Social determinants of early screening for prostate cancer: a study of Nairobi county, Kenya

Abstract

Prostate cancer (PCa) is a major global public health concern, and is the second leading cause of death after lung cancer among men worldwide. The government of Kenya has put in place measures to increase uptake of PCa screening services. However, the uptake remains low, even in the study area, which has resources to conduct PCa screening. This study sought to investigate the social determinants of PCa early screening in Nairobi County. It specifically aimed to determine the knowledge on PCa screening; examine the attitudes on PCa screening; and establish the influence of socio-demographic factors on PCa screening among men. The study was conducted in Nairobi County, Kenya, and was guided by Gelberg-Andersen’s Behavioural Model for Vulnerable Populations. The study adopted mixed method approach and a cross-sectional survey design. A semi structured questionnaire, interviews, and focus group discussions were used for data collection. The population of males aged 35 – 50 years was 440,497 from which a sample of 384 were selected as the main respondents using Fischer et al (1998) formula, and arrived at using the multi-stage sampling procedures. Data from main respondents was complemented by information from 15 Key Informants who were purposively selected based on their bird’s eye view of the research problem. Quantitative data was analyzed using the statistics package for social sciences, and presented in tables and charts. Qualitative data was analyzed thematically, and presented in narrative form. All ethical principles were observed. The study found that knowledge on specific aspects of PCa was generally low. Most of the respondents were unfamiliar with PCa early symptoms, as well as prevention strategies. The study attributes the low levels of knowledge to the fact that social media, which has been found to be distortional, was one of the key sources of information on PCa. The study further established that most of the respondents (95.93%) had not been screened for PCa. Reasons for not screening included: lack of symptoms and thus no need for screening (72.8%), cost of screening (62.6%), fear of cancer (53.3%) and no family history (53.1%). Level of education had no positive association with screening, whereas religious affiliation and marital status had weak association. On the other hand, occupation had a strong and positive association with uptake of PCa screening. The study established there was low uptake of screening due to low knowledge levels, negative perception towards cancer disease and cost of screening services. The study recommend that the Ministry of Health should set a day for PCa to sensitize men on PCa. It also recommends the Ministry of Health to develop policies that make it mandatory for patients to go through treatment literacies before any services. The Ministry of Health to Ministry of Health to develop a policy to allow for waiver on medical covers.