title: Predictors of default from follow-up care in a cervical cancer screening program using direct visual inspection in south-western Nigeria.
abstract: BACKGROUND
  Increasingly evidence is emerging from south East Asia, southern and east Africa on the burden of default to follow up care after a positive cervical cancer screening/diagnosis, which impacts negatively on cervical cancer prevention and control. Unfortunately little or no information exists on the subject in the West Africa sub region. This study was designed to determine the proportion of and predictors and reasons for default from follow up care after positive cervical cancer screen.
  
  
  METHODS
  Women who screen positive at community cervical cancer screening using direct visual inspection were followed up to determine the proportion of default and associated factors. Multivariate logistic regression was used to determine independent predictors of default.
  
  
  RESULTS
  One hundred and eight (16.1%) women who screened positive to direct visual inspection out of 673 were enrolled into the study. Fifty one (47.2%) out of the 108 women that screened positive defaulted from follow-up appointment. Women who were poorly educated (OR: 3.1, CI: 2.0 - 5.2), or lived more than 10 km from the clinic (OR: 2.0, CI: 1.0 - 4.1), or never screened for cervical cancer before (OR: 3.5, CI:3:1-8.4) were more likely to default from follow-up after screening positive for precancerous lesion of cervix . The main reasons for default were cost of transportation (48.6%) and time constraints (25.7%).
  
  
  CONCLUSIONS
  The rate of default was high (47.2%) as a result of unaffordable transportation cost and limited time to keep the scheduled appointment. A change from the present strategy that involves multiple visits to a "see and treat" strategy in which both testing and treatment are performed at a single visit is recommended.
authors.affiliation: Clinical Sciences Division, Nigerian Institute of Medical Research, Lagos, Nigeria. oezechi@yahoo.co.uk.
authors.forename: Oliver Chukwujekwu
authors.initials: OC
authors.lastname: Ezechi
authors.forename: Karen Odberg
authors.initials: KO
authors.lastname: Petterson
authors.forename: Titilola A
authors.initials: TA
authors.lastname: Gbajabiamila
authors.forename: Ifeoma Eugenia
authors.initials: IE
authors.lastname: Idigbe
authors.forename: Olutunmike
authors.initials: O
authors.lastname: Kuyoro
authors.forename: Innocent Achaya Otobo
authors.initials: IA
authors.lastname: Ujah
authors.forename: Per Olof
authors.initials: PO
authors.lastname: Ostergren
mesh_terms: D000293:Adolescent; D000328:Adult; D055088:Early Detection of Cancer / Q000379:methods; D005260:Female; D006801:Humans; D059012:Lost to Follow-Up; D008403:Mass Screening; D008875:Middle Aged; D009549:Nigeria; D012307:Risk Factors; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*