Background and context: Nigeria presently grapples with a high burden of all forms of cancers with breast cancer being the most common and most lethal with estimated 27,304 new cases and 13,960 deaths annually. Poor knowledge of breast cancer and the wrong perception about its treatment is pervasive among many Nigerian women particularly those in rural communities leading to late presentation and poor treatment outcomes. Community health workers (CHWs) are at the forefront of closing the knowledge gap and improving on attitude toward breast cancer and its treatment in these rural settings through provision of an effective cancer patient care and support. Against this backdrop, the University of Nigeria Teaching Hospital-Breast cancer support group (UNTH-BCSG) was established by a group of health professionals involved in caring for cancer patients in the eastern parts of the country. The consortium provides education and supports to breast cancer patients, training support to community health workers for early detection and prompt referral, carry out community outreach and education in both urban and rural communities, free cancer screening services to communities, as well as creating and supporting systems that effectively links cancer patients from the community level to the treatment centers. Aim: To implement a training program aimed at improving community health workers knowledge of and attitude toward breast cancer in selected rural communities in eastern Nigeria. Strategy/Tactics: A cross-sectional study design was used to select total of 521 health workers drawn across the 7 randomly selected local government areas in Enugu state, southeastern Nigeria. Respondents' level of knowledge and attitude toward breast cancer was assessed before and after the training. Data were collected using self-administered questionnaire, while data analysis was done with Statistical Package for Social Sciences (IBM-SPSS) version 20. Program/Policy process: Advocacy and campaign on breast cancer screening. Outcomes: Out of a total 521 CHWs with a mean age of 37.71 ± 8.789 years, majority of the workers were females (92.9%), married (74.1%) received formal trainings in community health education (67.3%). Prior to training, only 18.4% of respondents had ever screened for breast cancer, while 68.3% practice breast self-examination. T-test analysis showed that the mean knowledge score of breast cancer (6.86 ± 2.48), mean knowledge of risk of breast cancer (5.69 ± 3.15) and the mean attitude toward breast cancer score (5.98 ± 3.04), significantly improved with the training program to 7.56 ± 2.29, 10.62 ± 3.09, and 7.21 ± 2.69 respectively ( P < 0.01). What was learned: Community health worker still need more sustained training as they operate at the grass root of health care system. Every little assistance will be translated to reduced cancer morbidity and a lot of lives being saved through early detection.
The global role, impact, and limitations of Community Health Workers (CHWs) in breast cancer screening: a scoping review and recommendations to promote health equity for all
