Introduction
Prostate cancer is one of the domineering cancers among
other cancers such as the breast cancer, cervical cancer,
liver cancer, colorectal cancer, etc., which are currently
global health burden. Prostate cancer across the globe
is responsible for the global health burden of quite a
significant magnitude as can be observed in the trends
of the disease in different parts of the globe. From the
available data across the globe, the incidence of prostate
cancer is quite significant. In Eastern Europe, the
available data showed the incidence of prostate cancer
as 168/100,000 Persons" Year (PY), this is about 24.3-
52.8/100000 PY in Africa and in the Middle East, and
about 7.0/100000 PY in Asia. In North America, the incidence
of prostate cancer is about 141.0?106.7/100000
PY; this is about 186.7/100000 PY in Central and South
America.[-] While the trend and the impact of the
disease are felt across the globe,[,] the specific causative
factor(s) is yet to be empirically established warranting,
the need for proactive measures such as dictating
and management of the problem.
There is a remarkable differences in prostate cancer
mortality and morbidity rates across the globe showing
an evidence of inequality in the public health institutions
and infrastructures between the developing and
developed nations. Among the developed nations, the
morbidity rate is higher while the corresponding mortality
rate is lower, compared to the developing nations
where the morbidity rate is lower but the mortality rate
is higher.[-] Although comprehensive data are lacking
on the factors responsible for the disparity, some
studies have shown some evidence of lack of regular
prostate cancer check up among the population, poor
registry, poor public health institutions etc. in the developing
nations as possible factor.
Prostate cancer screening practices among the
developing nations have been connected to the public
perception of the disease as well as access to, and
familiarity with the public health system among the
population.[-] While socioeconomic conditions
have affected the extent of willingness and commitment
to regular prostate cancer check up and screening
mostly among the population in the lower quartile
of socioeconomic rating among the developing
nations, in other contexts, this has been connected to
ignorance of the disease as well as poor knowledge of
the necessary actions to prevent, dictate and manage
the problem.[,] As a matter of fact, some studies
showed that most people diagnosed with prostate
cancer in Nigeria come at the advanced stage of the problem, and majority of such people died shortly after
being diagnosed with the disease due to the complicated
stage before the diagnosis.[-]
Observation from Nigeria showed lower morbidity
and high mortality rates of prostate cancer among
men, which invariably showed the evidence of dearth
of screening register as well as willingness among the
population to go for prostate cancer screening.[-]
While few private and public health facilities are available
with relatively poor equipment and procedures
in the screening and management of prostate cancer,
much of the population are wallowing in the ignorance,
social stigma of the disease as well as the fear
of unaffordable nature of the procedures and treatment
among the public and private health facilities.[-]
Beyond the socioeconomic complexities and ignorance
of the disease, a study conducted by Kaninjing,
Lopez, Nguyen, Odedina and Young[] showed that
utilization of alternative medicine among the population
in the developing nations is affecting their perception
and management of prostate cancer. Owing to
poor public health system and infrastructures, the local
population are drifting towards the traditional healers
who are using alternative medicine to manage different
health issues. Practice and utilization of alternative
medicine operate in multiple dimension such as cultural
practices connected to health management, belief
about health issues embedded in the traditional understanding
of health matters as well as traditional healers
applying herbs and other fetish elements in controlling
health issues. In some cases, these practices appear to
be serving the needs and expectations of the patient
and the practitioners alike. However, a number of studies
have proved local alternative medicine counterproductive
as far as prostate cancer is concerned owing
to the fact that what appear as symptoms of prostate
cancer can be misconstrued.[,] In most of these
Contrary to the United Nations Sustainable Development
Goal-3 emphasizing comprehensive health and
wellbeing among the global population, the significant
proportion of Nigerian population (males-107million),
who are potentially at risk of prostate cancer are not
properly captured in the extant public health policies.
This is more complicated among the rural population
who are characterized by poor public health awareness,
socioeconomic status and lack of resources needed for
proactive measure for optimal healthcare. The rural
population are vulnerable to socioeconomic poverty
compared to their urban counterparts in Nigeria.
[,] This is evident in their access to health services,
education and other life supporting social amenities for sustainability. Prostate cancer is one of the health issues
men in rural southeast Nigeria. Southeast Nigeria
is one of the regions with high prevalence of prostate
cancer from the available information.[,] However,
there seems to be at the same time, the prevalence
of ignorance, social stigma and poor perception of
prostate cancer screening and maintenance among the
population, prompting the need for further empirical
investigation to understand the underlying factors to
these. Although other scholars have explored the issue
of prostate cancer among men from other dimensions,
the issue of awareness and regular screening for sustainable
men health in rural southeast Nigeria is lacking
in the available literature on prostate cancer and
public health. Against this backdrop, the present study
examined the prevalence of awareness about prostate
cancer and the extent of commitment to regular prostate
cancer screening exercise. This was guided by the
following research questions
i. What are the factors associated with awareness of
prostate cancer screening exercise among men in
rural southeast Nigeria?
ii. What are the factors associated with regular prostate
cancer screening exercise among men in rural
southeast Nigeria?
Methods
Study Period and Population
The study was carried out between July and September
2023 among the remote communities in southeast
Nigeria, involving men 30 years and above. Southeast
Nigeria is one of the six geopolitical zones of the federal
republic of Nigeria, which comprises five administrative
states of which each of the states comprised at least
three senatorial zones and 26 local councils. Each of
the local councils contains at least thirteen communities/
villages, making up a complex administrative and
population units. Categories of the health facilities followed
the federal, state and private owned health facilities
with cost implications according to the category of
ownership.
Population Sampling
The study applied survey design with focused on men
from 30 years and above who are living in the rural communities.
The study followed multistage, clustered and
simple random sampling techniques in the selection of
states, senatorial zones, local councils, local communities
and the respondents for the study. Three states from
the southeast geopolitical zone were randomly selected for the study, while six senatorial zones were randomly
selected from the three states. From the six senatorial
zones, 36 local councils were selected for the study following
clustered sampling techniques due to the nature
and locations of these councils and their implication to
the purpose of the study; 108 communities were selected
from the 36 local councils with the application of systematic
random sampling technique, while 1080 respondents
(10 men from each of the communities) were selected for
the study. The communities were also grouped into clusters
to capture the communities with rural characteristics.
After grouping the communities into clusters, the
study selected from the communities with rural characteristics.
The study selected wards and households following
the political delineation of electoral wards, which
captured small groupings of families and households
in the area. From each of the communities, five wards
were selected using simple random sampling while, ten
households were selected following 5th term in the order
of residential arrangements. From each of the households,
the study applied purposive sampling to select
individual men from the age of 30 years and above.
Instrument for Data Collection
Questionnaire instrument was utilized in collecting
data for the study; the questionnaire was designed to
include elements developed by other researchers and
substantive issues peculiar to southeast Nigerian population
such as literacy, awareness and familiarity with
the indicators of prostate cancer.
The questionnaire contained socio-demographic
indicators, knowledge, perception, attitude towards
prostate cancer and regular prostate cancer screening.
The elements of the questionnaire instrument followed
the indicators of awareness of prostate cancer the nature,
appearance and health implication of prostate
cancer among the potential victims (men), and regular
screening for prostate cancer captured on monthly,
quarterly, on six-months basis or even annually among
men whether they are prostate cancer patient or not.
Instrument Validation, Data collection Procedure
and Analysis
The instrument for data collection from the respondents
was reviewed by the University of Nigeria, Nsukka
faculty of the social sciences human research ethical
review board and was cleared after series of evaluations
showed the method and instrument for data collection
met the set ethical standards. 120 copies of the questionnaire
instrument were taken to the field for pilot
study aiming at understanding the familiarity with the instrument by the potential respondents. 112 copies
of the questionnaires (93.3%) were returned, properly
filled by the respondents. The overall consistency of the
questionnaire items according to Cronbach alpha value
is (0.89). During the main data collection, the questionnaire
instrument was giving to the respondents through
house-to-house visit by the research assistants who
were recruited for the study from the local communities
because of their familiarity with the terrain. The
data collected for the study were analysed using SPSS
version23 as well as descriptive and inferential statistics
such as percentages, logistic and linear models.
Results
From the study, about five percent of the respondents
are in the age category of 30?35 years, about eight percent
of the respondents are between 36 and 40 years,
about eight percent are equally within the age range of
41 to 45 years, while 20.1% are within the age bracket
of 46 to 50 years. 14.4% are in the age bracket of 51 to
55 years, 20% are in the age category of 56 to 60 years,
while 22.9% are in the age category of 61years and
above. 11.3% of the respondents are single, 57.2% are
married, 11.5% are divorced, while 20% of the respondents
are separated. About 25% of the respondents had
no formal education, 25.8% had only basic primary
education, 20% had secondary/high school education,
while 28.5% had tertiary education.
From the study, 34.3% of the respondents are farmers,
28.6% are traders, 22.8% are public servants, while
14.4% are artisans. Majority of the respondents (60%)
are Christians, about eight percent are in Islam, 22.9%
are African Traditional Religion adherents, while about
eight percent of the respondents are non religion adherents.
About 14% of the respondents are on monthly
income of at least, 10000NGN to 40000NGN, 31.5% are
on monthly income of 41000NGN to 66000NGN, 17.2%
of the respondents are on the income range of 77000?
92000NGN, about two percent are in the income range of
93000?110000NGN, while 32.4% of the respondents are
in the income range of 110000NGN and above. Among
the respondents, 74.3% have heard about prostate cancer,
while 25.7% indicated otherwise; equally, majority of
the respondents (61.2%) indicated the knowledge of the
symptoms of prostate cancer, while 38.8% of the respondents
indicated otherwise however, only 31.8% of the
respondents have heard about prostate cancer screening
practices, while only 11.4% indicated that they are involved
in regular prostate cancer screening.
The logistic regression on awareness of prostate
cancer is supported by the explanatory power of 54.5%
(Cox & Snell) and 80.2% (Nagel kerke) (Table 1).
From the regression, awareness about prostate cancer
is predicted by age of the respondents, marital status,
occupation, education, income and having seen someone
living with prostate cancer. Nevertheless, the positive
predictors, which are supportive to awareness of
prostate cancer, are the marital status of the respondents
and observing someone living with prostate cancer. These
two factors hinged on their information provision
values in the life of men at various ages. Majority of the
men who are involved in the study are married and this
points to the fact that through some networks of interactions,
men get to know about prostate cancer issues.
These networks of interactions included extended family
networks as it is obtainable in this part of the world,
extended relationships of colleagues in the network of
the wife and the likelihood of marrying someone with
extended network of medical knowledge. Equally, observing
someone with prostate cancer problem is a
powerful awareness picture and experience.
Table 1 Logistic regression on awareness about prostate cancer and other variables
Linear regression on the chances of going for regular
prostate cancer screening, a number of factors appeared
as predictors of regular prostate cancer screening
(Table 2). From the regression, factors such as the
age of the respondents, marital status, education, occupation,
source of prostate cancer awareness and seeing
someone living with prostate cancer all appeared to be
predictors of going for regular prostate cancer screening
among the respondents. However, according to
the dimensions of relationship, only age of the respondents,
educational level and source of prostate cancer
awareness appeared to be related with regular prostate
cancer screening practices positively.
Table 2 Coefficients of going for regular prostate cancer screening and other variables
Discussion
From the findings of the study, there are some pressing
issues pointing other complex relationship of variables;
about 74% of the respondents indicated that they are
aware of prostate cancer, while only about 11% have
participated in any type of cancer screening exercise.
This finding re-echoed the stigmatization and poor public
health aware issues associated with prostate cancer
awareness and screening as showcased by the findings
of other studies.[,] The relative awareness about
prostate cancer among the men has not translated into
proactive action against prostate cancer such as going for
prostate cancer screening on regular basis. For instance, more than 60% of the respondents are aware of the
symptoms of prostate cancer however, only about 30%
are aware of prostate cancer screening. Other studies in
Nigeria and elsewhere have given much attention to the
public knowledge and perception of prostate cancer confirming
the present finding.[,] This highlights the
issue of poor public health orientation among the rural
population, which is surfacing in different dimensions of
human health problems. Other studies on prostate cancer
and related public health issues have shown that the
possible gap between awareness and implementations
among the rural dwellers are connected with the quality
of the health practitioners available among the rural
communities especially in the developing nations.[,]
Age of the respondents according to the regression
test showed negative correlation with prostate cancer awareness. this by implication points to the possible
lack of opportunities of enlightenment on public
health issues in the early stage of their adulthood.
there is no positive correlation between educational
qualification and prostate cancer awareness, which in
any case, showed that the weakness of educational institutions
in public health awareness and orientation.
The situation here projects to the researching community,
the underlying impacts of isolated education
in relation to public health knowledge, which is obvious
in most developing nations, where education is
yet to broadly accommodate some specific knowledge
at various stages of education especially the basic elementary
and high school education. Meanwhile, the
finding supports the findings by other researchers
whose studies confirmed the inalienable role of education in the management of awareness and practices
towards prostate cancer.[,]
Occupation is another factor in the model with further
implication to the overall awareness and prostate
cancer screening practices. Apart from education as a
source of basic and allied knowledge for the members
of the society, career path is expected to generate opportunity
for public enlightenment on such critical
matters as public health as obtainable in some developed
nations,[-] however, there seems to be a lacuna
between the expected and the realities perhaps
for other extraneous variables not treated here. This
is equally the situation with the level of income and
awareness of prostate cancer among the men. Higher
income levels did not translate to awareness and of
prostate cancer and prostate cancer screening exercise.
The finding here further revealed that seeking for
quality healthcare of which involves prostate cancer
screening invariably, is dependent on the knowledge
and enlightenment about health and public health
matters order than socioeconomic class. Other studies
such as the ones by Enemugwem et al.[] and Ilic have
confirmed the contradiction between socioeconomic
status and willingness for prostate cancer screening
among men in the rural communities and the work
places. Meanwhile, two factors such as marital status
of the men and observing people with prostate cancer
showed positive correlation with prostate cancer
awareness. Awareness of prostate cancer among men
seems to be stronger among men with a partners possibly
because partners" exposure to health issues and
curiosity to protect their partners. This confirms the
study by Ogunsanya et al.,[] which revealed that
men who are married are more likely to be exposed to
health issues such as prostate cancer, than those who
have not married. Observing people living with prostate
cancer appeared to be powerful information to the
men living in the rural communities. This is because;
with a clinical confirmation of the presence of the disease
and the daily experience of the patients, every man
around has a clear message of the existence of prostate
cancer and its excruciating impacts.
Going for regular prostate cancer screening among
the men living in the rural communities in the southeast
Nigeria is dependent on a number of factors. Age is
one of the factors affecting or determining the willingness
to go for prostate cancer screening among the men.
This relationship is showing age of the respondents as
a contributing factor to their going for regular prostate
cancer screening. The finding here supported the findings
by Kohestani, Chilov and Carlsson[] and Catalona[] who discovered the role of age in prompting
people to seek for medical attention among the developing
nations. Due to the unattractive nature of health
facilities in the rural communities, seeking for medical
attention seems to be secondary matter in the scale of
preference of in the population in the rural communities.
For instance, even though marital status is a contributing
factor to awareness about prostate cancer, it
is negatively correlated with prostate cancer screening
practices among the men. This can be explained by the
socioeconomic atmosphere around the men.
Education and occupation of the respondents
showed positive correlation with regular prostate
cancer screening practices. This can be explained by
other factors such as exposure and conviction and
the existence and impact of prostate cancer. When
an individual has opportunity to learn the realities
of certain phenomenon, it usually trigger the person
to take action according to the Health Belief Model,[,] equally, weighing the two options of using
the available resources to confront the situation and
allowing the situation to escalate, the individual usually
prevent the undesirable by taking the first option.[-] This is further explained by the source
of prostate cancer awareness among the population,
which in the model showed positive correlation with
regular prostate cancer screening practices. Seeing
someone living with prostate cancer can be a trigger
to regular prostate cancer screening practices possibly
because of fear and belief.
Conclusion
Prostate cancer issue among the developing nations
is yet to be properly addressed especially among the
rural population. This hinges on the challenges of the
commitment of the rural population in taking responsibility
in the clinical and behavioural dimensions of
the issue. Although the level of awareness among the
surveyed population appeared to be high, the corresponding
commitment to regular screening exercise
among the population is far lower showing the presence
of other extraneous factors. The present study
has revealed the challenges as they are obtainable in
the area and by implication, calls for policy intervention
in the areas of public awareness and access to
healthcare facilities among the rural population. This
is in connection with the socioeconomic factors as indicators
of poor willingness to go for regular prostate
cancer screening among the population.
Ethics Committee Approval: The study was approved by
the Faculty of the Social Sciences University of Nigeria Ethics
Committee (no: ORD/FSS/UNN/23/061, date: 28/08/2023).
Authorship contributions: Concept - E.I.; Design - S.O.;
Supervision - E.I.; Materials - O.O.; Data collection and/or
processing - E.I.; Data analysis and/or interpretation - M.O.,
A.O.; Literature search - R.O., I.A.; Writing - O.O.; Critical
review - S.O.
Conflict of Interest: All authors declared no conflict of interest.
Use of AI for Writing Assistance: We did not use assistance
of AI.
Financial Support: None declared.
Peer-review: Externally peer-reviewed.
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