www.idosr.

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©IDOSR PUBLICATIONS
International Digital Organization for Scientific Research ISSN: 2579-0730
IDOSR JOURNAL OF BIOLOGY, CHEMISTRY AND PHARMACY 8(3)82-93, 2023.
https://doi.org/10.59298/IDOSR/JBCP/23/11.1117

Breast Cancer Awareness Among Pregnant Women at Hoima Regional

Referral Hospital, Western Uganda

Magumba Yatifu

Faculty of Medicine and Surgery Kampala International University Western Campus

Uganda

ABSTRACT
Breast cancer is a significant public health challenge, especially in less developed regions
like sub-Saharan Africa. This study assessed the awareness of breast cancer among
pregnant women attending antenatal care services at Hoima Regional Referral Hospital in
Western Uganda. A total of 200 participants were involved in this cross-sectional study. The
results showed that 86% of the participants had heard about breast cancer, while 14% had
never heard of it. Factors like age, level of education, religion, and occupation were found
to influence awareness levels. However, most women had insufficient knowledge about
breast cancer risk factors. This study highlights the need for intensified health education
programs and the decentralization of breast cancer screening services to improve
awareness and early detection.
Keywords: Breast cancer, cancer mortality, Antenatal care services, Women,
Mammography.

INTRODUCTION
Breast cancer is an important public corresponding mortality due to the
health challenge and is the leading cause disease. Women in Uganda and most
of female cancer mortality globally, with LMICs are disproportionately affected by
an incidence rate of 25.1%. Recent high mortality associated with breast
GLOBOCAN statistics revealed that breast cancer compared to their counterparts in
cancer mortality rates in less developed Western countries such as the United
regions of the world, such as sub-Saharan Kingdom, Canada, or the United States of
Africa (SSA), are approximately 62%, America. Although the exact cause of this
accounting for almost two-thirds of global disparity is unknown, some studies have
mortality before cervical cancer [1–3]. In identified delayed detection as a major
low- and middle-income countries (LMICs) contributing factor [6, 7]. Primary
like Uganda, breast cancer mortality poses randomized controlled trials have shown
a significant public health problem. the importance of mammography in the
More than three-fourths of patients are early diagnosis of breast cancer in
diagnosed with late-stage disease (stages asymptomatic women, and it has been
III and IV), which is associated with effective in decreasing mortality,
greater social stigma, more expensive especially in women aged 50-69 years,
treatment, and poorer survival [4]. with reductions of 20% to 35%.
According to Nagini et al. [5], breast Nevertheless, mammography remains
cancer is the second most commonly underutilized by women, even though it
diagnosed female cancer in Uganda after can be effective in the early detection of
cervical cancer, with an estimated breast cancer [8]. Generally, late
incidence rate of 15.8% and an associated presentation of cancer including breast
mortality rate of 11.4% among all female cancer leads to poor disease outcomes [9].
cancers, indicating a high incidence and Breast cancer is preventable through the

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uptake of modalities such as nationwide common cancers and a major public
breast cancer awareness programs health challenge for women's health.
involving clinics in remote areas and a There has been a significant increase in
referral system to improve detection and the annual incidence of breast cancer,
treatment [10]. Beliefs can help guide particularly in countries with low
health behavior but can be problematic incidence rates. According to the World
when not grounded in scientific evidence Health Organization (WHO), over 1.15
and obstruct health-seeking behavior. million women are diagnosed with breast
Current efforts to promote breast cancer cancer each year, resulting in an annual
awareness in Uganda include television reported death toll of 502,000 worldwide
and radio commercials and health fairs [16, 17]. In Uganda, the estimated annual
run by village health teams. Village health incidence rate is 4.5%, as per the age-
teams comprise elected community standardized incidence rate, but it is
volunteers who are taught health curable if promptly diagnosed through
information by clinical providers from the breast self-examination (BSE) and clinical
community health center to deliver to diagnosis [18]. Breast cancer accounts for
their villages [11]. As the burden of breast 16% of cancer deaths in adult women and
cancer increases, there is minimal is considered a significant threat
awareness in most parts of Africa, requiring prompt intervention [10]. Many
hindering the possibility of cure, women with breast cancer present at
prevention, and possible elimination. This health institutions with advanced
has led to unacceptably high infection multiple nodal involvements, leading to
rates and deaths among females [10]. For poor prognostic outcomes [19]. Studies
women to present early, they need to be have indicated that this late presentation
aware of the disease and must be able to of breast cancer patients is linked to poor
recognize the symptoms of breast cancer knowledge of the disease [20]. However,
through routine practice. Poor knowledge for women to present early, they need to
about breast cancer symptoms delays be aware of the disease and recognize its
early diagnosis, particularly among symptoms through routine practice. Poor
women in rural areas who are the most knowledge about breast cancer symptoms
vulnerable and least informed individuals. results in delayed early diagnosis [21].
This lack of knowledge can have serious Knowledge and awareness of breast
consequences if necessary actions are not cancer promote health-seeking behavior,
taken [12, 13]. leading to early diagnosis and increased
The Breast Health Global Initiative, an survival rates of breast cancer cases [21].
organization focused on providing The World Health Organization has
resource-stratified guidelines to improve emphasized the importance of raising
survival in LMICs, recommends an awareness among women for early
understanding of local beliefs about detection and reporting of breast cancer
breast cancer as a prerequisite for to improve the quality of life and survival,
effective early breast cancer detection as well as to address the increasing
programs [14]. Therefore, gaining a burden of this deadly disease [22].
greater understanding of the nature and However, recent studies indicate that
drivers of poor breast cancer awareness there is minimal awareness in most parts
among women will inform much-needed of Africa, hindering the possibility of
awareness programs aimed at assessing cure, prevention, and possible
the level and nature of breast cancer elimination, resulting in unacceptably
awareness in African countries [15]. This high infection rates and deaths among
study aims to empirically ascertain the females [10]. The aim of this study is to
level of awareness of breast cancer among assess the level of awareness of breast
women, which will hopefully guide future cancer among women attending Antenatal
intervention programs on breast cancer Care services at Hoima Regional Referral
prevention and control in the community. Hospital, Hoima District.
Globally, breast cancer is one of the most

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METHODOLOGY
Study Design 87.4%)(Ghrayeb FA., et al., 2018).
A descriptive cross-sectional study Z = 1.96 (for 95% confidence interval)
involving both qualitative and E = margin of error set at 5%
quantitative data analysis was conducted n = (Z)²P (1-P)/(E)²
on women attending ANC services at n = (1.96)² * 0.95(1-0.95)/(0.05)²
HRRH. n = 73 participants.
Area of Study Sampling Techniques
The study was conducted at the antenatal A simple random sampling technique was
clinic at Hoima Regional Referral Hospital, used to select participants.
which is in Hoima municipality. It is Sampling Procedures
located 101 km away from Kijjungu Road I selected one convenient day per week to
and is situated 200 km west of Kampala, visit the ANC clinic for the whole month.
in Hoima district, western Uganda. Hoima On each visit, 25 patients and one medical
Regional Referral Hospital caters to the personnel (one of a clinician, nurse,
population of the Bunyoro region, dispenser, social worker, or any staff in
encompassing the districts of Hoima, the hospital) were selected. The
Kibale, Masindi, Bulisa, Kiryandongo, interviewer wrote papers with numbers
Kagadi, Kikuube, and the eastern part of from 1 to 50, which were then folded and
DR Congo, overall serving over 3 million put in an opaque box. Questionnaires
people. The present bed capacity is 300. were then given to respondents who
The hospital is one of the oldest hospitals picked papers with odd numbers. Medical
in Uganda, dating back to 1935. Initially, personnel who were conveniently selected
it served a very small area in Hoima were also served with a questionnaire.
district, but in 1994, it was upgraded to a Data Collection Methods and
referral hospital targeting the Bunyoro Management
region with pregnant women attending A semi-structured questionnaire
ANC services every day, including those composed of open-ended questions was
from large areas. used to collect data. The questionnaire
Study Population was translated into the local languages of
The study included all women attending the area and then back-translated to
ANC services at HRRH. English to ensure consistency of meaning.
Inclusion Criteria After the questionnaires were filled, and
The study included all women attending data collected, forms were packaged in
ANC services at HRRH who would consent envelopes, and a database was formulated
to participate in the research or the study. using Microsoft Office tables before
Exclusion Criteria analysis using the SPSS version.
The study excluded any woman not Data Analysis
seeking services at HRRH, women from The data collected from the study's
districts in Uganda other than the study different specific objectives were
area, women from other countries who assembled, processed, and analyzed
were residing there temporarily, and using different computer programs and
those who had not consented or were not applications. Discussion, conclusion, and
willing to participate. recommendations were done afterward to
Sample Size Determination have a meaningful research report.
The sample size was determined using Quality Control
Kish Leslie's (1965) formula[23]: The participants were informed about the
n = (Z)²P(1-P)/(E)² purpose of the research and reassured
Where: that the research would not cause any
n = estimated minimum sample size psychological or physical discomfort to
required them. Therefore, the quality of the
P = proportion of a characteristic in a research depended on their collaboration
sample = 95% (Corrected value from and faithfulness. To ensure quality during

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data collection, notes against each understood, and translated to the
question asked and answered respectively participants who had consented in the
in their corresponding orders were made. local language.
A simple random sampling technique was Ethical Considerations
used to offer equal chances to The principles of ethics were put into
respondents to avoid bias. The research consideration, such as the principles of
focused objectively on the relevant autonomy, confidentiality, justice,
information, leaving out the non-relevant informed consent, beneficence, and non-
information. A team of researchers or malfeasance, among others, to ensure that
investigators was trained before the the patients were not negatively affected
research and were able to speak the local during the research processes and to
language or had translators. The ensure the rights and well-being of the
questionnaires were clearly read, patients were optimized.
RESULTS
Level of Awareness about Breast Cancer Out of the 200 participants, 172 (86.0%)
This study determined the level of had heard about breast cancer and
awareness about breast cancer among 28(14.0%) had never heard about breast
women attending antenatal care services. cancer as shown in the figure below.

Level of awareness of Breast Cancer

14.00%

86.00%

Ever Heard Never Heard

Figure 1: Level of awareness

In this study, majority of the study (85.5%), Farmer (36.5%) and attained
participants were aged 28-37(36.5%), secondary/Tertiary education (53.0%) as
Catholic (36.5%), Munyoro by Tribe shown in the table below.

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Table 1: Socio-demographic Factors
Variable Category Frequency(N) Percentage (%)

Age(Years) 18-27 46 23.0

28-37 73 36.5

38-47 58 29.0

≥48 23 11.5

Religion Muslim 47 23.5

Anglican 61 30.5

Catholic 73 36.5

Others 19 9.5

Ethnicity Munyoro 171 85.5

Others 29 14.5

Occupation Farming 73 36.5

Housewife 65 32.5

Business 37 18.5

Student 14 7.0

Daily labourer 11 5.5

Education No formal education 19 9.5

Primary 75 37.5

Secondary/Tertiary 106 53.0

Association between Socio-demographic aged 28- 37(94.5%), Anglicans (93.4%),

factors and level of awareness of Breast Banyoro (91.8) %, Students (100.0%) and
Cancer those who attained Secondary/Tertiary
According to the study, the Level of education (98.1%) as shown in the table
awareness was highest among women below.

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Table 2: Association between Socio-demographic factors and level of awareness of
Breast Cancer
Variable Category Frequency Level of awareness of
Breast Cancer
Frequency Percentage
(n) (%)
Age(Years) 18-27 46 40 87.0
28-37 73 69 94.5

38-47 58 47 81.0

≥48 23 16 69.7
Religion Muslim 47 40 85.1

Anglican 61 57 93.4

Catholic 73 65 89.0

Others 19 10 52.6

Ethnicity Munyoro 171 157 91.8

Others 29 15 51.7
Occupation Farming 73 59 80.8

Housewife 65 61 93.8

Business 37 31 83.8

Student 14 14 100.0

Daily labourer 11 07 63.6

Education No formal education 19 09 47.4

Primary 75 59 78.7
Secondary/Tertiary 106 104 98.1

Awareness of Breast Cancer risk factors aware of more than two risk factors while
Among participants who had ever heard 17(9.88%) were able to recall at least two
about breast cancer,155(90.12%) were not risk factors as shown in the figure below.

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9.88%

90.12%

Aware Unaware

Figure2: Awareness of Breast Cancer

DISCUSSION
Level of Awareness about Breast Cancer fell after the introduction of screening
This study determined the level of mammography. Accurate knowledge
awareness about breast cancer among about early warning signs and screening
women attending antenatal care services. methods plays an effective role in
The general lack of awareness among developing and employing early detection
women has been one of the barriers to programs in the community. Thus,
screening and early presentation. The understanding the factors that influence
level of awareness among the 200 patient delay is a prerequisite for the
participants was high; specifically, 172 development of strategies to shorten
(86.0%) had heard about breast cancer, delays.
and 28 (14.0%) had never heard about According to the study, the level of
breast cancer. This is consistent with a awareness was highest among women
study which reported the level of aged 28-37 (94.5%). This is inconsistent
awareness to be 92.8%[24, 25]. This with the findings of a study in West
finding is concordant with the findings of Amazon, which found the level of
a study in Malaysia which found the awareness to be highest among women
prevalence of poor awareness to be aged 40-69 years, with a drastic decrease
63.4%[26, 27]. This may be because of among those aged ≥ 70 years [28]. Among
various government programs put in female medical students, awareness of
place to increase awareness and improve breast cancer was high among older
breast cancer screening. students compared to younger ones [29–
Association between Socio-demographic 31]. This may be because young females
Factors and Level of Awareness perceive themselves not to be at risk and,
Because delayed presentation of therefore, do not take the time to explore
symptomatic breast cancer is associated more about the disease. In the current
with lower survival rates, higher rates study, the level of awareness was highest
may be achieved by encouraging women among Anglicans (93.4%) compared to
to seek help early. It has been observed other religious denominations. Religious
that the rate of detection of large tumors groups often enrich women with

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knowledge regarding various issues, level of education. This is because the
including health-related matters. higher the education, the more exposure
The current study also found that the to knowledge one gets access to.
level of awareness was high among Awareness of Breast Cancer Risk Factors
Banyoro. To the best of my knowledge, no Among participants who had ever heard
published study has measured the about breast cancer, 155 (90.12%) were
influence of ethnicity on awareness about not aware of more than two risk factors,
breast cancer. However, this may be while 17 (9.88%) were able to recall at
attributed to the fact that the majority of least two risk factors. Awareness of breast
the study participants were actually cancer risk factors was low compared to
Banyoro. According to our study, the level the study which found that 28.6% of the
of awareness was also found to be high women were aware that advanced age
among women who were students increases the risk of breast cancer [28].
compared to other occupations. This is in This finding is low compared to that in
line with the findings of a study in Saudi Pakistan which showed that the
Arabia which revealed a high level of proportion of women aware of age-related
awareness among university and medical and lifetime risk of getting breast cancer
students [32]. This is because students was 15.0%[33]. However, this is
are exposed to diverse knowledge on a inconsistent with a study in Saudi Arabia
regular basis. Those who attained which reported that 75.8% of the
secondary/tertiary education were found participants had good knowledge while
to be more informed about breast cancer 24.4% demonstrated poor knowledge [34].
than those who had no formal education Most education programs give women
or attained the utmost primary education. inadequate information about breast
This is consistent with a study by Olayide cancer; moreover, women themselves take
et al., [20], which reported the level of less/no initiative to appreciate the
awareness to vary proportionally with the disease.
CONCLUSION
The study revealed that awareness of found to influence awareness levels. To
breast cancer is relatively high among address this, it is essential to intensify
pregnant women attending antenatal care health education programs and
services in Hoima, Western Uganda. decentralize breast cancer screening
However, there is a significant knowledge services to reach a broader population.
gap regarding breast cancer risk factors. These efforts will contribute to improving
Socio-demographic factors, such as age, early detection and, ultimately, reducing
education, religion, and occupation, were the impact of breast cancer in the region.
RECOMMENDATION
The recommendations for enhancing more conveniently. Community
breast cancer awareness in Western engagement, including health workers
Uganda include intensifying health and volunteers, can also play a crucial
education programs, decentralizing role in educating women about the
screening services, engaging local disease and encouraging regular
communities, incorporating breast cancer screenings. Continuous research and
education into school curriculums, and evaluation can guide the development of
continuously monitoring the impact of targeted interventions. By implementing
awareness programs. These strategies aim these recommendations, healthcare
to target women of all ages, particularly providers, policymakers, and
underserved populations, and make early organizations can work together to reduce
detection services more accessible. late-stage diagnoses and improve the
Decentralization can help women in overall well-being of women in Western
remote areas access screening services Uganda.
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www.idosr.org Magumba

CITE AS: Magumba Yatifu (2023). Breast Cancer Awareness Among Pregnant Women at
Hoima Regional Referral Hospital, Western Uganda. IDOSR JOURNAL OF BIOLOGY,
CHEMISTRY AND PHARMACY 8(3)82-93.
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