Model comparison and random effect.

Introduction
Worldwide, breast cancer accounts for about 2.3 million new cases and 685,000 deaths, making it the second most common cancer in women. It can be detected through breast examination like mammograms, self-breast examination and clinical breast examinations in the early stage potentially before it spreads to other organs. The current study aimed to determine the awareness of breast examination to detect breast cancer and its determinant factors.
Methods
A total of 16,474 women of reproductive age were included. The 2022 Kenyan demographic and health survey dataset were used. The data were analyzed using STATA version14.0. Multilevel mixed-effects logistic regression was employed to identify potential factors of the outcome variable. Variables with p-values <0.05 were considered statistically significant.
Result
Nearly 44.4% of women were aware of breast examinations to detect breast cancer. Older age [AOR = 2.517, 95%CI: 2.11–3.00], higher educational level [AOR = 5.755, 95%CI: 4.631–7.153], being an active worker [AOR = 1.343, 95%CI:1.232–1.465], being the wealthiest [AOR = 1.526, 95%:1.336–1.744], use of the internet [AOR = 1.451, 95%CI:1.323–1.592], exposure to different media [AOR = 1.350, 95%CI:1.187–1.536] and health facility contact within 12 months [AOR = 1.496, 95%CI:1.385–1.615] were positively associated at the individual level, while low community poverty [AOR = 0.777, 95%:0.676–0.892] and high literacy level [AOR = 1.412, 95%CI:1.190–1.677] were significant factors at the community level.
Conclusion and recommendation
Less than half of the women were aware of breast examination to detect breast cancer. Older age, high level education, being active worker, exposure for media, using internet, being rich were favorable covariates at the individual level while high literacy and low poverty were found to be enabling factors at the community level. This study recommends that educating women, engaging them in different occupational activities, decreasing poverty, improving media and internet accessibility can bring positive change of women’s awareness towards breast examination.