Factors associated with breast cancer screening among insured and uninsured women in Tanzania: an analysis of the Tanzania demographic and health survey 2022.

backgroundGlobally, breast cancer is one of the most common cancers among women, especially in low- and middle-income countries (LMICs). The health insurance status in LMICs is approximately 31.1% as of 2023, indicating that out-of-pocket (OOP) payments are common in these countries. In Tanzania, women experience financial difficulties related to breast cancer, which can put both the women and their households at risk of catastrophic health expenditures. The co-payments of health insurance can improve access to health services. This study aimed to assess factors associated with breast cancer screening (BCS) among insured and uninsured women in Tanzania. METHODS AND TOOLS: This study conducted a cross-sectional secondary study using the 2022 Tanzanian Demographic Health Survey (TDHS) 2022 by employing a quantitative approach. The study included a total of 15,254 women from a survey conducted by the Tanzania National Bureau of Statistics (NBS). During the analysis, data were weighted using individual women's sample weights to account for the complex sampling design and non-response rate. The univariate, bivariate and multivariable logistic regression analysis models were used to determine the association between independent variables (health insurance and other socio-economic factors) and dependent variables (BCS status). All analyses were performed using Stata version 16, and svyset commands were applied in the multivariable logistic regression analysis to account for the complex survey design.

resultsAmong the total respondents, 15,254 were included in the study, a total of 15,188 women were asked if they were screened for breast cancer. Only 4.95% were screened for breast cancer. Health insurance coverage had a statistically significant association with BCS for both the crude (COR 4.39; p-value < 0.001) and adjusted model (OR 2.17; p-value < 0.001). This means that the insured women had four times higher odds of BCS than the uninsured women for the crude model and two times for the adjusted model. In addition, age, education level, current working status and those who visited the health facility at least 12 months were significantly associated with the BCS for both crude and adjusted models.

conclusionThis study emphasizes the significance of factors associated with BCS in Tanzania. These factors include being an active member of a health insurance scheme, socioeconomic status, and education. Therefore, policymakers, especially the Ministry of Health and the President’s Office-Regional Administration and Local Government, should integrate these factors into national strategies and guidelines to improve equitable access to BCS. Targeted interventions that address financial and socio-economic barriers will be essential for increasing screening coverage and reducing the burden of breast cancer among women in Tanzania.