Barriers and facilitators to upper gastrointestinal endoscopy among patients with dyspepsia at two national referral hospitals in Uganda: a prospective cohort study

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. The study objective was to determine the frequency of EGD and analyze patient-level facilitators and barriers to EGD among dyspeptic patients at Mulago and Kiruddu Hospitals. 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 Gastrointestinal (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. 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. However, abstaining from tobacco smoking 5.72 (1.04–31.46), former tobacco smoking 9.66 (2.38–39.20), and former alcohol use 9.12 (2.66–31.23) were significant facilitators to attending EGD. 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. This underscores the importance of understanding barriers and facilitators to EGD in Uganda. Therefore, larger mixed-methods studies with extended follow-up intervals are recommended to provide in-depth understanding of barriers and facilitators to attending EGD in Uganda.