服务可及性是津巴布韦Gwanda地区宫颈癌筛查的决定因素

Fennie M., Timothy L.L., Yevonnie C.
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引用次数: 0

摘要

津巴布韦是世界上宫颈癌发病率最高的国家之一。该国的筛查覆盖率较低,尽管有包括筛查在内的成本效益高、循证的疾病预防干预措施。因此,这项研究评估了服务可及性是津巴布韦瓜达区筛查的一个决定因素。首先采用解释性顺序混合方法设计,通过多阶段随机抽样对609名符合筛查条件的女性进行定量调查。随后,从定量阶段有意挑选的36名妇女参加了重点小组讨论,25名卫生保健工作者作为主要信息提供者。约74.4%的农村参与者从未接受过筛查,而城市参与者的这一比例为62.1%。定性调查结果显示,该地区有两个筛查点,均位于城市地区。农村妇女通过外展诊所获得服务,这与没有提供治疗不一致。此外,治疗设施集中在省级医院,收费。与差旅费用和治疗费用相关的财务限制成为阻碍参与筛查的关键因素。更好地获得服务可以大大提高筛查率,以满足该地区的高需求。将筛查分散到初级卫生机构可以确保随时获得服务并加强筛查。除此之外,还需要增加和维持对难以到达地区的外展服务。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Service Accessibility as a Determinant of Cervical Cancer Screening in Gwanda District, Zimbabwe
Zimbabwe has one of the highest prevalence of cervical cancers in the world. The country has a low screening coverage despite the availability of cost-effective and evidence-based interventions for the prevention of the disease that include screening. This study therefore assessed service accessibility as a determinant of screening in Gwanda District, Zimbabwe. An explanatory sequential mixed-method design was employed firstly using a quantitative survey of 609 screening-eligible women selected through multi-stage random sampling. Subsequently, 36 women purposely selected from the quantitative phase were engaged in focus group discussions, and 25 health-care workers as key informants. About 74.4% of rural participants had never been screened compared to 62.1% of urban participants. Qualitative findings revealed that the district has two screening sites, both in urban locations. Rural based women access the service through outreach clinics which are inconsistent with no provision for treatment. Furthermore, treatment facilities are centralised to the provincial hospital at a fee. Financial constraints associated with travel expenses and treatment costs emerged as the key factor that hinders participation in screening. Improved access to services could greatly increase screening rates to match the high demand in the district. Decentralising screening to primary health facilities could ensure ready access of the service and enhance screening. Supplemental to that, outreach services to hard to reach areas need to be increased and sustained.
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