Centre for Social Research in Health, The University of New South Wales, Sydney, Australia.
Centre for Health Policy and Implementation Research, Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana.
BMC Public Health. 2023 May 19;23(1):915. doi: 10.1186/s12889-023-15782-w.
Regular breast screening is one of the most effective ways to detect early signs of breast cancer but travel distance to cancer-diagnostic facilities can affect breast screening attendance. Yet, limited studies have examined the impact of distance to cancer-diagnostic facilities on clinical breast screening behaviour among women in sub-Saharan Africa (SSA). This study examined the influence of travel distance to a health facility on clinical breast screening behaviour in five SSA countries: Namibia, Burkina Faso, Cote D'Ivoire, Kenya, and Lesotho. The study further assessed variations in clinical breast screening behaviour across diverse socio-demographic characteristics of women.
A sample of 45,945 women was drawn from the most recent Demographic and Health Surveys (DHS) for the included countries. The DHS uses 2-stage stratified cluster sampling to select nationally representative samples of women (15-49) and men (15-64) via a cross-sectional design. Proportions and binary logistic regression were used to examine associations between the women's socio-demographic characteristics and breast screening attendance.
The overall proportion of survey participants who underwent clinical breast cancer screening was 16.3%. Travel distance to a health facility had a significant (p < 0.001) impact on clinical breast screening behaviour as 18.5% of participants who self-reported distance as "not a big problem" attended clinical breast screening compared to 10.8% who self-reported distance as "a big problem". The study further found that various socio-demographic factors were significantly associated with breast cancer screening uptake, including age, education level, media exposure, wealth status, parity, contraceptive use, health insurance coverage, and marital status. The multivariate analysis controlling for other factors confirmed the strong association between distance to health facilities and screening uptake.
The study found that travel distance is a significant factor affecting clinical breast screening attendance among women in the selected SSA countries. Furthermore, the likelihood of breast screening attendance varied depending on different women's characteristics. It is crucial to prioritise breast screening interventions, particularly among the disadvantaged women identified in this study, to achieve maximum public health benefits.
定期进行乳房筛查是发现乳腺癌早期迹象的最有效方法之一，但前往癌症诊断机构的距离可能会影响乳房筛查的参与度。然而，针对撒哈拉以南非洲（SSA）地区女性，距离癌症诊断机构对临床乳房筛查行为的影响的研究有限。本研究检查了旅行距离对五个 SSA 国家（纳米比亚、布基纳法索、科特迪瓦、肯尼亚和莱索托）的女性进行临床乳房筛查行为的影响。该研究还评估了不同社会人口统计学特征的女性之间在临床乳房筛查行为上的差异。
从所纳入国家的最新人口与健康调查（DHS）中抽取了 45945 名女性样本。DHS 使用两阶段分层聚类抽样，通过横断面设计，选择全国具有代表性的女性（15-49 岁）和男性（15-64 岁）样本。使用比例和二元逻辑回归来检查女性社会人口统计学特征与乳房筛查参与之间的关联。
进行临床乳腺癌筛查的调查参与者的总体比例为 16.3%。前往医疗机构的距离对临床乳房筛查行为有显著影响（p<0.001），18.5%的报告距离“不是大问题”的参与者接受了临床乳房筛查，而报告距离“是大问题”的参与者比例为 10.8%。研究还发现，各种社会人口统计学因素与乳腺癌筛查的接受度显著相关，包括年龄、教育水平、媒体接触、财富状况、生育次数、避孕措施使用、医疗保险覆盖范围和婚姻状况。在控制其他因素的多变量分析中，确认了距离医疗机构与筛查接受度之间的强关联。
本研究发现，旅行距离是影响所选 SSA 国家女性临床乳房筛查参与度的重要因素。此外，筛查参与的可能性取决于不同女性的特征。优先考虑乳房筛查干预措施至关重要，特别是针对本研究中确定的弱势女性，以实现最大的公共卫生效益。
