Knowledge and attitudes about cervical cancer and its prevention among female secondary school students in Nigeria

Awareness of cervical cancer risk factors and preventive approaches, and perceived causes of cervical cancer among secondary school girls: a cross-sectional study in Northern Uganda

BACKGROUND

The majority of women in low- and middle-income countries have low awareness of cervical cancer. This study sought to establish awareness of cervical cancer risk factors and preventive approaches, as well as sources of information and perceived causes of cervical cancer among secondary school girls in northern Uganda.

METHODS

This was a cross-sectional study conducted in rural northern Uganda. We collected data using an investigator administered pre-tested questionnaire. Analysis was done with STATA version 14.0. Multivariate analyses with logistic regressions models were used to determine magnitudes of association between independent and outcome variables. Odds ratios and accompanying 95% confidence intervals are reported. Statistical significance was considered if the two sided p-value <.05.

RESULTS

Most participants (97%; n = 624) had heard of cervical cancer before this study. The most common source of information about cervical cancer was friends (31.1%; n = 194). More than half of the participants (59%; n = 380) had heard about a vaccine that prevents cervical cancer, but only a third (33%; n = 124) had ever received a dose of the vaccine. The majority of participants (89%; n = 550) reported that cervical cancer could be prevented; however only half (52%; n = 290) knew that vaccination of girls aged 9-13 years could prevent cervical cancer. The majority of participants did not recognize the risk factors for cervical cancer; for example, only 15% (n = 98), 7% (n = 45), and 1.4% (n = 9) recognized early onset of sexual intercourse, infection by the human papillomavirus (HPV), and smoking respectively. On adjusting for age, students' class, and religion, students in schools with school health programs were twice (aOR = 2.24: 95%CI; 1.24-4.06) more likely to know that cervical cancer is preventable.

CONCLUSION

Secondary school girls need information on cervical cancer risk factors and approaches to prevention so that they may avoid exposures to the risk factors and promptly seek and undertake preventive approaches including HPV vaccinations.

Prevalence and Correlates of Cervical Cancer Prevention Knowledge Among High School Students in Ghana

INTRODUCTION

Cervical cancer is a preventable yet highly prevalent disease in Africa. Despite female adolescents and young women being a target group for cervical cancer prevention strategies, little research has examined their knowledge of how to prevent the disease. The study aimed to describe: (a) knowledge about cervical cancer prevention and (b) sociodemographic, social, and systemic factors associated with and interacting with knowledge among female senior high school students in Ghana.

METHODS

A cross-sectional survey assessed knowledge about (a) risk factors and (b) primary and secondary prevention of cervical cancer among 2,400 female students from 17 public senior high schools in the Ashanti region, Ghana. Descriptive statistics were used to describe knowledge. Linear mixed-effects regression models were used to examine factors associated with knowledge scores.

RESULTS

Knowledge gaps were observed for at least two-thirds (>65%) of students. Most students (mean age = 17) did not know that early sexual debut (before 18 years) is a risk factor for cervical cancer (72%) and that a blood test cannot detect cervical cancer (71%). Students in later stages of senior high school education and those who received sexual health education from teachers and parents had significantly greater cervical cancer knowledge scores than their counterparts. Interactive effects showed that school-based sexual health education was associated with higher knowledge scores than home-based education among students.

CONCLUSIONS

Most female senior high school students had gaps in knowledge about cervical cancer prevention. Finding new ways to strengthen the capacity of schools and parents to deliver accurate cervical cancer prevention information is warranted.

Uptake of Human Papilloma Virus Vaccination and Associated Factors Among Female Students Attending Secondary Schools in South West Shoa, Oromia, Ethiopia, 2022

BACKGROUND

Human papillomavirus (HPV) vaccination is one of the key preventative measures for cervical cancer, provided that effective vaccine uptake is employed. However, HPV vaccine uptake is low in settings with limited resources such as low- and middle-income countries.

OBJECTIVES

To assesses the uptake of HPV vaccine and associated factors among female students attending secondary schools in South West Shoa Zone, Oromia, Ethiopia, 2022.

METHODS

A cross-sectional study was conducted in secondary schools of South West Shoa Zone between November 1st to November 30th 2022. A multi-stage sampling technique was employed among 634 female students attending secondary schools. Data were collected by self-administered structured questionnaires, entered into Epi-info version 7.2.2.6, and exported to SPSS version 25 for statistical analysis. Bivariable analyses were considered for Multivariable analysis. Adjusted odds ratio (AOR) along with 95% confidence levels were estimated to assess the strength of the association, and a P value <0.05 was considered to indicate statistical significance.

RESULTS

The proportion of HPV vaccine uptake was 31.65% (95% CI, 25-38). Having adequate knowledge AOR = 8.51 (95% CI = 4.57-15.84), living in rural area AOR = 0.25 (95% CI = 0.15-0.42), having older sibling AOR = 4.07(95% = 2.50-6.63), mother's educational level (Diploma and above) AOR = 4.08 (95% CI = 1.75-9.49), and secondary education AOR = 3.98 (95% CI = 1.87-8.48) were significantly associated with HPV vaccine uptake among female students attending secondary schools in South West Shoa Zone, Oromia, Ethiopia.

CONCLUSIONS

The study revealed that HPV vaccine uptake was very low among female students attending secondary schools in South West Shoa Zone, Oromia, Ethiopia. Adequate knowledge, having older sibling, living in rural area, and having mothers with higher educational level were significantly associated with HPV vaccine uptake. All concerned bodies should work jointly to enhance the uptake of HPV vaccination among female students.

Human Papilloma Virus Infection and Vaccine Knowledge Levels, Attitudes, Beliefs in University Students: Turkey and Ghana Comparison

Purpose: Studies reported that early diagnosis, treatment, and prevention of cervical cancer are influenced by knowledge, beliefs, and attitude toward screening. This descriptive-comparative study aimed to assess human papilloma virus (HPV) knowledge, attitudes, and beliefs in university students and the affecting factors and to compare between Turkish and Ghanaian students. Methods: The sample consists of 933 university students studying in 4 different faculties in 2 universities from Turkey and Ghana. The data were collected between November 2019 and February 2020. The study's data were analyzed using Analysis of Variance, Pearson Correlation test, t-test, and Mann-Whitney U test. Results: The findings of the study showed that none of the students in both countries had HPV vaccination. It was found that students have low level of knowledge about HPV infection and vaccine (3.28 ± 2.14) and positive attitudes (16.57 ± 3.28) and beliefs (36.74 ± 6.55) toward vaccine. The attitude score of the Ghanaian students (17.54 ± 3.23) was found to be significantly higher than the Turkish students (15.74 ± 3.09). The knowledge score of the Ghanaian students who had sexual intercourse was found to be significantly higher than others. The findings of the study revealed that the students of both countries had low level of knowledge about HPV infection and vaccine and positive attitudes and beliefs toward the vaccine. Conclusions: It is recommended to increase effective interventions to increase the knowledge level of university students about HPV infection and vaccine. In addition, the vaccine should be included in the immunization program in both countries.

Applying the COM-B behaviour model to understand factors which impact school immunisation nurses' attitudes towards designing and delivering a HPV educational intervention in post-primary schools for 15-17 year old students in Northern Ireland, UK

INTRODUCTION

Human Papilloma Virus (HPV) is responsible for the development of cervical, vaginal, vulvar, penile, oropharyngeal and anal cancers. Throughout the UK, Immunisation nurses (IMNs) deliver school-based HPV vaccinations to students 12-13 years old. Providing HPV education to 15-17 year old students may promote decision-making regarding their sexual health and award opportunity for unvaccinated students to self-consent to the vaccination. This study aims to explore the perceptions of IMNs regarding the value of providing HPV education to 15-17 year old students and to explore whether IMNs feel that the design/delivery of this education should form part of their professional role.

METHODS

Six focus groups were conducted online with IMNs from all five Health and Social Care Trusts in Northern Ireland, UK, between January-June 2021. Data were analysed using the COM-B model to identify factors that might influence IMNs' behaviour towards designing/delivering this education for 15-17 year old students.

RESULTS

IMNs were highly motivated to design and deliver this HPV education. Facilitators promoting this behaviour included their specialist training, their previous sexual health teaching experience and their desire to educate young people. Barriers negatively influencing this behaviour included lack of time/resources, parental influences, lack of school support and lack of teaching/presentation skills training.

CONCLUSION

IMNs feel that they are the most appropriate professionals to design/deliver HPV education for 15-17 year old students. National policy change, based on collaboration between the Public Health Agency and Education Authority, is a key factor in facilitating IMNs to implement this school-based HPV education intervention.

Cervical cancer screening and vaccination: knowledge, awareness, and attitude of female staff in a Nigerian University

BACKGROUND

Poor knowledge and awareness of cervical cancer screening and vaccination are significant barriers to effective cervical cancer prevention in developing countries. Knowledge of cervical cancer and vaccination against cervical cancer remains low in Nigeria. The purpose of this study was to assess the knowledge, awareness, and attitude of female staff of Afe Babalola University towards cervical cancer screening and vaccinations.

METHODS

This study was a cross-sectional study conducted using a semi-structured questionnaire among female staff of Afe Babalola University, Ado-Ekiti, Ekiti State, Nigeria. The workers' knowledge and awareness were assessed using yes and no questions while the attitude was assessed using Likert scale questions. The workers' knowledge was ranked as good (≥ 50%) and poor (< 50%) while attitude was ranked as positive (≥ 50%) and negative (< 50%). The relationship between demographics, attitude and knowledge of cervical cancer screening and vaccination was carried out using the Chi-square test. Analyses were conducted using SPSS software version 20.

RESULTS

A total of 200 staff consented to participate in the study out of which 64% were married with mean age 32.81 ± 8.164 years. Majority (60.5%) of the participants knew the causes of cervical cancer while 7.5% strongly agreed that they do not see the need for cervical screening. Majority (63.5%) of the participants showed good knowledge while 46% had a positive attitude towards cervical cancer screening and vaccination.

CONCLUSIONS

The study participants showed good knowledge and awareness but poor attitude towards cervical cancer screening and vaccinations. Interventions and continuous education are needed to improve the population's attitude and eliminate misconceptions.

Knowledge and acceptability of cervical cancer screening among female undergraduates in Babcock University Ilishan-Remo, Ogun State, Nigeria

Background

Cervical cancer (CC) is currently the fourth most common cancer among women. There are several factors which have, in recent times, posed a threat to the recognition and acceptance of CC screening in Nigeria. This study was undertaken to assess the predictors of knowledge of female undergraduates at Babcock University, Ogun State, Nigeria, on CC screening and the level of acceptance readiness.

Method

This study was a descriptive cross-sectional survey of 345 female undergraduates at Babcock University, Ogun State, Nigeria, using a self-administered structured questionnaire. Data collected were analysed using the Statistical Package for the Social Sciences (SPSS) version 23 software. Hypotheses were tested using Pearson product-moment correlation at p < 0.05 level of significance.

Results

This study revealed that majority of the respondents have a substantial awareness and knowledge of CC screening (68.4%). The study suggested that health talk and level of exposure might be responsible for the good knowledge. While 47.5% were ready to undergo CC screening, 76.2% were ready to undergo the screening if a health professional performed the procedure, and 66.1% will tell their family members to go for screening. However, 49.9% reported not having the correct information on CC screening. A significant correlation was found between knowledge and acceptability of CC screening among the students (r = -0.366, p ˂ 0.05). Also, this study suggested that the age of female undergraduates is correlated with acceptance of CC screening (r = -0.221, p ˂ 0.05).

Conclusion

As the acceptability of CC screening was high, CC screening facilities could be made available for the students. Similarly, educational interventions to improve awareness of CC screening among this population are warranted, as over one-third reported they did not have the correct information on CC screening.

The effectiveness of health education interventions on cervical cancer prevention in Africa: A systematic review

Low levels of knowledge and awareness on cervical cancer play a role in limiting cervical cancer prevention uptake. This systematic review aimed to identify effective educational interventions to increase cervical cancer awareness, knowledge, and subsequently screening or vaccination uptake in African women. A literature search was conducted in Medline and EMBASE databases. We examined original, peer-reviewed English literature published between 2005 and 2020. Nineteen studies examining health education interventions' impact on awareness, knowledge, and screening or vaccination uptake in African women were included. Ten studies were controlled trials, nine performed pre- and post-measurements in one group. Most studies were published between 2015 and 2020 (86%), many were from Nigeria (47%). Studies were mostly set up in communities and schools. The most frequently used intervention was lectures, alone or combined with videos and practical demonstrations. Sixteen studies evaluated knowledge or awareness, and all showed a statistically significant improvement following the intervention. Of the ten studies that evaluated screening uptake, either as the single outcome or combined with knowledge or awareness, six found a significant rise in screening uptake after intervention. Educational interventions increased knowledge and awareness in African women, some boosted uptake of cervical cancer screening, especially when using peer health educators and culturally tailored methods. Innovative approaches such as self-collected HPV testing and mHealth also demonstrated a potential to increase uptake of screening. More research is needed to identify and analyse barriers to screening uptake, which can still be present even after a successful educational intervention.

Knowledge, Attitude, and Practice Toward Cervical Cancer Screening and Associated Factors Among College and University Female Students in Dire Dawa City, Eastern Ethiopia

Introduction:

Cervical cancer is preventable and, in most cases, curable if identified at an early stage. Cervical cancer is the second leading cause of cancer-related mortality Ethiopia with screening accounting for only 0.8%. Furthermore, female students and young adults in colleges and universities’ have a high prevalence of genital HPV infection because of their risky sexual behavior, lack of knowledge on screening and very few students receive screening services. This study aimed to assess the Knowledge, attitudes, and practice toward cervical cancer screening and its associated factors among female college students in Dire Dawa City, Ethiopia.

Methods:

An institutional-based cross-sectional study was conducted using a multistage sampling technique from November to December 2020, among 730 female college students in Dire Dawa. Descriptive statistics and binary logistic regression were used to describe each variable and identify associations between the dependent and independent variables respectively. Adjusted odds ratio with 95% confidence interval and P-value <.05 used to determine the association.

Results:

The results showed, only 64 (9.3%) participants were knowledgeable, 413 (60.1%) had positive attitudes and 17 (2.5%) were screened in their lifetime. Age group, years of study, and history of cervical cancer practice were significantly associated with knowledge of cervical cancer screening. The year of study was based on cervical cancer smears and the number of screenings was significantly associated with attitude.

Conclusion:

This study showed that students’ knowledge of cervical cancer screening is low. Overall attitudes toward cervical cancer screening among female students were good, but only a small proportion of students had undergone cervical cancer screening. The most common reasons for the low screening practice were lack of information and undecided. There is a need to promote different campaigns for cervical cancer screening programs, in order to increase awareness.

Cervical Cancer and Human Papillomavirus Vaccine Knowledge, Utilisation, Prevention Educational Interventions and Policy Response in Nigeria: A Scoping Review

PURPOSE

This review evaluated the knowledge, utilisation, prevention education, and policy response across the six geopolitical regions of Nigeria to inform national efforts for the prevention and control of cervical cancer.

METHODS

A keyword-based systematic search was conducted in PubMed/MEDLINE (NCBI), Google Scholar, and AJOL electronic databases, including a manual scan of papers, journals and websites to identify relevant peer-reviewed studies. Articles were screened and assessed for eligibility.

RESULTS

Many (158) articles were downloaded and after duplicates were removed, 110 articles were included in the final analysis. These were made up of qualitative, quantitative (cross-sectional), intervention and policy studies. Studies have generally reported poor knowledge and awareness of cervical cancer screening but those carried out in urban areas demonstrated a slightly higher level of awareness of Human Papilloma Virus (HPV) vaccine, HPV vaccination uptake and utilization of cervical cancer preventive services than the rural studies. The studies did not show strong government support or policies in relation to cervical cancer control.

CONCLUSION

Knowledge and uptake of cervical cancer preventive services across diverse groups in Nigeria remain poor. These could be linked to socio-cultural factors, the lack of an organised cervical cancer screening programme and low financial resource pool for cervical cancer prevention. Therefore, it is necessary to increase government, donor prioritisation and political support in order to ensure increased investment and commitment to cervical cancer elimination in Nigeria.

Attitude and practice on human papilloma virus infection and vaccination among students from secondary occupational health school: a cross-sectional study

Cervical cancer (CC) is reported as the second-most common female cancer worldwide, of which 99% is caused by persistent human papillomavirus (HPV) infection. HPV vaccine protects against HPV infection and most cases of CC, which has only been introduced for a short time in mainland China. This study aimed to evaluate the attitude and practice related to HPV infection and vaccination among students at secondary occupational health school (SOHS) in China. We conducted a cross-sectional study in Southern China where data of 2248 participants were collected through questionnaires to estimate attitude and practice of students. Only 4.1% believed they were easily infected by HPV, 38.2% were willing to receive HPV vaccine and 30.8% intended to do regular screening of HPV infection in the future. Students in the second grade (OR = 1.51, 95%CI [1.25, 1.81]) and third grade (OR = 3.99, 95%CI [2.53, 6.27]) were more willing to take HPV vaccine compared to students in the first grade. Among the non-vaccinated participants, the most frequent reason for not receiving HPV vaccine was insufficient knowledge about HPV (91.1%). Characteristics of higher grade, personal education before enrollment and academic performance, medical specialty, history of sex experience and HPV vaccine and family history of other cancers were associated with higher attitude scores (p < .05). Considering the increasing prevalence of HPV infection and the need of improvement in attitude and practice toward HPV, more education about HPV infection and vaccination should be incorporated into school curriculum.

Krüppel-like factor 5-induced overexpression of long non-coding RNA DANCR promotes the progression of cervical cancer via repressing microRNA-145-3p to target ZEB1

Long non-coding RNA (lncRNA) differentiation antagonizing non-protein coding RNA (DANCR) participates in the development of diverse cancers. Nevertheless, the impact of DANCR on cervical cancer (CC) remains largely unknown. This study aims to explore the effects of DANCR sponging microRNA-145-3p (miR-145-3p) on CC. Expression of KLF5, DANCR, miR-145-3p, and zinc finger E-box binding homeobox 1 (ZEB1) in CC and adjacent normal tissues was determined. Human CC cell lines were, respectively, treated with silenced DANCR or miR145-3p mimic/inhibitor. Then, the viability, migration, invasion, and apoptosis of CC cells were measured. The cell growth in vivo was observed as well. Chromatin immunoprecipitation assay was performed to analyze the binding of KLF5 and DANCR promoter. Interaction among DANCR, miR-145-3p, and ZEB1 was assessed. KLF5, DANCR, and ZEB1 were upregulated but miR-145-3p was downregulated in CC tissues. KLF5 activated DANCR expression and the high DANCR expression was related to tumor staging, infiltrating muscle depth and lymphatic metastasis of CC patients. Reduced DANCR or elevated miR-145-3p repressed malignant behaviors of CC cells. The tumor diameter and weight were also repressed by DANCR silencing or miR-145-3p elevation. The effect of DANCR knockdown on CC cells could be reversed by miR-145-3p inhibitor. MiR-145-3p was targeted by DANCR and ZEB1 was targeted by miR-145-3p. KLF5-induced overexpression of DANCR promotes CC progression via suppressing miR-145-3p to target ZEB1. This study may provide potential targets for CC treatment.

Factors associated with HPV vaccination initiation among United States college students

Human papillomavirus (HPV) remains the most common sexually transmitted infection (STI) in the U.S. despite widespread availability of a safe, effective vaccine. Although young adults are at greatest risk of HPV infection, extensive vaccine promotion and intervention efforts has been directed toward 11-12-year-olds. College students represent an ideal audience for HPV vaccine "catch-up;" however, research indicates inconsistent HPV vaccination rates within this demographic. An online survey assessing HPV and HPV vaccine knowledge and behaviors was distributed to all undergraduate college students at a large, public university in the Deep South region of the U.S. The primary outcome was receipt of HPV vaccination (binary response options of Yes/No). Logistic regression analyses were performed to determine predictors of HPV vaccination. Of the 1,725 who completed the survey, 47.0% reported having received at least one dose of HPV vaccine; overall series completion (series = 3 doses for this population) was 17.4%. The primary outcome was HPV initiation among college students, defined as having received at least one dose of the HPV vaccine. Results indicated substantial gaps in participants' knowledge of their vaccination status. Provider and parental recommendations as well as social influences were shown to significantly impact student vaccination status, emphasizing the importance of incorporating these elements in future interventions, potentially as multi-level strategies. Future college interventions should address HPV and vaccination knowledge and the importance of provider and parental recommendations.

Biopsychosocial risk factors and knowledge of cervical cancer among young women: A case study from Kenya to inform HPV prevention in Sub-Saharan Africa

Background

Cervical cancer is the second most common female reproductive cancer after breast cancer with 84% of the cases in developing countries. A high uptake of human papilloma virus (HPV) vaccination and screening, and early diagnosis leads to a reduction of incidence and mortality rates. Yet uptake of screening is low in Sub-Saharan Africa and there is an increasing number of women presenting for treatment with advanced disease. Nine women in their twenties die from cervical cancer in Kenya every day. This paper presents the biopsychosocial risk factors that impact on cervical cancer knowledge among Kenyan women aged 15 to 24 years. The findings will highlight opportunities for early interventions to prevent the worrying prediction of an exponential increase by 50% of cervical cancer incidences in the younger age group by 2034.

Methods

Data from the 2014 Kenya Demographic and Health Survey (KDHS) was analysed using complex sample logistic regression to assess biopsychosocial risk factors of knowledge of cervical cancer among young women aged 15 to 24 years (n = 5398).

Findings

Close to one third of the participants were unaware of cervical cancer with no difference between participants aged 15–19 years (n = 2716) and those aged 20–24 years (n = 2691) (OR = 1; CI = 0.69–1.45). Social predisposing factors, such as lack of education; poverty; living further from a health facility; or never having taken a human immunodeficiency virus (HIV) test, were significantly associated with lack of awareness of cervical cancer (p<0.001). Young women who did not know where to obtain condoms had an OR of 2.12 (CI 1.72–2.61) for being unaware of cervical cancer. Psychological risk factors, such as low self-efficacy about seeking medical help, and an inability to refuse unsafe sex with husband or partner, perpetuated the low level of awareness about cervical cancer (p<0.001).

Conclusions

A considerable proportion of young women in Kenya are unaware of cervical cancer which is associated with a variety of social and psychological factors. We argue that the high prevalence of cervical cancer and poor screening rates will continue to prevail among older women if issues that affect young women’s awareness of cervical cancer are not addressed. Given that the Kenyan youth are exposed to HPV due to early sexual encounters and a high prevalence of HIV, targeted interventions are urgently needed to increase the uptake of HPV vaccination and screening.

Targeting cervical cancer campaigns on teenage high schoolers in resource-limited economies: lessons from an intervention study of Nigerian senior secondary school girls

BACKGROUND

Given the dearth of government-sponsored programmes, preventive lifestyles and practices are the realistic hopes for millions of women in developing countries against cervical cancer. Early interventions for teenage high school girls have been advocated recently, but evidence-base for sustainable activities at this demographic is lacking. This article reduces this gap by determining the impact of two cervical cancer education techniques.

METHOD

This is a 6-month interventional cohort study of 432 female high school students in South-eastern Nigeria.

RESULTS

A total of 317 (73.4%) and 301 (69.7%) valid responses were received from the pre-intervention (16.8 ± 1.5 years) and post-intervention (17.2 ± 1.6 years) surveys, respectively. About 213 (70.8%) were fully engaged with the interventions. Logistic regression revealed that participants who were 'engaged' with the interventions, either through symposium attendance or by reading of the printed handouts, showed significant improvements across multiple cervical cancer parameters regarding knowledge on 'pap smears' (analysed with four items), 'HPV vaccine' (two items) and 'risk factors' (two items). Improvements in Knowledge of 'early symptoms' were not improved, with 'post-coital bleeding' [odds ratio (OR) = 0.95; P = 0.87] and 'being asymptomatic' (OR = 0.69; P = 0.32) remaining statistically similar between the engaged and the unengaged. If 'engagement' with either intervention was disregarded, a chi-square analysis identified no significant improvement in knowledge on any parameter.

CONCLUSION

Ensuring 'engagement' with intervention campaigns is vital to achieving effective and sustainable cervical cancer knowledge. Engagement may be achieved by repeating the education activities across all the years/classes that make up high school in each developing country, along with formal examinations at each level.

Re-thinking breast and cervical cancer preventive campaigns in developing countries: the case for interventions at high schools

BACKGROUND

The negative impact of cervical and breast cancers in low and lower-middle income countries are worsening, and, along with other non-communicable diseases, occur disproportionately in these resource-limited economies. Most preventive approaches to these cancers require government funding, but few countries with the most at-risk population can afford government-sponsored universal vaccination, screening, diagnostic and treatment programmes, which, along with socioeconomic issues, contribute to the poor outcomes in these mostly developing countries. An urgent need exists, therefore, to find an effective, affordable, cost-effective, culturally-acceptable and sustainable way of reducing these cancers. This paper advocates a re-thinking in the current preventive campaigns.

MAIN BODY

Using evidence provided by recently-published papers, a case is made for enlightenment campaigns to primarily target teenagers (boys and girls) in high schools of developing countries. Inclusions into the schools' academic curricula are the recommended approach, given that both cancers take hold on populations within that age bracket. This approach, if adopted, may be the only accessible, affordable and realistic approach that gives millions of women in low and lower-middle income countries the chance at survival. Empowering them early instils the self-awareness and confidence necessary for young adults to take charge of their own health. The acquired knowledge, in turn, helps them adopt positive attitudes and preventive behaviours that will, ultimately, prolong their lives.

CONCLUSION

The recommended approach offers governments and concerned stakeholders an evidence-based option that allows them to deliver cost-effective and sustainable life-saving interventions, while hoping to get around the bottlenecks that limit the large scale implementation of other effective but capital-intensive strategies.

Sustainable and cost-effective teenage breast awareness campaigns: Insights from a Nigerian high school intervention study

BACKGROUND

With limited government-sponsored breast screening programmes in developing countries, breast awareness remains the only realistic survival hope for millions. Poor levels of knowledge and preventive practices remain in these countries, and early enlightenment to empower teenage high school girls has been advocated for, recently. This study evaluates ways to ensure sustainability for such an approach.

METHOD

A 6-month longitudinal, interventional cohort study of 432 high school female students in South-eastern Nigeria. The efficacies of a video-assisted face-to-face intervention, as well as the use of printed handouts, were evaluated.

RESULTS

A total of 317 (73.4%) and 301 (69.7%) valid responses were received from the pre-intervention (16.8 ± 1.5 years) and post-intervention (17.2 ± 1.6 years) surveys, respectively. Logistic regression revealed that participants who were "engaged" with the campaigns, either through symposium attendance or by reading handouts, showed significant improvements on most aspects of knowledge regarding the cancer's early symptoms and risk factors, as well as breast self-examination (BSE). However, the monthly practice of BSE was not significantly increased (Attendees: OR = 1.44, P = 0.18; Handout-readers: OR = 1.52; P = 0.17). Also, when "engagement" to the respective empowerment activities was disregarded, a chi-squared analysis comparing the pre-intervention and post-intervention groups showed significant improvements on specific knowledge regarding risk factors and early symptoms of breast cancer, as well as BSE techniques and regular monthly practice: χ² (1, N = 596) = 46.703, P < 0.001. Across multiple parameters, the impact of exclusive face-to-face participation was not different to that from the reading of handouts.

CONCLUSION

Face-to-face and handout were both effective and of similar impact. However, sustained impact on monthly BSE is doubtful. To surmount this, strategies to ensure ongoing engagements are vital. Perhaps adjusting existing high school curricula to allow repeated yearly teachings on breast cancer and BSE, along with in-built-in evaluation systems like examinations and quizzes, are ways of ensuring engagement.