Session 3: Amos Deogratius Mwaka

Understanding cultural and other barriers to early diagnosis and treatment of cervical cancer in

Northern Uganda

Mwaka Amos Deogratius (MBChB, M.MED – Mak)THRIVE PhD Fellow

Supervisors: Prof. H. Wabinga; Dr. E. Rutebemberwa, Dr. J. KiguliMentors: Prof. R. Martin; Dr. E.S. Okello; Dr. G. Lyratzopoulos

Motivation for the research

Advances in medical science are very

important, but are of no use if they can’t

get put into practice.

Many of Africa’s health problems are not

because we don’t have knowledge, but

because we can’t implement it.

The burden of cancer increasing worldwide –

particularly in low and middle income countries (LMIC) • 2008: 8 m cancer deaths; ~ 63% of them in LMIC

(Ferlay , 2010)

• 2030: 70% of new cancer diagnoses in LMIC (Beaulieu 2009; Boyle, 2008).

• In LMIC, 80% of cancers are detected too late for effective treatment (WHO, 2005).

• In sub-Saharan countries, cancer kills more people p.a. than AIDS, TB, & malaria combined (Seffrin, 2008).

Source: IARC

Eastern Africa

Western Europe

Globally:

~0.5 million new cases ~0.25 m deaths

from cervical cancer

Mostly (87%) occurring in middle and low income

countries

Source: IARC

The inverse care law for cancer cervix• Along with many other colleagues, the aim of

my project is to help us move from the position we are now, into the position encountered in western Europe and North America:

• Turning cervical cancer from a major cause of premature death in African women into a rare, (and in the future extinct) cancer. 

WELLCOME - THRIVE – Cambridge – Makerere

ObjectivesTo explore:• patients’ knowledge and beliefs about cervical cancer

causes, symptoms and management.• community knowledge and beliefs about cervical

cancer causes, symptoms and management.• determinants and barriers cervical cancer care from

patients’ and health providers perspectives.

Study population: Lacor and Gulu (Northern Uganda)

Methods

• Design: cross-sectional, descriptive and analytical; Qualitative and quantitative approaches

• Participants: Women with cervical cancer, health providers in Gulu and Lacor hospitals, and people in Gulu district

• Study period: Feb 2012 – April 2014

Measurements

• Beliefs / prior knowledge about cervical cancer, symptom awareness, health seeking-behaviour

• Previous experiences of conflict, socioeconomic factors, education level

• Services / places were care sought, and reasons for such choices

• Stage of disease at Lacor / Gulu hospitals

Analysis• Qualitative data: Coding, categorizations and

themes identification.

• Grounded theory constant comparison (GTCC) – mid-range theories on cancer causation and management.

• Content analysis and thematic analysis.

• Statistical analysis - quantitative / survey data

Gender Considerations and Limitations• Cervical cancer – Directly affects women but its

within a family. • Balance of power, economics and cultural beliefs of

the men and women: Relevant factors

• Gender and age disparities between cervical cancer patients (most maybe older than investigator); female research assistants will be used.

• Model (explanatory) presupposes linearity.

Acknowledgements

• Supervisors and Mentors (Makerere, Cambridge)

• THRIVE/WELLCOME TRUST

• Colleagues at Departments of Medicine and Pathology and

• Fellow Makerere PhD students