|Year : 2023 | Volume
| Issue : 1 | Page : 17-23
Determinants of willingness to uptake prostate cancer screening amongst Men in Ile-Ife, Nigeria
FO Fehintola, OA Ogundele, O Olusiyan, U Okpala, OE Folorunso, AA Amuda
Department of Community Health, Faculty of Clinical Sciences, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
|Date of Submission||02-Apr-2023|
|Date of Decision||07-May-2023|
|Date of Acceptance||23-May-2023|
|Date of Web Publication||17-Jul-2023|
Dr. F O Fehintola
Department of Community Health, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Osun State
Source of Support: None, Conflict of Interest: None
Background: Prostate cancer is a major health problem amongst middle-aged and elderly men globally. Screening can significantly reduce morbidity and mortality from prostate cancer, but this is hardly done amongst men in developing countries. This study assessed the factors associated with prostate cancer screening amongst men over 40 years in the Ife central local government area.
Methods: This cross-sectional study was conducted amongst 261 men that were selected by multistage sampling technique. Data were collected using a pretested self-administered questionnaire and analysed using IBM SPSS Version 21. The Chi-square test was used for the association, while logistic regression was used to determine the predictors. A P < 0.05 was considered statistically significant.
Results: The mean age of respondents was 45 ± 3.1 years. About 34.4% had a good knowledge of prostate cancer, while more than two-thirds of the respondents (67.2%) had ever heard of prostate cancer screening. Only 10.7% of the respondents had ever been screened for prostate cancer. Majority of the respondents (73.4%) were willing to be screened for prostate cancer. Determinants of willingness to be screened for prostate cancer were older age (adjusted odds ratio [AOR] = 2.34, 95% confidence interval [CI] = 2.09–5.46, P = 0.001), being married (AOR = 1.83, 95% CI = 1.57–3.84, P = 0.034), formal level of education (AOR = 4.36, 95% CI = 2.67–6.87, P = 0.014) and good knowledge of prostate cancer (AOR = 3.45, 95% CI = 2.76–7.85, P = 0.001).
Conclusion: There is an urgent need to intensify health education on knowledge of prostate cancer and its screening amongst Nigerian men to enhance prostate cancer screening uptake amongst them.
Keywords: Cancer, determinants, prostate, screening, willingness
|How to cite this article:|
Fehintola F O, Ogundele O A, Olusiyan O, Okpala U, Folorunso O E, Amuda A A. Determinants of willingness to uptake prostate cancer screening amongst Men in Ile-Ife, Nigeria. Niger J Health Sci 2023;23:17-23
|How to cite this URL:|
Fehintola F O, Ogundele O A, Olusiyan O, Okpala U, Folorunso O E, Amuda A A. Determinants of willingness to uptake prostate cancer screening amongst Men in Ile-Ife, Nigeria. Niger J Health Sci [serial online] 2023 [cited 2023 Sep 26];23:17-23. Available from: http://www.https://chs-journal.com//text.asp?2023/23/1/17/381741
| Introduction|| |
According to the World Health Organization, prostate cancer is the most common cause of cancer in males worldwide. An estimated 1.1 million cases and 0.37 million deaths of prostate cancer occur annually in the world. The burden of prostate cancer is further expected to grow to 1.7 million new cases and 499,000 new deaths by the year 2030. This cancer is the second-leading cause of cancer-related deaths amongst men after lung cancer and it is the fourth-most occurring cancer overall. In fact, available statistics reveal that almost one in every 11 men will develop prostate cancer during his lifetime. Its incidence and prevalence are in multiples in developing countries compared with the developed ones as shown by several studies. A review of current estimates of the burden of cancer in Africa revealed a high prevalence of prostate cancer in Africans. While prostate cancer is the most common kind of cancer amongst men of African descent, testing amongst African men is uncommon. Low uptake of testing is linked to barriers related to access to cancer-related healthcare, including diagnosis, treatment and general lack of medical information on risk factors.
Yet screening can significantly reduce morbidity and mortality from prostate cancer. One of the most worrying aspects is that many prostate cancers develop without men experiencing any symptoms. This is found amongst African-Americans with the highest incidence of prostate cancer globally. It occurs in men between the ages of 40-69 years.
The prevalence of prostate cancer in African countries revealed that Nigeria is ranked amongst the countries with the highest prevalence of prostate cancer., In Nigeria, prostate cancer is the most commonly diagnosed malignancy amongst men and a hospital prevalence of 182.5/100,000 male admissions was recorded in 2010 in Osun state., Furthermore, a study by Mbah-Omeje revealed that. despite the presence of screening programmes in Nigeria, the number of prostate cancer cases is on the increase.
In Nigeria, 75% of patients present with locally advanced or metastatic diseases, and mortality due to prostate cancer has been reported to be as high as 64% within 2 years of diagnosis. Studies on prostate cancer from the Ibadan cancer registry showed that the relative ratio frequency for prostate cancer, when compared to other male cancers, increased from 4.45% to 10.5% over the last three decades.
Recommended screening test for prostate cancer is the measurement of serum prostate-specific antigen levels; other methods of screening, such as digital rectal examination or ultrasonography, are secondary; the American urological association and the American cancer society recommend screening for all men aged 50 years and above with life expectancy more than 10 years and also men aged 40–45 years who are at a high-risk for the condition like African-Americans and those with affected first-degree relatives. The stage of the disease at diagnosis is one of the most important predictors of survival from prostate carcinoma.
The primary goal of prostate cancer screening is to reduce deaths due to prostate cancer through early detection and prompt management. In Nigeria, the mean age of prostate cancer patients at the time of diagnosis has been reported to be about 68.3 years, while the national prostate cancer risk was put at 2% of all patients based on a pool of 110,000 men with most being diagnosed with advanced stages of the disease. Based on these data Osegbe concluded that “Prostate cancer incidence and the magnitude of risk in our population may have been grossly underestimated and that the prostate cancer rate may be as high as those noted in black men in the United States” This has been attributed mainly to poor awareness, inadequate health education, lack of screening programmes for prostate cancer, poverty, poor healthcare facilities and paucity of specialist urological care.
Despite the global increase in awareness as a result of the widespread availability of screening tools for prostate cancer, there is no evidence that the knowledge, attitudes and screening practices of Nigerian men have changed regarding prostate cancer.
Several studies have documented factors associated with uptake of prostate cancer screening tests worldwide. Such factors include the age of the men, their marital status, risk perception, financial constraint, and knowing someone who has prostate cancer. It is, therefore, vital to understand contextually how some of these factors influence the uptake of prostate cancer screening exercises amongst Nigerian men. This study aimed at providing information that could be useful to policymakers in shaping prostate cancer screening programmes in Nigeria. It also aimed at bridging the practice gap for prostate screening amongst Nigerian men. The study objectives were to assess the wiliness to uptake of prostate cancer screening amongst men, and also sought to identify factors influencing the uptake of screening programmes amongst men residing in Ife central local government area (LGA), Osun State.
| Methods|| |
The study was conducted in Ife Central LGA of Osun State. Ile-Ife is an ancient Yoruba city and the cradle of the Yoruba race. It is an important city located in Osun East senatorial district of Osun State, southwest of Nigeria. Administratively, Ile-Ife hosts the headquarters of two LGAs, namely Ife Central and Ife East, with an estimated population of 167,254 and 188,027, respectively (NPC, 2009). Geographically, Ile-Ife lies on latitude 7.4670N and longitude 4.5670E. The city experienced two distinct seasons, the rainy season spanning between April and October and the dry season between November and March. The annual rainfall is about 1330 mm, with the highest temperature hovering over 28.3°C. Most of the residents are farmers, with about 75% of the population engaged in agriculture and agro-allied industries, while others are traders and civil servants. The predominant religions are Christianity and Islam, with minority groups engaged in traditional religious practices. The population is 167,204, male 88,403 and female 78,801 (NPC, 2009). The LGA is densely populated by the Yoruba speaking people of south western Nigeria, in addition to other ethnic groups; such as Igbo and Hausa.
The study employed a community-based, cross-sectional descriptive design.
Participants and sampling
The sample size was calculated using Leslie Fischer's formula for estimating single proportion. Based on the documentation of a previous study conducted in Nigeria by Ikuerowo et al., a proportion of 11% was used as the percentage of Nigerian men who were aware of prostate cancer. A precision of 10% was used and correction for nonresponse was made. Thus, a total of 165 men were selected using a multistage sampling technique between May and June 2018. The first stage involved the selection of 3 enumeration areas from the 11 enumeration areas in the LGA by simple random sampling technique. In the second stage, one community in the selected enumeration area was selected by simple random sampling technique. All households in the chosen communities with eligible respondents were selected for the study. In houses where there are more than one household with eligible respondents, a household was randomly selected by simple random sampling technique balloting.
All adult men who were at least 40 years of age and who gave their written consent were recruited to participate in the study.
Men who were too ill or not consenting to participate were exempted from the study.
Study 1 procedures
Data were obtained using semi-structured interviewer guided questionnaire. The questionnaire was developed based on information obtained from previous studies on prostate cancer screening. Data were collected on socio-demographic characteristic of the respondents, their awareness on prostate cancer/screening, knowledge about the disease, their attitudes towards screening, and reasons for no screening. Respondents who had not been screened were asked to select one best reason (from a list of options) for their lack of screening. The questionnaire was translated into the Yoruba language for Yoruba-speaking respondents. The questionnaire was pretested in another enumeration area different from the one selected for the main study. Ambiguous questions observed during pretesting were either rephrased or removed in line with the study objectives.
The Statistics for Windows, Version 21.0. (IBM Corp., Armonk, NY) was used for analysis. Initial analyses were done by generating frequency tables and graphs, while further analyses were done to explore the statistical association between variables. Appropriate bivariate analysis was carried out to assess statistical association on variable types and a logistic regression model was performed to identify factors that were significantly associated with uptake of prostate cancer screening. Some of the independent variables used include the age of the respondents, educational level and marital status. The level of statistical significance was set at P < 0.05. Control for potential confounders such as age and educational level of respondents was done by placing our respondents in different categories. The adjusted odds ratio and 95% confidence interval were obtained to determine factors that were significantly associated with the uptake of prostate cancer screening programmes amongst our respondents.
Key variables and measurements
Knowledge and awareness of respondents on prostate cancer and its screening. To assess this, respondents were asked if they had ever heard about prostate cancer and of the screening. The response to each of the questions was 'yes' or 'no'. Respondents' level of knowledge was categorised as good or poor based on the knowledge score. The mean knowledge score was determined and values below the mean score were categorised as poor, while the mean value and above were categorised as good knowledge. For ease of analysis at the multivariate level respondents age, marital status, occupation and level of education were classified into two categories. Respondents' occupation were classified using the International Classification of Occupations approach.
Ethical approval for this study was sought from the research and ethics committee of the Institute of Public Health, Obafemi Awolowo University, Ile Ife. However, permission was sought and obtained from the respondents, before their enrolment into the study. Verbal consent was obtained from respondents after explaining the aim and objectives of the study to them. Participation of women was also voluntary and their confidentiality was guaranteed by making the questionnaire anonymous: names of respondents were not requested in completing the questionnaire.
| Results|| |
Socio-demographic characteristics of respondents
Majority of the respondents, 71.3%, were in middle age (45–64 years). Majority were married and were Christian (82.4% and 70.9%, respectively). Majority were Yoruba (77%), and they about a third (34.5%) had tertiary education. Majority of the respondents were on <50,000 naira per month [Table 1].
Knowledge of prostate cancer and its screening
One hundred and sixty-six (63.6%) of the respondents were aware of prostate cancer. Sources of information on prostate cancer were friends/relatives 56 (21.4%), the mass media 48 (18.4%), workplace 24 (9.2%) and health workers 133 (51. 0%). About a third of the respondents recognise symptoms of prostate cancer as inability to urinate. Majority of the respondents (72.8%) identify surgery as the treatment option for the treatment of prostate cancer. Two-thirds (63.2%) of the respondents have poor knowledge of prostate cancer and its screening [Table 2].
Uptake and willingness to screen for prostate cancer
Majority (89.3%) of the respondents have not been screened for prostate cancer. Although majority of the respondents showed a willingness to be screened (171, 73.4%), Less than half (46.4%) of the respondents were motivated to be screened for prostate cancer because they were sick. About a third of the respondents (35.6%) did not go for screening because they had never heard of screening [Table 3].
Factors associated with willingness to screen
[Table 4] reveals that there is a statistically significant relationship between respondents educational level (χ2 = 36.928, P < 0.001), type of occupation (χ2 = 12.383, P = 0.030), income (χ2 = 6.183, P = 0.045) and knowledge about prostate cancer and its screening (χ2 = 58.322, P < 0.001).
|Table 4: Factors associated with willingness to screen for prostate cancer|
Click here to view
Determinants of willingness to screen
Respondents of older age group and those that were married were twice likely to screen for prostate cancer compared with their younger counterparts (adjusted odds ratio [AOR] = 2.34, 95% confidence interval [CI] = 2.09–5.46, P = 0.023) (AOR = 2.34, 95% CI = 1.57-3.89, P = 0.034). Respondents with formal education were four times more likely to screen for prostate cancer compared with respondents that have no formal education (AOR = 4.36, 95% CI = 2.67–6.87, P = 0.014). Respondents that have good knowledge of prostate cancer and its screening were three times more likely to screen for prostate cancer compared with their counterparts with poor knowledge (AOR = 3.45, 95% CI = 2.76–7.85, P = 0.001) [Table 5].
| Discussion|| |
This study revealed that two-thirds of the respondents were aware of prostate cancer and sources of information were mostly healthcare workers and relatives. This is contrary to findings of a study done in Oyo state amongst older men, which reveals that the level of awareness of prostate cancer amongst older men was 80%. The higher level of awareness amongst respondents in the study carried out in Oyo state might be due to the ongoing radio jingles on prostate cancer at the time the study was conducted.
In the current study, only 34.4% of respondents had good knowledge of prostate cancer, which is similar to the findings of a study done in Ikenne amongst rural men, but contrary to the findings of a study conducted at the University of Nigeria Nsukka that placed the prevalence of good knowledge at 71.2%. This variation might be because the Nsukka study was carried out amongst University staff who are highly learned and might have had health education sessions on prostate cancer.
Majority of the respondents in this study had not been screened for prostate cancer. This is similar to the findings of previous studies that revealed that the majority of Nigerian men have not been screened for prostate cancer.,,
Although the majority of respondents have not been screened for prostate cancer, about three-quarters of the respondents were willing to be screened for prostate cancer. This is similar to the findings of previous studies done in Nigeria that revealed a higher level of willingness to screen for prostate cancer.,
Findings from this study revealed that respondents of older age groups and those that were married were more likely to screen for prostate cancer compared with their younger counterparts. This is similar to the findings of a study done in Tanzania amongst men residing in Dar es Salaam which reveals that older men were more willing to screen for prostate cancer than younger men and another study done in Uganda on the uptake of prostate cancer screening amongst men revealed that older men, family history of prostate cancer were important predictors of screening for prostate cancer. Furthermore, findings from this research revealed that respondents that have good knowledge of prostate cancer and its screening and those with formal education were more likely to screen for prostate cancer; this is similar to findings of a study done by Olarewaju et al. at Iseyin that reveals that men with poor knowledge of prostate cancer and those that are non-professional were less likely to be willing to screen for prostate cancer.
| Conclusion|| |
This study showed that the knowledge of prostate cancer and prostate cancer screening was poor amongst men in Ife Central LGA, Osun State. Although only a few of the respondents have been screened, most of the respondents were willing to screen for prostate cancer.
The authors acknowledge all the study participants.
Financial support and sponsorship
This study was entirely funded by the authors.
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]