Browsing by Author "Wabinga, Henry"

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Awareness of Cervical Cancer Risk Factors and Symptoms: Cross-Sectional Community Survey in Post-Conflict Northern Uganda
(John Wiley & Sons, Inc., 2015-06-11) Mwaka, Amos Deogratius; Orach, G. Christopher; Were, M. Edward; Lyratzopoulos, Georgios; Wabinga, Henry; Roland, Martin
Background Lack of awareness of risk factors and symptoms for cancer may lead to late diagnosis and poor prognosis. Objective We assessed community awareness about cervical cancer risk factors and symptoms and perceptions about prevention and cure of cervical cancer in order to contribute data to inform inter ventions to improve cervical cancer survival. Design Cross-sectional population-based survey. Setting and participants We conducted this study in Gulu, a post-conflict district in Uganda in 2012. The sample included 448 persons aged 18 years and above, selected through a multi-stage stratified cluster sampling process. Data collection methods and analysis We collected data using a pretested structured questionnaire. Logistic regressions were used to determine magnitudes of associations between socio-demographic and outcome variables. Results Most participants (444/448) had heard about cervical cancer. Known risk factors including multiple sexual partners, human papillomavirus infection, and early onset of sexual activity, were recognized by 88%, 82%, and 78% of respondents respectively. 63% of participants believed that prolonged use of family planning pills and injections caused cervical cancer. The majority of participants recognized symptoms of cervical cancer including inter-menstrual bleeding (85%), post-menopausal bleeding (84%), and offensive vaginal discharge (83%). 70% of participants believed that cervical cancer is preventable and 92% believed that it could be cured if diagnosed at an early stage.
Cancer Care in Countries in Transition in Africa: The Case of Uganda
(Springer, Cham, 2016) Mwaka, Amos Deogratius; Wabinga, Henry; Garimoi, Orach Christopher
Uganda is a low-income country experiencing epidemiological transition with a double burden of communicable diseases including malaria, tuberculosis, and HIV as well as a rising incidence of noncommunicable diseases including cancers, hypertension, and heart diseases and diabetes. The country has a high population growth rate of 3.5 %. The population of the older people who are more prone to cancers is increasing exponentially and cancers related to lifestyles and old age are on the increase. This is in addition to the high rates of infection-related cancers including cervical cancer (most common cancer among women in Uganda), Kaposi sarcoma, and hepatocellular carcinoma. These infection-related cancers predominantly affect the young economically productive age groups and hence contribute negatively to economic production and poverty eradication. Majority of cancer patients in Uganda are diagnosed with advanced stage cancers and experience poor survival. There are few specialized cancer care facilities and cancer specialists in Uganda. Hospice Africa Uganda contributes immensely to the care of the terminally ill cancer patients while the Kampala Cancer registry provides high quality data on cancer exposures, incidences, and mortality to guide planning, research, and policy on care for cancer.
Perceptions and Beliefs of Lay People From Northern Uganda Regarding Surgery for Diagnosis and Treatment of Cervical Cancer
(John Wiley & Sons, Inc., 2018-05-02) Mwaka, Amos Deogratius; Okello, Sarikiaeli Elialilia; Wabinga, Henry
Objective To explore perceptions and beliefs of people in a rural community in northern Uganda regarding surgery for the diagnosis and treatment of cervical cancer. The aim of the study was to inform interventions to reduce delay and improve timely diagnosis and prompt appropriate treatments for patients with symptoms of cervical cancer. Methods A semi‐structured study guide informed by Kleinman's explanatory model for illness was used to collect data during 24 focus group discussions involving 175 men and women aged 18 to 59 years in Gulu, northern Uganda. Using thematic analysis, themes and subthemes were identified from the data through an iterative process and consensus among the authors. Results Surgery for diagnosis and management of cervical cancer was perceived as (1) appropriate when performed at early stage of cancer and by senior doctors, but (2) a potential catalyst for the spread of cancer and early death; and (3) a challenge to childbearing and motherhood as well as a source of distress to women and families if surgery involved removal of the uterus with subsequent permanent infertility. Conclusions There are some negative perceptions about surgery for cervical cancer that may deter prompt help‐seeking for symptoms. However, targeted messages for public awareness interventions to promote help‐seeking can be built on the positive perceptions and beliefs that surgery could be curative when undertaken for early‐stage cancer and by skilled doctors.
Social, Demographic and Healthcare Factors Associated With Stage at Diagnosis of Cervical Cancer: Cross-Sectional Study in a Tertiary Hospital in Northern Uganda
(BMJ Publishing Group Ltd, 2015-11-23) Mwaka, Amos Deogratius; Garimoi, Orach Christopher; Were, Maloba Edward; Roland, Martin; Wabinga, Henry; Lyratzopoulos, Georgios
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. Design Cross-sectional hospital-based study. Setting Tertiary, not-for-profit private hospital in postconflict region. Participants Consecutive tissue-diagnosed symptomatic patients with cervical attending care. Of 166 patients, 149 were enrolled and analysed. Primary outcome 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.
Symptom Appraisal, Help-seeking and Perceived Barriers to Healthcare Seeking in Uganda: An Exploratory Study Among Women With Potential Symptoms of Breast and Cervical Cancer
(BMJ Publishing Group Ltd, 2021-01-19) Mwaka, Amos Deogratius; Walter, M. Fiona; Scott, Suzanne; Harries, Jane; Wabinga, Henry; Moodley, Jennifer
Objective We assessed the process of recognising abnormal bodily changes, interpretations and attributions, and help-seeking behaviour among community-based Ugandan women with possible symptoms of breast and cervical cancer, in order to inform health interventions aiming to promote timely detection and diagnosis of cancer. Design Qualitative in-depth interviews. Setting Rural and urban communities in Uganda. Participants Women who participated in the African Women Awareness of cancer cross-sectional survey who disclosed potential breast and cervical cancer symptoms were eligible; recruitment was purposive. Interviews were conducted in women’s homes, lasted between 40 and 90min, were audio-recorded, transcribed verbatim and translated to English. Thematic analysis was used to identify themes and subthemes, underpinned by the conceptual framework of the Model of Pathways to Treatment. Results 23 women were interviewed: 10 had potential symptoms of breast cancer and 13 of cervical cancer. Themes regarding symptom appraisal and help-seeking included the: (1) detection and interpretation of abnormal bodily sensations; (2) lay consultations regarding bodily changes; (3) iterative process of inferring and attributing illnesses to the bodily changes; (4) restricted disclosure of symptoms to lay people due to concerns about privacy and fear of stigmatisation; (5) help-seeking from multiple sources including both traditional and biomedical health practitioners, and (6) multiple perceived barriers to help-seeking including long waiting times, lack of medicines, absenteeism of healthcare professionals, and lack of money for transport and medical bills. Conclusion Women with potential symptoms of breast and cervical cancer undergo complex processes of symptom interpretation, attributing symptoms or inferring illness, and lay consultations before undertaking help-seeking and management. Increasing community understanding of breast and cervical cancer symptoms, and tackling perceived barriers to health-seeking, could lead to prompt and appropriate symptom appraisal and help-seeking, and contribute to improving cancer outcomes.
Symptomatic Presentation With Cervical Cancer in Uganda: A Qualitative Study Assessing the Pathways to Diagnosis in a Low-Income Country
(BioMed Central Ltd, 2015-02-18) Mwaka, Amos Deogratius; Okello, Sarikiaeli Elialilia; Wabinga, Henry; Walter, M Fiona
Background Symptomatic cervical cancer patients in low- and middle-income countries usually present with late stage disease and have poor survival. We explored the views of cervical cancer patients on their symptom appraisal and interpretations, and their help-seeking including lay consultations. Methods We conducted an in-depth interview study in two northern Ugandan hospitals. Theoretical models underpinned the study guide for data collection and analysis. We used thematic analysis techniques, informed by the theoretical concepts in the Model of Pathways to Treatment. Sub-themes and themes were identified through consensus among investigators. Results Eighteen women aged 35–56 years, recently diagnosed with cervical cancer were interviewed. Their first symptoms included abnormal vaginal bleeding, offensive vaginal discharge and lower abdominal pain. Most participants did not perceive themselves to be at risk for cervical cancer and they usually attributed the initial symptoms to normal bodily changes or common illnesses such as sexually transmitted diseases. Lay consultations with husbands, relatives and friends were common and often influenced decisions and timing for seeking care. Prompt help-seeking was frequently triggered by perceived life threatening symptoms such as heavy vaginal bleeding or lower abdominal pain; symptom burden sufficient to interfere with patients’ work routines; and persistence of symptoms in spite of home-based treatments. Participants did not promptly seek care when they perceived symptoms as mild; interpreted symptoms as due to normal bodily changes e.g. menopause; and attributed symptoms to common illnesses they could self-manage. Their cancer diagnosis was often further delayed by long help-seeking processes including repeated consultations. Some healthcare professionals at private clinics and lower level health facilities failed to recognize symptoms of cervical cancer promptly therefore delayed referring women to the tertiary hospitals for diagnosis and treatment. Conclusion Ugandan patients with symptomatic cervical cancer often misattribute their gynaecological symptoms, and experience long appraisal and help-seeking intervals. These findings can inform targeted interventions including community awareness campaigns about cervical cancer symptoms, and promote prompt help-seeking in Uganda and other low- and middle-income countries with high incidence and mortality from cervical cancer.