Determinants Of Delay In Seeking Medical Care Among Women With Invasive Cervical Cancer In Western Kenya

ABSTRACT

Cervical cancer is a disease with tremendous public health significance. It is the

leading cause of cancer morbidity and mortality among women in Kenya.

Although curable through regular screening and treatment of precancerous

lesions, its incidence is on the rise in Eastern Africa and many women are

presenting with advanced disease leading to low survival rates. In Western

Kenya, it is the most common type of cancer affecting women. Patient delay

accounts for a large proportion of those who present with advanced disease in

developing countries. Reducing the time from onset of first symptoms to

diagnosis will effectively improve quality of life and prognosis of cervical

cancer patients. This cross-sectional study was conducted to explore the process

of symptom appraisal and determine socioeconomic, psychosocial, and cultural

and health system factors that contribute to patient delay in seeking medical care

for cervical cancer among women in two county referral hospitals in rural

Kenya. In the setting where the study was carried out, the prevalence of

HIV/AIDS is relatively high. There were 274 respondents who participated in

the study. Face to face interviews using a pretested structured questionnaire and

medical records review were carried out. Data was collected from all those who

met the inclusion criteria and had given their informed consent with the option

of voluntary withdrawal from the study at any stage. Descriptive and inferential

statistics were analyzed using Statistical Packages for Social Sciences version 21

(SPSS Inc, USA). Chi square test and logistic regression was used to derive

relationships between variables; results were considered significant with p value

≤0.05. Outcome measures were a description of determinants of late

presentation and diagnosis of cervical cancer. The findings indicate that 55% of

patients waited more than three months before seeking medical care mainly

because they did not appraise the symptoms as serious warranting medical

attention. This was despite majority (85%) of them having good access to

medical facilities. Psychosocial factors such as beliefs and perceptions held by

the patients about initial symptoms and availability of social support networks

were the most significant predictors of delay in seeking medical care. Age of

patient, education level, employment status, access to insurance, beliefs about

traditional medicine, knowledge of cervical cancer and preventative health

orientation of the respondents also contributed to delay in seeking care. In

conclusion, there is need to raise awareness about cancer to empower both the

public and health workers to recognize its signs and symptoms early and seek

treatment. There is a need for the patients to be economically empowered in

order to access available cancer care. They could be encouraged to enroll in the

National Health Insurance Fund in order to benefit from its various cancer

treatment packages.