Contributors to Delayed Diagnosis among Cervical Cancer Patients at the Kenyatta National Hospital in Kenya

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.