Rift Valley University

Breast self-examination practice and its associated factors among women attending family
planning in akaki kality sub city, Addis Ababa, Ethiopia.

Prepared by: Birhane Doyo (BSc)

A research proposal submitted to the School of Graduate of Rift Valley University Lancha
campus, School of Public Health for the partial fulfillment of the requirement for the degree of
masters of public health with specialty of General Public Health.

May 2024 G.C

Addis Ababa, Ethiopia

 Rift Valley University

Lancha campus

Masters of Public Health department

Research Project Submission form

Name of Investigator Birhane Doyo (BSc)

Name of Primary Advisor Bikila tesfa (MPH, PhD)

Full title of the research Breast self-examination practice and its associated factors among women
Title attending family planning in akaki kality sub city, Addis Ababa, Ethiopia.

Duration Of Project May,2024- July, 2024

Study Area Akaki Kality Sub-city, Addis Ababa, Ethiopia

Total Cost of the Project 42,490.00ETB

Address of investigator Tel: +251923782099

Email: [email protected]
Abbreviation

BC: breast cancer

BSE: breast self-examination

LMICs: low- and middle-income countries

Acknowledgment
First of all, I would like to express my deepest gratitude to my Advisors Bikila tesfa (MPH, PhD)
for help, guidance, encouragement and constructive comments and critiques. Secondly, I would
like to acknowledge Rift Valley University for giving me this chance. Last but not lists; I would
like to thank my families’ classmates and my entire friend for beside me though all this time.
Summary
Background: Breast cancer is the leading cause of cancer death worldwide and the second
common cancer overall. Breast self-examination is one of the cheapest methods used for the
early detection of breast cancer in asymptomatic women. However, the practice of breast self-
examination remains low in Ethiopia. Therefore, this study aimed to assess breast self-
examination practice and associated factors among women attending family planning services in
Akaki kality Addis Ababa Ethiopia.

Objectives: This study aims to assessing Breast self-examination practice and its associated
factors among women attending family planning in Akaki kality sub city, Addis Ababa, Ethiopia.

Methods: The institution-based cross-sectional study design will conduct Breast self-
examination practice and its associated factors among women attending family planning in
Akaki kality sub city, Addis Ababa, Ethiopia. Data were collected from 427 women by using an
interviewer-administered structured questionnaire. Variables which will significantly associated
with breast self-examination in binary logistic regression analyses with a P-value <0.05 will
included in the multivariable logistic regression analysis to identify the independent predictors of
breast self-examination practice..

Work plan and budget: The tasks starting from proposal writing to final defense will be done
May, 2024- July, 2024 by the principal investigator, data collector and Advisors.

This investigation will cost a total of 42,490 ETB.

Contents
Abbreviation..............................................................................................................................................3
Acknowledgment.......................................................................................................................................4
Summary....................................................................................................................................................5
Introduction.............................................................................................................................................10
1.1. Background..............................................................................................................................10
1.2. Statement of the problem...........................................................................................................11
1.2. Significance of the study..........................................................................................................12
2. Literature Review............................................................................................................................13
2.1 Socio demography factor.................................................................................................................13
2.2 Breast Self-Examination Practice....................................................................................................14
2.3 Breast Self-Examination Practice and Associated Factors...............................................................15
2.4. Conceptual framework....................................................................................................................17
3. Objectives.........................................................................................................................................18
3.1. General objective.......................................................................................................................18
3.2. Specific objectives.....................................................................................................................18
4. Methods............................................................................................................................................19
4.1. Study area..................................................................................................................................19
4.3. Source population......................................................................................................................19
4.4. Study population........................................................................................................................19
4.5. Inclusion and Exclusion Criteria................................................................................................20
4.5.1 Inclusion Criteria......................................................................................................................20
4.5.2 Exclusion Criteria.....................................................................................................................20
4.6. Sample size................................................................................................................................20
4.7. Data collection procedure..........................................................................................................21
4.8. Operational definition................................................................................................................21
4.9. Data analysis..............................................................................................................................22
4.10 Variables...................................................................................................................................22
4.10.1 Dependent variables.........................................................................................................22
4.10.2 Independent variables.....................................................................................................22
4.11. Data management..................................................................................................................22
4.12. Data quality assurance...........................................................................................................22
4.13. Ethical Consideration.............................................................................................................23
5. Work plan........................................................................................................................................24
6. Cost of the project...............................................................................................................................25
Reference..................................................................................................................................................26
Annex I:.....................................................................................................................................................29
Annex II:...................................................................................................................................................30
List of Tables

Table 1: Budget plan for assessing Breast self-examination practice and its associated factors
among women attending family planning in Akaki kality sub city, Addis Ababa, Ethiopia........19
Table 2: Budget break down for assessing Breast self-examination practice and its associated
factors among women attending family planning in Akaki kality sub city, Addis Ababa, Ethiopia.
.......................................................................................................................................................20
List of Figure

Figure 1: Conceptual framework designed for Breast self-examination practice and its associated
factors among women attending family planning in Akaki kality sub city, Addis Ababa, Ethiopia.
.......................................................................................................................................................17
Introduction
1.1. Background

Breast cancer is the most prevalent form of cancer in Ethiopia of all female cancers. It is
considered to be a progressive disease with a poor prognosis if detected late (1).

Breast cancer is the most prevalent cancer among females globally, encompassing nearly a
quarter of diagnosed cases among females, since 1.15 million cases are diagnosed annually
around the world. Breast cancer is common in both developed and developing countries.

Nevertheless, its rates are three times higher in developing countries. Breast cancer is a leading

cause of mortality among females in Africa (2). Nearly 60% of BC deaths affect low- and
middle-income countries, where access to diagnostic and curative facilities is problematic, and
screening programs are underdeveloped or nonexistent(3). Early diagnosis of breast cancer is
critical to reducing cancer-related mortality, particularly where radiation, hormonal, and
chemotherapy are not widely available. Early detection relies on breast awareness and utilization
of screening methods. While mammography is the only screening modality proven to reduce
breast cancer mortality, mammography is neither affordable nor feasible in many low- and
middle-income countries (LMICs) (4).

Breast self-examination (BSE) is a simple, very low-cost, non-invasive early detection method
used to detect breast cancer at early stage. It should be done for all women older than 20 years
(5). Studies on BSE practices and attitudes have shown that the rate of this screening, as well as
knowledge of BSE, is low among women of different ages(3).

Evidence shows that having knowledge of BSE has a positive impact on early detection of BC.
Knowledge of BSE may also influence the attitude and practice of BSE. Attitude is a settled way
of thinking about BSE which includes acceptance that BSE is necessary, all women should
perform it, ready to encourage other people to get information and to practice it and seeking
early medical care with any abnormalities(6). However, the practice of breast self-examination
remains low in Ethiopia. Therefore, this study aimed to assess breast self-examination practice
and associated factors among women attending family planning services in Akaki kality Addis
Ababa Ethiopia.
1.2. Statement of the problem
Breast Self-Examination is the process where by a woman examines her own breasts by seeing
and feeling with fingers to detect breast lump or swelling. More than 90% cases of breast cancer
are detected by women themselves. Poor practice of breast self-examination is usually associated
with patient delay (7).

The study conduct in Debre Berhan University Students most of the participants had low
knowledge and practice of BSE (1).

Study conduct in Welkite University Breast self-examination knowledge and practice are vital to
detect breast cancer early and take the necessary measure. Age, years of study, source of
information, and place of grew up are major predictors of BSE knowledge and age, religion,
place of grew up and knowledge of breast self-examination were major BSE predictors(8).

Despite the many benefits of BSE, only a few childbearing women practice it due to poor
knowledge about screening methods. In Ethiopia the knowledge and practice level of BSE at
community level is unknown and most of the studies have been conducted on university students
and health care providers. Due to this, many women miss early detection as well as treatment
opportunities due to poor practice level of BSE. Thus, this study planned to assess the level BSE
practice of BSE and associated factor among women in attending family planning services in
Akaki kality Addis Ababa Ethiopia.
1.2. Significance of the study

The study of breast self-examination (BSE) practice and its associated factors among women is
of vital significance in the realm of preventive healthcare. Breast cancer remains a leading cause
of mortality among women globally, and early detection through regular self-examination is a
crucial first line of defense. This research delves into the intricate web of factors that influence a
woman's propensity to engage in this life-saving practice. By identifying the barriers and
enablers of BSE, healthcare providers can tailor educational campaigns and interventions to
empower women, fostering a culture of proactive, self-directed breast health management.
Moreover, understanding the patterns and predictors of BSE adherence allows for the targeted
allocation of resources, ensuring that screening programs reach the most vulnerable populations.
Ultimately, this research serves as a catalyst for promoting women's health, empowering
individuals to take charge of their own well-being through a simple, cost-effective practice that
can significantly improve early cancer detection and treatment outcomes.
2. Literature Review

2.1 Socio demography factor

Breast cancer is a global concern affecting over 2 million women worldwide , Globally, 2.4
million new breast cancer cases and 53,000 deaths were reported in 2015; Of which, 13%
occurred in Africa According to World Health Organization (WHO), almost 58% of breast
cancer related deaths occur in less developed countries(9).

In Sub-Saharan Africa, breast cancer is the second leading cause of death and most commonly
diagnosed cancer in women with an age-adjusted incidence rate of 28 per 100,000 women. It is
estimated that 10, 000 Ethiopian women have breast cancer with a thousand cases being
unreported and becoming fatal due to late presentation, limited resources, and strong traditional
beliefs delaying medical care(6).

Breast cancer occurs in every country of the world in women at any age after puberty but with
increasing rates in later life. In contrast to this breast cancer occur in Ethiopia at a younger age,
more than 50% occurred at premenopausal, aged<40 years with stage 3 disease(6).

Study conduct in Croatia some participants under 20 years of age reported performing BSE,
suggesting that younger participants are aware of the importance of BSE for the early detection
of BC(3).

The age of the women and women’s educational level was significantly associated with the
attitude of BSE. History of breast cancer and good knowledge of BSE were significantly
associated with performing BSE. Women college and above were about 4 times [AOR: 3.8,
(95% CI: 1.43–10.14)] more likely to know of BSE than those who uneducated women. The
spouses whose educational level College and above was about 3 times [AOR: 3.03, (95% CI:
1.04–8.84)] more likely to be knowledgeable towards BSE than those who had an illiterate
husband(10).
2.2 Breast Self-Examination Practice
Unlike clinical breast examination and mammography, (BSE) allows women to perform breast
examinations independently without being dependent on health care professionals. BSE remains
recommended as a general approach to increase breast health awareness allowing for early
detection of abnormalities(11).

Study conduct in Croatia, 2423 (68.5%) participants reported performing BSE. As reasons for
not performing BSE, 521 (14.7%) reported forgetting, while 363 (10.3%) reported that they did
not know how(3).

Study conduct in Dire Dawa One hundred forty one (38.2%) of the participants indicated that
they performed BSE every month, but only 23(16.3%) of them performed daily. Similarly,
34(21.4%) of them performed BSE 1-3 times a week, 47(33.3%) performed 1-5 times for 2
weeks and the remaining 37(26.3%) performed 1-5 times for 3 weeks regularly in the last 1
month. However, significant number 229(61.8%) participants did not perform BSE for the last
one month. The reasons for not doing BSE were carelessness 53(21.4%), forgetfulness
61(26.6%), fear of being diagnosed with breast cancer 72 (31.4%), have no breast problem
25(10.9%) and other reasons 18(8.2%)(12).

Studies conducted in different regions of Ethiopia revealed performance rates of BSE that varied
between 6.5% and 39.4% among adult women (11-13).

Study conduct on Harari revealed that 171(47.2%) of the participants ever practiced breast self-
examination; of them, 19.9% practiced regularly. Among the study participants who practiced
breast self-examination, 55(15.2%) of the study participants performed BSE two to three days
after cessation of menstruation More than two-thirds of 107(29.6 %%) of the study participants
had started practicing BSE before the age of 25years. More than one-third, 83(46.9%) of the
study participants performed breast self-examination less than five times in the last six months
(14).

Study conduct on Mojo among the 420 participants 86 (20.5%) (P=20.5%; 95% CI: 16.7, 24.5)
of the participants had ever performed BSE while 11 (12.8%) practiced regularly. The major
reason for performing BSE was for early detection and treatment of breast cancer 39 (45.3%).
The major reason that they do not practice BSE was they do not know how to examine their
breast(15).

Study conduct in Gondar town Among 541 study participants, 248 (45.8%) performing breast
self-examination and 31% (95% CI: 25–37%) had good practices of breast self-examination.
From the total respondents, more than half 54.2% (n = 293) of them did not practice BSE. The
main reasons for not practicing BSE 175 (57.4%) were not having breast problems and 31.7% (n
= 93) don’t know how to breast self-examine(10).

2.3 Breast Self-Examination Practice and Associated Factors

Study conduct on Malaysian Regarding the factors that influenced their practice of BSE; age
significantly influenced the practice of BSE (p = 0.045).Exercise was also significantly
associated with the practice of BSE (p=0.002). A family history of cancer significantly
influenced the practice of BSE (p=0.017). Smoking, drinking alcohol, and residency were not
significantly associated with the practice of BSE(16).

Study conduct North Shoa Zone, Oromia, Ethiopia, 192 (18.2%; 15.7%–20.5%) of the
participants had ever performed BSE. Having a family history of breast cancer (BC) (adjusted
OR (AOR)=6.9, 95% CI 4.6 to 10.3), being knowledgeable on BSE (AOR=3, 95% CI 1.9 to 4.3),
having high perceived susceptibility (AOR=1.7, 95% CI 1.2 to 2.5), having high self-efficacy
(AOR=1.5, 95% CI 1.1 to 2.3) and having a high perceived benefit to BSE (AOR=1.5, 95% CI
1.1 to 2.3) were significantly associated with increased odds of BSE practice(17).

Study conduct in female health professionals in Western Ethiopia Professionals who had
personal history of breast cancer were 5 times (AOR=4.7, 95%CI: 1.32, 17.07) more likely to
perform BSE. Those professionals knowledgeable on BSE were 4 times (AOR=4.2, 95%CI:
1.36, 5.65) more likely to examine their breast than those who were not knowledgeable, those
study participants reporting teaching BSE to a client were 5 times more likely (AOR=5.2,
95%CI: 2.33, 8.14) to practice BSE than those who do not counsel clients on BSE. Those who
had positive attitude toward BSE were four times more likely to perform BSE than who had
negative attitude (AOR=3.8, 95%CI: 2.11, 9.17)(18).
Study conduct Secondary School Female Teachers in Gammo Gofa Zone, Southern, Ethiopia
Participants who ever heard about BSE were twice as likely to practice BSE [AOR=2.26, 95%
CI (1.07, 4.77)] than their counterparts. Participants having knowledge on BSE practice were
three times more likely to practice BSE [AOR=2.84, 95% C. I (1.41, 5.72)] compared with those
less knowledgeable. Participants having less perceived barrier to BSE were three times more
likely to practice BSE [AOR=2.62, 95% C. I (1.26, 5.46)] than their counterparts. Those having
high perceived confidence and motivation were four and three times more likely to practice BSE
[AOR=3.63, 95% C. I (1.79, 7.39)] and [AOR=3.29, 95% CI (1.15, 9.45)] than their
counterparts, respectively, and those who were married were four times more likely
[AOR=4.098, 95% C. I (1.644, 10.219)] to practice than their counterparts(19).

Study conduct in Gondar town Women who have personal and family history of breast cancer
were about 6 times [AOR: 6.06, (95% CI: 2.19–16.74)] more likely to perform BSE than women
who do have not the history of breast cancer. A woman who has adequate knowledge of BSE
about 3 times [AOR: 2.67 (95% CI: 1.18–6.04)] is more likely to perform BSE than women who
have inadequate knowledge(10).

Study conduct on mojo a binary logistic regression analysis was done to identify factors
associated with BSE practice. In bivariate logistic regression analysis variables; age between 30
and 39, government employment, educational status of secondary and tertiary level, family
history of breast cancer, personal history of breast disease, being knowledgeable about BSE, and
positive attitude towards BSE were statistically significant (at P-value ≤ 0.2). In multivariable
logistics regression, tertiary-level educational status, knowledge about BSE, and Positive attitude
towards BSE were found to be significantly associated with BSE practice (at p-value <0.05).
BSE practice among women with tertiary level of education were 2.14 [AOR: 2.14; 95% CI:
(1.45, 6.74)] times higher compared to those with secondary education. Women who were
knowledgeable about BSE were 4.32 [AOR: 4.32; 95% CI: (1.81, 10.81)] times higher odds of
BSE practice compared to their counterparts(15).
2.4. Conceptual framework
Efforts has been made to develop a summarizing conceptual frame work presented below by
taking the above reviewed literatures into consideration about the practice of breast self-
examination and associated factor . This conceptual frame work will help us to design a research
question regarding the practice of breast self-examination and associated factor among women.

Socio-demographic factor
 Age
 Marital status
 Educational background
 Employment status

Practice of breast self-examination

Knowledge about BSE Practice

Family and Personal history of breast

disease or cancer

Figure 1: Conceptual framework designed for Breast self-examination practice and its associated
factors among women attending family planning in Akaki kality sub city, Addis Ababa, Ethiopia.
3. Objectives

3.1. General objective

This study aims to assess breast self-examination practices and associated factors among women
attending family planning services in Akaki Kality Sub City, Addis Ababa, Ethiopia.

3.2. Specific objectives

 To asses Breast self-examination practice among women attending family planning in
Akaki

Kality sub city, Addis Ababa, Ethiopia.

 To assess associated factors among women attending family planning in Akaki kality sub
city, Addis Ababa, Ethiopia.
4. Methods

4.1. Study area

The institution-based cross-sectional study design will conduct Breast self-examination practice
and its associated factors among women attending family planning in Akaki kality sub city,
Addis Ababa, Ethiopia. According to Addis Ababa city administration report Akaki Kality sub-
city is one of the eleven sub-cities of Addis Ababa city administration. Based on the 2022
population projection, the total population of the sub-city is 255,348 of which 131,525 (51.5%)
are females. There are about 10 public health centers in the sub-city that provide family planning
services for the community(20). All these facilities, namely, Tulu Dimtu, Akaki, Akaki Kela,
Selam Fire, Kality, Saris, Sirte, Kilinto, Gelan Gura, and Gelan health centers, will included in
the study

projection, the total population of the

sub-city is 255,348 of
which 131,525 (51.5%) are females.
There are about 10
public health centers in the sub-city that
provide family
planning services for the community. All
these facilities,
namely, Tulu Dimtu, Akaki, Akaki Kela,
Selam Fire, Kality,
Saris, Sirte, Kilinto, Gelan Gura, and
Gelan health centers,
were included in the study
4.2. Study design and period

The institution-based cross-sectional study design will be conduct on women attending family
planning service in Akaki kality sub city public health facilities from May 01/ 2024–July30/
2024.

4.3. Source population

The source population will be all reproductive-age women who were attending family planning
services at health facilities in the Akaki Kality sub-city, Addis Ababa, Ethiopia.

4.4. Study population

The study population will be selected from reproductive-age women who were attending family
planning services at health facilities of Akaki Kality sub-city during the data collection period.
All reproductive-age women (20–49 years) who came during the study period and were willing
to participate were included in the study.

4.5. Inclusion and Exclusion Criteria

4.5.1 Inclusion Criteria

All women aged 20–49 attended family planning service in Akaki kality public health facilities
during the study period were included in the study.

4.5.2 Exclusion Criteria

Women who were diagnosed with breast cancer were excluded.

4.6. Sample size

The required sample size will calculated by using single population proportion formula with an
assumption of 95% confidence interval (CI), 5% margin of error, The value of proportion “p”
will considered as 53.6 % based on a previous study conducted on the proportion of breast self-
examination practice among women taken from a study in Mekelle town, northern Ethiopia(21).
Therefore, using the formula single population

n= (z2 *p*q)/d2 proportion, z=1.96 with 95% of confidence interval, q = 1-p, d = margin of error
tolerated (0.05) n = the required sample size, p= proportion of breast self-examination practice
among women (53.6%).

2 a
n=z P ( 1−P ) (1 . 96)2∗0 . 53∗0 .53
2 = = 385
2 (0 .05)2
d

By adding a 10% non-response rate, N= n/1-0.1, 385/0.9 the final sample size will be 427.
Therefore, these 427 total samples distributed equally for 10 Health Center found in the sub city.

4.7. Data collection procedure

A structured quantitative questionnaire developed by reviewing different literatures and adapted
to local situation with necessarily modifications. The self-administered questionnaires were
prepared originally in English and then translated in Amharic (local language) version then
translated back to English version to check for its consistency. A one-day training of data
collectors will give on how to collect data. Four staffs distributed questionnaires at the health
facilities who gave consent after clear explanation of the methods, tools, and how to handle
ethical issues will discussed with the data collector; the data will collected from July 05 to July
10/2024. Regular supervision by the supervisor and principal investigator will made to ensure
that all necessary data were properly collected.

4.8. Operational definition

Early detection methods of breast cancer: Breast self-examination, clinical breast examination
and mammography are the early detection methods of breast cancer(22).
Practice of breast self-examination: Those who carried out breast self-examination practice a
week after each menses used their palm and middle three fingers(22, 23).
Clinical breast examination: This will measure to see whether participants had at least one
clinical check-up in the last 1-year period.
Mammography check-ups: This will measure to see whether the participants had at least one
mammography check-up in their life time.
Good knowledge about breast cancer early detection methods: Participants were considered
as having good knowledge if they answered more than the mean score of the knowledge
assessment questions.
Poor knowledge about breast cancer early detection methods: Participants were considered
as having poor knowledge if they answered less than the mean score of the knowledge
assessment questions.

4.9. Data analysis

The collected data will code and entered into Epi-info version 7.2 and then exported to SPSS
version 24.0 for analysis. Descriptive statistics will done by computing summary statistics like
frequency, mean, percentages, and standard deviations, and the results will presented in tables
and graphs. Binary logistic regression will be done to assess the crude relationship between the
independent variables and the dependent variable. Then those independent variables which will
significantly associated with breast self-examination in binary logistic regression analyses with a
P-value <0.05 will included in the multivariable logistic regression analysis to identify the
independent predictors of breast self-examination practice. Finally odds ratio with its p-value and
confidence interval of those independent variables that maintain their association with outcome
variable in multiple logistic regression model will reported.

4.10 Variables
4.10.1 Dependent variables
 BSE practice
4.10.2 Independent variables
  Socio-demographic status knowledge, attitude, history of Breast cancer and Breast
disease: Family history of breast cancer, personal history of breast disease, and
familiarity with other people who have breast cancer.

4.11. Data management

The questionnaire will be checked for completeness for completeness and consistency by the
principal investigator. A continuous supervision and a daily meeting with data collectors will be
conducted while collecting data. The collected data will be coded, cleaned and into Epi info
version 7.2 and exported to SPSS version 24 for data analysis.

4.12. Data quality assurance

The questionnaire will be checked for completeness and consistency by the principal
investigator. A continuous supervision and a daily meeting with data collectors will conduct
while collecting data.

4.13. Ethical Consideration

The ethical approval and clearance will obtained from the research ethics review committee of
the school of public health, post graduate studies, Rift Valley University Lancha campus.
Permission will sought from Akaki kality sub city health office. The objective, methods, benefits
and risks, if there is any, of the study, privacy, confidentiality and the possibility to refuse
participation at any time of the data collection will explained orally to the ambulance care
providers and informed written consent will sought accordingly.
 5. Work plan

Responsible Time frame

body May. – May. – June 15. – June 30. – July 20. –
May. May. June 30. July 20. July 30.
2024 2024 2024 2024 2024
Weeks Weeks Weeks Weeks Weeks
S 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3
n Activities 4 4 4 4 4
1. Proposal writing PI
Finalize research proposal, submission &
2. defense PI
3. Prepare for fieldwork PI
4. Data collectors training PI
5. Data collection DC
6. Data entry PI
7. Data analysis, &write up the findings PI
Writing discussion, conclusion&
8. recommendation PI
9. Submission of1st&2nddraft
10. Thesis defense PI
11. Dissemination of the findings PI
Table 1: Budget plan for assessing Breast self-examination practice and its associated factors among women attending family
planning in Akaki kality sub city, Addis Ababa, Ethiopia.
6. Cost of the project
SN Budget category Unit cost Multiplying factors Measurement Total cost
Personal (For data collection)
Number of groups members *
Daily wage/diem Number of working day * Daily wage
1 Training for data collectors 250 per day 250 * 4 * 2 days 2000

2 Data collector fee (For Interviewers) 50 ETB per Questionnaire 466 * 50 ETB 23300

Data Collectors Refreshment during 50 Per water and snack

3 data collections (Snacks with water ) per day 50 * 30 * 4 6000
Logistics and other supplies
Cost Per Item Number of Item * cost per item Measurement
2 * 10 Page interview questionnaire
4 Questionnaire duplication 2 ETB per page 9320
*466 sample
5 Pin 3 3* 30 Sample 90
6 Flip chart paper for training 80 1 x 80 ETB =80 80
7 Pack of Pen 5 150 ETB ETB x 5 Pack 750
8 Pencil for data collection 10 10 x5 ETB 50
9 Printing and binding of the 100 6 x 150 ETB 3 Proposal 900
proposal
Total Costand thesis and 3 Thesis 42490.00
Table 2: Budget break down for assessing Breast self-examination practice and its associated factors among women attending
family planning in Akaki kality sub city, Addis Ababa, Ethiopia.
Reference
1. Birhane K, Alemayehu M, Anawte B, Gebremariyam G, Daniel R, Addis S, et al.
Practices of breast self-examination and associated factors among female debre berhan university
students. International journal of breast cancer. 2017;2017.
2. Mohamed AOA, Nori MMM, Ahmed ASM, Altamih RAA, Kunna ESM. Knowledge,
attitude, and practice of breast cancer and breast self-examination among female detainees in
Khartoum, Sudan 2018. Journal of Preventive Medicine and Hygiene. 2020;61(3):E470.
3. Apatić R, Lovrić R. Factors Related to the Knowledge and Practice of Breast Self-
Examination: A Cross-Sectional Study. European journal of breast health. 2023;19(3):215.
4. Azemfac K, Christie SA, Carvalho MM, Nana T, Fonje AN, Halle-Ekane G, et al. A
Community‐Based Assessment of Knowledge and Practice of Breast Self ‐Examination and
Prevalence of Breast Disease in Southwest Cameroon. Journal of cancer epidemiology.
2019;2019(1):2928901.
5. Getu MA, Kassaw MW, Tlaye KG, Gebrekiristos AF. Assessment of breast self-
examination practice and its associated factors among female undergraduate students in Addis
Ababa University, Addis Ababa, Ethiopia, 2016. Breast Cancer: Targets and Therapy. 2018:21-
8.
6. Udoh RH, Tahiru M, Ansu-Mensah M, Bawontuo V, Danquah FI, Kuupiel D. Women’s
knowledge, attitude, and practice of breast self-examination in sub-Saharan Africa: a scoping
review. Archives of Public Health. 2020;78(1):84.
7. Kebede L, Abdo M, Megerso A. Breast self-examination practice and associated factors
among women of reproductive age in Adama Town, Oromia Regional State, Ethiopia. Cent
African J Public Heal. 2021;7(4):227-35.
8. Zepre K, Mussie M, Gebremeskel A. Knowledge and Practice of Breast Self Examination
as Early Detection Method of Breast Cancer and Associated Factors Among Wolkite Univeresity
Female Students, Southern Ethiopia. 2023.
9. Mekonnen BD. Breast self-examination practice and associated factors among female
healthcare workers in Ethiopia: a systematic review and meta-analysis. PloS one.
2020;15(11):e0241961.
10. Asmare K, Birhanu Y, Wako Z. Knowledge, attitude, practice towards breast self-
examination and associated factors among women in Gondar town, Northwest Ethiopia, 2021: a
community-based study. BMC Women's Health. 2022;22(1):174.
11. Abay M, Tuke G, Zewdie E, Abraha TH, Grum T, Brhane E. Breast self-examination
practice and associated factors among women aged 20–70 years attending public health
institutions of Adwa town, North Ethiopia. BMC research notes. 2018;11:1-7.
12. Dagne I, Tesfaye F, Abdurashid N, Mekonnen R. Breast self-examination practice and
associated factors among female healthcare professionals at Dire Dawa administration, Eastern
Ethiopia. European Journal of Biomedical. 2019;6(1):161-9.
13. Segni M, Tadesse D, Amdemichael R, Demissie H. Breast self-examination: knowledge,
attitude, and practice among female health science students at Adama Science and Technology
University, Ethiopia. Gynecol Obstet (Sunnyvale). 2016;6(368):2161-0932.
14. Dechasa DB, Asfaw H, Abdisa L, Dessie Y, Bete T, Sertsu A, et al. Practice of breast
self-examination and associated factors among female health professionals working in public
hospitals of Harari regional state: Eastern Ethiopia multicenter study. Frontiers in Oncology.
2022;12:1002111.
15. Urga Workineh M, Alem Lake E, Asmare Adella G. Breast self-examination practice and
associated factors among women attending family planning service in modjo public health
facilities southwest Ethiopia. Breast Cancer: Targets and Therapy. 2021:459-69.
16. Al-Naggar RA, Al-Naggar DH, Bobryshev YV, Chen R, Assabri A. Practice and barriers
toward breast self-examination among young Malaysian women. Asian Pac J Cancer Prev.
2011;12(5):1173-8.
17. Hussein D, Oyato BT, Gashaw K, Geleta TA, Tufa DG, Geleta LA. Practice of breast
self-examination and associated factors among women of reproductive age in the North Shoa
Zone, Oromia, Ethiopia, 2022: a convergent mixed-methods study. BMJ open.
2024;14(5):e073951.
18. Elias LN, Worku DH, Alemu SM. Assessment of breast self-examination practice and
associated factors among female health professionals in Western Ethiopia: a cross sectional
study. International Journal of Medicine and Medical Sciences. 2017;9(12):148-57.
19. Mekuria M, Nigusse A, Tadele A. Breast self-examination practice and associated factors
among secondary school female teachers in gammo gofa zone, southern, Ethiopia. Breast
Cancer: Targets and Therapy. 2020:1-10.
20. Goyomsa GG, Geleta LA, Debela SA, Reshid N, Ogeto Luke A, Lamaro Abota T, et al.
Quality of family planning counseling and associated factors among women attending family
planning clinics at selected health centers in Akaki Kality sub-city, Addis Ababa, Ethiopia.
Frontiers in Global Women's Health. 2022;3:939783.
21. Legesse B, Gedif T. Knowledge on breast cancer and its prevention among women
household heads in Northern Ethiopia. Open journal of preventive medicine. 2014;2014.
22. Aberaraw R, Boka A, Teshome R, Yeshambel A. Social networks and quality of life
among female breast cancer patients at Tikur Anbessa specialized hospital, Addis Ababa,
Ethiopia 2019. BMC Women's Health. 2020;20:1-9.
23. Getachew S, Tesfaw A, Kaba M, Wienke A, Taylor L, Kantelhardt EJ, et al. Perceived
barriers to early diagnosis of breast Cancer in south and southwestern Ethiopia: a qualitative
study. BMC women's health. 2020;20:1-8.
Annexes

Annex I:
Information sheet and consent form (In English)
Rift Valley University Lancha Campus, Public Health, Post Graduate Student
I. Participant information sheet for Breast self-examination practice and its associated
factors among women attending family planning
Greeting my name is Birhane Doyo. I came from Rift Valley University; Post Graduate Public
Health department to conduct Breast self-examination practice and its associated factors among
women attending family planning in Akaki kality sub city, Addis Ababa, Ethiopia. The objective
of this questionnaire is to gather appropriate Information about Breast self-examination practice
and its associated factors among women. The study focuses on the Breast self-examination
practice and its associated factors among women attending family planning. So, the investigation
will try to bring out a better strategic solution to solve the problems that encounter on breast
cancer. Self-administered questioner will be conducted with the respondents to gather the
necessary information about Breast self-examination practice and its associated factors among
women. The study has an ethical approval from the rift valley university post graduate public
health department. By assuring that information that you provide will be treated with strict
confidentiality and honesty. If you have any question about the research you may contact

 Birhane Doyo (PI): +251923782099

Informed consent form

Taking the above information into consideration, I kindly ask you to take part in the study.
I undersign will like to approve that as I give my consent to participate in this study after detailed
Objective of the study have been explained to in the language that I understand. I also understand
that I can discontinue from the study any time without loss of any personal benefits.
1. If you your response is yes, please continue to the following questions
2. If no please No, provide gratitude and skip to the next participant
Participant signature: ____________________________ Date: _______________________
Name of data collector: _______________________ Signature: ____________ Date: _________
Identification
Questionnaire code: _______________ District of the establishment: ________
Annex II:
S.No Question Response Skip
A. socio-demographic characteristics

1 What is your age? ________________

1. Male
2 Sex?
2. Female
1. Orthodox
2. Protestant
3 Religion?
3. Muslim
4. Other
1. Single
What is your marital 2. Married
4
status? 3. Separated /divorced
4. Widow/widower
1. No formal education
2. Secondary education (grade 9–
12)
4 Educational background?
3. Diploma

4. Degree and above

1. Student
2. Housewife
Employment 3. Government employed
5
status?
4. Self-employed

5. Private employed

B. Family and Personal history of breast disease or cancer

Personal history of breast 1. Yes

1
disease? 2. No

Family history of breast 1. Yes

2
cancer? 2. No

C. Knowledge About BSE Practice

 Ever heard about breast 1. Yes If your answer is yes go
1
self- examination? 2. No to question No 2-8
1. Mass media

Source of information? 2. Health professionals

2
3. Friends/ relatives
4. neighbors
1. At age less than20
2. At Age 20
3 Age to start BSE?
3. At age 30
4. I do not know
1. Monthly
Frequency BSE should be
4 2. Every 3 month
performed?
3. Other
1. Few days before menses
2. 2–3 days after menses
5 Time to perform BSE?
3. Anytime During menses
4. I do not know
1. Standing in front of the mirror
Body position to perform 2. Lying down
6
BSE? 3. I do not know
4. Other
1. To become familiar with how
your breasts normally look and feel
7 Benefit of BSE? 2. To identify changes you see or
feel in your breasts
3. I do not know
1. Inspecting the breast in front of
the mirror

Technique to perform 2 Palpating using the finger pads in

8 circular motion
BSE?
3.Squeezing the tip of the nipple for
Discharge
4. I do not know
1. Breast lump
Signs of breast cancer 2. Swelling of the breast
9
when BSE perform? 3. Bloody Discharge
4. I do not know
10 Do you think finding 1. Yes
 changes in your breasts
does mean there is cancer? 2. No

D. BSE Practice
1. Yes If yes please answer
1 Ever performed BSE?
2. No questions 2-9
1. For early detection and
treatment of breast cancer
2 Reasons to perform BSE?
2. Fear of developing breast cancer
3. Recommended by professionals
1. < 20 years
Age when you started 2. At 20 years
3
performing BSE? 3. At 30 years
4. At 35years
1. Monthly
Frequency of performing
4 2. Every 6 month
BSE ?
3. Annually
1. Few days before menses
Time of performing
5 2. 2–3 days after menses
BSE ?
3. Anytime during menses
The body position used 1. Standing in front of a mirror
6
while performing BSE? 2. Lying down
1. Inspection of the breast in front of
a mirror
2. Palpation of the breasts with the
BSE techniques used pads of the 3 middle fingers in a
7
while performing BSE? circular motion
3. Squeezing the tip of the nipples
for discharge
Used the right hand to 1. Yes
palpate the left breast and
8
the left hand to palpate the 2. No
right breast ?
1. Breast lump
2. Swelling of the breast
Signs of breast cancer
9 3. Bloody discharge
checked during BSE
4. Change in color and shape of the
breast skin

Assurance of principal Investigator

The undersigned agrees to accept responsibility for the scientific ethical and technical conduct of
the research project and for provision of required progress report as per term and conditions of
the research publications office in effect at the time of grant is forwarded as the result of this
application.

Name of the student: ______________________________________________________

Date:_______________________________ Signature:______________________________

Approval of the primary advisor

Name of the primary advisor:_______________________________________________

Date:_______________________________ Signature:______________________________