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Factors Associated With Late-stage Oesophageal Cancer Presentation in an Arid Pastoralist Setting: A Cross-sectional Study at Wajir County Referral Hospital, Kenya
Background: Oesophageal cancer carries a disproportionate burden in sub-Saharan Africa, yet factors associated with late-stage presentation in arid and semi-arid land (ASAL) settings remain unquantified. We aimed to identify socioeconomic and health system factors associated with late-stage presentation among patients attending Wajir County Referral Hospital (WCRH), Kenya.
Methods: We conducted an analytical cross-sectional study at WCRH, the sole Level 5 referral facility in Wajir County (population 831,353). Adults aged ≥25 years with biopsy-confirmed oesophageal cancer were enrolled consecutively over eight weeks. The primary outcome was late-stage presentation (AJCC 8th edition Stage III or IV). Associations were examined by Firth’s penalised logistic regression to address the small early-stage event count (n=4).
Findings: Of 77 participants, 73 (94·8%) presented with Stage III or IV disease. In a parsimonious multivariable model, visiting three or more health facilities before diagnosis was the only exposure independently associated with late-stage presentation (adjusted odds ratio [aOR] 20·71, 95% CI 2·09–378·44; p=0·009). Transport expenditure ≥1,000 Kenyan shillings (KES) was significant on bivariate analysis (Firth OR 10·92, 95% CI 1·63–120·18; p=0·014) but attenuated after adjustment (aOR 3·81, 95% CI 0·39–43·47; p=0·198). Diagnostic system delay accounted for 59·7% of predominant delays. With four early-stage events, adjusted estimates are exploratory and confidence intervals wide; findings were preserved in a pre-specified sensitivity analysis (n=74).
Interpretation: Late-stage oesophageal cancer presentation in this ASAL setting appears closely associated with health system fragmentation rather than patient-side awareness deficits, although the exploratory nature of the multivariable analysis precludes definitive causal inference. Referral pathway reform, sub-county diagnostic capacity expansion, and transport subsidisation warrant evaluation as priorities within Kenya’s National Cancer Control Strategy.
Mohamed, Jamal Abade and Abdullahi, Dr Samar Rashid and Sigat, Dr Hussein Iman and Ahmed, Dr Abdirahman Mohamed, Factors Associated With Late-stage Oesophageal Cancer Presentation in an Arid Pastoralist Setting: A Cross-sectional Study at Wajir County Referral Hospital, Kenya. Available at SSRN: https://ssrn.com/abstract=6861464 or http://dx.doi.org/10.2139/ssrn.6861464
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