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Evaluation of pathology resources for cervical cancer detection between 2018 and 2022: a retrospective study at Moi
Nelson Anangwe1,2, Jon Steimgrimson3, Susan Cu-Uvin3
1School of Public Health, Moi University, Eldoret, 4606 - 30100, Kenya. nelson_anangwe@alumni.brown.edu.
Background:
Cervical cancer cases are increasing in sub-Saharan Africa, particularly in Kenya, exacerbated by inadequate histopathology resources, posing a significant barrier to timely diagnosis and treatment. There has been little research on the availability and evolution of histopathology resources for diagnosing cervical cancer over the years. This retrospective study evaluated this evolution at Moi Teaching and Referral Hospital in Kenya between 2018 and 2022.
Methods:
We used a mixed-methods approach. An in-depth interview was conducted with one of MTRH's pathology laboratory staff to assess the equipment, personnel, and quality control trends between 2018 and 2022. A thematic analysis was conducted in NVivo. We also retrospectively conducted a comprehensive inventory review of laboratory resources from 2018 to 2022 via purposive sampling. Microsoft Excel and Stata version 17 were utilized for descriptive statistical analysis. Turnaround time (TAT) was assessed against the UK's National Health Service Cervical Screening Program guidelines.
Results:
The number of histopathology laboratory personnel at MTRH increased from 2018 to 2022, during which the facility included two pathologists, one records person, and one office administrator. Cervical cancer biopsy samples processed by the histopathology lab increased from 225 in 2018 to 674 in 2022. However, the histopathology personnel-to-population ratio decreased from 1.5 pathologists and 2.7 histo-technicians per 100,000 in 2018 to 1.4 pathologists and 1.8 histo-technicians per 100,000 in 2022. Despite this decrease, lab equipment, automatic tissue processors and embedding machines were added, and an average 14-day turnaround time was maintained for cervical cancer pathology reports.
Conclusions:
Our study highlights a growing burden of cervical cancer with biopsy samples processed by the MTRH histopathology laboratory, increasing from 225 in 2018 to 674 in 2022. Despite challenges such as a declining staff-to-patient ratio and limited resources, the lab maintained a commendable 14-day turnaround time, supporting timely cervical cancer diagnoses. These findings emphasize the need for continued investment in pathology resources and personnel to enhance diagnostic capacity and address the rising incidence of cervical cancer in Kenya and similar low-resource settings. The decline in the personnel-to-patient ratio underscores challenges in diagnosis, emphasizing the need to address workforce and infrastructure gaps to improve patient care within similar low-resource settings.
