Spatial autocorrelation and determinants of low uptake of breast cancer screening among women of reproductive age: A mixed-effect multilevel analysis of Tanzanian population-based survey

Abstract

INTRODUCTION: Breast cancer remains an important public health problem with high mortality in low-income countries like Tanzania. This is because of the low uptake of screening for breast cancer, an intervention that could be cost-effective and significant in reducing mortality and poor prognosis in such a setting. This is a population-based survey to uncover the spatial distribution and determinants of low uptake of breast cancer screening among women of reproductive age in Tanzania. METHODS: This analytical cross-sectional study utilized data from 2022 Tanzania Demographic and Health Survey and Malaria Indicator Survey (TDHS-MIS). A total of 15254 women aged 15-49 years were included in the analysis. The outcome variable was the uptake of breast cancer screening, coded as "1" for the women who reported a doctor or other healthcare provider examined their breasts to check for cancer, and "0" otherwise. Descriptive and geospatial analyses were conducted to assess patterns of screening uptake across regions. To identify associated factors, a mixed-effect multilevel logistic regression analysis was performed using Stata version 17. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported, and a significance level of p < 0.05 was used. RESULTS: The findings revealed that only 5% of the respondents reported having undergone breast cancer screening in Tanzania. The lowest uptake was in the Western (2.17%) and Southern (3.34%) zones of Tanzania. Regions with the poorest uptake of breast cancer screening were Kigoma (1.68%), Katavi (1.94%), Singida (1.54%), and Tabora (1.66%). Women with older ages, formal education, health insurance coverage, and reading newspapers, magazines, or using the internet had higher odds of uptake breast cancer screening than their counterparts. CONCLUSIONS: The uptake of breast cancer screening remains low throughout Tanzania and worst situation was noted in rural areas. Formal education, insurance coverage, and access to information continue to propel the low uptake of breast cancer screening in Tanzania. The fair distribution of health-promotive services could be vital in increasing uptake of breast cancer screening for the early detection and prevention of mortalities and other outcomes related to this severe disease.