Predictors of Compliance with Further Management of Precancerous Cervical Lesions Among Visually Inspected Positive Women in Apac District.

Abstract

Background: Cervical cancer is the most common cancer and cause of death among women worldwide. The disease has a higher incidence in low income countries like Uganda. One way of reducing morbidity and mortality due to cervical cancer is by early detection. Early detection of precancerous cervical cancer lesion is screening using visual inspection using acetic acid (VIA). If the precancerous lesion is detected and treated early using the cryotherapy machine it prevents the occurrence of cervical cancer. In Apac district where this screening is being conducted have no cryotherapy machine and therefore if a woman is found positive with VIA, they are referred to lira regional referral hospital where the cryotherapy machine is located for further management. However it is unclear if these women who are referred do comply with the referral and factors that influence compliance is unknown. This study therefore estimated the number of those that complied and identified factors affecting their compliance. Methodology: This cross sectional study design used pre-coded semi structured questionnaires and data extraction form to collect data. The data were analyzed using STATA 10 using logistic regressions and odds ratio as a measure of association. Results: Overall, 52.3% of the women with positive VIA results complied with the referral. Factors that influenced compliance were believed that traditional medicine did not cure cervical cancer. Adjusted Odds ratio (AOR): 2.5, 95% confidence Interval (CI), 1.6 – 23.1) with p value =0.007, accessing treatment at the first time of visit AOR: 7.2, 95% CI: 2.2 – 23.5 with p=0.001 and community relating VIA screening results to sexually transmitted infections AOR: 4.0, 95%CI: 1.0 – 15.6, p=0.046.

Conclusion: Number of women who complied with the referral for further management is still low in Apac district and compliance to further management of precancerous cervical lesions is influenced by accessing treatment at the first visit, claim that traditional medicine cures cervical and community relating VIA results to sexually transmitted infections. Recommendations: Apac district officials need to conduct health educations emphasizing the cause and benefit of further management of precancerous cervical cancer lesions to prevent occurrence of cervical cancer. More health workers also need to be trained in cervical cancer related services and also more cryotherapy machines needs to be place in hospitals and the necessary supplies provided to ensures its smooth running.