Frequency and barriers to upper gastrointestinal endoscopy among patients with dyspepsia at Mulago and Kiruddu hospitals: a prospective cohort study.

Abstract

Background: Uganda has a high prevalence of over 50% of uninvestigated dyspepsia, which delays the timely diagnosis of potentially curable diseases like early gastric and oesophageal cancer. Notably, more than 90% of dyspepsia patients in Uganda have structural causes, underscoring the importance of esophagogastroduodenoscopy (EGD) as a definitive diagnostic method. However, the majority of patients with dyspepsia do not undergo EGD due to certain unknown barriers. Objectives: To determine the frequency of EGD and analyze patient-level barriers to EGD among dyspeptic patients at Mulago and Kiruddu Hospitals. Methods: This prospective cohort study was conducted over three months (December 2024–February 2025) and included 423 dyspeptic patients aged 30 years or older who were recommended for EGD at the GI clinics of Mulago and Kiruddu hospitals. Data were collected via interviewer-administered questionnaires during initial in-person interviews and one-month follow-up telephone calls. The primary outcome was EGD attendance. Results: A total of 402 participants were successfully followed up. The cohort had a male-to- female ratio of 1:2.8 and a mean age of 50.4 years (SD ±12.7). The one-month frequency of EGD was 4.48%. The high price of EGD 0.139 (-3.832 – -1.296) was a significant limiting factor to attending EGD. Furthermore, a positive family history 0.27 (0.08 – 0.89) and social history 0.05 (0.01 – 0.20) of GI cancer was a significant barrier to undergoing EGD. However, abstaining from tobacco smoking 5.72 (1.04 – 31.46) as well as former tobacco smoking 9.66 (2.38 – 39.20) and alcohol use 9.12 (2.66 – 31.23) were all significant facilitators to attending EGD. Conclusion: This study experienced a minimal follow-up loss of 4.96%, allowing for a precise estimate that only 4.48% of dyspeptic patients underwent EGD within one month, despite receiving a doctor's recommendation. We recommend a policy review to reduce the price of EGD, which may include a national health insurance scheme that provides for public hospitals, to make EGD more affordable at Mulago and Kiruddu Hospitals. Secondly, qualitative mixed- methods studies with extended follow-up periods are recommended to provide an in-depth understanding of the barriers to attending Endoscopy among patients with dyspepsia.