Multilevel factors associated with clinical breast examination uptake among women in the Northern Region of Ghana: a cross-sectional survey.

Abstract

Background: Despite the World Health Organization's recommendation of clinical breast examination (CBE) in resource-limited settings where mammography services are unavailable, the participation rate among women in Ghana remains low. This study examined multilevel factors associated with CBE uptake among women in the Northern Region of Ghana.

Methods: A multi-stage cluster sampling technique was employed to recruit women aged 25 years and older from 30 communities in the Tamale metropolis, Northern Region of Ghana. To determine the factors associated with CBE uptake, multilevel logistic regression models were fitted. The outcome of the fixed effects analysis was presented using adjusted odds ratios (aOR), with a 95% confidence interval (CI) and a p-value of less than 0.05.

Results: Approximately 1,543 women were recruited from 30 communities with 48 clusters. The prevalence of CBE uptake was 23%. From the fixed effects results, women with tertiary education (aOR = 2.53, 95%CI = 1.49-4.29) were more likely to have CBE compared to those with no formal education. Women with increased knowledge of breast cancer (BC) were more likely to undergo CBE (aOR = 1.04, 95%CI = 1.00-1.07). The higher the perceived susceptibility to BC, the higher the likelihood of undergoing CBE (aOR = 1.25, 95%CI = 1.06-1.47). Women with increased perceived barriers to BC screening (aOR = 0.54, 95%CI = 0.41-0.73) and higher perceived fear of BC (aOR = 0.72, 95%CI = 0.57-0.91) were less likely to undergo CBE. Women who received recommendations from friends (aOR = 1.99, 95%CI = 1.25-3.18) and healthcare providers (aOR = 1.55, 95%CI = 1.00-2.39) were more likely to utilize CBE compared to their counterparts. Women in communities with health facilities (aOR = 2.14, 95%CI = 1.43-3.21) and those who resided in urban areas (aOR = 1.72, 95%CI = 1.10-2.69) were more likely to utilize CBE than their counterparts.

Conclusion: The findings signify that a multifactorial systematic approach is required to increase CBE uptake among Ghanaian women. We recommend a comprehensive community-based education program about BC, targeted at raising awareness of breast health and improving the knowledge of the disease, together with the benefits of CBE uptake. Concurrently, improving access to health facilities and CBE services is needed.