Abnormal Cervical Lesions and Its Associated Factors Using Visual Inspection With Acetic Acid (VIA) at a Referral Hospital in Ethiopia

Abstract

Background: Ethiopia has over 29 million women aged 15 years and older who are at risk for developing cervical cancer. Aim: To provide prevalence of precancerous cervical lesions and its associated factors among women visiting gynecology department of Felege Hiwot referral Hospital (FHRH). Methods: A cross sectional study was conducted from December 2016 to June 2017 on 428 women who were seeking medical service in FHRH. Relevant sociodemographic data were collected using structured questionnaire. Clients were screened for abnormal cervical presentation by physicians and those with indicative clinical presentations were recruited for visual inspection using 5% acetic acid (VIA) as per cervical cancer prevention guideline for low-resource settings. The screening result was documented based on the national VIA screening record format as; 'No acithowhite lesion', 'Acithowhite lesion eligible for cryo', 'Acithowhite lesion non eligible for cryo' or 'Suspicious for cancer'. Data were analyzed using SPSS v23. Statistical significance was set at P value < 0.05. Results: Most of the participants, 270 (63.1%), 296 (69.2%), 379 (88.6%), 247 (57.7%) and 194 (45.3%) were from urban settings, married, fertile, used long term contraceptive and HIV-positive, respectively. Similarly, the majority, 242 (56.5%) were in the age group of 39-49 years with the median age at 35.0 years. Furthermore, 167 (39.0%) and 5 (1.2%) participants reported as they experienced STI ever and practiced tobacco smoking, respectively. The median age during first sex was at 16 years. On top of this, more than half of the participants at 268 (62.6%) exercised multiple sexual partner (i.e., two and more). Majority of the screened clients at 367 (85.7%) were negative for precancerous lesions. The rest, at 61 (14.3%) had abnormal cervical lesion of which some 23% (14/61) were suspicious for cervical cancer. Among VIA positive participants, 75.4% (46/61) were eligible for cryotherapy and got the treatment. The odds of having VIA positive result was lower by 24% among women engaged in private business than government employees [adjusted OR: 0.24, 95% CI (0.07-0.85)]. The other variables tested in the model didn't show statistical association ( P value > 0.05) with VIA positive result. Conclusion: The observed VIA screening result calls stakeholders to strengthen the primary cervical cancer prevention strategies in the studied area.