Chapter 1 Research

FACTORS HINDERING EARLY DIAGNOSIS OF CERVICAL CANCER AMONG
WOMEN ATTENDING KERUGOYA COUNTY REFERRAL HOSPITAL
BY;
KIPKEMOI CHERUIYOT
HB101/G/3034/17
A RESEARCH PROJECT SUBMITTED IN PARTIAL FULFILLMENT OF THE
AWARD OF BACHELOR OF SCIENCE IN CLINICAL MEDICINE AND
COMMUNITY HEALTH; KIRINYAGA UNIVERSITY
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CHAPTER 1: INTRODUCTION
1.1 Background information
In 2019, a total of 565 541 new cases of cervical cancer with a confidence level (636435–481 524) were
reported in women worldwide, with an incidence of ASR of 13.35 cases per 100 000 people. The same
statistics show that the lower the SDI index is, the higher age‐standardized incidence rates of cervical
cancer will be so that the highest standardized age incidence can be found in countries with low SDI and
the lowest in countries with high SDI. This rate is equal to 8.91 in high SDI countries and 23.21 in low SDI
countries. According to the World Bank classification, the incidence of ASR has the lowest value (9.21) in
the high‐income countries and the highest value (30.29) in the low‐income countries. Among the
continents, the highest incidence of ASR is in Africa (24.02) and the lowest is in Europe (10.79).
According to the World Health Organization (WHO), the highest standard incidence is in the African
region and the lowest is in the Eastern Mediterranean region, The global incidence rate of cervical cancer,
(2019).
Also, in general and based on GBD regions, the highest incidence of ASR is in Sub‐Saharan African
countries (WB) and then Latin America & Caribbean countries.
Latest cervical cancer data
Cervical cancer (also known as cancer of the cervix uteri) is the 4th most commonly occurring cancer in
women and the 7th most common cancer overall. There were more than 604,000 new cases of cervical cancer
in 2020.
The 10 countries with the highest rates of cervical cancer and the highest number of deaths from cervical
cancer in 2020 are shown in the tables below.
ASR = age-standardised rates. These are a summary measure of the rate of disease that a population would
have if it had a standard age structure. Standardisation is necessary when comparing populations that differ
with respect to age because age has a powerful influence on the risk of dying from cancer.
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Cervical cancer rates
This table shows global cervical cancer incidence in 2020. Eswatini (which changed its name from
Swaziland in 2018) had the highest rate of cervical cancer in 2020, followed by Malawi, World Cancer
Research Fund International, 2020.
Rank Country Number ASR/100,000
World 604,127 13.3

1 Eswatini 341 84.5
2 Malawi 4,145 67.9
3 Zambia 3,161 65.5
4 Tanzania 10,241 62.5
5 Zimbabwe 3,043 61.7
6 Lesotho 541 56.8
7 Uganda 6,959 56.2
8 Comoros 167 56.0
9 Mozambique 5,325 50.2
10 Guinea 2,068 50.1
HPV vaccination was rolled out nationally in October of 2019, initially targeting 10-year-old girls.
Although approximately half of the initial cohort received the first dose, the programme was severely
affected by the closure of schools due to the COVID-19 pandemic. The National Cancer Screening
Guidelines (2018) recommended HPV testing as the screening modality of first choice. However, the
availability of this test was very limited and the cost prohibitive. Therefore, during the 2010–2020 period,
the vast majority of women screened had VIA. Interventions towards rolling out HPV-based cervical
cancer screening included a pilot in 2019/2020, assessing the feasibility of using GeneXpert as a point-of-
care test for HPV, integrating it with TB control programme. This point-of-care test HPV DNA assay has
been validated by WHO and fulfils requirements for primary cervical cancer screening [18]. A second pilot
was feasibility of HPV sample referral from health facilities to the National Oncology Reference
Laboratory (NORL) and relaying of results back to health facilities. Findings from these pilots are meant to
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guide the MoH on the most practical and cost-effective modality of availing HPV testing across the
country. None of the policy documents included provisions on invitation for screening for eligible women.
In all the policy documents, the target age group for cervical cancer screening in Kenya is 25–49 years,
while screening frequency was every 5 years for HIV-negative women and annually for HIV-positive
women, using VIA, “Lessons to guide elimination as a public health problem, (2020).”
The cervical cancer programme implementation in Kenya over the last decade has had some interventions
on each of the WHO health system strengthening blocks. The impact of these investments, however, was
limited by various factors, both within and outside the health system.
The chief officer of health said that cervical cancer had become rampant among women and appealed to
parents with daughters aged 10 years to take them to the nearest health facility for immunization against
human papilloma virus which greatly increases the risk of cervical cancer. He pointed out that the County
Government was in the process of setting up a cancer center that would provide timely and quality care to
cancer patients in the Kirinyaga County.
1.2 Statement of the problem
Cervical cancer is the leading cause of death among cancer cases diagnosed in the country. Delayed
diagnosis leads to delayed treatment and hence early and unnoticeable spread of the diseases to other parts
of the body, what is called metastasis. Other than individual patient factors, there are factors associated
with the organization of the health care system that may be responsible for late diagnosis of cervical cancer.
Level of training of health-care personnel, availability of diagnostic services at the primary health systems
and proximity to these facilities are some of the factors that may impact on diagnosis of cancer. Missed or
wrong diagnosis by primary doctors and failure to advice on referrals may contribute to delays leading to
late diagnosis and treatment of cervical cancer. Early detection greatly improves the chances of successful
treatment and prevents cervical cell changes from becoming cancerous. In Africa the treatment outcomes
for cervical cancer is still less optimal due to poor living standards. In developed countries like the United
States of America, early diagnosis as a result of routine Pap smear screening has led to low mortality rates
due to cervical cancer. In Kenya, the high incident rates and the late stage presentation may be attributed to
lack of screening services at primary health care facilities. This is further compounded by issues of
accessibility, affordability and availability of health care services.
1.3 Objectives of the study

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Broad objectives
The main objective of this study was to determine barriers to early diagnosis of cervical cancer
among patients reporting at the radiotherapy clinic and admitted in gynaecology wards.
Specific objectives
1. To determine the role of socio-economic factors associated with the diagnosis of cervical
cancer among patients at Kenyatta National Hospital.
2. To determine the role of personal and cultural factors in the diagnosis of cervical cancer.
3. To identify factors related to the health care organization that are associated with delayed
diagnosis of cervical cancer.
1.4 Research questions
1. What are the patterns and types of cervical cancer diagnosed at Kerugoya County Referral
Hospital?
2. What is the role of socio-economic factors associated with late diagnosis of
cervical cancer among patients at Kerugoya county referral hospital?
3. What is the role of personal and cultural factors in late diagnosis of cervical
cancer?
1.5 Justifications
It has been established, in a recent study done at Kerugoya County Referral Hospital, that, more
than 90% women in Kenya with cancer of the cervix are diagnosed at advanced stages,
Kirinyaga residents urged to embrace routine cancer screening, “Kenya News Agency –
Information For Development, (2021).”
Therefore, there are limited options available for treatment: mainly initial evaluation,
symptomatic treatment and referral delayed diagnosis of cervical cancer has led to increased
mortality rates related to cervical cancer complication because late diagnosis is associated with
advanced stages of the cancer which are hard to manage and treat.
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This research project will be done to determine those factors that hinder early diagnosis and
hence prevent complications associated with late diagnosis of cervical cancer reducing the
overall mortalities due to cervical cancer.
1.6 Scope
This study will be contacted at Kerugoya County Referral Hospital in February and March, 2024.

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FACTORS HINDERING EARLY DIAGNOSIS OF CERVICAL CANCER AMONG

WOMEN ATTENDING KERUGOYA COUNTY REFERRAL HOSPITAL

A RESEARCH PROJECT SUBMITTED IN PARTIAL FULFILLMENT OF THE

AWARD OF BACHELOR OF SCIENCE IN CLINICAL MEDICINE AND

COMMUNITY HEALTH; KIRINYAGA UNIVERSITY

1.1 Background information

Latest cervical cancer data

Rank Country Number ASR/100,000

World 604,127 13.3

1.2 Statement of the problem

1.3 Objectives of the study

1.4 Research questions

2. What is the role of socio-economic factors associated with late diagnosis of

cervical cancer among patients at Kerugoya county referral hospital?

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