Social, demographic and healthcare factors associated with stage at diagnosis of cervical cancer: cross sectional study in a tertiary hospital in Northern Uganda

Objective: To examine patient and primary healthcare factors and stage at diagnosis in women with cervical cancer in Northern Uganda with the intention to identify factors that are associated with advanced stages in order to inform policies to improve survival from cervical cancer in the low- and middle-income countries. Design: Cross sectional hospital-based study Setting: Tertiary, not-for-profit private hospital in post-conflict region. Participants: Consecutive tissue-diagnosed symptomatic cervical cancer patients attending care. Of 166 patients, 149 were enrolled and analysed. Primary outcome: Cervical cancer stage at diagnosis. Results: Most women were diagnosed in stages III (45%) or IV (21%). After controlling for age, marital status, educational attainment and number of biological children, there was evidence for association between greater likelihood of advanced stage at diagnosis and pre-referral diagnosis of cancer by primary healthcare professionals (Adjusted OR (AOR)=13.04:95%CI; 3.59-47.3), financial difficulties precluding prompt help-seeking (AOR=5.5:95%CI; 1.58-20.64). After adjusting for age, marital status, and educational attainment, women with 5-9 biological children (AOR = 0.27:95%CI; 0.08-0.96) were less likely to be diagnosed with advanced stage (defined as stages III/IV) cancer. In this pilot study, there was no statistical evidence for associations between stage at diagnosis and factors such as age at diagnosis and marital status. Conclusions: This study is a first attempt to understand the descriptive epidemiology of cervical cancer in rural Ugandan settings. Understanding individual patient factors, patients’ behavioural characteristics and healthcare factors associated with advanced stage at diagnosis is essential for targeted effective public health interventions to promote prompt health seeking, diagnosis at early stage and improved survival from cervical cancer.The work was supported by Training Health Researchers into Vocational Excellence (THRiVE) in East Africa, Grant number 087540, funded by Wellcome Trust.This is the final version of the article. It first appeared from the BMJ Group via http://dx.doi.org/10.1136/bmjopen-2015-00769