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

Hirut Teame, Adamu Addissie, Wondimu Ayele, Selamawit Hirpa, Alem Gebremariam, Gdiom Gebreheat, Ahmedin Jemal, Hirut Teame, Adamu Addissie, Wondimu Ayele, Selamawit Hirpa, Alem Gebremariam, Gdiom Gebreheat, Ahmedin Jemal

Abstract

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.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

References

    1. Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, et al. GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer; 2013. Available from: , accessed on 08/11/2017. 2013.
    1. Sankaranarayanan R, Wesle RS. A Practical Manual on Visual Screening for Cervical Neoplasia. accessed from on July 20, 2017. International Agency for Research on Cancer; Lyon, France: 2003.
    1. Botelho MC, Alves H, Richter J. Estrogen catechols detection as biomarkers in schistosomiasis induced cancer and infertility. Lett Drug Des Discov. 2017;14(2):135–8. . Pubmed Central PMCID: PMC5179139. Epub 2016/12/27. eng.
    1. Pathfinder international. Single-Visit Approach to Cervical Cancer Prevention. Clinical Standards of Practice and Counseling Guidelines. May 2012.
    1. Shiferaw N, Salvador-Davila G, Kassahun K, Brooks MI, Weldegebreal T, Tilahun Y, et al. The Single-Visit Approach as a Cervical Cancer Prevention Strategy Among Women With HIV in Ethiopia: Successes and Lessons Learned. Global health, science and practice. 2016. March;4(1):87–98. doi: . Pubmed Central PMCID: PMC4807751. Epub 2016/03/27. eng.
    1. World Health Organization. WHO Guidelines for Screening and Treatment of Precancerous Lesions for Cervical Cancer Prevention. Geneva: World Health Organization; 2013. accessed on October 20, 2017 from:
    1. Federal Democratic Republic of Ethiopia Ministry of Health. Guideline for Cervical Cancer Prevention and Control in Ethiopia, January 2015 (unpublished document).
    1. Tefera F, Mitiku I. Uptake of Cervical Cancer Screening and Associated Factors Among 15-49-Year-Old Women in Dessie Town, Northeast Ethiopia. Journal of cancer education: the official journal of the American Association for Cancer Education. 2016. April 13 doi: . Epub 2016/04/15. eng.
    1. Bayu H, Berhe Y, Mulat A, Alemu A. Cervical Cancer Screening Service Uptake and Associated Factors among Age Eligible Women in Mekelle Zone, Northern Ethiopia, 2015: A Community Based Study Using Health Belief Model. PloS one. 2016;11(3):e0149908 doi: . Pubmed Central PMCID: PMC4786115. Epub 2016/03/11. eng.
    1. Mitiku I, Tefera F. Knowledge about Cervical Cancer and Associated Factors among 15–49 Year Old Women in Dessie Town, Northeast Ethiopia. PloS one. 2016;11(9):e0163136 doi: . Pubmed Central PMCID: PMC5045174. Epub 2016/10/01. eng.
    1. Bezabih M, Tessema F, Sengi H, Deribew A. Risk Factors Associated with Invasive Cervical Carcinoma among Women Attending Jimma University Specialized Hospital, Southwest Ethiopia: A Case Control Study. Ethiopian journal of health sciences. 2015. October;25(4):345–52. . Pubmed Central PMCID: PMC4762973. Epub 2016/03/08. eng.
    1. Belete N, Tsige Y, Mellie H. Willingness and acceptability of cervical cancer screening among women living with HIV/AIDS in Addis Ababa, Ethiopia: a cross sectional study. Gynecologic oncology research and practice. 2015;2:6 doi: . Pubmed Central PMCID: PMC4881166. Epub 2015/01/01. eng.
    1. Getahun F, Mazengia F, Abuhay M, Birhanu Z. Comprehensive knowledge about cervical cancer is low among women in Northwest Ethiopia. BMC cancer. 2013. January 02;13:2 doi: . Pubmed Central PMCID: PMC3559275. Epub 2013/01/04. eng.
    1. Dulla D, Daka D, Wakgari N. Knowledge about cervical cancer screening and its practice among female health care workers in southern Ethiopia: a cross-sectional study. International journal of women's health. 2017;9:365–72. doi: . Pubmed Central PMCID: PMC5446960. Epub 2017/06/06. eng.
    1. Wondimu YT. Cervical cancer: assessment of diagnosis and treatment facilities in public health institutions in Addis Ababa, Ethiopia. Ethiopian medical journal. 2015. April;53(2):65–74. . Epub 2015/11/26. eng.
    1. Getinet M, Gelaw B, Sisay A, Mahmoud EA, Assefa A. Prevalence and predictors of Pap smear cervical epithelial cell abnormality among HIV-positive and negative women attending gynecological examination in cervical cancer screening center at Debre Markos referral hospital, East Gojjam, Northwest Ethiopia. BMC clinical pathology. 2015;15:16 doi: . Pubmed Central PMCID: PMC4579834. Epub 2015/09/25. eng.
    1. Gedefaw A, Astatkie A, Tessema GA. The prevalence of precancerous cervical cancer lesion among HIV-infected women in southern Ethiopia: a cross-sectional study. PloS one. 2013;8(12):e84519 doi: . Pubmed Central PMCID: PMC3869839. Epub 2014/01/01. eng.
    1. Leyh-Bannurah SR, Prugger C, de Koning MN, Goette H, Lelle RJ. Cervical human papillomavirus prevalence and genotype distribution among hybrid capture 2 positive women 15 to 64 years of age in the Gurage zone, rural Ethiopia. Infectious agents and cancer. 2014;9(1):33 doi: . Pubmed Central PMCID: PMC4197284. Epub 2014/10/17. eng.
    1. Gessesse Z, Tadesse Z, Alemayehu M, Hiruye A, Getachew Y, Derbew M, et al. Determinant factors of Visual Inspection with Acetic Acid (VIA) positive lesions among hiv positive women in mekelle hospital, northern ethiopia: a case control study. Ethiopian medical journal. 2015. July;Suppl 2:17–24. . Epub 2015/11/26. eng.
    1. Federal Democratic Republic of Ethiopia Ministry of Health. Health Sector Development Programme IV 2010/11–2014/15, final draft. 2010.
    1. Central Statistical Agency [Ethiopia], ICF International. Ethiopia Demographic and Health Survey 2011. Addis Ababa, Ethiopia and Calverton, Maryland, USA: Central Statistical Agency and ICF International; 2012.
    1. Deksissa ZM, Tesfamichael FA, Ferede HA. Prevalence and factors associated with VIA positive result among clients screened at Family Guidance Association of Ethiopia, south west area office, Jimma model clinic, Jimma, Ethiopia 2013: a cross-sectional study. BMC research notes. 2015. October 29;8:618 doi: . Pubmed Central PMCID: PMC4627428. Epub 2015/10/31. eng.
    1. Tekola F, Bull S, Farsides B, Newport MJ, Adeyemo A, Rotimi CN, et al. Impact of social stigma on the process of obtaining infrmed consent for genetic research on podoconiosis: a qualitative study. BMC Medical Ethics. 2009;10(13).
    1. Addissie A, Abay S, Feleke Y, Newport M, Farsides B, Davey G. Cluster randomized trial assessing the effects of rapid ethical assessment on informed consent comprehension in a low-resource setting. BMC Medical Ethics. 2016;17(40).
    1. Abate SM, Trends of Cervical Cancer in Ethiopia. Cervical Cancer: Open Access. 2015;1(103).
    1. Jean D., Sabin N., Marie A., Lydia E., Joseph N., David J. Prevalence and risk factors for cervical cancer and pre-cancerous lesions in Rwanda. Pan African Medical Journal. 2015;22(26).
    1. Fitzmaurice C, Allen C, Barber RM, Barregard L, Bhutta ZA, Brenner H, et al. Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life-years for 32 Cancer Groups, 1990 to 2015: A Systematic Analysis for the Global Burden of Disease Study. JAMA oncology. 2017. April 01;3(4):524–48. Epub 2016/12/06. eng. doi:
    1. Nesrin R., Nezihe K., Dilek K. Risk Factors for Cervical Cancer: Results from a Hospital-Based Case-Control Study. International Journal of Hematology and Oncology. 2011;21(3).
    1. Vere michael. Risk Factors for Cervical Precancer Lesions among Women Attending Cervical Cancer Screening Clinics in Harare; University of Zimbabwe; August 2013 accessed on October 20, 2017 from:
    1. Gedefaw A. Astatkie A. Tessema GA. The Prevalence of Precancerous Cervical Cancer Lesion among HIV-Infected Women in Southern Ethiopia: A Cross-Sectional Study. PLoS ONE. 2013;8(12).
    1. Williamson Anna-Lise. The Interaction between Human Immunodeficiency Virus and Human Papillomaviruses in Heterosexuals in Africa Journal of Clinical Medicine. 2015;4:579–92. doi:
    1. Trufelli DC, Matos LL, Santi PX, Del Giglio A. Adjuvant treatment delay in breast cancer patients. Rev Assoc Med Bras (1992). 2015. Sep-Oct;61(5):411–6. doi: . Epub 2015/11/26. eng.
    1. Dam J, Ismail Z, Kurebwa T, Gangat N, Harmse L, Marques HM, et al. Synthesis of copper and zinc 2-(pyridin-2-yl)imidazo[1,2-a]pyridine complexes and their potential anticancer activity. European journal of medicinal chemistry. 2017. January 27;126:353–68. doi: . Epub 2016/12/03. eng.
    1. Ethiopia Human Papillomavirus and Related Cancers,Fact Sheet 2014. ICO Information Centre on HPV and Cancer; December 15, 2014

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