Women’s knowledge, attitude, and practice of breast self- examination in sub-Saharan Africa: a scoping review

Abstract

Background Breast cancer (BC) is a non-communicable disease with increased morbidity and mortality. Early detection of BC contributes to prompt linkage to care and reduction of complications associated with BC. Breast self-examination (BSE) is useful for detecting breast abnormalities particularly in settings with poor access to healthcare for clinical breast examination and mammography. Therefore, we mapped evidence on women’s knowledge, attitude, and practice of BSE in sub-Sahara Africa (SSA). Methods We conducted a systematic scoping review using Arskey and O’Malleys’ framework as a guide. We searched PubMed, Google Scholar, CINAHL, and Science Direct databases for relevant studies on women’s knowledge, attitude and practice on BSE. Studies included in the review were from SSA countries as defined by the World Health Organization published from 2008 to May 2019. Two reviewers independently screened the articles at the abstract and full-text screening guided by inclusion and exclusion criteria. All relevant data were extracted, and a thematic analysis conducted. The themes were collated, and a narrative summary of the findings reported. Results Of the 264 potentially eligible articles identified from 595,144, only 21 met the inclusion criteria and were included for data extraction. These included studies were conducted in 7 countries of which 11 were conducted in Nigeria; two each in Ethiopia, Ghana, Cameroon, and Uganda; and one each in Kenya and Sudan. Of the 21 included studies, 18 studies reported evidence on BSE knowledge and practice; two on only knowledge; one on only practice only; and six presented evidence on women’s attitude towards BSE. The study findings suggest varying knowledge levels on BSE among women in SSA countries. The study findings also suggest that BSE practice is still a challenge in SSA. Conclusion There is a paucity of published literature on women’s knowledge, practice, and attitude of BSE in SSA. Hence, this study recommends further studies on knowledge, practice, and attitude of BSE, to identify contextual challenges and provide evidence-based solutions to improve women’s knowledge, practice, and attitude of BSE in SSA.

Knowledge and Practice on Breast Self-Examination and Associated Factors among Summer Class Social Science Undergraduate Female Students in the University of Gondar, Northwest Ethiopia

“…A recent scoping review on BSE among women in SSA demonstrates limited published research and revealed varied level of knowledge ranging from 8.7% [ 5 ] to 98.9% [ 7 ] and practice ranging from 11.7% to 78%. It further suggests that BSE practice remains a challenge in SSA [ 8 ]. In Ethiopia, studies regarding BSE largely focused on health care workers and health science students and were conducted in large cities of the country mainly at referral hospitals [ 9 – 13 ].…”

Practice of Breast Self-Examination among Female Students of Chukwuemeka Odumegwu Ojukwu University, Awka

“…10 BSE has many benefits: easy to learn, cost-effective to the patient, high patient acceptability, and noninvasive procedure. [14][15][16][17] Other advantages are that it is a reasonably reliable procedure for early detection of breast cancer, it helps women to be familiar with their breasts and increases awareness of breast cancer and other breast cancer screening modalities such as CBE and mammography. [14][15][16][17] BSE also has some shortcomings like: it requires a lot of patient motivation for regular practice, can only detect palpable breast lesions, it increases benign breast biopsy rate, and there is difficulty in measuring adherence and competence.…”

“…[14][15][16][17] Other advantages are that it is a reasonably reliable procedure for early detection of breast cancer, it helps women to be familiar with their breasts and increases awareness of breast cancer and other breast cancer screening modalities such as CBE and mammography. [14][15][16][17] BSE also has some shortcomings like: it requires a lot of patient motivation for regular practice, can only detect palpable breast lesions, it increases benign breast biopsy rate, and there is difficulty in measuring adherence and competence. 7 In low and medium-income countries, BSE is still very relevant as a means of cancer detection because up to 90% of the breast cancers in these regions are still self-detected.…”

A Preliminary Psychometric Assessment of the Attitude of Health Trainee Undergraduate Students towards Breast - Self Examination in Ghana.

“…A recent very comprehensive systematic review Udoh et al, [24] of most BSE researches done in the SSA concluded among others that there is "limited literature on women's attitudes towards BSE" (p.6). Thus, even among the extant predorminantly female literature, there is paucity in the Attitude domain of the whole BSE research area as a lot of the research effort into BSE in Sub-Saharan Africa (SSA) have focused on the knowledge and practice areas at the expense of attitude.…”

“…Thus, even among the extant predorminantly female literature, there is paucity in the Attitude domain of the whole BSE research area as a lot of the research effort into BSE in Sub-Saharan Africa (SSA) have focused on the knowledge and practice areas at the expense of attitude. They recommended identification of, and evidentbased solutions to BSE contextual challenges when they wrote "…this study recommends further studies on knowledge, practice, and attitude of BSE, to identify contextual challenges and provide evidence-based solutions to improve women's knowledge, practice, and attitude of BSE in SSA…" [24] (p.1).…”