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Table 3 Challenges to health seeking and cervical cancer care in Gulu

From: Mind the gaps: a qualitative study of perceptions of healthcare professionals on challenges and proposed remedies for cervical cancer help-seeking in post conflict northern Uganda

Challenges in cervical cancer care

Respondents by hospital and gender

N

 

Public hospital

Mission hospital

 
 

Male

Female

Male

Female

 

A. Individual and community related challenges

     

Lack of awareness amongst women; Inadequate sensitization and mobilization of communities

R5

R1, R3, R4

R11

R7, R8, R9

8

Late stage disease at presentations and its management challenges

R5, R6

R2, R3, R4, R14

R11

R7, R8, R10, R15

11

Inadequate psychosocial support to and abandonment of patients by relatives

R6

  

R7, R10, R15

4

Fear of exposure (undressing and lying in lithortomy position) and perceived pain from speculum during screening

 

R3

R13

R15

3

Complaints against/Stigma from other patients because of smell from cervical cancer patients

 

R3

  

1

Patients cannot pay for services such as histology and EUA

R6

 

R11

R10, R15

4

Refusal to consent

   

R7, R9, R15

3

Inadequate contact address of patients and hence poor follow up to let results known to them

R5

 

R11

 

3

B. Individual health professional related challenges

     

Inadequate knowledge and skills in cervical screening, cervical cancer diagnosis and care

R5, R6

R1, R2, R3, R14

R10, R11, R12, R13

R7, R8, R15

13

C. Health system related challenges

     

No pathologist and no Pap smear test

R5, R6

R1

 

R15

4

No gynecologists or doctors in gynecology department to supervise screening, do biopsy, do operations

R5, R6

R1, R2, R4

  

5

Delayed histology results and or specimens/results getting lost

R6

R2, R3

 

R10, R15,

5

Inadequate space/ward for cervical cancer patients

 

R3

R12

 

2

Abandonment of histology results

R5

 

R11

 

2

Long distance to and lack of transport to screening points

 

R4, R14

 

R10

3

Congestion at screening, long waiting time to screening, scheduling delay

  

R11

R7

2

Lack of formalin for biopsies

 

R2

  

1

Few nurses and midwives to support screening and health talk to women

 

R3, R14

 

R15

3

Lack of blood for transfusion before and during operations

  

R12

R15

2

Stock out of morphine and inadequate pain control

   

R7, R10

2

Hospital does not provide food to the patients who stay for long and run out of money and support

R6

R3, R4, R14

 

R10

5

Inadequate labeling of clinics and lack of integration of services

R5

   

1

Poor reputation of hospital and inhibiting health seeking there

R5

   

1

Men health workers doing screening

   

R7, R15

2

D. Health policy related challenges

     

Lack of vaccination against HPV

R5

R1, R2

R11,R12, R13

R15

7

Radiotherapy is very far and patient cannot afford transport and cost of care in city

R6

R14

  

2

  1. Note: R1, R2 = Respondents’ order of interview as on Table 2.