Delayed health-seeking behavior and its associated factors among cancer patients in Ethiopia: A systematic review and meta-analysis, 2025

Clinical Snapshot

Key Findings

• P Value: Not reported in abstract; statistical significance inferred from CIs not crossing 1.0 for all AORs

• Effect Size: Pooled prevalence 54%; Rural residence AOR 3.00; Poor cancer knowledge AOR 6.63; Lack of cancer awareness AOR 2.63; Absence of pain AOR 3.38

• Primary Outcome: Pooled prevalence of delayed health-seeking behavior among cancer patients in Ethiopia: 54% (95% CI: 39%–68%) based on seven studies with 2,641 participants

• Nnt Or Sensitivity: Not applicable for prevalence meta-analysis; no NNT, sensitivity, or specificity data reported. Odds ratios represent association strength for identified risk factors of delayed presentation.

• Confidence Interval: Prevalence: 95% CI 39%–68%; Rural residence: 95% CI 1.81–4.19; Poor knowledge: 95% CI 2.21–11.05; Lack of awareness: 95% CI 1.75–3.51; Absence of pain: 95% CI 2.44–4.67

Clinical Application

The identified modifiable risk factors (poor cancer knowledge, lack of awareness) are amenable to community health worker programs, mass media campaigns, and school-based health education. Rural healthcare expansion requires significant infrastructure investment. Absence of pain as a delay trigger highlights the need for symptom-independent cancer awareness messaging. These interventions are feasible within existing Ethiopian Health Extension Program frameworks. Direct clinical applicability to Australian practice is limited. Australia has established national cancer screening programs (BreastScreen, National Bowel Cancer Screening Program, National Cervical Screening Program) and universal healthcare access via Medicare, which substantially mitigate the patient-initiated delay factors identified in this review. However, findings are relevant to: (1) Australian clinicians working in global health or with newly arrived migrants from sub-Saharan Africa; (2) RACGP guidance on culturally and linguistically diverse (CALD) populations where health literacy barriers may parallel Ethiopian findings; (3) Aboriginal and Torres Strait Islander communities in remote Australia, where analogous barriers of rurality, limited cancer awareness, and healthcare access constraints exist. The TGA and PBS do not directly regulate health-seeking behavior interventions, but Cancer Australia and state-based cancer councils may find these findings informative for equity-focused programs. RACGP Standards for General Practice emphasise culturally safe care and health literacy support, which align with the review's recommendations. Adult cancer patients in low-resource sub-Saharan African settings, particularly Ethiopia, where healthcare access is geographically and economically constrained. Findings are most directly applicable to patients presenting to Ethiopian regional and referral hospitals with any cancer type.

Abstract

BACKGROUND: Delayed Health-seeking behavior among cancer patients is a major contributor to late diagnosis, poor prognosis, and high mortality, particularly in low-resource settings like Ethiopia. However, evidence on the magnitude and determinants of delayed care-seeking remains fragmented. OBJECTIVE: This systematic review and meta-analysis aimed to estimate the pooled prevalence of delayed Health-seeking behavior among cancer patients in Ethiopia and to identify associated factors influencing delays. METHODS: This study employed a systematic review and meta-analysis design to assess delayed Health-seeking behavior and its influencing factors among cancer patients in Ethiopia. A systematic search was conducted in PubMed, Scopus, Web of Science, CINAHL, AJOL, Google Scholar, and Ethiopian University repositories until April 27, 2025. The data were extracted from March 10-20 and analyzed from March 21-30, with report generation till April 27, 2025, using R software. Meta-analysis was performed using a random-effects model, with forest plots illustrating pooled prevalence and associated factors. Heterogeneity was assessed using the I² statistic, and study quality was evaluated using a validated tool. RESULTS: Seven studies conducted across multiple regions of Ethiopia were included in the final analysis with a total of 2,641 participants. The pooled prevalence of delayed Health-seeking behavior among cancer patients was 54% (95% CI: 39%-68%). Meta-analysis of associated factors showed that rural residence was significantly associated with delayed Health-seeking behavior, with patients residing in rural areas having more than threefold higher odds of delay (AOR = 3; 95% CI: 1.81-4.19), poor knowledge about cancer was strongly associated with delay, with nearly seven times higher odds among patients with poor knowledge compared to those with adequate knowledge (AOR = 6.63; 95% CI: 2.21-11.05), lack of cancer awareness was also a significant predictor of delayed Health-seeking behavior (AOR = 2.63; 95% CI: 1.75-3.51), and patients without pain were over three times more likely to delay Healthcare(AOR = 3.38; 95% CI: 2.44-4.67) were factors associated with delayed Health-seeking behavior. CONCLUSIONS: Our review showed that half of the cancer patients in Ethiopia experienced delayed health-seeking behavior. Delayed care-seeking was associated with rural residence, poor knowledge, limited awareness of cancer, and absence of pain symptoms. Targeted interventions, including public awareness campaigns, expansion of healthcare services in rural areas, and financial support initiatives, are urgently needed to reduce delays and improve early cancer diagnosis and outcomes. PROSPERO REGISTRATION NUMBER: CRD420251037845.

References

1. 1.Abdulwehab, S., Genati, D. D., & Kedir, F. (2025). Delayed health-seeking behavior and its associated factors among cancer patients in Ethiopia: A systematic review and meta-analysis. PLoS ONE. https://doi.org/10.1155/2011/150423