title: Estimates of delays in diagnosis of cervical cancer in Nepal.
abstract: BACKGROUND
  Cervical cancer is the leading cause of cancer related deaths among women in Nepal. The long symptom to diagnosis interval means that women have advanced disease at presentation. The aim of this study was to identify, estimate and describe the extent of different delays in diagnosis of cervical cancer in Nepal.
  
  
  METHODS
  A cross-sectional descriptive study was conducted in two tertiary cancer hospitals of Nepal. Face to face interview and medical records review were carried out among 110 cervical cancer patients. Total diagnostic delay was categorized into component delays: patient delay, health care providers delay, referral delay and diagnostic waiting time.
  
  
  RESULTS
  Total 110 patients recruited in the study represented 40 districts from all three ecological regions of the country. Median total diagnostic delay was 157 days with more than three fourth (77.3%) of the patients having longer total diagnostic delay of >90 days. Out of the total diagnostic delay, median patient delay, median health care provider delay, median referral delay and median diagnostic waiting time were 68.5 days, 40 days, 5 days and 9 days respectively. Majority of the patients had experienced longer delay of each type except referral delay. Fifty seven percent of the patients had experienced longer patient delay of >60 days, 90% had suffered longer health care provider delay of >1 week, 31.8% had longer referral delay of >1 week and 66.2% had waited >1 week at diagnostic center for final diagnosis. Variation in each type of delay was observed among women with different attributes and in context of health care service delivery.
  
  
  CONCLUSIONS
  Longer delays were observed in all the diagnostic pathways except for referral delay and diagnostic waiting time. Among the delays, patient delay is of crucial importance because of its longer span, although health care provider delay is equally important. In the context of limited screening services in Nepal, the efforts should be to reduce the diagnostic delay especially patient and health care provider delay for early detection and reduction of mortality rate of cervical cancer.
authors.affiliation: Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal. deepaknu@gmail.com.
authors.forename: Deepak
authors.initials: D
authors.lastname: Gyenwali
authors.forename: Gita
authors.initials: G
authors.lastname: Khanal
authors.forename: Rajan
authors.initials: R
authors.lastname: Paudel
authors.forename: Archana
authors.initials: A
authors.lastname: Amatya
authors.forename: Jitendra
authors.initials: J
authors.lastname: Pariyar
authors.forename: Sharad Raj
authors.initials: SR
authors.lastname: Onta
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D057210:Delayed Diagnosis; D003695:Delivery of Health Care / Q000592:standards*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009390:Nepal; D010342:Patient Acceptance of Health Care; D012017:Referral and Consultation / Q000592:standards*; D013997:Time Factors; D002583:Uterine Cervical Neoplasms / Q000150:complications / Q000175:diagnosis*; D014592:Uterine Hemorrhage / Q000209:etiology; D019522:Vaginal Discharge / Q000209:etiology