Cervical cancer knowledge, attitudes, beliefs and practices of women aged at least 25 years in Harare, Zimbabwe

Background Cervical cancer is the most common cancer and a major cause of morbidity and mortality among women in Zimbabwe yet it is preventable, early detectable and highly curable. The objective of this study was to investigate knowledge, attitudes, beliefs and practices towards cervical cancer, its prevention and treatment in Harare, Zimbabwe. Methods Sequential explanatory mixed methods approach consisting of analytical cross sectional survey and a qualitative inquiry was used. Study population consisted of women with cervical cancer, health workers and other stakeholders who are involved in cancer control programmes. Patient survey data were collected using validated structured questionnaire in Surveytogo software in an android tablet. Qualitative study used key informant interviews to understand survey findings better. Data analyses for the survey involved univariate and multivariate analyses using STATA version 14. For qualitative study, themes in transcripts were coded and analyzed using Dedoose software to generate evidence for the study. Results Participants reported different levels of knowledge of causes (23%), risk factors (71%), prevention (72%), screening (73%) and treatment (80%) of cervical cancer. Knowledge of causes of cervical cancer were negatively associated with: being aged 45 or more years (OR = 0.02; p = 0.004), having no household income (OR = 0.02;p = 0.007), household income <US$600 per month (OR = 0.02; p = 0.015), middle class wealth (OR = 0.01;p = 0.032), watching TV daily (OR = 0.01;p = 0.007) and 1–6 times per week (OR = 0.02; p = 0.045). Knowledge of causes of cervical cancer were also positively associated with listening to radio daily (OR = 394, CI: 11.02–1406) (p = 0.001) and 1–6 times a week (OR = 100, CI: 2.95–3364) (p = 0.010). Knowledge of prevention was only positively associated with listening to the radio daily (OR = 77, CI: 1.89–3114) (p = 0.022) and 1–6 times a week (OR = 174, CI: 2.42–1255) (p = 0.018). Major drivers of lack of knowledge for cervical cancer were: limited awareness programmes, lack of knowledge among health workers, donor prioritization of infectious diseases, infancy of cervical cancer interventions, negative attitudes towards cervical cancer and misconceptions. Conclusions This study revealed that knowledge of causes and prevention of cervical cancer was associated with frequent radio listenership. Strengthening of health education through the packaging of messages targeting the wider society using different delivery channels is thus recommended

Sociodemographic inequities in cervical cancer screening, treatment and care amongst women aged at least 25 years: evidence from surveys in Harare, Zimbabwe

Background Cervical cancer is the most commonly diagnosed cancer among women in Zimbabwe; however; access to screening and treatment services remain challenged. The objective of this study was to investigate socio-demographic inequities in cervical cancer screening and utilization of treatment among women in Harare, Zimbabwe. Methods Two cross sectional surveys were conducted in Harare with a total sample of 277 women aged at least 25 years. In the community survey, stratified random sampling was conducted to select 143 healthy women in Glen View, Cranborne, Highlands and Hopely communities of Harare to present high, medium, low density suburbs and rural areas respectively. In the patient survey, 134 histologically confirmed cervical cancer patients were also randomly selected at Harare hospital, Parirenyatwa Hospital and Island Hospice during their routine visits or while in hospital admission. All consenting participants were interviewed using a validated structured questionnaire programmed in Surveytogo software in an android tablet. Data was analyzed using STATA version 14 to yield descriptive statistics, bivariate and multivariate logistic regression outcomes for the study. Results Women who reported ever screening for cervical cancer were only 29%. Cervical cancer screening was less likely in women affiliated to major religions (p < 0.05) and those who never visited health facilities or doctors or visited once in previous 6 months (p < 0.05). Ninety-two (69%) of selected patients were on treatment. Women with cervical cancer affiliated to protestant churches were 68 times [95% CI: 1.22 to 381] more likely to utilize treatment and care services compared to those in other religions (p = 0.040). Province of residence, education, occupation, marital status, income (personal and household), wealth, medical aid status, having a regular doctor, frequency of visiting health facilities, sources of cervical cancer information and knowledge of treatability of cervical cancer were not associated with cervical cancer screening and treatment respectively. Conclusion This study revealed few variations in the participation of women in cervical cancer screening and treatment explained only by religious affiliations and usage of health facilities. Strengthening of health education in communities including churches and universal healthcare coverage are recommended strategies to improve uptake of screening and treatment of cervical cancer

Determinants of access and utilization of cervical cancer treatment and palliative care services in Harare, Zimbabwe

Background: Cervical cancer treatment and care services have remained largely centralized in Zimbabwe thereby entrenching inequities to access amongst patients. The objective of this study was to investigate the determinants of access to treatment and care among women with cervical cancer in Harare, Zimbabwe. Methods: A sequential explanatory mixed methods design was used. In phase 1, three surveys (namely community, patient and health worker) were conducted with sample sizes of 143, 134 and 78 participants respectively. Validated structured questionnaires programmed in Android tablet with SurveytoGo software were used for data collection during the surveys. Univariate, bivariate and multivariate logistic regression analyzes were conducted using STATA® version 14 to generate descriptive statistics and identify determinants of access to cervical cancer treatment and care. In phase 2, 16 in-depth interviews, 20 key informant interviews and 6 focus groups were conducted to explain quantitative data. Participants were purposively selected and saturation principle was used to guide sample sizes. Manually generated thematic codes were processed in Dedoose software to produce final outputs for qualitative study. Results: Knowledge of causes (p = 0.046), perceptions of adequacy of specialists (p < 0.001), locus of control (p =0.009), service satisfaction (p = 0.022) and walking as a means of reaching nearest health facilities (p < 0.001) were associated with treatment or perceptions of access by healthy women. Perceptions of access to treatment amongst health workers were associated with their basic training institution (p = 0.046), health service quality perceptions (p = 0.035) and electricity supply status in their respective health facilities (p = 0.036).Qualitative findings revealed health system, societal and individual factors as barriers to accessing treatment and palliative care. Conclusions: There are numerous prevailing multi-dimensional barriers to accessing cervical cancer treatment and palliative care in a low –income setting. The findings of this study revealed that heath system and societal factors were more important than individual level factors. 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. Keywords: Cervical cancer, Access, Determinants, Treatment, Palliative care, Inequity, Health system, Sequential mixed methods, Zimbabw

Chronic cough in primary health care attendees, Harare, Zimbabwe: diagnosis and impact of HIV infection.

BACKGROUND: Cough lasting for > or = 3 weeks (i.e., chronic cough) indicates that a patient has suspected tuberculosis (TB). At the primary health care level, the spectrum of disease that causes chronic cough has not been previously investigated in a setting with a high prevalence of human immunodeficiency virus (HIV) infection. METHODS: A total of 544 adults with chronic cough were recruited systematically from 2 primary health care clinics, and they were evaluated using preset first- and second-line investigations and diagnostic case definitions. RESULTS: The overall prevalence of HIV infection among the study cohort was 83%. TB was the most common diagnosis, with 207 HIV-positive patients (46%) and 27 HIV-negative patients (30%) having confirmed or probable TB. Of these, 145 HIV-positive patients with TB (70%) and 20 HIV-negative patients with TB (74%) had smear-positive cases of TB. Only 17 HIV-positive and 2 HIV-negative patients had smear-negative but culture-positive cases of TB. Lower respiratory tract infections (n = 178; HIV prevalence, 79%) and pneumonia (n = 87; HIV prevalence, 89%) were the next most common diagnoses. Asthma (n = 26; HIV prevalence, 46%), posttuberculous disease and other fibrotic lung disease (n = 34; HIV prevalence, 88%), and cardiac disease (n = 15; HIV prevalence, 93%) were more common than were Pneumocystis jiroveci pneumonia and cryptococcosis (n = 8 and n = 5, respectively; HIV prevalence, 100%), and we found no cases of nocardiosis or histoplasmosis. CONCLUSIONS: TB was diagnosed for 43% of patients who presented with chronic cough to primary health care clinics in Harare, with 71% having smear-positive disease. The findings of TB culture added relatively little to the findings of fluorescent microscopy of concentrated sputum specimens. The prevalence of HIV infection was high across a range of diagnoses, suggesting that an HIV test should be recommended in the initial investigation of chronic cough