{"paper_id":"13606c45-a3d9-4732-bb04-86be1a40a91c","body_text":"Treatment compliance among adult cervical cancer patients receiving care at Uganda Cancer Institute, Uganda: a retrospective data review | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Treatment compliance among adult cervical cancer patients receiving care at Uganda Cancer Institute, Uganda: a retrospective data review Josephine Irene Najjemba, Regina Ndagire, Pius Mulamira, Solomon Kibudde, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2280112/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 05 Jul, 2023 Read the published version in BMC Cancer → Version 1 posted 8 You are reading this latest preprint version Abstract Background Cervical cancer is one of the most common cancers and a major cause of morbidity among women globally. Chemoradiation therapy is the preferred standard treatment for women with stage IB to IVA. However, the benefits of this treatment can only be achieved if patients adhere to the treatment guidelines. In this study, the proportion of compliance or adherence to chemo-radiation treatment among cervical cancer patients at Uganda Cancer Institute (UCI) was determined. Methods This was a cross-sectional study that reviewed data retrospectively for 196 cervical cancer patients who were prescribed to chemo-radiation therapy at UCI between November 2020 to May 2021, having been diagnosed with disease stage IB to IVA. Patient data and information on treatment uptake was obtained by review of the patient’s medical records. Treatment compliance was determined by calculating the number of participants who completed the prescribed treatment (definitive pelvic concurrent chemoradiation to 50 Gy external beam radiotherapy with weekly concurrent cisplatin followed by intracavitary brachytherapy 24 Gy in 3 fractions at 8 Gy once a week over 3 weeks). Associations between patient factors and treatment adherence were determined using logistic regression analysis. In all statistical tests, a P- value of < 0.05 was considered as significant. Results The proportion of patients who were administered with external beam radiation (EBRT), chemotherapy and brachytherapy were 82.6%, 52.04% and 66.2% respectively. However, only 23 of 196 patients (11.7%) were found to have adhered to the treatment plan by completion of all definitive pelvic concurrent chemoradiation to 50 Gy external beam radiotherapy (5 weeks) with weekly concurrent cisplatin (5 cycles) followed by intracavitary brachytherapy 24 Gy in 3 fractions at 8 Gy once a week over 3 weeks (3 sessions). There were no significant aassociations between patient factors and treatment adherence after multivariable analysis. Conclusions Treatment compliance was found in only 12% of the cohort participants. No association of patient factors with treatment compliance was found. Additional studies on treatment adherence with larger sample sizes are needed to confirm the associations. Cervical cancer Treatment compliance Uganda Figures Figure 1 Figure 2 Figure 3 Background Cervical cancer continues to be a major cause of morbidity and mortality among women globally, accounting for over 604,000 new cancer cases and 342,000 deaths in 2020 [ 1 ]. The greater burden of the disease is reported in low- and middle-income countries, where it is the third most common cancer among women [ 1 ]. Uganda is among the countries with the highest incidence rates of cervical cancer, with over 20.5% of new cases reported in 2020 [ 2 ]. The incidence rate in Uganda is estimated at 52.6 per 100,000 population and this is projected to increase to 66.1 per 100,000 population by 2030 [ 3 ]. According to Kampala Cancer Registry, more than 80% of women with cervical cancer are referred to Uganda Cancer Institute (UCI) with advanced disease, usually at stage III or higher [ 4 ], yet the survival rates from cervical cancer remain considerably low [ 2 ]. Chemoradiation therapy is the recommended standard treatment for women with stage IB to IVA disease [ 5 , 6 ], because it is known to improve quality of life and to increase patient survival [ 7 ]. However, the beneficial effects of chemoradiation therapy can only be realized if patients adhere to treatment [ 8 ]. Good compliance or adherence implies that the patient follows recommendations by the treatment provider on timing, dosage, and frequency of medication [ 9 ], however, this remains a significant challenge for many people living with cancer in resource-limited settings [ 10 – 14 ]. Several studies done previously in the sub-Saharan region have reported considerable treatment non-compliance rates among cervical cancer patients [ 13 , 15 , 16 ], with patient loss to follow-up of up to 15% or greater [ 17 , 18 ]. In a more recent study done in Zimbabwe’s Parirenyatwa hospital, radiotherapy uptake was reported in about 86% of the patients, with only 38% receiving concurrent chemotherapy [ 13 ]. Many of these studies however, have been done in populations outside Uganda. There is still limited information regarding chemoradiation treatment adherence among cervical cancer patients in Uganda. According to anecdotal reports from UCI, over 75% of cervical cancer patients at UCI are indicated for chemo-radiation therapy but the majority (56%) are found to not adhere to the treatment plan. Poor adherence to cancer medication has been associated with decreased survival [ 7 ], higher recurrence/treatment failure rates [ 19 ], and increase of health care costs [ 20 ]. Without adequate investment in cervical cancer control and increased adherence to chemoradiation, the rates of cervical cancer are only expected to rise [ 21 ]. However, in Uganda the burden of chemoradiation non-adherence among cervical cancer patients is not documented. In this study, the proportion of compliance or adherence to chemo-radiation treatment among cervical cancer patients at UCI was determined. Understanding the rate of treatment compliance is important in providing baseline data of value in cervical cancer interventions. Methods Study design and setting This was a cross-sectional study that reviewed data retrospectively from a cohort of cervical cancer patients receiving care at UCI in Uganda. UCI is an autonomous, specialized public medical care facility owned by Uganda’s Ministry of Health, located approximately 5 Km North East of the central business district of Kampala, along upper Mulago hill road. It is the home of East Africa’s center of excellence for oncology serving a combined population of 170 million people. Patient enrolment The study cohort was recruited from a population of cervical cancer patients who were prescribed to chemo-radiation therapy at UCI between November 2020 to May 2021, having been diagnosed with disease stage IB2 to IVA according to the National Comprehensive Cancer Network (NCCN) guidelines for cervical cancer [ 22 ]. Treatment of cervical cancer followed standard guidelines, which included pelvic external beam radiation (EBRT) + concurrent platinum-containing chemotherapy and brachytherapy [ 22 ]. EBRT dose was 50 Gy in 25 fractions, given once daily (5 weeks) with concurrent chemotherapy with cisplatin at 40 mg/m 2 administered weekly for 5 weeks, after assessing for creatinine clearance and other blood parameters such as complete hemogram, random blood sugar, and liver function tests. Brachytherapy was given at 8 Gy per fraction, every week for 3 weeks using a high dose rate (HDR) unit [ 6 , 23 ]. Eligible participants were duly expected to have completed all the prescribed chemo-radiation therapy cycles plus the additional brachytherapy treatment. A total of 196 eligible patients were enrolled in the study to determine the rate of patient compliance to chemo-radiation treatment. Data collection Patients were examined for cervix cancer by attending gynecology–oncologist physicians at UCI. Patients who were diagnosed with disease stage IB to IVA were prescribed to chemoradiation treatment following standard treatment guidelines [ 22 ]. Baseline data including age, residence, marital status, occupation, religion, kinship, medical history, surgical history and type of surgery done, presence of co-morbidities, disease stage at presentation, history of cancer in the family and treatment cycle was extracted from the patient files using data abstraction forms. Treatment compliance was determined by having completed all the scheduled chemo-radiation (5 weeks of EBRT and 5 cycles of chemotherapy) and 3 cycles of brachytherapy as per the chart and completion of treatment plan as prescribed by the gynecology–oncologist. A team of well-trained health workers and researchers collaborated to cross-check patient data and verify the completeness and accuracy of the data. Data management and analysis Data were entered and cleaned using EpiData version 4.6.0.2. Descriptive statistics, bivariate and multivariate analysis were carried out using STATA 14.0 statistical software (STATA, College Station, Texas). Means and standard deviations (SD) were calculated for normally distributed continuous data, while proportions and frequencies were used for categorical variables. The proportion of patients who were adherent to treatment was determined by calculating the number of participants who completed the prescription (5 weeks of EBRT, 5 cycles of chemotherapy, and 3 cycles of brachytherapy) divided by the study sample size. The association between patient factors and treatment adherence was assessed using bivariate and multivariate analysis. Initial bivariate analysis identified significant variables ( P -values < 0.2) that were included in the final logistic regression analysis to determine the extent to which treatment compliance was affected by patient factors. Adjusted odds ratios (AORs) and their corresponding 95% confidence intervals (Cl) were calculated. All statistical tests were two-tailed and P -values < 0.05 were regarded as significant. Results Patient characteristics A total of 196 patient files were reviewed. The mean patient age was 51.6 ± 13.0 years. Slightly below half of the study participants (46.9%) were married, the majority (61.3%) were in informal employment, 43.5% were Catholics, and almost all patients (99.5%) had a next of kin. At presentation, above half of the patients (54.9%) were in disease stage IIIA-IIIB, but 68.2% of the respondents had patient investigations completed. Patients were examined for other co-morbidities at presentation. The majority (71.9%) reported no underlying medical illness, while 67 of 194 (34.5%) were known to be HIV positive. Many participants (73.7%) reported no previous surgical operation and only 19 of 192 (9.9%) reported having a history of cervical cancer in the family. Details of the patient demographic and clinical characteristics are given in Table 1 . Table 1 Patient demographic and clinical characteristics Patient characteristic Category Frequency (n) Percentage (%) Age [mean (SD)] 51.6 (13.0) Marital status(n = 192) Married Single Widow Divorced/separated 90 64 22 16 46.88 33.33 11.46 8.33 Occupation (n = 194) Formal employment Informal Self employed 13 119 62 6.70 61.34 31.96 Religion (n = 193) Catholic Anglican Moslem *Others (B/A, SDA& Ortho) 84 71 29 9 43.52 36.79 15.03 4.66 Had next of kin (n = 196) Yes No 195 1 99.49 0.51 Relationship with next of kin (n = 196) Mother/father Daughter/son Brother/sister Husband Other relative 9 92 25 61 9 4.59 46.94 12.76 31.12 4.59 Medical history (n = 192) Yes No 54 138 28.13 71.88 Surgical history (n = 190) Yes No 50 140 26.32 73.68 Disease stage (n = 193) Stage IB2- IB3 Stage IIA-IIB Stage IIIA-IIIB Stage IVA 18 61 106 8 9.33 31.61 54.92 4.15 HIV status (n = 194) Yes No 67 127 34.54 65.46 Family history of Cervical cancer (n = 192) Yes No 19 173 9.90 90.10 Completed investigations (n = 192) Yes No 131 61 68.23 31.77 * B/A = Born again Christian; SDA = Seventh-day Adventist; Ortho = Orthodox Uptake of chemo-radiation therapy in the study population In this study, 147 of 178 patients (82.6%) were initiated on EBRT, and only slightly above half (102 of 196; 52.04%) received concurrent chemotherapy. The proportion of patients who received the additional brachytherapy was 66.2%. Details of the uptake of chemoradiation treatment are given in Table 2 . Table 2 Number of patients who received each of EBRT, chemotherapy or brachytherapy. Treatment received Frequency (n) Percentage (%) # EBRT (n = 178) Yes No 147 31 82.58 17.42 Chemotherapy (n = 196) Yes No 102 94 52.04 47.96 Brachytherapy (n = 192) Yes No 127 65 66.15 33.85 # EBRT- External beam radiation There was no consistency in uptake for all prescribed chemoradiation schedule. The proportion of patients who completed all five weeks of EBRT was 87.8%. However, only 27 of the 102 patients (26.5%) completed the five cycles of chemotherapy. The number of weeks of EBRT, and cycles of chemotherapy received are shown in Fig. 1 . Completion of treatment was highest for brachytherapy with 117 of the 127 patients (92.1%) having completed all three cycles, as shown in Fig. 2 . Adherence to chemo-radiation treatment in the study population In this study, only 23 of 196 patients (11.7%) adhered to the treatment plan by completing of all the prescribed cycles (5 weeks of EBRT, 5 cycles of chemotherapy, and 3 cycles of brachytherapy). The highest number (88.3%) did not adhere to the prescribed chemo-radiation treatment (see Fig. 3 ). Relationship between patient factors and adherence to chemo-radiation treatment The association between patient factors and adherence to chemo-radiation was determined using multivariate logistic regression analysis. An initial bivariate analysis (Table 3 ) identified the patient’s occupation ( p = 0.030), disease stage ( p = 0.073), distance ( p = 0.109) and having missed a medical appointment ( p < 0.001) to be significantly associated with the patient’s adherence to chemoradiation treatment. However, no single patient factor was found to be independently associated with the patient’s adherence to chemo-radiation treatment after multivariable analysis. Details of the multivariate analysis of patient factors and adherence to chemo-radiation treatment are given in Table 4 . Table 3 Bivariate analysis of patient factors and adherence to chemo-radiation treatment Outcome Bivariate Patient factor Category Adhered Unadjusted OR 95%Cl P-value No, n (%) Yes, n (%) Age (years) < 51 ≥ 51 85(88.54) 88(88.0) 11(11.46) 12(12.0) 0.95 Reference 0.39 - 2.27 0.906 Marital status(n = 192) Married Single Widow/Divorced/separated 81(90) 55(85.94) 35(92.11) 9(10) 9(14.06) 3(7.89) Reference 1.47 0.77 0.55 − 3.95 0.20 − 3.02 0.441 0.710 Occupation (n = 194) Formal employment Informal Self-employed 9(69.23) 108(90.76) 54(87.1) 4(30.77) 11(9.24) 8(12.9) 4.36 Reference 1.45 1.15 − 16.52 0.55 − 3.83 *0.030 0.448 Religion (n = 193) Catholic Anglican Moslem Others (B/A, SDA& Ortho) 74(88.1) 64(90.14) 25(86.21) 8(88.89) 10(11.9) 7(9.86) 4(13.79) 1(11.11) Reference 0.81 1.18 0.93 0.29–2.25 0.34–4.11 0.10 − 8.19 0.685 0.790 0.944 Relationship with next of kin Mother/father Daughter/son Brother/sister Husband Other relative 9(100) 83(90.22) 21(84.0) 53(86.89) 7(77.78) 0(0) 9(9.78) 4(16.0) 8(13.11) 2(22.22) 1 Reference 1.76 1.39 2.63 - 0.49–6.26 0.51–3.83 0.47–14.64 - 0.377 0.521 0.241 Medical history (n = 192) No Yes 120(86.96) 50(92.59) 18(13.04) 4(7.41) Reference 0.53 0.17–1.65 0.277 Surgical history (n = 190) No Yes 125(89.29) 42(84.0) 15(10.71) 8(16.0) Reference 1.58 0.63–4.00 0.328 Disease stage (n = 193) Stage IAI- IB2 Stage IIA-IIB Stage IIIA-IIIB Stage IVA-IVB 16(88.89) 50(81.97) 97(91.51) 8(100) 2(11.11) 11(18.03) 9(8.49) 0(0) 1.34 2.37 Reference 1 0.27–6.81 0.92–6.10 - 0.719 *0.073 - HIV status No Yes 110(86.61) 61(91.04) 17(13.39) 6(8.96) Reference 0.63 0.24–1.70 0.367 Family history of Cervical cancer No Yes 154(89.02) 15(78.95) 19(10.98) 4(21.05) Reference 2.16 0.73–5.05 0.209 Completed investigations No Yes 56(91.8) 113(86.26) 5(8.2) 18(13.74) 0.56 Reference 0.20 - 1.59 0.276 Distance (km) 1–5 6–10 11–20 > 20 8(72.73) 25(86.21) 9(90.0) 129(89.58) 3(27.27) 4(13.79) 1(10.0) 15(10.42) 3.23 1.37 0.96 Reference 0.77–13.48 0.47–3.70 0.42–4.49 *0.109 0.593 0.967 Missed appointment No Yes 1(5.0) 166(98.22) 19(95.0) 3(1.78) 1051.33 Reference 104.10–10617.2 *<0.001 All investigations done at UCI No Yes 149(87.65) 23(92.0) 21(12.35) 2(8.0) Reference 0.62 0.14–2.80 0.532 * Refers to significant p-value; OR- Odds ratio; CI- Confidence interval Table 4 Multivariate analysis of patient factors and adherence to chemo-radiation treatment Outcome Patient factor Category Adhered Adjusted OR 95%Cl P-value No, n (%) Yes, n (%) Occupation (n = 194) Formal employment Informal Self-employed 9(69.23) 108(90.76) 54(87.1) 4(30.77) 11(9.24) 8(12.9) 1.31 Reference 0.48 0.04–46.02 0.03–6.72 0.882 0.586 Disease stage (n = 193) Stage IAI- IB2 Stage IIA-IIB Stage IIIA-IIIB Stage IVA-IVB 16(88.89) 50(81.97) 97(91.51) 8(100) 2(11.11) 11(18.03) 9(8.49) 0(0) 3.43e-07 2.16e-13 Reference 1 0 - - 0 - - - 1.000 1.000 - Distance (n = 194) 1–5 6–10 11–20 > 20 8(72.73) 25(86.21) 9(90.0) 129(89.58) 3(27.27) 4(13.79) 1(10.0) 15(10.42) 1.36 0.41 3.34e-07 Reference 0.02–78.91 0.02–10.75 1.0 0.881 0.597 1.000 Missed appointment (n = 189) No Yes 1(5.0) 166(98.22) 19(95.0) 3(1.78) 1.52e + 15 Reference 0 - - 1.000 Discussion Chemoradiation treatment non-compliance has been reported in studies done previously in low- and middle-income countries [ 13 , 15 , 16 ], however, most of these studies were done in populations outside Uganda. In the present study, the rate of compliance to chemoradiation treatment among cervical cancer patients at Uganda Cancer Institute was determined. This was a cross-sectional study that reviewed medical records retrospectively for cervical cancer patients that were prescribed to chemoradiation treatment. The study also benefits from the patient clinical data to determine associations between patient factors and treatment compliance. In this study, only 12% of the patients were found to have adhered to the prescribed chemoradiation treatment plan. Majority of the patients who were initiated on treatment completed one or a combination of two treatment modalities; either radiotherapy (87.8%%) or chemotherapy (26.5%) or brachytherapy (92.1%) or a combination of two, but not all the prescribed cycles of chemoradiation. This level of adherence is low when compared to that reported in previous studies in similar settings [ 15 , 16 ] and to the adherence rates reported in a systematic review done elsewhere of 42–54% [ 7 ]. Recent studies done in Uganda have attributed delays in the initiation and continuation of cancer treatment to the poor socio-economic status of the patients, inadequate infrastructure for cancer care, and inefficiencies in the health care system [ 14 , 24 ]. Also notably, this study was carried during November 2020 to May 2021, when the nation was on the road to recovery from the COVID − 19 pandemic. The adverse effects of the COVID − 19 pandemic on the socio-economic status and patient’s well-being may have additionally contributed to the low treatment adherence rates. The present findings relate to those published by authors in Zimbabwe’s Parirenyatwa hospital where radiotherapy uptake was reported in about 86% of the patients, with only 38% administered with chemotherapy [ 13 ]. In both settings, similar health system constraints are reported [ 13 , 14 , 24 ]. In another study done in India, treatment completion rates for EBRT and Brachytherapy were also found to be low (39%) [ 23 ]. Without proper adherence, the chances of patient survival are decreased, and there are higher recurrence/treatment failure rates and increase of health care costs. The present findings and those reported in related studies thus call for the need for health system strengthening in resource-limited settings such as Uganda. From an initial bivariate analysis, occupation, disease stage, distance from health facility, and missing a medical appointment were found to be associated with treatment adherence. However, no single patient factor was found to be independently associated with treatment adherence in the study population. In previous studies, distance [ 23 ], socio-economic status [ 25 ], missed medical appointment [ 16 ] disease stage and age [ 26 ] were found to be significantly associated with cervical cancer treatment adherence. In the present study, the number of participants that were adherent to treatment (23 of 196) was too small to allow for the detection of possible associations. Additional studies with larger sample sizes are needed to confirm associations. Conclusions Treatment compliance was found in only 12% of the cohort participants. The association of patient factors with treatment compliance was not observed. Similar studies with larger sample sizes are needed to confirm the associations. Abbreviations UCI- Uganda Cancer Institute; NCCN-National Comprehensive Cancer Network; EBRT-External beam radiation; HDR-High dose rate; SD-Standard deviation; AOR-Adjusted odds ratio; CI; Confidence interval; HIV-Human immunodeficiency virus; IRB- Institutional review board. Declarations Ethics approval and consent to participate The clinical study and all study protocols were approved by Clarke International University Research and Ethics Committee (CLARKE -2021-100) and the institutional review board (IRB) of UCI (SR.32/21). Informed consent to use patient data was sought from all enrolled patients as they reported to the clinic for review. The privacy and confidentiality of study participants were maintained by using study identifiers. All methods were carried out in accordance with relevant guidelines and regulations. Consent for publication Not applicable Competing interests The authors declare that they have no competing interests. Funding There was no funding provided for this study. Authors' contributions JIN and CNL conceived the study. JIN participated in study design and data collection. RN participated in data analysis. PM, SK and CNL supervised data collection and analysis. All authors participated in the writing and review of the manuscript. All authors read and approved the final manuscript. Availability of data and material The clinical data sets used and /or analyzed during this study are available from the corresponding author upon request. Acknowledgements We are grateful to all the patients whose data was used in the study. We thank the clinical team and administration at Uganda Cancer Institute for the technical support. References Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F: Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries . CA: a cancer journal for clinicians 2021, 71 (3):209-249. World Health Organization: International Agency for Research on Cancer: The Global Cancer Observatory . 2021. Asasira J, Lee S, Tran TXM, Mpamani C, Wabinga H, Jung S-Y, Chang YJ, Park Y, Cho H: Infection-related and lifestyle-related cancer burden in Kampala, Uganda: projection of the future cancer incidence up to 2030 . 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Cite Share Download PDF Status: Published Journal Publication published 05 Jul, 2023 Read the published version in BMC Cancer → Version 1 posted Editorial decision: Major revision 11 Apr, 2023 Reviews received at journal 08 Apr, 2023 Reviewers agreed at journal 29 Mar, 2023 Reviewers invited by journal 28 Mar, 2023 Editor assigned by journal 16 Mar, 2023 Editor invited by journal 24 Nov, 2022 Submission checks completed at journal 24 Nov, 2022 First submitted to journal 16 Nov, 2022 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-2280112\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":false,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":154851290,\"identity\":\"d853fd51-e501-41bf-b16f-e49f169b3461\",\"order_by\":0,\"name\":\"Josephine Irene Najjemba\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Clarke International University\",\"correspondingAuthor\":false,\"submittingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Josephine\",\"middleName\":\"Irene\",\"lastName\":\"Najjemba\",\"suffix\":\"\"},{\"id\":154851291,\"identity\":\"a7ae34dc-ce08-4b95-a86e-1105a8156ee8\",\"order_by\":1,\"name\":\"Regina Ndagire\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Clarke International University\",\"correspondingAuthor\":false,\"submittingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Regina\",\"middleName\":\"\",\"lastName\":\"Ndagire\",\"suffix\":\"\"},{\"id\":154851292,\"identity\":\"3a25cc46-bce4-4d8b-b3c4-7110f7b9b4fd\",\"order_by\":2,\"name\":\"Pius Mulamira\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Uganda Cancer Institute\",\"correspondingAuthor\":false,\"submittingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Pius\",\"middleName\":\"\",\"lastName\":\"Mulamira\",\"suffix\":\"\"},{\"id\":154851293,\"identity\":\"c1675c1b-1346-44eb-acc3-db71182e5bb1\",\"order_by\":3,\"name\":\"Solomon Kibudde\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Uganda Cancer Institute\",\"correspondingAuthor\":false,\"submittingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Solomon\",\"middleName\":\"\",\"lastName\":\"Kibudde\",\"suffix\":\"\"},{\"id\":154851295,\"identity\":\"fc6f5d47-05f5-42ef-9989-e2bdf7b19eae\",\"order_by\":4,\"name\":\"Catherine Nassozi Lwanira\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0UlEQVRIiWNgGAWjYDACdhBhwMDAz8DYQKQWZqgWyQbStIB0HSDWXfzNPIafCwruyRsfP9wmwVBjx2BwfgF+LRKHeYylZxgUG247kwjUciyZweDGA/xaDJh5N0jzGCQwbrvBCNTCdgCohYATgVo2/wZqsd88A6TlH3FatoFsSdwgAdTC2AbUcr6BkF/4v1kDtSTPOJPYbJHYl8wjeQO/Dgb+9rbk2zx/Emz7248/vPHhm50c33kCDkMFCQwMPAwSCaRogVhMki2jYBSMglEwAgAAQp49dQ64nhQAAAAASUVORK5CYII=\",\"orcid\":\"\",\"institution\":\"Clarke International University\",\"correspondingAuthor\":true,\"submittingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Catherine\",\"middleName\":\"Nassozi\",\"lastName\":\"Lwanira\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2022-11-16 11:29:16\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-2280112/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-2280112/v1\",\"draftVersion\":[],\"editorialEvents\":[{\"content\":\"https://doi.org/10.1186/s12885-023-11145-1\",\"type\":\"published\",\"date\":\"2023-07-05T21:32:50+00:00\"}],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":29671769,\"identity\":\"2f54aff1-01c0-4ade-af96-f64ddcb325d6\",\"added_by\":\"auto\",\"created_at\":\"2022-11-29 17:26:44\",\"extension\":\"jpg\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":66122,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003e\\u003cstrong\\u003eNumber of weeks of EBRT and cycles of chemotherapy administered\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e88% of the study participants completed all 5 weeks of EBRT, while 26.5% completed all 5 cycles of chemotherapy.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"1.jpg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-2280112/v1/e1b59266d496f0d3a0318eff.jpg\"},{\"id\":29671771,\"identity\":\"95ef84fd-3451-4b18-a4a5-f3e0e6e73f9f\",\"added_by\":\"auto\",\"created_at\":\"2022-11-29 17:26:44\",\"extension\":\"jpg\",\"order_by\":2,\"title\":\"Figure 2\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":36789,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003e\\u003cstrong\\u003eNumber of brachytherapy cycles administered\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e92% of the study participants completed all 3 cycles of brachytherapy\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"2.jpg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-2280112/v1/0ddacca162eb67a7e061ffd7.jpg\"},{\"id\":29671767,\"identity\":\"8fccf322-b531-469f-af66-488f59ea5edb\",\"added_by\":\"auto\",\"created_at\":\"2022-11-29 17:26:43\",\"extension\":\"jpg\",\"order_by\":3,\"title\":\"Figure 3\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":38698,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003e\\u003cstrong\\u003eAdherence to chemo-radiation treatment\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eFigure shows the proportion of patients who adhered to the treatment plan by completion of all 5 weeks of EBRT, 5 cycles of chemotherapy and 3 cycles of brachytherapy as prescribed by the gynecology–oncologist. Only 12% of the study participants were found to have adhered to the treatment plan.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"3.jpg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-2280112/v1/e326b3933527424531911f87.jpg\"},{\"id\":44733532,\"identity\":\"fd086bcc-3441-4127-95e3-749568c8b76a\",\"added_by\":\"auto\",\"created_at\":\"2023-10-16 22:07:42\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":1112252,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-2280112/v1/7ca677c7-851a-481b-a5b3-acda11de5f2e.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Treatment compliance among adult cervical cancer patients receiving care at Uganda Cancer Institute, Uganda: a retrospective data review\",\"fulltext\":[{\"header\":\"Background\",\"content\":\"\\u003cp\\u003eCervical cancer continues to be a major cause of morbidity and mortality among women globally, accounting for over 604,000 new cancer cases and 342,000 deaths in 2020 [\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e]. The greater burden of the disease is reported in low- and middle-income countries, where it is the third most common cancer among women [\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e]. Uganda is among the countries with the highest incidence rates of cervical cancer, with over 20.5% of new cases reported in 2020 [\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e]. The incidence rate in Uganda is estimated at 52.6 per 100,000 population and this is projected to increase to 66.1 per 100,000 population by 2030 [\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e]. According to Kampala Cancer Registry, more than 80% of women with cervical cancer are referred to Uganda Cancer Institute (UCI) with advanced disease, usually at stage III or higher [\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e], yet the survival rates from cervical cancer remain considerably low [\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eChemoradiation therapy is the recommended standard treatment for women with stage IB to IVA disease [\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e], because it is known to improve quality of life and to increase patient survival [\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e]. However, the beneficial effects of chemoradiation therapy can only be realized if patients adhere to treatment [\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e]. Good compliance or adherence implies that the patient follows recommendations by the treatment provider on timing, dosage, and frequency of medication [\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e], however, this remains a significant challenge for many people living with cancer in resource-limited settings [\\u003cspan additionalcitationids=\\\"CR11 CR12 CR13\\\" citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e]. Several studies done previously in the sub-Saharan region have reported considerable treatment non-compliance rates among cervical cancer patients [\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e], with patient loss to follow-up of up to 15% or greater [\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e]. In a more recent study done in Zimbabwe\\u0026rsquo;s Parirenyatwa hospital, radiotherapy uptake was reported in about 86% of the patients, with only 38% receiving concurrent chemotherapy [\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e]. Many of these studies however, have been done in populations outside Uganda. There is still limited information regarding chemoradiation treatment adherence among cervical cancer patients in Uganda.\\u003c/p\\u003e \\u003cp\\u003eAccording to anecdotal reports from UCI, over 75% of cervical cancer patients at UCI are indicated for chemo-radiation therapy but the majority (56%) are found to not adhere to the treatment plan. Poor adherence to cancer medication has been associated with decreased survival [\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e], higher recurrence/treatment failure rates [\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e], and increase of health care costs [\\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e]. Without adequate investment in cervical cancer control and increased adherence to chemoradiation, the rates of cervical cancer are only expected to rise [\\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e]. However, in Uganda the burden of chemoradiation non-adherence among cervical cancer patients is not documented. In this study, the proportion of compliance or adherence to chemo-radiation treatment among cervical cancer patients at UCI was determined. Understanding the rate of treatment compliance is important in providing baseline data of value in cervical cancer interventions.\\u003c/p\\u003e\"},{\"header\":\"Methods\",\"content\":\"\\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eStudy design and setting\\u003c/h2\\u003e \\u003cp\\u003e This was a cross-sectional study that reviewed data retrospectively from a cohort of cervical cancer patients receiving care at UCI in Uganda. UCI is an autonomous, specialized public medical care facility owned by Uganda\\u0026rsquo;s Ministry of Health, located approximately 5 Km North East of the central business district of Kampala, along upper Mulago hill road. It is the home of East Africa\\u0026rsquo;s center of excellence for oncology serving a combined population of 170\\u0026nbsp;million people.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec4\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003ePatient enrolment\\u003c/h2\\u003e \\u003cp\\u003eThe study cohort was recruited from a population of cervical cancer patients who were prescribed to chemo-radiation therapy at UCI between November 2020 to May 2021, having been diagnosed with disease stage IB2 to IVA according to the National Comprehensive Cancer Network (NCCN) guidelines for cervical cancer [\\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e]. Treatment of cervical cancer followed standard guidelines, which included pelvic external beam radiation (EBRT)\\u0026thinsp;+\\u0026thinsp;concurrent platinum-containing chemotherapy and brachytherapy [\\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e]. EBRT dose was 50 Gy in 25 fractions, given once daily (5 weeks) with concurrent chemotherapy with cisplatin at 40 mg/m\\u003csup\\u003e2\\u003c/sup\\u003e administered weekly for 5 weeks, after assessing for creatinine clearance and other blood parameters such as complete hemogram, random blood sugar, and liver function tests. Brachytherapy was given at 8 Gy per fraction, every week for 3 weeks using a high dose rate (HDR) unit [\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e]. Eligible participants were duly expected to have completed all the prescribed chemo-radiation therapy cycles plus the additional brachytherapy treatment. A total of 196 eligible patients were enrolled in the study to determine the rate of patient compliance to chemo-radiation treatment.\\u003c/p\\u003e \\u003cdiv id=\\\"Sec5\\\" class=\\\"Section3\\\"\\u003e \\u003ch2\\u003eData collection\\u003c/h2\\u003e \\u003cp\\u003ePatients were examined for cervix cancer by attending gynecology\\u0026ndash;oncologist physicians at UCI. Patients who were diagnosed with disease stage IB to IVA were prescribed to chemoradiation treatment following standard treatment guidelines [\\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e]. Baseline data including age, residence, marital status, occupation, religion, kinship, medical history, surgical history and type of surgery done, presence of co-morbidities, disease stage at presentation, history of cancer in the family and treatment cycle was extracted from the patient files using data abstraction forms. Treatment compliance was determined by having completed all the scheduled chemo-radiation (5 weeks of EBRT and 5 cycles of chemotherapy) and 3 cycles of brachytherapy as per the chart and completion of treatment plan as prescribed by the gynecology\\u0026ndash;oncologist. A team of well-trained health workers and researchers collaborated to cross-check patient data and verify the completeness and accuracy of the data.\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec6\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eData management and analysis\\u003c/h2\\u003e \\u003cp\\u003eData were entered and cleaned using EpiData version 4.6.0.2. Descriptive statistics, bivariate and multivariate analysis were carried out using STATA 14.0 statistical software (STATA, College Station, Texas). Means and standard deviations (SD) were calculated for normally distributed continuous data, while proportions and frequencies were used for categorical variables. The proportion of patients who were adherent to treatment was determined by calculating the number of participants who completed the prescription (5 weeks of EBRT, 5 cycles of chemotherapy, and 3 cycles of brachytherapy) divided by the study sample size.\\u003c/p\\u003e \\u003cp\\u003eThe association between patient factors and treatment adherence was assessed using bivariate and multivariate analysis. Initial bivariate analysis identified significant variables (\\u003cem\\u003eP\\u003c/em\\u003e-values\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.2) that were included in the final logistic regression analysis to determine the extent to which treatment compliance was affected by patient factors. Adjusted odds ratios (AORs) and their corresponding 95% confidence intervals (Cl) were calculated. All statistical tests were two-tailed and \\u003cem\\u003eP\\u003c/em\\u003e-values\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05 were regarded as significant.\\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cdiv id=\\\"Sec8\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003ePatient characteristics\\u003c/h2\\u003e \\u003cp\\u003eA total of 196 patient files were reviewed. The mean patient age was 51.6\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;13.0 years. Slightly below half of the study participants (46.9%) were married, the majority (61.3%) were in informal employment, 43.5% were Catholics, and almost all patients (99.5%) had a next of kin. At presentation, above half of the patients (54.9%) were in disease stage IIIA-IIIB, but 68.2% of the respondents had patient investigations completed. Patients were examined for other co-morbidities at presentation. The majority (71.9%) reported no underlying medical illness, while 67 of 194 (34.5%) were known to be HIV positive. Many participants (73.7%) reported no previous surgical operation and only 19 of 192 (9.9%) reported having a history of cervical cancer in the family. Details of the patient demographic and clinical characteristics are given in Table \\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e.\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003ePatient demographic and clinical characteristics\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"4\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePatient characteristic\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eCategory\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eFrequency (n)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003ePercentage (%)\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAge [mean (SD)]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e51.6 (13.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMarital status(n\\u0026thinsp;=\\u0026thinsp;192)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eMarried\\u003c/p\\u003e \\u003cp\\u003eSingle\\u003c/p\\u003e \\u003cp\\u003eWidow\\u003c/p\\u003e \\u003cp\\u003eDivorced/separated\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e90\\u003c/p\\u003e \\u003cp\\u003e64\\u003c/p\\u003e \\u003cp\\u003e22\\u003c/p\\u003e \\u003cp\\u003e16\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e46.88\\u003c/p\\u003e \\u003cp\\u003e33.33\\u003c/p\\u003e \\u003cp\\u003e11.46\\u003c/p\\u003e \\u003cp\\u003e8.33\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eOccupation (n\\u0026thinsp;=\\u0026thinsp;194)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eFormal employment\\u003c/p\\u003e \\u003cp\\u003eInformal\\u003c/p\\u003e \\u003cp\\u003eSelf employed\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e13\\u003c/p\\u003e \\u003cp\\u003e119\\u003c/p\\u003e \\u003cp\\u003e62\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e6.70\\u003c/p\\u003e \\u003cp\\u003e61.34\\u003c/p\\u003e \\u003cp\\u003e31.96\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eReligion (n\\u0026thinsp;=\\u0026thinsp;193)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eCatholic\\u003c/p\\u003e \\u003cp\\u003eAnglican\\u003c/p\\u003e \\u003cp\\u003eMoslem\\u003c/p\\u003e \\u003cp\\u003e*Others (B/A, SDA\\u0026amp; Ortho)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e84\\u003c/p\\u003e \\u003cp\\u003e71\\u003c/p\\u003e \\u003cp\\u003e29\\u003c/p\\u003e \\u003cp\\u003e9\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e43.52\\u003c/p\\u003e \\u003cp\\u003e36.79\\u003c/p\\u003e \\u003cp\\u003e15.03\\u003c/p\\u003e \\u003cp\\u003e4.66\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eHad next of kin (n\\u0026thinsp;=\\u0026thinsp;196)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e195\\u003c/p\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e99.49\\u003c/p\\u003e \\u003cp\\u003e0.51\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eRelationship with next of kin (n\\u0026thinsp;=\\u0026thinsp;196)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eMother/father\\u003c/p\\u003e \\u003cp\\u003eDaughter/son\\u003c/p\\u003e \\u003cp\\u003eBrother/sister\\u003c/p\\u003e \\u003cp\\u003eHusband\\u003c/p\\u003e \\u003cp\\u003eOther relative\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e9\\u003c/p\\u003e \\u003cp\\u003e92\\u003c/p\\u003e \\u003cp\\u003e25\\u003c/p\\u003e \\u003cp\\u003e61\\u003c/p\\u003e \\u003cp\\u003e9\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e4.59\\u003c/p\\u003e \\u003cp\\u003e46.94\\u003c/p\\u003e \\u003cp\\u003e12.76\\u003c/p\\u003e \\u003cp\\u003e31.12\\u003c/p\\u003e \\u003cp\\u003e4.59\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMedical history (n\\u0026thinsp;=\\u0026thinsp;192)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e54\\u003c/p\\u003e \\u003cp\\u003e138\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e28.13\\u003c/p\\u003e \\u003cp\\u003e71.88\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSurgical history (n\\u0026thinsp;=\\u0026thinsp;190)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e50\\u003c/p\\u003e \\u003cp\\u003e140\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e26.32\\u003c/p\\u003e \\u003cp\\u003e73.68\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDisease stage (n\\u0026thinsp;=\\u0026thinsp;193)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eStage IB2- IB3\\u003c/p\\u003e \\u003cp\\u003eStage IIA-IIB\\u003c/p\\u003e \\u003cp\\u003eStage IIIA-IIIB\\u003c/p\\u003e \\u003cp\\u003eStage IVA\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e18\\u003c/p\\u003e \\u003cp\\u003e61\\u003c/p\\u003e \\u003cp\\u003e106\\u003c/p\\u003e \\u003cp\\u003e8\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e9.33\\u003c/p\\u003e \\u003cp\\u003e31.61\\u003c/p\\u003e \\u003cp\\u003e54.92\\u003c/p\\u003e \\u003cp\\u003e4.15\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eHIV status (n\\u0026thinsp;=\\u0026thinsp;194)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e67\\u003c/p\\u003e \\u003cp\\u003e127\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e34.54\\u003c/p\\u003e \\u003cp\\u003e65.46\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eFamily history of Cervical cancer (n\\u0026thinsp;=\\u0026thinsp;192)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e19\\u003c/p\\u003e \\u003cp\\u003e173\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e9.90\\u003c/p\\u003e \\u003cp\\u003e90.10\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eCompleted investigations (n\\u0026thinsp;=\\u0026thinsp;192)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e131\\u003c/p\\u003e \\u003cp\\u003e61\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e68.23\\u003c/p\\u003e \\u003cp\\u003e31.77\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003ctfoot\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"4\\\"\\u003e* B/A\\u0026thinsp;=\\u0026thinsp;Born again Christian; SDA\\u0026thinsp;=\\u0026thinsp;Seventh-day Adventist; Ortho\\u0026thinsp;=\\u0026thinsp;Orthodox\\u003c/td\\u003e\\u003c/tr\\u003e \\u003c/tfoot\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec9\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eUptake of chemo-radiation therapy in the study population\\u003c/h2\\u003e \\u003cp\\u003eIn this study, 147 of 178 patients (82.6%) were initiated on EBRT, and only slightly above half (102 of 196; 52.04%) received concurrent chemotherapy. The proportion of patients who received the additional brachytherapy was 66.2%. Details of the uptake of chemoradiation treatment are given in Table \\u003cspan refid=\\\"Tab2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e.\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab2\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 2\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eNumber of patients who received each of EBRT, chemotherapy or brachytherapy.\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"4\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eTreatment received\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eFrequency (n)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003ePercentage (%)\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003csup\\u003e#\\u003c/sup\\u003eEBRT (n\\u0026thinsp;=\\u0026thinsp;178)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e147\\u003c/p\\u003e \\u003cp\\u003e31\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e82.58\\u003c/p\\u003e \\u003cp\\u003e17.42\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eChemotherapy (n\\u0026thinsp;=\\u0026thinsp;196)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e102\\u003c/p\\u003e \\u003cp\\u003e94\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e52.04\\u003c/p\\u003e \\u003cp\\u003e47.96\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBrachytherapy (n\\u0026thinsp;=\\u0026thinsp;192)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e127\\u003c/p\\u003e \\u003cp\\u003e65\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e66.15\\u003c/p\\u003e \\u003cp\\u003e33.85\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003ctfoot\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"4\\\"\\u003e\\u003csup\\u003e\\u003cb\\u003e#\\u003c/b\\u003e\\u003c/sup\\u003eEBRT- External beam radiation\\u003c/td\\u003e\\u003c/tr\\u003e \\u003c/tfoot\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003eThere was no consistency in uptake for all prescribed chemoradiation schedule. The proportion of patients who completed all five weeks of EBRT was 87.8%. However, only 27 of the 102 patients (26.5%) completed the five cycles of chemotherapy. The number of weeks of EBRT, and cycles of chemotherapy received are shown in Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e. Completion of treatment was highest for brachytherapy with 117 of the 127 patients (92.1%) having completed all three cycles, as shown in Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec10\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eAdherence to chemo-radiation treatment in the study population\\u003c/h2\\u003e \\u003cp\\u003eIn this study, only 23 of 196 patients (11.7%) adhered to the treatment plan by completing of all the prescribed cycles (5 weeks of EBRT, 5 cycles of chemotherapy, and 3 cycles of brachytherapy). The highest number (88.3%) did not adhere to the prescribed chemo-radiation treatment (see Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig3\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e).\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec11\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eRelationship between patient factors and adherence to chemo-radiation treatment\\u003c/h2\\u003e \\u003cp\\u003eThe association between patient factors and adherence to chemo-radiation was determined using multivariate logistic regression analysis. An initial bivariate analysis (Table \\u003cspan refid=\\\"Tab3\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e) identified the patient\\u0026rsquo;s occupation (\\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.030), disease stage (\\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.073), distance (\\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.109) and having missed a medical appointment (\\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001) to be significantly associated with the patient\\u0026rsquo;s adherence to chemoradiation treatment. However, no single patient factor was found to be independently associated with the patient\\u0026rsquo;s adherence to chemo-radiation treatment after multivariable analysis. Details of the multivariate analysis of patient factors and adherence to chemo-radiation treatment are given in Table \\u003cspan refid=\\\"Tab4\\\" class=\\\"InternalRef\\\"\\u003e4\\u003c/span\\u003e.\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab3\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 3\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eBivariate analysis of patient factors and adherence to chemo-radiation treatment\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"7\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c7\\\" colnum=\\\"7\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c4\\\" namest=\\\"c3\\\"\\u003e \\u003cp\\u003eOutcome\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c7\\\" namest=\\\"c5\\\"\\u003e \\u003cp\\u003eBivariate\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003ePatient factor\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eCategory\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c4\\\" namest=\\\"c3\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eAdhered\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eUnadjusted OR\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e95%Cl\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eP-value\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eNo, n (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eYes, n (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAge (years)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u0026lt;\\u0026thinsp;51\\u003c/p\\u003e \\u003cp\\u003e\\u0026ge;\\u0026thinsp;51\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e85(88.54)\\u003c/p\\u003e \\u003cp\\u003e88(88.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e11(11.46)\\u003c/p\\u003e \\u003cp\\u003e12(12.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.95\\u003c/p\\u003e \\u003cp\\u003eReference\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.39 - 2.27\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.906\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMarital status(n\\u0026thinsp;=\\u0026thinsp;192)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eMarried\\u003c/p\\u003e \\u003cp\\u003eSingle\\u003c/p\\u003e \\u003cp\\u003eWidow/Divorced/separated\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e81(90)\\u003c/p\\u003e \\u003cp\\u003e55(85.94)\\u003c/p\\u003e \\u003cp\\u003e35(92.11)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e9(10)\\u003c/p\\u003e \\u003cp\\u003e9(14.06)\\u003c/p\\u003e \\u003cp\\u003e3(7.89)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eReference\\u003c/p\\u003e \\u003cp\\u003e1.47\\u003c/p\\u003e \\u003cp\\u003e0.77\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.55 \\u0026minus;\\u0026thinsp;3.95\\u003c/p\\u003e \\u003cp\\u003e0.20 \\u0026minus;\\u0026thinsp;3.02\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.441\\u003c/p\\u003e \\u003cp\\u003e0.710\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eOccupation (n\\u0026thinsp;=\\u0026thinsp;194)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eFormal employment\\u003c/p\\u003e \\u003cp\\u003eInformal\\u003c/p\\u003e \\u003cp\\u003eSelf-employed\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e9(69.23)\\u003c/p\\u003e \\u003cp\\u003e108(90.76)\\u003c/p\\u003e \\u003cp\\u003e54(87.1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e4(30.77)\\u003c/p\\u003e \\u003cp\\u003e11(9.24)\\u003c/p\\u003e \\u003cp\\u003e8(12.9)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e4.36\\u003c/p\\u003e \\u003cp\\u003eReference\\u003c/p\\u003e \\u003cp\\u003e1.45\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e1.15 \\u0026minus;\\u0026thinsp;16.52\\u003c/p\\u003e \\u003cp\\u003e0.55 \\u0026minus;\\u0026thinsp;3.83\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e*0.030\\u003c/b\\u003e\\u003c/p\\u003e \\u003cp\\u003e0.448\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eReligion (n\\u0026thinsp;=\\u0026thinsp;193)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eCatholic\\u003c/p\\u003e \\u003cp\\u003eAnglican\\u003c/p\\u003e \\u003cp\\u003eMoslem\\u003c/p\\u003e \\u003cp\\u003eOthers (B/A, SDA\\u0026amp; Ortho)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e74(88.1)\\u003c/p\\u003e \\u003cp\\u003e64(90.14)\\u003c/p\\u003e \\u003cp\\u003e25(86.21)\\u003c/p\\u003e \\u003cp\\u003e8(88.89)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e10(11.9)\\u003c/p\\u003e \\u003cp\\u003e7(9.86)\\u003c/p\\u003e \\u003cp\\u003e4(13.79)\\u003c/p\\u003e \\u003cp\\u003e1(11.11)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eReference\\u003c/p\\u003e \\u003cp\\u003e0.81\\u003c/p\\u003e \\u003cp\\u003e1.18\\u003c/p\\u003e \\u003cp\\u003e0.93\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.29\\u0026ndash;2.25\\u003c/p\\u003e \\u003cp\\u003e0.34\\u0026ndash;4.11\\u003c/p\\u003e \\u003cp\\u003e0.10 \\u0026minus;\\u0026thinsp;8.19\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.685\\u003c/p\\u003e \\u003cp\\u003e0.790\\u003c/p\\u003e \\u003cp\\u003e0.944\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eRelationship with next of kin\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eMother/father\\u003c/p\\u003e \\u003cp\\u003eDaughter/son\\u003c/p\\u003e \\u003cp\\u003eBrother/sister\\u003c/p\\u003e \\u003cp\\u003eHusband\\u003c/p\\u003e \\u003cp\\u003eOther relative\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e9(100)\\u003c/p\\u003e \\u003cp\\u003e83(90.22)\\u003c/p\\u003e \\u003cp\\u003e21(84.0)\\u003c/p\\u003e \\u003cp\\u003e53(86.89)\\u003c/p\\u003e \\u003cp\\u003e7(77.78)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0(0)\\u003c/p\\u003e \\u003cp\\u003e9(9.78)\\u003c/p\\u003e \\u003cp\\u003e4(16.0)\\u003c/p\\u003e \\u003cp\\u003e8(13.11)\\u003c/p\\u003e \\u003cp\\u003e2(22.22)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003cp\\u003eReference\\u003c/p\\u003e \\u003cp\\u003e1.76\\u003c/p\\u003e \\u003cp\\u003e1.39\\u003c/p\\u003e \\u003cp\\u003e2.63\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003cp\\u003e0.49\\u0026ndash;6.26\\u003c/p\\u003e \\u003cp\\u003e0.51\\u0026ndash;3.83\\u003c/p\\u003e \\u003cp\\u003e0.47\\u0026ndash;14.64\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003cp\\u003e0.377\\u003c/p\\u003e \\u003cp\\u003e0.521\\u003c/p\\u003e \\u003cp\\u003e0.241\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMedical history (n\\u0026thinsp;=\\u0026thinsp;192)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e120(86.96)\\u003c/p\\u003e \\u003cp\\u003e50(92.59)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e18(13.04)\\u003c/p\\u003e \\u003cp\\u003e4(7.41)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eReference\\u003c/p\\u003e \\u003cp\\u003e0.53\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.17\\u0026ndash;1.65\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.277\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSurgical history (n\\u0026thinsp;=\\u0026thinsp;190)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e125(89.29)\\u003c/p\\u003e \\u003cp\\u003e42(84.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e15(10.71)\\u003c/p\\u003e \\u003cp\\u003e8(16.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eReference\\u003c/p\\u003e \\u003cp\\u003e1.58\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.63\\u0026ndash;4.00\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.328\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDisease stage (n\\u0026thinsp;=\\u0026thinsp;193)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eStage IAI- IB2\\u003c/p\\u003e \\u003cp\\u003eStage IIA-IIB\\u003c/p\\u003e \\u003cp\\u003eStage IIIA-IIIB\\u003c/p\\u003e \\u003cp\\u003eStage IVA-IVB\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e16(88.89)\\u003c/p\\u003e \\u003cp\\u003e50(81.97)\\u003c/p\\u003e \\u003cp\\u003e97(91.51)\\u003c/p\\u003e \\u003cp\\u003e8(100)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e2(11.11)\\u003c/p\\u003e \\u003cp\\u003e11(18.03)\\u003c/p\\u003e \\u003cp\\u003e9(8.49)\\u003c/p\\u003e \\u003cp\\u003e0(0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.34\\u003c/p\\u003e \\u003cp\\u003e2.37\\u003c/p\\u003e \\u003cp\\u003eReference\\u003c/p\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.27\\u0026ndash;6.81\\u003c/p\\u003e \\u003cp\\u003e0.92\\u0026ndash;6.10\\u003c/p\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.719\\u003c/p\\u003e \\u003cp\\u003e\\u003cb\\u003e*0.073\\u003c/b\\u003e\\u003c/p\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eHIV status\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e110(86.61)\\u003c/p\\u003e \\u003cp\\u003e61(91.04)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e17(13.39)\\u003c/p\\u003e \\u003cp\\u003e6(8.96)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eReference\\u003c/p\\u003e \\u003cp\\u003e0.63\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.24\\u0026ndash;1.70\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.367\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eFamily history of Cervical cancer\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e154(89.02)\\u003c/p\\u003e \\u003cp\\u003e15(78.95)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e19(10.98)\\u003c/p\\u003e \\u003cp\\u003e4(21.05)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eReference\\u003c/p\\u003e \\u003cp\\u003e2.16\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.73\\u0026ndash;5.05\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.209\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eCompleted investigations\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e56(91.8)\\u003c/p\\u003e \\u003cp\\u003e113(86.26)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e5(8.2)\\u003c/p\\u003e \\u003cp\\u003e18(13.74)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.56\\u003c/p\\u003e \\u003cp\\u003eReference\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.20 - 1.59\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.276\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDistance (km)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1\\u0026ndash;5\\u003c/p\\u003e \\u003cp\\u003e6\\u0026ndash;10\\u003c/p\\u003e \\u003cp\\u003e11\\u0026ndash;20\\u003c/p\\u003e \\u003cp\\u003e\\u0026gt;\\u0026thinsp;20\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e8(72.73)\\u003c/p\\u003e \\u003cp\\u003e25(86.21)\\u003c/p\\u003e \\u003cp\\u003e9(90.0)\\u003c/p\\u003e \\u003cp\\u003e129(89.58)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e3(27.27)\\u003c/p\\u003e \\u003cp\\u003e4(13.79)\\u003c/p\\u003e \\u003cp\\u003e1(10.0)\\u003c/p\\u003e \\u003cp\\u003e15(10.42)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e3.23\\u003c/p\\u003e \\u003cp\\u003e1.37\\u003c/p\\u003e \\u003cp\\u003e0.96\\u003c/p\\u003e \\u003cp\\u003eReference\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.77\\u0026ndash;13.48\\u003c/p\\u003e \\u003cp\\u003e0.47\\u0026ndash;3.70\\u003c/p\\u003e \\u003cp\\u003e0.42\\u0026ndash;4.49\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e*0.109\\u003c/b\\u003e\\u003c/p\\u003e \\u003cp\\u003e0.593\\u003c/p\\u003e \\u003cp\\u003e0.967\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMissed appointment\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1(5.0)\\u003c/p\\u003e \\u003cp\\u003e166(98.22)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e19(95.0)\\u003c/p\\u003e \\u003cp\\u003e3(1.78)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1051.33\\u003c/p\\u003e \\u003cp\\u003eReference\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e104.10\\u0026ndash;10617.2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e*\\u0026lt;0.001\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAll investigations done at UCI\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e149(87.65)\\u003c/p\\u003e \\u003cp\\u003e23(92.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e21(12.35)\\u003c/p\\u003e \\u003cp\\u003e2(8.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eReference\\u003c/p\\u003e \\u003cp\\u003e0.62\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.14\\u0026ndash;2.80\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.532\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003ctfoot\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"7\\\"\\u003e* Refers to significant p-value; OR- Odds ratio; CI- Confidence interval\\u003c/td\\u003e\\u003c/tr\\u003e \\u003c/tfoot\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab4\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 4\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eMultivariate analysis of patient factors and adherence to chemo-radiation treatment\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"7\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c7\\\" colnum=\\\"7\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c4\\\" namest=\\\"c3\\\"\\u003e \\u003cp\\u003eOutcome\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c7\\\" namest=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003ePatient factor\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eCategory\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c4\\\" namest=\\\"c3\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eAdhered\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eAdjusted OR\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e95%Cl\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eP-value\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eNo, n (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eYes, n (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eOccupation (n\\u0026thinsp;=\\u0026thinsp;194)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eFormal employment\\u003c/p\\u003e \\u003cp\\u003eInformal\\u003c/p\\u003e \\u003cp\\u003eSelf-employed\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e9(69.23)\\u003c/p\\u003e \\u003cp\\u003e108(90.76)\\u003c/p\\u003e \\u003cp\\u003e54(87.1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e4(30.77)\\u003c/p\\u003e \\u003cp\\u003e11(9.24)\\u003c/p\\u003e \\u003cp\\u003e8(12.9)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.31\\u003c/p\\u003e \\u003cp\\u003eReference\\u003c/p\\u003e \\u003cp\\u003e0.48\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.04\\u0026ndash;46.02\\u003c/p\\u003e \\u003cp\\u003e0.03\\u0026ndash;6.72\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.882\\u003c/p\\u003e \\u003cp\\u003e0.586\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDisease stage (n\\u0026thinsp;=\\u0026thinsp;193)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eStage IAI- IB2\\u003c/p\\u003e \\u003cp\\u003eStage IIA-IIB\\u003c/p\\u003e \\u003cp\\u003eStage IIIA-IIIB\\u003c/p\\u003e \\u003cp\\u003eStage IVA-IVB\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e16(88.89)\\u003c/p\\u003e \\u003cp\\u003e50(81.97)\\u003c/p\\u003e \\u003cp\\u003e97(91.51)\\u003c/p\\u003e \\u003cp\\u003e8(100)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e2(11.11)\\u003c/p\\u003e \\u003cp\\u003e11(18.03)\\u003c/p\\u003e \\u003cp\\u003e9(8.49)\\u003c/p\\u003e \\u003cp\\u003e0(0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e3.43e-07\\u003c/p\\u003e \\u003cp\\u003e2.16e-13\\u003c/p\\u003e \\u003cp\\u003eReference\\u003c/p\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0 - -\\u003c/p\\u003e \\u003cp\\u003e0 - -\\u003c/p\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e1.000\\u003c/p\\u003e \\u003cp\\u003e1.000\\u003c/p\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDistance (n\\u0026thinsp;=\\u0026thinsp;194)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1\\u0026ndash;5\\u003c/p\\u003e \\u003cp\\u003e6\\u0026ndash;10\\u003c/p\\u003e \\u003cp\\u003e11\\u0026ndash;20\\u003c/p\\u003e \\u003cp\\u003e\\u0026gt;\\u0026thinsp;20\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e8(72.73)\\u003c/p\\u003e \\u003cp\\u003e25(86.21)\\u003c/p\\u003e \\u003cp\\u003e9(90.0)\\u003c/p\\u003e \\u003cp\\u003e129(89.58)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e3(27.27)\\u003c/p\\u003e \\u003cp\\u003e4(13.79)\\u003c/p\\u003e \\u003cp\\u003e1(10.0)\\u003c/p\\u003e \\u003cp\\u003e15(10.42)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.36\\u003c/p\\u003e \\u003cp\\u003e0.41\\u003c/p\\u003e \\u003cp\\u003e3.34e-07\\u003c/p\\u003e \\u003cp\\u003eReference\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.02\\u0026ndash;78.91\\u003c/p\\u003e \\u003cp\\u003e0.02\\u0026ndash;10.75\\u003c/p\\u003e \\u003cp\\u003e1.0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.881\\u003c/p\\u003e \\u003cp\\u003e0.597\\u003c/p\\u003e \\u003cp\\u003e1.000\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMissed appointment (n\\u0026thinsp;=\\u0026thinsp;189)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1(5.0)\\u003c/p\\u003e \\u003cp\\u003e166(98.22)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e19(95.0)\\u003c/p\\u003e \\u003cp\\u003e3(1.78)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.52e\\u0026thinsp;+\\u0026thinsp;15\\u003c/p\\u003e \\u003cp\\u003eReference\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0 - -\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e1.000\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eChemoradiation treatment non-compliance has been reported in studies done previously in low- and middle-income countries [\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e], however, most of these studies were done in populations outside Uganda. In the present study, the rate of compliance to chemoradiation treatment among cervical cancer patients at Uganda Cancer Institute was determined. This was a cross-sectional study that reviewed medical records retrospectively for cervical cancer patients that were prescribed to chemoradiation treatment. The study also benefits from the patient clinical data to determine associations between patient factors and treatment compliance.\\u003c/p\\u003e \\u003cp\\u003eIn this study, only 12% of the patients were found to have adhered to the prescribed chemoradiation treatment plan. Majority of the patients who were initiated on treatment completed one or a combination of two treatment modalities; either radiotherapy (87.8%%) or chemotherapy (26.5%) or brachytherapy (92.1%) or a combination of two, but not all the prescribed cycles of chemoradiation. This level of adherence is low when compared to that reported in previous studies in similar settings [\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e] and to the adherence rates reported in a systematic review done elsewhere of 42\\u0026ndash;54% [\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e]. Recent studies done in Uganda have attributed delays in the initiation and continuation of cancer treatment to the poor socio-economic status of the patients, inadequate infrastructure for cancer care, and inefficiencies in the health care system [\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e]. Also notably, this study was carried during November 2020 to May 2021, when the nation was on the road to recovery from the COVID \\u0026minus;\\u0026thinsp;19 pandemic. The adverse effects of the COVID \\u0026minus;\\u0026thinsp;19 pandemic on the socio-economic status and patient\\u0026rsquo;s well-being may have additionally contributed to the low treatment adherence rates. The present findings relate to those published by authors in Zimbabwe\\u0026rsquo;s Parirenyatwa hospital where radiotherapy uptake was reported in about 86% of the patients, with only 38% administered with chemotherapy [\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e]. In both settings, similar health system constraints are reported [\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e]. In another study done in India, treatment completion rates for EBRT and Brachytherapy were also found to be low (39%) [\\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e]. Without proper adherence, the chances of patient survival are decreased, and there are higher recurrence/treatment failure rates and increase of health care costs. The present findings and those reported in related studies thus call for the need for health system strengthening in resource-limited settings such as Uganda.\\u003c/p\\u003e \\u003cp\\u003eFrom an initial bivariate analysis, occupation, disease stage, distance from health facility, and missing a medical appointment were found to be associated with treatment adherence. However, no single patient factor was found to be independently associated with treatment adherence in the study population. In previous studies, distance [\\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e], socio-economic status [\\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e], missed medical appointment [\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e] disease stage and age [\\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e] were found to be significantly associated with cervical cancer treatment adherence. In the present study, the number of participants that were adherent to treatment (23 of 196) was too small to allow for the detection of possible associations. Additional studies with larger sample sizes are needed to confirm associations.\\u003c/p\\u003e\"},{\"header\":\"Conclusions\",\"content\":\"\\u003cp\\u003eTreatment compliance was found in only 12% of the cohort participants. The association of patient factors with treatment compliance was not observed. Similar studies with larger sample sizes are needed to confirm the associations.\\u003c/p\\u003e\"},{\"header\":\"Abbreviations\",\"content\":\"\\u003cp\\u003eUCI- Uganda Cancer Institute; NCCN-National Comprehensive Cancer Network; EBRT-External beam radiation; HDR-High dose rate; SD-Standard deviation; AOR-Adjusted odds ratio; CI; Confidence interval; HIV-Human immunodeficiency virus; IRB- Institutional review board.\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eEthics approval and consent to participate\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe clinical study and all study protocols were approved by Clarke International University Research and Ethics Committee (CLARKE -2021-100) and the institutional review board (IRB) of UCI (SR.32/21). Informed consent to use patient data was sought from all enrolled patients as they reported to the clinic for review.\\u0026nbsp;The privacy and confidentiality of study participants were maintained by using study identifiers. All methods were carried out in accordance with relevant guidelines and regulations.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConsent for publication\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNot applicable\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCompeting interests\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors declare that they have no competing interests.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThere was no funding provided for this study.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthors' contributions\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eJIN and CNL conceived the study. JIN participated in study design and data collection. RN participated in data analysis. PM, SK and CNL supervised data collection and analysis. All authors participated in the writing and review of the manuscript. All authors read and approved the final manuscript.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAvailability of data and material\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe clinical data sets used and /or analyzed during this study are available from the corresponding author upon request.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAcknowledgements\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eWe are grateful to all the patients whose data was used in the study. We thank the clinical team and administration at Uganda Cancer Institute for the technical support.\\u0026nbsp;\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n\\u003cli\\u003eSung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F: \\u003cstrong\\u003eGlobal cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries\\u003c/strong\\u003e. \\u003cem\\u003eCA: a cancer journal for clinicians \\u003c/em\\u003e2021, \\u003cstrong\\u003e71\\u003c/strong\\u003e(3):209-249.\\u003c/li\\u003e\\n\\u003cli\\u003eWorld Health Organization: International Agency for Research on Cancer: \\u003cstrong\\u003eThe Global Cancer Observatory\\u003c/strong\\u003e. 2021.\\u003c/li\\u003e\\n\\u003cli\\u003eAsasira J, Lee S, Tran TXM, Mpamani C, Wabinga H, Jung S-Y, Chang YJ, Park Y, Cho H: \\u003cstrong\\u003eInfection-related and lifestyle-related cancer burden in Kampala, Uganda: projection of the future cancer incidence up to 2030\\u003c/strong\\u003e. \\u003cem\\u003eBMJ open \\u003c/em\\u003e2022, \\u003cstrong\\u003e12\\u003c/strong\\u003e(3):e056722.\\u003c/li\\u003e\\n\\u003cli\\u003eNakisige C, Schwartz M, Ndira AO: \\u003cstrong\\u003eCervical cancer screening and treatment in Uganda\\u003c/strong\\u003e. \\u003cem\\u003eGynecol Oncol Rep \\u003c/em\\u003e2017, \\u003cstrong\\u003e20\\u003c/strong\\u003e:37-40.\\u003c/li\\u003e\\n\\u003cli\\u003eChuang LT, Feldman S, Nakisige C, Temin S, Berek JS: \\u003cstrong\\u003eManagement and care of women with invasive cervical cancer: ASCO resource-stratified clinical practice guideline\\u003c/strong\\u003e. \\u003cem\\u003eJournal of clinical oncology: official journal of the American Society of Clinical Oncology \\u003c/em\\u003e2016, \\u003cstrong\\u003e34\\u003c/strong\\u003e(27):3354-3355.\\u003c/li\\u003e\\n\\u003cli\\u003eSingotia L JR, Panihar C, Rawat S and Raj A: \\u003cstrong\\u003eIntegration of Chemotherapy with Brachytherapy in the Treatment of Locally Advanced Uterine Cervical Cancer\\u003c/strong\\u003e. \\u003cem\\u003eJournal of Cancer Science \\u0026amp; Therapy \\u003c/em\\u003e2021, \\u003cstrong\\u003e13\\u003c/strong\\u003e:6.\\u003c/li\\u003e\\n\\u003cli\\u003ePutri NQ, Permata TBM, Wulandari NA, Handoko, Nuryadi E, Purwoto G, Gondhowiardjo SA: \\u003cstrong\\u003eRelationship of Adherence to Cervical Cancer Treatment Guideline Towards Patients' Five-year Survival: Systematic Review of Follow-up Trials\\u003c/strong\\u003e. \\u003cem\\u003eCancer Manag Res \\u003c/em\\u003e2020, \\u003cstrong\\u003e12\\u003c/strong\\u003e:12649-12655.\\u003c/li\\u003e\\n\\u003cli\\u003eZamorano AS, Barnoya J, Gharzouzi E, Chrisman Robbins C, Orozco E, Polo Guerra S, Mutch DG: \\u003cstrong\\u003eTreatment Compliance as a Major Barrier to Optimal Cervical Cancer Treatment in Guatemala\\u003c/strong\\u003e. \\u003cem\\u003eJ Glob Oncol \\u003c/em\\u003e2019, 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hospital in South East Nigeria\\u003c/strong\\u003e. \\u003cem\\u003eInt J Womens Health \\u003c/em\\u003e2014, \\u003cstrong\\u003e6\\u003c/strong\\u003e:123-130.\\u003c/li\\u003e\\n\\u003cli\\u003eEze JN, Emeka-Irem EN, Edegbe FO: \\u003cstrong\\u003eA six-year study of the clinical presentation of cervical cancer and the management challenges encountered at a state teaching hospital in southeast Nigeria\\u003c/strong\\u003e. \\u003cem\\u003eClin Med Insights Oncol \\u003c/em\\u003e2013, \\u003cstrong\\u003e7\\u003c/strong\\u003e:151-158.\\u003c/li\\u003e\\n\\u003cli\\u003eZibako P, Tsikai N, Manyame S, Ginindza TG: \\u003cstrong\\u003eCervical cancer management in Zimbabwe (2019-2020)\\u003c/strong\\u003e. \\u003cem\\u003ePLoS One \\u003c/em\\u003e2022, \\u003cstrong\\u003e17\\u003c/strong\\u003e(9):e0274884.\\u003c/li\\u003e\\n\\u003cli\\u003eKibudde S, Namisango E, Nakaganda A, Atieno M, Bbaale J, Nabwana M, Kiyange F, O’brien M, Luyirika EB, Orem J: \\u003cstrong\\u003eTurnaround time and barriers to treatment of newly diagnosed cancer in Uganda: a mixed-methods longitudinal study\\u003c/strong\\u003e. \\u003cem\\u003eAfrican Health Sciences \\u003c/em\\u003e2022, \\u003cstrong\\u003e22\\u003c/strong\\u003e(1):327-337.\\u003c/li\\u003e\\n\\u003cli\\u003eDegu A, Njogu P, Weru I, Karimi P: \\u003cstrong\\u003eAssessment of drug therapy problems among patients with cervical cancer at Kenyatta National Hospital, Kenya\\u003c/strong\\u003e. \\u003cem\\u003eGynecol Oncol Res Pract \\u003c/em\\u003e2017, \\u003cstrong\\u003e4\\u003c/strong\\u003e:15.\\u003c/li\\u003e\\n\\u003cli\\u003eGebre Y, Zemene A, Fantahun A, Aga F: \\u003cstrong\\u003eAssessment of treatment compliance and associated factors among cervical cancer patients in Tikur Anbessa specialized hospital, oncology unit, Ethiopia 2012\\u003c/strong\\u003e. \\u003cem\\u003eInt J Cancer Stud Res \\u003c/em\\u003e2015, \\u003cstrong\\u003e4\\u003c/strong\\u003e(2):67-74.\\u003c/li\\u003e\\n\\u003cli\\u003eHabinshuti P, Hagenimana M, Nguyen C, Park PH, Mpunga T, Shulman LN, Fehr A, Rukundo G, Bigirimana JB, Teeple S\\u003cem\\u003e et al\\u003c/em\\u003e: \\u003cstrong\\u003eFactors Associated with Loss to Follow-up among Cervical Cancer Patients in Rwanda\\u003c/strong\\u003e. \\u003cem\\u003eAnn Glob Health \\u003c/em\\u003e2020, \\u003cstrong\\u003e86\\u003c/strong\\u003e(1):117.\\u003c/li\\u003e\\n\\u003cli\\u003ePark PH, Davey S, Fehr AE, Butonzi J, Shyirambere C, Hategekimana V, Bigirimana JB, Borg R, Uwizeye R, Tapela N\\u003cem\\u003e et al\\u003c/em\\u003e: \\u003cstrong\\u003ePatient Characteristics, Early Outcomes, and Implementation Lessons of Cervical Cancer Treatment Services in Rural Rwanda\\u003c/strong\\u003e. \\u003cem\\u003eJ Glob Oncol \\u003c/em\\u003e2018, \\u003cstrong\\u003e4\\u003c/strong\\u003e:1-11.\\u003c/li\\u003e\\n\\u003cli\\u003eParveen S, Sajjad R, Masood M, Usmani HA, Sadiq R, Yunus N, Asghar S: \\u003cstrong\\u003eCervical cancer: outcome of treatment and causes of failure\\u003c/strong\\u003e. \\u003cem\\u003eJ Pak Med Assoc \\u003c/em\\u003e2006, \\u003cstrong\\u003e56\\u003c/strong\\u003e(10):436-440.\\u003c/li\\u003e\\n\\u003cli\\u003eIuga AO, McGuire MJ: \\u003cstrong\\u003eAdherence and health care costs\\u003c/strong\\u003e. \\u003cem\\u003eRisk Manag Healthc Policy \\u003c/em\\u003e2014, \\u003cstrong\\u003e7\\u003c/strong\\u003e:35-44.\\u003c/li\\u003e\\n\\u003cli\\u003eLaVigne AW, Triedman SA, Randall TC, Trimble EL, Viswanathan AN: \\u003cstrong\\u003eCervical cancer in low and middle income countries: Addressing barriers to radiotherapy delivery\\u003c/strong\\u003e. \\u003cem\\u003eGynecol Oncol Rep \\u003c/em\\u003e2017, \\u003cstrong\\u003e22\\u003c/strong\\u003e:16-20.\\u003c/li\\u003e\\n\\u003cli\\u003eAbu-Rustum NR YC, Bean S, Bradley K, Campos SM, Chon HS, Chu C, Cohn D, Crispens MA, Damast S, Dorigo O \\u003cem\\u003eet al\\u003c/em\\u003e: \\u003cstrong\\u003eNational Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology: Cervical Cancer (NCCN Guidelines)\\u003c/strong\\u003e. 2019, \\u003cstrong\\u003eVersion 4. 2019\\u003c/strong\\u003e.\\u003c/li\\u003e\\n\\u003cli\\u003eDutta S, Biswas N, Muhkherjee G: \\u003cstrong\\u003eEvaluation of Socio-demographic Factors for Non-compliance to Treatment in Locally Advanced Cases of Cancer Cervix in a Rural Medical College Hospital in India\\u003c/strong\\u003e. \\u003cem\\u003eIndian J Palliat Care \\u003c/em\\u003e2013, \\u003cstrong\\u003e19\\u003c/strong\\u003e(3):158-165.\\u003c/li\\u003e\\n\\u003cli\\u003eNakaganda A, Solt K, Kwagonza L, Driscoll D, Kampi R, Orem J: \\u003cstrong\\u003eChallenges faced by cancer patients in Uganda: implications for health systems strengthening in resource limited settings\\u003c/strong\\u003e. \\u003cem\\u003eJournal of Cancer Policy \\u003c/em\\u003e2021, \\u003cstrong\\u003e27\\u003c/strong\\u003e:100263.\\u003c/li\\u003e\\n\\u003cli\\u003ePfaendler KS, Chang J, Ziogas A, Bristow RE, Penner KR: \\u003cstrong\\u003eDisparities in Adherence to National Comprehensive Cancer Network Treatment Guidelines and Survival for Stage IB-IIA Cervical Cancer in California\\u003c/strong\\u003e. \\u003cem\\u003eObstet Gynecol \\u003c/em\\u003e2018, \\u003cstrong\\u003e131\\u003c/strong\\u003e(5):899-908.\\u003c/li\\u003e\\n\\u003cli\\u003eBoyce-Fappiano D, Nguyen KA, Gjyshi O, Manzar G, Abana CO, Klopp AH, Kamrava M, Orio PF, 3rd, Thaker NG, Mourtada F\\u003cem\\u003e et al\\u003c/em\\u003e: \\u003cstrong\\u003eSocioeconomic and Racial Determinants of Brachytherapy Utilization for Cervical Cancer: Concerns for Widening Disparities\\u003c/strong\\u003e. \\u003cem\\u003eJCO Oncol Pract \\u003c/em\\u003e2021, \\u003cstrong\\u003e17\\u003c/strong\\u003e(12):e1958-e1967.\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":true,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-cancer\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"bcan\",\"sideBox\":\"Learn more about [BMC Cancer](http://bmccancer.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/bcan/default.aspx\",\"title\":\"BMC Cancer\",\"twitterHandle\":\"BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Cervical cancer, Treatment compliance, Uganda\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-2280112/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-2280112/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003ch2\\u003eBackground\\u003c/h2\\u003e \\u003cp\\u003eCervical cancer is one of the most common cancers and a major cause of morbidity among women globally. Chemoradiation therapy is the preferred standard treatment for women with stage IB to IVA. However, the benefits of this treatment can only be achieved if patients adhere to the treatment guidelines. In this study, the proportion of compliance or adherence to chemo-radiation treatment among cervical cancer patients at Uganda Cancer Institute (UCI) was determined.\\u003c/p\\u003e\\u003ch2\\u003eMethods\\u003c/h2\\u003e \\u003cp\\u003e This was a cross-sectional study that reviewed data retrospectively for 196 cervical cancer patients who were prescribed to chemo-radiation therapy at UCI between November 2020 to May 2021, having been diagnosed with disease stage IB to IVA. Patient data and information on treatment uptake was obtained by review of the patient\\u0026rsquo;s medical records. Treatment compliance was determined by calculating the number of participants who completed the prescribed treatment (definitive pelvic concurrent chemoradiation to 50 Gy external beam radiotherapy with weekly concurrent cisplatin followed by intracavitary brachytherapy 24 Gy in 3 fractions at 8 Gy once a week over 3 weeks). Associations between patient factors and treatment adherence were determined using logistic regression analysis. In all statistical tests, a P- value of \\u0026lt;\\u0026thinsp;0.05 was considered as significant.\\u003c/p\\u003e\\u003ch2\\u003eResults\\u003c/h2\\u003e \\u003cp\\u003eThe proportion of patients who were administered with external beam radiation (EBRT), chemotherapy and brachytherapy were 82.6%, 52.04% and 66.2% respectively. However, only 23 of 196 patients (11.7%) were found to have adhered to the treatment plan by completion of all definitive pelvic concurrent chemoradiation to 50 Gy external beam radiotherapy (5 weeks) with weekly concurrent cisplatin (5 cycles) followed by intracavitary brachytherapy 24 Gy in 3 fractions at 8 Gy once a week over 3 weeks (3 sessions). There were no significant aassociations between patient factors and treatment adherence after multivariable analysis.\\u003c/p\\u003e\\u003ch2\\u003eConclusions\\u003c/h2\\u003e \\u003cp\\u003eTreatment compliance was found in only 12% of the cohort participants. No association of patient factors with treatment compliance was found. Additional studies on treatment adherence with larger sample sizes are needed to confirm the associations.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Treatment compliance among adult cervical cancer patients receiving care at Uganda Cancer Institute, Uganda: a retrospective data review\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2022-11-29 17:26:39\",\"doi\":\"10.21203/rs.3.rs-2280112/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0},{\"type\":\"decision\",\"content\":\"Major revision\",\"date\":\"2023-04-11T04:14:23+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2023-04-08T19:14:27+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"0b2f77c0-3ac5-4038-9f7a-8ccdd53662ef\",\"date\":\"2023-03-29T09:30:54+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewersInvited\",\"content\":\"\",\"date\":\"2023-03-29T01:46:38+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorAssigned\",\"content\":\"\",\"date\":\"2023-03-16T13:34:46+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvited\",\"content\":\"\",\"date\":\"2022-11-24T15:36:39+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"checksComplete\",\"content\":\"\",\"date\":\"2022-11-24T15:31:13+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"submitted\",\"content\":\"BMC Cancer\",\"date\":\"2022-11-16T11:21:24+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-cancer\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"bcan\",\"sideBox\":\"Learn more about [BMC Cancer](http://bmccancer.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/bcan/default.aspx\",\"title\":\"BMC Cancer\",\"twitterHandle\":\"BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"09b220f6-111e-4899-9bdf-0925ec9653dc\",\"owner\":[],\"postedDate\":\"November 29th, 2022\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"published-in-journal\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2023-10-16T21:50:19+00:00\",\"versionOfRecord\":{\"articleIdentity\":\"rs-2280112\",\"link\":\"https://doi.org/10.1186/s12885-023-11145-1\",\"journal\":{\"identity\":\"bmc-cancer\",\"isVorOnly\":false,\"title\":\"BMC Cancer\"},\"publishedOn\":\"2023-07-05 21:32:50\",\"publishedOnDateReadable\":\"July 5th, 2023\"},\"versionCreatedAt\":\"2022-11-29 17:26:39\",\"video\":\"\",\"vorDoi\":\"10.1186/s12885-023-11145-1\",\"vorDoiUrl\":\"https://doi.org/10.1186/s12885-023-11145-1\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-2280112\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-2280112\",\"identity\":\"rs-2280112\",\"version\":[\"v1\"]},\"buildId\":\"7rjqhiLT3MXkJMwkYKINL\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}