Our findings indicated that service satisfaction was correlated with receipt of treatment services among cervical cancer patients. This means that most patients who were treated were satisfied with the services they were provided.
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These findings could be due to few treatment centers in Zimbabwe to compare with and also the fact that most patients present late with severe symptoms of bleeding and pain and the treatment they are given which is usually palliative is perceived as satisfactory. Our results revealed that most respondents had reported that to them treatment meant alleviation of their pain and symptoms even if the primary condition was not treatable. All patients who received treatment had gone through many processes to access treatment and by the time they were engaged into treatment their hope was low.
Some studies have shown that satisfaction with cervical cancer services was associated with knowledge of visual inspection with acetic acid VIA screening test, with women who knew about this procedure apriori being less satisfied when they were tested. Distance to the health facilities was also found to be associated with level of satisfaction with women who travelled more than five kilometers reporting higher satisfaction levels [ 32 ].
These findings are consistent with our present work with regards to satisfaction as most patients travelled great distances to get treatment at Parirenyatwa Hospital, of the major treating center in Zimbabwe. Walking as a means of reaching nearest health facilities was negatively associated with perceptions of access to treatment for cervical cancer among healthy women. In a US study transport to health facilities was found to influence access to cervical cancer screening in urban settings [ 33 ].
Results from our qualitative study revealed that the second most frequently reported barrier to treatment was transport and its associated costs as most patients had to travel to treating facilities.
Challenges faced in seeking treatment by patients were slightly significant to perceptions of access to treatment. These findings are supported by our qualitative results which suggested that health system factors were more important to accessing treatment by cervical cancer patients. This study deserves the justice of mentioning its limitations; that it was conducted in Harare and some findings may not be generalizable as cancer services are fairly available in Harare compared to other areas across the country.
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Secondly, this study comprised of cross sectional surveys whose findings may not be used to infer causal relationships. Thirdly, survey data was collected amidst a series of strikes by health workers, therefore selection bias may have been incurred as a particular group of cervical cancer patients may have visited the study sites during the study period. Lastly, the use of qualitative inquiry is inherently associated with bias and therefore the findings from the inquiry may not be generalizable beyond the study setting.
This study had its fair share of strengths, to our knowledge this is the first primary research study to investigate the determinants of access and usage of cervical cancer services in Zimbabwe. The majority of studies cited have used either qualitative or quantitative methods and for policy recommendations mixed methods provide better outcomes [ 34 , 35 ]. A plethora of studies in low-to-middle income countries have focused on primary and secondary prevention of cervical cancer but there is a general paucity of information on tertiary interventions in these contexts. There are numerous prevailing multi-dimensional barriers to accessing cervical cancer treatment and palliative care in Zimbabwe.
Our findings revealed that heath system and societal factors are more important than individual level factors. Strategies to subsidize or remove user fees for the diagnosis, staging and treatment of cancer may go a long way to improve access to treatment in a country where the majority of people are living in poverty. Health education and promotion interventions cannot be underestimated to address the societal factors impeding treatment while reinforcing facilitating factors such as social support.
Overall, multi-sectoral approaches are recommended to address all the multifaceted barriers in order to improve cervical cancer treatment and palliative care access for better outcomes in resource-limited contexts. Nyakabau AM. Priorities for cancer prevention and control in Zimbabwe.
Global Links
Cancer Control. Accessed 17 July Cervical cancer in Zimbabwe: a situation analysis. Pan Afr Med J. Zimbabwe demographic and health survey Harare: Zimbabwe National Statistics Agency; Google Scholar. General Assembly UN. Universal declaration of human rights. Paris: United Nations; Accessed 15 July A review of cervical cancer patients presenting in Harare and Parirenyatwa hospitals in Cent Afr J Med. Knowledge of cervical cancer among Zimbabwean women on anti retroviral therapy Fallala MS, Mash R.
Cervical cancer screening: safety, acceptability, and feasibility of a single-visit approach in Bulawayo, Zimbabwe. Ministry of Health and Child Care. The national cancer prevention and control strategy for Zimbabwe — Harare: MoHCC; Zimbabwe cervical Cancer prevention and control strategy for Zimbabwe — Accessed 12 Mar Ehrlich R, Joubert G.
Epidemiology: a research manual for South Africa. Cape Town: Oxford University Press; Mann CJ. Observational research methods. Research design II: cohort, cross sectional, and case-control studies. Emerg Med J. Creswell JW. Research design: qualitative, quantitative, and mixed methods approaches. Thousand Oaks: Sage; Kish L. A procedure for objective respondent selection within the household. J Am Stat Assoc. Sample size calculations. Nephron Clin Pract.
PSMAS Packages
Design and validation of questionnaires investigating access and utilization of cervical cancer treatment and palliative care. Global J Health Sci. Kumar K. Conducting key informant interviews in developing countries. Report No. Hosmer DW, Lemeshow S. Applied logistic regression. New York: Wiley; Dreyer G. Operative management of cervical cancer.
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Factors involved in the delay of treatment initiation of cervical cancer patients. Huchcroft SA, Snodgrass T. Cancer patients who refuse treatment. Cancer Causes Control. Marital status and survival in locally advanced cervical cancer treated with radiation and brachytherapy. Factors associated with receipt of radiation therapy for rectal cancer. Am J Clin Oncol.
Geographic access to radiation therapy facilities and disparities of early-stage breast cancer treatment. Geospat Health. Health care access dimensions and cervical cancer screening in South Africa: analysis of the world health survey. BMC Public Health. Determinants of patient delay in seeking diagnosis and treatment among Moroccan women with cervical cancer. Obstet Gynecol Int. Lalos A, Eisemann M. Social interaction and support related to mood and locus of control in cervical and endometrial cancer patients and their spouses.
Support Care Cancer. Fylan F. Br J Gen Pract. Knowledge and practices about cervical cancer and Paps smear testing amongst patients at Kenyatta National Hospital, Nairobi, Kenya. Int J Gynecol Cancer. Indian J Med Res. Health systems challenges in cervical cancer prevention program in Malawi. Glob Health Action.
Picking Up the Pieces
Client satisfaction with cervical cancer screening in Malawi. Coughlin SS, King J. Breast and cervical cancer screening among women in metropolitan areas of the United States by county-level commuting time to work and use of public transportation, and Complementary use of qualitative and quantitative cultural assessment methods. Organ Res Methods. Hussein A. The use of triangulation in social sciences research: can qualitative and quantitative methods be combined?
J Comp Soc Work. Fortune Nyasha Nyamande, spokesperson for the Zimbabwe Association of Doctors for Human Rights, said the strike poses an existential threat to the health of pregnant women, and it disrupts access to antenatal, delivery and postnatal care with huge implications on morbidity and mortality rates related to maternal health. Nyamande said maternal health interventions such as early antenatal appointments, prevention of parent-to-child transmission programs, deliveries supervised by qualified health personnel, and post-natal care and monitoring are all rendered unavailable by the continued failure to meet the demands of doctors and nurses.
Skilled care before, during and after childbirth, can save the lives of women and newborns, said Itai Rusike, executive director of the Community Working Group on Health. He said poor quality of care remains an issue for maternal and child health services in the public health institutions during the strike. He worries that the prolonged impasse may result in the reversal and erosion of gains achieved in the elimination of mother-to-child transmission of HIV and syphilis. A traditional birth attendant, Esther Zinyoro, left helps pregnant women who are being turned away from clinics who deliver at her home in what's known as "backyard" maternity wards.
However, the government holds firm on salary adjustments. The World is a public radio program that crosses borders and time zones to bring home the stories that matter.