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01.12.2014 | Research article | Ausgabe 1/2014 Open Access

BMC Health Services Research 1/2014

Predictors of default from follow-up care in a cervical cancer screening program using direct visual inspection in south-western Nigeria

BMC Health Services Research > Ausgabe 1/2014
Oliver Chukwujekwu Ezechi, Karen Odberg Petterson, Titilola A Gabajabiamila, Ifeoma Eugenia Idigbe, Olutunmike Kuyoro, Innocent Achaya Otobo Ujah, Per Olof Ostergren
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1472-6963-14-143) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

OCE conceived, designed the study, supervised data collection, analyzed the data, drafted the paper and approved the final version. TAG, IEI and OK contributed to study design, collected the data and the draft of the paper. IAOU co-supervised the study, contributed to study design, reviewed result of data analysis and draft for important intellectual content. KOP and POO contributed to the conception, modified the original concept and design, supervised the study, reviewed and contributed to the manuscript drafts. All authors read and approved the final manuscript.



Increasingly evidence is emerging from south East Asia, southern and east Africa on the burden of default to follow up care after a positive cervical cancer screening/diagnosis, which impacts negatively on cervical cancer prevention and control. Unfortunately little or no information exists on the subject in the West Africa sub region. This study was designed to determine the proportion of and predictors and reasons for default from follow up care after positive cervical cancer screen.


Women who screen positive at community cervical cancer screening using direct visual inspection were followed up to determine the proportion of default and associated factors. Multivariate logistic regression was used to determine independent predictors of default.


One hundred and eight (16.1%) women who screened positive to direct visual inspection out of 673 were enrolled into the study. Fifty one (47.2%) out of the 108 women that screened positive defaulted from follow-up appointment. Women who were poorly educated (OR: 3.1, CI: 2.0 – 5.2), or lived more than 10 km from the clinic (OR: 2.0, CI: 1.0 – 4.1), or never screened for cervical cancer before (OR: 3.5, CI:3:1–8.4) were more likely to default from follow-up after screening positive for precancerous lesion of cervix . The main reasons for default were cost of transportation (48.6%) and time constraints (25.7%).


The rate of default was high (47.2%) as a result of unaffordable transportation cost and limited time to keep the scheduled appointment. A change from the present strategy that involves multiple visits to a “see and treat” strategy in which both testing and treatment are performed at a single visit is recommended.
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