Examining Social Determinants of Health and Cervical Cancer Risk and Outcomes in Ecuadorian Women
Background and Significance: The burden of cervical cancer in the Latin American region is high. The crude incidence rate and the crude mortality rate in Ecuador are significantly higher than that of South America and the World. Riobamba, Ecuador, where the Fundación Internacional Buen Samaritano Paul Martel (FIBUSPAM) hospital is located, has been found to be one of the cities most affected with cervical cancer in the country. Risk factors for cervical cancer that have been identified in Latin American women include chronological age, age of first sexual intercourse, number of sexual partners, number of pregnancies, use of oral contraceptives, smoking, and Sexually Transmitted Disease (STD) status. Barriers in accessibility to cervical cancer screening in Latin American women include health-system related, social, and cultural barriers. Objective/Hypotheses: The purpose of the study is to identify factors associated with the risk of cervical cancer in Ecuadorian women. This study also seeks to identify the factors associated with preventing Ecuadorian women from accessing cervical cancer screening services. The first hypothesis is that in Ecuadorian women, risk factors of smoking, oral contraception use, age, age of first sexual encounter, number of sexual partners, previous positive STD test, previous diagnosis of specific STDs, number of children, ethnicity, and socioeconomic status, will be associated with a positive Visual Inspection with Acetic Acid (VIA) result. The second hypothesis is that in Ecuadorian women, VIA result, past healthcare services access, level of education received, socioeconomic status, and ethnicity will be associated with time taken to healthcare facility and type of transport used to reach the healthcare facility. Methods: A secondary data analysis was executed on a cervical cancer dataset collected from February 2017 to May 2017 from the FIBUSPSAM cervical cancer program, which used a screen-and-treat method of screening 1000 Ecuadorian women with a VIA test and treating them with cryotherapy. Results: There was a statistically significant difference in the percent of people who have ever used birth control and VIA result (p=0.006, X2=12.57). There was a statistically significant difference in the percent of people by ethnicity and type of transport used to reach the clinic (p=0.000, X2=54.90). Also, there was a statistically significant difference in the percent of people by education and type of transport used to the health care facility (p=0.000, X2=71.83). It was also found that age had a statistically significant impact on VIA result F(3, 929)= 5.509, p=0.001. Finally, the time taken to seek services at the healthcare facility differed significantly by ethnicity H-value=17.02 df=3, p=0.001. Conclusions/Recommendations: Study findings indicate that birth control usage and age were significantly associated with VIA result. Additionally, ethnicity and highest education level received were significantly associated with type of transport used to reach the healthcare facility. Finally, ethnicity was significantly associated with time taken to healthcare facility. These findings advance literature related to cervical cancer risk and access to cervical cancer services and the health consequences for minority and medically-underserved communities globally. For priority communities, policies consistent with these results can be proposed to the Ministry of Public Health in Ecuador to increase cervical cancer screening programs that incorporate population/region specific risk factors and barriers.
Public health|Latin American Studies
Tewari, Pooja, "Examining Social Determinants of Health and Cervical Cancer Risk and Outcomes in Ecuadorian Women" (2022). ETD Collection for University of Texas, El Paso. AAI29209979.