School of Public Health, College of Medicine and Health Sciences, Wachemo University, Hosanna, Ethiopia.
Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand.
Front Public Health. 2024 Sep 13;12:1409054. doi: 10.3389/fpubh.2024.1409054. eCollection 2024.
Despite a higher rate of breast cancer in sub-Saharan Africa (SSA), efforts to treat the disease through breast cancer screening are suboptimal, resulting in late diagnosis of breast cancer and poor outcomes. Several studies have been conducted in SSA countries about screening uptake, yet they addressed country or sub-country level data and did not consider both individual and beyond-individual factors related to screening. Hence, pooled prevalence as well as multilevel correlates of screening in the region is sparse, which have been addressed by this study using the most recent data among women with SSA.
This study was conducted using the Demographic Health Survey data (2013-2022) from six countries, and a total weighted sample of 95,248 women was examined. STATA version 16 was used for the data analysis. Multilevel mixed-effects logistic regression was performed and significant predictors were reported using adjusted odds ratios (aOR) with 95% confidence intervals (95% CI).
The overall weighted prevalence of clinical breast cancer screening was 14.23% (95% CI: 13.97-14.75), with Namibia and Tanzania having the highest (24.5%) and lowest (5.19%) screening rates, respectively. Higher breast cancer screening uptake was observed among women of advanced age (35-49) [aOR = 1.78; 95% CI: 1.60, 1.98], had higher educational levels [aOR = 1.84; 95% CI: 1.66, 2.03], cohabited [aOR = 1.37; 95% CI: 1.21, 1.55], in the richest wealth quintile [aOR = 2.27; 95% CI: 1.95, 2.64], urban residents [aOR = 1.21; 95%CI: 1.10, 1.33], multiparous [aOR = 1.47; 95% CI: 1.30, 1.68], visited health facilities [aOR = 1.64; 95% CI: 1.52, 1.76], and read newspapers [aOR = 1.78; 95%CI: 1.60, 2.15].
The prevalence of clinical breast cancer screening was low (14%). Strengthening awareness campaigns, improving healthcare infrastructure, health education, universal health coverage, and screening program access, with a focus on rural areas, women who lack formal education, and low socioeconomic status, are critical to increasing breast cancer screening rates and equity. Scale-up local and regional collaborations and the involvement of media agencies in the implementation of screening programs, advocacy, dissemination of information, and integration of screening programs with their routine care, such as perinatal care, can boost the screening. The existing health service delivery points also need to focus on integrating breast cancer screening services with routine care such as perinatal care.
尽管撒哈拉以南非洲（SSA）的乳腺癌发病率较高，但通过乳腺癌筛查来治疗该疾病的努力并不理想，导致乳腺癌诊断较晚，治疗效果不佳。在 SSA 国家已经进行了一些关于筛查参与度的研究，但这些研究仅涉及国家或次国家层面的数据，并未考虑与筛查相关的个体内外因素。因此，该地区的汇总患病率以及多水平相关性的筛查数据仍然很匮乏，本研究通过使用 SSA 地区女性的最新数据对此进行了研究。
本研究使用了来自六个国家的 2013-2022 年人口健康调查数据，并对总计 95248 名女性的加权样本进行了检查。使用 STATA 版本 16 进行数据分析。采用多水平混合效应逻辑回归，使用调整后的优势比（aOR）和 95%置信区间（95%CI）报告显著预测因素。
临床乳腺癌筛查的总体加权患病率为 14.23%（95%CI：13.97-14.75），纳米比亚和坦桑尼亚的筛查率最高（24.5%）和最低（5.19%）。年龄在 35-49 岁的女性（aOR=1.78；95%CI：1.60，1.98）、教育程度较高的女性（aOR=1.84；95%CI：1.66，2.03）、同居的女性（aOR=1.37；95%CI：1.21，1.55）、最富裕的五分位数的女性（aOR=2.27；95%CI：1.95，2.64）、城市居民（aOR=1.21；95%CI：1.10，1.33）、多产的女性（aOR=1.47；95%CI：1.30，1.68）、经常去卫生机构的女性（aOR=1.64；95%CI：1.52，1.76）和经常阅读报纸的女性（aOR=1.78；95%CI：1.60，2.15）更有可能进行临床乳腺癌筛查。
临床乳腺癌筛查的患病率较低（14%）。加强宣传活动、改善医疗基础设施、开展健康教育、实现全民医保以及扩大筛查项目的可及性，重点关注农村地区、缺乏正规教育的女性以及社会经济地位较低的人群，对于提高乳腺癌筛查率和公平性至关重要。扩大地方和区域合作，并让媒体机构参与实施筛查项目、宣传、信息传播以及将筛查项目与围产期护理等常规护理相结合，可以促进筛查工作的开展。现有的卫生服务提供点还需要重点关注将乳腺癌筛查服务与围产期护理等常规护理相结合。
