Breast self-examination and associated factors among women in Wolaita sodo city, Ethiopia: Community based cross sectional study

DOI: https://doi.org/10.21203/rs.2.14961/v2

Abstract

Background: Early detection of breast cancer plays an important role in decreasing morbidity and mortality associated with breast cancer. Breast self-examination (BSE) is one of the screening methods for early detection of breast cancer. BSE involves the woman herself looking at and feeling each breast for possible lumps, distortions or swelling. BSE is a simple exercise which can potentially save the life of a woman but it is not well focused yet. So, this study was aimed to assess breast Self-Examination and associated factors among women in Wolaita Sodo city, Ethiopia.

Methods: Community based cross-sectional study design was employed. Systematic random sampling technique was used to select 626 women aged 20-65 years old. The data were collected using pre-tested and structured questionnaire. The data was entered using Epi data version 3.5.1 and exported to SPSS version 21 software for statistical analysis. Bivariable and multiple logistic regression analysis were done.Variables with P-value less than 0.05 were considered as statically significant.

Results: A total of 629 women were included in the study. More than half (60.9%) of the participants were in the age range of 20-29 years. Women who had mentioned BSE as method for early detection of breast problem were 6.36 times (AOR: 6.36, 95% CI :( 3.72, 10.71) more likely to perform BSE than those who say that they don’t know any method. Women breast feed 13-24 months were 2.43 times AOR: 2.43, 95% CI :( 1.28, 4.59) more likely to examine their breast than those who breast feed different duration. Employed women were 3.13 times more likely AOR: 3.13 95% CI :( 1.14, 8.58) to practice BSE than women not employed. Likewise being student was 3.73 times AOR: 3.73, 95% CI (1.19, 11.73) more likely to perform BSE than others.

Conclusion: The finding of this study showed that women’s practice of breast self-examination is relatively low. Knowledge of BSE, breast feeding 13-24 months, being employed and being student were factors affecting performing breast self-examination. Therefore, educating girls and increasing awareness on electronics media is important. 

Introduction

Breast cancer has increasingly become an issue of public health importance in both developed and developing nations. Because of its high prevalence, it over-burdened health system and direct medical expenditure. Breast cancer is the second leading cause of death among women worldwide with an estimated 1.38 million new cases diagnosed annually which accounts for 10.9% of all cancer cases next to lung cancer(1, 2). Its incidence is increasing both in developed and developing regions. In 2008, an estimated 636,000 incident cases were diagnosed in high resource countries, while 514,000 cases were diagnosed in low and middle resource countries. Breast cancer is the most frequent cause of death among women both in developing (269,000 deaths (12.7%) of total) and developed region with an estimated 189,000 deaths. It is estimated that 70% of all breast cancer cases worldwide will be in low and middle resource countries by 2020 (3).

The incidence varies across the continent ranges from 19.3 per 100,000 per year in Eastern Africa to 38.1 per 100,000 in Southern Africa(4).

Breast self-examination (BSE) is one of screening methods, which involves the woman herself looking at and feeling each breast for possible lumps, distortions or swelling. BSE is a simple exercise which can potentially save the life of a woman. It is recommended for every woman to start breast self-examination at age of 20 years and this expected to be done for 20 minutes every month(5). However, women in developing countries do not perform BSE for various reasons(1). A woman who performs BSE may be more motivated to seek medical attention, including Clinical Breast Examination (CBE) and mammography(6).

In Ethiopia more than half of women with breast cancer were age 50 and younger. Evidence shows that 69.6% of patients ignored their symptoms initially for an average of more than one and half year(7). BSE is still recommended as a general approach to increasing breast health awareness and thus potentially allow for early detection of any anomalies, because it is free, painless and easy to practice(5).

The American Cancer Society also recommends that women, starting from the age of 20 years should be educated on the pros and cons of performing a monthly BSE(8).

Breast cancer in low to middle income countries has late presentation with poor treatment outcomes due to several factors such as unequal access to prompt high quality treatment and lack of early screening(3)

Despite the fact breast cancer comes out recently as the worst killer of young women especially those in urban area, Ethiopia health system has traditionally concentrated on communicable diseases prevention(7).

Even though breast cancer is among the leading causes of morbidity and mortality among women, very limited report has been published that measures the level of BSE

So, this study will contribute towards building on breast self-examination related issues. And also seeks to identify the need for information on breast cancer self-examination.

Therefore, this study was aimed to assess breast self-examination and associated factors among women aged 20–65 years in Wolaita Sodo city.

Methods

Study setting and design

The study was carried out in Wolaita Sodo city. The city has a total population of 250521. Male 79871 (52%), female 73650 (48%) and the city has three sub cities, 18 kebeles, three health centers, one hospital owned by MOH and one private hospital. The city is located 160km from regional city Hawassa and 327 km from Addis Ababa, the capital of Ethiopia (9). A Community based cross-sectional study design was employed.

Source population

All women age 20–65years were considered as a source population.

Study population

The house in selected kebeles were taken by systematic random sampling technique and study unit was selected by simple random sampling technique.

Inclusion and exclusion criteria

Women age 20–60 years were included in the study and women who were seriously ill during data collection time, having known breast cancer and those not willing to participate in the study were excluded.

Sample size and sampling procedure

Sample size was calculated with open- Epi statistical software version 3.03 using single population proportion statistical formulas. n = Z (1.96)2 P (1-P)/ d 2

With assumption of: z = 1.96, at 95% confidence level.

P-prevalence of breast self-examination 53.6 %( 0.536) from previous study (10).

Non-respondent rate 10% and confidence levels of 95% and 5% margin of error.

Therefore a calculated sample size was 572 and after considering 10% non-response the final sample size was 629.

Sampling procedure

Multi stage sampling technique was used to select the respondents of the study. First, among the 18 kebeles in the city, 6 kebeles were randomly selected by simple random sampling method to represent all kebeles. The number of source population in each selected kebeles was identified from Wolaita Sodo finance economic development department data(9). The calculated sample size allocated to the selected kebeles proportionate to the number of source population in the kebele. Sampling interval was calculated by diving source population to our sample (N/n) = 15098/629 = 24. The first house hold was selected by simple random sampling method from 1–24 households listed and 10 th household was chosen randomly

Sampling frame (households) containing lists of the population from selected kebeles was obtained and every 24 th house was visited to select the study population by systematic random sampling technique until the given sample size filled for a given kebele and the respondents from each selected house hold was taken by simple random sampling technique whenever there were more than one eligible women in a selected household.

Data collection procedure

Structured, pre-tested and interviewer administered questionnaires were used. Questions on the questionnaire include the socio demographic characteristics and BSE related issues. The questionnaires were adapted from Ethiopian Development and Health Survey (EDHS) and different published literatures. Data were collected for the period of 24 November 2018 to 2 December 2018 by trained data collectors. Data were collected through face-to-face interview maintaining the pre-determined sampling intervals. The data collectors informed the respondents all details of the research purpose and procedures and what was expected of them, potential risk and benefit in order to encourage accurate and honest response. When the woman was not available in the first visit, data collectors arranged alternative visits. If a woman was still not available on second visits or declined to participate in the study, the household was jumped and the immediate next household in the sampling frame was considered.

Data quality management

Before data collection the questionnaire was first prepared in English and translated into Amharic and back to English to keep the consistence of questionnaire. Two days training was given to data collectors and supervisors by the principal investigator before data collection.

A pretest was conducted in Dilbetigil kebele which was other than selected kebele and 5% of total sample size was tested. Based on the pretest, questionnaires were revised, edited and the necessary corrections made accordingly. Daily check-up of data for completeness and consistency was done during data collection.

Data analysis procedures

The data entry was done using EPidata version 3.1 and cleaned to check for accuracy, consistencies, completeness, values and any error identified was corrected.

The data was exported to SPSS version 21 software for analysis. Descriptive statistics was done. Bivariable analysis was computed and variables with p-value of less than 0.25 was made candidate for multiple logistic regression analysis. Multiple logistic regression analysis was done and variables with P-values ≤ 0.05 were considered as statistically significant. Adjusted Odds Ratio (AOR with 95% C.I) used to declare statistically significant association.

Ethical issues

Ethical clearance was obtained from Wolaita sodo university Institutional Review Board (IRB). Written permission was obtained from Sodo city health department. During data collection all respondents were asked their permission and informed consent was obtained from each study participants.

Operational definitions

Breast self-examination (BSE): The examination of their breast by themselves, to identify any changes in the breast(25).

Breast self-examination performed: If the woman performed breast self-examination at least once in the last 12 months.

Age 20 to 65: American cancer society recommended BSE for women aged 20 or older, and mammography for women aged 40 or older (8).

Result

Socio demographic characteristics of the subjects

A total of 629 women were interviewed and subjected to analysis. The participants were between the age 20 and 65 years. More than half (60.9%) of the participants were in the age range 20–29 years and 8.2% were greater than 50 years. Majority of women (87.3%) were Wolaita in ethnicity and 444 (70.6%) were protestant. Three hundred thirty eight (53.7%) of the respondents had completed secondary education and majority (76%) of the study participants were married. (Table1).

Knowledge and practice of BSE and information sources of women

Among the respondents, 591 (94%) knew (heard or read) about breast cancer and their main source of information was electronic media (62.4%). The contribution of health professionals as a source of breast cancer information was found to be (14.7%). Electronic media, family/friends, and health workers were respectively reported as a major source of information. Forty five (7.6%) of the respondents who reported to have had information on breast cancer mentioned other sources like journals, books, nongovernmental organizations (Figure 1).

The methods of screening for breast cancer reported were clinical breast examination 268 (45.3%), breast self-examination 107 (18%), and 216 (36.5%) women responded that they do not know any method of breast screening breast cancer. Of those who ever heard breast cancer, 272(46%) have also heard about breast self-examination (BSE) and among the study participants who had information on BSE, only 217 (79.8%) have ever done BSE and 195(71.6%) reported they keep on performing it. Among those who have ever heard breast cancer, 92% has known (heard) their family history of breast cancer. Majority of the respondents (63.5%) not know their status of benign breast lamp ( Table 2).

Knowledge of the right age to perform BSE and the reasons given to perform or not

Different responders, those who perform BSE, cited different prospective on correct age at which BSE commenced, which is at the range of 10 - 30 year (mean age 18.41±2.8 SD). Of these, 63(29%) recommend it at the age of 20 years and one hundred forty four (144) responded, I don’t know. Breast –Self Examination performers claimed to have their own performance at varying time period. Of these; few days after menses, few days before menses were ninety seven (44.7%), thirteen (6%) respondents respectively and one hundred seven (49%) answers no specific time/ any time they remember. From those participants who have ever done BSE, One hundred thirty three (61.2%) of them reported to practice it on a regular basis. Among the participants who practiced BSE on regular basis, 98(45%) were practicing monthly, and any time they observe a change were 65(30%). ( Table3).

Reasons of not performing breast self-examination

From those responded as ever heard breast self-examination (BSE), ninety eight (45%) believed that they have some kind of barrier to practice BSE. pressure of work/too busy, I don’t have enough privacy to do BSE, I know I can never have Bca, and forgetfulness, doubt about its effectiveness were mentioned as main barriers/reason not to perform BSE by 30(14%), 14 (6.4%), 13 (5.9%), 10(4.6%), and 11(5%) of the respondents, respectively. However more than half of performers 119(54.8%) claimed that there is no obstacle (Figure 2).

Distribution of spousal/parents support to perform BSE and the need of information on BSE

Spousal and other person support for breast-self-examination was 146(67.2%). On the other hand, majority of BSE performers were confident (88%) in exercising self-examination. Almost all study participants 98.6% knew early detection of breast cancer improve chance of survival. Most respondents, two hundred forty nine (91%) wanted more information on BSE. Of the total BSE performers two hundred seven claimed BSE is very important. Most of the respondents (91.1%) of the participants responded health facility was their first choice to visit if find any breast mass within one month,1–3 months,˃ 3 months(85.5%, 12.6% and 0.3%) respectively. whereas 49(22.5%)choices traditional healers. Within a year just prior to this study, among performers of BSE, one hundred forty nine (23.7%) participants performed it more than six times and four to six times 26 (4.1%) less than 4 times2 6 (4.1%)(table 4).

Factors associated with breast self-examination

The Bivariate binary logistic regression analysis yielded that occupational status, duration of breast feed,women education,husband education, early detection method for breast cancer, Source of information, Knowledge of personal history of having benign breast lamp became candidate for multiple logistic regression analysis at p≤0.25.

In the final logistic regression (multivariable logistic regression analysis) model occupational status of women, duration of breast feed and previously heard on BSE were significantly associated with performing BSE at P-value less than 0.05. Women who had mention BSE as method for early detection of breast problem were 6.36 times AOR: 6.36, 95% CI:( 3.72, 10.71) more likely to perform BSE than those who say that they don’t know any method. Those who had breast feed 13–24monnths were 2.43 times AOR: 2.43, 95% CI:( 1.28, 4.59) more likely to examine their breast than those who mention different category/duration of breast feed The study participants who were employed were 3.13 times more likely AOR: 3.13 95% CI:( 1.14, 8.58) to practice BSE than those who were not employed. Likewise being student was 3.73 times AOR: 3.73, 95% CI (1.19, 11.73) more likely to perform BSE than others (table 5).

Discussion

This study showed that 94% of respondents had ever heard or read about breast cancer. This is higher than the study done among Mekelle town women which showed 83% (10), lower than study findings done in Malaysian among female students is 99.5% (14) This could be due to the difference of education level among the study participants and difference in time interval between the studies. The present study also revealed that 46% of the women have previously heard about breast self-examination. This is lower than study done among Women in Malaysia where 78.4% heard about breast self-examination (13),Jordanian Women 67(15) study done among female undergraduate students in a higher teachers training college in Cameroon 47%(17), A study of BSE among Chinese immigrant women indicated that 80.9% reported having heard of BSE(1) Another study on a group of women in a rural area of Western Turkey found that 72.1% of the respondents had heard about BSE(26) and on the other hand this study was higher than study result done in Benghazi, Libya which showed only 41.5% heard BSE (16). The difference observed could be due to the difference in socio-economic and demographic characteristics among the study population. The relatively low knowledge of our respondents about BSE might preclude them from practicing BSE, which might lessen chances of early detection of the disease. Three-fifth (62 %) of those who had breast cancer information indicated that their major source of information was media. Colleagues/friends were also mentioned as important sources of information on breast cancer. Surprisingly, the proportion of respondents who mentioned health professionals as major source of breast cancer information was lower than the above once 13.8%. This is consistent to the findings of a similar study conducted among Jordanian females where relatives, friends and neighbors were found to be the main sources of breast cancer information(15).and inconsistent with study done among Iranian women which the health professionals are the major source of information 32.4% (27).

In the present study, large proportion [98%] of breast cancer informed participants knew that early detection of breast cancer improves chances of survival from the disease. This finding is supported by the study of Mekelle town women (10) and higher than study done western part of Ethiopia [74.7%](24). The present study showed that among the respondents who reported to have had information on breast self-examination, 79% have ever done BSE, this was smaller than study done Nigerian Nurses in Lagos general hospital [89%] (4), and greater than studies done among women in north Ethiopia [37.3%](29),  Malaysian female students 25.5%(14), Female Traders in Ibadan, Nigeria [18%] (6), women in a rural area in western Turkey 40.9% (26), women household heads in Northern Ethiopia [53.6](10). But consistence with study done among female health professionals in Wolega 77%(24) And also 45% participant of this study performing BSE on a regular monthly basis. Studies done in Jordanian Women only 7% (15),  Malaysian female students31.2%(14), among female undergraduate students in a higher teachers training college in Cameroon 25.9 (17) This could be due to difference in time interval between the studies.

Furthermore, present study revealed that 29% of the participants know correct age at which BSE commenced this was slightly greater than study in Benghazi, Libya [27.7%](16) and smaller than study done in South East Asia where 44% of the study participants had recommended practicing BSE at age of 20(5), Nigerian women(60.28%) recommend age twenty(20) Kyadondo County, Uganda 40% could correctly answer about the recommended age of starting BSE(28)

Breast screening method cited by the participants in present study was: breast self-examination (BSE) 15.4%, clinical breast examination 42.4% and mammography 0.3%. The methods of screening for breast cancer reported by Canadian women were: BSE (64.3%), clinical breast examination (45.7%), and mammogram (32.7%)(29). A study done in northern Ethiopia the methods of screening for breast cancer reported by health extension workers were breast self-examination (14.4%), clinical breast examination (22.3%) and mammogram (3%)(12). The difference may be due to difference in educational status and composition of participant.

In this study 53.6% of BSE performers had support from their partners which was inconsistent with other study done saying,(39.8%) of BSE performers were getting support from spouse/partner (21).

The major barriers for practicing BSE identified in the present study were: pressure of work/too busy, I don’t have enough privacy to do BSE, I know I can never have Bca, forgetfulness and doubt about its effectiveness were mentioned as main barriers/reasons not to perform BSE by 30(13.8%), 14 (6.4%), 13 (5.9%), 10(4.6%), and 11(5%) of the respondents, respectively. However more than half of the performers 119(54.8%) claimed that there is no obstacle.

Study done in western part of Ethiopia showed the barriers for not performing BSE were: no breast problem (12.7%), do not feel comfortable performing BSE (2.7%), scared of being diagnosed with breast problem or cancer, do not believe it is beneficial (4%) and do not know how to do it (7.7%)(24).

On the other study the three main reasons for not doing BSE were no breast problem (53.2%), not knowing BSE technique (30.6%), and not knowing the importance of BSE (21.4%](12) In study among Female Debre Birhan University Students the main reasons for not performing BSE were lack of knowledge on how to conduct BSE and not having any symptoms of breast cancer (22) other Study among women household heads in Northern Ethiopia indicate the major barriers for practicing BSE identified were absence of the symptoms and lack of knowledge about its importance(10). And Being health 100 (44.8%) and lack of knowledge 60 (26.9%) were the most barriers mention for not practicing BSE in Adama Science and Technology University (25).

The current study revealed that women who responded BSE as an early detection method of breast cancer were 6.36 times more likely to practice breast self-examination than women who do not know any methods of early detection breast cancer. This finding is consistent with study conducted among women in Malaysia which showed that knowledge of women that BSE is an early detection method of breast cancer was significantly associated with breast self-examination (13).

In current study women engagement in occupation ns other than housewife was significantly associated with performing BSE AOR: 3.12 95% CI:( 1.14, 8.58).These results are in agreement with findings that were reported among Nigerian women (30), study in Benghazi, Libya (16) and study done in Southern Ethiopia (21).

Those women who breast had feed their child 13–24 months were 2.43 times more likely to examine their breast than those who mention different duration of breast feed, this may be due to, those who optimally breast feed were conscious/educated to perform BSE.

Women who use electronic media as source of information were 1.59 times more likely to practice BSE than women who use other media types. This may be due to its relative accessibility than other source of information for women get information about BSE.

Strength and limitation of the study

Strengths: previous studies conducted in Ethiopia were merely focused on health professionals at their institution but this study was focused on the urban community.

Limitations: this study was conducted in urban community, Sodo city which may not equally represent the rural community and also in this study causal conclusions cannot be drawn.

Conclusion and recommendation

Participant previously heard on breast self-examination were low among women included in the study. Almost half (49%) of BSE performers responded no specific time (irregularly) perform it.

Less than one third correctly recognized age at which BSE commenced and Electronic Media, occupation and early detection method were among factors associated with breast self-examination. Therefore, based on the findings of the study we recommend: Wolaita Sodo administrative need to use electronic media consistently and programmatically (e.g. Wolaita Sodo FM, south TV) to advocate performing breast self-examination.Make weekly or monthly mobile phone message and encourage performing BSE. Make permanent video screen at the center of the city that demonstrate BSE issues. Ensure the advantage of performing BSE over other early screening methods.

Declarations

Abbreviations (acronyms and abbreviations)

AOR———adjusted odds ratio, AIDS—-acquired immune deficiency syndrome, Bca——-breast cancer, BSE——breast self-examination, Ca—-cancer, CBE—-clinical breast examination, CI—Confidence interval, HEW———Health Extension Workers, HIV—-human immune deficiency virus, HPV——-human papilloma virus, NCD——none communicable disease, NCR—-national cancer registry, OR——Odds Ratio, RHEW——Rural health extension workers, SNNPR—south nation nationality peoples region, UHEW—- health extension workers, WHO——world health organization.

Acknowledgment

We would like to forward our gratitude to Wolaita Sodo University, College of Health Sciences and Medicine. We also thank Wolaita Zone administrators, the supervisors, respondents and data collectors.

Authors’ contribution

TL, AB, BF and SA

These authors equally contributed to this research work

Funding

This study is not funded

Availability of data & materials

The data for this research is available, so we can contact you when you need our data for the future process.

Ethics approval and consent to participate

Ethical clearance and approval letter to conduct study was obtained from Wolaita Sodo University institutional review board and a letter of cooperation was taken from the Wolaita Sodo University College of health science and Medicine to Wolaita Sodo city health bureau. Written consent was obtained from the study participants after explaining the study objectives and procedures and their right to refuse not to participate in the study any time they want was assured. For this very purpose, a one page consent letter was attached to the cover page of each questionnaire stating about the general objective of the study and issues of confidentiality which was discussed by the data collectors before proceeding with the interview. Confidentiality of the information was ensured by coding. The interview was undertaken privately in separate area. Only authorized person was getting access to the raw data collected from the field.

Consent for publication

Not applicable

Competing interests

The authors have declared that no competing interests exist.

References

  1. Fung S. Factors associated with breast self-examination behaviour among Chinese women in Hong Kong,” Patient Education and Counseling1 998. pp. 233–43, p.
  2. Bray F RJ, Masuyer E, Ferlay J. Global cancer prevalence for 27 sites in the adult population in 2008. Int J Cancer 132(5):1333–1145. 2013.
  3. International Agency for Research on Cancer ( IARC). Breast Cancer Incidence, Mortality and Prevalence Worldwide. Available at: [email protected]. 2008
  4. Ibrahim NA OO. Knowledge of risk factors, beliefs and practices of female healthcare professionals towards breast cancer in a tertiary institution in Lagos, Nigeria. BMC Cancer 2009;9(1):76.
  5. Ginseng GM LJ, Zelle S, Baeten,et al. Cost effectiveness of strategies to combat breast, cervical, and colorectal cancer in Sub-Saharan Africa and South East Asia. Mathematical modelling study BMJ 344:614.
  6. Balogun MO OE. Knowledge and practice of BSE among female Trader in Ibadan,. Nigeria Ann Ibadan Postgraduate Med 3(2):52–56.
  7. Dye TD BS, Hobden C, Tilahun Y,et el. Experience of Initial Symptoms of Breast Cancer and Triggers for Action in Ethiopia. Int. J. Breast Cancer.. https://wwwhindawicom/journals/ijbc/2012/908547/abs/.Volume 2012 (2012).
  8. The American Cancer Society. Breast Cancer Prevention and Early Detection duidelines. 2014
  9. Wolaita Zone Finance, Socio Economic and Population report, 2017/2018 p 49.
  10. Befikadu L TG. Knowledge on breast cancer and its prevention among women household heads in Northern Ethiopia. Vol4, No1. 2014.
  11. Mesfin T DM, Roza A, et al. Breast Self-examination: Knowledge, Attitude, and Practice among Female Health Science Students at Adama Science and Technology University, Ethiopia. Gynecol Obstet (Sunnyvale) 2016;2016.
  12. Azage M AG, Mekonnen A et al. Assessment of factors associated with breast self-examination among health extension workers in West Gojjam Zone, Northwest Ethiopia. IntJBreastCancer2013:814395Availableat:https://wwwhindawicom/journals/ijbc/2013/814395. 2013.
  13. Redhwan Ahmed Al-Naggar1, Yuri V Bobryshev, Karim Al-Jashamy. Practice of Breast Self-Examination among Women in Malaysia.2012. DOI:http://dxdoiorg/107314/APJCP20121383829
  14. Akhtari‑Zavare et al. Barriers to breast self-examination practice among Malaysian female students: a cross sectional study. springer Plus. 2015.
  15. Hadayat A RA. Breast self-examination and risk factors of breast cancer: Awareness of Jordanian nurses.. Health science journal. 2013;volume 7 (2013).
  16. Ziuo FM TA, Huria et al.. Low awareness about breast self examination and risk factors of breast cancer in Benghazi, Libya. Ibnosina J Med Biomed Sci 2018.10:54–9.
  17. Carlson-B S BD, Jules Awareness of breast cancer and breast self-examination among female undergraduate students in a higher teachers training college in Cameroon. pan African medical journal. 2017:p 3–4. 16.
  18. Ethiopia FmohNccpo. Addis Ababa, Ethiopia: FMOH. 2016:p 716. 9.
  19. JA. B. Breast self examination among older women. Health Education 3:181 9.
  20. Okobia MN BC, Okonufua FE, O et al. Knowledge, attitude and practice of Nigerian women towards breast cancer: A cross sectional study. World J Surg Oncol. 2006;4:11.
  21. Minasie A HB, Abraham A. Breast Self-examination Practice among Female Health Extension Workers. ReprodSyst Sex Disord 2017;6: 219.
  22. Kala B M, B et al. Practices of Breast Self-Examination and Associated Factors among Female DebreBerhan University Students. International Journal of Breast Cancer 2017;Volume 2017.
  23. Roy Rellera Marzao etal. Factors associated with breast self-examination practices among junior and senior nursing students in baguio city Philippines. IJAMSCR, 2015.
  24. Elias L. N WDH, Alemu S. M. Assessment of breast self-examination practice and associated factors among female health professionals in Western Ethiopia. http://wwwacademicjournalsorg/IJMMS 2016;9(12).
  25. Mesfin T DM, Roza A, et al. Breast Self-examination: Knowledge, Attitude, and Practice among Female Health Science Students at Adama Science and Technology University, Ethiopia. Gynecol Obstet (Sunnyvale) 2016;2016.
  26. Pinar Erbay Dündar et al.el. The knowledge and attitudes of breast self-examination and mammography in a group of women in a rural area in western Turkey. BMC Cancer. 2006.vol. 6, article p 43.
  27. Sadigheh Sadat Tavafian, Laleh Hasani, Teamur Aghamolaei, Shahram Zare et al. Prediction of breast self-examination in a sample of Iranian women: an application of the Health Belief Model. BMC Women’s Health. 2009;vol.9, article page 37.
  28. HR Wabinga, DM Parkin, F Wabwire-Mangen and S Nambooze. Trends in cancer incidence in Kyadondo County, Uganda, 1960–1997,” British Journal of Cancer 2000,. pp. 1585–92 p.
  29. Maxwell CJ, Bancej CM, Snider J (2001). Predictors of mammography use among Canadian women aged 50–69: findings from the 1996/97 National Population Health Survey. CMAJ, 164, 329–34..
  30. Olumuyiwa O. Odusanya, Olufemi O. Tayo (2001) Breast Cancer Knowledge, Attitudes and Practice among Nurses in Lagos, Nigeria, Acta Oncologica, 40:7, 844–848, DOI: 10.1080/02841860152703472

Tables

Table 1 Socio demographic Characteristics of women in Sodo City, 2019(n=629)

Variables/ characteristics

     Frequency (%)

 

Age distribution  of the  women 

    20-29 years

     30-39 years

     40-49 years

     ≥50 years

Marital status

    Never married

    Married

    Divorce

   Widowed

Women Education

    No education

    primary

    secondary

    higher education

Husband education

     No education

     primary

     secondary

     higher education

  Religion

     Protestant

     Orthodox

     Muslim

     Catholic

 

 

 

383(60.9)

139((22.1)

55(8.7)

52(8.3)

 

113(8.0)

478(76)

 17(2.7)

 21(3.3)

 

73(11.6)

218(34.7)

179(28.5)

159(25.3)

 

20(4%)

131(27.4%)

148(31%)

179(34%)

 

       444(70.6)

131(20.8)

24(3.8)

16(2.5)

Ethnicity

       Wolaita

       Gamo

       Garage

       Amhara

       Others   

Occupational status of the women

         House wife   

        Employee

        Merchant 

        Student                                                 

        Other

Age at which first pregnancy occur

                15-24 years

                25-34 years

                35-44 years

               ≥45 years

Duration of breast feeding

              Birth-12months

              13-24months

              25-34months

№ of children

               None

                One

                Two

               Three and more

             

      

 

549(87.3)

32(5.1)

18(2.9)

12(1.9)

14(2.2)

 

312(49.6)

133(21.1)

74 (11.8)

54(8.6%)     

56(8.9%)

 

382(60.7)

111(17.6)

2(0.3)

6(0.2)

 

      77(15.4%)

      280(56%)

     141(28%)

 

     23(7.8%)

      107(20.7%)

      117(23%)

      232(43%)

 

  

 

Table 2:  knowledge and practice of BSE and main information source among women in Sodo city, 2019(n=629).

Characteristics/variables  

Frequency (%)

Ever heard Breast cancer

      Yes

       No

Source of information

      Electronic media

      Journal/brochure/leaflet/magazine

      Books

      Educational institution

      Non-governmental organizations

      Health workers

      Family/friend

      Other person

Previously heard on BSE

     Yes

      No

Early detection method for Breast cancer

      Breast self-examination(BSE)

      Clinical breast examination(CBE)

      I don’t know

Perform breast self-examination

      Yes

       No

Still perform breast self-examination

      Yes

       No

Knowledge  whether early detection of Breast cancer improve chance of survival

       Yes

        No

        I don’t know

 Family history of Bca

       Yes

        No

       I don’t know

Personal history of having benign breast lamp

        Yes

        No

        I don’t know    

Knowledge of someone suffering from Bca

         Yes

          No

Ever nurse Bca patient

          Yes

           No

 

Had close contact with person having benign breast lamp

           Yes

             No

Knowledge of Personal status of other body part cancer

          Yes

           No

   

 Position BSE

                Standing

             Lying

             Sitting

             Standing and lying 

Technical knowledge of BSE

        With palm and three middle fingers     

         Simply touch and feel

         I don’t know

    BSE practices applied

            Inspection

             Palpation

             inspection and palpation

Knowledge about which arm to be used for BSE

        Right hand for left breast and vice versa

         The same arm for the same side breast

         Any(no protocol)

         

 

591(94%)

38(6%)

 

366(62%)

4(0.8%)

3(0.5%)

9(1.4%)

1(0.2)

87(14.7%)

93(15.8%)

28(4.7%)

 

272(46%)

319(54%)

 

107(18%)

268(45.3%)

216(36.5%)

 

217(78%)

55(20.2%)

 

195(90%)

22(10%)

 

 

570(96%)

13(2%)

8(1.3%)

 

14(2.4%)

523(88.4%)

54(9%)

 

20(3.3%)

197(33.3%)

374(63%)

 

116(20%)

475(80.3%)

 

4(0.7%)

587(99%)

 

 

18(3%)

573(97%)

 

 

446(75.4%)

145(25%)

 

49(22.5%)

45(21%)

16(7.3)

107(49.3)

 

 

35(16%)

157(72.3%)

25(11.5%)

 

 

 

3(1.4%)

116(53.4%)

98(45%)

 

 

 

 

33(15.2%)

 

 

13(6%)

171(79%)

 

Table 3: Distribution of time BSE practiced and the reasons given to perform or not among women in Sodo city, 2019(n=626).

Variable/characteristics

         Frequency (%)

 Appropriate time of BSE

           Few days after menses

            Few days before menses

          No specific time

 Frequency of BSE practices

        Twice per month

         Once Every month

          Once Every 6 month

         Once per year

         Any time I observe a change

Advantage of regular breast self-examination

           Detect any abnormality

           Learn how the breast normally looks and feels

           Detect breast cancer earlier and promote treatment

Reasons for performing BSE

           Fear from breast cancer

            Early detection of breast cancer

            Breast cancer in the my family/friends

            Previous breast problems

           Heard from media

Barriers towards BSE

           I don’t have enough privacy for BSE practice

           Pressure of work/ I am too busy

           Doubt about its effectiveness

           Absence of symptom/disease  

           I am scared of being diagnosed with breast cancer

            Forgetfulness

            I know I can never have BC

            No obstacle(barriers)

                          

 

97(44.7)

13(6%)

107(49%)

 

 

48(22%)

98(45%)

2(0.9%)

4(1.8%)

65(30%)

 

72(33%)

56(26%)

89(41%)

 

 

51(23.5%)

128(59%)

13(6%)

3(1.4%)

 

 

22(10%)

 

 

14(6.4%)

30(13.8)

 

11(5%)

13(6%)

 

7(3.2%)

10(4.6%)

 

13(6%)

119(54.8%)

 

Table 4: Distribution of spousal/parents support to perform BSE and the need for further information among women in Sodo city, 2019(n=626).

Variables/characteristics

Frequency (%)

Support on BSE from spouse/partner

                Yes

                No

Desire information on how to do BSE

                   Yes

                   No

Impressed on importance of BSE

               Very Important

               Important

Self-confidence to perform BSE

             Yes

              No

Where will you go, if you discover a breast lump

                 Health facility

                Traditional healer

     

 

146(67.2%)

71(32.7%)

 

 

249(91%)

23(8.5%)

 

 

207(95.3)

10(4.6%)

 

 

191(88%)

26(11%)

 

 

 

 

168(77.4%)

 

49(22.5%)

 

Table 5: Factors associated with breast self-examination among women in Sodo city, 2019 (n=626).

     Variables

      Perform BSE

             Odds ratio (95% CI)

Yes

No

COR(95%CI)

AOR(95%CI)

Women’s Occupation⃰ status

     House wife

      Employee

      Merchant

      Student

 

 

 

 

96(15%)

76(12%)

26(4%)

19(3%)

217(34.4%)

57(9%)

49(7.7%)

89(14%)

1.00

2.07(1.20,3.59)

6.25(3.42, 11.41)

2.49(1.25,  4.94)

1.00

3.13(1.14,8.58)

6.47(2.31-18.12)

3.73(1.19-11.73)

Duration of breast feed⃰

       Birth-12months

      13-24months

      25-34months

 

39(7.8%)

101(20%)

46(9.2%)

 

39(7.8%)

181(36.4%)

92(18.4%)

 

1.00

2.10(1.18, 0.74)

1.16(0.75, 0.78)

 

1.00

2.43(1.28-4.59)

1.19(0.74-1.92)

Early detection method⃰ for Bca

      BSE

      I don’t know

 

111(32%)

106(20%)

 

9(33%)

364(59%)

 

7.03(4.14,11.95)

1.00

 

6.36(3.72-10.71)

1.00

Personal history of having benign breast lamp

        Yes

         No

 

 

21(3.5%)

196(33%)

 

 

59(10%)

315(53%)

 

 

2.31(1.20,4.46)

1.00

 

 

0.03(0.08,1.52)

1.00

Women’s Educational status

     Primary

     Secondary

 

82(28.2%)

135(39.9%)

 

209(71.8%)

203(60.1%)

 

1.00

1.70(1.21, 2.37)

 

 

1.00

0.81(0.29,2.24)

 

    Husband’s educational status

       Primary

      Secondary

 

51

134

 

118

175

 

1.00

1.80(1.21,2.67)

 

0.62(0.26,1.49)

Source of information⃰

      Electronics media

      Otherwise

 

151(25.5%)

66(11%)

 

218(36.8)

156(26.3)

 

1.63(1.14,2.32)

1.00

 

1.59(1.01,2.59)

1.00

           

Adjusted odds ratio (AOR), Significant at P-value<=0.05