Colorectal cancer screening in Zambia

3 December, 2021

Dear HIFA and HIFA-Zambia colleagues,

The authors of this conference poster note that colorectal cancer screening is 'rarely practiced in most African countries' and reveal 'poor colorectal cancer screening knowledge and attitudes among medical doctors in Zambia'. Citation, abstract and a comment from me below.

CITATION: Colorectal Cancer Screening in Zambia, Southern Africa: A Nationwide Survey on Knowledge, Attitudes, and Practices (KAP) Amongst Medical Doctors

Conference poster, October 26, 2021. Comfort Asante et al.


Introduction: Colorectal cancer (CRC) is a global public health problem that requires early diagnosis and management to decrease mortality and morbidity. Yet, despite the existence of international CRC screening guidelines and recommendations, CRC screening is rarely practiced in most African countries and Zambia is no exception. We conducted a survey to understand the knowledge, attitudes, and practices about colorectal cancer screening among medical doctors in Zambia and assessed treatment referral patterns.

Methods: A multi-institutional cross-sectional study of all registered medical doctors working in Zambia using a self-administered online structured survey was carried out. The survey comprised of 23 standardized qualitative and quantitative questions. Descriptive analysis was used to describe frequencies of the variables; chi square analysis was used to determine associations between knowledge, attitudes and practices and multiple logistic regression was used to describe associations between knowledge of CRC screening and referral patterns. Statistical significance was evaluated at P <0.05.

Results: Out of 243 medical doctors, 147 medical doctors completed the survey giving us a response rate of 61%. Of the respondents 93 (63.3%) were male, with mean years in clinical practice of 3 years (± 3.4 years). Most see about 60 patients per day. One-third (n=50, 34%) of respondents had good knowledge on the appropriate age of initiation of CRC screening, while almost all (n=138, 95.2%) had poor knowledge on the screening modalities of CRC. Three-fifths (n=84, 60%) exhibited poor attitudes towards CRC, while more than half (n=86, 58.5%) report having referred patients for some form of CRC treatment in past year. There was no association between the knowledge and attitude towards screening (p= 0.948) or knowledge of CRC screening practices (p= 0.414) and referral patterns (p=0.433). Provider factors associated with CRC screening include a reduced clinic patient volume (p= 0.0176), and patient factors include family history of ulcerative colitis (p= 0.0151), having at least one first degree relative with CRC younger than 50 (p=0.0542), and knowledge that screening impacts management (p= 0.0571).

Discussion: The poor colorectal cancer screening knowledge and attitudes among medical doctors in Zambia suggests a need for studies that explore the magnitude of association between knowledge and practices to help establish national screening guidelines.

COMMENT (NPW): This research is potentially important, but raises a number of questions: What is the disease burden of colorectal cancer in Zambia? What is the policy of the Ministry of Health of Zambia regarding screening for colorectal cancer? If there is a national policy, to what extent is this being implemented and what are the barriers? I invite HIFA and HIFA-Zambia colleagues to comment.

Neil Pakenham-Walsh, HIFA Coordinator,