| Popis: |
Background: Equitable access to women’s health services, including cancer prevention programs, is lacking in many countries. Sénégal ranks 17 th in the world in the age-standardized incidence rate of cervical cancer. The Kédougou region is located in the southeastern corner of Sénégal and has many structural barriers to preventive care, including economic disadvantage, a low literacy rate, and a shortage of healthcare workers. The goal of this study was to investigate the barriers and facilitators of cervical cancer screening uptake in this region. Methods: We conducted a cross-sectional survey of 158 participants, 101 women and 57 men (ages 30 - 59) across nine non-probability-sampled communities located throughout three districts in the Kédougou region of Sénégal from October 2018 through January 2019. We collected demographic information and data on health service utilization, cervical cancer knowledge, and experience of cervical cancer screening. Associations were tested using the Fisher’s Exact test statistic. Results: The majority of our study population speaks one or both of the prevalent local languages, Malinké (62.7%) and Pulaar (59.5%), with fewer Wolof (26.6%) and French (31%) speakers. Among the women in our sample, 84.2% had never been screened for cervical cancer. Among men, 78.9% stated that they have the final say at home regarding healthcare decisions. In contrast, only 16.0% of women made their own healthcare decisions. For those who speak Malinké, 48.0% received services in another language. We found significant gender differences between women and men in the knowledge that a woman is at risk if she has multiple sexual partners (p = 0.010) and that a woman is at increased risk if her partner has multiple sexual partners (p < 0.001). Conclusions: This study demonstrates the critical need to overcome both clinical and informational barriers, as well as structural barriers, to ensure the implementation and sustainment of an equitable health service. In this highly underdeveloped region where workforce challenges are extraordinary, innovative solutions are needed to address these underlying social determinants of health while simultaneously improving quality of care at the point of service. Trial registration: This study is registered on clinicaltrials.gov with the Clinical Trials Study Identifier: NCT03540069 |
