Background Cervical cancer is the second most prevalent cancer among women in the developing countries including Ethiopia. Precancerous lesions can be developed and risk to the development of cervical cancer over time. Early identification of the precancerous lesion and its risk factor is paramount in preventing cervical cancer. However, the determinants of cervical precancerous lesions are not well documented in Ethiopia. Therefore, this study is conducted to determine factors associated with cervical precancerous lesion among women screened for cervical cancer. Methods A hospital-based unmatched case-control study was conducted in selected health facilities in Addis Ababa from March to April 2016. Data were collected from 114 cases and 229 controls using an interviewer-administered questionnaire, entered to Epi Info version 7, and exported to SPSS version 20 for analysis. Odds ratios with its 95% confidence intervals and two-tailed P-value were calculated. Variables with P-value ≤ 0.2 in the bivariate analysis were included in the multivariate logistic regression model. Results Women aged 40-49 years had 2.4-fold higher odds of precancerous lesions compared to those aged 30-39 (Adjusted Odds Ratio = 2.4, 95% Confidence Interval: 1.27-4.54). Women having history of sexually transmitted infections were significantly associated with cervical precancerous lesion compared to their counterparts (Adjusted Odds Ratio = 3.20, 95% Confidence Interval: 1.26-8.10). Similarly, those women who had two or more lifetime sexual partners (Adjusted Odds Ratio = 2.17 95% Confidence Interval: 1.01-4.67), and women whose husbands had two or more lifetime sexual partners (Adjusted Odds Ratio = 3.03, 95% Confidence Interval: 1.25, 7.33) had higher odds of cervical precancerous lesions. Conclusions Older age, history of multiple sexual partners and sexual transmitted infections were associated with increased risk of precancerous lesion. Therefore, women with higher risk of precancerous lesions should be encouraged to be screened more frequently for cervical cancer.

/pdf/factors-associated-with-cervical-precancerous-lesions-among-2pvtzglmbb.pdf

Factors associated with cervical precancerous lesions among women screened for cervical cancer in Addis Ababa, Ethiopia: A case control study.

In sub-Saharan Africa, cervical cancer is an intersecting epidemic with HIV and it is the second most common cause of cancer-related deaths in women. Therefore, this study was aimed to estimate the current status of the prevalence and associated factors of precancerous cervical lesions among HIV-positive women in sub-Saharan Africa. A systematic literature search was conducted from legitimate electronic databases, including MEDLINE (Ovid), PubMed, EMBASE (Ovid), Emcare (Ovid), CINAHL (EBSCOhost), Web of Science, Scopus, and PopLine and other gray literature including Google, Google Scholar, World Cat, ResearchGate, and Mednar. Data were extracted with a structured format prepared in Microsoft Excel. Each study was evaluated using the Joanna Briggs Institute critical appraisal tool for cross-sectional and cohort studies checklists. Accordingly, medium and high-quality studies were included in the review. Data synthesis and statistical analysis was conducted using OpenMeta and comprehensive meta-analysis version 2 software. The study protocol is registered on PROSPERO with ID: CRD42018114266. The pooled prevalence of precancerous cervical lesion among HIV-positive women in sub-Saharan Africa was 25.6% (95% confidence interval [CI]: 19.4%-31.8%). Having more than 2 lifetime sexual partners (odds ratio [OR]: 4.77; 95% CI: 1.35-16.93), having had a history of sexually transmitted infections (STIs; OR: 1.92; 95% CI: 1.03-3.57), having more than 2 births (OR: 1.84; 95% CI: 1.33-2.53), and CD4 count <200 cells/mm3 (OR: 1.765; 95% CI: 1.23-2.535) were significantly associated with precancerous cervical lesions. The prevalence of precancerous cervical lesion among HIV-positive women was high. One in 4 HIV-infected women suffers from precancerous cervical lesion. Lower CD4 cell count, STIs, multiple sexual partnering, and histories of multiple births and abortions were the foremost contributing factors for this burden. Precancerous cervical lesion could be reduced significantly if preventive and promotive measures are done on the associated factors.

https://journals.sagepub.com/doi/pdf/10.1177/1073274819845872

Precancerous Cervical Lesion Among HIV-Positive Women in Sub-Saharan Africa: A Systematic Review and Meta-Analysis.

Background: The risk of death from complications related to cancer of the cervix is a main health problem over the course of a woman’s life in low income countries. It commonly affects women infected with HIV. Therefore, screening women infected with HIV should start in low income countries, including Ethiopia. Methods: We conducted an institution based cross-sectional study from September 1st, 2015 to December 30th, 2015. During the study, 435 women were included in the study. The data were collected through face to face interviews and patient chart re- view using pre-tested and structured questionnaires. Data was also collected through visual inspection with acetic acid applied for screening and treatment. Data was entered into Epi-info version 7, cleaned and analyzed using SPSS version 20. Logistic regression analysis fitted and odds ratio with 95% confidence interval were computed. Results: The overall prevalence of pre-cancerous lesions of the cervix was 20.2% (95%CI: 13%, 29%). Having more than one lifetime sexual partner (AOR=2.91, 95%CI:1.13, 7.52), a history of sexually transmitted disease (AOR=4.04, 95%CI: 2.19, 7.44), age at first birth less than 18 years (AOR=3.36, 95%CI: 1.79, 5.01) and baseline CD4 count less than 200 cells/mm3 (AOR=7.51, 95%CI: 3.58, 15.68)  were significantly associated with pre-cancerous lesion of the cervix. Conclusion: This study points out the prevalence of pre-cancerous lesions of the cervix is high. Thus, the findings recommend raising of a screening strategy for cervical intraepithelial neoplasia for all women living with HIV should be undertaken. In ad- dition, awareness creation about the impact of multiple sexual partner, promotion of early HIV diagnosis and timely baseline CD4 cell count is important. Keywords: Pre-cancerous, cervical lesion, HIV, cancer, visual inspection, acetic acid.

/pdf/precancerous-lesions-of-cervix-among-women-infected-with-hiv-4nmwrr59z2.pdf

Precancerous lesions of cervix among women infected with HIV in Referral Hospitals of Amhara Region, Northwest Ethiopia: a cross sectional study.

Background Cervical cancer remains one of the major public health challenges in low and middle-income countries including Ethiopia. There was a scarce of evidence regarding the effect of woman’s socio-demographic characteristics and body mass index on the development of precancerous cervical lesions in Ethiopia. Therefore, the current study aimed at identifying the risk factors of precancerous cervical lesions among women visiting referral hospitals for cervical cancer screening in Amhara national regional state. Methods A hospital-based case-control study was conducted from 22 December 2019 to 8 April 2020 among 200 women including 67 visual inspections with acetic acid (VIA) positive women (i.e., cases) and 133 visual inspections with acetic acid (VIA) negative women (i.e., controls). The study was conducted at randomly selected referral hospitals in Amhara national regional state. Data were collected mainly through face to face interview and chart review using structured questionnaire and checklist respectively. Data were then entered to EpiData version 4.6 and exported to SPSS version 25 for analysis. Binary logistic regression model was fitted and variables with p-value of < 0.2 at bivariable logistic regression analysis were candidates for the multivariable analysis. Level of significance was claimed based on adjusted odds ratio (AOR) with 95% confidence interval (CI) at p-value of ≤ 0.05. Results This study illustrates that the odds of being positive for precancerous cervical lesion (PCL) were higher among women who had body mass index (BMI) of <18.5 kg/m2 (AOR = 3.83; 95% CI: 1.26, 8.76), early coitarche (AOR = 3.15; 95% CI: 1.50, 11.49, history of using oral contraceptive pills (AOR = 2.74; 95% CI: 1.6, 7.4), lifetime sexual transmitted infections (AOR = 3.73; 95% CI: 2.5, 12.28) and multiple sexual partners (AOR = 3.23; 95% CI: 1.82, 9.29). On the other hand, participants’ BMI of ≥25 kg/m2 (AOR = 0.46; 95% CI: 0.36, 0.75) and level of education of college and above (AOR = 0.29; 95% CI: 0.23, 0.77) were identified to be protective factors of PCL. Conclusion Most of the determinants of precancerous cervical lesions were modifiable and mainly related to women’s socio-demographic characteristics, sexual behaviors and body mass index. Therefore, strengthening awareness on safe sexual practices and healthy life styles through information, education and communication (IEC), and behavioral change communication (BCC) would decrease the incidence of precancerous cervical lesions.

/pdf/risk-factors-of-precancerous-cervical-lesions-the-role-of-f89x4cnjze.pdf

Risk factors of precancerous cervical lesions: The role of women’s socio-demographic, sexual behavior and body mass index in Amhara region referral hospitals; case-control study

Introduction Precancerous lesions of the cervix are changes in cervical cells that make them more likely to develop into cancer. Understanding the prevalence and determinants of the precancerous lesions of the cervix among women helps to take an action like vaccination programs, improving screening coverage, and close management and follow-up which could decrease the morbidity and mortality caused by cervical cancer. Materials and methods The international databases, PubMed/MEDLINE, Web of Science, EMBASE, CINAHL, Google Scholar, Science Direct and Cochrane Library and unpublished reports were systematically searched. Two authors independently extracted all necessary data using a standardized data extraction format. STATA 14 statistical software was employed to analyse the data. The Cochrane Q test statistics and I2 tests were used to assess the heterogeneity between the studies. A random-effect model was computed to estimate the pooled prevalence of precancerous lesions of the cervix in Ethiopia. Determinants of the precancerous lesion of cervix (early initiation of sexual intercourse, multiple sexual partners, and history of sexually transmitted infection) were analysed. Results Thirteen studies fulfilled the inclusion criteria and included in the meta-analysis. The I2 test result showed high heterogeneity (I2, 93.2%, p = <0.001). Using the random effect analysis, the pooled prevalence of precancerous lesions of the cervix among women in Ethiopia was 14.21% (95% CI (10.49, 17.94). After adjusting of publication bias using trim-and-fill method, the pooled prevalence was 9.43% (95% CI (5.23, 13.62). Women who had multiple sexual partners in their lifetime (OR:2.67 CI: 1.49,4.79) and had a history of sexually transmitted infections (OR:6.22 CI: 2.99,12.92) were more likely to have a precancerous lesion of the cervix. Conclusion The pooled prevalence of the precancerous lesions of the cervix among Ethiopian women was 9.43%. It was associated with having multiple sexual partners and a history of sexually transmitted infections.

/pdf/precancerous-lesions-of-the-cervix-and-its-determinants-4oeputawb9.pdf

Precancerous lesions of the cervix and its determinants among Ethiopian women: Systematic review and meta-analysis.

Background: Cervical cancer is the second commonest type and third cause of cancer death among women in low-income countries. Women with HIV/AIDS are at greater risk of developing cervical cancer. The study is aimed at identifying determinants for suspected precancerous cervical lesions among HIV- positive women at Mekelle Hospital . Methods: An unmatched case-control study was conducted among randomly selected HIV positive women in Mekelle hospital in 2014. Visual inspection with acetic acid (VIA) is done in HIV positive women by trained nurses routinely. A number of 116 cases, who had suspicious findinsgs on VIA, and 232 HIV-positive controls without suspicious findings on VIA were randomly selected and enrolled into the study. The determinants for precancerous cervical lesion were analyzed using multiple logistic regression and described as adjusted odds ratio (AOR). Results: HIV positive women who had CD4 counts less than  350/mm 3 were two times more likely to have precancerous cervical lesion compared to those with CD4 cells above 350/mm 3 . Women with two (AOR=3.6; 95% CI: 1.7, 7.7)   and three (AOR=2.5; 95% CI: 1.2, 5.4) sexual partners were four and three times more likely to have precancerous cervical lesions, respectively,as compared to those who had one sexual partner. Age, History of STI  and duration of ART had no influence on presence of VIA positive lesions in HIV positive women. Conclusion : CD4 count cells and number of sexual partners were predictors of VIA positivecervical lesion among HIV positive women. Key words: Precancerous cervical lesion, VIA, HIV positive women, determinants, Tigray.

Determinant factors of visual inspection with acetic acid (via) positive lesions among hiv positive women in mekelle hospital, northern ethiopia: a case control study

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Determinant factors of visual inspection with acetic acid (via) positive lesions among hiv positive women in mekelle hospital, northern ethiopia: a case control study