Social determinants of follow up of women with abnormal Pap smear in Buenos Aires, Argentina

PAOLINO M; ARROSSI S

Congreso; 5to. Congreso Internacional de Control de Cáncer; 2013

Background Follow up of positive screening test to complete diagnosis and treatment is one of the main priorities to reduce cervical cancer incidence and mortality. However, it remains a challenge of screening programs.   Objectives 1) To analyze social determinants of abandonment of follow up and treatment of women with abnormal Pap smear, and 2) to describe the reasons for abandonment.   Methodology We carried out a survey among women who were screened at public health services from the District of Florencio Varela (Metropolitan Area of Buenos Aires), and had an abnormal Pap result, during the period 2009-2011. A face-to-face interview was performed using a structured questionnaire that included questions about socio-economic characteristic, reasons for abandonment and institutional barriers to attendance.     Results Of the 374 women with an abnormal Pap during 2009-2011, we were able to contact 221 (59%). 22% of interviewed women abandoned the follow up and treatment processes. Main reasons for abandonment were health care organization problems (39%) and Childcare (21%). In the first multivariate analysis (adjusted by socio-economic variables) women with children aged less than 5 years were 2.4 times more likely to abandon than women without children aged less than 5 years (95% IC: 1,2 ? 4,8). In the second model (adjusted by socio-economic and institutional variables) women who lived in overcrowded conditions were 2.9 times more likely to abandon than women who did not lived in overcrowded conditions (95% IC: 1.2 ? 7.3), and women who were screened in primary health care center were 4.6 times more likely to abandon than women who were screened in general hospital (95% IC: 1.7 ? 12.3).   Conclusion Women?s life conditions and institutional factors are social determinants of abandonment. These data underscore the importance of designing specific strategies to encourage and support women to attend diagnosis work up and eventual treatment.