Abstract
Penile cancer is a rare but preventable malignancy with disproportionately high burden in low- and middle-income countries. In Ghana, data on knowledge of penile cancer among university students, where health information dissemination can have a broader public health impact, are limited. This study assessed penile cancer awareness among university students in Ghana, focusing on knowledge of risk factors, symptoms, and prevention, and identifying misconceptions and perceived barriers to care. A descriptive cross-sectional study was conducted among 781 tertiary students at Kwame Nkrumah University of Science and Technology (KNUST) and Presbyterian University, Ghana (PUG) between April and July 2025. Data were collected using a web-based, self-administered questionnaire administered via Google Forms, and analyzed using Stata version 14, with a focus on descriptive analysis only. Results were summarized using descriptive statistics, including frequencies and percentages for categorical variables and means with standard deviations for continuous variables. Overall awareness of penile cancer was relatively high (613, 78.5%); however, detailed knowledge was limited. Only 299 (38.3%) of the respondents were aware of its causes, 371 (47.5%) recognized symptoms, and 282 (36.1%) knew prevention methods, while 625 (80.0%) reported never having received formal education on the topic. Human papillomavirus infection (508, 65.0%) and poor genital hygiene (471, 60.0%) were the most commonly identified risk factors. Misconceptions were widespread, and 365 (60.3%) of respondents perceived stigma as a barrier to seeking information or care, despite 689 (93.0%) expressing a desire for further education. Penile cancer awareness among tertiary students in Ghana remains suboptimal, with misconceptions and stigma posing barriers to timely care. Targeted, youth-friendly educational interventions within tertiary institutions are needed to improve knowledge, reduce stigma, and promote early presentation, thereby reducing the disease burden in Ghana and similar settings.
Background
Penile cancer, although relatively rare on a global scale, represents a serious but preventable malignancy affecting the male genitalia, most commonly manifesting as squamous cell carcinoma (SCC) (Cassell et al., 2020; Kamkari et al., 2025). In 2020, global data estimated approximately 36,068 new cases of penile cancer, with an age-standardized incidence rate of about 0.80 per 100,000 men and an age-standardized mortality rate of roughly 0.29 per 100,000 (Fu et al., 2022). Geographic differences are significant, with Latin America, parts of Asia, and sub-Saharan Africa showing much higher rates compared with high-income countries (Giona, 2022).
In sub-Saharan Africa, patients often seek medical care at later stages when the disease has already progressed significantly. A review of penile cancer management in these settings revealed that many men are diagnosed at a locally advanced or advanced stage, often resulting in limited treatment options, poor outcomes, and the frequent need for mutilating surgeries (Cassell et al., 2020). Despite established risk factors such as human papillomavirus (HPV) infection, inadequate genital hygiene, phimosis, smoking, and the absence of circumcision, public awareness of penile cancer remains insufficiently researched in many of these regions (Giona, 2022).
In Ghana, research on cancer awareness primarily concentrates on cancers affecting women, especially cervical cancer. Surveys indicate that awareness of HPV and vaccination is low, and screening rates are also limited among Ghanaian women, particularly in rural regions (Adzigbli et al., 2025), as well as among female health care providers (Avinu et al., 2023). Similar gaps have been identified in the awareness of HPV vaccination among boys in Ghana, where numerous respondents lacked knowledge of HPV in males and expressed concerns regarding side effects or cost before accepting vaccination (Appiah et al., 2023). There exists a limited body of published data regarding the awareness and understanding of penile cancer among male populations or university students. Cultural taboos surrounding male genital health often lead to a silent stigma (Saalim et al., 2023), which can suppress open conversations, hinder awareness, and delay seeking medical care.
Awareness, which involves recognizing and understanding a disease’s existence, risk factors, symptoms, and prevention, is an essential initial step for early diagnosis and improved outcomes. Research in various settings indicates that awareness of HPV-related cancers tends to be higher for cervical cancer than for penile cancer. For instance, a survey of U.S. college students revealed that approximately 70% recognized HPV as a cause of cervical cancer, whereas only around 38% knew that HPV is associated with penile cancer (Franca et al., 2023).
University students, being in a transitional phase marked by growing independence, exposure to sexual health information, and the development of lifelong habits, represent a key demographic for targeted interventions. The awareness and knowledge levels of university students can influence not only their personal health behaviors but also shape the attitudes of peers, family members, and the wider community. Since early detection is closely linked to improved outcomes in penile cancer (Cassell et al., 2020; Chalya et al., 2015; Yang et al., 2019), it is crucial to understand what students know, misunderstand, or lack information about. This knowledge is vital for developing effective health education programs and public health campaigns.
This study aims to assess penile cancer awareness among university students in Ghana, focusing on their knowledge of risk factors, symptoms, and prevention. It also seeks to identify misconceptions and barriers to care. The goal is to provide evidence to guide interventions that reduce late diagnoses, stigma, and the disease burden in Ghana and similar settings.
Material and Methods
Study Design and Setting
This investigation employed a descriptive cross-sectional design to assess university students’ awareness and knowledge of penile cancer in Ghana. The survey was conducted from April to July 2025 at two higher education institutions in the Ashanti region of Ghana: the Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, and the Presbyterian University, Ghana (PUG), Asante Akyem Agogo campus. The design enabled the collection of data on awareness, risk factors, symptoms, prevention strategies, and misconceptions about penile cancer at a single point in time.
Study Population
The study population consisted of undergraduate students enrolled at KNUST and PUG, aged 18 to 35 years. These individuals were deemed suitable respondents owing to their potential to benefit from enhanced health education and to disseminate health information within their communities.
Sampling Technique, Sample Size, and Data Collection Procedure
Respondents were recruited using convenience sampling. Eligible respondents were individuals who had access to the survey link and consented to participate. This approach was chosen due to its practicality and suitability for rapid data collection within the study context.
Data were collected through a web-based survey hosted on Google Forms. To minimize duplicate responses, the survey settings were configured to restrict submissions to one response per IP address. The survey link was disseminated through institutional social media platforms, including WhatsApp groups and established peer networks, to enhance reach and participation.
A structured, self-administered questionnaire was developed based on existing literature on cancer awareness and knowledge surveys among tertiary students (Kamkari et al., 2025; Moraes-Filho et al., 2018), and adapted to the specific context of penile cancer. To ensure content validity, four experts (a gynecology oncologist, a urologist, a pathologist, and a public health researcher) reviewed the initial draft. Their feedback informed revisions to improve clarity and refine item wording. The questionnaire was pretested with 10 undergraduate students at the PUG Okwahu campus, Abetifi. The pretest assessed item clarity, average completion time (about 15 min), and overall face validity. Based on participant feedback, a few modifications were made, including simplifying medical terminology related to penile cancer risk factors, adding additional response options for sources of information, and reordering sections to improve flow. Individuals who participated in the pretest were excluded from the final study sample, as all students from the Okwahu campus of PUG were excluded.
The final questionnaire comprised four sections: sociodemographic characteristics; general awareness of penile cancer; knowledge of penile cancer risk factors, symptoms, and prevention strategies; and misconceptions and barriers to accessing information about penile cancer. Knowledge variables were not scored. This approach was adopted because the study aimed to provide a descriptive assessment of awareness and knowledge patterns rather than to generate composite knowledge scores. In addition, the heterogeneity of items (risk factors, symptoms, and prevention strategies) and the absence of a previously validated scoring system for penile cancer knowledge in this population made the use of aggregate scoring less appropriate. Presenting item-level responses allows for clearer identification of specific knowledge gaps and misconceptions, thereby improving interpretability and public health relevance.
Respondents were recruited through departmental communication channels during academic activities. Participation was voluntary, and informed consent was implied by completing and submitting the online questionnaire. Responses were automatically captured and stored in a secure database, ready for cleaning and subsequent analysis. All respondents completed the online questionnaire, and there were no missing responses, as the survey was configured to require responses to all items before submission. Ethical approval to conduct the study on both campuses was obtained from PUG (approval letter dated February 20, 2025) and the KNUST Ethics Committee (reference number CHRPE/AP/247/25).
A total of 781 students participated in the study, comprising 327 (41.9%) students from KNUST and 454 (58.1%) from PUG, Asante Akyem Agogo campus. The sample size exceeded the minimum required sample size of 385, as calculated using Cochran’s formula (Cochran, 1977) with a finite population correction, thereby ensuring adequate representation for descriptive analysis.
Data Management and Analysis
Completed responses were automatically captured and securely stored in the Google Forms platform, then exported for analysis. Only fully completed questionnaires were included in the final dataset. Data were analyzed using Stata version 14. Descriptive statistics, including frequencies, percentages, means, and standard deviation, were used to summarize respondents’ demographic characteristics, awareness, and knowledge variables.
This study did not generate a composite knowledge score. Given the exploratory aim and the absence of a validated scoring framework for penile cancer awareness, responses were analyzed descriptively at the item level. This approach allowed for a more nuanced understanding of specific knowledge gaps across different domains (e.g., risk factors, symptoms, and prevention), avoiding potential bias and information loss associated with arbitrary scoring systems.
Results
Sociodemographic Characteristics of Respondents
A total of 781 respondents participated in the study. Most respondents were aged 21 to 24 years (485, 62.1%), followed by those aged 17 to 20 years (201, 25.7%). A smaller proportion, 95 respondents (12.2%), were aged 25 years or older (see Table 1). Most respondents were female (580, 74.3%), while a small proportion preferred not to disclose their gender (11, 1.4%).
Sociodemographic Characteristics of Respondents, Including Age, Gender, and Level of Study.
Percentages may not total exactly 100% due to rounding.
Nearly all respondents were single (743, 95.1%), while a few were married (29, 3.7%) or cohabiting (9, 1.2%). Respondents were drawn from two institutions, with slightly more than half from Presbyterian University, Ghana-Agogo campus (440, 56.3%) and the remainder from KNUST (341, 43.7%).
With respect to the program of study, the vast majority were enrolled in health-related programs (756, 96.8%). Almost half of the respondents were in their third year (380, 48.7%), followed by first-year students (193, 24.7%). Only a small proportion were postgraduate students (15, 1.9%) (Table 1).
General Awareness of Penile Cancer
Overall, respondents’ awareness of penile cancer was relatively high. A total of 613 respondents (78.5%) reported having heard of penile cancer, while 168 (168, 21.5%) had never heard of the condition. Schools were the most frequently cited single source of information (252, 32.3%), followed by the internet (68, 8.7%) and social media (52, 6.7%). Notably, a substantial proportion of respondents (318, 40.7%) reported receiving information from multiple sources, indicating diversified exposure to information on penile cancer (Table 2).
General Awareness of Penile Cancer Among Respondents, Including Prior Awareness, and Sources of Information.
Most respondents perceived penile cancer as a preventable disease, with 606 (77.6%) affirming its preventability. However, knowledge gaps were evident regarding specific aspects of the disease. Less than half of the respondents had heard about the causes of penile cancer (299, 38.3%) or its associated symptoms (371, 47.5%). Formal education on penile cancer appeared limited, as only 156 respondents (20%) reported having received a lecture on the condition.
The majority of respondents correctly identified penile cancer as a disease affecting only men (691, 88.5%). Despite this, awareness of preventive measures was relatively low, with only 282 respondents (36.1%) indicating awareness of prevention strategies. Encouragingly, nearly all respondents expressed interest in learning more about penile cancer, with about 689 (93.0%) indicating a desire for additional information (Table 2).
Knowledge on Penile Cancer, Including Treatment
The majority correctly identified penile cancer as a cancer affecting the penis (631, 80.8%), while smaller proportions misclassified it as a general penile infection (71, 9.1%) or a non-cancerous genital tumor (31, 4.0%); and about 48 (6%) were unsure. Knowledge of disease presentation was mixed: about 45.7% correctly indicated that penile cancer may be asymptomatic in its early stages, whereas 47.1% were uncertain (Table 3).
Knowledge of Penile Cancer Among Respondents, Including Definition, Symptoms, Perceptions, Treatment Awareness (Multiple-Response Items), Early Detection Beliefs, and Prevention Methods.
Multiple responses were allowed for items under “Treatment awareness (types of treatment)” and “Prevention methods”; therefore, percentages may exceed 100%.
More than half of the respondents perceived penile cancer to be similar to cervical cancer (464, 59.4%). However, opinions were divided on whether penile cancer can be detected earlier than cervical cancer, with 370 (47.4%) agreeing and 411 (52.6%) disagreeing. Respondents generally rated their symptom-related knowledge as inadequate, with the majority reporting poor (268, 34.3%) or fair (329, 42.1%) knowledge, while fewer than one-quarter (23.6%) rated their knowledge as good or excellent.
Regarding treatment awareness, about 474 (60.7%) were aware that penile cancer is treatable. Surgery (575, 73.6%), chemotherapy (540, 69.1%), and radiotherapy (447, 57.2%) were the most commonly identified treatment modalities. Very few respondents believed that vaccination could treat penile cancer (0.3%), while non-medical options such as herbal treatment (67, 8.6%) and prayer camps (28, 3.6%) were infrequently endorsed. Almost all respondents (751, 96.2%) believed that early detection improves outcomes.
Knowledge of preventive measures was uneven. Most respondents recognized regular medical check-ups (609, 78.0%), male circumcision (590, 75.5%), good genital hygiene (572, 73.2%), HPV vaccination (535, 68.5%), and condom use (64.4% rating it as very important) as relevant strategies. In contrast, fewer respondents recognized smoking cessation (341, 43.7%), avoidance of unprotected sex (155, 19.9%), and reduced red meat consumption (59, 7.6%) as relevant. Although nearly all respondents considered university-based awareness programs important (738, 94.5%), relatively few reported having been exposed to penile cancer education or awareness campaigns (150, 19.2%) (Table 3).
Respondents’ Knowledge of Penile Cancer Risk Factors and Symptoms
Respondents demonstrated varying levels of knowledge regarding the risk factors and symptoms associated with the condition. Awareness of infectious and hygiene-related risk factors was relatively high. The most commonly identified risk factors were human papillomavirus (HPV) infection (508, 65%) and poor genital hygiene (471, 60.0%). Nearly half of respondents recognized multiple sexual partners (388, 49.7%) and a previous sexually transmitted infection (380, 48.7%) as risk factors. Knowledge of behavioral and anatomical factors such as zoophilia (342, 43.8%), phimosis (315, 40.3%), and being an uncircumcised male (296, 37.9%) was moderate. In contrast, awareness of obesity (69, 8.8%), condom use (41, 5.3%), and lubricant use (217, 27.8%) as related factors was notably low (Figure 1).
Perceived risk factors of penile cancer among respondents (multiple-response question; percentages represent proportion of respondents selecting each option).
Regarding symptoms, respondents most frequently identified a painless lump or sore on the penis (507, 64.9%) and swelling or irritation of the glans (493, 63.1%). Dysuria was commonly recognized (476, 61.0%). Moderate proportions identified erectile dysfunction (376, 48.1%), skin changes (369, 47.3%), foul-smelling discharge (355, 45.5%), and penile rash (333, 42.6%) as symptoms. Infertility was the least recognized symptom, reported by 293 (37.5%) of the respondents (Figure 2).
Knowledge of symptoms of penile cancer among respondents (multiple-response question; percentages represent proportion of respondents selecting each option).
Misconceptions and Barriers to Information Access Regarding Penile Cancer
Respondents’ perceptions of misconceptions and barriers regarding penile cancer awareness and access to information are summarized in Table 4. Overall, responses revealed substantial uncertainty and mixed views across most statements, with a large proportion selecting neutral responses, alongside notable endorsement of several misconceptions and structural barriers.
Respondents’ Perceptions of Misconceptions and Barriers to Penile Cancer Information Access, Measured Using a 5-Point Likert-Type Scale (Strongly Disagree to Strongly Agree).
Note. SD = Strongly Disagree, D = Disagree, N = Neutral, A = Agree, SA = Strongly Agree. Each statement was assessed as a single-response Likert-type-scale item; therefore, percentages for each row sum to approximately 100%.
A considerable proportion of respondents disagreed that penile cancer only affects men older than 60 years (432, 55.3% combined SD/D), and 108 (13.9%) agreed with this misconception. Views on etiology were mixed: while 285 (36.5%) agreed that sexually transmitted infections cause penile cancer, one-third remained neutral (33.9%), reflecting uncertainty about established risk factors. Similarly, misconceptions surrounding circumcision were evident, as 262 (33.6%) believed circumcision eliminates the risk of penile cancer, despite 282 (36.2%) disagreeing with this statement. Poor hygiene was widely perceived as a cause of penile cancer, with almost half of respondents (365, 46.7%) agreeing or strongly agreeing, suggesting over-attribution to hygiene-related factors. In contrast, awareness-related barriers were more consistently acknowledged. More than half of respondents agreed that awareness of penile cancer is inadequate within health care settings (365, 58.3%) and that social stigma prevents men from seeking information (471, 60.3%). Structural and systemic barriers were also prominent. More than half of the respondents perceived that health care systems prioritize other cancers over penile cancer awareness (412, 52.7%). Difficulties accessing reliable online information were reported by 185 (27.5%), while cultural acceptability of educational campaigns generated mixed responses, with nearly half disagreeing and about one-quarter agreeing (Table 4).
Discussion
This study demonstrates high general awareness of penile cancer among university students, largely reflecting the predominantly young, single, and health-related student population sampled. Awareness levels were higher than those reported in community-based studies from sub-Saharan Africa, where penile cancer knowledge is often limited due to cultural silence around male genital health (Cassell et al., 2020; Lekoane et al., 2019; Morhason-Bello et al., 2013). The relatively high level of awareness of penile cancer observed in this study should be viewed in the context of the study population, which was heavily skewed toward students in health-related programs (756, 96.8%). This overrepresentation likely contributed to the elevated awareness, as students in biomedical and health sciences are more frequently exposed to formal education on cancer epidemiology, risk factors, and preventive health practices. This finding supports previous evidence that training in health-related disciplines improves knowledge and recognition of reproductive cancers (Alshafie et al., 2025). Furthermore, the choice of study sites, both of which mainly offer health-focused programs, further reinforces this sampling pattern. As a result, the findings may overestimate awareness levels compared with the general tertiary student population in Ghana, especially among students in non-health-related fields who may have less exposure to such information. In addition, the study sample was disproportionately female (approximately 75%), despite penile cancer being a male-specific condition. This gender imbalance may have influenced the study outcomes, as male students, the primary at-risk group, were underrepresented. The observed distribution may partly reflect broader trends in Ghana, where females constitute a significant proportion of students and professionals in the health sector, particularly in nursing and allied health fields. Despite high awareness, substantial gaps were observed in knowledge of causes, symptoms, and prevention, suggesting superficial familiarity rather than comprehensive understanding.
Notably, fewer respondents reported having received formal lectures on penile cancer, highlighting curricular gaps even within health-focused training. Similar deficiencies have been documented among medical and nursing students in low- and middle-income countries, where male genital cancers receive less emphasis compared with breast or cervical cancer (Keten et al., 2025; Makadzange et al., 2022). Limited awareness of etiology and prevention is particularly concerning, given the established roles of human papillomavirus (HPV) infection, poor genital hygiene, phimosis, and smoking in penile carcinogenesis (Morrison, 2014; Giona, 2022). This gap may hinder preventive efforts and timely health-seeking behavior (Kamkari et al., 2025).
The finding that most respondents recognized penile cancer as preventable but could not identify specific preventive measures points to missed public health opportunities. Evidence shows that male circumcision, HPV vaccination, and genital hygiene significantly reduce penile cancer risk (Larke et al., 2011; Giona, 2022). Despite the generally high awareness of penile cancer in this study, only 64% of the respondents correctly identified HPV as a causal factor. The overwhelming demand for more information on penile cancer indicates receptiveness to targeted education. Integrating male reproductive cancers into university curricula and leveraging digital and social media platforms (which are already prominent information sources) could deepen knowledge and promote preventive practices.
The findings suggest variable levels of knowledge across domains of penile cancer, with relatively higher awareness of certain established risk factors, particularly HPV infection and poor genital hygiene, as both are well-recognized contributors to penile carcinogenesis (Mannam et al., 2024). Epidemiological evidence consistently identifies HPV infection and phimosis as principal risk factors (Colberg et al., 2018; Douglawi & Masterson, 2017, 2019), with HPV present in a substantial proportion of penile cancers and phimosis contributing to chronic inflammation and carcinogenesis in uncircumcised individuals (Larke et al., 2011; Mannam et al., 2024; Morrison, 2014). Despite moderate awareness of key symptoms such as painless lumps and dysuria, misconceptions persisted, particularly regarding age specificity and the causal role of STIs, reflecting gaps observed in other cancer awareness research where HPV’s link to non-cervical malignancies remains poorly recognized (Franca et al., 2023; Stephens et al., 2023).
The prominence of barriers such as stigma and perceived prioritization of other cancers underscores the well-documented challenge that social stigma and limited health system focus impose on early presentation and diagnosis, which in turn contributes to later-stage disease and poorer outcomes (Gupta et al., 2015; Stecca et al., 2021). Improving penile cancer literacy among young adults is critical, as early awareness supports prompt presentation, reduces stigma, and enhances prevention through vaccination and hygiene promotion. Universities represent strategic settings for such interventions, particularly in Ghana, where HPV vaccination programs are expanding and could benefit from stronger male engagement. Addressing these knowledge gaps may contribute to earlier diagnosis, reduced morbidity, and broader cancer prevention efforts.
Despite the anticipated utility of these findings, several limitations should be carefully considered when interpreting the results. First, the descriptive cross-sectional design precludes any causal inferences; therefore, the findings are appropriately interpreted as exploratory and hypothesis-generating. The use of convenience sampling and a web-based survey introduces the potential for selection bias, as participation was limited to individuals with internet access and a willingness to engage with the survey. Although efforts such as wide circulation across faculties, extended data collection, and a mobile-friendly design were implemented to improve reach, some degree of underrepresentation, particularly among students with limited digital access, may persist. In addition, reliance on self-reported data introduces the possibility of self-report and social desirability biases, which may have led respondents to overestimate their knowledge or provide responses perceived as favorable.
The study population was restricted to university students within a specific geographic context, which further limits the generalizability of the findings beyond this setting. Moreover, there was a pronounced skew toward students enrolled in health-related programs, with only 3.2% of respondents representing non-health disciplines. This imbalance constrained the feasibility of stratified analyses and limited the statistical power required for meaningful subgroup comparisons. Consequently, potential differences in awareness and knowledge between health and non-health students could not be robustly examined. Future studies should prioritize more balanced sampling across academic disciplines and broader geographic regions to enhance representativeness and allow for more nuanced comparisons.
In addition, the overrepresentation of female respondents may have introduced gender-related bias, potentially obscuring important differences in awareness, perceptions, and educational needs between male and female students. A more equitable gender distribution would enable more reliable gender-disaggregated analyses and support the development of targeted interventions. These sampling imbalances underscore the need for cautious interpretation of the findings.
Notwithstanding these limitations, the study provides important insights that can inform practical and contextually relevant interventions within university settings. Specifically, universities could integrate targeted health education modules into general orientation programs and compulsory interdisciplinary courses to ensure broader reach beyond health-related faculties. Peer-led education initiatives, student ambassador programs, and collaboration with campus health services may further enhance engagement and knowledge dissemination. In addition, leveraging digital platforms such as university learning management systems, social media channels, and webinars offers a scalable and cost-effective approach to delivering tailored health information. Periodic awareness campaigns, workshops, and curriculum-embedded content that emphasize identified knowledge gaps could also improve outcomes. Importantly, these interventions should be designed to be inclusive, addressing both gender differences and the needs of students from non-health disciplines. Future research should build on these findings by employing more rigorous sampling strategies, including multi-institutional and regionally diverse samples, to improve external validity. Longitudinal or interventional study designs would also be valuable in assessing changes in awareness over time and evaluating the effectiveness of targeted educational strategies.
Conclusion
While respondents demonstrated a generally good level of awareness of penile cancer, important gaps persist in knowledge of its symptoms, risk factors, prevention, and treatment options. These findings should be interpreted cautiously, given the exploratory cross-sectional design, potential selection and self-report biases inherent in a web-based convenience sample, the restriction to a certain geographic and university context, and notable sampling imbalances, including the overrepresentation of health-related programs and female respondents. Despite these limitations, the study offers meaningful, context-specific insights that highlight the need for targeted, inclusive, and age-appropriate sexual and reproductive health education within tertiary institutions. Integrating penile cancer education into orientation programs, interdisciplinary curricula, peer-led initiatives, and campus health services alongside the strategic use of digital platforms and awareness campaigns could help address identified knowledge gaps, correct misconceptions, and promote early health-seeking behaviors. Future research employing more representative, multi-institutional samples and longitudinal or interventional designs is warranted to strengthen external validity and evaluate the effectiveness of these strategies. Collectively, these efforts may contribute to reducing delayed diagnosis and improving male reproductive cancer outcomes in Ghana and similar settings.
Footnotes
Acknowledgements
We acknowledge Atta Amoako Panyin Mensah, a Teaching Assistant at the School of Nursing and Midwifery, PUG, for providing administrative support and for receiving training and participating in data collection.
Author Contributions
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.