Effect of a Community Based Health Education Intervention on Breast and Cervical Cancer Awareness and Screening among Women of Reproductive Age in Kitui County, Kenya

Abstract

Cancer is one of the major non-communicable diseases (NCDs), and together with cardiovascular diseases, diabetes and chronic respiratory diseases they cause over 60% of total global mortality every year. In Sub-Saharan Africa, the incidence and mortality attributable to cancer has been on an increasing trend. The National Cancer Control Strategy 2017-2022 indicates that breast and cervical cancer contributes 23.3 % and 20% respectively of cancer deaths in Kenya. Early screening and detection is the only effective way of managing these cancers. Engaging Community Health workers in health service delivery especially in resource-poor countries is effective. This study sought to determine the effect of a Community Based Health Education Intervention on breast and cervical cancer awareness and screening among women of reproductive age in Kitui County, Kenya. The study adopted a quasi-experimental design with a pre and post intervention survey. Two sub-counties (Kitui EastIntervention and Mwingi West-Control) were purposively sampled for inclusion in the study to ensure there is a buffer zone to minimize contamination. Respondents for participation were randomly selected for inclusion from the two study areas. The sample size constituted of 491 respondents at baseline and 496 at end line. An interviewer administered questionnaire was employed to collect data. SPSS version 22 was used to analyse data. Awareness and screening for both breast and cervical cancer were the main outcomes of the study. Data was analyzed by use of descriptive statistics. Z-scores and DiD were calculated to establish change in proportions between baseline and endline. A binary logistic regression model that provided for both crude and adjusted ODDS ratios (OR) was used to test the hypothesis. At endline, respondents in the intervention site were 3.8 times more likely to know the danger signs of breast cancer (Adj. OR=3.895, P<0.001, 95%CI: 2.538-5.979). The results were also similar for cervical cancer with respondents in the intervention site being 4.9 times more likely to be aware of the danger signs of cervical cancer at endline compared to baseline (Adj. OR=4.991, P<0.001, 95%CI: 3.554-7.008). The intervention increased breast cancer screening by 4.458 (Adj. OR=4.458, P<0.05, 95%CI: 3.204-6.202). Subsequently, at end line, respondents in Kitui East were ten (10) times more likely to screen for cervical cancer (Adj. OR=10.307, P<0.05, 95%CI: 6.284-16.904). This study concludes that the intervention increased awareness and promoted screening for both breast and cervical cancers. However, there is still a big proportion of women of reproductive age who are not aware of both breast and cervical cancers and are therefore exposed to the risk of developing these cancers. Key recommendation from the study is that the Ministry of Health (MoH) and County governments need to review existing policies to incorporate an expanded role of the community health volunteers as a critical service provider since they are effective in delivering health messages contributing to improved maternal health service uptake.