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Abstract：
UNASSIGNED: Cervical cancer is the leading cause of cancer mortality among women in Kenya. Two thirds of cervical cancer cases in Kenya are diagnosed in advanced stages. We aimed to identify factors associated with late diagnosis of cervical cancer, to guide policy interventions.
UNASSIGNED: An unmatched case control study (ratio 1:2) was conducted among women aged ≥ 18 years with cervical cancer at Kenyatta National and Moi Teaching and Referral Hospitals. We defined a case as patients with International Federation of Gynecology and Obstetrics (FIGO) stage ≥ 2A and controls as those with stage ≤ 1B. A structured questionnaire was used to document exposure variables. We calculated adjusted odds ratio (aOR) to identify any associations.
UNASSIGNED: We enrolled 192 participants (64 cases, 128 controls). Mean age 39.2 (±9.3) years, 145 (76 %) were married, 77 (40 %) had primary level education, 168 (88 %) had their first pregnancy ≤ 24 years of age, 85 (44 %) were > para 3 and 150 (78 %) used contraceptives. Late diagnosis of cervical cancer was associated with cost of travel to cancer centres > USD 6.1 (aOR 6.43 95% CI [1.30, 31.72]), age > 50 years (aOR 4.71; 95% CI [1.18, 18.80]), anxiety over cost of cancer care (aOR 5.6; 95% CI [1.05, 32.72]) and ultrasound examination during evaluation of symptoms (aOR 4.89; 95% CI [1.07-22.42]). Previous treatment for gynecological infections (aOR 0.10; 95% CI [0.02, 0.47]) was protective against late diagnosis.
UNASSIGNED: Cost of seeking care and the quality of the diagnostic process were important factors in this study. Decentralization of care, innovative health financing solutions and clear diagnostic and referral algorithms for women presenting with gynecological symptoms could reduce late-stage diagnosis in Kenya.
UNASSIGNED: An unmatched case control study (ratio 1:2) was conducted among women aged ≥ 18 years with cervical cancer at Kenyatta National and Moi Teaching and Referral Hospitals. We defined a case as patients with International Federation of Gynecology and Obstetrics (FIGO) stage ≥ 2A and controls as those with stage ≤ 1B. A structured questionnaire was used to document exposure variables. We calculated adjusted odds ratio (aOR) to identify any associations.
UNASSIGNED: We enrolled 192 participants (64 cases, 128 controls). Mean age 39.2 (±9.3) years, 145 (76 %) were married, 77 (40 %) had primary level education, 168 (88 %) had their first pregnancy ≤ 24 years of age, 85 (44 %) were > para 3 and 150 (78 %) used contraceptives. Late diagnosis of cervical cancer was associated with cost of travel to cancer centres > USD 6.1 (aOR 6.43 95% CI [1.30, 31.72]), age > 50 years (aOR 4.71; 95% CI [1.18, 18.80]), anxiety over cost of cancer care (aOR 5.6; 95% CI [1.05, 32.72]) and ultrasound examination during evaluation of symptoms (aOR 4.89; 95% CI [1.07-22.42]). Previous treatment for gynecological infections (aOR 0.10; 95% CI [0.02, 0.47]) was protective against late diagnosis.
UNASSIGNED: Cost of seeking care and the quality of the diagnostic process were important factors in this study. Decentralization of care, innovative health financing solutions and clear diagnostic and referral algorithms for women presenting with gynecological symptoms could reduce late-stage diagnosis in Kenya.
摘要：
宫颈癌是肯尼亚女性癌症死亡的主要原因。肯尼亚三分之二的宫颈癌病例被诊断为晚期。我们旨在确定与宫颈癌晚期诊断相关的因素，指导政策干预。
在Kenyatta国立和Moi教学和转诊医院对年龄≥18岁的宫颈癌女性进行了一项不匹配的病例对照研究（比例为1:2）。我们将一个病例定义为国际妇产科联合会（FIGO）分期≥2A的患者，而对照为分期≤1B的患者。使用结构化问卷记录暴露变量。我们计算了调整后的比值比（aOR）以确定任何关联。
■我们登记了192名参与者(64例，128个控件）。平均年龄39.2(±9.3)岁,145（76%）已婚，77人（40%）接受过初等教育，168人（88%）第一次怀孕≤24岁，85（44％）>第3段和150（78％）使用避孕药具。宫颈癌的晚期诊断与前往癌症中心的旅行费用>6.1美元相关(aOR6.4395%CI[1.30,31.72]),年龄>50岁(aOR4.71；95%CI[1.18,18.80])，对癌症治疗费用的焦虑(aOR5.6;95%CI[1.05,32.72])和症状评估期间的超声检查(aOR4.89;95%CI[1.07-22.42])。先前对妇科感染的治疗（aOR0.10;95％CI[0.02,0.47]）对晚期诊断具有保护性。
■寻求护理的成本和诊断过程的质量是本研究的重要因素。护理权力下放，在肯尼亚,创新的健康融资解决方案以及针对出现妇科症状的女性的明确诊断和转诊算法可以减少晚期诊断.
在Kenyatta国立和Moi教学和转诊医院对年龄≥18岁的宫颈癌女性进行了一项不匹配的病例对照研究（比例为1:2）。我们将一个病例定义为国际妇产科联合会（FIGO）分期≥2A的患者，而对照为分期≤1B的患者。使用结构化问卷记录暴露变量。我们计算了调整后的比值比（aOR）以确定任何关联。
■我们登记了192名参与者(64例，128个控件）。平均年龄39.2(±9.3)岁,145（76%）已婚，77人（40%）接受过初等教育，168人（88%）第一次怀孕≤24岁，85（44％）>第3段和150（78％）使用避孕药具。宫颈癌的晚期诊断与前往癌症中心的旅行费用>6.1美元相关(aOR6.4395%CI[1.30,31.72]),年龄>50岁(aOR4.71；95%CI[1.18,18.80])，对癌症治疗费用的焦虑(aOR5.6;95%CI[1.05,32.72])和症状评估期间的超声检查(aOR4.89;95%CI[1.07-22.42])。先前对妇科感染的治疗（aOR0.10;95％CI[0.02,0.47]）对晚期诊断具有保护性。
■寻求护理的成本和诊断过程的质量是本研究的重要因素。护理权力下放，在肯尼亚,创新的健康融资解决方案以及针对出现妇科症状的女性的明确诊断和转诊算法可以减少晚期诊断.
