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Advisory Committee Chair

Maja Altarac

Advisory Committee Members

Russell Kirby

Leslie A McClure

Beverly Mulvihill

Isabel Scarinci

Document Type

Dissertation

Date of Award

2009

Degree Name by School

Doctor of Public Health (DrPH) School of Public Health

Abstract

In Colombia, cervical cancer is the most common cancer among women with incidence (36.4/100,000) and mortality rates (18/100,000) much higher than those of the U.S. (7.7 and 2.3 respectively). About 70% of the Colombian population has health care coverage (HCC) through the subsidized regime (SR) which serves the poorest persons and the contributory regime (CR) which serves the working population. Our goal was to determine the role that HCC plays in cervical cancer screening follow-up among Colombian women. A population-based cross-sectional study of 24,717 women between the ages of 18 and 49, using the 2005 Demographic and Health Survey was conducted. In our study, cervical cancer screening follow-up was measured by obtaining Pap smear results and having a follow-up of abnormal results. Nearly 4% of women did not seek their results and 5.4% sought their results but did not obtain them. Approximately 17% of women did not have a follow-up of abnormal results. Women without HCC and those in the SR were less likely to obtain Pap smear results than women in the CR, even after adjusting for socio-demographic factors (ORa:0.51; 95%CI:0.42,0.62 and ORa:0.68; 95%CI:0.56,0.84, respectively). Similar results were found for follow-up of abnormal results (ORa:0.71; 95%CI:0.54,0.95 and ORa:0.75; 95%CI:0.57,0.98, respectively). However, given the extent of confidence iv intervals, findings for follow-up of abnormalities need to be interpreted with caution. Other variables associated with both obtaining results and follow-up of abnormalities were geographic region, perceived health status, and health care visits within the last year. The main barriers women listed for not obtaining results were: institution did not return the results and that they were not interested in the results. The main barriers for not having a follow-up of abnormalities were: laziness/lack of interest, lack of economic resources, fear. At least in the short term, universal HCC for all women may not be realistic. However, we can start improving cervical cancer prevention services for those enrolled in the SR. Based on previous literature, some of the barriers in the health care system in Colombia appear to be of an administrative nature. Educational strategies addressing the importance of timely follow-up are also important.

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