Prevalence and multilevel factors associated with clinical breast examination uptake among women in sub-Saharan Africa: a systematic review and meta-analysis.

BACKGROUND: Clinical breast examination (CBE) is a feasible early-detection method in low-resource settings, but critical gaps remain regarding its uptake in sub-Saharan Africa. We estimated the prevalence of CBE uptake and synthesized multilevel factors associated with uptake, organized within a socio-ecological framework. METHODS: We conducted a PRISMA-guided systematic review and meta-analysis of cross-sectional studies assessing self-reported CBE uptake. PubMed, Embase, Web of Science, CINAHL, Africa-Wide Information, Google Scholar, and gray literature were searched. Random-effects meta-analysis was used to pool prevalence estimates and adjusted odds ratios for determinants. RESULTS: The pooled prevalence of CBE uptake was 13% (95% CI, 9-18%). Pooled determinant analyses showed that higher educational attainment, greater household wealth, health insurance coverage, and recent health-facility contact were associated with higher CBE uptake. Internet use, radio listening, and rural residence were not statistically significant in the pooled analysis. Additional non-pooled findings suggested that age, breast cancer awareness, breast self-examination, reproductive and maternal health-service contact, and empowerment-related factors are also associated with CBE uptake. CONCLUSION: CBE uptake in sub-Saharan Africa is low and socioecologically patterned, underscoring the need for integrated, equity-focused early detection strategies at the individual, community, and health-system levels.