RIFT VALLEY UNIVERSITY

COLLEGE OF HEALTH SCIENCE

DEPARTMENT OF NURSING

ASSESSMENT OF KNOWLEDGE, ATTITUDE AND PRACTICE OF BREAST

CANCER WOMEN BREAST SELF EXAMINATION THE CASE OF GUDURU
HOSPITAL, KOMOLCHA, HORO GUDURU WOLLEGA ZONE

MAY, 2016

ADDIS ABABA, ETHIOPIA

Table of content
Content Page

II
ACKNOWLEDGMENT ............................................................................................................. I
Table of content ......................................................................................................................... II
List of tables ............................................................................................................................ IV
List of figures ............................................................................................................................. V
Acronyms ................................................................................................................................ VI
Abstract .................................................................................................................................. VII
1. Introduction............................................................................................................................. 1
Background of the study ................................................................................................... 1
Statement of the problem ..................................................................................................3
Significance of the study ................................................................................................... 5
2. Literature Review .................................................................................................................... 6
Magnitude of breast cancer ...............................................................................................6
General situation about breast self-examination ................................................................ 6
Knowledge of breast self-examination ..............................................................................7
Breast self-examination practice ..................................................................................... 10
Factors associated to knowledge and practice of breast self-examination......................... 13
Conceptual framework .................................................................................................... 15
3. Objective of the study............................................................................................................ 16
General objective ............................................................................................................. 16
Specific objectives ........................................................................................................... 16
4. Methodology ......................................................................................................................... 17
4.1 Study area and period....................................................................................................... 17
Study design ................................................................................................................... 17
Population and sampling ................................................................................................. 17
Source of population................................................................................................. 17
Study population....................................................................................................... 18
Inclusion and Exclusion Criteria ............................................................................... 18
Sample size calculation............................................................................................. 18
Sampling procedure .................................................................................................. 19
Variable ........................................................................................................................... 21
Dependent variables .................................................................................................. 21
Independent variable ................................................................................................. 21
Operational definitions..................................................................................................... 21
Data collection instrument .............................................................................................. 21
Data collection ................................................................................................................ 22
Quality control (Data quality assurance).......................................................................... 22
4.9 Data processing & analysis .............................................................................................. 23
4.10. Ethical Consideration .................................................................................................... 23
4.11 Dissemination of the result ............................................................................................. 23

III
IV
Acronyms
AAU Addis Ababa University

AOR Adjusted Odds Ratio

BSE Breast Self-Examination

CBE Clinical Breast Examination

CI Confidence Interval

COR Crude Odds Ratio

ETB Ethiopian Birr

GLOBOCAN Global Burden of Cancer

HEW Health Extension Worker

IARC International Agency for Research of Cancer

IRB Institution Review Board

ROC Reproductive Organ Cancer

SPSS Statistical Package for Social Science

WHO World Health Organization

US United State

V
Abstract
Background: Breast self-examination (BSE) is a simple, very low cost, non-invasive screening
method used to detect breast cancer early which involves the woman herself looking at and
feeling for any change in their breast as early as possible. Breast self-examination should be done
for all women above the age of 20 years.
Objective: To assess the knowledge and practice of breast self-examination among Guduru
Hospital
Method: Institutional based cross-sectional study was conducted to assess the knowledge and
practice of breast self-examination among female undergraduate students in Addis Ababa
University, College of Business and Economics. Departments were selected from College of
Business and Economics by using lottery method. Then a simple random sampling technique
was used to select a total of 407 female students from each department. Data was collected by
using self-administered, structured and pre tested questionnaire from February 1-30, 2016.
Quantitative method was employed to achieve the research objective. The data was entered into
Epidata and analyzed by Statistical Package for Social Science (SPSS) window software. Binary
logistic regression and multiple logistic regressions were done to confirm association between
variables.

1. Introduction
1
 Background of the study
Cancer is a major public health problem in many parts of the world. Breast cancer is one type of
cancer which is malignant tumor that starts in the cells of the breast. It occurs mostly in women,
but men can also be affected .

An estimated 231,840 new cases and 40,290 deaths of breast cancer are expected to occur among
women in the US during 2021. In 2021, an estimated 232,340 new cases and 39,620 death from
breast cancer is expected to occur in woman .

According to Global Burden of Cancer (GLOBOCAN) 2022, an estimated 14.1 million new
cancer cases and 8.2 million cancer-related deaths occurred in 2012, compared with new cancer
cases and cancer related deaths in 2008 which is 12.7 million and 7.6 million, respectively.
Among the most commonly diagnosed cancers worldwide breast cancer accounts 10.9% and
11.9% of all cancer cases next to lung cancer in 2008 and 2022 respectively (4,5).

In 2021, there were nearly 8 million cancer-related deaths. All cancers, taken together, are now a
leading cause of death worldwide, responsible for 14% of the total of 55 million deaths from all
causes .

The prevalence of breast cancer among women in Southern Africa showed (9,000 cases, 4,500
deaths) and Northern Africa (28,000 cases, 14,600 deaths) in 2008. Opportunities for reducing
suffering and death from cancer in Africa exist across all stages of the cancer control spectrum,
from prevention, to early detection, treatment, and palliative care .

Breast self-examination (BSE) is a simple, very low cost, non-invasive screening method used to
detect early breast cancer which involves the woman herself looking at and feeling for any
change in their breast as early as possible, that yield a better survival rate. Breast self-
examination should be done for all women above the age of 20 years (8).

2
A study done on BSE practice and its impact on breast cancer diagnosis in Alexandria, Egypt,
showed that BSE was practiced in 10.4% of cases. There was significant association between
failure to practice BSE and diagnostic delay. This emphasized the need for breast self-
examination awareness campaigns as a key measure for ensuring earlier diagnosis and hence
better prognoses for breast cancer patients in Egypt. Recent studies implicate BSE is also reliable
screening method when it is used with Clinical Breast Examination (CBE) and imaging studies
According to GLOBOCAN 2012, international Agency for Research Cancer (IARC) estimated
cancer, incidence, mortality and prevalence report in Ethiopia, breast cancer incidence was
18.2%, mortality 14.1% and 5year prevalence 25%. Breast cancer was reported to be the second
out of the ten top cancers registered in Black Lion specialized hospital Radio Therapy Center (5).

3
 Statement of the problem

Breast cancer is one of the most commonly diagnosed cancers worldwide which account (1.7
million, 11.9%) in 2012 and there were 6.3 million women alive who had been diagnosed with
breast cancer in the previous five years. Since the 2008 the mortality rate of breast cancer is
increased by 14%. Breast cancer is also the most common cause of cancer death among women
(522,000 deaths in 2012) and the most frequently diagnosed cancer among women in 140 of 184
countries worldwide. It is also the leading cause of cancer death in less developed countries of
the world. Even though the incidence of breast cancer is higher in developed countries but the
mortality is higher in less developed countries due to lack of early detection and management
service as well as limited awareness of early signs and symptoms of cancer among the public and
health care providers .

Unlike early detection in western world, women in Ethiopia usually present late screening for
breast cancer and are expected to have a very limited life span. The Oncologic service in
Ethiopia is limited to only one Radiotherapy Center at Black Lion Specialized Hospital (10).

In Ethiopia, It is estimated that around 10,000 Ethiopian women have breast cancer with
thousands of more cases unreported because the women living in rural areas preferred a
treatment from traditional healers. In Ethiopia, Breast cancer become fatal due to late
presentation, limited resources, low awareness of breast cancer and its detection,
symptoms, prevention and strong traditional beliefs that can delay biomedical care
(11).Therefore, many women miss early detection and treatment opportunities due to lack of
information, knowledge, and practice of early detection breast cancer.
In Ethiopia, communicable and chronic diseases have been given a major concern and all
the efforts and recourses are engaged into it. Government, non-government organizations
and international partners all focused to these diseases. The detection and treatment of
reproductive organ cancers (ROCs), particularly breast cancer is low. Despite its prevalence
ROC are not managed as a major public health problem at any levels of health care delivery
system. Nationwide, there is no organized ROC prevention, education, screening or curative care
program. Little is known about the scale of the problem, which makes it all the more difficult to

4
formulate policies and/or develop practical strategies for dealing with it. It may be one of the
reasons for absence of adequate facilities to fight against breast cancer in this country
Even though women knew about the various breast cancer screening methods, findings from
female Medical Students in Haramaya University, Ethiopia , indicated that the practice of BSE
while perceived as being important is not frequently practiced by the students.
Prevention remains the cornerstone of the fight against breast cancer. In order to prevent or
reduce the mortality, morbidity of breast cancer diagnosis of breast cancer during the early
stage of the disease play big role and it helps in reducing the cost of management .
The screening methods for early detection of this fatal disease are: mammography, clinical breast
examination and breast self-examination. Although some early detection methods, may remain
inaccessible to women in developing countries due to limited diagnostic and curative
facilities. Mammography cannot be routinely applied in countries with limited health
service resources, since it is expensive it need technology and trained professional. CBE also
need professional skills and health facility visit to be conducted .BSE is still recommend as a
general approach to increasing breast health awareness and allows for early detection of any
abnormalities. BSE continues to be recommended by health care practitioners because it is free,
simple, need low technology and teaching is possible. BSE also recommended in low resource
countries like Ethiopia where resources are inadequate (mammography is not available) for early
breast cancer detection .
Moreover limited studies are conducted about BSE knowledge and practice among women’s
calls for exploration of knowledge and practice of BSE among female undergraduate student.

5
 Significance of the study
The study is important in providing information towards knowledge and practice of BSE among
female undergraduate students in Addis Ababa University, College of Business and Economics.
Better documenting students’ knowledge and practice of BSE would be useful to governmental
and nongovernmental organization in the design of interventions aimed at effective prevention of
breast cancer through increased awareness and/or improved screening and it may also encourage
other researchers and policy makers to carry out a more extensive research in this particular area
being as base line data.
As this study is focused on women, it reinforces cancer prevention at an early age, provides
teaching opportunities for shaping health behaviors into adulthood and also encourages dialogues
of students with their parents and other family members. Young females are both at the greatest
risk of mortality from aggressive breast disease and have the greatest chance of benefit from
early detection interventions like breast self- examination.
This study will have significance for Nurses who are in the best position to educate and motivate
women on breast self-examination in health care institutions. Nurses are the forerunners in the
education of patients; therefore there is a need to explore students’ level of knowledge and
practice on breast self- examination which can indirectly influence nurses and planners to
modify, emphasis, strengthening and select best and more effective health education program
and breast awareness campaigns pertaining to BSE. Finally it is hope that, the problem of late
presentation can be curbed and the survival of breast cancer patients would be improved.
This study is also considered vital because BSE can be a simple means through which early
detection of a breast disease could be made. So assessing the knowledge and practice of
breast self-examination will be helpful over scarce diagnostic service.

6
2. Literature Review
Magnitude of breast cancer
Breast cancer is the most frequently diagnosed cancer in women worldwide with an estimated
1.4 million new cases in 2008. About half of these cases occurred in developing countries. Breast
cancer ranks as the most prevalent form of the disease in almost all countries of the world.
Female breast cancer incidence rates varied internationally by more than 13-fold in 2008,
ranging from 8.0 cases per 100,000 in Mongolia and Bhutan to 109.4 per 100,000 in Belgium.
This reflects low breast cancer screening and incomplete reporting in developing countries.
Breast cancer is the leading cause of cancer death among women worldwide (17,18).
The Estimated New Cancer Cases and Deaths of female breast cancer were 226,870(29%) and
39,510(14%) respectively in the United States in 2012 (19). An estimated 231,840 new cases of
breast cancer are expected to be diagnosed among women in the US during 2015.Excluding
cancers of the skin; breast cancer is the most frequently diagnosed cancer in women .
While cervical cancer in Eastern, Middle and western Africa and breast cancer in Southern and
Northern Africa were the most commonly diagnosed cancer among women in 2008, these two
cancers occurred with similar frequency in Middle and Western Africa . In several sub-Saharan
African countries breast cancer is the most commonly diagnosed cancer in women .
General situation about breast self-examination
Early detection program allow for a more favorable prognosis for patients, offer increased and
less toxic treatment options, and enable the provision of services cost-effectively. It is important
to note that a high proportion of cancers detected at the early stages in developed countries
continue to be diagnosed at more advanced and often fatal stages in developing countries, thus
increasing the associated burden of disease. With the anticipated increasing cost of cancer
therapy, early detection will become cost saving .
Breast self-examination is a simple, very low cost, noninvasive adjuvant screening method
for the detection of early breast cancer (BC) in women. It helps women to detect any
changes like a lump in their breasts early and make them familiar with the appearance and feel
their breasts.

7
Breast self-examination is very important for a woman to learn the topography of her breast, and
to identify changes in the breast. Although there is controversy surrounding the efficacy of
BSE alone in countries where CBE and mammography are readily available, BSE remains a
cost-effective ,easiest and precise method to detect breast cancer in resource-constrained
countries. A woman who performs regular BSE may be more motivated to seek medical
attention, including CBE and mammography .
Knowledge of breast self-examination
A descriptive cross sectional study was conducted among nursing students in Arab American
university had shown that majority of the respondents have poor knowledge of breast self-
examination 43.3%, while 41.2% were with fair knowledge. The majority of poor knowledge
level was among first year students then second year respectively (28.9% and 10.3%)
while the good knowledge was among fourth year then third year respectively (8.2% and
4.1%). One fifth of the students with poor knowledge were living in urban and rural areas
(21.6%). Nearly half of them live in urban area and 85.6% of respondents have negative family
history of breast cancer. Around two thirds were received information about breast self-
examination from mass media .
A research conducted in Iran about knowledge on screening program, 31%, 21%, and 9% heard
about BSE, clinical examination, mammography respectively and 39% of respondents knew
nothing about any of screening methods. Their major source of information was Television 34%
followed by friends 20% and physicians 19%. Their knowledge regarding frequency of BSE is
17% of participants respond monthly BSE and 20% agrees occasional BSE (14).
A cross-sectional study conducted in a Jordan on a sample size of 519 women from two major
universities in Jordan in which 36% of the sample was university employees and 64% were
graduate and undergraduate students. Majority of the sample (82%) reported that they had heard
about breast cancer and BSE. The main source of information about breast cancer and breast self
examination was television and/or radio programs (42%). Health professionals (doctors/nurses)
were mentioned as a source of information on breast tumors and BSE, 11% and 12%,
respectively (22).

8
A cross sectional survey conducted among female university students in Oman found that 134
(85.35%) participants were well informed that BSE is used as a screening method for
breast cancer, however, only 77% aware of the correct step in performing BSE. Only 114
(72.61%) participants correctly identified that BSE should be performed monthly on a
regular basis, though only 96 (61.1%) respondents knew the correct timing for performing
BSE which is a week after menses .
According to a study done among female university students in Ajman, United Arab Emirates
showed approximately half of the students 46.2% of participants had never heard about BSE.
Majority of respondents 86.5%, of participants had low/below average knowledge scores
regarding early detection of breast cancer. The vast majority of the participants did not aware of
the recommended frequency of BSE (98%) or its timing in relation to their menstrual cycle
(94%). Participants were asked how often they practiced BSE and they respond only 89(22.7%)
participants admitted to having ever conducted BSE and only 13 (3.3%) of the students practiced
monthly BSEs. The median knowledge scores of participants who conducted BSEs were
significantly higher comparing with those who did not practice BSE (24).
A study conducted in Malaysia had shown that knowledge mean score was 60.4% and only
38.4% of participants had good knowledge towards BSE. The highest mean score belongs to the
knowledge on ‘Hands should be raised up alternately above the head when doing the BSE in
front of the mirror’ has a mean score of 1.60 followed by ‘BSE should be done in front of the
mirror’ with a mean score of 1.53. The knowledge on the ‘BSE include ‘Undress until the waist
when doing the BSE’, ‘Need to observe for unusual change in shape and size of breast’ and ‘Use
finger pulps to examine any lump or thickening of the skin’ with the mean score more than 1.2.
85.5% of respondents answered correctly about the frequency of breast self-breast examination
(once per month). On the other hand, more than two thirds (70.5%) do not know the correct time
to perform the examination (25).
Another cross-sectional study conducted in Malaysia among undergraduate female student
showed participants (74.3%) respond mammography as screening method, while 36.3% of
students knew about clinical breast examination. Majority of respondents (84%) knew the name
of different position for doing a BSE and fifty-five percentages (55.7%) of respondents know
about the appropriate age to initiate BSE. In study conducted among private high learning
institution

9
in Malaysia showed majority of participants 95.5% are aware of BSE. In spite of being aware
about BSE, only 19.5% has sufficient knowledge on BSE. Newspaper was identified as the
main source of information about BSE by 38.2% of the participants, whereas TV/Radio
was mentioned as the second source of information by 31.9% of them 57.5% of respondents
reported BSE should be started at age greater than nineteen years old and 47.5%, 22.5%, and
19,5% of respondents agreed BSE is done yearly, weekly and monthly respectively . 69.2% of
study participants agreed BSE is done in front of mirror and 21.4 % reported BSE done in bath
room .
Finding from a study conducted among female University students in Ghana had shown 95% of
participants had knowledge about breast cancer and BSE. Their sources of information were 48%
mentioned the media, 16% stated the health center as their source of information. Participants
responded about the method of breast cancer detection as 19% stated mammography as a
method, 15% stated clinical examination of the breast, and 60% stated breast self-examination.
80% of respondents perform BSE. Furthermore, respondents were asked on the methods of
performing breast self-examination and 38% indicated standing and looking for discharges in
front of the mirror, 9% indicated feeling for changes in their breast while showering. Those who
did not perform BSE, were further asked on their reasons for not performing BSE and 30% said
they do not have time, 11% said they didn’t feel it was necessary, while 59% did not have a
specific reason for not performing BSE .
Age and the year of study of the respondents had a significant association with the level
of knowledge of breast cancer. The median knowledge score of breast cancer among the
respondents was 42.8% and 28.9% had a good knowledge of breast cancer and 46.4% had
poor knowledge. Among the participants on the study only 20% knew the appropriate time to
do a BSE which is immediately after menstruation and only 2.5% were able to mention the
three correct steps involved in carrying out BSE (look, feel and express nipple for discharge).
Only 4% of the respondents had good overall knowledge of BSE.
A Cross-sectional study done among female medical students in Haramaya University, had
showed that almost all female medical students who participates in the study had previous heard
about BSE which accounts 95.23% and 87.3% of the students have knowledge about BSE and
majority of them got information about BSE through lecture, (26.98%) television and (8.73%)

10
radio. Of all respondents 85.7% participants agreed that early detection improves survival.
Almost 93.6% of students agreed that BSE can be an important tool for early detection (13).
Finding from a study conducted on knowledge of breast cancer and screening methods among
nurses in Addis Ababa, Ethiopia had shown that among respondents asked to list the early
detection measures for breast cancer;74.8%, 44.4% and 38.5% mentioned BSE, breast
examination by a health professional (CBE),and mammography respectively as an early
detection measures (30).
For the question how often should breast self-examination be performed, 51.5% of the study
subjects reported BSE should be performed monthly after menses, and 71.9% respondents
identified the age to perform BSE to be at year of 20. About 65.9% of respondents were aware
that doing regular breast cancer screening has a great deal in curing breast cancer while 7.4%
indicated it has little or no difference (30).
Breast self-examination practice
Assessment of Jordanian nurses’ knowledge and practice of breast self-examination identified
85% of participants said that they had practiced BSE during their life time. Of these, only 21%
reported that they had performed BSE on monthly basis during the last year. Another study
conducted in Jordanian woman on factors associated with breast self-examination had shown
only 26% of them indicated they themselves practiced BSE in the previous 12 months, and only
7% performed BSE on a regular monthly basis. Others reported performing BSE every 2–3
months (9%), once every 6 months (5%) and once a year (6%). A total of 73% of the participants
indicated that they had never performed BSE .
A quantitative study done on knowledge and practice of Breast Self-Examination in Islamabad
medical and dental collage depicted the ideal age to start BSE have been described to be after 20
years by 28% doctors, 39% nurses, and 22% by medical students. Majority of participants 91%
lives in urban and 9% in rural.
Study conducted in United Arab Emirates reported 89(22.7%) participants ever conducted BSE
and only 13 (3.3%) of the students practiced monthly BSEs. The median knowledge scores of
participants who conducted BSEs were significantly higher comparing with those who did not
practice BSE.

11
Practicing breast self-examination among women attending primary health care in Kuwait
showed practicing women is older than non-practicing women. Also family history of BC were
a factor that causes BSE practice.
A cross-sectional study carried out among female nurses in Egypt, showed that 56.4% of nurses
performed BSE in their life time but only 18.8% of respondents practiced BSE on a monthly
basis and 68.0% of those who practiced BSE were married. 79.3% nurses reported that they did
not practice BSE because they perceived they did not have a breast problem, and 68.9% of them
were not convinced that BSE is important. 53.4% of the nurses reported that they did not know
how to practice BSE. Only 17.2% reported that they did not practice BSE because they are lazy.
Among 66.16% of nurses working in Ayub teaching hospital, and who had performed BSE,
34.9% of them did it once in life while 65.1% did on monthly basis. The remaining 33.84%
never performed BSE. 52% of those who never performed BSE, didn’t perform it of fear of
finding something bad, 25% said that they don’t have time for it .
Finding from a study done among female cleaners in Nigeria revealed, majority (69%) of the
women claimed to have practiced BSE. Out of these, 17.1% monthly, 5.3% once in every 2
month, 29% rarely, 37% every day, and 10% no specific time. As regards what time these
women usually practiced their BSE, 19% of them observed it a week after menstrual period, 12%
observed it during menstruation and 8% before menstruation .
Another study conducted in Northwestern Nigeria about knowledge and practice of BSE among
221 female students fifty seven percent of them had ever practiced BSE, 37.3% correctly
describes it and only 32.1% of them currently practice it. The reasons they mentioned for not
practicing breast self-examination were forgetfulness, lack of time and belief that there is no
problem with their breast. Only 19.0% of the respondent practice BSE every month. One
hundred and ninety five of the respondents (88.2%) didn’t know the age of starting BSE as only
11.8% were aware it .

12
Study conducted in conducted among nursing female university students in Ghana had shown
76% respondents perform BSE. Respondents were further asked how often they performed BSE
only 31% stated monthly, 29% said yearly, and 21% stated they performed BSE at random.
Respondents were asked on the appropriate time for performing BSE and 11% stated that the
appropriate time to perform SBE is before menstruation, 4% said during menstruation, while
62% stated some days after menstruation, and 23% stated that there is no particular time to
perform BSE .
Another study conducted among female school teachers in rural community in Nigeria had
shown that BSE is poorly practiced in the study population as it is revealed by 62% of
respondents who didn’t practice BSE. Among respondents who practiced BSE, majority of
participants 42% performed BSE before menstruation, 20% after menstruation and 30% perform
BSE at any time. Only 12% of respondents practiced BSE monthly.
A study conducted in Haramaya University, Ethiopia had shown that majority of the students
(77%) had never performed BSE, even though they had good knowledge of BSE. Their reasons
for this were as follows: have no signs or symptoms (28.8%); forgetfulness (17%); fear of
detecting some abnormality (16.4%); lack of privacy (15.4%). 41.37% of the study
respondents started to perform BSE at the age of 20 years. Out of the 23% of students who had
done BSE, 16 (55.1%) didn’t exactly remember how often they have done it; 8(27.5%) practiced
it yearly, one responder (3.44%) has done BSE less than 3 times in last 12 months, 4 (13.79%)
more than 3 times in the last 12 months .
Finding from the study conducted in west Gojjam, Ethiopia on factors affecting breast self-
examination among female health extension workers(HEWs) had shown that the methods of
screening for breast cancer reported by health extension workers were clinical breast
examination (22.3%), breast self examination (14.4%), and mammogram (3%). Among all
HEWs, only 14.4% practiced BSE regularly (every month) and 147 (37.3%) HEWs reported that
they practiced BSE during their life time. The three main reasons for not doing BSE were had no
breast problem (53.2%), lack of knowledge how to perform BSE (30.6%), and not knowing the
importance of BSE (21.4%). One hundred thirty (32.9%) HEWs had discussions with families on
the importance of BSE and 24.3% of participants had got information on BSE from health
professionals.

13
Regarding to attitude of BSE, a study conducted in Malaysia indicated, the mean for total
attitude score pertaining to BSE was 37.1 (total mean percent: 77.3%) and the highest was
regarding to ‘I’m not afraid to think about the breast cancer’ (mean percent: 82.8%). The mean
percent of ‘poor preference to seek traditional healers’ was 75.8%. All the items assessing the
attitude showed the mean score above 2.0.
Factors associated to knowledge and practice of breast self-examination
There is a significant relation between age and knowledge of breast self-examination. It was
found that younger participants had significantly lower knowledge scores in comparison to older
participants.(24,38) There was no significant difference between knowledge scores and
nationalities which may indicate the possibility that cultural and ethnic factors have no
significant effect on breast cancer awareness .
According to a study done among female university student in United Arab Emirates depicted
participants with a family history of breast cancer had significantly higher knowledge scores on
breast cancer risk factors and screening methods. According to a study conducted among
students in private higher learning institution showed that socio-demographic data, relevant
menstrual, family, and social histories in relation to the knowledge about BSE. Having a
family history of malignancy other than breast cancer seems to be the only significant
variable .
According to a study conducted on knowledge of breast cancer and screening method among
nurses in Addis Ababa had shown that marital status had a significant association with the
knowledge of breast cancer and screening methods. Unmarried respondents were more
knowledgeable than married ones. Nurses with family history of breast cancer were more likely
to be knowledgeable than nurses with no family history of breast cancer. Other socio
demographic factors like age, history of breast disease were not found to be significantly
associated with knowledge of breast cancer and screening methods.
A research conducted in Iran and Jordan had shown BSE practice was significantly related to
age, education, knowledge of breast cancer and its screening programs. It was evident that BSE
was practiced frequently by older women and those with more than a high school education .In
addition, those who have knowledge on breast cancer perform BSE frequently.

14
Personal history of breast tumors and other demographic variables didn’t show significant
association with BSE practice .
Study conducted among saudi female students had shown marital status, knowing of someone
with breast cancer was associated with practice of BSE .
In a study conducted in Malaysia had shown breast self-examination practice significantly
associated with knowledge of BSE. Another study done in Northwest Nigeria identified practice
of BSE was higher among participants with family history of breast cancer. While study done in
Malaysia on undergraduate female university had shown family history of breast cancer had not
significant association with BSE practice .
Significant association has been observed in study conducted in conducted among nursing
female university students in Ghana between the educational level of the student and the ability
to perform BSE. The ability to perform BSE improved as the educational level improved.
A study conducted in Northwestern Nigeria about knowledge and practice of BSE revealed that
regular performance of BSE was significantly associated with duration of stay in the University;
students who have spent more years in the university were more likely to practice BSE.

15
 Conceptual framework
Demographic data

 Age
 Marital status
 Religion
 Year of study
 Family income level
 Father and mother
educational status
 Previous place of
residence

Knowledge of Breast Self-

breast self- examination
examination Practice

Breast cancer history

Attitude of
 Family history of breast
Breast self-examination cancer
 Personal history of breast
cancer
 Know someone suffering
with breast cancer

Figure 1 Conceptual framework on knowledge and practice of breast self-examination among

female undergraduate students in Addis Ababa University, College of Business and Economics,
Addis Ababa, Ethiopia

(which is developed from various literatures by the principal investigator)(25,39,42,43)

16
 3. Objective of the study
General objective
To assess the level of knowledge and practice of Breast self-examination among women Guduru
Hospital in Kombolcha, Horo Guduru Zone, Ethiopia, 2023.
Specific objectives
 To assess the level of knowledge of breast self-examination among respondents.
 To examine Breast self-examination practice among respondents.
 To determine factors associated with knowledge of Breast self-examination
 To identify factors associated with Breast self-examination practice

Research Question

1. What is the level of knowledge of breast self examination among women in Guduru Hospital?

2. What looks like Breast self examination practice among women in Guduru Hospital

3.What is the factor associated with knowledge of Breast self examination?

17
 4. Methodology

4.1 Study area and period

The study will carrying out in Guduru Hospital. Guduru Hospital was established in 2000.
Study design
Institutional based cross sectional study was conducted.
Population and sampling
Source of population
All Women In Guduru Hospital attending their healthy at Guduru Hospital
Study population
All Women In Guduru Hospital attending their healthy at Guduru Hospital.

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