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. Kiguli Mentors : Prof. R. Martin; Dr. E.S. Okello; Dr. G. Lyratzopoulos
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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