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BMC Public Health

, 19:109 | Cite as

Women’s knowledge, attitudes and practices (KAP) relating to breast and cervical cancers in rural Zimbabwe: a cross sectional study in Mudzi District, Mashonaland East Province

  • Lovemore MakurirofaEmail author
  • Priscilla Mangwiro
  • Victoria James
  • Amos Milanzi
  • Junior Mavu
  • Michael Nyamuranga
  • Sydney Kamtauni
Open Access
Research article
Part of the following topical collections:
  1. Bristol-Myers Squibb Foundation Secure the Future
  2. Health behavior, health promotion and society

Abstract

Background

Breast and cervical cancers constitute the most common cancers among women in sub-Saharan Africa. In Zimbabwe, cervical cancer accounts for more than a third of all cancers among women of African descent. Cancer knowledge levels, attitudes and practices of people in different sections of society should be assessed in order to guide current cancer interventions. This study aimed to assess breast and cervical cancer knowledge, attitudes and practices of women of reproductive age, in Mudzi District, Republic of Zimbabwe.

Methods

A cross-sectional community-based survey was conducted. A total of 409 survey household questionnaires were administered to women of reproductive age (15–49 years) in 2014.

Results

A total of 409 respondents were interviewed. Nearly 85% of respondents had heard of cancer. 34.2% did not know of any cervical cancer risk factors and 51% were not familiar with the signs and symptoms of cervical cancer. Fifty five percent (55%) had not discussed cancer issues with partners in the past 12 months, and only 27.4% had discussed cancer issues with partners at all. Most of the respondents (96.2%) had never undergone cervical cancer screening. The majority of the respondents (70.8%) had never discussed breast cancer issues with community members. About 70% had never discussed cervical cancer issues with community members.

Conclusions

This study revealed a lack of awareness and comprehensive knowledge about breast and cervical cancer. It also revealed low self-risk perception, low uptake of cancer early detection services and low capacity of the local health institution in offering cancer services. It is recommended that the scaling-up of cancer information, dissemination, and early detection services must be prioritised, including training of local health institutions.

Keywords

Breast cancer Cervical cancer Cross-sectional study Knowledge Attitudes And practices Women Zimbabwe 

Abbreviations

AIDS

Acquired Immune deficiency syndrome

DA

District Administrator

DMO

District Medical Officer

HIV

Human Immuno- Virus

HPV

human papilloma virus

MoHCC

Ministry of Health and Child Care

MRCZ

Medical Research Council of Zimbabwe

SSA

Sub-Saharan Africa

UICC

Union for International Cancer control

VIAC

Visual Inspection with Acetic Acid and Cervicography

WCD

World Cancer Declaration

WCR

World Cancer Report

ZDHS

Zimbabwe Demographic and Health Survey

Background

Breast and cervical cancers are the most common cancers among women in Sub-Saharan Africa (SSA) [1]. In Zimbabwe, over 5000 new cancer diagnoses and over 1000 cancer-related deaths are recorded every year [2]. The incidence of cancer in Zimbabwe is on the rise; it increased from 2728 new cases in 2008, to 7165 in 2015. Breast and cervical cancer constituted a respective 7 and 19% of Zimbabwe’s total cancer incidences in 2015. Breast and cervical cancer alone contributed 11.6 and 34.8%, respectively, to the total cancer incidences of indigenous Zimbabwean women in 2015. Breast and cervical cancer constituted 7 and 12%, respectively, of the total number of cancer deaths recorded in 2015 [3]. Despite the increase in cervical and breast cancer cases, current cancer screening coverage and accessibility to screening services in Zimbabwe is still limited. The estimated cervical cancer screening coverage among the 15 to 49 age group in 2015 was 13%. Urban - rural disparities still exist (21% in urban as compared to 7% in rural áreas) [4, 5].

The above figures likely underestimate the magnitude of the overall cancer burden in Zimbabwe because of centralisation of the cancer registry [2]. Similarly to the situation in other sub-Saharan African countries, the majority of cancer cases are detected very late. This generally results in poor prognosis. An estimated 84% of the staged cancer patients in Zimbabwe (29%) present with advanced stages of the disease [3]. Some of the many possible reasons for late detection include common myths and misconception about cancer, and lack of access to early detection services. A study in Bindura District, Zimbabwe, for example, revealed that the majority of respondents had not heard of breast self-examination and that more than half did not think that they could develop breast cancer. The majority of the respondents demonstrated low levels of knowledge regarding breast and cervical cancer [6].

Studies elsewhere in sub-Saharan Africa show limited knowledge of cervical cancer among the general population. Lack of information and misinformation about cervical cancer have been documented in countries as disparate as Ethiopia, (Chaka B, Sayed A, Goeieman B, Rayne S: A survey of knowledge, attitudes, to cervical and bresat cancers among women in Ethiopia, submitted) Ghana, [7] South Africa, [8] Sudan [9] and Tanzania [10]. A study conducted among hospital staff in Mulago hospital in Uganda found that medical workers, who are ordinarily responsible for their patients’ cancer testing, do not necessarily undergo screening themselves. Over half of these respondents did not feel that they were susceptible to cervical cancer, and the majority had never been screened [11]. This study showed a low level of cervical cancer knowledge among medical staff. A study in Zimbabwe’s Mudzi District also revealed lack of knowledge and incorrect beliefs about the risk of developing cervical cancer among health workers. The majority of respondents did not know about human papilloma virus (HPV) screening, or about the visual inspection of the cervix using acetic acid. Most believed that they were not at risk of developing cervical cancer and most of the respondents (81.7%) had not undergone cervical cancer screening [12].

Only two previous studies have assessed breast and cervical knowledge in Zimbabwe [6, 12]. The study focused on breast cancer knowledge levels in an urban set up only [6] while the other earlier study focused on the knowledge of healthcare workers only [12]. The knowledge, attitudes and practices of women in Mudzi, however, have not been assessed. This study, therefore, aims to fill this literature gap and is the first KAP study done at the district level in an exclusively rural context in Zimbabwe. This study seeks to determine the breast and cervical cancer knowledge levels, attitudes and practices of women of reproductive age, in Mudzi District, Republic of Zimbabwe.

Methods

A descriptive, cross-sectional study was carried out in Mudzi District, Zimbabwe among women between the ages of 15 and 49. The district is one of the most remote rural communities in Zimbabwe, at the border with Mozambique. It is approximately 250 km east of the capital, Harare.

The study employed quantitative research methods. A total of 409 survey household questionnaires were administered through interviews by pre-survey trained and qualified personnel to women of reproductive age (15–49 years old) in the five wards of the Mudzi District, in 2014. The study focused on women between 15 and 49 years because that was the target group of the cancer education and screening project which was incorporated in the existing HIV and AIDS interventions in Mudzi district which already targeted the reproductive age group (15–49 years age group). The questionnaire was pilot tested. The training of data collection staff and pilot testing of the data collection tool was done to minimise potentiation bias. Likert scale was employed in generating the attitudes of the respondents to make sure that respondents are not forced to either or opinion but rather allow them to choose to be neutral if they wish so.

Household questionnaire

The survey collected the respondents’ socio-demographic characteristics and quantified women’s cancer knowledge levels. It also consisted of sections whose aim was to deduce the attitudes and practices of the respondents (Annex 1). Stratified random cluster sampling was employed in the selection of survey households and then one woman, who fit the eligibility criteria, was randomly selected from each household.

Sampling

The survey was conducted in five (5) out of eighteen (18) wards in Mudzi district. Stratified random cluster sampling was used in this survey. The first level was dividing the district into five strata namely northern, southern, western, eastern and central areas of the district. One (1) ward was then randomly selected from each stratum. This was followed by random selection of one village (second level) in each ward. At village level, households (third level) were randomly selected in line with the sample size. One woman aged 15–49 years was selected at each selected household. In households with more than one woman within the survey age range the enumerator would randomly select one woman from the household (Fig. 1). The advantages of stratified random cluster includes that each stratum/subgroup of the study population is considered unlike in simple random sampling method. This sampling method avoided potential bias inherent is simple random sampling by incorporating each stratum/cluster of the study population/area. Thus, all the 18 wards of the Mudzi district are well represented in the sample selection process.
Fig. 1

The stratified random cluster sampling process

Ethical issues

The study received approval from the Medical Research Council of Zimbabwe (MRCZ) in 2014 (MRCZ/A/1823). The study was also approved by the Cancer Association of Zimbabwe board and the local rural authorities, including the district administrator (DA) and the district medical officer (DMO). The study respected each respondent’s freedom to participate and adhered to all research principles pertaining to privacy and confidentiality. Consent was sought from all the participants including parental consent and assent for the participants below 18 years old.

Data analysis

Quantitative data were analysed using the Statistical Package for Social Scientists (SPSS), version 20 [13]. Data purification was done before analysis by checking data completeness, verifying random samples of the electronic data against the original data and running frequencies, means or ranges to detect errors and anomalous values. All errors and outliers were corrected by comparing with the original questionnaire. Univariate and bivariate analysis methods were used. Bivariate analysis was used to determine the relationship between knowledge, attitudes and practices, and the independent variables using Pearson’s chi-square test. The P-value of the chi-squared test was set at a 95% confidence interval.

Results

Socio-demographic characteristics of respondents

A total of 409 respondents were interviewed. The majority (72%) of the respondents were either married or cohabiting. Fifty-nine percent (59%) of respondents had a primary education and 37.4% had attained ordinary-level education. The majority (59.9%) of respondents belonged to the apostolic religion sect. (Table 1).
Table 1

Demographic and socio-economic characteristics of respondents (N = 409)

Demographic and Socio-economic variables

Response distribution

Frequency

%

Age Distribution (years)

15–19 years

76

18.6

20–24 years

76

18.6

25–29 years

63

15.4

30–34 years

47

11.5

35–39 years

66

16.1

40–44 years

36

8.8

45–49 years

45

11.0

Total

409

100

Marital Status

Married/Cohabiting

294

72

Never Married

57

14

Divorced/Separated

29

7

Widowed

29

7

Total

409

100

Level of Education

None

11

2.7

Adult literacy

3

0.7

Primary

241

58.9

Ordinary Level

153

37.3

Diploma

1

0.2

Degree and above

0

0

Total

409

100

Religious Affiliation

Apostolic Sect

245

59.9

Pentecostal

61

14.9

Roman Catholic

20

4.9

African Traditional Religion

7

1.7

Protestant

39

9.5

None

33

8.1

Other

3

0.7

Total

408

100

Employment Status

Formally employed

4

1

Informally employed

61

15

Student

25

6

Not employed

319

78

Total

409

100

General cancer knowledge levels

Nearly 85% of respondents reported having heard about cancer. The most commonly-known cancers were cervical cancer (65.3), breast cancer (60.4%), Kaposi sarcoma (8.1%) and colon cancer (4.4%) (Tables 2 and 3).
Table 2

Respondents who have heard of cancer, by age group (N = 409)

 

Heard about cancer

Total

Yes

No

Age of respondent

15–19 years

Count

49

27

76

% within age of respondent

64.5%

35.5%

100.0%

20–24 years

Count

65

11

76

% within age of respondent

85.5%

14.5%

100.0%

25–29 years

Count

54

9

63

% within age of respondent

85.7%

14.3%

100.0%

30–34 years

Count

41

6

47

% within age of respondent

87.2%

12.8%

100.0%

35–39 years

Count

61

5

66

% within age of respondent

92.4%

7.6%

100.0%

40–44 years

Count

34

2

36

% within age of respondent

94.4%

5.6%

100.0%

45–49 years

Count

41

4

45

% within age of respondent

91.1%

8.9%

100.0%

Total

Count

345

64

409

% within age of respondent

84.4%

15.6%

100.0%

Table 3

Respondents with knowledge of types of cancers (N = 409)

Types of cancers knowna

Respondents reporting knowledge of the cancer types

N

%

Breast Cancer

247

60.4

Cervical Cancer

267

65.3

Bladder Cancer

1

0.2

Kaposi sarcoma

33

8.1

Colon and Rectal Cancer

18

4.4

Endometrial Cancer (Uterus lining)

7

1.7

Kidney (Renal Cell) Cancer

2

0.5

Leukaemia (White Blood Cells)

5

1.2

Lung Cancer

6

1.5

Melanoma/Skin Cancer

7

1.7

Non-Hodgkin Lymphoma

5

1.2

Pancreatic Cancer

0

0

Prostate Cancer

7

1.5

Thyroid Cancer

1

0.2

a There is no statistically significant relationship between age and knowledge of types of cancers

Knowledge on breast and cervical cancer symptoms, risk factors and prevention

Over 18% of respondents did not know of any breast cancer symptoms, while only 27.8% could identify “a lump” as one of the sign of breast cancer (Table 4). More than half of the respondents (51%) reported that they did not know the signs and symptoms of cervical cancer. Vaginal bleeding and foul smelling vaginal discharges were noted as some of the common symptoms of cervical cancer, by 11 and 13% of the respondents, respectively (Table 5). Of all respondents, 34.2% reported that they did not know of any cervical cancer risk factors. Of all respondents, 22.2% identified “insertion of herbs into the vagina” as one of the common risk factors for cervical cancer. More than a quarter of respondents (29.9%) reported that they were not aware of how cervical cancer could be prevented, and 36.2% reported that they did not know any breast cancer prevention methods (Table 6).
Table 4

Respondents with knowledge of breast cancer symptoms (N = 409)

Knowledge of breast cancer symptomsa

n

%

A lump or thickening in or near the breast or in the underarm that persists through the menstrual cycle

46

11.2

A mass or lump, which may feel as small as a pea

68

16.6

A change in the size, shape, or contour of the breast

45

11

A blood-stained or clear fluid discharge from the nipple

20

4.9

Redness of the skin on the breast or nipple

20

4.5

Other (specify)___________

30

7.3

Do not know

75

18.3

a There is no statistically significant relationship between age and knowledge of symptoms of breast cancer

Table 5

Percentage of respondents with knowledge of cervical cancer symptoms (N = 409)

Symptoms

%

Vaginal bleeding

11

Vaginal foul smelling discharges

13

Back ache

8.3

Pain during and after sexual intercourse

6

Other (Specify)_____________

16

Do not know

51

Table 6

Respondents with knowledge of risk factors of cervical cancer, methods of prevention of cervical cancer and methods of prevention of breast cancer

Risk factors of cervical cancer (N = 409)

n

%

 Having multiple sexual partners

54

13.2

 Early onset of sexual activity

12

2.9

 Sexually transmitted infections (STIs)

21

5.1

 Tobacco use

4

1

 Insertion of herbs

91

22.2

 Dry sex

17

4.2

 Other (specify)

26

6.4

 Do not know

140

34.2

Methods of prevention for cervical cancer (N = 409)

n

%

 Early treatment of STIs

14

3.4

 Avoid multiple sexual partners

47

11.5

 Avoid early sexual intercourse

12

2.9

 Quit Tobacco use

4

1

 Through vaccination of HPV vaccine

3

0.7

 Practice safe sex

23

5.6

 Avoid insertion of herbs/dry sex

82

20

 Encourage partner to go for male circumcision

26

6.4

 Regular screening

16

3.9

 Other (Specify)

9

2.2

 Do not know

122

29.8

There is no statistically significant relationship between age and knowledge of preventing the development of cervical cancer

Prevention methods for breast cancer (N = 409)

n

%

 Breast cancer screening(self-breast examination or mammogram)

65

15.9

 Avoid exposure to environmental carcinogens

16

3.9

 Reduce alcohol intake

0

0

 Quit smoking

3

0.7

 Exercising regularly

249

60.9

 Balanced diet

6

1.5

 Other (Specify)_______________

15

3.7

 Do not know

148

36.2

There is no statistically significant relationship between age and knowledge of methods of preventing breast cancer.

Knowledge levels of breast cancer risk factors are low. Forty-six percent of respondents reported that they did not know of any breast cancer risk factor. Although tobacco consumption is a well-documented risk factor responsible for a third of the cancers worldwide [1], only 1% of the respondents identified tobacco-use as a risk factor. Eighty-one percent of the 27 respondents who knew “other” breast cancer risk factors cited “putting money in the bra” as a risk factor.

The study revealed low knowledge of cancer risk factors and ways of preventing breast and cervical cancers. Only 15.9% could identify breast self-examination and mammography as methods of preventing breast cancer. None of the respondents identified “reducing alcohol intake” as a way of preventing breast cancer. Only 2.9% of respondents identified avoiding early sexual intercourse, early treatment of sexually transmitted infections (3.4%), safer sex (5.6%), regular screening (3.9%), and vaccination (0.7%) as ways of preventing cervical cancer (Table 6).

Attitudes on breast and cervical cancer

Fourteen percent (14%) of respondents strongly disagreed, 1.6% disagreed and 4.8% neither agreed nor disagreed with the statement that “any adult woman, including I, can develop breast and cervical cancer”. In addition, 17.5% agreed, 3.2% strongly agreed and 28% neither agreed nor disagreed with the statement that “cervical cancer is a disease for prostitutes”. Nineteen percent (19%) of the respondents strongly agreed that they would rather not know if they had cancer, and would prefer to stay ignorant of their cancer diagnosis. A small proportion (2.2%) strongly agreed, 10.9% agreed and 5.4% neither agreed nor disagreed with the statement that “Getting breast and cervical cancer is a death sentence” (Table 7).
Table 7

Respondent attitudes toward statements on breast and cervical cancer (N = 409)

Statement

Strongly agree (%)

Agree (%)

Neither agrees nor disagree (%)

Disagree (%)

Strongly disagree (%)

Any adult woman including me can develop breast or cervical cancer

23.2

56.1

4.8

1.6

14.3

Cervical cancer is a disease for prostitutes

3.2

17.5

13.4

28.0

37.9

Breast and cervical cancer are diseases for the elderly women

3.2

7.0

8.0

36.9

44.9

I would rather not know if I had breast or cervical cancer

18.5

2.5

1.9

34.1

43.0

Getting breast and cervical cancer is a death sentence. There is not much that can be done when someone has breast or cervical cancer

2.2

10.9

5.4

28.2

53.2

Talking to family/friends about symptoms of breast or cervical cancers is embarrassing

1.9

2.9

1.0

35.0

59.2

Breast and cervical cancer practices

Approximately 55% of the respondents reported that they had never discussed cancer issues with their partners in the past 12 months and 27.4% had discussed cancer issues with their partners. Most of the respondents (96.2%) had never received cervical cancer screening. There was no statistically significant relationship between age and having undergone cervical cancer screening. The majority of the respondents (70.8%) had never discussed breast cancer issues with other community members. Similarly, approximately 70% reported that they had never discussed cervical cancer issues with community members (Table 8).
Table 8

Respondent attitudes toward statements related to breast and cervical cancer prevention practices (N = 409)

Statement

Response Category

Percent

Ever discussed general cancer issues with a partner or spouse in the last three months

Yes

27.3

No

54.8

Do not remember

0.3

Not Applicable

17.6

Total

100

Ever Screened of Cervical screening (VIAC or Pap smear test)

Yes

3.8

No

96.2

Total

100

Last time of having cervical cancer screening (for only the respondents who had had a cervical cancer screening test)

In the last 12 months

33

In the last 2 years

17

More than two years ago

50

Total

100

Ever discussed cervical cancer related issues other community members

Yes

20.9

No

70.2

Don’t remember

1.1

Total

100

Ever discussed cervical cancer related issues other community members

Yes

27.9

No

70.8

Don’t remember

1.3

Total

100

Ever had Self Breast examination

Yes

50.3

No

49.7

Total

100

Discussion

In order to achieve Sustainable Development Goal 3 [14] and World Cancer Declaration (WCD) 2013’s overarching goal of reducing premature deaths from cancer, improving quality of life and increasing cancer survival rates worldwide, [15] sub-Saharan African countries need to focus on community based approaches for both cancer information dissemination and access to cancer services. To help reach these goals, this study set out to assess rural Zimbabwean women’s knowledge, attitudes and practices relating to breast and cervical cancer.

The majority of respondents were aware of breast and cervical cancer as diseases, and some were also aware of Kaposi’s sarcoma (8.1%) and colon cancer (4.4%). Knowledge of different cancers seems to correlate with the prevalence of different cancers in the country, as the Zimbabwe National Cancer Registry [3] demonstrates that breast and cervical cancer contributed the most to Zimbabwe’s overall cancer burden in 2015, followed by Kaposi’s sarcoma and colon cancer [3].

Nearly two-fifths of respondents were not aware of breast and cervical cancers at all, significantly lower than respondents in similar studies elsewhere in Africa [7, 8, 9, 10]. Moreover, the majority of the respondents in Chipfuwa, et al.’s study (84.4%) in urban Zimbabwe had heard about cancer [6]. Still, the rate of knowledge was much higher than in our present study in rural Zimbabwe, suggesting that there is a strong urban-rural divide in cancer knowledge in Zimbabwe. Therefore, relevant stakeholders must further disseminate cancer-related information in rural Zimbabwe to bridge this apparent gap.

A similar study in sub-Saharan African countries by Perlman, et al. showed that study participants were willing to accept the HPV vaccine, but that they had low levels of knowledge and awareness of cervical cancer in general [16]. Similarly, study findings in Bindura, Zimbabwe showed that the majority of the respondents (69.4%) did not know the risk factors of breast cancer [6]. These results show that while targeted action is required in rural Zimbabwe, the rest of the country, and the region in general, also require cancer knowledge dissemination.

Healthcare providers are generally considered to be custodians of correct health information. However, the present study revealed that the most common sources of cancer information were television and radio (40.8%) and that health workers were identified as cancer information sources by only 15.6% of the respondents. This finding is in contradiction to the one demonstrated by Chipfuwa, et al. In their Bindura, Zimbabwe study, health care providers were shown to be the most often cited source of cancer-related information (30%). Friends (18.1%) and the radio (11.2%) were both much less likely to be cited [6]. The respondents in the Bindura study, unlike our Mudzi study, consisted largely (84.9%) of urban residents.

These results related to healthcare providers may point to a necessity to further train Zimbabwean rural health workers. In a study among university students in Angola, knowledge on breast cancer symptoms was found to be low among both medical and non-medical students. Fewer than 40% of the participants knew that changes in colour or shape of the nipple could be a sign of breast cancer [17]. A regional study in East, Central and Southern Africa showed that health workers believed themselves to be at low risk of developing cervical cancer [18]. Such a perception results in delayed medical attention as evidenced by the fact that 81% of new cancer cases in Zimbabwe are diagnosed late [3]. In the context of this regional data and the findings of the present study, the capabilities of rural health workers in Zimbabwe need to be improved.

HIV and AIDS augment the rate of HIV-related cancers as 60% of Zimbabwe’s new cancers are associated with it [10]. Zimbabwe’s HIV and AIDS prevalence rate among the 15–49 age group is 13.8% [4]. Prevalence is higher among women (16.7%) than among men (10.5%) [4]. Despite the prevalence of HIV and its associated risk factors, nearly two-fifths of respondents reported having no knowledge of the link between cervical cancer and HIV/AIDS. Twenty-two percent identified “insertion of herbs into the vagina” as one of the common possible risk factors of cervical cancer while 34.2% of respondents reported not knowing any cervical cancer risk factor. Insertion of herbs into the vagina for perceived improved sexual pleasure is a common practice in Mudzi; however, no study has been done to determine the relationship of this traditional practice and cervical cancer.

In Zimbabwe, Visual Inspection with Acetic Acid and Cervicography (VIAC) is recommended as a cervical cancer screening modality [19]. However, this study showed that rural women generally did not recognise regular screening as a key method of preventing cervical cancer. Although the structure of the health system in Zimbabwe is such that it is decentralised to ward level, the capacity of the peripheral rural health centres to provide both correct cancer information/education and basic breast and cervical cancer screening is minimal.

The study revealed low self-risk perception and ignorance about cancer diagnosis. The low self-risk perception agrees well with Chipfuwa, et al.’s 2014 studies in Bindura, Zimbabwe, in which the authors found that 53% of the respondents did not think that they could develop breast cancer [6]. Mudzi health staff study revealed that 73.3% believed that they were not at risk of developing cervical cancer [12].

Cervical cancer screening is highly recommended by the World Health Organization (WHO) to prevent invasive cervical cancer [1, 20]. As a consequence, the government of Zimbabwe’s screening guidelines recommend cervical cancer screenings for every three years for all women, and every year for HIV positive women [5, 21]. However, most of the respondents in this study (96.2%), had never received the screening. In this study, 49.7% of respondents had never done breast self-examination. Similarly, findings by Chipfuwa, et al. revealed that only 20.9% of the respondents had undergone a mammography [6].

Review-level evidence suggests that reasons for low breast and cervical cancer screening uptake among women in sub-Saharan Africa are generally similar, despite the enormous diversity of the region. Women throughout the continent have reported fear of screening procedure and negative outcome, low level of awareness of services, embarrassment and possible violation of privacy, lack of spousal support, societal stigmatisation, cost of accessing services and health service factors like proximity to facility, facility navigation, waiting time and health care personnel attitude [22].

Results show low community dialogue regarding cancer, as approximately 70% reported that they had never discussed breast and cervical cancer issues with community members. Community dialogue on cancer is low and this may lead to stigma and discrimination. Interventional studies need to be done to investigate current strategies to enable improvement in cancer knowledge, attitudes and practices, especially in rural areas.

The results from this study must be interpreted with some limitations. Though post-menopausal women also develop cancer, this study focused only on women of reproductive age. Moreover, this study was conducted in only five/18 wards of one district. It is therefore suggested that similar studies be conducted at a national scale, and with a broader target population. Analysis of the results did not account for the survey’s complex sampling design and results are only generalizable to the study population.

This cross-sectional study does not evaluate the cancer intervention measures implemented in Zimbabwe. Interventional studies should be carried out to measure the effectiveness of the current intervention measures in order determine cost effective, sustainable and evidence-based interventions. Further research should be carried out on breast and cervical cancer tertiary prevention and quality of life of cervical cancer survivors which are two severely under-researched areas in Zimbabwe and sub-Saharan Africa in general [22].

Conclusion

Breast and cervical cancers account for almost half of all new cancer cases among women in Zimbabwe. The general lack of awareness and comprehensive knowledge about breast and cervical cancer noted in this study revealed the gaps currently existing in the national cancer prevention and control programme.

Low self-risk perception, low uptake of cancer early detection services and lack of capacity of local health centres to provide cancer services need immediate attention. Therefore, scaling-up cancer information dissemination and early detection services must be prioritized. This scaling-up must include capacitation of local health institutions, in order to reduce both breast and cervical cancer morbidity and mortality. Both World Cancer Declaration target 5 (reducing stigma, damaging myths and misconception) and target 6 (universal screening, early detection) can only be achieved if rural communities have correct information about cancer and accessible early detection services.

Notes

Acknowledgements

The authors would like to acknowledge New Dimension Consultancy (NEDICO) for their technical assistance throughout the study. The authors would also like to acknowledge the Ministry of Health and Child Care for the support during all the implementation phases of the Mudzi cancer education and screening project including data collection of this study and the women in Mudzi district who agreed to participate in the study. The authors would also like to thank the Provincial Mashonaland East and Mudzi district local government including the Mudzi district traditional chiefs for all the cooperation and support which was crucial in carrying out the survey and the subsequent project implementation a success. We would also like to acknowledge the technical support we received from Daniel J Bromberg and Camila Picchio (Barcelona Institute of Global Health (ISGlobal)) during the final editing of this article.

Funding

The survey was funded by Bristol Meyers Squib Foundation - Secure The Future (BMSF-STF) as part of the 2014 cervical and breast cancer mobile education and screening project in Mudzi District, Zimbabwe. This survery is the baseline study which was meant to guide programme implemention.

Availability of data and materials

The data used and analysed during the current study are available from the corresponding author upon reasonable request.

Authors’ contributions

LM designed, monitored and evaluated the Mudzi breast and cervical cancer education and screening project. He was responsible for writing of the survey draft report with technical assistance from New Dimenssions Consultancy Zimbabwe (NEDICO). He was responsible for supervision of the baseline survey data collection and entry processes. He was responsible for the writing of the article. He was also responsible for project reporting. PM helped in the data collection and entry processess and was responsible for cancer education during the implementation of the project. VJ was responsible for the application of ethical clearences. She was also responsible for the capacity building of the Mudzi breast and cervical cancer education and screening project staff. AM was responsible for data analysis including design of data entry templates. JM was responsible for administration of the Mudzi breast and cervical cancer education and screening project. MN was responsible for all medical and clinical aspects of the Mudzi breast and cervical cancer education and screening project and also helped in getting community approvals for the study. SK helped in the data collection process and was responsible for moblization of the communities during the implementation of the project. All authors helped prepare and approved the final manuscript.

Author’s information

Lovemore Makurirofa holds a Diploma in occupational health and safety from the University of Zimbabwe, College of Health Sciences, a Bachelor of Arts from the University of Zimbabwe and MSc in Population Studies from the University of Zimbabwe, Centre for Population Studies. He is currently the Information, Research and Evaluation Manager for the Cancer Association of Zimbabwe. He designed the Mudzi cancer education and screening project and was responsible for the administration, monitoring, evaluation and reporting of the Mudzi cancer education and screening project. He is also one of the current advisory techinical committee members of the Zimbabwe National Cancer Registry. He has passion for research.

Ethics approval and consent to participate

Medical Research Council of Zimbabwe (MRCZ) approval. The study was also approved by the Cancer Association of Zimbabwe board and the local rural authorities including District Administrator (DA) and District Medical Officer (DMO). The study respected freedom to participate and adhered to research principles pertaining to privacy and confidentiality and consent was sought from all the participants including parental consent and assent for the participants below 18 years. Written consent was sought from the participants except 17 participants from which we failed to get written consent. We submitted a protocol deviation for the failure to get written consent and relied on verbal consent from the 17 participants out of the total of 409 participants enrolled in the survey. The protocol deviation was sought by the authors and was approved by the Medical Research Council of Zimbabwe on 28 August 2014.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Copyright information

© The Author(s). 2019

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Authors and Affiliations

  1. 1.Cancer Association of ZimbabweHarareZimbabwe
  2. 2.Allied Health Practitioners Council of ZimbabweHarareZimbabwe
  3. 3.New Dimension ConsultancyHarareZimbabwe
  4. 4.Nurses Council of ZimbabweHarareZimbabwe
  5. 5.Ministry of Health and Child CareMudzi districtZimbabwe
  6. 6.Cancer Association of ZimbabweMudzi districtZimbabwe

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