Breast Self-Examination and Health Seeking behavior of Women in Leku Town, Sidama Region, Southern Ethiopia

Breast cancer is the second most common cancer related death next to lung cancer among women in the world and most of African countries, including Ethiopia. In developing countries like Ethiopia, mortality rate is higher than that of developed countries because patients are found in advanced stage of the disease, where little or nothing can be done. To assess the awareness of breast cancer, breast self-examination practice and health seeking behavior for breast cancer among women in Leku town, Sidama Region, southern Ethiopia. A community based cross sectional study was employed. Systematic random sampling technique was used as a data collection technique. Structured and semi-structured questionnaire was used and data collectors were trained on data collection process and techniques in order to collect valid information to meet the proposed study objectives. About 206 (61.31%) women, who participated on this study, have ever heard about breast cancer. From these only 28 (13.6%) were found to have good knowledge. Nearly about half 102(49.5%) of the women, who are informed about breast cancer, believe that early detection of breast cancer improves survival. The result showed, out of the women who reported to have had breast cancer information, 94(45.6%) have ever heard/read about breast self-examination, but only 13(13.8%) practice breast self-examination and 256(76.2%) of the participant have a positive health seeking behavior. The study participants have very poor knowledge about breast cancer. Furthermore, low and improper breast self-examination practice was observed.

stage of the disease at presentation. The 2927 incident cases of breast cancer identified in 2002 had the following distribution by stage: stage 0 (in situ), 424(14%); stage I, 1118 (38%); stage II, 938 (32%); stage III, 233 (8%); stage IV, 123 (4%); unknown, 91 (3%) [4]. Breast cancer risk factors among Ethiopian women are not well known because of small number of studies conducted on this area. The burden of the disease is not easy to estimate according to hospital and health facility reports; because thousands of breast cancer cases remain unreported as women living in rural areas often seek treatment from traditional healers before seeking help from health facilities [5].
Among the early breast cancer detection methods, Breast Self-Examination (BSE) is cost-effective, especially in resource poor countries. American Cancer Society recommends monthly practice as an option for women starting from early 20s. More than 90% of cases of breast cancer can be detected by women themselves, stressing the importance of BSE as the key breast cancer detection mechanism. In Ethiopia, poor awareness of breast cancer symptoms and lack of practice of BSE has usually been associated with patient delay in seeking help resulting in reduced survival, more aggressive disease and fewer treatment options [6].

Study Area
The study was conducted in one of the randomly selected semiurban; kebele' (the smallest administrative hierarchy) of Leku town found in Sidama Region, south Ethiopia. Leku is one of the towns in Shebedino 'woreda' which is the second higher administrative structure equivalent to county and lower than zonal administrative structure. There is only one health center providing service to

Study Design and Study Period
A community based cross sectional study was employed.

A.
Source Population: All women in Leku town.

B.
Study Population: All women in the Leku town who are 20 years old and above, who have resided in the town for at least six months.
C. Study Unit: Randomly selected woman is participated in the study. At the beginning, the household was randomly selected and the women in that household who are above 20 years of age were randomly contacted for data collection depending on the inclusion criteria.

Data collection and Quality Control
Data was collected by trained data collectors. Data collectors were well informed about the study to provide a sufficient information or informed consent for respondents to get reliable data. On-site supervision was carried out by supervises to check the completeness, accuracy and consistency and corrective measures was taken when needed. The questionnaire was prepared in English language and translated to local language to make the data collection easier and understood by respondents. Before the actual data collection, pretest was conducted on the 5 % of sample size.
The contents of the questionnaire were modified based on the result of pretest.

Results
The study participants lie between the age of 20 and 79 years;  is from health professionals and 36 (17.5%) from friends ( Figure   1). The overall knowledge score of the 206 respondents who have heard about breast cancer ranged from 2 to 26, with a mean score (46.6%) respondents respectively ( Table 2).   Mammography was known by very few 24(11.7%) respondents.       The reason for most women not to visit a health facility was not considering breast abnormalities as a serious problem 32 (40%) ( Table 5).

Factors Determining Knowledge and Practices
The   (Table 7).  as the other barrier to consider alternative therapies [15]. The main reason for not seeking health facility for women not thinking it's a serious problem32(40%) and the belief that traditional healers are better than health facilities27(33.7%).

Conclusion
The findings of this study indicate that there is lack of appropriate information about breast cancer and early detection methods; may be due to the inability of the participants to read On the other hand, having good knowledge has association with BSE practice. Even though most of the women have good health seeking behavior, some women prefer traditional medicine and have negative attitude towards health care seeking. Above all, majority of them have positive attitude towards the cancer treatment which they said is given at hospital; even though the cost is not affordable.

Recommendation
As this study depicts, to fill the significant gap between the healthcare system and the community's knowledge and practice, we recommend Leku hospital and Sidama Region health bureau to work in collaboration on awareness creation program about breast cancer and its early detection methods by campaigns or by recommending health professionals to communicate more with the community and give health education for every patient available to increase a dissemination of proper information about breast cancer and BSE practice.