Ayebeng Castro, Okyere Joshua, Okantey Christiana, Addo Isaac Yeboah
School of Demography, Australian National University, Canberra, Australian Capital Territory, Australia.
Department of Population and Health, University of Cape Coast, Cape Coast, Ghana.
PLoS One. 2025 Jan 13;20(1):e0316800. doi: 10.1371/journal.pone.0316800. eCollection 2025.
Clinical breast examination (CBE) open the pathway to early detection and diagnosis of breast cancer. This study examined barriers to CBE uptake in seven sub-Saharan African (SSA) countries.
Data from the most current Demographic and Health Surveys of Burkina Faso, Cote d'Ivoire, Ghana, and Kenya Mozambique, Senegal and Tanzania was used. A weighted sample size of 65,486 women aged 25-49 years was used to estimate the pooled prevalence of CBE. We employed a multilevel logistic regression modelling technique, with results presented in adjusted odds ratios (aOR) along with a 95% confidence interval (CI).
The pooled prevalence of CBE uptake in the studied SSA countries is low at 19.2% [95%CI: 18.5-19.8]. Screening uptake was significantly low among women reporting difficulty in getting permission (aOR = 0.88, 95% CI: 0.82-0.95), and distance (aOR = 0.95, 95% CI: 0.89-0.99), as well as those who reported financial constraints (aOR = 0.92, 95% CI: 0.88-0.97), as barriers to access healthcare facilities. However, surprisingly, women who faced travel-alone barriers were 1.19 times (95%CI: 1.10-1.28) more likely to utilise CBE than those who did not face this barrier.
We conclude that barriers such as difficulties in obtaining permission, long distances to healthcare facilities, and financial constraints significantly reduce the likelihood of women undergoing CBE. The study underscores a need to improve access to healthcare facilities. Practically, this can be achieved by expanding mobile health services and integrating CBE into primary healthcare will help overcome distance-related challenges. Additionally, targeted outreach and transportation initiatives are necessary to support women facing travel barriers.
临床乳房检查（CBE）为乳腺癌的早期发现和诊断开辟了道路。本研究调查了撒哈拉以南非洲（SSA）七个国家CBE接受率的障碍因素。
使用了布基纳法索、科特迪瓦、加纳、肯尼亚、莫桑比克、塞内加尔和坦桑尼亚最新的人口与健康调查数据。采用加权样本量为65486名年龄在25 - 49岁之间的女性来估计CBE的合并患病率。我们采用了多水平逻辑回归建模技术，结果以调整后的优势比（aOR）以及95%置信区间（CI）呈现。
在所研究的SSA国家中，CBE的合并接受率较低，为19.2%[95%CI：18.5 - 19.8]。在报告难以获得许可（aOR = 0.88，95%CI：0.82 - 0.95）、距离（aOR = 0.95，95%CI：0.89 - 0.99）以及报告有经济困难（aOR = 0.92，95%CI：0.88 - 0.97）的女性中，筛查接受率显著较低，这些因素被视为获取医疗设施的障碍。然而，令人惊讶的是，面临独自出行障碍的女性接受CBE的可能性是未面临此障碍女性的1.19倍（95%CI：1.10 - 1.28）。
我们得出结论，诸如难以获得许可、距离医疗设施较远以及经济困难等障碍因素显著降低了女性接受CBE的可能性。该研究强调了改善医疗设施可及性的必要性。实际上，这可以通过扩大移动健康服务以及将CBE纳入初级医疗保健来实现，这将有助于克服与距离相关的挑战。此外，有针对性的外展和交通举措对于支持面临出行障碍的女性是必要的。
