Table 3.
Challenges to health seeking and cervical cancer care in Gulu
|
Challenges in cervical cancer care |
Respondents by hospital and gender |
N |
|||
|---|---|---|---|---|---|
| |
Public hospital |
Mission hospital |
|
||
| Male | Female | Male | Female | ||
|
A. Individual and community related challenges |
|
|
|
|
|
| Lack of awareness amongst women; Inadequate sensitization and mobilization of communities |
R5 |
R1, R3, R4 |
R11 |
R7, R8, R9 |
8 |
| Late stage disease at presentations and its management challenges |
R5, R6 |
R2, R3, R4, R14 |
R11 |
R7, R8, R10, R15 |
11 |
| Inadequate psychosocial support to and abandonment of patients by relatives |
R6 |
|
|
R7, R10, R15 |
4 |
| Fear of exposure (undressing and lying in lithortomy position) and perceived pain from speculum during screening |
|
R3 |
R13 |
R15 |
3 |
| Complaints against/Stigma from other patients because of smell from cervical cancer patients |
|
R3 |
|
|
1 |
| Patients cannot pay for services such as histology and EUA |
R6 |
|
R11 |
R10, R15 |
4 |
| Refusal to consent |
|
|
|
R7, R9, R15 |
3 |
| Inadequate contact address of patients and hence poor follow up to let results known to them |
R5 |
|
R11 |
|
3 |
|
B. Individual health professional related challenges |
|
|
|
|
|
| Inadequate knowledge and skills in cervical screening, cervical cancer diagnosis and care |
R5, R6 |
R1, R2, R3, R14 |
R10, R11, R12, R13 |
R7, R8, R15 |
13 |
|
C. Health system related challenges |
|
|
|
|
|
| No pathologist and no Pap smear test |
R5, R6 |
R1 |
|
R15 |
4 |
| No gynecologists or doctors in gynecology department to supervise screening, do biopsy, do operations |
R5, R6 |
R1, R2, R4 |
|
|
5 |
| Delayed histology results and or specimens/results getting lost |
R6 |
R2, R3 |
|
R10, R15, |
5 |
| Inadequate space/ward for cervical cancer patients |
|
R3 |
R12 |
|
2 |
| Abandonment of histology results |
R5 |
|
R11 |
|
2 |
| Long distance to and lack of transport to screening points |
|
R4, R14 |
|
R10 |
3 |
| Congestion at screening, long waiting time to screening, scheduling delay |
|
|
R11 |
R7 |
2 |
| Lack of formalin for biopsies |
|
R2 |
|
|
1 |
| Few nurses and midwives to support screening and health talk to women |
|
R3, R14 |
|
R15 |
3 |
| Lack of blood for transfusion before and during operations |
|
|
R12 |
R15 |
2 |
| Stock out of morphine and inadequate pain control |
|
|
|
R7, R10 |
2 |
| Hospital does not provide food to the patients who stay for long and run out of money and support |
R6 |
R3, R4, R14 |
|
R10 |
5 |
| Inadequate labeling of clinics and lack of integration of services |
R5 |
|
|
|
1 |
| Poor reputation of hospital and inhibiting health seeking there |
R5 |
|
|
|
1 |
| Men health workers doing screening |
|
|
|
R7, R15 |
2 |
|
D. Health policy related challenges |
|
|
|
|
|
| Lack of vaccination against HPV |
R5 |
R1, R2 |
R11,R12, R13 |
R15 |
7 |
| Radiotherapy is very far and patient cannot afford transport and cost of care in city | R6 | R14 | 2 | ||
Note: R1, R2 = Respondents’ order of interview as on Table 2.