Prevalence and associated factors of baseline anemia among cervical cancer patients in Tikur …
Study design, period and area
Institutional based cross-sectional study was done at the cancer center of TASH from March to April 2019. TASH is the biggest referral public hospital in Ethiopia established in 1972. It is the training center of health professionals including undergraduate and postgraduate medical students, dentists, nurses, pharmacists, laboratory technicians and others paramedics.
The hospital is staffed by many health professionals from various disciplines. It has total beds of 800 and the beds reserved for cancer care are 20. TASH is the only center providing comprehensive cancer care in Ethiopia.
Populations
All medical records of women diagnosed with cancer of the cervix in TASH cancer center were source populations and all medical records of cancer of the cervix who attended in cancer center of TASH from January 1, 2014 to December 31, 2016 were study populations. Cervical cancer patients with incomplete medical charts and charts that were not found during data collection period were excluded.
Sample size determination, sampling procedure and study variables
All patients with cancer of the cervix diagnosed at TASH cancer center from January 2014 to December 2016 was the total sample size. Census sampling procedure was used and the procedure was as follows: at the beginning, profiles of all women with cancer of the cervix who diagnosed between January 2014 to December 2016 in the TASH was assessed and 1227 cervical cancer patient charts were found. 634 charts that fulfilled the inclusion criteria (charts with complete information) were identified and finally data were collected from 634 patient medical records. Baseline anemia was the outcome variable and Sociodemographic characteristics (marital status, residential address, age at diagnosis, substance use, number of children, region, occupation, religion), pathological and clinical factors (stage at presentation, histology type, comorbidity and types of comorbidity) were independent variables.
Operational definitions
Anemia: patients’ Hb level below 12.0 g/dl was classified as anemic [14, 15]
Comorbidity: The presence of any conditions (mentioned in the Carlson comorbidity Index [16]) other than cervical cancer at diagnosis which was designated as “yes” in the checklist.
Substance use: Patients who used one, two or all of the three substances (cigarate, chat and alcohol) [17].
Stage at diagnosis: The revised FIGO staging for carcinoma of the vulva, cervix, and endometrium was used in this study [18].
Data collection instrument, quality assurance and collection procedures
Data were collected from patients’ charts using pre-tested and structured checklist prepared in English. The checklist consisted of two parts: (1) sociodemographic and individual level factors and (2) pathological and clinical factors. Two supervisors having second degree in oncology nursing and three data collectors having first degree in nursing were involved in the data collection process. One day intensive training was given to data collectors and supervisors. Pretest was conducted by considering 5% of the total sample size to test its consistency with actual data collection in the charts recorded during the study period and necessary corrections were done accordingly. Every day after data collection, checklists were reviewed and checked for completeness, accuracy and clarity by the supervisors and principal investigator and the necessary feedback was offered to data collectors.
Data processing and analysis
Data were coded and then entered, edited and cleaned using Epi-data 3.1 and exported to STATA14.2 statistical software for analysis. Frequencies, proportions and descriptive statistics were used to describe the study population in relation to relevant variables and was presented using tables and graphs. Binary logistic regression model was used to analyze factors that affect the outcome variable.
Before running the Binary logistic regression model, assumption of the model fitness was checked. The model assumption was checked using Hosmer and Lemeshow test and the test result with P value > 0.05 indicates the data fulfilled the model assumption [19]. The P vale of Hosmer and Lemeshow test was 0.129 in this study indicating the data fitted the binary logistic regression model. Variables in multivariable binary logistic regression with a P value < 0.05 were considered to have actual interference with the outcome variable(anemia) with 95% confidence interval.
Ethical clearance
Ethical approval for this study was obtained from the Institutional Review Boards of school of nursing and midwifery, Addis Ababa University. The letter of permission was written from school of nursing and midwifery to the cancer center of TASH. Then, the cancer center chief administrator allowed to collect the data from the cervical cancer patents medical records. The study was conducted without individual informed consent since it relies on chart review.
Published at Mon, 25 Jan 2021 10:41:15 +0000