Study design, period and area
Institutional based cross-sectional study was conducted in the oncology center of TASH, Ethiopia, from March to April 2019. TASH is the biggest referral public hospital in Ethiopia established in 1972. It is the training center of health professionals with undergraduate and postgraduate programs and others paramedics. The hospital is staffed by many health professionals from various disciplines. It has over 800 beds and the beds reserved for cancer care are 20. It is the only oncology center in Ethiopia and the only cancer registry center for Addis Ababa.
All medical records of the women diagnosed with cervical cancer in TASH cancer center from January 1, 2014 to December 31,2018 were study populations. Cervical cancer patients with medical charts that were incomplete and not found during data collection were excluded in the study.
Sample size and study variables
All women with cervical malignancy diagnosed at TASH beginning January 2014 to December 2018 was the sample size. Profiles of all women with cervical malignancy diagnosed and treated from January 2014 to December 2018 were evaluated and 1057 medical records that met the inclusion criteria were selected. Stage at presentation of cervical cancer was the outcome variable whereas sociodemographic, pathological and clinical characteristics were explanatory variables.
Stage at diagnosis: the revised FIGO staging for carcinoma of the vulva, cervix, and endometrium was used .
Late stage: late stage at presentation was to mean patients presented with FIGO stages III and IV.
Anemia: patients’ hemoglobin level below 12.0 g/dl was classified as anemic .
Comorbidity: The presence of any conditions (mentioned in the Carlson comorbidity Index  other than cervical cancer at diagnosis.
Substance use: Patients who used one, two or all of the three substances (cigarate, chat and alcohol) .
Data collection tools and quality assurance
Data was collected from the patients’ medical records using structured check list. The checklist consisted three parts: sociodemographic, pathological and clinical characteristics. Two master’s holders in clinical oncology nursing supervised the data collection process and three nurses with bachelors of science in nursing were data extractors. Pretest of the checklists was done to test the checklists’ reliability with real data collection and essential modifications were made accordingly.
Data processing and analysis
The extracted data were entered and checked using Epi-data 3.1, then it was exported in to Stata14.2 for analysis. Frequencies, proportions and descriptive statistics were used to explain the study population with the relevant variables. Binary logistic regression was used to analyze factors that affect the outcome variable. Variables with p- value < 0.2 with bivariable analysis were included to multivariable analysis. Explanatory variables which have p-value < 0.05 in multivariable analysis were identified as a significant factor affecting the outcome variable (late stage) with 95% confidence level.
Ethical approval for this study was obtained from the Institutional Review Boards of school of nursing and midwifery, Addis Ababa University. The letter of permission was written from school of nursing and midwifery to the oncology center of TASH. Then, the oncology center chief administrator permitted to collect the data. The study was conducted without individual informed consent since data extraction were relied on chart review other than patients.