Socio-demographic characteristics
A total of 836 mothers completed the questionnaire for a response rate 99.4 %, The mothers had a mean age of 31.09 ±7.34 SD years. Forty-five percent of the study participants were illiterate. The majority, 744 (89.0%) of the study participants were married. Ninety percent of women were housewives. Regarding husband’s level of education, above half 439 (52.5%) had finished primary school. The majority 463 (55.4%) of respondents had a monthly income below the poverty line (Less than 1311 EB or $1.90 per month). The majority 475 (56.8%) of the study participants had television or radio. The majority 210 (74.9%) were rural dwellers. Health centers or hospitals were very close to 667 (79.8%) of the study participants (about five kilometers or less, maximum journey of 2 hours on foot) (Table 1).
Table 1. Socio-demographic characteristics of the respondents in Bale zone, southeast Ethiopia, 2017
Variable
|
|
Number
|
%
|
Maternal Age (Years)
|
15-24
|
146
|
17.5
|
|
25-34
|
424
|
50.7
|
|
35-49
|
266
|
31.8
|
Mother’s Educational Level
|
Illiterate
|
376
|
45.0
|
|
Primary School
|
362
|
43.3
|
|
Secondary School
|
98
|
11.7
|
Occupation
|
House wife
|
752
|
90.0
|
|
Civil Servant
|
62
|
7.4
|
|
Merchant
|
22
|
2.6
|
Marital Status
|
Married
|
744
|
89.0
|
|
Separated/Divorced
|
57
|
6.8
|
|
Widowed
|
35
|
4.2
|
Husband’s Educational Level
|
Illiterate
|
278
|
33.3
|
|
Primary School
|
439
|
52.5
|
|
Secondary School
|
119
|
14.2
|
Having TV or Radio
|
No
|
361
|
43.2
|
|
Yes
|
475
|
56.8
|
Monthly Income
|
Bellow 1311
|
463
|
55.4
|
|
More than 1311
|
373
|
44.6
|
Residence
|
Rural
|
210
|
74.9
|
|
Urban
|
626
|
25.1
|
Distance of health facility
|
<= 5 kms
|
667
|
79.8
|
|
> 5kms
|
169
|
20.2
|
Breast self-examination practice
The majority, 576 (68.8%) of the respondents had sufficient knowledge about breast cancer screening. Regarding sources of information: television and radio were the main sources, 98 (56.6%). This finding was supported by comments from a 19 year old merchant mother who reported, “…in our place there is no awareness creating activities or education by doctors on breast problem: presence of the disease, its consequences, its sign and symptoms, and its risk factors, and an options for treatment. We heard information from the television and radio. Some of us even heard the presence of its management today from this discussion.”
A 42 year old civil servant also stated that, “…I heard my neighbour complaining of a breast disease; I heard also that the disease was cancer. Many women have suffered with disease of the breast, yet I haven’t seen any breast disease on my body…. When I was a child, I heard a neighbour whom died due to breast disease. Her breast was wounded, and she was referred and taken far out of this area to receive better treatment in referral hospitals. Even though she had visited many hospitals, she died as the consequence of the disease.”
Only 187 (22.2%) of participants knew the appropriate timing to perform BSE. The knowledge how BSE is performed was known to 491 (58.7%) of the study participants. The majority, 650 (77.8%) of the mothers responded that performing BSE is important. Above ninety percent of respondents had visited health facilities at some time for sickness. However, only thirty-seven percent of the mothers had a clinical breast examination by health workers during the visit (Table 2).
Table 2. Breast self-examination knowledge and practice in Bale zone, southeast Ethiopia, 2017
Variables Number %
Have you heard about BSE
|
No
|
663
|
79.3
|
|
Yes
|
173
|
20.7
|
*If yes, what is/are the sources?
|
Health workers
|
87
|
50.3
|
|
TV or radio
|
98
|
56.6
|
|
Family or friends
|
55
|
31.8
|
Knowledge of BC screening
|
Not knowledgeable
|
260
|
31.2
|
|
Knowledgeable
|
576
|
68.8
|
Knowing how BSE is done
|
One finger palpation
|
73
|
8.7
|
|
Palm and three finger palpation
|
491
|
58.7
|
|
Do not know how to do
|
272
|
32.6
|
Ever visiting health facility for any sickness
|
No
|
76
|
9.1
|
|
Yes
|
760
|
90.9
|
History of BE by health worker
|
No
|
527
|
63.0
|
|
Yes
|
309
|
37.0
|
Have you practiced BSE
|
No
|
726
|
86.4
|
|
Yes
|
110
|
13.2
|
Detected abnormalities during BSE (n=110)
|
Contour
|
36
|
32.7
|
BSE (n=110)
|
Lump in breast
|
29
|
26.4
|
|
Pain of breast
|
26
|
23.6
|
|
Itching of the breast
|
12
|
10.9
|
|
Tenderness
|
9
|
8.2
|
|
No any abnormal
|
8
|
7.3
|
Did you consult health workers (n=102)
|
No
|
38
|
37.3
|
|
Yes
|
64
|
62.7
|
Is it important to examine
|
Important
|
650
|
77.8
|
your breast by yourself?
|
Not important
|
186
|
22.2
|
Knowing appropriate time for
|
2-3 days after monthly menstruation
|
187
|
22.2
|
performing BSE
|
Monthly at any time
|
144
|
17.5
|
|
Few days before menstruation starts
|
212
|
25.4
|
|
Do not know specific time
|
293
|
34.9
|
|
|
|
|
*Multiple responses allowed; P/E: Physical Examination; HF: Health Facility health center or Hospital).
During another FDG a 16 year old housewife reported, “…this breast disease is certainly present in its massive form; I have not experienced this disease on myself; it has hurt many women; and some people say it became ‘’hola‟ on a woman; some say cancer, and some other say another thing. Even at the moment, there is a woman with breast problem, she gave birth recently, her breast has not produced milk, and she has severe breast ache. The problem is existed among us however; we don’t know the right time to perform BSE…”
In this study, only 110 (13.2%) of the mothers performed BSE. The main reasons given by the mothers were; lack of information 269 (37.1%), fear of detecting abnormalities 158 (21.7%) and lack of privacy 138(16.5%) (Figure 1).
During a focus group discussion about BSE, six mothers stated that breast self-examination was not practiced among them. For example, a 23 year old civil servant woman reported that, “…I don’t need to touch and examine my breast if I don’t suspect the problem. If it develops a problem, symptoms force us to touch and examine the breast. It is important to see some internally felt discomfort or externally observed signs and symptoms of disease. We don’t know breast cancer. Therefore, we don’t give focus to our breast. If we have a previous problem, we check the improvement of that problem from time to time. Unless and otherwise, we don’t examine our breast…”
Those mothers who performed BSE had detected abnormalities in their breasts such as changes in contour 36 (32.7%), and lump in breast 29 (26.4%). The majority, 64 (62.7%) of the respondents who detected abnormalities in their breasts did consult health workers (Table 2).
A 47 year old house wife also stated, “… for example, when I have pain of the breast, if all things, even children touch me, I feel pain on both breasts specially at the tip of it, before this time I haven’t ever see such things. For this reason, I have started to touch and look at my breast. If somebody has such problem that woman should touch and examine their own breast, otherwise there is no need to touch...”
During another FDG a 35 year old health extension worker stated that, “…women know their breasts or their bodies especially during a change. Breast pain is not simple, its pain is more severe than other disease; therefore, it is easy to know breast problem on ourselves. However, women have seen this problem traditionally and some of them mostly seek traditional treatment because, they will not permit to expose their breast to health professionals if the disease is not severe. This makes the disease too fatal among our community...”
Factors associated with breast self-examination practice
Women in the age range of 25-34, and 35-49 were more likely to practice BSE compared to those women in the age range of 15-24, AOR=3.61(95%CI: 1.13, 11.58), and AOR=9.35(95%CI: 2.31, 37.85) respectively. Participants who have finished primary education, AOR=3.88(95%CI: 1.26, 11.98), and secondary and above, AOR=11.14(95%CI: 2.48, 49.96) times more likely to practice BSE than illiterate mothers. In addition, participants who have ever had breast examination previously by health workers were more likely to practice BSE compared to those mothers who have never had clinical breast examination, AOR=3.62 (95%CI: 1.15, 11.45) (Table 3).
Table 3. Factors associated with breast self-examination practice in Bale zone, southeast Ethiopia, 2017
Variables Ever performing BSE OR (95%) CI
|
No
|
Yes
|
COR
|
AOR
|
Present maternal age
|
|
|
|
|
15-24
|
132
|
14
|
1.0
|
1.0
|
25-34
|
379
|
45
|
1.61(0.76-3.41)
|
3.61(1.13-11.58) *
|
35-49
|
215
|
51
|
3.44(1.26-9.39)
|
9.35(2.31-37.85) *
|
Mother’s level of education
|
|
|
|
|
Illiterate
|
357
|
19
|
1.0
|
1.0
|
Primary school
|
307
|
55
|
2.89(1.37-6.10)
|
3.88(1.26-11.98) *
|
Secondary & above
|
62
|
36
|
5.68(2.23-14.51)
|
11.14(2.48-49.96) *
|
Occupation
|
House maker
|
668
|
84
|
1.0
|
1.0
|
|
Civil servant
|
52
|
10
|
0.57(0.22-1.47)
|
0.74(0.18-3.12)
|
|
Merchant
|
6
|
16
|
1.83(0.63-5.30)
|
0.56(0.13-2.46)
|
Residence
|
Rural
|
200
|
10
|
1.0
|
1.0
|
|
Urban
|
526
|
100
|
2.11(0.45-9.03)
|
3.02(0.98-4.58)
|
Knowledge of BC screening
|
Not knowledgeable
|
237
|
23
|
1.0
|
1.0
|
Knowledgeable
|
489
|
87
|
1.84(0.84-4.03)
|
1.45(0.38-5.53)
|
Ever visiting health facility for any sickness
|
No
|
32
|
44
|
1.0
|
1.0
|
Yes
|
694
|
66
|
3.23(1.68-6.19)
|
0.90(0.31-2.59)
|
Knowing how BSE is done
|
One finger palpation
|
63
|
10
|
1.0
|
1.0
|
Palm & 3 finger palpation
|
407
|
84
|
2.47(0.75-8.15)
|
3.59(0.82-15.79)
|
Do not know
|
256
|
16
|
0.20(0.06-0.68)
|
0.36(0.08-1.56)
|
Having TV or Radio
|
No
|
351
|
10
|
1.0
|
1.0
|
Yes
|
375
|
100
|
2.35(0.95-5.81)
|
1.62(0.30-8.64)
|
History of BE by health workers
|
No
|
508
|
19
|
1.0
|
1.0
|
Yes
|
218
|
91
|
5.11(2.36-11.06)
|
3.62(1.15-11.45) *
|
Have you heard about BSE
|
No
|
621
|
42
|
1.0
|
1.0
|
Yes
|
105
|
68
|
2.16(1.15-4.05)
|
1.11(0.41-3.01)
|
Distance from home to the nearest health facility
|
<= 5kms
|
594
|
73
|
1.0
|
1.0
|
> 5kms
|
132
|
37
|
0.23(0.09-0.61)
|
1.42(0.32-6.41)
|
Importance of BSE
|
Important
|
552
|
98
|
1.0
|
1.0
|
Not important
|
174
|
12
|
0.35(0.15-0.84)
|
0.73(0.15-3.58)
|
Knowing appropriate time for performing BSE
|
2-3 days after menses gone
|
144
|
43
|
1.0
|
1.0
|
Monthly in fixed days
|
113
|
31
|
0.92(0.37-2.29)
|
1.50(0.43-5.29)
|
Before menstruation starts
|
198
|
14
|
0.29(0.11-0.73)
|
1.05(0.27-4.05)
|
Do not have specific time
|
271
|
22
|
0.33(0.14-0.76)
|
0.98(0.26-3.65)
|
*: The test was significant at α=0.05