A recent study by Ayebeng et al. (2025) titled “Multifaceted barriers associated with clinical breast examination in sub-Saharan Africa: A multilevel analytical approach,” published in PloS one, reveals that CBE uptake is low in SSA due to financial, social, and access barriers, with unexpected trends linked to travel-alone challenges.
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Financial, social, and access barriers, including travel-alone challenges, significantly hinder clinical breast examination uptake in sub-Saharan Africa.– Ayebeng et al. 2025
This study explores the barriers associated with clinical breast examination (CBE) uptake in seven sub-Saharan African (SSA) countries: Burkina Faso, Côte d’Ivoire, Ghana, Kenya, Mozambique, Senegal, and Tanzania. CBE is an essential screening method for early breast cancer detection, particularly in regions where advanced screening technologies like mammography are less accessible. The research utilizes data from recent Demographic and Health Surveys (DHS) to estimate the prevalence of CBE uptake, which was found to be low at 19.2%. It employs a multilevel analytical approach to examine how factors such as difficulty in getting permission, financial constraints, long distances to healthcare facilities, and challenges in traveling alone affect the likelihood of women undergoing CBE. The findings highlight significant barriers—such as financial constraints and geographic limitations—that reduce CBE participation but also reveal that women who face travel-alone barriers are more likely to undergo screening than those who do not.
How the Study was Conducted
This research conducted a secondary cross-sectional analysis using the most recent Demographic and Health Survey (DHS) data from seven sub-Saharan African (SSA) countries: Burkina Faso, Côte d’Ivoire, Ghana, Kenya, Mozambique, Senegal, and Tanzania. The focus was on examining the prevalence and barriers to clinical breast examination (CBE) uptake among women aged 25–49 years, a group selected due to their higher risk of breast cancer.
Data Source and Sampling
The DHS employed a standardized two-stage stratified sampling design. First, enumeration areas (clusters) were selected based on each country’s latest census data. Then, households were systematically sampled from these clusters. Within selected households, women aged 15–49 were surveyed on various health behaviors, including CBE uptake. For this study, a weighted analytic sample of 65,486 women aged 25–49 years was utilized.
Methodology and Statistical Analysis
The study estimated CBE uptake prevalence and assessed associated barriers using multilevel logistic regression modeling. Four models were constructed:
Null Model – Baseline with no predictors
Model I – Included only barrier-related variables
Model II – Adjusted for individual-level factors (age, education, wealth)
Models III & IV – Adjusted for both individual and community-level factors
Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were reported. Both fixed and random effects analyses were conducted to evaluate influences at individual and community levels. Additionally, intra-class correlation coefficients (ICCs) and proportional change in variance (PCV) were calculated to assess community-level variation.
What the Authors Found
The study found that the uptake of clinical breast examination (CBE) in the seven sub-Saharan African (SSA) countries surveyed was low, at 19.2%. Several factors influenced this low screening rate, including financial constraints, distance to healthcare facilities, and difficulty in obtaining permission to access care.
Why is this important
Early Detection Saves Lives: Clinical breast examination (CBE) is a cost-effective screening method that can help detect breast abnormalities before they progress, allowing for timely intervention.
Addressing Health Inequities: The study reveals financial, geographic, and social barriers that prevent women from accessing CBE, showing that low-income and rural populations are disproportionately affected.
Policy Implications: Understanding these barriers can inform healthcare policies aimed at improving accessibility, such as integrating CBE into primary healthcare services, expanding mobile health initiatives, and reducing financial obstacles.
Empowering Women’s Health Choices: The study emphasizes the importance of women’s autonomy in seeking medical care, as issues like needing permission to access healthcare directly impact screening uptake.
What the Authors Recommended
- The authors advocate that healthcare providers should deploy mobile clinics and outreach teams to deliver CBE services in underserved and remote areas, mitigating distance and transportation barriers.
- Policymakers institutionalize CBE as a standard component of primary healthcare visits to ensure consistent and opportunistic screening, especially for women who do not actively seek it.
- Launch culturally sensitive education campaigns and engage local leaders and healthcare workers to promote breast cancer awareness and the benefits of early screening.
- Furthermore, the study emphasizes implementing subsidized or free screening programs and offering transportation support to reduce cost-related and travel-related obstacles for women.
- In addition, advocate for national policies that prioritize breast cancer screening and foster partnerships between governments, NGOs, and healthcare providers to improve infrastructure and service delivery.
In conclusion, the study by Ayebeng et al. (2025) sheds critical light on the multifaceted barriers hindering clinical breast examination uptake across sub-Saharan Africa. By revealing how financial hardship, limited access, and social constraints intersect to limit preventive healthcare, the research underscores the urgent need for targeted, culturally sensitive, and policy-driven interventions. Strengthening community outreach, integrating CBE into routine primary care, and empowering women through education and autonomy are essential steps toward improving early breast cancer detection and ultimately saving lives in underserved regions.
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