Empowering high school students to combat breast cancer in Nigeria: evaluating a school-based intervention.

BACKGROUND

Disproportionate breast cancer burdens and poor outcomes in LMICS fuel global inequalities. Targeting teenage high schoolers has been mooted as a viable solution to the poor awareness compounding this. A Harvard-endorsed initiative to achieve this, in what was a global first, is evaluated in this paper.

METHOD: A 12-month, pre-and-post-tests quasi-experimental study of three randomly-selected schools in Southeast Nigeria. Exposure to breast cancer awareness teachings with integrated engagement-enhancing measures was the intervention.

RESULTS

Compared to 81.3% at baseline, breast cancer awareness was unchanged after one month (OR-1.10; CI 0.96-1.26) but significantly rose to 92.1% at the 12-month mark (OR 0.37; CI 0.26-0.52). Knowledge of breast self-examination (BSE), used to assess behavioural change, increased steadily. Levels at the baseline were 62.0% and 85.0% lower than that at one (OR 0.38; CI 0.34-0.42) and 12 months (OR 0.15; CI 0.12-0.19), respectively. In general, non-specific breast cancer knowledge did not improve over 12 months, but specifics related to early symptoms and risk factors, did. While, over the 12 months, 'knowledge' of preventive behaviours was not consistently improved relative to baseline, its actual 'practice' increased at both the one (+ 13.5%) and twelve (+ 17.3%) month marks, even though it's correct timing only improved after 12 months (+ 6.9%; p =  < 0.01) and not at one month (+ 0.8%; p = 0.17). Prolonged intervention (at 12 months) allowed males to match females on a few knowledge parameters.

CONCLUSION

Targeting high schools with breast awareness interventions that have engagement-enhancement measures appears impactful. Such outcomes may hold the key to stemming the inequalities in LMICs.