Breast self-examination practice and its determinants among women in Ethiopia: A systematic review and meta-analysis

Abstract

Background: The survival rate from breast cancer is lowest in African countries and the distribution of breast self-examination practice of and its determinants are not well investigated in Ethiopia. Therefore, this systematic review and meta-analysis was designed to determine the pooled prevalence of breast self-examination and its associated factors among women in Ethiopia.

Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed for this systematic review and meta-analysis. The databases used were; PUBMED, Cochrane Library, Google Scholar, CINAHL, African Journals Online, Dimensions and Summon per country online databases. Search terms used were; breast self-examination, breast cancer screening, early detection of breast cancer and Ethiopia. Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) was used for critical appraisal of studies. The meta-analysis was conducted using STATA 15 software. The pooled meta-analysis was computed to present the pooled prevalence and relative risks (RRs) of the determinate factors with 95% confidence intervals (CIs).

Results: We identified 2,637 studies, of which, 40 articles (with 17,820 participants) were eligible for inclusion in the final meta-analysis. The pooled estimate of breast self-examination in Ethiopia was 36.72% (95% CI: 29.90, 43.53). The regional distribution breast self-examination ranged from 21.2% (95% CI: 4.49, 37.91) in Tigray to 61.5% (95% CI: 53.98, 69.02) in Gambela region. The lowest prevalence of breast self-examination was observed among the general population (20.43% (95% CI: 14.13, 26.72)). Women who had non-formal educational status (OR = 0.4 (95% CI: 0.21, 0.77)), family history of breast cancer (OR = 2.04 (95% CI: 1.23, 3.39)), good knowledge of breast self-examination (OR = 4.8 (95% CI: 3.03, 7.6)) and favorable attitude toward breast self-examination (OR = 2.75, (95% CI: 1.66, 4.55)) were significantly associated with practice of breast self-examination.

Conclusions: Only a third of women in Ethiopia practiced breast examination despite WHO guidelines advocating for this practice among all women of reproductive age. Intervention programs should address the factors that are associated with breast self-examination. Population specific programs are needed to promote breast self-examination.

Fig 1. Flow diagram of the included studies in the systematic review and meta- analysis of breast self-examination practice among women in Ethiopia.

Fig 2. Forest plot pooled practice of breast self-examination in Ethiopia: Meta-analysis.

Fig 3. The funnel plot asymmetry for publication bias of the studies included in systematic review and meta-analysis of breast self-examination practice among women in Ethiopia.

Fig 4. Forest plot of subgroup analysis of breast self-examination among different populations of women in Ethiopia.

HCW: health care worker STE: school teacher.

Fig 5. Forest plot showing pooled odds ratio (log scale) of the associations between practice of breast self-examination among women’s and educational status of the women.

Fig 6. Forest plot showing pooled odds ratio (log scale) of the associations between practice of breast self-examination among women’s and family history of breast cancer.

Fig 7. Forest plot showing pooled odds ratio (log scale) of the associations between practice of breast self-examination among women’s and knowledge of breast cancer.

Fig 8. Forest plot showing pooled odds ratio (log scale) of the associations between practice of breast self-examination among women’s and attitude towards breast cancer.