Abstract:
Cervical cancer is the 4th leading cancer affecting women globally. In Kenya, it is
placed 2nd as the most diagnosed cancer and top cause of cancer-related deaths
among women. Early diagnosis (Stages I and II) is associated with a 98% 5-year
survival rate, while delayed diagnosis (Stages III and IV), is associated with lower
rates (17% 5-year survival rate). Globally, over 50% of cervical cancer diagnoses are
made late, with this proportion rising to 80% in developing countries. This study
aimed to determine factors that contribute to delayed diagnosis among cervical
cancer patients at the Kenyatta National Hospital (KNH). An analytical cross
sectional mixed method study design was adopted, and data was collected from 139
cervical cancer patients systematically sampled at KNH, using a semi- structured
questionnaire. Eight Key Informants were interviewed for in-depth views on the
study aim. The key outcome was Stage at diagnosis, categorized as; Early (stages I
and II) or Delayed (III and IV) diagnosis. Associations between stage at diagnosis
(dependent variable) and independent variables were analyzed using STATA 14.2, by
Logistic Regression at 95% Confidence Level. Odds Ratios, Confidence Intervals and
p-values were reported. Content Analysis was used to analyze qualitative data using
NVIVO 14. Majority 91(65.47%) were aged between 40-59 years and the mean age
was 51 years. All study participants were African and Christians. Most participants
88(63.31%) were married and educated up to primary level, and more than half
85(61.15%) were not employed. This study found the prevalence of delayed
diagnosis among KNH patients to be 86(61.9%). The potential risk factors for
delayed diagnosis were; Age 60-69 years (p-value=0.011), lack of employment(p
value=0.009), having a family member paying for Social Health Insurance Fund
(SHIF) (p-value=0.017), lack of cervical cancer awareness (p-value=0.009), lack of
HPV screening awareness(p- value<0.001), lack of prior Human Papilloma Virus
(HPV) screening (p-value=0.003), seeking medical attention only due to a
symptomatic trigger (p-value=0.031), more number of hospital referral times (p
value<0.001), facing referral challenges (p- value=0.041), and longer time taken for
diagnostic results (p-value=0.007), from the bivariate analysis. The inferential analysis
found, Age (50-69 yrs.), seeking medical attention only due to a symptomatic trigger,
more number of hospital referral times, facing referral challenges and longer time
taken for diagnostic results, to be independently significantly associated with delayed
diagnosis of cervical cancer. Qualitatively, high diagnosis costs, inadequate
awareness and knowledge on HPV screening and cervical cancer, poor referral
systems and delayed appointments and results, contributed to delayed diagnosis. This
study concluded that inadequate awareness and deficient health referral systems are
major hindrances in the access and availability of quality medical care leading to
advanced-stage cervical cancer diagnosis. The study recommends intensified
awareness and expansion of HPV screening and cancer diagnosis services to lower
tier health settings. to improve timely diagnosis.
