Patients’ pathways to cancer care in Tanzania: documenting and addressing social inequalities in reaching a cancer diagnosis

BMC Health Services Research

Twalib Ngoma¹  Phares G. M. Mujinja¹  Richard Ngilangwa²  Fortunata Songora Makene²  Cristina Santos³  Charlotte Cross³  Maureen Mackintosh³  Marc Wuyts⁴ 

[1] Department of Behavioural Sciences, Muhimbili University of Heath and Allied Sciences, United Nations Rd, Dar es Salaam, Tanzania;Economic and Social Research Foundation, P.O Box 31226, 51 Uporoto Street, Ursino Estate, Dar es Salaam, Tanzania;Faculty of Arts and Social Sciences, The Open University, Walton Hall, MK7 6AA, Milton Keynes, UK;International Institute of Social Studies, Erasmus University Rotterdam, Kortenaerkade 12, 2518 AX, The Hague, The Netherlands;

关键词: Cancer;    Patients’ pathways;    Diagnosis;    Access;    Inequality;    Delay;    Costs;    Disadvantage;   

DOI  :  10.1186/s12913-021-07438-5

来源: Springer

【 摘 要 】

BackgroundThis article investigates the extent and sources of late diagnosis of cancer in Tanzania, demonstrating how delayed diagnosis was patterned by inequities rooted in patients’ socio-economic background and by health system responses. It provides evidence to guide equity-focused policies to accelerate cancer diagnosis.MethodsTanzanian cancer patients (62) were interviewed in 2019. Using a structured questionnaire, respondents were encouraged to recount their pathways from first symptoms to diagnosis, treatment, and in some cases check-ups as survivors. Patients described their recalled sequence of events and actions, including dates, experiences and expenditures at each event. Socio-demographic data were also collected, alongside patients’ perspectives on their experience. Analysis employed descriptive statistics and qualitative thematic analysis.ResultsMedian delay, between first symptoms that were later identified as indicating cancer and a cancer diagnosis, was almost 1 year (358 days). Delays were strongly patterned by socio-economic disadvantage: those with low education, low income and non-professional occupations experienced longer delays before diagnosis. Health system experiences contributed to these socially inequitable delays. Many patients had moved around the health system extensively, mainly through self-referral as symptoms worsened. This “churning” required out-of-pocket payments that imposed a severely regressive burden on these largely low-income patients. Causes of delay identified in patients’ narratives included slow recognition of symptoms by facilities, delays in diagnostic testing, delays while raising funds, and recourse to traditional healing often in response to health system barriers. Patients with higher incomes and holding health insurance that facilitated access to the private sector had moved more rapidly to diagnosis at lower out-of-pocket cost.ConclusionsLate diagnosis is a root cause, in Tanzania as in many low- and middle-income countries, of cancer treatment starting at advanced stages, undermining treatment efficacy and survival rates. While Tanzania’s policy of free public sector cancer treatment has made it accessible to patients on low incomes and without insurance, reaching a diagnosis is shown to have been for these respondents slower and more expensive the greater their socio-economic disadvantage. Policy implications are drawn for moving towards greater social justice in access to cancer care.

【 授权许可】

CC BY