Abstract
Introduction: Precancerous cervical lesion is the potential risk factors of invasive cervical cancer. However, factors associated with premalignant cervical lesions remain poorly documented in general population in Adama town. The previous studies had their own methodological gaps which lead to generalizability limitations. Therefore, it is critical to identify the associated factors with precancerous cervical lesions for comprehensive and integrated screening services. Objective: To identify the determinants of precancerous cervical lesions among women screened for cervical cancer at Adama town public health facilities Adama, Oromia, Ethiopia, 2024. Method: Health facility based unmatched case control study design was carried out in selected public health facilities in Adama town. The public health facility participants were selected through simple random sampling techniques. The sample size of cases 84 and control 252 were collected by systematic random sampling. The data were entered and analyzed with Epi info 7.2.6 and SPSS 27. Variables with P-value < 0.25 in the binary logistic analysis were included in the multivariate logistic regression model. An odds ratio with its 95% CI and P value less than 0.05 was used to decide about the presence of association. Result: The median age of the participants was 36 years ± 8 IQR years. This study revealed that the odds of being positive for precancerous cervical lesion were higher among women who were widowed (AOR =10.679, 95% confidence interval CI: 3.049-37.405), with lower family income (AOR =4.662: 95% CI: 1.767-12.302), youngest first marriage age (AOR =5.005: 95% CI: 1.847-13.563), practicing sexual intercourse before age 16 (AOR =11.190: 95% CI: 1.280- 97.867), history of STIs (AOR =5.188: 95% CI: 1.689-15.934), partner history of STIs (AOR=5.324: 95% CI (1.521-18.630) and lifetime multiple sexual partners history (AOR=3.389: 95% CI: 1.438-7.987). Conclusion: Most of the determinants of precancerous cervical lesions were modifiable and mainly related to women’s socio-demographic related factors, reproductive, clinical and sexual behavior related. Therefore, strengthening awareness on safe sexual practices and healthy life styles through behavioral change communication would decrease the incidence of precancerous cervical lesions.
Keywords
Precancerous Cervical Lesion, Screened, Cervical Cancer, Determinants, Adama
1. Introduction
Cervical cancer is a malignant tumor of the cervix, the lowermost part of the uterus. Compared with other gynecologic malignancies, cervical cancer develops in a relatively younger population. Early-stage cervical cancer may create a watery, blood-tinged vaginal discharge and have a foul odor. Human papillomavirus (HPV) is central to the development of cervical neoplasia and can be detected in 99.7 percent of cervical cancers
| [1] | Hoffman BL, Schorge JO, Bradshaw KD, Halvorson LM, Schaffer JI, Corton MM. Williams Gynecology, Fourth Edition: McGraw Hill LLC; 2020. |
| [2] | Mayo Clinic gynecologic oncologist Kristina Butler MD, M. S. Cervical cancer overview 2023 https://www.mayoclinic.org/diseases-conditions/cervical-cancer/symptoms- causes/syc-20352501 |
[1, 2]
. Cervical intraepithelial neoplasia (CIN) is characterized by cellular changes in the transformation zone of the cervix and potential risk factors of cervical cancer. It may exist at any one of three stages: CIN1, CIN2, or CIN3. If left untreated, CIN2 or CIN3 (collectively referred to as CIN2+). The progressive potential increases with CIN grade
| [1] | Hoffman BL, Schorge JO, Bradshaw KD, Halvorson LM, Schaffer JI, Corton MM. Williams Gynecology, Fourth Edition: McGraw Hill LLC; 2020. |
| [3] | WHO. WHO guideline for screening and treatment of cervical pre-cancer lesions for cervical cancer prevention, second edition: use of mRNA tests for human papillomavirus (HPV). 21 November 2021. |
[1, 3]
. Typically, it takes 15-20 years for abnormal cells to become cervical cancer, but in women with weakened immune system, such as untreated HIV, this process can be faster and take 5-10 years. Risk factors for cancer progression include the grade of oncogenicity of the HPV type, immune status, the presence of other sexually transmitted infections, number of births, young age at first pregnancy, hormonal contraceptive use, and smoking
.
Globally, cervical cancer is the fourth most common cancer in women, with 662,301 new cases and 348,874 deaths in 2022. About 94% of the 350 000 deaths caused by cervical cancer occurred in low- and middle-income countries. The highest rates of cervical cancer incidence and mortality are in sub-Saharan Africa (SSA), Central America and South-East Asia
. As on Globocan's estimates for 2022, Ethiopia had 8,168 newly diagnosed cases of cervical cancer and 5,975 cervical cancer fatalities. These figures represent approximately 15.5% and 17.09% of all female cancer cases and deaths, respectively. It ranks second in Ethiopia for both the frequency of cancer diagnoses and the number of cancer-related deaths
.
Cervical cancer is usually developed after a prolonged phase of pre-invasive lesions in the cervix. Therefore, early identification and treatment at its pre-invasive stage may benefit the clients and decrease the burden of morbidity and mortality resulting from cervical cancer
| [7] | Merera D, Jima GH. Precancerous Cervical Lesions and Associated Factors Among Women Attending Cervical Screening at Adama Hospital Medical College, Central Ethiopia. Cancer Manag Res. 2021; 13: 2181-9. |
[7]
. VIA is encouraging the connection between screening and treatment. This "see and treat" approach lowers the possibility that women will become lost in the referral system and guarantees treatment compliance shortly after diagnosis. In low resource settings, VIA in conjunction with cryotherapy or thermal ablation, ideally a single visit approach (SVA), is an efficient and successful technique for secondary prevention of cervical cancer
.
Cervical cancer is a major global health concern, disproportionately affecting women in developing countries
| [10] | Wang M, Huang K, Wong MCS, Huang J, Jin Y, Zheng Z-J. Global Cervical Cancer Incidence by Histological Subtype and Implications for Screening Methods. Journal of Epidemiology and Global Health. 2024. |
[10]
. In Ethiopia, women are tragically dying of cervical cancer due to the silent nature of the disease until it becomes quite advanced and the presence of large gaps on responsible factors
| [11] | Dessie TM, Kassaw AT, Alen GD. Determinants of precancerous cervical lesion among HIV infected women on ART in Woldia comprehensive specialized hospital NorthEast Ethiopia. BMC Womens Health. 2023; 23(1): 458. |
[11]
. In Ethiopia, six in every ten cervical cancer cases are diagnosed at the late stage of the disease
. Poor awareness about cervical cancer and its treatment, long patient delay to seek care, and rural residence were positively associated with late–stage diagnosis
| [12] | Zewdie A, Shitu S, Kebede N, Gashaw A, Eshetu HB, Eseyneh T, et al. Determinants of late-stage cervical cancer presentation in Ethiopia: a systematic review and meta-analysis. BMC Cancer. 2023; 23(1): 1228. |
[12]
. Cervical cancer has an enormous socioeconomic impact on patients in terms of social discrimination, loss of body image, loss of sexual functioning, loss of femininity, loss of income, financial distress, and work and employment challenges
| [13] | Endale H, Mulugeta T, Habte T. The Socioeconomic Impact of Cervical Cancer on Patients in Ethiopia: Evidence from Tikur Anbessa Specialized Hospital. Cancer Manag Res. 2022; 14: 1615-25. |
[13]
. To address this serious public health problem, Ethiopia adopted SDG and WHO strategies and designed the National Cancer Control Plan
| [14] | FMoH E. National cancer control plan 2016–2020. Addis Ababa disease prevention and control directorate, editor Directorate dpac. 2015. |
[14]
.
In 2020, the cervical cancer screening coverage was only 259,706 (3%) among female 35-49 aged group in Ethiopia and which is far from the target for clearly unknown reason. To reach the target set by WHO, conducting research and surveillance to identify the associated factors among the general solution
. There was a variation of evidence reported on the effect of associated factors on precancerous cervical lesions like women's age, education, occupation, residence and age at first sexual intercourse
| [15] | Zena D, Elfu B, Mulatu K. Prevalence and Associated Factors of Precancerous Cervical Lesions among Women in Ethiopia: A Systematic Review and Meta-Analysis. Ethiop J Health Sci. 2021; 31(1): 189- 200. |
[15]
.
A different study was done on the associated factors of intraepithelial cervical neoplastic in some parts of the country. However, factors associated with premalignant cervical lesions remain poorly documented in general population in Adama town. In addition, the two studies were conducted in the study area. However, the two studies had their own methodological gaps which lead to generalizability limitation. The first study was retrospective record review unmatched case control design and skipping incomplete recorded client cards which leads to selection bias. The second research was cross-sectional design; temporal sequence between exposure and disease can‘t be established. Both the studies were done on single health facility.
The current study will fulfill the mentioned gaps by identifying the associated factors, conducting data collection from primary sources, using unmatched case control design and conducting study on multiple public health facilities. This study, therefore, aimed to find out the determinants of precancerous lesion among women of reproductive age group who was screened for cervical cancer at the cervical screening center at Adama public health facilities.
2. Methods and Materials
2.1. Study Area
The study was conducted in selected Adama town public health facilities (which has the cervical cancer screening service), which is found in Oromia Regional State, located at a distance of 99km from Addis Ababa. According to the 2016 E.C population projection, the town has a total population of 656,072. Adama town has two public hospitals (Adama hospital medical college and Wonji hospital) and thirteen public health centers. The two public hospitals and seven public health centers are providing routine cervical cancer screening. Adama hospital medical college and Wonji Primary hospital started cervical cancer screening in 2010 E.C and 2013 E.C respectively, and serves as referral centers for surrounding health centers. These public health facilities provide cervical cancer screening services with VIA for women aged 15-49 years.
2.2. Study Design and Period
Health facilities based unmatched case control study was carried out from July 1, 2024 to November 1, 2024.
2.3. Population
Source of Population
The source of population was all women of reproductive age group (15-49 years old) who attending at Adama public health facilities cervical cancer screening centers for which providing routine cervical cancer screening service.
Study population
Cases – All reproductive age group (15-49) women who had VIA positive cervical cancer screening result in selected Adama public health facilities during the study period.
Controls – All reproductive age group (15-49) women who had VIA negative cervical cancer screening result at selected Adama public health facilities during the study period
Eligibility Criteria Inclusion criteria
Cases - study participants who had positive results for the VIA test. Control - study participants who had negative results for the VIA test.
Exclusion Criteria-All adult women with history of hysterectomy, severely ill and unable to communicate patient, biopsy proven cervical cancer and refusal were excluded from the study during the study period.
2.4. Sample Size Determination
Two population proportion sample size calculation formula was used to estimate the required sample size using Epi Info version 7.2.6 with the assumption of 95% CI, power =80% with control to case ratio of 3:1. Being HIV positive from Woliso study
| [16] | Tesfaye B, Tilahun T, Dechasa Heyi W, Oljira R. Associated factors of positive visual inspection of cervix with acetic acid test among women screened for cervical cancer at public health facilities in Woliso town, Southwest Shoa, Ethiopia: A case-control study. SAGE Open Med. 2022; 10: 20503121221108227. |
[16]
, use of oral contraceptive from Adama town
| [17] | Kassa RT. Risk factors associated with precancerous cervical lesion among women screened at Marie Stops Ethiopia, Adama town, Ethiopia 2017: a case control study. BMC Research Notes. 2018; 11(1): 145. |
[17]
, age of first exposure to sexual intercourse <15, and history of STI, which was taken from the previous study done in Amhara regional referral hospital
| [18] | Taye BT, Mihret MS, Muche HA. 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. PLoS One. 2021; 16(3): e0249218. |
[18]
.
Table 1. Sample size determination by EPI-INFO version 7 for factors associated with Precancerous Cervical Lesions.
Variable | AOR | Ratio control | % of Cases exposed | % of Control exposed | Sample size | Total sample | References |
Age of first exposure to | 3.15 | 3 | 38.8 | 18 | 44 | 132 | 176 | 8] |
sexual intercourse<15 | | | | | | | | |
History of STI | 3.73 | 3 | 44.8 | 17.3 | 34 | 101 | 135 | 8] |
Being HIV positive | 3.85 | 3 | 31.4 | 7 | 57 | 171 | 228 | 6] |
Use of oral | 2.342 | 3 | 58.7 | 74.5 | 77 | 231 | 308 | 7] |
contraceptive | | | | | | | | |
The maximum sample size is 308. Taking 10% of nonresponse rate, the final sample size was 339. The case sample size is 85 and the control participants sample size is 254. The ratio control to case is 3:1.
2.5. Sampling Techniques and Procedure
Out of the 15 total public health facilities in Adama, 9 health facilities provide cervical cancer screening service. The study was conducted in 5 of those health facilities. The two hospitals (AHMC and Wonji primary hospital) and three health centers (Adama health center, Geda health center and Kuriftu health center) were selected using simple random sampling (lottery method) from nine Adama public health facilities for which providing routine cervical cancer screening.
Based on the two months cervical cancer screening report before data collection, the average monthly report for AHMC 116 with 30 positive for PCL, Wonji hospital 64 with 15 positive for PCL, Adama health center 39 with VIA positive 11, Geda health center 60 out of this VIA positive was 18 and Kuriftu health center 18 and VIA+ was 6 with total of 297 were screened for cervical screening and total VIA positive was 80. Therefore, by using the proportional allocation method to select the representative from each selected health facilities by the proportional allocation formula.
ni = n÷N× (Ni)… = 1, 2, 3, 4, 5
nAHMC = 133, nWH = 73, nGHC =68, nAHC =45, nKHC =20
Figure 1. Two hospitals and three health centers were selected based on provision of pre-cervical lesion screening among Adama town public health facilities, 2024.
Keys*: x̅ Average, ACSHMC-Adama comprehensive specialized hospital medical college, WH- Wonji hospital, GHC-Geda health center, AHC-Adama health center
Finally, systematic sampling method was used to select the study participants from each facility. Cases (positive visual inspection with acetic acid screens) selected every 2nd interval as they were diagnosed to have precancerous cervical lesion until the required sample size was obtained. For each case, three controls (negative visual inspection with acetic acid screens) were selected every two interval from the same health facilities.
2.6. Data Collection Procedure and Data Quality Control
A structured interviewer questionnaire was constructed by reviewing similar articles. Data were collected from the primary data sources by data collectors. Data were collected through face to face interview by using a structured questionnaire. The primary data sources were voluntarily consented reproductive age group women who would come at ACSHMC, Wonji primary hospital and three health centers (Adama health center, Geda health center and Kuriftu health center) cervical cancer screening units for cervical screening service. Data collection was collected by and screening using VIA was done by five already trained health professions, two Bsc nurses, and three Bsc midwives who have experience more than two years cervical cancer screening and treatment. One supervisor with MPH for supervision and have more than 3 years’ experience in research. First explained briefly on the data collection and then, the voluntarily consent was taken using written consent form tool before the interview start. It contains means of identification (age, educational status, socio-economic status occupational status and other socio- demographic statuses like marital status and place of residence), reproductive history (parity, abortion, age of first sexual intercourse, age of marriage,), and clinical and behavioral related factors (HIV status, history of STI, history of multiple sexual partners, history of smoking, history chronic corticosteroid use, ART status).
Each woman was received an explanation of the process prior to the VIA test being administered. The urethral entrance was examined for discharge and the external genitalia. The glands of skene and Bartholin were palpated. The cervix was examined with a speculum to check for signs of infection (cervicitis), such as mucopus, ectopy, ulcers, grossly apparent tumors, or nabothian cysts. A clean cotton swab was used to remove any mucus, discharge, or blood from the cervix. Next, a clean swab was soaked in a diluted 3-5% acetic acid solution was be applied to the cervix, and the area was carefully examined for any raised and thickened white plaques or aceto-white epithelium. The cervix was also carefully examined for easily bleeds. The area was examined closely to look for any aceto-white epithelium or elevated, thicker white plaques.
Training was given for two days on the way of interviewing and filling the questionnaire. The training also was given on the VIA test. The questionnaire was designed attentively and prepared in the English language first and then was translated into Afan Oromo. And was translated into Amharic by language professions and Afaan Oromoo and Amharic version was translated back to English by other persons to make it consistent. The questionnaire was pretested before actual data collection in 16 women in Modjo hospital which is out of the study facilities. Strict supervision was maintained during the VIA testing and data gathering phases. Every day, completed surveys were examined for consistency and completeness and addressed.
2.7. Study Variables
The dependent variable for the study was VIA results (VIA positive and negative). Socio- demographic characteristics of the study participants like age, marital status, socioeconomic status, occupation, educational level and place of residence were used. Others like number of children, early marriage, age of first intercourse, number of sexual partners, number of abortion, contraceptive use, and smoking, chronic corticosteroid use, history of sexual transmitted infections and women’s HIV status were also considered as independent variables in the study.
2.8. Data Processing and Analysis
Data was cleaned, coded, entered in to Epi version 7.2.6 and exported to and analysed by SPSS version 27. Descriptive statistics were computed for all data and presented as frequencies and percentages in tables. Quantitative data was checked for normality using Shapiro–Wilk’s test. Normally distributed continuous variables were presented as mean ± standard deviation (SD) while skewed continuous variables were expressed as the median and interquartile range (IQR). Binary and multiple logistic regression analysis were used to measure the association between dependent and independent variables. Variables with P-value < 0.25 in the binary logistic analysis were included in the multivariate logistic regression model. An odds ratio with its 95% CI and P value less than 0.05 was used to decide about the presence of association. Multicollinearity between independent variables was assessed using the variance inflation factor
(VIF) before entering the variables into the final model. The final model of multiple binary logistic regressions was fitted using a backward method with Hosmer and Lemeshow goodness of fit test.
2.9. Ethical Approval
Ethical clearance letter and approval were obtained from Adama Comprehensive Specialized Hospital Medical College Institutional Ethical Review Committee - (Protocol number: 0605/K- 373/16). The lead investigator was then submitting a letter of authorization to the public health facilities that have been chosen as well as the Adama City Health Office. Additionally, consent from the chosen healthcare facilities was requested prior to data collection. Participants' right to autonomy shall be upheld. There was no adverse effect on research participants from this study. It was also being made clear to participants that participation is entirely optional. After informing study participants of the study's purpose, their written agreement was obtained.
2.10. Result Dissemination Plan
The primary research findings will be published, presented, and submitted in hard copy, soft copy and other formats to the relevant parties. Adama Comprehensive and Specialized Hospital Medical College and Adama Health Bureau will receive a hard copy of the entire research thesis. Lastly, in an effort to reach a larger audience, it will also be published in scholarly journals.
3. Result
3.1. Socio-demographic Characteristics of the Study Participants
A total of 84 cases and 252 controls from 15 to 49 years were interviewed making a response rate of 99.11%. The median age of the participants was 36 years ± 8 IQR years. The mean age of cases with their standard deviations was 34.71 ± 6.019 years. The median age of cases with their IQR was 36.5 ± 8 years. Among the study participants, 65 (77.4%) of cases were found to be in the age group of more than 30 years and 19 (22.6%) of cases were found to be in the age group of less than 30 years. 211 (83.4%) of controls were found to be in the age group of more than 30 years and 41 (16.3%) of controls were found to be in the age group of less than 30 years. Seventy six (90.5%) cases and 224 (88.9%) controls were from urban residences. Regarding marital status, one third 27 (32.1%) of cases and nearly two third than, 162 (64.3%) of controls were married. Less than half 37 (44.0%) of cases and more than one third 91 (36.1%) of controls, were attended primary (1-8) education. Among study participants, 39 (46.4%) of cases and 109 (43.3%) of controls were non-employed. Nearly half 44 (52.4%) of cases and 199(79.0%) of controls had a monthly income of greater than 2500 birr. Nearly half participants, 39(46.4%) of cases and 109(43.3%) of controls were self-employed (
Table 2).
Table 2. Socio-demographic characteristics of women screened for cervical cancer at Adama Public Health Facilities, 2024.
Variables | Category | Case | Control |
Place of residence | Rural | 8(9.5) | 28(11.1) |
| Urban | 76(90.5) | 224(88.9) |
Marital status | Divorce | 25(29.8) | 49 (19.4) |
| Married | 27(32.1) | 162(64.3) |
| Unmarried | 13(15.5) | 30(11.9) |
| Widowed | 19(22.6) | 11(4.4) |
Education level | Don’t write and read | 9(10.7) | 18(7.1) |
| Only read and write | 11(13.1) | 27(10.7) |
| Primary (1-8) | 37(44.0) | 91(36.1) |
| Secondary (9-12) | 14(16.7) | 56(22.2) |
| Diploma or technical/vocational | 11(13.1) | 36(14.3) |
| Higher (bachelor and above) | 2(2.4) | 24(9.5) |
Age | ≤ 30 | 19(22.6) | 41(16.3) |
| >30 | 65(77.4%) | 211(83.7) |
Occupational status | Female sexual worker | 13(15.5) | 8(3.2) |
| Governmental employee | 6(7.1) | 51(20.2) |
| Non-governmental employee | 26(31.0) | 84(33.3) |
| Self-employed | 39(46.4) | 109(43.3) |
Income | ≤ 2500 | 40(47.6) | 53(21.0) |
| >2500 | 44(52.4) | 199(79.0) |
3.2. Reproductive Related Factors
Thirty-six (72.0%) of cases and 138 (69.3%) of controls have two or more children. Among the study participants, 54(64.3%) of cases and 196(77.8%) of controls had not history of abortion. The median age of first sexual intercourse of the women positive for precancerous cervical lesion was 17 ±2 IQR years. The median age of first sexual intercourse of the women negative for precancerous cervical lesion was 18 ±2 IQR years. Out of the participants more than half of the women 197 (58.6%) had first sexual intercourse below the age of 18 years. The median age at first marriage of women who positive for precancerous cervical lesion was 20 years ±2 IQR years. The mean age at first marriage of women who negative for precancerous cervical lesion was 23 years ± 5 IQR years. Fifty two (76.5%) of the respondents started their first sex at the age of 18 and below years old. Nearly nine in ten 78(92.9%) of cases and 178(70.6%) of controls had history of modern family planning usage. The foremost contraceptive method used by participants was implant 34(44.2%) of cases and 90(50.8%) of controls followed by injectable 14 (18.2%) of cases and 53(29.9%) of controls.
Table 3. Reproductive related factors of women screened for cervical cancer at Adama Public Health Facilities, 2024.
Variable | Category | Case, n (%) | Control, n (%) |
Birth history | Yes | 51(60.7) | 200(79.4) |
| No | 33(39.3) | 52(20.6) |
Number birth | > 3 | 20(39.2) | 51(25.6) |
| ≤ 3 | 31(60.2) | 148(74.4) |
Abortion history | Yes | 30(35.7) | 56(22.2) |
| No | 54(64.3) | 196(77.8) |
Number of abortion | ≥2 | 20(66.7) | 13(25.0) |
| <2 | 10(33.3) | 39(75.0) |
Age of first sexual | ≤ 15 | 16(19.0) | 11(4.4) |
intercourse | 16-20 | 66(78.6) | 195(77.4) |
| ≥21 | 2(2.4) | 46(18.3) |
First marriage age | ≤ 18 | 52(76.5) | 69(31.1) |
| > 18 | 16(23.5) | 153(68.9) |
Contraceptive usage | Yes | 78(92.9) | 178(70.6) |
history | No | 6(7.1) | 74(29.4) |
Contraceptive | Implant | 34(44.2) | 90(50.8) |
Methods | Injectable | 14(18.2) | 53(29.9) |
| Oral contraceptive pills | 27(35.1) | 13(7.3) |
| Others | 2(2.6) | 21(11.9) |
3.3. Clinical Related Factors
Concerning participants’ HIV/AIDS status, 51 (60.7%) of cases and 212(84.1) of controls were negative for HIV. More than half 50 (59.5%) of the cases and 37 (14.7%) of the controls had history of sexual transmitted infections. Among the respondents 79(94.0%) of cases and
250(99.2%) of controls had not history of corticosteroid usage. Majority of cases 81(96.4%) and controls 242(96.0%) had no family history of cervical cancer.
Table 4. Clinical related factors of women screened for cervical cancer at Adama Public Health Facilities, 2024.
Variable | Category | Case, n (%) | Control, n (%) |
HIV status | Positive | 29(34.5) | 23(9.1) |
| Negative | 51(60.7) | 212(84.1) |
ART status | Yes | 27(84.4) | 23(71.9) |
| No | 5(15.6) | 9(28.1) |
History of STI | Yes | 50(59.5) | 37(14.7) |
| No | 34(40.5) | 215(85.3) |
Partner history of STI | Yes | 26(31.0) | 17(6.7) |
| No | 58(69.0) | 235(93.3) |
Corticosteroid usage | Yes | 5(6.0) | 2(0.8) |
history | No | 79(94.0) | 250(99.2) |
Corticosteroid usage | ≥4 | 4(80.0) | 2(100) |
duration | <4 | 1(20.0) | 0(0.0) |
Family history | Yes | 3(3.6) | 10(4.0) |
| No | 81(96.4) | 242(96.0) |
Chronic non | Bronchial | 4(4.8) | 2(0.8) |
communicable diseases | Asthma | | |
| Diabetes | 11(13.1) | 7(2.8) |
| mellitus | | |
| Hypertension | 3(3.6) | 34(13.5) |
| Hypertension | 0(0.0) | 6(2.4) |
| and diabetes | | |
| mellitus | | |
| No NCD | 65(77.4) | 203(80.6) |
| Others | 1(1.2) | 0(0.0) |
3.4. Behavioral Related Factors
Among the study participants, having lifetime multiple sexual partner among cases and controls was 47 (56.0%) and 44 (17.5%), respectively. Similarly, about one third of the participants’ partners had two or more other lifetime sexual partners. Nine in ten, 76(90.5%) of cases and 246(97.6%) of controls had not the history of smoking.
Table 5. Behavioral related factors women screened for cervical cancer at Adama Public Health Facilities, 2024.
Variable | Category | Case | Control |
Smoking history | Yes | 8(9.5%) | 6(2.4) |
| No | 76(90.5) | 246(97.6) |
Smoking duration | ≥3 | 7(87.5) | 1(16.7) |
| <3 | 1(12.5) | 5(83.3) |
Life time multiple sexual | Yes | 47(56.0) | 44(17.5) |
partner | No | 37(44.0) | 208(82.5) |
Sexual partner number | ≥3 | 4(13.8) | 8(24.2) |
| <3 | 25(86.2) | 25(75.8) |
Life time multiple sexual | Yes | 30(35.7) | 35(13.9) |
partner of partner | No | 54(64.3) | 217(86.1) |
history | | | |
Sexual partner of partner | ≥3 | 32(71.1) | 15(35.7) |
number | <3 | 13(28.9) | 27(64.3) |
3.5. Determinants of Precancerous Cervical Lesion
In Bivariate logistic regression analysis, age, marital status, income status, occupational status, age at first sex, first marriage age, lifetime multiple sexual partner, HIV status, history of STIs, Partner`s lifetime multiple sexual partners of participants’, smoking history, corticosteroid usage history, partner history of STIs, birth history and abortion history of the respondents were found to have a p-value of ≤0.25. To control the effect of other confounding factors they were entered into multivariable logistic regression analysis. In the multivariable logistic regression analysis, marital status, income status, first marriage age, age at first sex, history of STIs, partner history of STIs, birth history and partner life time multiple sexual history were found to be a significant predictor of precancerous cervical lesion in women with precancerous cervical cancer.
The odds of being positive for cervical pre-cancerous lesion was found to be10.679 times (AOR =10.679, 95% CI: 3.049-37.405) higher among widowed women compared to married women. Women with family income were 2500 or less birr had 4.662 times (AOR =4.662: 95% CI: 1.767-12.302) higher odds of being positive for cervical pre-cancerous lesion compared to their counterpart. Marital age showed significant relation with cervical pre-cancerous lesion. The odds of being positive for pre-cancerous cervical lesion was found to be 5.005 times (AOR =5.005: 95% CI: 1.847-13.563) higher among women with first marriage age at young age compared to their counterpart. Those participants who started practicing sexual intercourse before age 16 were 11.190 times more likely to have positive for the pre-cancerous cervical lesion compared to those who started after 21 (AOR =11.190: 95% CI: 1.280-97.867). Women who had history of STIs had 5.188 times (AOR =5.188: 95% CI: 1.689- 15.934) higher odds of being positive for pre-cancerous lesion compare to those who had no history of STI. Women whose partner had history of STIs had 5.324 times (AOR =5.324: 95% CI: 1.521-18.630) higher odds of being positive for pre-cancerous cervical lesion compare to their counterpart. Those having lifetime multiple sexual partners history were3.389 times (AOR=3.389: 95% CI: 1.438- 7.987) higher to develop precancerous cervical cancer compared to those who had no lifetime multiple sexual partners.
Table 6. Determinants of precancerous cervical lesions among women screened for cervical cancer at Adama Public Health Facilities, 2024.
Variables | | Case, n (%) | Control, n (%) | COR (CI95%) | AOR (CI95%) | P-value |
Marital status | Married | 29(34.5) | 162(64.3) | 1 | 1 | |
| Unmarried | 17(20.2) | 30(11.9) | 3.16(1.55-6.47) | 1.99(0.59-3.342) | 0.996 |
| Divorced | 25(29.8) | 49(19.4) | 2.85(1.53-5.31) | 2.163 (0.827-5.658) | 0.116 |
| Widowed | 13(15.5) | 11(4.4) | 6.6(2.698-16.2) | 10.679 (3.049-37.405) | 0.000 |
Age | ≤ 30 | 19(22.6) | 41(16.3) | 1 | 1 | |
| >30 | 65(77.4) | 211(83.7) | 0.66(0.36-1.22) | 0.563 (0.191-1.656) | 0.297 |
Income status | > 2500 | | | 1 | | |
| ≤ 2500 | 40(47.6) | 53(21.0) | 3.41(2.02-5.76) | 4.662 (1.767-12.302) | 0.002 |
Occupational status | Governmental | 8(9.5) | 51(20.2) | 1 | 1 | |
Job less | 38(45.2) | 110(43.7) | 2.20(0.959-5.0) | 0.489 (0.138-1.735-) | 0.268 |
| Non- | 25(29.8) | 84(33.3) | 1.897(0.796-4.524) | 0.679 (0.186-2.482) | 0.558 |
| Governmental | 13(15.5) | 7(2.8) | 11.8(3.6-38.65) | 1.371 (0.180-10.433) | 0.761 |
Abortion | No | 54(64.3) | 196(77.8) | 1 | | |
history | Yes | 30(35.7) | 56(22.2) | 1.94(1.14-3.32) | 1.611 (0.619-4.195) | 0.329 |
First marriage | >18 | 44(64.7) | 207(93.2) | 1 | 1 | |
age | ≤ 18 | 24(35.3) | 15(6.8) | 7.5(3.66-15.5) | 5.005 (1.847-13.563) | 0.002 |
First sexual | >20 | 2(2.4) | 46(18.2) | 1 | | |
intercourse age | 16-20 | 66(78.6) | 195(77.4) | 7.78(1.83-32.9 | 2.028 (0.326-12.609) | 0.448 |
| ≤ 15 | 16(19.0) | 11(4.4) | 33.4(6.6-167.4) | 11.190 (1.280-97.867) | 0.029 |
HIV status | Negative | 55(65.5) | 229(90.9) | 1 | | |
| Positive | 29(34.5) | 23(9.1) | 5.25(2.82-9.77) | 1.715 (0.623-4.718) | 0.296 |
STI history | No | 39(40.5) | 215(85.3) | 1 | | |
| Yes | 50(59.5) | 37(14.7) | 8.55(4.89-14.9) | 5.188 (1.689-15.934) | 0.004 |
Partner STI | No | 58(69.0) | 235(93.3) | 1 | | |
history | Yes | 26(31.0) | 17(6.7) | 6.2(3.15-12.2) | 5.324 (1.521-18.630) | 0.009 |
Steroidal use | No | 77(91.7) | 248(98.4) | 1 | | |
history | Yes | 7(8.3) | 4(1.6) | 5.6(1.61-19.76) | 1.252 (0.152-10.323) | 0.834 |
Multiple sexual | No | 37(44.0) | 208(82.5) | 1 | | |
partner | Yes | 47(56.0) | 44(17.5) | 6.0(3.50-10.30) | 3.389 (1.438-7.987) | 0.005 |
multiple sexual | No | 54(64.3) | 217(86.1) | 1 | | |
partner of partner history Smoking | Yes | 30(35.7) | 35(13.7) | 3.44(1.95-6.10) | 0.932 (0.303-2.865) | 0.902 |
No | 76(90.5) | 246(97.6) | 1 | | |
history | Yes | 8(9.5) | 6(2.4) | 4.31(1.45-12.8) | 1.187 (.0.166-8.491) | 0.864 |
Birth history | No | 33(39.3) | 52(20.6) | 1 | | |
| Yes | 51(60.7) | 200(79.4) | 0.4(0.236-0.68) | 0.179 (0.068-0.471) | 0.000 |
4. Discussion
Early detection and treatment of pre-cancerous cervical lesions is critical to prevent the progression of cervical cancer. This study indicates that widowed women are associated with an increased risk of developing precancerous cervical lesions compared to married women. The finding is comparable with a study conducted in Gabon, Tigray regional state, and Arsi zone sude district, further validating the relationship between being widowed women and cervical health outcomes
| [19] | Abera GB, Yebyo HG, Hailekiros H, Niguse S, Berhe Y, Gigar G, et al. Epidemiology of pre- cancerous cervical lesion and risk factors among adult women in Tigray, Ethiopia. PLoS One. 2023; 18(1): e0280191. |
| [20] | Garoma S, File T, Yadeta F. Precancerous Cervical Cancer Lesion and Associated Factors among Rural Women of Age 30–49 Years, in Sude District, Oromia Region, Ethiopia. Ethiopian Journal of Reproductive Health. 2021; 13(03): 9. |
| [21] | Woromogo SH, Ambounda Ledaga N, Yagata-Moussa FE, Mihindou AS. Uterine cervical neoplasms mass screening at the University Hospital Centre of Libreville, Gabon: Associated factors with precancerous and cancerous lesions. Plos one. 2021; 16(7): e0255289. |
[19-21]
. This implies that women who have started sexual practice and have widowed and or without having a permanent husband are likely to be exposed to multiple sexual partners; which increases the risk of HPV infection.
The result of the current study indicates that low income status is significant association with PCL. This study evidence is supported by the study done in Arizona, south Ethiopia and Addis Ababa
| [22] | Beyene T, Akibu M, Bekele H, Seyoum W. Risk factors for precancerous cervical lesion among women screened for cervical cancer in south Ethiopia: Unmatched case-control study. Plos one. 2021; 16(7): e0254663. |
| [23] | Riggs SL, Thomson CA, Jacobs E, Cutshaw CA, Ehiri JE. Hispanic ethnicity and cervical cancer precursors among low-income women in Arizona. International Journal of Women's Health. 2021: 929- 37. |
| [24] | Ararsa T, Tadele N, Ayalew Y, Gela D. Knowledge towards cervical cancer screening and associated factors among urban health extension workers at Addis Ababa, Ethiopia: facility based cross- sectional survey. BMC Cancer. 2021; 21(1): 224. |
[22-24]
. This consistency to the South Ethiopia study may be due to the similarities in the study designs, and the study participants. One possible reason may be low-income women's limited access to health care services, which could have an impact on their health by depriving them of routine tests or education regarding the detrimental health impacts of risk factors associated with their lifestyle. Moreover, women under tough economic situations and material needs engaged in commercial sexual work, early marriage, early sexual debut and with multiple sexual partners to fulfill their and family’s needs which increases chance of HPV infection and others STIs. HPV infection could lead the PCL through immature squamous cells and leaves infected cells vulnerable to malignant transformation by loss of cell-cycle control, cellular proliferation, and accumulation of DNA mutations over time by degrading tumor suppressors’ proteins such as P53 and Retinoblastoma
| [1] | Hoffman BL, Schorge JO, Bradshaw KD, Halvorson LM, Schaffer JI, Corton MM. Williams Gynecology, Fourth Edition: McGraw Hill LLC; 2020. |
[1]
. This study highlights the importance of improving of every family income to prevent and enable early detection of precancerous cervical lesions.
In the current study, women who married at young age of were five times more likely to be positive for PCL compared to their counterpart. This finding is align with the conducted at Saints Paul’s Hospital and Millennium College
| [25] | Ansa M, Mekonnen T. PREVALENCE OF VIA POSITIVE CERVICAL LESIONS AND DETERMINANT FACTORS AMONG WOMEN ATTENDING REGULAR GYNECOLOGY OUTPATIENT DEPARTMENT (RGOPD) AT SAINT PAUL’S HOSPITAL MILLENNIUM MEDICAL COLLEGE (SPHMMC). Ethiopian Journal of Reproductive Health. 2018. |
[25]
, and in Nepal
| [26] | Thapa B, Ranabhat MK, Dahal BD, Dhungana GP, Rajbanshi L. Factors associated with precancerous cervical lesion among women attending cervical cancer screening camps. risk. 2019; 543: 5. |
[26]
which revealed that women married before 20 years associated with cervical precancerous lesions compared to the counter parts. However, this significance was not supported by another study conducted in the Sude district, Arsi, which found no association between early marriage and precancerous cervical lesion
| [20] | Garoma S, File T, Yadeta F. Precancerous Cervical Cancer Lesion and Associated Factors among Rural Women of Age 30–49 Years, in Sude District, Oromia Region, Ethiopia. Ethiopian Journal of Reproductive Health. 2021; 13(03): 9. |
[20]
. This discrepancy may be due to variations in the study design and sample size. The reason of this association may be, at a young age, the cervix has immature squamous cells, thus making it more susceptible to etiological agents, particularly high-risk types of HPV
| [1] | Hoffman BL, Schorge JO, Bradshaw KD, Halvorson LM, Schaffer JI, Corton MM. Williams Gynecology, Fourth Edition: McGraw Hill LLC; 2020. |
[1]
. The findings have implications for the implementation evidence based strategies to delay early marriage that educate families and community members on the dangers of early marriage, provide girls with education and life skills, and offer legal services.
Our analysis revealed that women who initiated sexual intercourse before the age of 16 were eleven times more likely to develop precancerous cervical lesions compared to those who began sexual activity after the age of 16 and late. This study finding consistent with the studies conducted in China, Amhara North Shoa and Harar
| [27] | Wakwoya EB, Gemechu KS. Prevalence of Abnormal Cervical Lesions and Associated Factors Among Women in Harar, Eastern Ethiopia. Cancer Manag Res. 2020; 12: 12429-37. |
| [28] | Yang D, Zhang J, Cui X, Ma J, Wang C, Piao H. Risk factors associated with human papillomavirus infection, cervical cancer, and precancerous lesions in large-scale population screening. Frontiers in Microbiology. 2022; 13: 914516. |
| [29] | Teklehaimanot DA, Mekuria AD, Dadi AF, Derseh BT. Precancerous lesion determinants in women attending cervical cancer screening at public health facilities in North Shoa Zone, Amhara, Ethiopia: an unmatched case-control study. BMC Women's Health. 2024; 24(1): 271. |
[27-29]
. The cervical membranes of younger women are immature enough to be susceptible to oncogenic agents which may put the girls at higher risk of contracting STIs more particularly HPV infections. This is resulting uncontrolled epithelial cells proliferation through degrading the host's tumor suppressor genes by HPV's oncogenes
| [1] | Hoffman BL, Schorge JO, Bradshaw KD, Halvorson LM, Schaffer JI, Corton MM. Williams Gynecology, Fourth Edition: McGraw Hill LLC; 2020. |
[1]
. This finding highlights the importance of youth and adolescent health program in health facilities and community advocacy to prevent and delay the early coitharche.
Sexually Transmitted Infections (STIs) represent another significant determinant factor for the development of precancerous cervical lesions among women, as evidenced by this study. Women with a history of STIs were found to have 5.188 times more likely developing precancerous cervical lesions compared to those without such a history. This study finding is consistent with the studies conducted in Uganda, Amhara regional referral hospital and Woliso town
| [16] | Tesfaye B, Tilahun T, Dechasa Heyi W, Oljira R. Associated factors of positive visual inspection of cervix with acetic acid test among women screened for cervical cancer at public health facilities in Woliso town, Southwest Shoa, Ethiopia: A case-control study. SAGE Open Med. 2022; 10: 20503121221108227. |
| [18] | Taye BT, Mihret MS, Muche HA. 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. PLoS One. 2021; 16(3): e0249218. |
| [31] | Mekouzou MGT, Ntsama JAM, Okobalemba EA, Tsopmene MR, Koh VM, Foumane P. Risk Factors of Cervical Cancer in Yaounde: A Case-Control Study: Facteurs de Risque du Cancer du Col à Yaoundé: Une étude Cas-Témoins. HEALTH SCIENCES AND DISEASE. 2024; 25(5). |
[16, 18, 31]
. The possible reason for the association might be due to the fact that infection with the herpes virus was thought to be the initiating event in cervical neoplastic lesion; however, infection with human papillomavirus (HPV) was determined to be the causal agent in the development of cervical neoplastic lesions, with herpes virus and Chlamydia trachomatis likely acting as cofactors ending in cervical neoplastic lesions due to disruption of apoptosis and DNA repair
| [30] | Eilu E, Aliero AA, Odoki M, Tibyangye J, Akinola SA, Ntulume I, et al. Prevalence of cervical intraepithelial neoplasia and its associated factors among women attending healthcare services in Eastern Uganda. Journal of Cancer Research and Experimental Oncology. 2020; 12(1): 1-12. |
[30]
. The findings have implications for the implementation of public health education that may reduce the development of cervical neoplastic lesions such as awareness creation on safe sexual activity and expand safe and highly effective vaccines.
Women who had partners with a history of Sexually Transmitted Infection were also showed
5.324 times more likely higher odds of positive for precancerous cervical lesion compared to the opponents. This finding is in line with study done in Cameroon
| [31] | Mekouzou MGT, Ntsama JAM, Okobalemba EA, Tsopmene MR, Koh VM, Foumane P. Risk Factors of Cervical Cancer in Yaounde: A Case-Control Study: Facteurs de Risque du Cancer du Col à Yaoundé: Une étude Cas-Témoins. HEALTH SCIENCES AND DISEASE. 2024; 25(5). |
[31]
. This evidence also agreed other studies conducted in Gojjam and west Wollega which validating that partner sexually transmitted infections strongly associated with cervical lesions
| [30] | Eilu E, Aliero AA, Odoki M, Tibyangye J, Akinola SA, Ntulume I, et al. Prevalence of cervical intraepithelial neoplasia and its associated factors among women attending healthcare services in Eastern Uganda. Journal of Cancer Research and Experimental Oncology. 2020; 12(1): 1-12. |
| [32] | Getinet M, Taye M, Ayinalem A, Gitie M. Precancerous Lesions of the Cervix and Associated Factors among Women of East Gojjam, Northwest Ethiopia, 2020. Cancer Manag Res. 2021; 13: 9401-10. |
[30, 32]
. This may be due to the direct transmission of the causative agent (HPV) and other STIs causing agents that aggravate the chance of occurring precancerous cervical lesions by the mechanism of epithelial cell cycle disruption
| [33] | Berek JS, Berek DL. Berek & Novak's Gynecology, 16e: Lippincott Williams & Wilkins, a Wolters Kluwer business; 2020. |
[33]
. This implies that the health of partner is important for health of woman.
Moreover, there is a positive association between multiple sexual partner and PCL. The odds of being positive for PCL were 3.389 times higher among women having multiple sexual partners than monogamous women. The result of the current study is comparable with the study conducted in Nigeria, Amhara regional state and Dukem
| [18] | Taye BT, Mihret MS, Muche HA. 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. PLoS One. 2021; 16(3): e0249218. |
| [34] | Lemma TM, Bala ET, Hordofa MA, Solbana LK. Precancerous cervical lesions and associated factors among women on antiretroviral therapy at Dukem Health Center, Central Ethiopia: A cross- sectional study. Health Sci Rep. 2024; 7(3): e1972. |
| [35] | Okunowo AA, Ugwu AO, Ajose AO, Kuku JO, Okunowo BO, Ani-Ugwu NK, et al. Pattern and predictors of cervical epithelial cell abnormalities among unscreened and under-screened women in Lagos, Nigeria: a cross-sectional study. Ecancermedicalscience. 2023; 17: 1504. |
[18, 34, 35]
. The reason for this could be having sex with multiple partners may increase the chance of transmission of HPV, resulting in cervical neoplastic lesions through the mechanism of epithelial cells cycle deregulation
| [36] | Teka T, Kote M, Kejela G, Getachew T. Magnitude and factors associated with precervical cancer among screened women in Southern Ethiopia. Advances in Public Health. 2019; 2019(1): 5049752. |
[36]
. The finding has implications for the implementation of public health education that may reduce the development of cervical neoplastic lesions such as practicing safe sex, avoiding multiple sexual intercourses and encouraging early screening for cervical cancer.
The other determinant was birth history. Women who had history of gave birth 82.1% less likely develop precancerous cervical lesion compared to those women who had not history of gave birth. However, another studies done in west Wollega, and Cameroon showed that having history of gave birth was found to be risk factor compared to having not history of gave birth
| [30] | Eilu E, Aliero AA, Odoki M, Tibyangye J, Akinola SA, Ntulume I, et al. Prevalence of cervical intraepithelial neoplasia and its associated factors among women attending healthcare services in Eastern Uganda. Journal of Cancer Research and Experimental Oncology. 2020; 12(1): 1-12. |
| [37] | Wabo B, Nsagha DS, Nana TN, Assob CJN. Prevalence and risk factors associated with precancerous cervical lesions among women in two cities in Cameroon. Pan Afr Med J. 2022; 41: 276. |
[30, 37]
. The reason for the difference might be the small number of women with history of birth in our study compared to other studies. Because of this conflicting finding, future research with a large sample size in this area might be needed to identify the association between parity and precancerous cervical lesion.
Limitations of the Study
This study is conducted on selected health facilities and is thus difficult to generalize for the general population. Because of the study design was retrospective, there was recall bias. Moreover, there may be social desirability bias since the study assessed the lifestyle and sexual behavior of the participants.
5. Conclusion and Recommendation
5.1. Conclusion
Most of the determinants of precancerous cervical lesions were modifiable and mainly related to women’s socio-demographic related factors, reproductive, clinical and sexual behavior related. Therefore, strengthening awareness on safe sexual practices and healthy life styles through behavioral change communication would decrease the incidence of precancerous cervical lesions.
5.2. Recommendations
For policy makers
The significant determinants of cervical neoplastic lesions were mainly modifiable which leads to cervical HPV infection. In order to prevent cervical neoplastic lesions, the government should prioritize funding for HPV vaccine supply and vaccination, age-appropriate comprehensive sexuality education, advocacy to prevent early marriage, early coitarche, and STIs. The Ministry of health should also expand HPV DNA test and Pap smear screening services. It is important that the government promote poverty elimination and increase universal health access.
For Adama health office
The majority of the variables that predicted precancerous cervical lesions were changeable and mostly connected to the socio-demographic characteristics, sexual habits, and clinically relevant factors of women. Adama health office should strengthen age-and culturally-appropriate sexuality education, along with primary prevention measures like vaccination of girls, regular condom distribution, and screening for people who have a history of multiple sexual partners, low income, widowed women, women who have a history of early marriage, started sexual intercourse at young age, women with a history of STIs, and women with a history of partner/husband STIs.
Health Facilities
The health facilities conduct advocacy meetings at different levels, such as women groups and promote advocacy campaigns at district, village and community levels. The health facilities administer HPV vaccination for eligible girls as per the national immunization schedule. They should encourage community for health promotion and health education to prevent early marriage, and STI. Promoting the health of community by providing sexuality education tailored to age and culture.
For community: Advocate delaying of early marriage to mitigate the preventive and controllable cause of cervical cancer.
For mass media: Prepare consistent mass campaign for cervical cancer screening and diagnosis as it is vital to track the cases early.
For researchers: Further research is needed to identify community awareness in relation to risk factors of precancerous cervical lesions and cervical cancer and importance of cervical cancer screening.
Abbreviations
ACSHMC | Adama Comprehensive and Specialized Hospital Medical College |
ART | Anti Retroviral Therapy VIA- Visual Inspection with Acetic Acid |
CIN | Cervical Intraepithelial Neoplastic COR-Crude Odd Ratio |
DNA | Deoxyribonucleic Acid |
FMOH | Federal Ministry of Health FSW-Female Sexual Worke |
GLOBOCAN | Global Cancer Observatory |
HIV | Human Immunodeficiency Virus |
HPV | Human Papilloma Virus |
IUCD | Intrauterine Contraceptive Device PCL- Precancerous Cervical Lesion |
SNNP | Southern Nation and Nationalities People |
SPSS | Statistical Package for Social Sciences |
SSA | Sub-Saharan Africa |
STI | Sexual Transmitted Infection SVA- Single Visit Approach |
WHO | World Health Organization |
Acknowledgments
First of all, I would like to express my College, Adama Comprehensive Specialized Hospital and Medical College for giving the master’s program chance and effort to make me knowledgeable. I would like to express my sincere gratitude to my advisor, Mr. Ebrahim Mohammed and Dr. Abebe Megerso for their invaluable guidance and support throughout my master’s program. Their expertise and encouragement helped me to complete this research and write this thesis. I would also like to give my warmest thanks to my whole lecturers for their effort to made good profession in public health.
Finally, I would like to give special thanks to my family for continuous support and understanding when writing research.
Author Contributions
Tolosa Lemma: Conceptualization, Data curation, Formal Analysis, Investigation, Methodology, Resources, Software, Supervision, Validation, Visualization, Writing – original draft, Writing – review & editing
Abebe Megerso: Writing –review & editing
Ebrahim mohammed: Writing –review & editing
Legese Lemma: Software, Writing – original draft, Writing – review & editing
Financial Disclosure
All the expense for this original study was covered by principal investigators.
Ethics Approval
Ethical Approval was obtained from Adama hospital medical college, Adama woreda Health Office.
Key Message
Original data is available on request.
Conflicts of Interest
The authors declare that they have no competing interests.
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Lemma, T., Mohammed, E., Megerso, A., Lemma, L. (2025). Determinants of Precancerous Cervical Lesions Among Women Screened for Cervical Cancer at Adama Public Health Facilities, Adama, Ethiopia. American Journal of Laboratory Medicine, 10(5), 91-104. https://doi.org/10.11648/j.ajlm.20251005.11
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Lemma, T.; Mohammed, E.; Megerso, A.; Lemma, L. Determinants of Precancerous Cervical Lesions Among Women Screened for Cervical Cancer at Adama Public Health Facilities, Adama, Ethiopia. Am. J. Lab. Med. 2025, 10(5), 91-104. doi: 10.11648/j.ajlm.20251005.11
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Lemma T, Mohammed E, Megerso A, Lemma L. Determinants of Precancerous Cervical Lesions Among Women Screened for Cervical Cancer at Adama Public Health Facilities, Adama, Ethiopia. Am J Lab Med. 2025;10(5):91-104. doi: 10.11648/j.ajlm.20251005.11
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@article{10.11648/j.ajlm.20251005.11,
author = {Tolosa Lemma and Ebrahim Mohammed and Abebe Megerso and Legese Lemma},
title = {Determinants of Precancerous Cervical Lesions Among Women Screened for Cervical Cancer at Adama Public Health Facilities, Adama, Ethiopia
},
journal = {American Journal of Laboratory Medicine},
volume = {10},
number = {5},
pages = {91-104},
doi = {10.11648/j.ajlm.20251005.11},
url = {https://doi.org/10.11648/j.ajlm.20251005.11},
eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajlm.20251005.11},
abstract = {Introduction: Precancerous cervical lesion is the potential risk factors of invasive cervical cancer. However, factors associated with premalignant cervical lesions remain poorly documented in general population in Adama town. The previous studies had their own methodological gaps which lead to generalizability limitations. Therefore, it is critical to identify the associated factors with precancerous cervical lesions for comprehensive and integrated screening services. Objective: To identify the determinants of precancerous cervical lesions among women screened for cervical cancer at Adama town public health facilities Adama, Oromia, Ethiopia, 2024. Method: Health facility based unmatched case control study design was carried out in selected public health facilities in Adama town. The public health facility participants were selected through simple random sampling techniques. The sample size of cases 84 and control 252 were collected by systematic random sampling. The data were entered and analyzed with Epi info 7.2.6 and SPSS 27. Variables with P-value Result: The median age of the participants was 36 years ± 8 IQR years. This study revealed that the odds of being positive for precancerous cervical lesion were higher among women who were widowed (AOR =10.679, 95% confidence interval CI: 3.049-37.405), with lower family income (AOR =4.662: 95% CI: 1.767-12.302), youngest first marriage age (AOR =5.005: 95% CI: 1.847-13.563), practicing sexual intercourse before age 16 (AOR =11.190: 95% CI: 1.280- 97.867), history of STIs (AOR =5.188: 95% CI: 1.689-15.934), partner history of STIs (AOR=5.324: 95% CI (1.521-18.630) and lifetime multiple sexual partners history (AOR=3.389: 95% CI: 1.438-7.987). Conclusion: Most of the determinants of precancerous cervical lesions were modifiable and mainly related to women’s socio-demographic related factors, reproductive, clinical and sexual behavior related. Therefore, strengthening awareness on safe sexual practices and healthy life styles through behavioral change communication would decrease the incidence of precancerous cervical lesions.
},
year = {2025}
}
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TY - JOUR
T1 - Determinants of Precancerous Cervical Lesions Among Women Screened for Cervical Cancer at Adama Public Health Facilities, Adama, Ethiopia
AU - Tolosa Lemma
AU - Ebrahim Mohammed
AU - Abebe Megerso
AU - Legese Lemma
Y1 - 2025/10/28
PY - 2025
N1 - https://doi.org/10.11648/j.ajlm.20251005.11
DO - 10.11648/j.ajlm.20251005.11
T2 - American Journal of Laboratory Medicine
JF - American Journal of Laboratory Medicine
JO - American Journal of Laboratory Medicine
SP - 91
EP - 104
PB - Science Publishing Group
SN - 2575-386X
UR - https://doi.org/10.11648/j.ajlm.20251005.11
AB - Introduction: Precancerous cervical lesion is the potential risk factors of invasive cervical cancer. However, factors associated with premalignant cervical lesions remain poorly documented in general population in Adama town. The previous studies had their own methodological gaps which lead to generalizability limitations. Therefore, it is critical to identify the associated factors with precancerous cervical lesions for comprehensive and integrated screening services. Objective: To identify the determinants of precancerous cervical lesions among women screened for cervical cancer at Adama town public health facilities Adama, Oromia, Ethiopia, 2024. Method: Health facility based unmatched case control study design was carried out in selected public health facilities in Adama town. The public health facility participants were selected through simple random sampling techniques. The sample size of cases 84 and control 252 were collected by systematic random sampling. The data were entered and analyzed with Epi info 7.2.6 and SPSS 27. Variables with P-value Result: The median age of the participants was 36 years ± 8 IQR years. This study revealed that the odds of being positive for precancerous cervical lesion were higher among women who were widowed (AOR =10.679, 95% confidence interval CI: 3.049-37.405), with lower family income (AOR =4.662: 95% CI: 1.767-12.302), youngest first marriage age (AOR =5.005: 95% CI: 1.847-13.563), practicing sexual intercourse before age 16 (AOR =11.190: 95% CI: 1.280- 97.867), history of STIs (AOR =5.188: 95% CI: 1.689-15.934), partner history of STIs (AOR=5.324: 95% CI (1.521-18.630) and lifetime multiple sexual partners history (AOR=3.389: 95% CI: 1.438-7.987). Conclusion: Most of the determinants of precancerous cervical lesions were modifiable and mainly related to women’s socio-demographic related factors, reproductive, clinical and sexual behavior related. Therefore, strengthening awareness on safe sexual practices and healthy life styles through behavioral change communication would decrease the incidence of precancerous cervical lesions.
VL - 10
IS - 5
ER -
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