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

Abstract

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.

Risk factors of cervical cancer and role of primary healthcare providers regarding PAP smears counseling: Case control study

“…The knowledge was better than the study of Minhas et al 13 , this study revealed 3% knowledge about cervical cancer screening among females of Punjab, Pakistan. On the contrary Ozcan H et al; 23 revealed that 48.6% Turkstat had knowledge of screening of CA cervix and 16.2% received this knowledge from healthcare provider. Regrettably; PAP smear testing has not been implemented properly in Pakistan.…”

Early-onset of sexual activity as a potential risk of cervical cancer in Africa: A review of literature

“…This study was restricted to African countries because the sexual behavior of this population was varied from developed regions and other parts of the world (for instance developed countries have late age at first sexual intercourse [ 35 , 36 ] and the study site was therefore excluded from this analysis. Besides, early marriage is a culture and commonly practiced in the African population which has a relation with the development of cervical cancer [ 15 ].…”

“…Interestingly, the available literature consistently showed age is another risk factor for developing cervical cancer since cervical cancer occurs mainly after the middle life of women [ 15 , 25 , 26 ]. However, there has been some conflicting findings in the literature about whether early sexual intercourse is linked to cervical cancer [ 27 ].…”

Association between HIV serostatus and premalignant cervical lesions among women attending a cervical cancer screening clinic at a tertiary care facility in southwestern Uganda: a comparative cross-sectional study

“…Increased access to antiretroviral therapy (ART) has increased the life expectancy of women living with HIV, but many remain susceptible to high-risk HPV infection, persistence, cervical lesion incidence and progression to carcinoma of the cervix (24). The association between HIV and premalignant cervical lesions is moderated by several other factors, such as early age of rst sexual debut, multiple sexual partners, previous history of sexually transmitted infections (e.g., chlamydia infections), level of education, oral contraceptive use, multiparity, smoking and low body mass index (25)(26)(27)(28).…”