This research proposal aims to assess the knowledge, attitude, and practice of self breast examination among women of childbearing age at Mandera General Hospital. The study reveals that while a majority of women are aware of self breast examination (77.5%), only 60% actually practice it due to lack of proper health education. The study recommends the World Health Organization to promote self breast examination awareness as a public health policy to facilitate early detection of breast cancer.

1. 1
PRACTICES ON SELF BREAST EXAMINATION AS RELATED TO BREAST
CANCER AMONG WOMEN OF CHILD BEARING AGE (18-40 YEARS) ATTENDING
MCH/FP CLINIC IN MANDERA GENERAL HOSPITAL.
BY
ABDIFATAH MOHAMED ISSACK
+254722234375
A RESEARCH PROPOSAL SUBMITTED TO.
ALL PEOPLE

2. i
DECLARATION
1 hereby declares that this is my original work that has not been presented before for any
academic purpose or otherwise. It should not be produced without prior written permission by
the author.
Abdifatah Mohamed
Signature: _______________________ Date: ________________________
DEDICATION
This research proposal is dedicated to my family and friends for their prayers, encouragement,
understanding and financial support during the entire process of this research. Thanks for your
concern.

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May God Bless You All.
ACKNOWLEDGEMENT
I give all the glory to the almighty God for this abundant grace, which has seen me through my
study period. In all ups and downs that I went through, He renewed my strength each day and
this far he is worthy of my praise.

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The success of this study depended on a team of people who have contributed psychologically,
materially and theoretically.
I hereby wish to express my heart felt gratitude to the university supervisor Mrs. Monica, for her
guidance and advice throughout the project, may god bless her abundantly,
I also pass my gratitude to my beloved sister Faiza Hassan for the financial support.
I would also wish to pass my regards to the team that helped me in data collection. Finally I
thank the staff Mandera General Hospital for according me cooperation during this period.
OPERATIONAL DEFINATIONS
Knowledge - Level of awareness on information about self breast examination related to breast
cancer.
Attitude - A tendency to think or behave in a certain way.

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Practice - The method used to the examination.
Breast cancer - Malignant disease that affects the mammary glands
LIST OF ABBREVIATIONS
BSE - Breast Self Examination
PGH - Provincial General Hospital
MCH/FP - Maternal Child Health and Family Planning

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MOH - Medical Officer of Health
CME - Continuous Medical Education
LIST OF FIGURES
Figure 1…………………………………………………………………………………………7

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TABLE OF CONTENTS
DECLARATION ..............................................................................................................................i
DEDICATION..................................................................................................................................i
ACKNOWLEDGEMENT ...............................................................................................................ii
OPERATIONAL DEFINATIONS .................................................................................................iii

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LIST OF ABBREVIATIONS.........................................................................................................iv
LIST OF FIGURES .........................................................................................................................v
ABSTRACT....................................................................................................................................ix
CHAPTER ONE ............................................................................................................................. 1
1.0 INTRODUCTION.......................................................................................................... 1
1.1 PROBLEM STATEMENTS ......................................................................................... 2
1.2 PURPOSE OF THE STUDY ................................................................................................ 2
1.3 JUSTIFICATION FOR THE STUDY.................................................................................. 3
1.3.1 CLIENT (COMMUNITY) ............................................................................................. 3
1.3.2 HEALTH WORKERS.................................................................................................... 3
1.3.3 NATION ......................................................................................................................... 4
1.3.4 THE RESEARCHER...................................................................................................... 4
1.4 BROAD OBJECTIVE........................................................................................................... 4
1.5 SPECIFIC OBJECTIVE ....................................................................................................... 4
1.6 HYPOTHESIS..................................................................................................................... 4
CHAPTER TWO .......................................................................................................................... 5
2.0 LITERATURE REVIEW.............................................................................................. 5
2.1 KNOWLEDGE ON SELF BREAST EXAMINATION IN WOMAN OF CHILD
BEARING AGE.......................................................................................................................... 5

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2.2 ATTITUDE TOWARDS SELF BREAST EXAMINATION IN WOMEN OF CHILD
BEARING AGE.......................................................................................................................... 5
2.3 PRACTICE OF SELF BREAST EXAMINATION ............................................................. 5
2.4 STEPS IN PERFORMING SELF BREAST EXAMINATION ........................................... 6
2.5 PALPATION......................................................................................................................... 7
2.6 ROLE PLAYED BY HEALTH WORKERS IN SELF BREAST EXAMINATION .......... 8
CHAPTER 3 ................................................................................................................................... 9
3.0 METHODOLOGY......................................................................................................... 9
3.1 STUDY AREA...................................................................................................................... 9
3.2 STUDY DESIGN.................................................................................................................. 9
3.3 DEFINATION OF VARIABLES ......................................................................................... 9
3.4 INCLUTION AND EXECUTION CRITERIA .................................................................... 9
3.5 SAMPLE SIZE DETERMINATION.................................................................................. 10
3.6 SAMPLING METHOD ...................................................................................................... 10
3.7 TECHNIQUE METHOD OF DATA COLLECTION........................................................ 10
3.8 DATA COLLECTION INSTRUMENT............................................................................. 10
3.9 ETHICAL CONSIDERATIONS........................................................................................ 10
3.10 STUDY LIMITATIONS................................................................................................... 11
3.11 DATA ANALYSIS AND PRESENTATION................................................................... 11

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ABSTRACT
The study was cross sectional study design. The main purpose of the study was to determine
knowledge, attitude and practice of self breast examination amongst women of child bearing age
attending Mandera General Hospital clinic.
The study targeted women of child bearing age. A total of 80 women were selected and
interviewed using systematic sampling method. From the study self breast examination was
known by majority of women attending MCH/FP clinic as it was represented by
77.5%.

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Also the study revealed that majority of the women attending MCH/FP clinic Mandera practiced
self breast examination as represented by 60%. Those who practiced BSE practiced it at any time
which was attributed to by lack of proper health education on the appropriate time for BSE. I
have explained the five steps carried out by a woman in order to rule out any abnormality
especially the development of a lump. The study therefore recommends the World health
organization to make BSE a public policy so that there is community mobilization through
creating awareness. I would also make an appeal to the Ministry of Health to incorporate BSE as
one of the services among the services offered in MCH/FP services in order to reach the 40% of
women who do not practice BSE. This will help in early detection of breast cancer hence reduce
mortality.

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CHAPTER ONE
1.0 INTRODUCTION
Breast disorders may be non-cancerous (benign) or cancerous (malignant). Most of them are
non-cancerous and not life threatening often they do not require treatment. In contrast breast
cancer can mean a loss of breast or life. However potential problems can be detected early
enough when women regularly examine their breast themselves and have mammograms.
Common problems include breast pain, lumps and a discharge from the nipple.
Breast symptoms do not necessary mean that a woman has breast cancer or another serious
disorder. However, if a woman has any of the following symptoms, she should see her doctor.
A lump that feels distinctly different from other breast tissue or that does not go away. Dimpling
in the skin of the breast, scaly skin around the nipple, change in the shape of the breast.
Changes in the nipples such as turning in-ward, discharge from the nipple especially if it is
bloody.
Many women experience breast pain. Breast pain maybe related to hormonal changes for
example, it may occur during or just before menstrual period (as part of the premenstrual
syndrome) or early in pregnancy. Women take oral contraceptive or who take hormone therapy
after menopause commonly have this kind of pain. The pain is due to growth of breast tissue.
Such pain is usually diffuse making the breast tender to touch. Pain related to menstrual period
may come and go for months or years. Other causes of breast pain include breast cysts, infections
and abscesses.

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Breast pain that persists for more than one month should be evaluated. Lumps in the breasts are
relatively common and are usually not cancerous, but because they may be cancerous, they
should be evaluated by a doctor without delay.
One or both nipples sometimes discharge a fluid. A nipple discharge occurs normally during
milk production (lactation). After child birth or as a result of mechanical stimulation of nipple by
fondling, suckling or irritation (Beer B mark fietcher, Adrew 2003).
Self breast examination helps in early detection of breast cancer.
1.1 PROBLEM STATEMENTS
In the world breast cancer causes 10,000 deaths annually. It is said that 1:17 female born will
develop breast cancer in their life time (Beer B Fietcher J Adrew 2003).
Self breast examination remains the most reliable method of detecting the signs of breast cancer.
Early detection and diagnosis remains the most important of obtaining a prime diagnosis in most
cancer patients.
However though many women notice a lump on the breast, they do not seek medical advice
because it is painless and they do not know its implication.
In Africa the rate of breast cancer is lower than the western countries. However women in Africa
presents at advanced stages hence high mortality rate.
1.2 PURPOSE OF THE STUDY
This is to assess the knowledge, attitude and practice on self breast examination among women
of child bearing age. Create awareness on development of cancer of the breast among women of

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child bearing age. Also address the importance of self breast examination since it helps in early
detection of breast cancer.
1.3 JUSTIFICATION FOR THE STUDY
Since breast cancer is a major health problem, which can occur to any woman, self breast
examination remains the most affordable and simple way of early detection of breast lumps.
Therefore the research will benefit the following.
1.3.1 CLIENT (COMMUNITY)
By assessing their knowledge, attitude and practice on self breast examination, more health
education will be provided to them on breast cancer. They will see the need to examine their
breast monthly to rule out or detect breast lumps early. They will also seek medical assistance
early before the cancer will invade other breast tissues. This will cost a lot and bring suffering to
the victim, family and community because when one member of the family is affected the whole
community is affected.
When large numbers of clients become aware of self breast examination, they will spread news
to their family members which will result to the whole community getting informed about the
benefits of self breast examination.
1.3.2 HEALTH WORKERS
The research on self breast examination will help the health worker as well because after
indentifying the knowledge, attitude and practice on self breast examination among their clients
they will know the effectiveness of their services and hence the need to work more towards
improving their services.

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1.3.3 NATION
When clients detect breast lumps and seek medical intervention before cancer cell invade other
breast tissue, the nation will benefit because the cost of treatment will be reduced. Treatment of
advanced cancer is very expensive.
The nation will also have healthy women hence a healthy working nation. This will reduce the
morbidity and mortality rate among women of child bearing age.
1.3.4 THE RESEARCHER
The researcher will develop skills, which will help in future researches. It will also act as a
partial fulfillment in award of Diploma in Environmental Health Science.
1.4 BROAD OBJECTIVE
To determine the knowledge, attitude and practice on self breast examination as related to breast
cancer among woman of child bearing age attending MCH/FP clinic in Mandera General
Hospital.
1.5 SPECIFIC OBJECTIVE
 To assess knowledge on self breast examination in woman of child bearing age in Mandera
General Hospital.
 To determine the attitude toward self breast examination in woman of child bearing age.
 To assess the practice on self examination among woman of child bearing age attending
MCH/FP clinic in Mandera General Hospital.
 To establish the role played by health workers in self breast examination.
1.6 HYPOTHESIS
Clients attending MCH/FP clinic in Mandera General Hospital has deficient knowledge on self
breast examination.

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CHAPTER TWO
2.0 LITERATURE REVIEW
2.1 KNOWLEDGE ON SELF BREAST EXAMINATION IN WOMAN OF CHILD
BEARING AGE.
Breast cancer appears to be a disease of both developing and developed countries. Among
Turkish women breast cancer is the second leading cause of cancer related deaths.
A study carried out among Turkish women revealed that they used self breast examination as a
tool for early detection of breast cancer.
Level of breast cancer knowledge was the only variable significantly associated with the self
breast examination (Parkin DM 2005).
2.2 ATTITUDE TOWARDS SELF BREAST EXAMINATION IN WOMEN OF CHILD
BEARING AGE.
Many women believe that the size and shape of the breast determine their sexuality desirability
or lack of it. The breast also defines their acceptability as women in society eyes. The loss of a
breast therefore threatens the fundamental components of a woman’s identity cause that’s her
feminism, herself image and her measure of self as a person.
Accordingly women are often reluctant to do anything even if they detect a lump in their breast,
yet it has been recognized that one of the best means of obtaining an early diagnosis in breast
cancer is periodical self breast examination. (Smelter c Suzanne 2000)
2.3 PRACTICE OF SELF BREAST EXAMINATION
It is estimated that only 25% to 35% of women perform self breast examination proficiently each
month. Some find breast examinations to be exciting, others find it too difficult to differentiate

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between normal changes and worrisome findings. Younger women may find self breast
examination particularly difficult because of the density of their tissue.
Even women who perform self breast examination and detect a change may delay to seek
medical attention because of fear, economic factors, lack of education and modesty (Brunner
Suddaths 2007).
Cancer of the breast can be detected early through self breast examination, doing it regularly will
help a woman learn what is normal for her breast and she will be able to notice changes.
Self breast examination should be performed at least once in a month and at the same time even
after menopause. If the breast has to be removed self breast examination should be done on the
site of the surgery.
Self breast examination does not involve many parties and no cost is involved.
2.4 STEPS IN PERFORMING SELF BREAST EXAMINATION
STEP 1
INSPECTION
The client should stand in front of a mirror and check both breasts for discharge from the nipple
dimpling and discolored area of the skin.
STEP 2
The client raises her hand over the head and observes changes in the contour of the breast.

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STEP 3
The client puts her hand on her hips, press against her hips which tightens the muscles
underneath the breast. She observes again for dimples again for dimples or flattered places which
look different between the two breasts.
The client observes for any ulcers, rashes or discharge. Observes if one nipple is inverted and the
other one is not.
For step 1-3 the client observes herself in front of a mirror.
2.5 PALPATION
The breast is divided into 4 quadrants with the tail extending into the axilla. (Under arm)
PALPATION Figure 1
Raise
the left
arm, using three or four fingers of the right hand, palpate the breast thoroughly with the flat part
of the fingers in small circles around the breast. Begin at the outer edge and gradually move in
towards the nipple. Press gently but firmly feeling for any unusual lump or mass under the skin,
be sure to check the whole breast. Also carefully probe the area between the breast and the arm
(including the under arm for lump) squeeze the left nipple gently and look for any discharge.

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Repeat palpation on the other breast using the left hand. A woman should repeat this procedure
at the same time each month. She should report anything abnormal or uncertain about her breast
to the doctor for further investigation diagnosis and early treatment in case of any need.
2.6 ROLE PLAYED BY HEALTH WORKERS IN SELF BREAST EXAMINATION
The nurse plays an important role in breast examination (BSE) education, a modality used for
early detection of breast cancer.
BSE can in a variety of setting either on a one basis or in a group. It can also be initiated by a
health care practioner during a patient’s routine physical examination.
Variations in breast tissue occur during the menstrual cycle, pregnancy and the onset of
menopause. Women on hormone therapy can also experience fluctuations. Normal changes must
be distinguished from those that may signal disease. Most women notice increase tenderness and
lumpiness before their menstrual periods; therefore, BSE is the best performed after menses
(Brunner Suddaths 2007).
A study carried out among Turkish women reported that they had acquired information on BSE
from health professionals (Parkin DM 2005).

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CHAPTER 3
3.0 METHODOLOGY
3.1 STUDY AREA
Mandera County General Hospital was the study area. It is located in Mandera location,
Municipality Division, Mandera Central District in North Eastern Province. It is one kilometer
from Mandera Town Centre. It is one of the major hospitals from Mandera Districts.
Also acts as a referral Hospital for the neighboring Districts.
The hospital has an outpatient department in which there is casualty department, consultation
rooms and maternal child. Health clinic whereby integrated services are carried out. These
services include immunization as per Kepi schedule, family planning, antenatal care which
includes prevention of mother to child transmission of HIV. Post natal care p is also done.
3.2 STUDY DESIGN
Descriptive study was used to determine knowledge, attitude and practice of self-breast
examination among women of child bearing age.
3.3 DEFINATION OF VARIABLES
Dependent variables – breast examination
Independent variables – knowledge, practice and attitude.
3.4 INCLUTION AND EXECUTION CRITERIA
INCLUSION CRITERIA – women of child bearing between 15-49 years
EXECUION CRITERIA - clients aged below 15 years and above 49 years.

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STUDY POPULATION
The study populations were women of child bearing age 15-49 years
3.5 SAMPLE SIZE DETERMINATION
Maternal child health records and family planning had a total of 822 clients who had been seen at
the clinic for the last three months.
To determine sample size 10% of the study population will take i.e.
10/100 x 822
=82.2
82 clients
3.6 SAMPLING METHOD
Systematic sampling method was used whereby the first 20 clients were picked every day and
were interview.
3.7 TECHNIQUE METHOD OF DATA COLLECTION
The method of data collection was by interviewing clients attending MCH/FP clinic.
3.8 DATA COLLECTION INSTRUMENT
The instrument/tool for data collection was an interview schedule which consisted of 4 sections.
Demographic data, knowledge, practice and attitude.
3.9 ETHICAL CONSIDERATIONS
Permission to collect data was obtained from Mandera Further permission to collect data was
obtained from nursing officer in charge MCH/FP clinic Mandera
Hospital.

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3.10 STUDY LIMITATIONS
Time to collect data was too short. Harsh weather condition data was collected during winter
season.
Lack of enough resources in terms of money to train more people to collect data making data
collecting difficult.
3.11 DATA ANALYSIS AND PRESENTATION
The interview schedules were checked for errors and corrected.
The data was manually analyzed and findings were presented in tables, bar charts histograms and
percentages.