Common cancers in India: knowledge, attitudes and behaviours of urban slum dwellers in New Delhi

A contextual exploration of healthcare service use in urban slums in Nigeria

Introduction

Many urban residents in low- and middle-income countries live in unfavorable conditions with few healthcare facilities, calling to question the long-held view of urban advantage in health, healthcare access and utilization. We explore the patterns of healthcare utilization in these deprived neighborhoods by studying three such settlements in Nigeria.

Methods

The study was conducted in three slums in Southwestern Nigeria, categorized as migrant, indigenous or cosmopolitan, based on their characteristics. Using observational data of those who needed healthcare and used in-patient or out-patient services in the 12 months preceding the survey, frequencies, percentages and odds-ratios were used to show the study participants’ environmental and population characteristics, relative to their patterns of healthcare use.

Results

A total of 1,634 residents from the three slums participated, distributed as 763 (migrant), 459 (indigenous) and 412 (cosmopolitan). Residents from the migrant (OR = 0.70, 95%CI: 0.51 to 0.97) and indigenous (OR = 0.65, 95%CI: 0.45 to 0.93) slums were less likely to have used formal healthcare facilities than those from the cosmopolitan slum. Slum residents were more likely to use formal healthcare facilities for maternal and perinatal conditions, and generalized pains, than for communicable (OR = 0.50, 95%CI: 0.34 to 0.72) and non-communicable diseases (OR = 0.61, 95%CI: 0.41 to 0.91). The unemployed had higher odds (OR = 1.45, 95%CI: 1.08 to 1.93) of using formal healthcare facilities than those currently employed.

Conclusion

The cosmopolitan slum, situated in a major financial center and national economic hub, had a higher proportion of formal healthcare facility usage than the migrant and indigenous slums where about half of families were classified as poor. The urban advantage premise and Anderson behavioral model remain a practical explanatory framework, although they may not explain healthcare use in all possible slum types in Africa. A context-within-context approach is important for addressing healthcare utilization challenges in slums in sub-Saharan Africa.

Understanding Social Media Usage and Engagement among Women to inform Breast Cancer Knowledge and Prevention Practices: Cross - sectional study in Delhi -National Capital Region of India

Background:

Breast cancer is the major concern worldwide and in India too. Lack of awareness is one of the causes of increasing mortality rate in India. Social media is playing an important role in health communication including breast cancer information. In India, number of women are using social media.

Objective:

To explore the impact of social media usage and engagement in enhancing knowledge and practices to prevent breast cancer among women of India.

Methodology:

A cross-sectional study was conducted in Delhi-National Capital Region of India with a sample of 649 women (response rate 83.51%). The questionnaire consisted of three sections. In first section, sociodemographic details (four items) were collected, second section contained five items on social media use and engagement and third part included items on knowledge about risk factors (seven items), symptoms (eight items), and screening (six items) of breast cancer and practice (seven items). Descriptive statistics, Chi-square, Cramer-V test, and structural equation modeling-Analysis of a moment structure were used to identify the relationship between social media engagement and knowledge and practices of women.

Results:

Around 80% (431/542) of women have medium level of social media engagement and 20% are highly engaged. The slope coefficient of the relationship between social media engagement and knowledge is 0.805 and between knowledge and practice is 0.309, Chi-square value is 52.053 and 29.624, Cramer-V statistics is 0.310 and 0.165, respectively, which indicates significant relationship.

Conclusion:

The study result justified significant impact of social media engagement on knowledge and practices of women to prevent breast cancer.

A study on awareness about breast carcinoma and practice of breast self-examination among basic sciences' college students, Bengaluru

BACKGROUND

In India, the number of new breast cancer cases is about 115,000 per year and this is expected to rise to 250,000 new cases per year by 2015. It needs to be noted that breast cancer is leading in the age groups of 15-34 years which is a cause of concern as this denotes the need for educative and awareness programs targeting younger members of the society, to implement early practices of breast examination. This study was carried out with the intention of assessing the level of knowledge and awareness of carcinoma breast and breast self-examination (BSE) in female college students.

MATERIALS AND METHODS

This cross-sectional study was carried out in a well-known basic sciences college. After the pretest questionnaire was given, an awareness talk was given about breast cancer and BSE. A posttest questionnaire was administered. The data of pre- and post-test were collected and analyzed using SPSS.

RESULTS

Pretest and posttest were collected from 1030 students. The age of the study participants was ranged between 18 and 23 years. Most of them were aware of breast carcinoma, but half of them thought breast cancer affects the elderly. Regarding different aspects studied, 58% had a knowledge of at least one of the symptoms and 59% knew at least one of the risk factors for breast carcinoma. Only 185 (18%) women knew about BSE and 107 women practice it.

CONCLUSIONS

This study concluded that the awareness of the breast cancer was good but the knowledge of signs and BSE was poor, which is utmost important for early detection and in reduction of mortality.

Breast Cancer Awareness among Middle Class Urban Women--a Community-Based Study from Mumbai, India

Targeting breast cancer awareness along with comprehensive cancer care is appropriate in low and middle income countries like India, where there are no organized and affordable screening services. It is essential to identify the existing awareness about breast cancer in the community prior to launching an organized effort. This study assessed the existing awareness about breast cancer amongst women and their health seeking practices in an urban community in Mumbai, India. A postal survey was undertaken with low or no cost options for returning the completed questionnaires. The majority of the women were aware about cancer but awareness about symptoms and signs was poor. Women were willing to accept more information about cancer and those with higher awareness scores were more likely to seek medical help. They were also more likely to have undergone breast examination in the past and less likely to use alternative medicines. High income was associated with better awareness but this did not translate into better health seeking behaviour. Organized programmes giving detailed information about breast cancer and its symptoms are needed and women from all income categories need to be encouraged for positive change towards health seeking. Further detailed studies regarding barriers to health seeking in India are necessary.

Multiple Stakeholder Perspectives on Cancer Stigma in North India

BACKGROUND

Cancer is a leading cause of death worldwide. A large proportion of cancer deaths are preventable through early detection but there are a range of social, emotional, cultural and financial dimensions that hinder the effectiveness of cancer prevention and treatment efforts. Cancer stigma is one such barrier and is increasingly recognized as an important factor influencing health awareness and promotion, and hence, disease prevention and control. The impact and extent of stigma on the cancer early detection and care continuum is poorly understood in India.

OBJECTIVES

To evaluate cancer awareness and stigma from multiple stakeholder perspectives in North India, including men and women from the general population, health care professionals and educators, and cancer survivors.

MATERIALS AND METHODS

A qualitative study was conducted with in-depth interviews (IDIs) and focus group discussions (FGDs) among 39 individuals over a period of 3 months in 2014. Three groups of participants were chosen purposively - 1) men and women who attended cancer screening camps held by the Indian Cancer Society, Delhi; 2) health care providers and 3) cancer survivors.

RESULTS

Most participants were unaware of what cancers are in general, their causes and ways of prevention. Attitudes of families towards cancer patients were observed to be positive and caring. Nevertheless, stigma and its impact emerged as a cross cutting theme across all groups. Cost of treatment, lack of awarenes and beliefs in alternate medicines were identified as some of the major barriers to seeking care.

CONCLUSIONS

This study suggests a need for spreading awareness, knowledge about cancers and assessing associated impact among the people. Also Future research is recommended to help eradicate stigma from the society and reduce cancer-related stigma in the Indian context.

A review of breast cancer awareness among women in India: Cancer literate or awareness deficit?

Background

Breast cancer is the most common female cancer worldwide including India, where advanced stages at diagnosis, and rising incidence and mortality rates, make it essential to understand cancer literacy in women. We conducted a literature review to evaluate the awareness levels of risk factors for breast cancer among Indian women and health professionals.

Methods

A structured literature search using combined keywords was undertaken on bibliographic databases including MEDLINE, Cochrane Database of Systematic Reviews, Cumulative Index to Nursing and Allied Health (CINAHL) and SCOPUS. Searches were restricted to research published in English language peer-reviewed journals through December, 2014 in India.

Results

A total of 7066 women aged 15–70 years showed varied levels of awareness on risk factors such as family history (13–58%), reproductive history (1–88%) and obesity (11–51%). Literacy levels on risk factors did not improve over the 8-year period (2005–2013). On average, nurses reported higher, though still varied, awareness levels for risk factors such as family history (40.8–98%), reproductive history (21–90%) and obesity (34–6%). Awareness levels were not consistently higher for the stronger determinants of risk.

Conclusion

Our review revealed low cancer literacy of breast cancer risk factors among Indian women, irrespective of their socio-economic and educational background. There is an urgent need for nation- and state-wide awareness programmes, engaging multiple stakeholders of society and the health system, to help improve cancer literacy in India.

Knowledge, attitudes and practice about pap smear test among women living in Bojnourd, North East of Iran: a population-based study

BACKGROUND

The aim of the study was to assess the extent of knowledge, attitudes and practical behavior of women in Bojnourd conerning the Pap smear test.

MATERIALS AND METHODS

This cross-sectional and population-based study was conducted with 1000 Iranian women aged 15-60 years old in Bojnourd city. In order to collect the data, a validated questionnaire was provided in four sections covering demographic information and questions about knowledge, attitude and practice about the Pap smear. Statistical analysis was performed with the Statistical Package for Social Sciences (version 17.0) applying a 0.05 significance level.

RESULTS

Evaluation of knowledge showed that 146 women (14.6%) had very weak, and 594 women (59.4%) had weak knowledge. In contrast, most of the women studied, 873 (87.3%), had a positive attitude toward the Pap smear test. According to the findings, 375 women (37.6%) had done this test so far. Findings indicated that the extent of knowledge had a meaningful relationship with the attitude status (p<0.0001). Also, there was a meaningful relationship between knowledge and practice, so that the weakest practice was seen in women who had weak knowledge (61.1%), (p<0.0001).

CONCLUSIONS

According to findings of this research, most women do not have an appropriate knowledge about the necessity of having the Pap smear test, so that only a low percentage of women had undergone this test.

Current status of knowledge, attitude and practice (KAP) and screening for cervical cancer in countries at different levels of development

Cancer of the uterine cervix is a worldwide menace taking innumerable womens' lives. The literature is vast and a large number of studies have been conducted in this field. Analyses have shown significant differences exist in terms of screening and HPV testing facilities among high income and low to middle income countries. In addition, acute lack of awareness and knowledge among the concerned population is particularly noted in rural areas of the low income countries. A detailed review of Indian case studies revealed that early age of marriage and childbirth, multiparity, poor personal hygiene and low socio-economic status among others are the principal risk factors for this disease. This review concludes that a two pronged strategy involving strong government and NGO action is necessary to minimize the occurrence of cervical cancer especially in low and medium income countries.

Awareness regarding risk factors, symptoms and treatment facilities for cancer in selected states of India

OBJECTIVE

To study the level of awareness and knowledge about cancers and associated risk factors among households in selected states of India.

METHODS

In the study 3070 households were interviewed from six states viz, West Bengal, Kerala, Madhya Pradesh, Rajasthan and Mizoram.

RESULTS

Knowledge of cancers other than those related to tobacco was very low (prostate 8%, colon 11% ) among the communities, with a poor awareness of warning signs and symptoms. The knowledge varied from state to state. It is found that the major source of information related to cancers was television (38%) followed by friends and relatives (36%). Only about 15 % of respondents had knowledge about cancer awareness camps organized in their districts but they did not have knowledge about the organizers of the camp. Findings suggested a strong need for strengthening of DCCP.

CONCLUSION

It is important to create awareness among community through educational programs on cancer prevention, preventable cancer risk factors, benefits of early diagnosis, and availability of screening facilities. Integration of District Cancer Control activities with NRHM could be the most cost-effective strategy to prevent cancers and rural population.

Cervical cancer: the route from signs and symptoms to treatment in South Africa

In South Africa, in 2005-06, 100% of primary health care clinics in South Africa had health professionals trained to conduct Pap smears, yet the screening rate was only 1.3% and one in 26 women develop cervical cancer during their lifetime. Many women admitted to oncology wards are at such an advanced stage of disease that palliation is the only treatment option left. The purpose of this qualitative study in 2007, using semi-structured interviews with 15 women with advanced cervical cancer, was to understand the routes they followed from first signs and symptoms of disease to receiving treatment. The willingness of the women to be diagnosed was a positive finding of the study. The women did seek treatment, often more than once, and were not solely responsible for presenting late. The average number of months from first contact with a health care professional until diagnosis was 17.3, ranging from 11.8 months for urban participants to 28.4 months for rural participants, and three to seven months from diagnosis to referral for treatment. Lack of knowledge and awareness among health care professionals resulted in a low suspicion of cancer and misdiagnosis. A national cervical cancer strategy, including health education and re-training of health professionals, should be made a priority.