Skip to main content

Knowledge, attitude, practice towards breast self-examination and associated factors among women in Gondar town, Northwest Ethiopia, 2021: a community-based study

Abstract

Introduction

Breast cancer is the most common type of cancer among women, particularly in low and middle-income countries. Breast self-examination is one of the non-invasive methods of screening in which a woman looks at her breast for any abnormal findings like lumps, distortions, or swellings. Despite, realized effects of breast self-examination in detecting breast cancer earlier, the vast majority of the cases still present with an advanced stage.

Objective

This study aimed to assess knowledge, attitude, and practices toward breast self-examination and associated factors among women in Gondar Town, Northwest Ethiopia, 2021.

Methods

A community-based cross-sectional study was conducted on women living in Gondar town. A simple random sampling method was used to select 571 participants. Interviewer administered questionnaires were used for data collection. Data was entered into Epi-data version 4.6 and exported to Statistical Package for Social Science (SPSS) version 25 for analysis. Multivariate logistic regression was used where a p-value < 0.05 was used to identify variables significantly associated with the outcome variable.

Result

From the total of 571 women, about 541 participants were involved in the study with a response rate of 94.7%. Of these, 56%, 46% and 45.8% of women had adequate knowledge, favourable attitudes, and performed breast self-examination (BSE) respectively. Women College and above AOR: 3.8 (95% CI: 1.43–10.14) and spouses College and above AOR: 3.03 (95% CI: 1.04–8.84), Women College and above AOR: 4.18 (95% CI: 1.59–10.92) and history of breast cancer AOR: 6.06 (95% CI: 2.19–16.74) and knowledge level AOR: 2.67 (95% CI: 1.18–6.04) were significantly associated with knowledge, attitudes, and practices towards breast self-examination respectively.

Conclusion

The findings of this study were considerable for inadequate knowledge, unfavourable attitude and poor practice towards BSE among women. Emphasis should be made on boosting the knowledge, attitude, and practice of the women toward breast self-examination and strengthening the implementation of comprehensive, systematic, and continuous BSE educational programs that were recommended along with a breast cancer awareness campaign.

Peer Review reports

Introduction

Breast cancer is a type of malignant tumor that starts in the cells of the breast and commonly occurs in women [1]. This abnormal cell could destroy healthy tissue and then, spread beyond its usual boundaries [2]. Non-communicable diseases (NCD) including breast cancer considered not prevented, which is a noticeable common false perception of the community but it is a preventable cause of morbidity, disability, and mortality [3]. The most common risk factors of breast cancer are being a woman and getting ≥ 50 years old, having dense breasts, having a family history of breast cancer, early menstruation, and late menopause, late pregnancy, being on birth control pills, race, atypical hyperplasia of the breast, and previous treatment using radiation therapy [4, 5]. Lifestyle factors are obesity, lower amounts of physical activity, alcohol, and foods like high fats and low fiber diets [5]. Evidence suggested that; getting regular physical activity, staying at a healthy weight, limiting the amount of alcohol drink, avoiding the use of postmenopausal hormone therapy, breastfeeding, eating more fruits, vegetables, and fewer animal fats is linked with many health benefits and lower the risk of breast cancer [5]. Besides, it not only affect the breast tissue, but also spread to other part of the body organs like liver and lungs [6, 7].

According to global cancer statistics; breast cancer accounts for about 25% and 15% of total incidence and death respectively [8, 9]. In American an average risk of a woman of developing a breast cancer was 13% which is equivalent to one in every eight women had a chance of developing in their life time [10]. It is an important public health issues, not only in the developed world but also in resource limited nations [11]. It is the most frequent cause of death among women and estimated that 70% of all breast cancer cases worldwide were reported in low and middle-resource countries [12]. The incidence of breast cancer accounts for 22.6% of all cases of cancer in Ethiopia [13]. Breast self-examination (BSE) is one of the non-invasive methods of screening in which a woman looks at her breast for any abnormal findings like lumps, distortions, discharges or swellings with an intention to detect it early for early initiation of treatment and better chance of survival for breast cancer patients [14, 15].

Knowledge, attitude and practice of BSE have been reported in different countries. In regards to BSE knowledge 22.7% in Vietnam [16], 63.8% in Turkey [17], 41.5% in Libya [18], 34% in Sudan [19], 78% in Cameroon [20], 25.6% in Addis Ababa [21], 34.2% in Arba Minch [22], 43.1% in Jima [23], and 55.5% in Adwa town [24] had an adequate knowledge about breast self-examination. As per women’s attitude 64.01% in Saudi Arabia [25], 87.2% in Pakistan [26], 74.9% in Libya [18], 53.4% in Addis Ababa [21], and 46.3% in Adwa town [24] had a favorable attitude towards BSE. Considering practice towards BSE 43% in Saudi Arabia [27], 24.9% in Pakistan[26], 21% in Oman [28], 15.8% in Vietnam [16], 8.5% in turkey [17], 37.6% in Ghana [29], 38.5% in Cameroon [30], 39.2% in Egypt [31], 12.1% in Libya [18], 20.6% in Sudan [19], 13.3% in Arba Minch [32], and 18.6% in Addis Ababa [33] had a good practice of breast self-examination.

Factors affecting knowledge of the BSE were reported from the different countries. These are age, marital status, level of education, information of BSE, medical background, access to internet, source of information, and level of income. However, only the education levels and medical background for attitude towards BSE [16, 18, 26, 31, 33, 34]. Practice factors are almost similar to that of knowledge other than health education on breast cancer, knowing BSE techniques, occupation, and family history of breast cancer were related to women’s knowledge, attitude and practice towards BSE [16, 18, 33,34,35,36,37,38].

BSE is the only feasible approach that is cheap and easily applied method across wide population. Its ultimate purpose is early detection and treatment. Despite, its importance as an early detection strategy, poor knowledge of women has been a major obstacle. So, amplifying women’s knowledge, attitude, and practice towards BSE through creating breast cancer awareness campaign [39,40,41,42,43].

In our study area, there is a lack of evidence on women’s knowledge, attitude, and practice towards breast self-examination (BSE). Therefore, this study was aimed at assessing women’s knowledge, attitude, and practice on breast self-examination and thereby generates appropriate information that can be used by the central Gondar zonal health office and non-governmental organizations in the prevention and interventions of breast cancer.

Methods and materials

Study design, and period

A community-based cross-sectional study was conducted from April to May 2021.

Study setting

The study was conducted at Gondar Town, Northwest Ethiopia. Gondar Town is located 748 km from Addis Ababa the capital city of Ethiopia and 180 km from Bahir Dar capital city of Amhara regional state. The town has 6 sub-cities with 25 Kebele and 127,115 houses. Gondar Town is one of the ancient and densely populated towns in Ethiopia. According to the central Gondar zonal health office 2021 GC report, Gondar has a total population of 432,191 of whom 215,663 are men and 216,538 women. Nowadays the town is growing and it had 8 health centers, more than 15 private medical clinics, one private primary hospital, and one Comprehensive Specialized Hospital serving about 5 million populations.

Source population and study population

All adult women who are living in Gondar town were the source population. All women who are living in Gondar town during the data collection period were considered as the study population.

Inclusion and exclusion criteria

All women who were 20–70 age group living in Gondar town during the study period were included. Women who are severely ill during data collection time and those who refuse to participate in the study were excluded.

Sample size determination and calculation

The actual sample size for the study was determined using single population proportion formula with the assumption of 34.2% knowledgeable of BSE [32], 95% confidence interval; (α = 0.05), 5% margin of error, 10% none response rate, and 1.5 design effect.

$${\text{n}} = \frac{{\left( {{\text{Z}}\upalpha /2} \right)2\;{\text{p}}\left( {1 - {\text{p}}} \right) }}{{{\text{d}}2}} = \frac{{\left( {1.96} \right)2 \left( {0.342} \right) \left( {0.658} \right) }}{{\left( {0.05} \right)2}} = 346,$$

where n = is the minimum sample required; P = population proportion, 0.342; d = the margin of error, 0.05; Z = the upper percentile of the normal distribution at 95% CI.

By Multiply 1.5 design effect n = 519, adding 10% non-response rate = 52 and the final sample size would be 571 (Table 1). Sample size calculation on second the objective in the same study showed that only practice was significantly associated with BSE (Table 2).

Table 1 Sample size calculation for the dependent and independent variables among women in Gondar town, Northwest Ethiopia, 2021
Table 2 Sample size calculation for associated factors with breast self-examination among women in Gondar town, Northwest Ethiopia, 2021

The final sample size was from a single population proportion and the second objective was used the maximal one take from single population proportion knowledge of BSE = 571.

Sampling technique and procedures

A multi-stage sampling method was applied for the selection of houses from each Kebele. Firstly, Out of 25 kebeles in the Gondar town, 7 kebeles such as Aribengochi, Adebabayeyesuse, Abajalie, kehaeyesus, Shiwaber, Hidasie, and Aba Samuel kebele were randomly selected by lottery method to represent all kebeles (28% representativeness). Secondly, a systematic sampling technique was used to label the households within each Kebele The proportional allocation formula for each Kebele is \(n = \frac{njXnf}{N}\); Were, nf = final sample size, nj = total number of houses each Kebele, N = total number of houses (Fig. 1). Lastly, a simple random sampling was used to select 571 study participants within households using the sampling frame.

Fig. 1
figure 1

The schematic presentation of sampling procedure to select the study households of women aged 20–70 at Gondar Town, Northwest Ethiopia, 2021 (n = 571)

Data collection tools and procedures

The questionnaire was adapted from different works of literature [26, 44, 45]. The questionnaire was first prepared in English, and then it was translated into Amharic language and back to English. It contains four parts such as socio-demographic characteristics (n = 9), knowledge (n = 12), attitude (n = 13), and practice (n = 8) items. Then the data were collected by 5 data collectors using face-to-face interviewer administer questionnaires. The overall supervision was carried out by the principal investigator.

Operational definition

Adequate knowledge: It refers to participants who scored mean and above values 8 from the provided 12 close-ended questions about the knowledge of BSE [46].

Inadequate knowledge: It refers to participants who scored below mean values 8 from the provided 12 close-ended questions about the knowledge of BSE [46].

Favorable attitude: It refers to participants who scored mean and above values 6 for attitude-related questions towards BSE, which was measured by the provided 12 questions [46].

Unfavorable attitude: It refers to participants who scored below mean values 6 for attitude-related questions towards BSE, which was measured by the provided 12 questions [46].

Good practice: It refers to those who checked or perform BSE at least once per month just a week after each menses [47].

Poor practice: It refers to those who practice BSE other than the correct time in the cycle [47].

Data quality control

Pretest was done on 5% of the total sample size from the non-selected kebele of the same population before 4 days of actual data collected. Two days of training were given for data collectors and supervisors by investigators on the objectives of the study, ethical considerations, the content of the questionnaire, and how to conduct the interview. Based on the pre-test, questionnaires were edited, and necessary corrections made were on order of questions and that poses participant to confusion. The reliability of the tool on Cronbach’s alpha results knowledge = 0.81, attitude = 0.86, and practice = 0.71. The collected data was checked out for completeness, accuracy, and clarity by the principal Investigators before data entry.

Data processing and analysis

Data were entered using Epi data version 4.6 software and analyzed using SPSS version 25. Data cleaning and cross-checking were done before analysis. Descriptive statistics were summarized using the mean, and standard deviation. Frequencies and percentages were used in the presented table, figures and text. Multivariate logistic regression analysis were used to identify factors where p-value < 0.05 was declared as significantly associated with knowledge, attitudes, and practices of breast self-examination.

Result

Socio-demographic characteristics

Out of 571 participants, 541 agree to participate in the study, yielding a response rate of 95%. Nearly half (47.5%) of the participants were within the age range between 20 and 29 years. The minimum and maximum age of the participants was 20 and 69 respectively, the majority of women (87.4%) and 36.8% were orthodox and completed secondary education level respectively. Among the participants, 62.1% and 49.9% were married and housewives respectively (Table 3).

Table 3 Socio-demographic characteristics of the women aged 20–70 at Gondar Town, Northwest Ethiopia, 2021

Knowledge towards breast self-examination and their information source

Among the respondents, 66% of participants heard about breast self-examination. The majority (56%) (95% CI: 51–61) of participants had adequate knowledge (Fig. 2) and their main source of information was television/radio (43.2%), health institution/profession (30.8%), peer group, and school training (15.6%) and from newspaper and internet (10.2%) (Table 4).

Fig. 2
figure 2

The overall status of knowledge, attitude, and practice towards Breast self- examination among women aged 20–70 at Gondar Town, Northwest Ethiopia, 2021 (n = 571)

Table 4 Knowledge towards breast self-examination among women aged 20–70 at Gondar Town, Northwest Ethiopia, 2021

Attitude towards breast self-examination

Among 541 study participants, 46.0% (95% CI: 42–52) had positive attitudes towards breast self-examination, 60.3% of the respondents score breast self-examination as necessary (Table 5).

Table 5 Attitude towards breast self-examination among women aged 20–70 at Gondar Town, Northwest Ethiopia, 2021

Practices towards breast self-examination

Among 541 study participants, 248 (45.8%) performing breast self-examination and 31% (95% CI: 25–37%) had good practices of breast self-examination (Fig. 2). From the total respondents, more than half 54.2% (n = 293) of them did not practice BSE. The main reasons for not practicing BSE 175 (57.4%) were not having breast problems and 31.7% (n = 93) don’t know how to breast self-examine (Table 6).

Table 6 Practice towards breast self-examination among women aged 20–70 at Gondar Town, Northwest Ethiopia, 2021

Factors associated with breast self-examination

All independent variables entered into the logistic regression (multivariable logistic regression analysis). Women’s and husbands' education level were significantly associated with knowledge. The age of the women and women’s educational level was significantly associated with the attitude of BSE. History of breast cancer and good knowledge of BSE were significantly associated with performing BSE. Women college and above were about 4 times [AOR: 3.8, (95% CI: 1.43–10.14)] more likely to know of BSE than those who uneducated women. The spouses whose educational level College and above was about 3 times [AOR: 3.03, (95% CI: 1.04–8.84)] more likely to be knowledgeable towards BSE than those who had an illiterate husband (Table 7).

Table 7 Bivariate and multivariate analysis of factors associated with knowledge of BSE among women aged 20–70 at Gondar Town, Northwest Ethiopia, 2021

Women College and above was about 4 times [AOR: 4.18 (95% CI: 1.59–10.92)] and secondary school was about 3 times [AOR: 2.80 (95% CI: 1.25–6.29)] had favorable attitudes towards BSE than those women who are illiterate (Table 8).

Table 8 Bivariate and multivariate analysis of factors associated with Attitude towards BSE among women aged 20–70 at Gondar Town, Northwest Ethiopia, 2021

Women who have personal and family history of breast cancer were about 6 times [AOR: 6.06, (95% CI: 2.19–16.74)] more likely to perform BSE than women who do have not the history of breast cancer. A woman who has adequate knowledge of BSE about 3 times [AOR: 2.67 (95% CI: 1.18–6.04)] is more likely to perform BSE than women who have inadequate knowledge (Table 9).

Table 9 Bivariate and multivariate analysis of factors associated with the practice of BSE among women aged 20–70 at Gondar Town, Northwest Ethiopia, 2021

Discussion

The aim of this study was to assess knowledge, attitude, practice, and associated factors of breast self-examination among women in Gondar town. In this study, more than half 56% (n = 200) (95% CI: 52–62%) of the study participants had adequate knowledge regarding BSE, which is comparable with study conducted in Ethiopia that indicated 55.5% in Adwa town [24]. This similarities could be due to similar study subjects.

However, the finding is higher than that of Vietnam 22.7% [16], 34% Sudan [19], 41.5% Libya [18], 34.2% Arba Minch [32], 43.1% Jimma [23], and 25.6% Addis Ababa [21]. The difference might be due to by self-reporting data collection technique in Vietnam and Sudan, and the clustered sampling procedure was used in Libya. The self-reporting data collection method requires participants to respond to the researcher's questions without his/her interference [48]. In Ethiopia, the possible justification might be the educational level difference. In our study, 29.8% of participants were College and above educational status, but only 14.4% of study participants in Arba Minch, and 18.8% in Jima were college and above educational status. This finding is lower than the study conducted in Cameroon 78% [20], and 63.8% in Turkey [17]. The possible justification might be due to socio-economic, and study population differences. The current study was community-based, but that of Cameroon was conducted on patients attending a surgical outpatient clinic.

In this finding, about 46% (95% CI: 42–52%) of participants had a positive attitude towards breast self-examination, which is comparable with the study conducted in Ethiopia that indicated 46.3% in Adwa town [24].This consistency might be due to similar socio-cultural status and study population whose age were 20–70. However, it is lower than the studies conducted in Saudi Arabia 64.01% [25], 87.2% Pakistan [26], and 74.9% Libya [18]. This difference might be due to sampling size difference, educational level, and participant’s knowledge towards BSE, occupational difference, and information access availability.

In this finding, Nearly one-third 31% (n = 77) (95% CI: 25–37%) of participants had good practices towards BSE, which is comparable with the study done in Addis Ababa, 28.4% [33]. This consistency might be due to similar socio-cultural and economic status. Besides, factors that affect practice for early detection of BSE might be similar in both study settings. On contrary, this study is higher than the studies conducted in Arba Minch 13.3% [32], 12.1% Libya [18], and 8.5% Turkey [17]. The difference might be knowledge difference, and in Arba Minch, the majority (45%) of the participants are illiterate. On the other hand, this finding was lower than the studies conducted in Saudi Arabia 43% [27], and 37.6% in Ghana [29]. The possible justification might be educational and knowledge differences. In Saudi Arabia, the majority (65%) of participants had adequate knowledge about BSE, and 79% of the participant had an educational level completed university, whereas 88% of participants were aware of BSE in Ghana.

In this study, women’s educational level at College and University were about 4 times [AOR: 3.8, 95% CI: (1.43–10.14)] more likely to be knowledgeable with BSE than those who are illiterate. Also, the women whose husbands had an educational level College and University were about 3 times [AOR: 3.03, 95% CI: (1.04–8.84)] more likely to knowledgeable than those had illiterate husbands. Evidence shows that training women about breast self-examination goes correspondingly with their educational attainment of College level and above has a positive impact on their related knowledge and practices [49, 50].

Women’s College and above was also one of the significant factors for the attitudes of breast self-examination, women’s College and above was about 4 times AOR:4.18, (95% CI: 1.59–10.92) and secondary school was about 3 times [AOR: 2.80, 95% CI: (1.25–6.29)] more likely to had positive attitude towards BSE than women those who are illiterate. it was supported by the study done in Libya [18], and Turkey [17]. This might be due to educational attainment of secondary school and above could increase women’s attitudes towards breast self-examination besides it also enhance compliance towards breast self-examination behavior [51].

In this study, women who have a history of breast cancer were about 6 times [AOR: 6.06, 95% CI: (2.19–16.74)] more likely to perform BSE than their counter parts. This study was in line with the studies conducted in Jimma [23], Addis Ababa [36], and Libya [18]. A family history of breast cancer is positively affecting the practice of breast self-examination [52]. This could be women with a history of breast cancer performing breast self-examination at a regular basis and making them more cognizant, which in turn may lead to an earlier diagnosis of breast cancer.

Limitations

As practice was not directly observed rather we used checklist that will not know how exactly they were practicing it. Other limitations were being conducted in a single urban community, which may not be representative of the rural community or other urban communities in Ethiopia.

Conclusion

The findings of this study were considerable for inadequate knowledge, unfavorable attitude and poor practice towards BSE among women. Emphasis should be made to boost the attitude and practice of the women towards breast self-examination and strengthening of the implementation of comprehensive, systematic, and continuous BSE educational programs were recommended along with a breast cancer awareness campaign.

Availability of data and materials

The datasets used/or analyzed during the current study is available from the corresponding author on reasonable request.

Abbreviations

ACS:

American Cancer Society

BCA:

Breast Cancer

BSE:

Breast self-examination

CBE:

Clinical breast examination

ECA:

Ethiopian Cancer Association

SPSS:

Statistical package social science

COR:

Crude odds ratio

AOR:

Adjusted odds ratio

CI:

Confidence interval

UoG:

University of Gondar

References

  1. Akram M, Iqbal M, Daniyal M, Khan AU. Awareness and current knowledge of breast cancer. Biol Res. 2017;50(1):1–23.

    Article  CAS  Google Scholar 

  2. Milosevic M, Jankovic D, Milenkovic A, Stojanov D. Early diagnosis and detection of breast cancer. Technol Health Care. 2018;26(4):729–59.

    Article  PubMed  Google Scholar 

  3. Makary MA, Daniel M. Medical error—the third leading cause of death in the US. BMJ. 2016;353:i2139.

    Article  PubMed  Google Scholar 

  4. Kamińska M, Ciszewski T, Łopacka-Szatan K, Miotła P, Starosławska E. Breast cancer risk factors. Menopause Rev. 2015;14(3):196.

    Article  Google Scholar 

  5. Sun Y-S, Zhao Z, Yang Z-N, Xu F, Lu H-J, Zhu Z-Y, et al. Risk factors and preventions of breast cancer. Int J Biol Sci. 2017;13(11):1387.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Waks AG, Winer EP. Breast cancer treatment: a review. JAMA. 2019;321(3):288–300.

    Article  CAS  PubMed  Google Scholar 

  7. Tan PH, Ellis I, Allison K, Brogi E, Fox SB, Lakhani S, et al. The 2019 World Health Organization classification of tumours of the breast. Histopathology. 2020;77:181–5.

    Article  PubMed  Google Scholar 

  8. Iacorossi L, Gambalunga F, Fabi A, Giannarelli D, Facchinetti G, Piredda M, et al. Adherence to hormone therapy in women with breast cancer: a quantitative study. Prof Inferm. 2016;69(2).

  9. Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA A Cancer J Clin. 2015;65(2):87–108.

    Article  Google Scholar 

  10. DeSantis CE, Ma J, Gaudet MM, Newman LA, Miller KD, Goding Sauer A, et al. Breast cancer statistics 2019. CA A Cancer J Clin. 2019;69(6):438–51.

    Article  Google Scholar 

  11. Roy I, Othieno E. Breast Carcinoma in Uganda. Arch Pathol Lab Med. 2011;135:194–9.

    Article  PubMed  Google Scholar 

  12. Lera T, Beyene A, Bekele B, Abreha S. Breast self-examination and associated factors among women in Wolaita Sodo, Ethiopia: a community-based cross-sectional study. BMC Womens Health. 2020;20(1):1–10.

    Article  Google Scholar 

  13. John R. Global cancer facts and figures 4th edition-special section, the obesity epidemic. Am Cancer Soc. 2018;76:1–73.

    Google Scholar 

  14. DeSantis C, Ma J, Bryan L, Jemal A. Breast cancer facts and figures 2013–2014. Atlanda: American Cancer Society, Inc.; 2013.

    Google Scholar 

  15. Tarver T. Cancer facts and figures 2012. American Cancer Society (ACS) Atlanta, GA: American Cancer Society, 2012. Available from Taylor & Francis; 2012.

  16. Tuyen DQ, Dung TV, Dong HV, Kien TT, Huong TT. Breast self-examination: knowledge and practice among female textile workers in Vietnam. Cancer Control. 2019;26(1):1073274819862788.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Karahan N. Prevalence and determinants of breast self-examination in Karabuk. Turkey Cukurova Med J. 2019;44(3):1046–54.

    Google Scholar 

  18. Ziuo FM, Twoier AA, Huria TR, El-Khewisky FS. Low awareness about breast self-examination and risk factors of breast cancer in Benghazi, Libya. Ibnosina J Med Biomed Sci. 2018;10(2):54.

    Article  Google Scholar 

  19. Nugod SMAM. Breast self examination knowledge among females in Salha, Omdurman locality, Khartoum State, Sudan (2016): University of Gezira; 2016.

  20. Alegbeleye BJ, Jantchou P. Knowledge and practices of breast self-examination amongst women attending a surgical outpatient clinic, Cameroon. Breast cancer. 2018;13.

  21. Chimdi C. Assessment of knowledge, attitude and practice of breast self-examination among women aged 20–49 years in Addis Ababa. Ethiopia: Addis Ababa University; 2017.

    Google Scholar 

  22. Mereta B, Shegaze M, Mekonnen B, Desalegn N, Getie A, Abdilwohab MG. Assessment of breast self-examination and associated factors among women age 20–64 years at Arba Minch Zuria District, Gamo Zone Snnpr Ethiopia, 2019. 2020.

  23. Terfa YB, Kebede EB, Akuma AO. Breast self-examination practice among women in Jimma, Southwest Ethiopia: A Community-Based Cross-Sectional Study. Breast Cancer Targets Ther. 2020;12:181.

    Article  Google Scholar 

  24. Abay M, Tuke G, Zewdie E, Abraha TH, Grum T, Brhane E. Breast self-examination practice and associated factors among women aged 20–70 years attending public health institutions of Adwa town. North Ethiopia BMC Res Notes. 2018;11(1):1–7.

    CAS  Google Scholar 

  25. Alomair AN, Felemban D, Felemban M, Awadain J, Altowargi A, Alfawzan NF. Knowledge, attitude and practice of breast self-examination toward breast cancer among female students at king Saud University in Riyadh. Saudi Arabia EC Gynaecol. 2020;9(1):01–8.

    Google Scholar 

  26. Ahmed A, Zahid I, Ladiwala ZFR, Sheikh R, Memon AS. Breast self-examination awareness and practices in young women in developing countries: A survey of female students in Karachi. Pakistan J Educ Health Promot. 2018;7:90.

    Article  PubMed  Google Scholar 

  27. Al-Mulhim F, Bakr R, Almedallah D, Alkaltham N, Alotaibi A, Alnoaim S. Screening mammography and breast self-examination: attitudes and practices of women in the Eastern Province of Saudi Arabia. Screening. 2018;7(2):89–100.

    Google Scholar 

  28. Chattu VK, Kumary S, Bhagavathula AS. Community-based study on the knowledge, awareness, and practices of females towards breast cancer in Buraimi, Oman. South Asian J Cancer. 2018;7(4):215.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Dadzi R, Adam A. Assessment of knowledge and practice of breast self-examination among reproductive age women in Akatsi South district of Volta region of Ghana. PLOS ONE. 2019;14(12):e0226925.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Sama C-B, Dzekem B, Kehbila J, Ekabe CJ, Vofo B, Abua NL, et al. Awareness of breast cancer and breast self-examination among female undergraduate students in a higher teachers training college in Cameroon. Pan African Med J. 2017;28(1):164.

    Google Scholar 

  31. Salem MAA, Al Shazly HA, Ibrahem RA, Kasemy ZA, Abd El-Roaf SY. Knowledge, attitude, and practice of breast self-examination among women attending primary health care facility, Menoufia Governorate. Egypt Menoufia Med J. 2020;33(1):44.

    Article  Google Scholar 

  32. Getie A, Mereta B, Shegaze M, Mekonnen B, Desalegn N, Abdilwohab M. Assessment of breast self-examination and associated factors among women age 20–64 years at Arba Minch Zuria District, Gamo Zone Snnpr Ethiopia, 2019. 2020.

  33. Abeje S, Seme A, Tibelt A. Factors associated with breast cancer screening awareness and practices of women in Addis Ababa. Ethiopia BMC Women’s Health. 2019;19(1):1–8.

    Google Scholar 

  34. Karim NKA, Sooi LK, Mangantig E. Factors associated with breast-self examination practice and mammogram breast density among Malaysian women. Malays J Med Health Sci. 2019;15(109):96–101.

    Google Scholar 

  35. Olaogun JG, Emmanuel EE, Dada SA, Odesanmi OM, Adesua OA. The prevalence of practicing breast self-examination and knowledge of breast cancer disease among women attending secondary health facility. Int Surg J. 2017;4(10):3211–7.

    Article  Google Scholar 

  36. Getu MA, Kassaw MW, Tlaye KG, Gebrekiristos AF. Assessment of breast self-examination practice and its associated factors among female undergraduate students in Addis Ababa University, Addis Ababa, Ethiopia, 2016. Breast Cancer: Targets Ther. 2019;11:21.

    Google Scholar 

  37. Mengie T, Yifru A, Fikre A, Niguse W, Demsie D, Ekubay M. Assessment of knowledge, attitude and practice regarding breast self-examination among female students in Debre Birhan University, North Shewa Ethiopia. Am J Clin Exp Med. 2020;8(3):48–54.

    Article  Google Scholar 

  38. Ebrahim S. Knowledge of students toward breast cancer and breast self-examination practice at high school nursing in Basra city. Rev J Kufa for Nurs Sci. 2014;4(1):0.

  39. Suh MAB, Atashili J, Fuh EA, Eta VA. Breast self-examination and breast cancer awareness in women in developing countries: a survey of women in Buea. Cameroon BMC Res Notes. 2012;5(1):1–6.

    CAS  Google Scholar 

  40. Birhane K, Alemayehu M, Anawte B, Gebremariyam G, Daniel R, Addis S, et al. Practices of breast self-examination and associated factors among female Debre Berhan University students. Int J Breast Cancer. 2017;207:1–6.

    Article  Google Scholar 

  41. Mohamed AOA, Nori MMM, Ahmed ASM, Altamih RAA, Kunna ESM. Knowledge, attitude, and practice of breast cancer and breast self-examination among female detainees in Khartoum, Sudan 2018. J Prev Med Hyg. 2020;61(3):E470.

    PubMed  PubMed Central  Google Scholar 

  42. Sapountzi-Krepia D, Rekleiti M, Lavdaniti M, Psychogiou M, Chaliou M, Xenofontos M, et al. Evaluating female nursing students’ knowledge and attitudes regarding breast self-examination. Health Care Women Int. 2017;38(8):786–95.

    Article  PubMed  Google Scholar 

  43. Dir EDPC. National Cancer Control Plan Federal Ministry of Health, 2016–2020

  44. Toan DTT, Son DT, Hung LX, Minh LN, Mai DL, Hoat LN. Knowledge, attitude, and practice regarding breast cancer early detection among women in a mountainous Area in Northern Vietnam. Cancer Control. 2019;26(1):1073274819863777.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Desta F, Workicho A, Atomsa A, Workneh D, Tebeje B. Knowledge, practice and associated factors of breast self examination among female students of the College of Public Health and Medical Science, Jimma University, Ethiopia. Am J Health Res. 2018;6:44–50.

    Article  Google Scholar 

  46. Ameer K, Abdulie SM, Pal SK, Arebo K, Kassa GG. Breast cancer awareness and practice of breast self-examination among female medical students in Haramaya University, Harar, Ethiopia. Ethiopia IJIMS. 2014;2(2):109–19.

    Google Scholar 

  47. Desta F, Workicho A, Atomsa A, Workneh D, Tebeje B. Knowledge, practice and associated factors of breast self examination among female students of the college of public health and medical science, Jimma University, Ethiopia. Am J Health Res. 2018;6(2):44.

    Article  Google Scholar 

  48. Althubaiti A. Information bias in health research: definition, pitfalls, and adjustment methods. J Multidiscip Healthc. 2016;9:211.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Sani AM, Naab F, Aziato L. Influence of educational level on knowledge and practice of breast self-examination among women in Sokoto, Nigeria. J Basic Clin Reprod Sci. 2016;5(2):100–6.

    Article  Google Scholar 

  50. Ibrahim SQ, Abdullah WH, Ahmed HM, Al-Banna DA. Impact of education program on breast self examination among a group of women in the Kurdistan Women Union, Erbil city. Zanco J Med Sci. 2016;20(3):1450–7.

    Article  Google Scholar 

  51. Khiyali Z, Aliyan F, Kashfi SH, Mansourian M, Jeihooni AK. Educational intervention on breast self-examination behavior in women referred to health centers: application of Health Belief Model. Asian Pac J Cancer Prevent APJCP. 2017;18(10):2833.

    Google Scholar 

  52. Dewi TK, Massar K, Ruiter RA, Leonardi T. Determinants of breast self-examination practice among women in Surabaya, Indonesia: an application of the health belief model. BMC Public Health. 2019;19(1):1–8.

    Article  Google Scholar 

Download references

Acknowledgements

Our gratitude goes to the School of Nursing, College of Medicine and Health Sciences, the University of Gondar for giving us the chance to conduct this research. The authors' thank also goes to Gondar Town Kebele administrators and all study participants.

Funding

Not applicable.

Author information

Authors and Affiliations

Authors

Contributions

KA, ZW, and YB: Conceived, designed and organized the whole procedure of this article production, performed data analysis and interpreting of findings and performed data analysis, interpreting of findings and coaching and mentoring, and equally prepare the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Zerko Wako.

Ethics declarations

Ethics approval and consent to participate

Ethical clearance was obtained from the Institutional Review Board (IRB) of the School of Nursing from the University of Gondar with reference number: S/N/121/5/2011. A permission letter was written from the School of Nursing to each Kebele Administrator of Gondar town. Then, the Kebele administrator allowed to conduct the study. The informed verbal consent was obtained from each study participant. Confidentiality was maintained by avoiding registration of personal identifiers like name, resident identification, and also no raw data was given to any other person. All methods were carried out in accordance with the Helsinki declarations.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Asmare, K., Birhanu, Y. & Wako, Z. Knowledge, attitude, practice towards breast self-examination and associated factors among women in Gondar town, Northwest Ethiopia, 2021: a community-based study. BMC Women's Health 22, 174 (2022). https://doi.org/10.1186/s12905-022-01764-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s12905-022-01764-4

Keywords

  • Attitude
  • Knowledge
  • Practice
  • Breast self-examination
  • Factors
  • Ethiopia