Demographic determinants of breast self-examination among adult females in Botswana
Abstract
Background: Breast cancer is a major public health problem in Botswana, with an age-adjusted incidence of 20 per 100 000 females in 2020. It is the second most common female cancer. Between 72% and 90% of patients present with advanced stages at first diagnosis, which severely impacts survival. Breast self-examination (BSE) provides an easy, low-cost and safe tool to improve early detection. Objectives: This study aimed to determine the prevalence of and factors influencing BSE uptake among females across Botswana. Method: A cross-sectional hospital-based study was conducted from September 2023 to January 2024 among 158 females aged at least 18 years across four hospitals in Botswana. Systemic random sampling was used. Data on sociodemographic factors and BSE practices were collected via a pretested, Setswana-translated questionnaire adapted from the Breast Cancer Initiative. Analysis via StataNow 18 SE utilised descriptive statistics, Chi-square tests and binary logistic regression. Ethical approval and written consent were obtained. Results: Most participants (77.8%, n = 123) reported performing BSE, but only 10.6% (n = 13) practised it monthly as required. Only 27.8% (n = 44) had ever undergone a clinical breast examination. Multivariate analysis identified a lack of religious affiliation (adjusted odds ratio [AOR] 0.14; 95% confidence interval [CI] 0.03–0.63, p = 0.011) and lower education (AOR 0.12; 95% CI 0.03–0.56, p = 0.011) as significant predictors of decreased BSE practice. Conversely, females aged 30 years – 49 years were more likely to practise BSE than those aged 18 years – 29 years (AOR 3.14; 95% CI 1.22–8.03, p = 0.017). Conclusion: Most females in Botswana do not perform BSE regularly. Contribution: This study highlights three interactive predictors (religion, education and age) for BSE practice. We recommend integrating BSE education into school curricula, community outreach and healthcare provider training to improve breast health outcomes.