Prevalence of CBE among women by countries.

Objectives
Clinical breast examination (CBE) open the pathway to early detection and diagnosis of breast cancer. This study examined barriers to CBE uptake in seven sub-Saharan African (SSA) countries.
Methods
Data from the most current Demographic and Health Surveys of Burkina Faso, Cote d’Ivoire, Ghana, and Kenya Mozambique, Senegal and Tanzania was used. A weighted sample size of 65,486 women aged 25–49 years was used to estimate the pooled prevalence of CBE. We employed a multilevel logistic regression modelling technique, with results presented in adjusted odds ratios (aOR) along with a 95% confidence interval (CI).
Results
The pooled prevalence of CBE uptake in the studied SSA countries is low at 19.2% [95%CI: 18.5–19.8]. Screening uptake was significantly low among women reporting difficulty in getting permission (aOR = 0.88, 95% CI: 0.82–0.95), and distance (aOR = 0.95, 95% CI: 0.89–0.99), as well as those who reported financial constraints (aOR = 0.92, 95% CI: 0.88–0.97), as barriers to access healthcare facilities. However, surprisingly, women who faced travel-alone barriers were 1.19 times (95%CI: 1.10–1.28) more likely to utilise CBE than those who did not face this barrier.
Conclusions
We conclude that barriers such as difficulties in obtaining permission, long distances to healthcare facilities, and financial constraints significantly reduce the likelihood of women undergoing CBE. The study underscores a need to improve access to healthcare facilities. Practically, this can be achieved by expanding mobile health services and integrating CBE into primary healthcare will help overcome distance-related challenges. Additionally, targeted outreach and transportation initiatives are necessary to support women facing travel barriers.

研究目标
临床乳腺检查（Clinical Breast Examination, CBE）是实现乳腺癌早期筛查与诊断的重要路径。本研究针对七个撒哈拉以南非洲（Sub-Saharan African, SSA）国家中临床乳腺检查接受率的障碍因素展开分析。

研究方法
本研究使用上述七个国家的最新人口与健康调查数据，涉及国家包括布基纳法索、科特迪瓦、加纳、肯尼亚、莫桑比克、塞内加尔及坦桑尼亚。本研究纳入年龄为25~49岁的65486名加权女性样本，用于估算临床乳腺检查的合并接受率。本研究采用多水平logistic回归建模方法，研究结果以校正后比值比（adjusted Odds Ratio, aOR）及95%置信区间（Confidence Interval, CI）进行汇报。

研究结果
本次调研的七个撒哈拉以南非洲国家中，临床乳腺检查的合并接受率较低，仅为19.2%（95%CI：18.5~19.8）。在报告存在获取就诊许可困难（aOR=0.88，95%CI：0.82~0.95）、就医距离过远（aOR=0.95，95%CI：0.89~0.99）以及经济拮据（aOR=0.92，95%CI：0.88~0.97）等医疗服务可及性障碍的女性群体中，临床乳腺检查的接受率显著更低。但值得注意的是，存在独自就医出行障碍的女性相较于无此类障碍的女性，其临床乳腺检查的使用率反而高出1.19倍（95%CI：1.10~1.28）。

研究结论
本研究证实，获取就诊许可困难、就医距离遥远以及经济拮据等障碍因素，会显著降低女性接受临床乳腺检查的概率。本研究强调亟需提升医疗服务的可及性。具体而言，可通过拓展移动医疗服务，并将临床乳腺检查纳入基层医疗卫生服务体系，以解决与距离相关的筛查障碍。此外，针对存在出行障碍的女性群体，需推出针对性的外展服务与交通帮扶举措。