cancer among nuns is high mainly due to the basis of nulliparity. Among the effective approaches to addressing breast cancer is early screening. However, there are concerns over the uptake of screening across all populations, including nuns. The objective of the study is to determine the prevalence and the associated factors of breast cancer screening among nuns in the Catholic Archdiocese of Nairobi.

Methods

this research used the analytical cross-sectional design. A total of 384 nuns in the Catholic Archdiocese of Nairobi were recruited using a stratified sampling. Structured questionnaires were used to collect data. Chi-square and binary logistic regression were used to determine association between social-demographic factors and breast cancer screening. Statistical package for social sciences (SPSS version 26) was used for analysis. The level of significance was investigated at p<0.05.

Results

our findings revealed that the prevalence of breast cancer screening among nuns was 30.7%. The findings established that those who had knowledge on breast cancer screening (AOR=25.52, 95%CI: 8.87 - 73.45, p<0.001) and those who had congregational financial support (AOR=1.97, 95%CI: 1.68 - 5.74, p=0.021) were more likely to undergo breast cancer screening. Those who had hospital check-up for in more than six months prior to the study (AOR=0.001, 95%CI: 0.000 - 0.008, p<0.001) and those who never had a hospital check-up, (AOR=0.001, 95%CI: 0.000 - 0.006, p<0.001) were less likely to undergo breast cancer screening.

Conclusion

the findings have shown low uptake of breast cancer screening amongst nuns in the Catholic Archdiocese in Nairobi. Knowledge on breast cancer screening access to congregational support and hospital check-up have been identified as key factors associated with breast cancer screening. Therefore, there is a need to create adequate awareness be created and the Catholic reverend sisters educated through aggressive education campaign programs so as to eliminate misconceptions relating to the topic. Also, to integrate free access to screening services in the government health institutions for nuns.

Factors associated with the uptake of clinical breast examination among women of reproductive age in Lesotho: analysis of a national survey

BACKGROUND

In low-resource settings with weak health systems, the WHO recommends clinical breast examination (CBE) as the most cost-effective breast screening modality for women. Evidence shows that biennial CBE leads to significant downstaging of breast cancer in all women. Breast cancer is the second most common cancer among women in Lesotho with a weaker healthcare system and a low breast cancer screening rate. This study investigated the prevalence and factors associated with the uptake of CBE among women of reproductive age in Lesotho.

METHODS

This study used cross-sectional data from the 2014 Lesotho Demographic and Health Survey. A sample of 6584 reproductive-age women was included in this study. We conducted both descriptive and multivariable logistic regression analyses. The study results were presented in frequencies, percentages, and adjusted odds ratios (aOR) with their corresponding confidence intervals (CIs).

RESULTS

The prevalence of CBE uptake was 9.73% (95% CI: 8.91, 10.61). Women who were covered by health insurance (aOR = 2.31, 95% CI [1.37, 3.88]), those who were pregnant (aOR = 2.34, 95% CI [1.64, 3.35]), those who had one to three children (aOR = 1.81, 95% CI [1.29,2.52]), and women who frequently read newspapers or magazines (aOR = 1.33, 95% CI [1.02,1.72]) were more likely to undergo CBE than their counterparts. Women who were aware of breast cancer (aOR = 2.54, 95% CI [1.63,3.97]), those who have ever had breast self-examination (BSE) within the last 12 months prior to the study (aOR = 5.30, 95% CI [4.35,6.46]), and those who visited the health facility in the last 12 months prior to the study (aOR = 1.57, 95% CI [1.27,1.95]) were also more likely to undergo CBE than their counterparts. Women residing in the Qacha's-nek region (aOR = 0.42, 95% CI [0.26,0.67]) were less likely to undergo CBE than those in the Botha-bothe region.

CONCLUSION

The study found a low prevalence of CBE uptake among reproductive-age women in Lesotho. Factors associated with CBE uptake include health insurance coverage, being pregnant, those who had one to three children, exposure to media, breast cancer awareness, ever had BSE, and those who visited a health facility. To increase CBE uptake, these factors should be considered when designing cancer screening interventions and policies in order to help reduce the burden of breast cancer in Lesotho.

Maternal Tetanus Toxoid Vaccination in Benin: Evidence from the Demographic and Health Survey

Tetanus toxoid vaccination is critical for improving maternal and child health. Yet, the prevalence and correlates of maternal tetanus toxoid vaccination coverage remain largely underexplored in Benin where infant and child mortality rates are high. Using the 2017−18 Benin Demographic and Health Survey, we apply logistic regression analysis to address this void in the literature. We find that overall maternal vaccination coverage is 69%. A range of demographic, health care, and socioeconomic factors are associated with maternal tetanus toxoid vaccination coverage. Women aged 20−34 (OR = 0.84, p < 0.05) and 35−49 (OR = 0.63, p < 0.01) are less likely to receive tetanus toxoid vaccination in comparison to those aged 15−19. Health care factors are also significantly associated with maternal tetanus toxoid vaccination, indicating that women who deliver at home (OR = 0.20, p < 0.001) and visit antenatal care fewer than eight times (OR = 0.62, p < 0.001) are less likely to receive tetanus toxoid vaccination than their counterparts who deliver in a health facility and visit antenatal care eight times or more. We also find that women with secondary (OR = 0.54, p < 0.05), primary (OR = 0.47, p < 0.01), and no education (OR = 0.47, p < 0.01) are less likely to receive tetanus toxoid vaccination compared to their counterparts with higher education. Based on these findings, we discuss several implications for policymakers.

The Kenya UK Breast Cancer Awareness Week: curriculum codesign and codelivery with direct and lived experience of breast cancer diagnosis and management

Global health education holds a paradox: the provision of global health degrees focusing on challenges in low-income and middle-income countries has increased in high-income countries, while those in these low-income and middle-income countries lack access to contribute their expertise, creating an 'information problem'. Breast cancer is a pressing global health priority, which requires curriculum design, implementation, ownership and leadership by those with direct and lived experience of breast cancer.The Kenya-UK Breast Cancer Awareness Week was conceptualised following the signing of the Memorandum of Understanding between the Kenyan and UK governments launching the Kenya UK Health Alliance. This alliance aims to promote health cooperation to address Kenya's breast cancer challenge. Here, we present the first of the collaborative's initiatives: a breast cancer global health education programme designed, implemented, owned and led by Kenyan stakeholders.We present the utilisation of the Virtual Roundtable for Collaborative Education Design for the design and implementation of a nationwide virtual breast cancer awareness week delivered across eleven Kenyan medical schools. By involving partners with lived and/or professional experience of breast cancer in Kenya in all stages of the design and delivery of the awareness week, the project experimented with disrupting power dynamics and fostered ownership of the initiative by colleagues with direct expertise of breast cancer in Kenya.This initiative provides a platform, precedent and playbook to guide professionals from other specialties in the design and implementation of similar global collaborative ventures. We have used this approach to continue to advocate for global health curricula design change, so that those with lived experiences of global health challenges in their contextualised professional and personal environments are given leadership, reward and ownership of their curricula and further to highlight breast cancer as a global heath priority.

Very poor practices regarding breast cancer screening among Sudanese female workers at a secondary-level hospital: a cross-sectional study

Introduction

breast cancer (BC) mortality and morbidity burden in African countries is higher compared to western countries due to late diagnosis produced by deficient screening. We aimed to assess the level of knowledge, attitude and practice regarding breast cancer screening among Sudanese female workers at a secondary-level hospital.

Methods

this is a cross-sectional study carried out at the largest governmental hospital of Ad-Damazin City (capital of Blue Nile State, south-eastern Sudan) in 2018. It surveyed female healthcare providers "group A" compared to the non-medical female staff at the same hospital "group B" to assess their awareness, beliefs and behavior concerning Breast Cancer Screening (BCS). Chi-squared and Student t-tests were used for analysis with a significant p value of <0.05.

Results

participants were 110, included 78 (70.9%), ("group A") and 32 (29.1%) ("group B") women. Good overall knowledge score (47.4%) vs (43.8%), for "group A" and "group B", respectively, p=0.000. Positive attitude was scored by 63 (80.8%) vs. 23 (71.9%) participants in "group A" and "group B" respectively, p= 0.305. Obvious denial trend regarding susceptibility to this disease was noted in both groups. BCS practices were seriously unsatisfactory in both groups. As "group A" vs "group B" regarding breast self-examination, n=13 (16.7%) vs n=10 (31.3%); clinical breast examination n=4 (5.1%) vs n=4 (12.5%) and mammography was not performed by any woman in both groups.

Conclusion

the modest knowledge and poor BCS practices of our study groups strongly recommends appropriate official and educational actions.

Barriers and Facilitators to Integrating Clinical Breast Examinations With Cervical Cancer Screening Programs in Outpatient Clinics in Western Kenya

PURPOSE

Nearly half of Kenyan women with breast cancer present with advanced disease-owing partially to limited patient education and screening limitations in low- and middle-income countries. With increasing access to nurse-led cervical cancer screening (CCS) in government clinics in Kenya, we investigated provider-perceived barriers and facilitators to integrating clinical breast examinations (CBEs) with ongoing CCS programs in Kisumu County, Kenya.

METHODS

CCS providers within the Ministry of Health Clinics in Kisumu County, Kenya, were recruited to participate in a two-phase, sequential, mixed methods study. Knowledge of CBE guidelines was assessed with a questionnaire. Providers with significant CCS and CBE experience then completed a one-on-one interview discussing barriers and facilitators to integration.

RESULTS

Sixty-nine providers from 20 randomly selected facilities participated in the survey. Providers all agreed that breast cancer screening was very important. Although 93% said that they routinely offered CBEs, only 22% of these providers screened at least eight of their last 10 patients. Forty-four percent identified four or more of five signs and symptoms of breast cancer, and 33% identified four to five risk factors. Although providers showed enthusiasm for integration of CBEs into their practices, barriers were identified and grouped into four themes: (1) fragmentation of services, (2) staffing shortage and inadequate on-the-job training, (3) limited space and referral system challenges, and (4) limited patient awareness on need for cancer screening.

CONCLUSION

Addressing providers' concerns by providing routine on-the-job clinical training, improving staffing shortages, strengthening the diagnostic and treatment referral pathway, and increasing patient education are some of the first steps in facilitating integration of CBEs with CCS services in primary care clinics in Kenya.

The impact of the Covid-19 pandemic on breast cancer early detection and screening

The COVID-19 pandemic affects mortality and morbidity, with disruptions expected to continue for some time, with access to timely cancer-related services a concern. For breast cancer, early detection and treatment is key to improved survival and longer-term quality of life. Health services generally have been strained and in many settings with population breast mammography screening, efforts to diagnose and treat breast cancers earlier have been paused or have had reduced capacity. The resulting delays to diagnosis and treatment may lead to more intensive treatment requirements and, potentially, increased mortality. Modelled evaluations can support responses to the pandemic by estimating short- and long-term outcomes for various scenarios. Multiple calibrated and validated models exist for breast cancer screening, and some have been applied in 2020 to estimate the impact of breast screening disruptions and compare options for recovery, in a range of international settings. On behalf of the Covid and Cancer Modelling Consortium (CCGMC) Working Group 2 (Breast Cancer), we summarize and provide examples of such in a range of settings internationally, and propose priorities for future modelling exercises. International expert collaborations from the CCGMC Working Group 2 (Breast Cancer) will conduct analyses and modelling studies needed to inform key stakeholders recovery efforts in order to mitigate the impact of the pandemic on early diagnosis and treatment of breast cancer.

Gender Differences in Insurance, Surgical Admissions and Outcomes at a Kenyan Referral Hospital

INTRODUCTION

Gender is an important factor in determining access to healthcare resources. Women face additional barriers, especially in low- and middle-income countries. Surgical costs can be devastating, which can exacerbate engendered disparities. Kenya's National Hospital Insurance Fund (NHIF) aims to achieve universal coverage and protect beneficiaries from catastrophic health expenditures. We examine gender differences in NHIF coverage, health-seeking behavior, and surgical outcomes at a tertiary care hospital in Eldoret, Kenya.

MATERIALS AND METHODS

All patients ≥13 years admitted to the general surgery service at Moi Teaching and Referral Hospital from January 2018-July 2018 were enrolled. Health records were retrospectively reviewed for demographic data, clinical parameters, NHIF enrollment, and cost information. Descriptive analyses utilized Wilcoxon Rank Sum, Pearson's Chi-square, and Fisher's Exact tests.

RESULTS

366 patients were included for analysis. 48.6% were enrolled in NHIF with significant female predominance (64.8% versus 37.9%, P < 0.0001). Despite differing coverage rates, male and female patients underwent surgery and suffered in-hospital mortality at similar rates. However, women only comprised 39.6% of admissions and were significantly more likely to delay care (median 60 versus 7 days, P < 0.0001), be diagnosed with cancer (26.6% versus 13.2%, P = 0.0024), and require a palliative procedure for cancer (44.1% versus 13.0%, P = 0.013).

CONCLUSION

Many financial and cultural barriers exist in Kenya that prevent women from accessing healthcare as readily as men, persisting despite higher rates of NHIF coverage amongst female patients. Investigation into extra-hospital costs and social disempowerment for women may elucidate key needs for achieving health equity.

Determinants of delay in diagnosis and end stage at presentation among breast cancer patients in Iran: a multi-center study

One of the reasons for high mortality of breast cancer (BC) is long delay in seeking medical care and end stage at presentation. This study was designed to measure the association between a wide range of socio-demographic and clinical factors with diagnostic delay in BC and stage at presentation among Iranian patients. From June 2017 to December 2019, 725 patients with newly diagnosed BC in Shiraz and Kermanshah were selected and information on BC diagnosis delay was obtained from the patient’s medical record. Data on socio-economic status was obtained via a structured interview. Our findings suggest that 45.8% of the patients were diagnosed at a late stage (stage 3 or higher). A total of 244 (34%) patients had more than 3 months delay in diagnosis. We found a significant association between stage at diagnosis and place of residence (adjusted odds ratio (aOR rural vs. urban = 1.69, 95% CI 1.49–1.97), marital status (aOR 1.61, 95% CI 1.42–1.88), family history of BC (aOR 1.46, 95% CI 1.01–2.13), and history of benign breast disease (BBD) (aOR 1.94, 95% CI 1.39–2.72) or unaware of breast self-examination (BSE) (aOR 1.42, 95% CI 1.42–1.85), delay time (aOR 3.25, 95% CI 1.04–5.21), and left breast tumor (aOR right vs. left 2.64, 95% CI 1.88–3.71) and smoking (aOR no vs. yes 1.59, 95% CI 1.36–1.97). Also, delay in diagnosis was associated with age, family income, health insurance, place of residence, marital status, menopausal status, history of BBD, awareness of breast self-examination, type of first symptoms, tumor histology type, BMI and comorbidity (p < 0.05 for all). Factors including history of BBD, awareness of BSE, and suffering from chronic diseases were factors associated with both delay in diagnosis and end stage of disease. These mainly modifiable factors are associated with the progression of the disease.

Failure is not an option: Barriers to HIV treatment adherence in Kampala, Uganda

This study seeks to investigate challenges to combined antiretroviral therapy (cART) treatment adherence and treatment outcomes in Kampala, Uganda. Data was collected from a survey administered to two cohorts of patients with human immunodeficiency virus type 1 (HIV-1) receiving care and cART from the Joint Clinical Research Center (JCRC) in Kampala. Cohort I consisted of 93 individuals successfully treated on cART for a period of three years, while Cohort II consisted of 56 individuals who have experienced treatment failure with first-line cART within two years. We hypothesize that distance to the treatment facility would be a predictor of poor adherence and thus treatment failure. However, results suggested otherwise, whereby participants living more than 2 h away from their treatment facility were actually less likely to miss their daily dose of cART (OR = 0.33, p < .05), compared to those living in proximity to the treatment center. Further, high-income employment (OR = 3.82, p < .05) and partnered relationship status (OR = 4.28, p < .05) were predicted to increase the probability of missing doses. These findings may be explained by the deep-seated stigma which has remained pervasive in the lives of HIV-positive population in Kampala, even 30 years after the peak of the HIV/AIDS epidemic.

Prevalence and determinants of breast cancer screening in four sub-Saharan African countries: a population-based study

OBJECTIVES

Breast cancer is the most prevalent cancer and the second leading cause of cancer-related deaths among women after cervical cancer in much of sub-Saharan Africa. This study aims to examine the prevalence and sociodemographic-socioeconomic factors associated with breast cancer screening among women of reproductive age in sub-Saharan Africa.

DESIGN

A weighted population-based cross-sectional study using Demographic and Health Surveys (DHS) data. We used all available data on breast cancer screening from the DHS for four sub-Saharan African countries (Burkina Faso, Ivory Coast, Kenya and Namibia). Breast cancer screening was the outcome of interest for this study. Multivariable Poisson regression was used to identify independent factors associated with breast cancer screening.

SETTING

Four countries participating in the DHS from 2010 to 2014 with data on breast cancer screening.

PARTICIPANTS

Women of reproductive age 15-49 years (N=39 646).

RESULTS

The overall prevalence of breast cancer screening was only 12.9% during the study period, ranging from 5.2% in Ivory Coast to 23.1% in Namibia. Factors associated with breast cancer screening were secondary/higher education with adjusted prevalence ratio (adjusted PR)=2.33 (95% CI: 2.05 to 2.66) compared with no education; older participants, 35-49 years (adjusted PR=1.73, 95% CI : 1.56 to 1.91) compared with younger participants 15-24 years; health insurance coverage (adjusted PR=1.57, 95% CI: 1.47 to 1.68) compared with those with no health insurance and highest socioeconomic status (adjusted PR=1.33, 95% CI : 1.19 to 1.49) compared with lowest socioeconomic status.

CONCLUSION

Despite high breast cancer mortality rates in sub-Saharan Africa, the prevalence of breast cancer screening is substantially low and varies gradually across countries and in relation to factors such as education, age, health insurance coverage and household wealth index level. These results highlight the need for increased efforts to improve the uptake of breast cancer screening in sub-Saharan Africa.