A Systematic Review of Barriers to Breast Cancer Care in Developing Countries Resulting in Delayed Patient Presentation

Table 3

Critical appraisal of included studies.

Author	Country (𝑛)	Design	Factors relating to patient delay		Selection bias	Measurement bias	Confounding potential	Internal validity	External validity
Abdel-Fattah et al.[15]	Egypt; 𝑛=565	Cross-sectional	Failure to practice BSE		Good	Fair	Fair	Fair	Fair
Ali et al.[16]	India; 𝑛=522	Cross-sectional	Lower education level; Lower income status	Unmarried, widowed, or divorced	Good	Fair	Good	Good	Good
Aziz et al.[9]	Pakistan; 𝑛=286	Cross-sectional	Lower annual income		Fair	Fair	Poor	Poor	Poor
Clegg-Lamptey et al.[17]	Ghana; 𝑛=66	Case series	Financial incapability; Fear of mastectomy; Herbal treatment	Prayer; Ignorance	Poor	Fair	Poor	Poor	Poor
Ezeome [11]	Nigeria; 𝑛=164	Cross-sectional	Alternative practitioner use		Good	Fair	Poor	Fair	Fair
			Prayer house use
Harirchi et al.[13]	Iran; 𝑛=200	Cross-sectional	Lesser access to physicians; Negative family history; Ignorance of symptoms; Lower level of education; Rural residence	Older age; Married; Lower economic status; Less importance attributed to BSE	Good	Fair	Poor	Fair	Fair
Landolsi et al.[18]	Tunisia; 𝑛=160	Cross-sectional	Nonattribution of symptoms to cancer	Lack of BSE use	Good	Fair	Poor	Fair	Fair
Malik et al.[10]	Pakistan; 𝑛=103	Cross-sectional	Rural residency; Reluctance to see doctors	Poverty	Fair	Fair	Poor	Poor	Fair
Montazeri et al.[14]	Iran; 𝑛=190	Cross-sectional	Widowed/divorced; Lower education level	Positive family history	Good	Fair	Good	Good	Fair
Norsa’adah et al.[19]	Malaysia; 𝑛=328	Cross-sectional	Use of alternative therapy; Initial symptom: breast ulcer; Ignorance of symptoms as breast cancer	Fear of treatment; Presence of palpable axillary lymph nodes	Good	Poor	Good	Fair	Good
Piñeros et al.[20]	Colombia; 𝑛=903	Cross-sectional	Poorer housing conditions; Lack of pain as symptom; Ignorance of symptoms as breast cancer	Older age; Lower education level; Lack of affiliation with health system	Good	Fair	Poor	Fair	Good
Thongsuksai et al.[21]	Thailand; 𝑛=94	Cross-sectional	Unmarried		Fair	Fair	Good	Fair	Fair
Ukwenya et al.[12]	Nigeria; 𝑛=99	Case series	Alternative treatment use; Ignorance of symptoms as breast cancer; Fear of mastectomy	High cost of treatment; Family refused hospital treatment	Fair	Fair	Poor	Poor	Fair