Effect of a Community Health Worker Intervention on Uptake of Breast Cancer Screening Services among Women of Reproductive Age in Kitui County, Kenya

Abstract

Introduction
While communicable diseases remain the leading killers in many developing countries, the incidence and mortality from non-communicable diseases such as breast cancer and other cancers is rising rapidly. By 2015, estimated 2.4 Million new cases of breast cancer globally was reported. Screening is one way of improving the survival rate by reducing morbidity and mortality of Breast cancer. The annual incidence of cancer in Kenya was close to 37,000 new cases with annual mortality of over 28,000. Cervical and breast cancer were the leading diseases in women occurring at a rate of 40.1/100,000 and 38.3/100,000. The uptake of cancer screening services in Kenya was as low as 13.5%. Engaging CHWs in health service delivery especially in resource poor countries was found to be an achievement [6, 7] .
Objectives
In many developing countries, Community Health Workers (CHWs) provide a variety of services including outreach, counseling and patient home care services. This study aim was to assess the effect of a CHW led intervention on uptake of breast cancer screening services among women of reproductive age in Kitui County, Kenya.
Materials and methodology
This was a quasi-experiment with one pre-intervention and a post intervention survey conducted in both intervention (Kitui East ) and control site (Mwingi West) respectively. The intervention site received Community-Based Health Education (CBHE) aimed at promoting awareness and screening of both breast and cervical cancer. A total sample size of 422 participants were identified in each survey, based on Fisher et al 1998 formula. Purposive and simple random sampling method was used in identifying study area and respondents similarly. Data was collected using a research assistant administered questionnaire. Data analysis was done using frequencies and percentages, Z score tests, and ODDs Ratios. The study was subjected to the KNH-UoN Ethics Review committee (ERC) for ethical review and approval.
Results
The intervention of CHWs increased the proportion of women seeking facility-based breast cancer screening services significantly by 38% in the intervention site. A Difference in Differences(DiD) statistic indicated 33.3% net increase in the proportion of women seeking the services within the 8-month of intervention period. The odds of seeking breast cancer screening services were higher (4.5 times higher) [(crude OR=3.604: 95%CI of OR=2.698-4.813, P<0.05) (Adjusted OR=4.458: 95%CI of OR=3.204-6.202, P<0.05)] in intervention site compared to control site.
Conclusion and Recommendations
Conclusively, the CBHE intervention improved breast cancer screening among women of reproductive age in Kitui County. To reduce the high prevalence of breast cancer and the economic burden of treating breast cancer cases in Kenya, we recommend adoption of Community based strategies like CBHE's help in promoting early screening and treatment of breast cancer among women of reproductive age.

Keywords: Community Health Workers, CBHE, Breast Cancer, Screening