Knowledge, attitude and perception towards uterine artery embolization for treatment of uterine fibroids among healthcare workers and patients attending Muhimbili National Hospital

Abstract

ABSTRACT Background: Uterine fibroids are a prevalent condition among women of child bearing age, often leading to significant morbidity and mortality. Uterine Artery Embolization (UAE) is a minimally invasive treatment option for uterine fibroids; knowledge, attitude and perception of UAE may influence its utilization. Despite availability at Muhimbili National Hospital (MNH), its proven efficacy and safety; the adoption of UAE in low-resource settings like Tanzania remain limited. Objective: This study aimed to assess the knowledge, attitudes, and perceptions towards UAE between HCWs and patients (women diagnosed with uterine fibroids) at Muhimbili National Hospital from December 2023 to June 2024. Materials and Methods: A cross-sectional study using a quantitative approach was conducted among 94 HCWs and 127 patients (women diagnosed with uterine fibroids) attending MNH's Radiology and Obstetrics/Gynaecology departments. Data were collected using structured questionnaires to obtain sociodemographic characteristics, knowledge of UAE, attitudes towards the procedure, and perceptions of its effectiveness and preference. With assistance of SPSS 26 software, descriptive statistics and chi-square tests were appropriately applied as statistical data analysis tools. Results: Total of 221 participants were analyzed; 94 (42.5%) healthcare workers and 127 (57.5%) women diagnosed with uterine fibroids. Overall participants mean age was 33.99 years (SD ± 7.99), all (100%) participants reported having ever heard of UAE and they get information about the UAE procedure from Health care provider and from the internet (53% and 43% respectively). In overall UAE procedural knowledge was low as about half of respondents knew UAE as: 47.3% a minimally invasive procedure; 52.6% performed by interventional radiologists; 57.5% tiny particles are used to block blood vessels supplying fibroids; 57.4% use of moderate sedation. Knowledge on indications of UAE was low; 48.3% mentioned symptomatic uterine vi fibroid; 48.5% need to preserve the uterus and fertility and 40.9% treatment of postpartum hemorrhage. However, the knowledge on contraindications of UAE was adequate as; pregnancy, allergic to contrast media and uncorrectable coagulopathy reported by 70.9%, 67.6% and 66.0% respectively. About UAE complications, less than half know that allergy 47.4% and thrombosis 42.9% are complications. Most healthcare workers have a adequate knowledge about the UAE however, it is not reflected by patients. Attitude towards UAE was poor as 42.1% thought it was a safe procedure; 38.6% novel alternative treatment option to myomectomy for fibroids and 40.7% proffered in patients seeking future pregnancies. Perception of UAE was also inadequate; Less than half 42% participants believing UAE involves a shorter hospital stay and allows women to go back to work and other activities sooner. The results overall showed preference in recommendation to patient 145(66.5%) and more knowledge was equally preferred in more than one third of participants 86(45.3%). Conclusion: Overall knowledge of UAE contraindication was up to standard however, knowledge on the procedure, indication and complications was low leading to poor attitude and perceptions toward UAE. Again HCWs as compared to women with fibroids exhibited significant knowledge on every aspect of UAE. Thus, IR and other stakeholders should prioritize comprehensive patient education regarding the UAE.