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| ORIGINAL ARTICLE |
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| Year : 2017 | Volume
: 2
| Issue : 1 | Page : 22-26 |
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Breast cancer in Jos, Nigeria: An audit on knowledge, attitude, and practices
Nanloh S Jimam, Shalkur David, Gboluwaga O Ejisun
Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmaceutical Sciences, University of Jos, Jos, Nigeria
| Date of Submission | 20-Jan-2017 |
| Date of Acceptance | 21-Feb-2017 |
| Date of Web Publication | 19-Apr-2017 |
Correspondence Address:
Nanloh S Jimam
Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmaceutical Sciences, University of Jos, Jos
Nigeria
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/ed.ed_2_17
Objectives: The main purpose of the study was to assess the knowledge, attitudes, and practices of women concerning breast cancer in Jos and environs.
Methods: A semi-structured questionnaire was administered to 400 respondents within the age of 18 years and above residing in Jos North and South Local Government Areas of Plateau state. The data collected were then analyzed using the IBM Statistical Package for Social Sciences version 20.0 software programmer.
Results: Out of the 400 study populations, only 395 (98.8%) responded to the study and 209 (53.0%) of them fall within the age 18–27 years while 89 (22.6%) were within 28 and 37 years, with only 17.8% and 6.6% in the age groups of 38–47 and ≥48 years, respectively. Two hundred and twenty (55.6%) were single, 153 (38.8%) married, while 8 (2.3%) divorced/separated, and 11 (2.8%) were widowed. The highest number (172 [43.7%]) of the respondents had secondary certificates as their highest academic qualifications, followed by diploma/The Nigeria Certificate in Education/Community Health Extension Workers (25.1%) and first degree (20.8%). Nearly 95% of the respondents have heard of breast cancer, with 30.94% of them having knowledge of the risk factors, 59.9% knew the signs and symptoms of the disease, and their main source of information (35.8%) was the media. Most of the respondents had positive attitude toward the disease, but their cancer breast screening practices were generally poor as majority of them (47.1%) had no idea of the right age to initiate self-breast examination, with majority (28.4%) confessing not practicing self-breast examination very often, neither visiting medical practitioner for breast cancer examination and care.
Conclusion: The result of this study shows positive attitudes of the respondents toward the disease though high percentage of them had poor knowledge on risk factors and average knowledge of the signs and symptoms of the disease, in addition to poor breast self-examination practices. Keywords: Breast cancer, knowledge, attitudes, and practices, risk factors, self-breast examination
How to cite this article:
Jimam NS, David S, Ejisun GO. Breast cancer in Jos, Nigeria: An audit on knowledge, attitude, and practices. Environ Dis 2017;2:22-6 |
| Introduction | |  |
Cancer is a term used for diseases in which abnormal cells divide without control and are able to invade and destroy other tissues, and the first mention of breast cancer can be found in a papyrus dated 3000 B.C.(the papyrus found by the Egyptologist Edwin Smith).[1],[2]
Approximately 14 million new cancer cases were diagnosed in 2012 and 8.2 million people died of the disease in that year globally, and breast cancer was responsible for 521,000 of the deaths.[3] In Nigeria, about 250,000 new cancer cases and 10,000 deaths due to cancer are reported yearly.[4],[5],[6]
The causes of breast cancer have been associated with many factors, including diet and diet-related factors such as increased weight, height, westernized diet, low intake of fibers, low intake of fresh fruit and vegetables, and alcohol and tobacco consumption; hormones and reproductive factors; exposure to ionizing radiation; family history of breast cancer; and presence of benign breast disease.[3],[7],[8],[9]
Exposure of people to health-related risk factors that could significantly increase their tendencies of getting chronic diseases including breast cancer is on the increased in Nigeria. Especially, the adoption of western lifestyles behaviors which is characterized by a high-caloric diet rich in animal fat and proteins, combined with a lack of physical exercise, and the present day changes in environmental and social conditions in our societies.
According to world cancer report, >30% of cancer cases are preventable by avoiding the risk factors.[3] There is therefore urgent need for better breast cancer-free life among our women and is achievable when they have adequate knowledge regarding the predisposing risk factors, self-care practices, and needs for prompt health-care visits for regular breast cancer care among women of the state. The aim of this cross-sectional survey was to assess the knowledge, attitudes, and practices of women concerning breast cancer in Jos and environs for the purpose of future interventions.
| Methods | | |
Study location
Plateau is a highly heterogeneous state with over forty ethnolinguistic groups, and each ethnic group has its own distinct language, with English being the official language for communication, though Hausa has also gained acceptability as a medium of communication.[10] The main religions of the people of Plateau State are Christianity, traditional African religions, and Islam.[11]
The study was conducted in Jos South and North Local Government Areas (LGAs) of Plateau State, located in the North-Central part of Nigeria, popularly known as the middle belt. Jos North LGA has 14 political wards while Jos South LGA has a total of 16 political wards. The altitude of Jos ranges between 1200 m (about 4000 feet) to a peak of 1829 m above sea level at the Shere Hills.
Study population and sample size
The study population consisted of all women within the age limits of 18 years and above residing in Jos South and North LGAs while the samples are those who fall within the age bracket of 18 years and above and were willing to fill the questionnaires. Slovin's formula (written as: n = N/(1 + Ne 2), where n = number of respondents, N = number of population, e = error tolerance) at confidence interval of 95%, with absolute precision of 0.05, was used to estimate the needed sample size.[12] The calculation gave a total sample size of 400 women who were assessed for their knowledge, attitudes, and practice regarding breast cancer.
Sample selection
The sample selection involved the use of purposive, stratified, and simple random sampling techniques. Seven out of the 14 wards in Jos North LGA and eight out of the 16 wards in Jos South LGA were purposively selected based on strategic locations and population sizes and then stratified based on the population strength of each ward. At each specific location, simple random sampling was used in selecting the respondents for the study.
Ethical approval
The Ethics Committee of the Faculty of pharmaceutical sciences, University of Jos, reviewed and approved the study protocol. The purpose and objectives of the study were explained to the respondents, after which their verbal consents were obtained, and they were also assured of the confidentiality of their collected information.
Data collection
A semi-structured questionnaire covering the relevant information pertaining to the study variables such as sociodemographic information, knowledge, attitude, and practice of the respondent was included in the study. It was developed based on questions used in previous peer-reviewed published studies, and the instrument was pretested on ten respondents within the study areas, and the results was excluded from the main report of the study.
The pretested questionnaires were then self-administered to the respondents within the study areas, with special guidance given to those that were not sufficiently literate. After which the filled questionnaires were retrieved on the spot by the researcher and coded for analysis though some were retained by participants for a specified time after which they were returned.
Data analysis
After a concise rechecking procedure, the data were then encoded and analyzed using IBM Statistical Package for Social Sciences, version 20 (IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp. Released 2011). Test of associations between the variables was done using Chi-square statistical test, and P < 0.05 was considered statistically significant, and descriptive statistics (percentages) were used to describe the frequency.
| Results and Discussion | | |
A total of 395 respondents (98.8%) participated in the study; out of which 209 (53.0%) fall within the age 18–27 years while 89 (22.6%) were in the age bracket of 28 and 37 years, with only 17.8% and 6.6% of the respondents falling within the age groups of 38–47 years and >48 years, respectively. Two hundred and twenty (55.6%) of them were single, 153 (38.8%) married, while 8 (2.3%) were divorced/separated, with 11 (2.8%) widowed. The highest number (172 [43.7%]) of the respondents had secondary certificates as their highest academic qualifications, followed by diploma/The Nigeria Certificate in Education/Community Health Extension Workers (25.1%) and first degree (20.8%) in that order [Table 1].
Most of the respondents (95%) agreed that they have heard about breast cancer, but based on the percentage mean knowledge scores, the respondents' general knowledge regarding the risk factors was poor (30.94%) compared to results of similar studies conducted by Akhigbe and Omuemu [8] who found the respondents' knowledge of breast cancer risk factors to be about 55%, though result of the present study showed a slightly better knowledge on risk factors over a similarly study conducted among women in northern Nigeria.[13] The respondents' knowledge regarding the signs and symptoms of breast cancer was averagely good (59.9%) compare to their knowledge on the risk factors associated with the disease [Table 2]. Although the details of the results on signs and symptoms showed that those highly recognized by the respondents were those associated with the advancing stages of the disease and are obvious. For instance, 80.7% of them knew that the presence of lumps in the breast was a sign of breast cancer, changes in the shape of the breast (69.5%), swelling or enlargement of the breast (64.7%), pains in the breast (77%), and presence of discharge from the breast (61.9%) which are all indications of the late stage of the disease.[7],[14]
When asked about their sources of information on the disease, most of them (35.80%) said that they got information through the media, especially TV and radio [Figure 1]. This means that more advocacies on the disease can be passed to the public through this means; since most of them admitted the media as their major source of information on breast cancer, this is possible because the facilities are readily available in almost every household. Similarly, to maintain a healthy population and preserve quality of life of the citizens, it will be necessary to improve on the health-care system as a major sources for health information to the public; since the health-care professionals are the main custodians of health-related knowledge, they will be able to impact the right information to the public related to the ailment and its preventive measures.[15]
Regarding respondents' attitudes [Table 3], high percentage of them (66.3%) agreed that breast cancer was prevalent in Nigeria, in which 72.2% of them also agreed that any woman could be at risk of getting the disease. Many of them also agreed that breast cancer screening was not harmful (66.1%), and early diagnosis was the best approach toward prevention (71.4%) and treatment (65.3%), with majority of them agreeing with surgical operation as the best treatment option for the disease (48%). Although the respondents had positive attitude toward the disease, their breast screening practices were generally poor as majority of them (47.1%) had no idea of the right age to initiate self-breast examination. Furthermore, the high percentage of them (49.9%) that claimed to know how to carry out self-breast examinations, said they were not practicing self-breast examination very often, and 79.8% of them also confessed not visiting medical practitioner for breast cancer examination and care [Table 4]. This result of respondents' knowledge regarding breast screening methods and practices was similar to that of a study conducted by Okobia et al.,[5] who also found poor screening practices among respondents but is contrary to results of similar studies conducted in developed countries where the respondents reported carrying out breast self-screening on a regular bases, and when needs arouse to see health personnel, they did that at the appropriate time, and this has been found to be helpful in early detection of breast cancer incidence and prompt attention arresting the situations before becoming worst.[16],[17],[18]
On a general note, the high level of awareness of the respondents on the existence of the disease and their positive attitudes might not be unconnected with their levels of education as many of them were literate [Table 1] ; though, the association was not statistically significant at probability level of P=0.05 [Table 5]. Studies have shown that educational level may influence the levels of awareness and knowledge of women toward breast cancer.[19],[20],[21] The poor knowledge of respondents regarding risk factors and breast self-examination practices might be a reflection of their levels of understandings on the disease's pathology and self-examination practices.[19] | Table 5: Association between respondents' demography and breast cancer knowledge
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| Conclusion | | |
From the result, it could be concluded that though most of the study populations were aware of the existence of breast cancer disease, with positive attitudes toward it, high percentage of them had poor knowledge on risk factors and average knowledge on the signs and symptoms of the disease, in addition to poor breast self-examination practices among the respondents. As an intervention measure, respondents need to be taught about the risk factors and breast self-examination practices, bearing in mind the health education levels of the women. This might bring about changing their negative behaviors to positive healthy practices.[22]
Although the results might not be a true representation of the women population across Nigeria, there may be variations among the study populations depending on the location and time of study. For instance, the study location for the present research was in urban areas with many high institutions and business premises which might be the main reasons for high percentage of respondents being students, business women, and civil servants. For the purpose of generalization of the result, it might be important to replicate this study in various parts of Nigeria, with different respondents of varying educational and socioeconomic backgrounds.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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[Figure 1]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]
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