|ORIGINAL RESEARCH REPORT
|Year : 2019 | Volume
| Issue : 2 | Page : 61-67
Awareness and practice of testicular self-examination among regular undergraduate male health sciences university students, Debre Tabor, Northwest Ethiopia
Biresaw Wassihun Alemu1, Shegaw Zeleke Baih2
1 Department of Midwifery, College of Health Sciences, Arba Minch University, Arba Minch, Ethiopia
2 Department of Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
|Date of Web Publication||20-May-2019|
Mr. Biresaw Wassihun Alemu
Department of Midwifery, College of Health Sciences, Arba Minch University, Arba Minch, Ethiopia
Source of Support: None, Conflict of Interest: None
Background: Testicular cancer (TC) is the most common cancer among 15–35-year-old males and the incidence is increasing. This form of cancer is easily diagnosable by testicular self-examination (TSE) and is 96% curable if detected early. Objective: To assess awareness and practice of testicular self-examination among regular undergraduate Male Health Sciences University students, Debre Tabor, North West Ethiopia. Patients and Methods: An institution-based cross-sectional study design was conducted. The study participants were stratified based on their year of study and selected by simple random sampling method. Pretested and structured self-administered questionnaire were used. The data were entered to EpiData version 3.1 statistical software and exported to Statistical Package for the Social Sciences version 22.0 for analysis. Both bivariate and multivariate logistic regression analysis were performed to identify associated factors. P <0.05 with 95% confidence level was used to declare statistical significance. Results: A total of 225 respondents were participated with a response rate of 97.3%. Of the respondents, 53% had poor knowledge toward TC and 78% had poor practice toward TSE. The major reason 64.0% for poor practice of TSEs was inability to carry out the examination. Students in clinical year were more knowledgeable toward TSE with adjusted odds ratio (AOR = 5.27 [95% confidence interval (CI); 2.04, 13.66]) as compared to preclinical year and students in clinical year had good practice toward TSE with (AOR = 2.71 [95% CI; 1.10, 6.68]) than preclinical year of study.
Conclusion: knowledge and practice of TSE among respondents were poor. The reason not to perform TSE, as revealed in the study was not caring the examination and lack of knowledge toward TSE. They are unaware of their risk for TC, which is the most common neoplasm in this age group. Providing regular health education toward TSE is important to improve the knowledge of.
Keywords: Awareness, Ethiopia, practice, students, testicular self-examination
|How to cite this article:|
Alemu BW, Baih SZ. Awareness and practice of testicular self-examination among regular undergraduate male health sciences university students, Debre Tabor, Northwest Ethiopia. J Clin Sci 2019;16:61-7
|How to cite this URL:|
Alemu BW, Baih SZ. Awareness and practice of testicular self-examination among regular undergraduate male health sciences university students, Debre Tabor, Northwest Ethiopia. J Clin Sci [serial online] 2019 [cited 2019 Jun 19];16:61-7. Available from: http://www.jcsjournal.org/text.asp?2019/16/2/61/258641
| Introduction|| |
Testicular self-examination (TSE) refers to the procedure, in which a man checks the appearance as well as the consistency of his testicles. It is an important clinical tool for early detection of testicular cancer (TC). Despite improved treatment modalities, TC still remains the third leading cause of cancer deaths among young men aged 18–50 years. The advent of chemotherapeutic agents and radiation therapy in cancer treatment seems to have prompted many professional health-care providers to focus on therapy and posttherapeutic management only, thereby losing sight of the usefulness and benefits of early detection. A recent study described that 89% of the risk group (adult men below age 35) had never performed TSE, and only 4% knew that men in the 18- to 50-year-old age group should perform TSE every month.
The most common cancers that can be detected by regular self-examination are breast cancer for women and TC for men. While breast self-examination is gaining much attention among women in the Sub-Saharan region, knowledge of TSE in men in the same region remains very poor. Although TC is far less prevalent than breast cancer, it is the most frequent cancer for men aged 18–50 in high-risk groups.
Worldwide, TC is increasing among 15–35-year-old males. The prevalence and incidence of TC in Sub-Saharan Africa being increased due to poor public knowledge and awareness about TSE. In Ethiopia, the TC case report accounts 5.4% among all new male cancer patients age >15 years. Hence, early diagnosis and treatment are very important. One of the ways for early detection of TC is regular TSE. The literature shows that the lesion is easily detected at an early stage through frequent self-examination and can be effectively managed. Early diagnosis is associated with a reduction in mortality, and in earlier stages of the disease, management is more likely to be associated with simpler and less toxic treatment. The American Cancer Society advises men to be aware of TC and to see a health professional right away if they find a lump in a testicle, especially in the time of puberty. Sociocultural norms and religious beliefs deter men from performing this lifesaving technique in most developing nations including Ethiopia. Risk factors for TC are undescended testicle, family history of TC, human immunodeficiency virus infection, carcinoma in situ of the testicle, history of TC, and race/ethnicity. The lack of health education provided in this area by health-care workers is thought to contribute to delays in diagnosis. Unfamiliarity with the practice of TSE in this part of the world is attributable to professional health-care providers' lack of attention and activity toward providing TSE education to their patients. Recommended preventive techniques to reduce TC mortality and morbidity include TSE and clinical testicular examination. However, clinical testicular examination requires hospital visit and expertise, whereas TSE is an inexpensive tool that can be carried out by men themselves. In Ethiopia, little is known about TSE, but in this study area, there was no information regarding TSE and its associated factors among University Students. Therefore, this study is amid to assess the level of awareness and practice of TSE among male university health sciences students.
| Patients and Methods|| |
The study was conducted at Debre Tabor University, Southwest Gondar, Amhara region, Northwest Ethiopia. Debre Tabor is the capital city of South Gondar Zone which is located 50 km East of Lake Tana, 100 km from the capital city of Amhara region, Bahir Dar, and 666 km from the capital city of Ethiopia, Addis Ababa. This historic town has a latitude and longitude of 11°51′ N 38°1′E with an elevation of 2706 m (8878 ft.) above sea level. Debre Tabor University has one main campus which consists of five faculties and one college with a total of 33 departments. The campus has a total of 10,324 regular undergraduate students of these, 483 are male health sciences students.
Study design and period
The institution-based cross-sectional study design was conducted between March and May 2017.
All Health Sciences regular undergraduate male students in Debre Tabor University who were enrolled during data collection time were included in the study.
Students who were seriously ill and unable to communicate during data collection time were excluded from the study.
Sample size determination
The single population proportion formula was used to calculate the sample size by considering proportion of knowledge, attitude, and practice of TSE was 50%. Since the source population was below 10,000, reduction formula was used. Adding nonresponse rate of 5% and considering the assumption of a 95% confidence level, a 5% margin of error, the final sample size required was 225.
Students in each department were stratified based on their year of study as preclinical year (2nd and 3rd year) and clinical year (4th and above year) by assuming that their duration of stay in the campus affects their awareness and practice of TSE. Finally, proportional numbers of participants (students) were selected with their identification number by computer-generating simple random sampling techniques.
Data collection tools
Data were collected by self-administered structured questionnaire which was adapted from literature.,,,,,, The questionnaire was prepared in English language and then translated to the national language Amharic with second person and then it was also back translated to original language English with the third person to see its consistency. The questionnaire contains three sections:first, to assess sociodemographic characteristics of the respondents; second, to assess awareness of the respondents on TSE; and third, to assess practice-related questions toward TSE of students.
Data processing and analysis
The collected data were checked visually by the investigators, The data were entered with Epi data version 3.1 (EpiData Association, Odense, Denmark) statistical software and exported to SPSS version 22.0 (Armonk, NY: IBM Corp) for analysis. Descriptive statistical analyses such as simple frequencies, measures of central tendency, and measures of variability were used to describe the characteristics of participants. Then, the information was presented using frequencies, summary measures, tables, and figures. Initially, bivariate logistic regression was carried out to see the association of each of the independent variables with the outcome variable. Thereafter, the multivariable logistic regression method was used. The variables that were not significant in the bivariate logistic regression were not considered in the multiple regression analysis. P <0.05 and 95% confidence level were used as a difference of statistical significance.
Data quality control
After pretesting the questionnaire, Cronbach's Alpha was calculated using SPSS window version 22.0 to test internal consistency (reliability) of the item and Cronbach's Alpha >0.7 was considered as reliable. On the top of this, content validity was cross checked by another oncologist expert at Arba Minch and Addis Ababa University. Data collectors and supervisors were trained for 2 days on the study instrument and data collection procedure. The principal investigator and the supervisors checked the collected data for completeness and corrective measures were taken accordingly.
- Good knowledge: Those students/respondents who scored equal and above mean score of the knowledge questions
- Poor knowledge: Those students/respondents who scored below mean score of the knowledge questions
- Good practice: Those students/respondents who scored equal and above mean score of the practice questions
- Poor practice: Those students/respondents who scored below mean score of the practice questions.
Ethics approval and consent to participate
The study protocol was ethically approved by the Ethical Review Board (IRB) of Addis Ababa University College of Health Sciences, School of Allied Health Sciences, Department of Nursing and Midwifery. Official letter was written to Debre Tabor University College of Health Sciences. The study posed a low or not more than a minimal risk to the study participants. Furthermore, the study did not involve any invasive procedures. Accordingly, after the objective of the study was explained, verbal informed consent was obtained from all participants over the age of 16 years. In addition to this, verbal consent was obtained from a parent on behalf of the participants under the age of 16. Moreover, the confidentiality of information was guaranteed using code numbers rather than personal identifiers and by keeping the data locked.
| Results|| |
Sociodemographic characteristics of the study participants
In this study, a total of 225 study participants were participated with the response rate of 219 (97.3%). The mean age (standard deviation [SD]±) was 23.1 (SD ± 3.0) years with a range of 18–36 years. About 150 (68.5%) participants were in the age group of 20–24 years. Majority (186 ([84.9%]) were orthodox religion followers and 178 (81.3%) were Amhara by ethnicity [Table 1].
|Table 1: Sociodemographic characteristics of respondents among Debre Tabor University Health Sciences undergraduate regular students, Northwest Ethiopia, 2017 (n=219)|
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Knowledge of respondents on testicular self-examination
Of the total respondents who were participated in the study, only 71 (32.4%) have ever heard about TSE. From those students who heard about TSE. The main sources of information were teachers for 29 (40.8%) [Table 2].
|Table 2: Knowledge of respondents on testicular self-examination among Debre Tabor University Health Sciences undergraduate regular students, Northwest Ethiopia, 2017 (n=219)|
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Practice of respondents toward testicular self-examination
From respondents who were participated in the study, only 47 (21.5%) were ever examined their testis and from those students who were ever examined only 6 (12.8%) were performed regularly [Table 3].
|Table 3: Practice of testicular self-examination among Debre Tabor University Health Sciences undergraduate regular students, Northwest Ethiopia, 2017 (n=219)|
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Multiple logistic regression analysis
The result of multiple logistic regression analysis showed that, students who are in clinical year of study were five times more knowledgeable than preclinical students, (adjusted odds ratio [AOR] =5.27 [95% confidence interval (CI); 2.04, 13.67]). Similarly, students with a history of TC 5.7 times and who had self-efficacy 2.7 times had good knowledge than who had no history of TC and self-efficacy, (AOR = 5.72 [95% CI; 1.14,28.64]) and (AOR = 2.71 [95% CI; 1.41,5.19],) respectively [Table 4]. Similarly, students who were in clinical year of study had good practice for TSE compared to preclinical year of students (AOR = 2.71 [95% CI; 1.10, 6.68]) [Table 5].
|Table 4: Logistic regression model for knowledge of students toward testicular self-examination with determinant factors among the Debre Tabor University Health Sciences undergraduate regular students, Northwest Ethiopia, 2017 (n=219)|
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|Table 5: Logistic regression model for practice of students toward testicular self-examination with determinant factors among the Debre Tabor University Health Sciences undergraduate regular students, Northwest Ethiopia, 2017|
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| Discussion|| |
These studies suggest that most respondents had never heard of TC or TSE and had limited knowledge of common symptoms and had never practiced TSE. This study revealed that 32.4% of the respondents ever heard about TSE. This figure is higher than a study done at Turkey 5.9% and Nigeria 1.3%, respectively., This discrepancy might be due to sociodemographic factors and field of study. In this study, the overall knowledge level of respondent showed that 47.0% had good knowledge for TSE, this figure is comparable with research studied at Nigeria 52%. This finding is lower with comparable field of study conducted at Nigeria because 64% of medical students had good knowledge about TSE. This difference might be due to lack of information on importance of TSE. Only 28.8% of participants knew risk groups for TC. This finding is lower than research conducted at the USA, 68.5% of the study participants were aware of the age group at risk of TC. This discrepancy might be due to lower information dissemination about TSE, health promotion for early detection of TC is not much provoked, and the advantage of TSE for early detection of TC is insensible in our context. Above half of 56.3% of the participants did not know TC can be transmitted with hereditary. However, research has done at Nigeria revealed that 67.4% of the respondents said men who have blood relatives with TC are more prone to TC. This discrepancy showed that there is a lack of awareness regarding with risk factors for TC in our study. The finding revealed that 21.5% of the students have good performance of TSE. However, most of the participants had poor practice of TSE as a result of lack of knowledge of TSE. Even if regular monthly TSE is recommended for all risk groups 15–35 years of men but, there is a very low practice of TSE to the participants. Meanwhile, with similar field of study research conducted at Nigeria, 34.0% of the participants was performed regular TSE. This finding is also lower than researches which were conducted at Nigeria and Ireland were 45.9% and 59.0%, respectively., In this research, the main reason 64.0% not to perform TSE was not having TSE knowledge and not competent to perform TSE 19.2%. According to this research finding as students' year of study increased, their knowledge and practice of TSE were also increased by five times and two times, respectively. Again students who had self-efficacy were three times knowledgeable and two times good performance of TSE. This result is similar with research done at Duchy; students who had self-efficacy were 1.2 times more likely to have good practice and knowledge.
| Conclusion|| |
In low-resource country such as Ethiopia the knowledge deficits surrounding TC and TSE among young men remain at alarm levels, whereas TC remains the most common neoplasm in this age group. Irregular and inaccurate data make computing an accurate incidence and prevalence of TC impossible. Nurses and doctors are neither informing the population of this risk, nor are they teaching them the simple early detection technique for self-examination of the testes. Such teaching could be incorporated into routine outpatient and inpatient interactions with high-risk clients. Employing straightforward cognitive health education techniques might prove to be very effective among these vulnerable young men. Awareness of TSE would largely bridge the gap of global TC inequality, given that the most important tool for bridging this gap is initiating early detection of TC among the university students. This group of men will probably respond best to objective information that emphasizes the benefits of TSE, provides useful tips that help them keep up with regular TSE, and reinforces the importance of detecting TC at a preventable stage. The promotion of TSE is ultimately enhanced by a focus on these principles. We also recommend that the Ethiopian Federal Ministry of Health should consider to incorporating TSE as counseling parts in health institution and university.
The authors are grateful for the data collectors and study participants.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Albers P, Albrecht W, Algaba F, Bokemeyer C, Cohn-Cedermark G, Fizazi K, et al.
Guidelines on testicular cancer: 2015 update. Eur Urol 2015;68:1054-68.
Cronholm PF, Mao JJ, Nguyen GT, Paris RT. A dilemma in male engagement in preventive services: Adolescent males' knowledge and attitudes toward testicular cancer and testicular self-exam. Am J Mens Health 2009;3:134-40.
Gleason AM. Racial disparities in testicular cancer: Impact on health promotion. J Transcult Nurs 2006;17:58-64.
Mansbach JM, Forbes P, Peters C. Testicular torsion and risk factors for orchiectomy. Arch Pediatr Adolesc Med 2005;159:1167-71.
Agorye IJ, Beatrice O, Grace-Jane EA. Awareness and Practice of Testicular Self Examination among Male Medical Students of University Of Nigeria Enugu Campus South-East Nigeria. Journal of Nursing and Health Science 5. 2016;3:19-24.
Ugboma HA, Aburoma HL. Public awareness of testicular cancer and testicular self-examination in academic environments: A lost opportunity. Clinics (Sao Paulo) 2011;66:1125-8.
Gutema H, Debela Y, Walle B, Reba K, Wondiye H. Testicular self examination among Bahir Dar university students: Application of integrated behavioral model. BMC Cancer 2018;18:21.
Altinel B, Avci IA. The knowledge, beliefs and practises of university students on testicular cancer and testicular self-examination. TAF Prev Med Bull 2013;12:365-70.
Rudberg L, Nilsson S, Wikblad K, Carlsson M. Barriers identified by Swedish school nurses in giving information about testicular cancer and testicular self-examination to adolescent males. J Sch Nurs 2005;21:17-22.
Einhorn LH. Treatment of testicular cancer: A new and improved model. J Clin Oncol 1990;8:1777-81.
Huyghe E, Matsuda T, Thonneau P. Increasing incidence of testicular cancer worldwide: A review. J Urol 2003;170:5-11.
Allison RD, Tong X, Moorman AC, Ly KN, Rupp L, Xu F, et al
. Chronic Hepatitis Cohort Study (CHeCS) Investigators. Increased incidence of cancer and cancer-related mortality among persons with chronic hepatitis C infection, 2006–2010. Journal of hepatology 2015;63:822-8.
McClenahan C, Shevlin M, Adamson G, Bennett C, O'Neill B. Testicular self-examination: A test of the health belief model and the theory of planned behaviour. Health Educ Res 2007;22:272-84.
Özbaş A, Çavdar İ, Findik ÜY, Akyüz N. Inadequate knowledge levels of turkish male university students about testicular self-examination. Asian Pac J Cancer Prev 2011;12:919-22.
Pankhurst R. The History of Däbrä Tabor (Ethiopia). Bulletin of the School of Oriental and African Studies 1977;40:235-66.
McClenahan C, Shevlin M, Adamson G, Bennett C, O'neill B. Testicular self-examination: A test of the health belief model and the theory of planned behaviour. Health Education Research 2006;22:272-84.
Lechner L, Oenema A, de NJ. Testicular self-examination (TSE) among dutch young men aged 15-19: Determinants of the intention to practice TSE. Health Educ Res 2002;17:73-84.
Ugurlu Z, Akkuzu G, Karahan A, Beder A, Dogan N, Okdem S, et al.
Testicular cancer awareness and testicular self-examination among university students. Asian Pac J Cancer Prev 2011;12:695-8.
Peltzer K, Pengpid S. Knowledge, attitudes and practice of testicular self- examination among male university students from Bangladesh, Madagascar, Singapore, South Africa and Turkey. Asian Pac J Cancer Prev 2015;16:4741-3.
Lechner L, Oenema A, de Nooijer J. Testicular self-examination (TSE) among Dutch young men aged 15–19: Determinants of the intention to practice TSE. Health Education Research. 2002;17:73-84.
Vadaparampil ST, Moser RP, Loud J, Peters JA, Greene MH, Korde L, et al.
Factors associated with testicular self-examination among unaffected men from multiple-case testicular cancer families. Hered Cancer Clin Pract 2009;7:11.
Agorye IJ. Awareness and practice of testicular self examination among male medical students of university of Nigeria. IOSR J Nurs Health Sci 2016;5:19-24.
Agorye J. Awareness and practice of testicular self-examination among male students university of Nigeria enugu campus South-East Nigeria. IOSR J Nurs Health Sci 2016;5:19-24.
Lechner L, Oenema A, de Nooijer J. Testicular self-examination among dutchy men aged 15-50: Determinants of the intention to practice TSE. Health Educ Res 2012;17:925-8.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]