Background
Methods
Study design and setting
Country | Namibia | Nigeria | Uganda |
---|---|---|---|
Site | Public: AB May Cancer Care Centre, Windhoek Central Hospital | Public: Federal Medical Centre Owerri and Abia State University Teaching Hospital; Private: Marantha clinic, Aba | Public: Mulago Hospital and Uganda Cancer Institute, Kampala |
Catchment population | National | Federal | National |
ABC-DO participants* | 104 non-black and 398 black women | 313 public, 80 private patients | 430 |
Medical treatment: approximate patient out-of-pocket costs in USD, at time of study | |||
Imaging | |||
Mammography (diagnostic) | Free | 22 | 30 |
Computer tomography | Free | 145 | 100 |
BiopsyA | Free | 85 | 10 |
Fine-needle aspiration cytology (FNAC)A | Free | 6 | 10 |
Immunohistochemistry (IHC)AB | Free | Not available | 70 |
Full blood tests | Free | 40 | 5 |
ECG | Free | 90 | 20 |
Mastectomy | Free | 250 | Free |
Pre-chemotherapy tests | Free | No information | 50–400 |
Chemotherapy per cycle | Free | 65–1500 | 120–200 |
Hormone drugs/month | |||
Tamoxifen | Free | 40 | 10–20 |
Anastrazole | Free | 20 | 50–60 |
Herceptin | Free | 1100 | 3000 |
Radiotherapyc | Free | Nearest public radiotherapy facility is 150 km away from Enugu | Freec |
Treatment data
Determinants of treatment received
Statistical methods
Results
Study population
Percentage of women who had not initiated cancer treatment
Women not treated 227 (17.2%) | Women treated 1098 (82.8%) | Odds ratios for initiating treatment within 12 months of diagnosis | Test for interaction with population group | |||
---|---|---|---|---|---|---|
N (row %), all sites combined | OR (95% CI)A | OR (95% CI)B |
p
| |||
Stage at breast cancer diagnosis | 0.408 | |||||
I and II | 47 (10.4) | 403 (89.6) | 1 | 1 | ||
III | 101 (16.9) | 496 (83.1) | 0.86 (0.57 to 1.28) | 0.96 (0.63 to 1.45) | ||
IV | 41 (20.1) | 163 (79.9) | 0.60 (0.36 to 0.98) | 0.63 (0.37 to 1.07) | ||
Unknown | 38 (51.4) | 36 (48.6) | 0.26 (0.14 to 0.45) | 0.26 (0.14 to 0.48) | ||
Age at diagnosis | 0.640 | |||||
< 40 | 64 (20.9) | 243 (79.1) | 0.70 (0.44 to 1.10) | 0.68 (0.42 to 1.10) | ||
40–< 50 | 65 (17.4) | 308 (82.6) | 0.83 (0.53 to 1.30) | 0.77 (0.48 to 1.23) | ||
50–< 60 | 46 (14.3) | 276 (85.7) | 1 | 1 | ||
60–< 70 | 32 (16.2) | 165 (83.8) | 0.76 (0.44 to 1.30) | 0.74 (0.42 to 1.31) | ||
≥ 70 | 20 (15.8) | 107 (84.2) | 0.48 (0.25 to 0.93) | 0.57 (0.29 to 1.16) | ||
SEP | 0.917 | |||||
Low | 129 (21.5) | 408 (78.5) | 1 | 1 | ||
Middle | 56 (15.1) | 382 (84.9) | 1.20 (0.81 to 1.79) | 1.17 (0.77 to 1.76) | ||
High | 42 (11.8) | 246 (88.2) | 2.40 (1.56 to 3.69) | 2.45 (1.53 to 3.90) | ||
Employment | 0.941 | |||||
Unskilled | 172 (18.8) | 751 (81.2) | 0.70 (0.48 to 1.02) | 0.83 (0.56 to 1.23) | ||
Skilled | 55 (13.8) | 348 (86.2) | 1 | 1 | ||
BMI | (kg/m2) | 0.023 | ||||
< 18.5 | 9 (11.6) | 124 (88.4) | 1.58 (0.70 to 3.59) | 1.83 (0.79 to 4.21) | ||
18.5–25 | 103 (20.4) | 404 (89.6) | 1 | 1 | ||
25–30 | 67 (17.5) | 315 (82.5) | 1.09 (0.74 to 1.59) | 0.96 (0.65 to 1.41) | ||
30+ | 35 (11.5) | 269 (88.5) | 1.76 (1.10 to 2.81) | 1.53 (0.95 to 2.47) | ||
Residential area | 0.123 | |||||
Urban | 112 (16.5) | 569 (83.5) | 1 | 1 | ||
Rural | 115 (17.9) | 530 (82.1) | 0.88 (0.61 to 1.25) | 1.07 (0.73 to 1.56) | ||
Breast cancer knowledge | 0.286 | |||||
Yes | 170 (15.8) | 905 (84.2) | 1 | 1 | ||
No | 57 (22.7) | 194 (77.3) | 0.80 (0.54 to 1.17) | 0.81 (0.55 to 1.21) | ||
Belief in traditional medicine | 0.013 | |||||
Yes | 80 (25.2) | 238 (74.8) | 0.63 (0.44 to 0.89) | 0.67 (0.47 to 0.97) | ||
No | 147 (14.6) | 860 (83.4) | ||||
Belief in spiritual healing | 0.004 | |||||
Yes | 149 (17.4) | 727 (82.6) | 1.18 (0.83 to 1.68) | 1.21 (0.84 to 1.21) | ||
No | 78 (17.0) | 371 (83.0) | 1 | |||
HIV statusC | n.a. | |||||
Negative | 61 (16.1) | 1143 (83.9) | 1 | 1 | ||
Positive | 16 (32.0) | 39 (68.0) | 0.39 (0.19 to 0.79) | 0.33 (0.16 to 0.70) |