Health facility preparedness for early detection of symptomatic cancer in Southern Africa: a multi-centre cross-sectional study
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Abstract
Background For early detection and diagnosis of cancer to become a reality in African contexts, health services should identify people with symptoms suggestive of cancer, refer timeously, and implement diagnostic processes efficiently. This requires health facilities to have the necessary resources and infrastructure to provide these services. This study, the first in Southern Africa, reports on the availability of these services across referral pathways in four provinces of two Southern African countries, South Africa (SA) and Zimbabwe. Methods As part of the African Awareness of Cancer and Early Diagnosis (AWACAN-ED) programme, we conducted a quantitative cross-sectional study, from February to September 2023 at primary, secondary and tertiary level public sector health facilities. Data were collected on the availability of staff, infrastructure, diagnostic services, referral pathways and community engagement, and analysed descriptively. Results A total of thirty-four (N=34) facilities were included. Of these, twenty-two were primary care facilities, serving an estimated population of 1,068,177, with a nurse-to-people ratio of 0.46 per 1000 people, and doctor-to-people ratio of 0.04 per 1000 people. Twelve (n=12) secondary/tertiary (ST) facilities were included, serving a population of 18,750,387, with a nurse-to-people ratio of 0.3 per 1000 people, and doctor-to-people ratio of to 0.06 per 1000 people. There were differences between primary care versus secondary/tertiary facilities in availability of adequate communication infrastructure (29% vs 42%); patient transport systems (50% vs 100%); cervical smears/visual inspection (77% vs 100%) and colorectal clinical assessment (9% vs 58%). Mammography was not available at any Zimbabwean facilities. There was low availability of clinical protocols in primary care for cervical (30%) and breast (9%) cancer, and none for colorectal cancer. Community engagement activities focused on breast and cervical cancer. Conclusion This study identifies areas for improving early cancer diagnosis and provides a baseline for quality improvement interventions in facility infrastructure and referral pathways.
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Abstract
Background For early detection and diagnosis of cancer to become a reality in African contexts, health services should identify people with symptoms suggestive of cancer, refer timeously, and implement diagnostic processes efficiently. This requires health facilities to have the necessary resources and infrastructure to provide these services. This study, the first in Southern Africa, reports on the availability of these services across referral pathways in four provinces of two Southern African countries, South Africa (SA) and Zimbabwe.
Methods
As part of the African Awareness of Cancer and Early Diagnosis (AWACAN-ED) programme, we conducted a quantitative cross-sectional study, from February to September 2023 at primary, secondary and tertiary level public sector health facilities. Data were collected on the availability of staff, infrastructure, diagnostic services, referral pathways and community engagement, and analysed descriptively.
Results
A total of thirty-four (N=34) facilities were included. Of these, twenty-two were primary care facilities, serving an estimated population of 1,068,177, with a nurse-to-people ratio of 0.46 per 1000 people, and doctor-to-people ratio of 0.04 per 1000 people. Twelve (n=12) secondary/tertiary (ST) facilities were included, serving a population of 18,750,387, with a nurse-to-people ratio of 0.3 per 1000 people, and doctor-to-people ratio of to 0.06 per 1000 people. There were differences between primary care versus secondary/tertiary facilities in availability of adequate communication infrastructure (29% vs 42%); patient transport systems (50% vs 100%); cervical smears/visual inspection (77% vs 100%) and colorectal clinical assessment (9% vs 58%). Mammography was not available at any Zimbabwean facilities. There was low availability of clinical protocols in primary care for cervical (30%) and breast (9%) cancer, and none for colorectal cancer. Community engagement activities focused on breast and cervical cancer.
Conclusion
This study identifies areas for improving early cancer diagnosis and provides a baseline for quality improvement interventions in facility infrastructure and referral pathways.
Competing Interest Statement
The authors have declared no competing interest.
Funding Statement
This research was funded by the NIHR (NIHR133231) using UK international development funding from the UK Government to support global health research. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the UK government.
Author Declarations
I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.
Not Applicable
The details of the IRB/oversight body that provided approval or exemption for the research described are given below:
University of Zimbabwe Research Ethics Committee University of Cape Town Human Research Ethics Committee
I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.
Not Applicable
I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).
Not Applicable
I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.
Not Applicable
Data Availability
The full dataset is available on request from the corresponding author at tasleem.ras{at}uct.ac.za
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