Access to Breast Cancer Treatment Services in Mombasa County, Kenya: A Quality of Care Analysis of Patient and Survivor Experiences

Sultane Sherman^{1, 2} and Vincent Okungu^1,

¹Institute of Healthcare Management, Strathmore University, Nairobi, Kenya

²Aga Khan University Hospital, Mombasa, Kenya

Cite this paper:
Sultane Sherman and Vincent Okungu. Access to Breast Cancer Treatment Services in Mombasa County, Kenya: A Quality of Care Analysis of Patient and Survivor Experiences. American Journal of Public Health Research. 2018; 6(4):189-194. doi: 10.12691/ajphr-6-4-3

Abstract

The increasing burden of cancer in Kenya has serious implications particularly for women. Understanding how women access breast-cancer treatment services is essential for mitigating its effects. The aim of this study was to examine access to breast cancer treatment services and implications on quality of care in Mombasa County, Kenya. Focus group discussions (N= 3), in-depth interviews (N=7) and a questionnaire were used in data collection. Qualitative data were analyzed using preset themes of access. Other emergent themes were identified and analyzed. Quantitative data were analyzed in SPSS V.23 and tabulated as descriptive. Lack of equipment, distance to facilities, unavailability of specialized personnel, high cost of care and cultural stigma, were the main barriers of access to cancer services. These barriers impacted on quality of care in terms of timeliness, equity, effectiveness, patient-centeredness, safety and efficiency. Poor quality of care was exhibited in reports of wrong and late diagnosis, poor outcomes in surgery, severe burns, broken down equipment, among others. There were also social consequences of being diagnosed with breast cancer including loss of business and termination from employment. Concerted efforts including investments in health workers, equipment and awareness creation are required to support access to quality breast cancer care.

Keywords:
Kenya non-communicable diseases breast cancer access quality of care

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References:

[1]	Novartis Access, Novartis launches affordable treatment options for chronic diseases, in Sunday Nation. 2015, Nation Media Group: Nairobi.
[2]	Odeyemi, J., Cancer causes more deaths than HIV/AIDS, tuberculosis, malaria combined- Expert, in Daily Trust. 2016, DailyTrust: Lagos.
[3]	Mathers, C.D. and D. Loncar, Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med, 2006. 3(11): p. e442.
[4]	The Economist, Cancer in the developing world: Worse than AIDS, in The Economist. 2014, The Economist: United Kingdom.
[5]	Mojtehedzadeh, S., Killer cancer still neglected in Kenyan health care system, in Daily Nation. 2013, Nation Media Group: Nairobi.
[6]	Kairu, P., The Lord or the doctor, whoever comes first: Probing the state of Kenya’s cancer care, in Daily Nation. 2015, Nation Media Group: Nairobi.
[7]	Nugent, R., Chronic diseases in developing countries: health and economic burdens. Ann N Y Acad Sci, 2008. 1136: p. 70-9.
[8]	Korir, A., et al., Incidence of cancer in Nairobi, Kenya (2004-2008). Int J Cancer, 2015. 137(9): p. 2053-9.
[9]	Ministry of Health, Kenya STEPwise survey for non-communicable diseases risk factors 2015 report. 2015, Ministry of Health, Department of Non-Communicable Diseases: Nairobi.
[10]	Lima, M., F. Kerr-Côrrea, and J. Rehm, Alcohol consumption pattern and Coronary Heart Disease risk in Metropolitan São Paulo: analyses of GENACIS Project. Revista Brasileira de Epidemiologia, 2013. 16(1).
[11]	Tawa, N., J. Frantz, and F. Waggie, Risk factors to chronic non-communicable disease in Mombasa, Kenya: Epidemiological study using WHO step wise approach. African journal of health science, 2011. 19: p. 24-29.
[12]	Pan American Health Organization, Alcohol, gender, culture and harms in the Americas: PAHO Multicentric Study final report. 2007, Pan American Health Organization: Washington, DC.
[13]	Mwai, D. and M. Muriithi, Non-communicable diseases risk factors and their contribution to NCD incidences in Kenya. European Scientific Journal 2015. 11(30): p. 1857-7881.
[14]	Sandelowski, M., Sample size in qualitative research. Res Nurs Health, 1995. 18(2): p. 179-83.
[15]	Krejcie, R.V. and D.W. Morgan, Determining sample size for research activities. Educational and Psychological Measurement, 1970. 30: p. 607-610.
[16]	Joseph, N., E. Hinchcliff, and A. Goodman, Cervical Cancer Screening: The Challenges of Tracking and Follow-up. Journal of Genital System & Disorders, 2015. 4.4.
[17]	Lindesay, J., et al., Knowledge, uptake and availability of health and social services among Asian Gujarati and white elderly persons. Ethn Health, 1997. 2(1-2): p. 59-69.
[18]	Aikins, A., et al., Tackling Africa’s chronic disease burden: from the local to the global. Available: https://www.ncbi.nlm.nih.gov/pubmed/20403167, 2010.
[19]	Pearson, L. and R. Shoo, Availability and use of emergency obstetric services: Kenya, Rwanda, Southern Sudan, and Uganda. Int J Gynaecol Obstet, 2005. 88(2): p. 208-15.
[20]	Vardy, J. and I.F. Tannock, Quality of cancer care. Ann Oncol, 2004. 15(7): p. 1001-6.
[21]	Sankaranarayanan, R., et al., Cancer survival in Africa, Asia, and Central America: a population-based study. Lancet Oncol, 2010. 11(2): p. 165-73.
[22]	McIntyre, D., et al., What are the economic consequences for households of illness and of paying for health care in low- and middle-income country contexts? Soc Sci Med, 2006. 62(4): p. 858-65.
[23]	Russell, S., The economic burden of illness for households in developing countries: a review of studies focusing on malaria, tuberculosis, and human immunodeficiency virus/acquired immunodeficiency syndrome. Am J Trop Med Hyg, 2004. 71(2 Suppl): p. 147-55.
[24]	Battaglia, T.A., et al., Improving follow-up to abnormal breast cancer screening in an urban population. A patient navigation intervention. Cancer, 2007. 109(2 Suppl): p. 359-67.
[25]	Gondos, A., et al., Cancer survival in Kampala, Uganda. Br J Cancer, 2005. 92(9): p. 1808-12.
[26]	Mwaniki, M.K., et al., An increase in the burden of neonatal admissions to a rural district hospital in Kenya over 19 years. BMC Public Health, 2010. 10: p. 591.
[27]	Chuma, J., V. Okungu, and C. Molyneux, Barriers to prompt and effective malaria treatment among the poorest population in Kenya. Malar J, 2010. 9: p. 144.
[28]	Chuma, J., et al., Towards achieving Abuja targets: identifying and addressing barriers to access and use of insecticides treated nets among the poorest populations in Kenya. BMC Public Health, 2010. 10: p. 137.
[29]	Mwaka, A.D., et al., Understanding cervical cancer: an exploration of lay perceptions, beliefs and knowledge about cervical cancer among the Acholi in northern Uganda. BMC Womens Health, 2014. 14: p. 84.
[30]	Burgess, C., et al., Depression and anxiety in women with early breast cancer: five year observational cohort study. BMJ, 2005. 330(7493): p. 702.
[31]	Chapple, A., S. Ziebland, and A. McPherson, Stigma, shame, and blame experienced by patients with lung cancer: qualitative study. BMJ, 2004. 328(7454): p. 1470.