High rate of loss to follow-up among patients undergoing treatment for premalignant cervical lesions at Mbarara Regional Referral Hospital, South Western Uganda; a retrospective cohort study

Abstract

Abstract Background For a cervical cancer control program to be effective in reducing incidence of the disease, there should be a high compliance to treatment and follow-up of the women diagnosed with precursor lesions. Screening programs in low-resource countries like Uganda are challenged by poor adherence to follow-up following treatment for premalignant cervical lesions. This study sought to describe the burden and factors associated with loss to follow-up among women undergoing treatment for premalignant cervical lesions at a tertiary hospital in south-western UgandaMethods This was a retrospective cohort study. We reviewed the registers at the Mbarara Regional Referral Hospital cervical cancer clinic for a period of four years from January 2017 to December 2020. Data was collected on; age, district of residence, diagnosis, date of diagnosis, date and type of initial treatment as well as date of follow up visit. We also captured data on whether patients returned on the scheduled follow up date or within three months after the scheduled follow up date. We defined loss to follow-up as failure to return for follow up either on the scheduled date or within three months after the scheduled date.Results Out of the 298 patients who underwent treatment for premalignant cervical lesions in the study period, 227(76.2%) did not return for follow-up at one year. At bivariate analysis, failure to attend the review visit at 6weeks predicted the loss to follow up at one year following treatment for premalignant lesions almost perfectly (RR = 2.84, 95% CI: 2.18–3.71, p-value < 0.001). Negative HIV serostatus and receiving thermocoagulation, slightly increased the risk of getting lost to follow-up while being more than 45years old reduced the odds. At multi-variate analysis, treatment with thermocoagulation (ARR = 1.21, 95% CI:1.07,1.36, p-value-0.03) was associated with loss to follow-up at one year.Conclusion The proportion of women who don’t return for follow-up at one year following treatment for premalignant cervical lesions at Mbarara regional referral hospital is very high. There is need to implement strategies that prompt patients to return for follow-up following treatment for premalignant cervical lesions.