Impact of an educational intervention on breast cancer knowledge in western Kenya.

Our objective was to assess the effectiveness of educational sessions that accompanied breast cancer screening events in three communities in western Kenya between October and November 2013. Five hundred and thirty-two women were recruited to complete a test of breast cancer-relevant knowledge and randomly allocated to 'pre-test' or 'post-test' groups that immediately preceded or followed participation in the educational sessions. The education was organized as a presentation by health professionals and focused mainly on causes of breast cancer, early and late cancer presentation signs, high-risk groups, screening methods to find early-stage breast cancer, self-breast exam procedures and treatment options for this disease. Participants were invited to ask questions and practice finding nodules in silicone breast models. The median age was 35 years (interquartile range: 28-45), and 86% had not undergone breast cancer screening previously. Many individual items in our test of knowledge showed statistically significant shifts to better-informed responses. When all items in the assessment questionnaire were scored as a 'test', on average there was a 2.80 point (95% CI: 2.38, 3.22) significant improvement in knowledge about breast cancer after the educational session. Our study provides evidence for the effectiveness of an educational strategy carefully tailored for women in these communities in Kenya.

Bacillary angiomatosis masquerading as Kaposi's sarcoma in East Africa.

BACKGROUND: Bacillary angiomatosis (BA) is a rare manifestation of infection caused by Bartonella species, which leads to vasoproliferative lesions of skin and other organs. Bacillary angiomatosis affects individuals with advanced HIV disease or other immunocompromised individuals. In sub-Saharan Africa, despite the high prevalence of HIV infection and documentation of the causative Bartonella species in humans, mammalian hosts, and arthropod vectors, BA has only rarely been described. METHODS: Three adult patients from Uganda and Kenya with deep purple dome-shaped papules or nodules of the skin underwent punch biopsies for histopathologic diagnosis. The biopsies of all 3 patients were sent to a local pathologist as well as to a dermatopathologist at the University of California, San Francisco. RESULTS: All 3 patients were clinically suspected to have Kaposi's sarcoma (KS), and local pathologists had interpreted the lesions as KS in 2 of the cases and nonspecific inflammation in the third. Histologic examination by dermatopathologists in the United States revealed nodular dermal proliferations of irregular capillaries lined by spindled to epithelioid endothelial cells. The surrounding stroma contained a mixed inflammatory infiltrate with lymphocytes, eosinophils, and neutrophils. Extracellular deposits of pale amphophilic granular material were noted in the surrounding stroma. A Warthin-Starry stain highlighted clumps of bacilli, confirming the diagnosis of BA. CONCLUSIONS: These 3 cases, to our knowledge, are the first reports of BA in East Africa in the biomedical literature. Each had been originally incorrectly diagnosed as KS. We speculate BA is underdiagnosed and underreported in resource-poor regions, such as sub-Saharan Africa, that have high endemic rates of HIV infection.

BARRIERS TO UPTAKE OF BREAST CANCER SCREENING IN KENYA.

OBJECTIVES: To conduct clinical breast cancer screening in three sites in Western Kenya and explore community barriers to screening uptake. DESIGN: Cross-sectional study. SETTING: Western Kenya specifically, Mosoriot, Turbo, and Kapsokwony. SUBJECTS: Community members (18 years and older) who did not attend the screening events. OUTCOME MEASURE: The outcome measure was having heard about the breast cancer screening events. Both structured and open-ended questions were used for data collection. Item frequency, correlations, and content analyses were performed. RESULTS: A total of 733 community members were surveyed (63% women, median age 33 years, IQR = 26-43). More than half (55%) of respondents had heard about the screening but did not attend. The majority of those who had heard about this particular screening had knowledge of screening availability in general (45% vs. 25%, p < 0.001). Only 8.0% of those who heard and 6.0% of those who had not heard of the screening event had previously undergone clinical breast exam (p = 0.20). Reasons for not attending the screening event were personal factors, including busy schedule (41.0%), perceived low personal risk (12.7%), lack of transport (4.2%), as well as health facility factors such as poor publicity (14.4%) and long queues (8.7%). CONCLUSION: Barriers to breast cancer screening uptake were associated with inadequate publicity, perceived long waits at event and busy lives among community women.