The study collected data from 398 of the 410 intended women of reproductive age attending maternal clinic at JOOTRH. Most of the participants were aged between 25–30 years, 37.9% (151/398), 31–35 years and 27.6% (110/398). Approximately half of the participants 50.75% (202/398) had primary education while slightly more than a quarter had secondary education 28.6% (114/398). Participants that were married were 38.7% (154/398) and never married were slightly less at 37.2% (148/398). More than half of the participants were in the semi-skilled manual labor at 55.8% (222/398) compared to less than a tenth who were unemployed 9.1% (36/198) Table 1.
Table 1
Participant Characteristics
Characteristics | N | % |
Age group | | |
18–24 years | 85 | 21.36 |
25–30 years | 151 | 37.94 |
31–35 years | 110 | 27.64 |
36–49 years | 52 | 13.06 |
Education Level | |
None | 20 | 5.03 |
Primary | 202 | 50.75 |
Secondary | 114 | 28.64 |
College/higher | 62 | 15.58 |
Marital status | |
Married | 154 | 38.69 |
Single/Never married | 148 | 37.19 |
Separated/Divorced | 96 | 24.12 |
Occupation | |
Unemployed | 36 | 9.05 |
Semi-Skilled Manual | 222 | 55.78 |
Unskilled manual | 48 | 12.06 |
Agriculture | 38 | 9.55 |
Sale & Service | 31 | 7.79 |
Clerical | 3 | 0.75 |
Professional technical/managerial | 14 | 3.52 |
Student | 6 | 1.51 |
Religion | | |
Catholic | 136 | 34.17 |
Protestant | 150 | 37.69 |
Muslim | 8 | 2.01 |
Other | 104 | 26.13 |
Almost all the study participants had at least heard of breast cancer 96.2% (383/398). Majority of the participants reported having heard of breast cancer from the media (radio and television) 57.0% (227/398), the friends, doctor/nurse 10.1% (40/398) and relatives at 7.8% (31/398) as shown in Fig. 1. More than half of the participants who ever heard of BSE in relation to breast cancer were of the opinion that BSE should be conducted weekly 54.6% (209/383) while only a paltry 6.3% (24/383) yearly. Majority of the participants were of the opinion that BSE should be performed in front of the mirror 53.3% (204/383) and slightly more than half thought they were at a risk of having breast cancer 52.0% (207/383) (Table 2).
Table 2
Knowledge of Breast Self-Examination
Characteristics | N | % |
Ever heard of BSE and breast cancer | | |
Yes | 383 | 96.23 |
No | 15 | 3.77 |
Where heard from | | |
Internet | 54 | 13.57 |
Media (Radio & TV) | 227 | 57.04 |
Friends | 40 | 10.05 |
Doctor/Nurse | 31 | 7.79 |
Relatives | 31 | 7.79 |
Never Heard | 15 | 3.76 |
How often should one conduct BSE | | |
Not sure | 2 | 0.52 |
Weekly | 209 | 54.57 |
Monthly | 148 | 38.64 |
Yearly | 24 | 6.27 |
How should BSE be performed | | |
Don’t Know | 2 | 0.52 |
In front of mirror | 204 | 53.26 |
Lying on bed | 127 | 33.16 |
In the bathroom | 50 | 13.05 |
Do you think you are at risk of breast cancer | | |
No | 191 | 47.99 |
Yes | 207 | 52.01 |
Of the participants who ever heard of BSE, 42.3% (162/383) reported of ever practicing BSE. Among those who practiced 93.2% (151/162) reported performing BSE once in a month. The study found that 96.2% (383/398) of their partners are aware of breast cancer and a further 62.7% (240/383) reported that their partners had knowledge of BSE. More than three-quarters of the participants reported they would be willing to train their partners on BSE 78.3% (300/383). All the women reported that they would recommend BSE to other women while 87.0% (333/383) of the women reported that they would encourage other women to engage their partners on assisting them to perform BSE (Table 3).
Table 3
Practices of Breast Self-Examination
Characteristics | n | % |
Do you practice BSE | | |
Yes | 162 | 42.30 |
No | 221 | 57.70 |
How often perform BSE | | |
Once weekly | 3 | 1.85 |
Once monthly | 151 | 93.21 |
Once quarterly | 5 | 3.09 |
Once yearly | 3 | 1.85 |
Partner aware of breast cancer | | |
Yes | 383 | 96.23 |
No | 15 | 3.77 |
Partner has knowledge about BSE | | |
Yes | 240 | 62.66 |
No | 143 | 37.34 |
Are you able to train partner on BSE | | |
Yes | 300 | 78.33 |
No | 83 | 21.67 |
Partner can assist on BSE | | |
Yes | 137 | 35.31 |
No | 251 | 64.69 |
Partner helps perform BSE | | |
Yes | 48 | 35.04 |
No | 89 | 64.96 |
Would like partner to help perform BSE | |
Yes | 205 | 81.67 |
No | 46 | 18.33 |
Would you recommend BSE to other women | |
Yes | 383 | 100.00 |
No | 0 | 0.00 |
Would advise other women to engage their partners perform BSE |
Yes | 333 | 86.95 |
No | 50 | 13.05 |
On the Key Informant Interviews on male involvement in BSE, it was reported by some of the nurses that the cultural aspect acts as a challenge in their participation
“Very few men are involved in women health related services of their spouses including cancer screening services such as breast cancer and BSE education. In addition, men who take their wives to the hospital for maternal visits are always viewed as inferior by their fellow men.” (KII, Female, 46)
“In this facility I have not seen very many men escort their wives for common maternal hospital visits such as child delivery or infant vaccination services let alone for cancer awareness”. (KII, Male, 38)
Some of the KIIs also gave the perceived benefits of male involvement as shown in the excerpts that follow
“Generally, if the man understands his role as the head of the home and cares for his family decision making on woman health-related matters will be prompt. This discussion creates awareness in the home on the needs of the woman to the spouse making the man more responsible” (KII, Female, 30)
“The man will be aware of the benefits of healthy maternal lifestyle leading to prompt detection diagnosis and treatment should there be need.”. (KII, Female, 34)
About 39.4% (151/383) of the interviewed participants who ever heard of Breast Cancer had the correct knowledge and practice of BSE. Participants who were aged 41–49 years, 18(43.9%), of them had correct knowledge and practice of BSE. Fewer participants aged 18–24 years 24 (28.2%) had the correct knowledge and practice of BSE. Among participants who had college/ higher education, 31 (50.0%) of them had correct knowledge and practice of BSE. Almost half of the separated/divorced participants had the correct knowledge and practice of BSE. More of the results are as shown in Table 4.
Table 4
Determinants of correct knowledge and practice of BSE among women seeking maternal health care at JOOTRH
Characteristics | Knowledge and Practice (%) | uOR (95%CI) | p value | aOR (95%CI) | p value |
Age Group | | | 0.284 | | |
18–24 years | 24(28.24) | ref. | | | |
25–30 years | 62(41.06) | 1.77(0.99–3.14) | 0.051 | | |
31–35 years | 42(38.18) | 1.57(0.85–2.89) | 0.147 | | |
36–40 years | 18(43.90) | 1.99(0.91–4.33) | 0.083 | | |
41–49 years | 5(45.45) | 2.12(0.59–7.60) | 0.249 | | |
Education Level | | | 0.0794 | | |
None | 6(30.00) | ref. | | | |
Primary | 67(33.17) | 1.16(0.43–3.15) | 0.774 | 1.67(0.59–4.73) | 0.333 |
Secondary | 47(41.23) | 1.64(0.59–4.57) | 0.347 | 2.23(0.77–6.50) | 0.141 |
College/higher | 31(50.00) | 2.33(0.79–6.86) | 0.123 | 3.25(1.03–10.25) | 0.044 |
Marital status | | | 0.0063 | | |
Married/Cohabiting | 61(39.61) | ref. | | | |
Single/Never married | 43(29.05) | 0.62(0.39–1.01) | 0.054 | 0.60(0.36–0.99) | 0.048 |
Separated/Divorced | 47(48.96) | 1.46(0.87–2.45) | 0.147 | 1.07(0.61–1.88) | 0.808 |
Occupation | | | 0.1282 | | |
Unemployed | 16(44.44) | ref. | | | |
Agriculture | 87(39.19) | 0.81(0.40–1.64) | 0.551 | | |
Unskilled manual | 16(33.33) | 0.63(0.26–1.52) | 0.301 | | |
Semi-Skilled Manual | 8(21.05) | 0.33(0.34–2.38) | 0.035 | | |
Sale & Service | 13(41.94) | 0.90(0.34–2.38) | 0.836 | | |
Clerical | 3(100.00) | - | | | |
Professional technical/managerial | 8(57.14) | 1.67(0.48–5.79) | 0.422 | | |
Student | 0(0.00) | - | | | |
Religion | | | 0.9967 | | |
Catholic | 53(38.97) | ref. | | | |
Protestant | 58(38.67) | 0.98(0.61–1.59) | 0.958 | | |
Muslim | 0(0.00) | - | - | | |
Other | 40(38.46) | 0.98(0.58–1.65) | 0.936 | | |
Partner Knows about BSE | | | | |
Yes | 150(39.16) | ref. | 0.035 | | |
No | 1(6.67) | 0.11(0.01–0.85) | | 0.08(0.01–0.76) | 0.028 |
How often should one perform BSE | 0.0304 | | |
Not sure | 1(50.00) | ref. | | | |
Weekly | 67(31.31) | 0.46(0.03–7.40) | 0.581 | 0.10(0.00-4.55) | 0.24 |
Monthly | 71(46.41) | 0.87(0.05–14.10) | 0.919 | 0.18(0.00-7.87) | 0.372 |
Yearly | 12(41.38) | 0.71(0.04–12.43) | 0.812 | 0.14(0.00-6.46) | 0.312 |
Where heard from | | 0.045 | | |
Internet | 29(53.70) | ref. | | | |
Media (Radio & TV) | 84(37.00) | 0.51(0.28–0.92) | 0.026 | 0.51(0.27–0.97) | 0.039 |
Friends | 7(17.50) | 0.18(0.07–0.48) | 0.001 | 0.25(0.09–0.69) | 0.007 |
Nurse/Doctor | 10(32.26) | 0.41(0.16–1.03) | 0.059 | 0.45(0.17–1.21) | 0.115 |
Relatives | 14(40.00) | 0.57(0.24–1.36) | 0.208 | 0.61(0.25–1.50) | 0.281 |
Never Heard | 7(63.64) | 1.51(0.40–5.76) | 0.548 | 1.65(0.39–7.02) | 0.495 |
The study also found that participants with college education were more likely to report correct knowledge and practice of BSE (adjusted Odds Ratio [aOR] = 3.25, 95%CI [1.03–10.25], p = 0.044) compared to those with no education. In addition, those with primary and secondary education were also more likely to report correct knowledge on BSE (aOR = 1.67, 95%CI [0.59–4.73], p = 0.333) and (aOR = 2.23, 95%CI [0.77–6.50], p = 0.141) respectively than participants with no education, but it was not statistically significant. Participants who were not married/cohabiting were less likely to report correct knowledge and practice of BSE (aOR = 0.60, 95%CI [0.36–0.99], p = 0.048) compared to the married/cohabiting. Lastly, participants who heard about BSE from media (aOR = 0.51, 95%CI [0.27–0.97], p = 0.039) and friends (aOR = 0.25, 95%CI [0.09–0.69], p = 0.007) were less likely to report correct knowledge and practice than those who got the information from the internet (Table 4).