2 research outputs found
Health system constraints affecting treatment and care among women with cervical cancer in Harare, Zimbabwe
BACKGROUND : Cervical cancer is a major cause of morbidity and mortality among women yet access to treatment
and care remains a huge challenge in Zimbabwe. The objective of this study was to investigate health system
constraints affecting engagement into treatment and care by women with cervical cancer in Harare, Zimbabwe.
METHODS : A sequential explanatory mixed methods design was used for this study. Phase 1 comprised of two
surveys namely: patient and health worker surveys with sample sizes of 134 and 78 participants respectively.
Validated structured questionnaires programmed in Android tablet with SurveytoGo software were used for data
collection during the surveys. Univariate analyses were conducted using STATA® version 14 to generate descriptive
statistics. In phase 2, 16 in-depth interviews, 20 key informant interviews and 6 focus groups were conducted to
explain survey results. Participants were purposively selected and sample sizes were informed by saturation
principle. Participants in phase 1 and 2 were different. English transcripts were manually coded line by line in
Dedoose software using the thematic codes that had been established from the survey data. The final codes were
used to support and explain the survey data at the interpretation stages.
RESULTS : Health system constraints identified in surveys were: limited or lack of training for health workers,
weakness of surveillance system for cervical cancer, limited access to treatment and care, inadequate health
workers, reliance of patients on out-of-pocket funding for treatment services, lack of back-up for major equipment.
Qualitative inquiry revealed the following barriers to treatment and care: high costs of treatment and care, lack of
knowledge about cervical cancer and bad attitudes of health workers, few screening and treating centres located
mostly in urban areas, lack of clear referral system resulting in bureaucratic processes, and limited screening and
treating capacities in health facilities due to lack of resources.
CONCLUSION: The results of this study show that health system and its organization present barriers to access of
cervical cancer treatment and care among women. Strong political will, mobilization of resources both domestically
and from partners in addition to sound policies are imperative to address key health system challenges.Additional file 1. Validated structured questionnaire for healthy women
and cervical cancer patients [English & Shona].Additional file 2. Validated structured questionnaire for health workers
[English].Additional file 3. In-depth interview guide [English and Shona].The Letten Foundation, Norwayhttps://bmchealthservres.biomedcentral.comam2020Obstetrics and GynaecologySchool of Health Systems and Public Health (SHSPH
Limited knowledge and access to palliative care among women with cervical cancer: an opportunity for integrating oncology and palliative care in Zimbabwe
BACKGROUND : Cervical cancer is mostly diagnosed at advanced stages among the majority of women in low-income
settings, with palliative care being the only feasible form of care. This study was aimed at investigating palliative care
knowledge and access among women with cervical cancer in Harare, Zimbabwe.
METHODS : Sequential mixed methods design was used, consisting of two surveys and a qualitative inquiry. A census of
134 women diagnosed with cervical cancer who visited two cancer treating health facilities and one palliative care
provider in Harare between January and April, 2018 were enrolled in the study. Seventy-eight health workers were also
enrolled in a census in the respective facilities for a survey. Validated structured questionnaires in electronic format
were used for both surveys. Descriptive statistics were generated from the surveys after conducting univariate analysis
using STATA. Qualitative study used interview/discussion guides for data collection. Thematic analysis was conducted
for qualitative data.
RESULTS : Mean ages of patients and health workers in the surveys were 52 years (SD = 12) and 37 years
(SD = 10,respectively. Thirty-two percent of women with cervical cancer reported knowledge of where to seek
palliative care. Sixty-eight percent of women with cervical cancer had received treatment, yet only 13%
reported receiving palliative care. Few women with cervical cancer associated treatment with pain (13%) and
side effects (32%). More women associated cervical cancer with bad smells (81%) and death (84%). Only one
of the health workers reported referring patients for palliative care. Seventy-six percent of health workers
reported that the majority of patients with cervical cancer sourced their own analgesics from private pharmacies.
Qualitative findings revealed a limited or lack of cervical cancer knowledge among nurses especially in primary health
care, the existence of stigma among women with cervical cancer and limited implementation of palliative policy.
CONCLUSIONS : This study revealed limited knowledge and access to palliative care in a low-income setting due to multifaceted
barriers. These challenges are not unique to the developing world and they present an opportunity for lowincome
countries to start considering and strategizing the integration of oncology and palliative care models in line
with international recommendations.The Letten Foundation, Norwayhttps://bmcpalliatcare.biomedcentral.comam2020School of Health Systems and Public Health (SHSPH