**5. Discussions and conclusion**

*Public Health in Developing Countries - Challenges and Opportunities*

workshops/seminars [20, 25].

tion of the respondents for the IDIs.

**4. Methodology**

This revelation challenges social workers in the state and Nigeria as a whole to get more involved and work towards meaningful intervention strategies in relation to public health and breast cancer in particular given that both cancer victims and their families need a lot of social support and counseling for their coping with cancer. This involvement of social workers can come in the form of creating more awareness on both the occurrence of breast cancer and ways of managing and treating it when it does occur. This opinion gains more substance by the results from the study where 76.4% of the respondents stated that people's awareness of breast cancer and its prevention, care and management can be improved by social workers in the state through rural-based workshops/seminars, while 12.5 and 11.1% stated that the awareness needed can be created through regular counseling for women with breast cancer and in-service training for medical practitioners respectively; this can be explained by the fact that people are usually more responsive to things they are familiar with and, obviously, a lot of people are familiar with

The area of the study is Enugu State, a state that goes by such nicknames as "Wawa State", "Coal" and "Ọrānke Amaichekù" which is a mainland state in southeastern Nigeria, and the study focused on three LGAs drawn from the state. Hence, the study was carried out in Nsukka, Udi and Enugu north local government areas [26]. These areas are within the same axis and made for easier data collection. Furthermore, these areas have similarities in their traditions and attitudes towards diseases because traditionally they believe that certain serious diseases occur in individuals' lives as a result of evil deeds by the individuals or evil manipulations by the individuals' enemies. Enugu State has a population of 3, 267, and 837, and it was this population that formed the population of the study. The study sample was therefore drawn from the members of this population who are 18 years and above. Thirty respondents were selected for the in-depth interview (IDI) using the purposive sampling method, i.e. 10 respondents from each of the LGAs. The selection was guided by gender equity, age variation and different educational levels of the respondents in a bid to cover as much diversity as possible in the sample. In this case, the researcher used judgmental criteria in selecting respondents considered both knowledgeable in the subject of the study and also representative of the population. Thus, such factors as sex, age, and the need to spread respondents throughout the various quarters in each LGA were used in ensuring gender and socio-economic diversity or spread in the selec-

The in-depth interview guide/schedule addressed such issues as reproductive health of elderly women; awareness of breast cancer; dominant perception of the public health system and the management of breast cancer among elderly women; sociocultural factors impacting on perception of breast cancer among elderly women; societal perception of factors associated with breast cancer; services and agencies of breast cancer management, etc. They also provided probing questions aimed at generating more in-depth views or opinions and aided the researcher in maintaining focus during the interviews and in garnering deeper insights into people's perceptions of the concerns of the study. In addition, the non-verbal gestures and communications of the interviewees were also noted. These IDIs were conducted by the researcher with the help of a research assistant who acted as a recorder and note taker. The interviews were conducted in locations and at times chosen by the respondents, and the interviews were also recorded in order to explicitly capture both verbal and non-verbal responses. Finally, the analysis of the IDIs focused on

**196**

The goal of the study was to find out the dominant public perception of breast cancer among elderly women and the sociocultural factors that influence awareness, treatment and management of breast cancer using Enugu State which portends both urban and rural characteristics. Due to low socio-economic status, a good number of the women in this category are in this day and time still struggling to understand what the disease is all about and what exactly causes it. Low level of education/illiteracy served as a very strong negative influence in the awareness of the disease in the state, and in some cases, they argued based on their convictions that it is "mastitis" which is locally referred to as "eshi era" in areas like Nsukka as this only affects nursing mothers and implies a collection of breast milk even though it does not flow and inflict a lot of pain on the nursing mother. This however is handled by the intake of some local herbs and the bathing of the breasts with some concoctions to make the milk start flowing. In the case of breast cancer, the worry is that it affects everyone especially those who had exceeded the childbearing ages. It was also not surprising that they did not go for the regular medically advocated screening for breast cancer given that they do not even know what it means and what it is meant for.

Disheartening also was the discovery that most women died of breast cancers even after they had been detected because of their lack of access and use of the necessary health care needed for its treatment and management as a result of lack of funds and distance as they are often very far away from the places where these facilities can be accessed. Unfortunately, most public health centres that are easily accessible do not provide these women with the usual breast cancer screening and other related services needed for early detection. Even when they are eventually detected which are usually very late, financial constraints do not allow them to receive the necessary treatment to relieve their pains as the treatment is not subsidized by the government. Consequently, some of them refer to it as the *big man's disease* stating that when a poor person is affected by the disease, it simply means that her days are numbered. For a good number of the women, all they know about the disease is that it is a disease that affects the breasts and which can only be treated through surgery (i.e. the removal of the affected breasts). As a result of this poor knowledge about the disease, it was not surprising therefore that such terms as mammography, screening and staging were totally novel to them underlining the level of unawareness of breast cancer among women especially those from lower socio-economic status.

Social workers are, therefore, encouraged to help in the fight against breast cancer by creating awareness through seminars and workshops for women and the general public taking into consideration the educational level of the target audience. Consequently, posters, pictures and PowerPoint presentations should be used in getting the clear nature and symptoms of the disease across women as well as showing them the correct ways of carrying out the BSE, what mammography is all about and when to start seeking such services. Since there is an established distrust of public hospitals, government should also organize seminars focusing not only on women or the general public but also on the medical personnel especially those of them working in rural and semiurban-based public health centres in order to sensitize them to the kind of commitment needed in dealing with both cancer patients and their families bearing in mind that the disease poses a very serious challenge

not only to the affected persons but to their entire family. These seminars should also aim at educating the people on the right ways to live to prevent cancers and the right ways to live and manage them when they do occur. They should also be aimed at purging their minds of any misconceptions or stigmas they may have attached to the disease and those who are affected by it.

Finally, with regard to the theoretical framework, the study showed that the basic assumptions of the theories are true judging by the fact that those who believed they would be susceptible to breast cancer tried to live out a particular life pattern going in line with the Health Belief Model (HBM), while those who had little or no knowledge about the disease attributed it to charms or spells cast on individuals by other evil people in the society and had no idea how to deal with the disease or where to get help when affected by the disease going in line with the assertions of the Health Communication Theory (HCT).
