title: Social, demographic and healthcare factors associated with stage at diagnosis of cervical cancer: cross-sectional study in a tertiary hospital in Northern Uganda.
abstract: 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 low income and middle income countries.
  
  
  METHODS
  Cross-sectional hospital-based study.
  
  
  METHODS
  Tertiary, not-for-profit private hospital in postconflict region.
  
  
  METHODS
  Consecutive tissue-diagnosed symptomatic patients with cervical attending care. Of 166 patients, 149 were enrolled and analysed.
  
  
  METHODS
  Cervical cancer stage at diagnosis.
  
  
  RESULTS
  Most women were diagnosed at 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 advanced stage at diagnosis and pre-referral diagnosis of cancer by primary healthcare professionals (adjusted OR (AOR)=13.04:95% CI 3.59 to 47.3), and financial difficulties precluding prompt help seeking (AOR=5.5:95% CI 1.58 to 20.64). After adjusting for age, marital status and educational attainment, women with 5-9 biological children (AOR=0.27:95% CI 0.08 to 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.
authors.affiliation: Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
authors.forename: Amos Deogratius
authors.initials: AD
authors.lastname: Mwaka
authors.affiliation: Department of Community Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.
authors.forename: Christopher Orach
authors.initials: CO
authors.lastname: Garimoi
authors.affiliation: Department of Management Science for Health, Uganda.
authors.forename: Edward Maloba
authors.initials: EM
authors.lastname: Were
authors.affiliation: Department of Health Services Research, Institute of Public Health, University of Cambridge, Cambridge, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: Roland
authors.affiliation: Department of Pathology, Kampala Cancer Registry, College of Health Sciences, Makerere University, Kampala, Uganda.
authors.forename: Henry
authors.initials: H
authors.lastname: Wabinga
authors.affiliation: Department of Health Services Research, Institute of Public Health, University of Cambridge, Cambridge, UK.
authors.forename: Georgios
authors.initials: G
authors.lastname: Lyratzopoulos
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D003430:Cross-Sectional Studies; D057210:Delayed Diagnosis; D003906:Developing Countries; D004522:Educational Status; D005260:Female; D006801:Humans; D017533:Marital Status; D008875:Middle Aged; D009367:Neoplasm Staging; D010298:Parity; D010342:Patient Acceptance of Health Care; D010865:Pilot Projects; D011203:Poverty; D012424:Rural Population; D062606:Tertiary Care Centers; D014454:Uganda; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D055815:Young Adult
keywords: Cervical cancer; pathways to diagnosis and treatment; predictors of late stage