Vol. 9(3), pp.

46-50, March 2017

DOI: 10.5897/JPHE2016.0891
Article Number: 394E9DC62810
ISSN 2141-2316
Journal of Public Health and
Copyright © 2017 Epidemiology
Author(s) retain the copyright of this article
http://www.academicjournals.org/JPHE

Full Length Research Paper

Prevalence of precancerous cervical lesion and

associated factors among women in North Ethiopia
Kebede Haile Misgina*, Hailay Seyoum Belay and Teklehaymanot Huluf Abraha
Department of Public Health, College of Health Sciences, Aksum University, Aksum, Ethiopia.
Received 17 November, 2016; Accepted 16 December, 2016

Literature shows that cervical cancer is very prevalent among women living in low resource settings.
Once it progresses to invasive cervical cancer, its cost is very high. Thus, screening cervical cancer is
highly recommended in poor settings including Ethiopia, where the disease burden is very high.
However, little is documented on the prevalence and determinants of precancerous cervical lesion
among healthy women. Thus, this study aimed to assess the prevalence and factors associated with
precancerous cervical lesion among women working in Almeda textile factory, Adwa, North Ethiopia.
An institution-based cross-sectional study was conducted from February 20 to 25, 2016 among women
working in Almeda textile factory in North Ethiopia. Three hundred forty-two women were included in
this study. Data were collected using a structured checklist. SPSS version 20 was used for data entry
and analysis. Logistic regression was used to identify factors associated with the precancerous
cervical lesion. Statistical significance was set at p-value < 0.05. The mean (± SD) age of the
respondents included in this study was 32.95 (± 6.94). In this study, the overall prevalence of
precancerous cervical lesion was 6.7% (95% CI: 4.4, 9.6). Being infected with sexually transmitted
infections [AOR=49.88, 95% CI: (16.59, 149.91)] was significantly associated with the precancerous
cervical lesion. In conclusion, the prevalence of precancerous cervical lesion was high among women
working in Almeda textile factory in North Ethiopia. Therefore, cervical cancer screening and treatment
services should be initiated and expanded to reduce morbidity from cervical cancer and its adverse
effects.

Key words: Precancerous cervical lesion, screening, Ethiopia.

INTRODUCTION

Cervical cancer is caused by certain types of the human systems will eliminate HPV naturally, but if an infection
papillomavirus (HPV), the most common sexually with specific types of HPV associated with cervical
transmitted infection (STI). Almost all sexually active cancer persists, it may lead to precancerous lesions. If
individuals become infected with HPV at some point in left untreated, these lesions may progress to cervical
their lives; the peak time for infection is shortly after cancer (WHO, 2008; Ferlay et al., 2010; Bray et al., 2001;
starting to have sex. Fortunately, most women’s immune Munoz et al., 2004).

*Corresponding author. E-mail: kebede.haile82@gmail.com. Tel: +251919019819.

Author(s) agree that this article remain permanently open access under the terms of the Creative Commons Attribution
License 4.0 International License
 Misgina et al. 47

Cancer is the leading cause of death in economically MATERIALS AND METHODS

developed countries and the second leading cause of
Study setting, population, and sampling
death in developing countries (WHO, 2008; WHO, 2013).
Cervical cancer is the second most common cancer in An institution-based cross-sectional study was conducted from
women. Globally, more than half million (530,000) new February 20 to 25, 2016 among women employee of Almeda textile
cases of cervical cancer occur each year. More than factory, Adwa town. Adwa town is located in the northern part of
eighty-five percent of the cases occur in low-resource Ethiopia between 14012’ North Latitude and 38056’ East Longitude
at a distance of 977 km away from Addis Ababa. According to the
countries like Africa, Latin America and Southeast Asia census 2007 report of Central Statistical Agency of Ethiopia, the
(Ferlay et al., 2010). Sub-Saharan Africa is one of the total population of Adwa town is 40,500, of whom 18,307 are men
most affected regions. The incidence of cervical cancer is and 22,193 are women (CSA [Ethiopia], 2008). Almeda textile
52.8 per 100,000 women in sub-Saharan Africa, whereas factory is one of the biggest factories found in Adwa town, central
the incidence is only 6.8 per 100,000 women in Western zone of Tigray regional state. In Almeda textile factory currently,
countries (Ferlay et al., 2010). The disproportionately there are 4,400 women employees. Women employees who were
screened for precancerous cervical lesion from September 12 to
high burden of cervical cancer in developing countries 20, 2015 as part of the screening campaign made by Family
and elsewhere in medically underserved populations is Guidance Association (FGA) in Almeda textile factory was the
largely due to a lack of screening that allows detection of source population for this study. The precancerous cervical lesion
precancerous and early stage cervical cancer (Parkin et screening campaign was done by trained nurses using VIA. The
al., 2008; Mathew and George, 2009; Vizcaino et al., inclusion criteria for this study were being a female employee of
Almeda textile factory, 25 to 64 years old and being screened for
2000). The most simple, efficient and cost-effective
the precancerous cervical lesion in the screening campaign
screening technique in low-resource countries is visual conducted from September 12 to 20, 2015. Since the total women
inspection using acetic acid (VIA) (Sherris et al., 2009; included in the screening were 342, all the 342 women were eligible
Mvundura and Tsu, 2014), which performs well in and included in this study.
identifying precancerous lesions (Sherris et al., 2009;
Sauvaget et al., 2011). Different studies have Data collection tool and procedure
demonstrated that using VIA, trained physicians and
other health service providers can correctly identify A structured checklist, adapted from the available national medical
between 45 and 79% of women at high risk of developing registers used for similar purpose, was used to collect the data. The
cervical cancer (Sherris et al., 2009). In addition to checklist included selected socio-demographic and reproductive
characteristics. The data were collected by two diploma nurses and
screening, VIA is the lowest-cost option for treating the data collection was entirely supervised by one senior public
precancerous cervical lesion which significantly health professional. Furthermore, the data collection process was
decreases cervical cancer deaths (Mvundura and Tsu, closely monitored by the principal investigators. Both data collectors
2014). and supervisors were trained for two days on the objectives of the
Ethiopia is one of the sub-Saharan Africa countries study, sampling technique, ethical consideration, data collection
tool and techniques of collecting data to maintain precaution
most affected by cervical cancer. According to World
throughout the study. The collected data were checked daily by the
Health Organization (WHO) report, the age-adjusted supervisors and feedback was provided to data collectors when
incidence rate of cervical cancer in Ethiopia is 35.9 per necessary.
100,000 patients with 7619 annual number of new cases
and 6081 deaths every year (WHO/ICO, 2009). Data processing and analysis
Moreover, facility-based studies show that cervical
cancer is the leading cause of cancer in Ethiopia (Aseffa Data were entered, cleaned and analyzed by SPSS version 20
et al., 1986; Ruland et al., 2006) and other studies show statistical package for a window. Descriptive summaries using
that cervical cancer account for 25.8 to 32% of all female frequencies and proportions were used to present the study results.
Multivariable logistic regression was used to identify factors
malignancies (Loutfi and Pickering, 1992; Ashine and associated with the pre-cancerous cervical lesion. Adjusted odds
Lemma, 1999). Despite this fact, very few women receive ratio at 95% confidence interval and p-value were used to measure
screening services in Ethiopia (Waktola et al., 2005). the strength of association and identify statistical significant result.
Information on the prevalence and associated factors of P-value < 0.05 was considered as a statistically significant
precancerous cervical lesion among healthy women are association. Model goodness-of-fit was checked by Hosmer-
Lemeshow test (P=0.56). Multicollinearity was checked by VIF.
urgently needed to convince concerned bodies for
prioritizing, designing and initiating cervical cancer
screening programs aimed at improving maternal health. Ethical considerations
However, there is no study that documented the
prevalence and associated factors of precancerous Ethical clearance and official letter were obtained from Aksum
cervical lesion among healthy women in the study area. University College of Health Sciences and Tigray Regional Health
Bureau. Permission letter was then received from Family Guidance
Therefore, it is believed that this study will help health Association (FGA). As this study used secondary data, informed
planners to plan appropriate screening and treatment consent from individual women was not relevant and feasible.
strategies, to prevent cervical cancer mortality and Names and code numbers were not included in the study so as to
morbidity. ensure confidentiality.
48 J. Public Health Epidemiol.

Table 1. Selected socio-demographic and reproductive characteristics of women

working in Almeda textile factory, Adwa, North Ethiopia, 2015.

Variables Number (n) Percent (%)

Age
<35 218 63.7
≥35 124 36.3

Marital status
Married 233 68.1
Single 109 31.9

Educational status
Primary 83 24.3
Secondary and above 259 75.7

Parity
<4 299 87.4
≥4 43 12.6

History of STI
Yes 82 24.0
No 260 76.0

Current STI status

Positive 36 10.5
Negative 306 89.5

PITC (provider-initiated HIV testing and

counselling) test result
Positive 16 4.7
Negative 326 95.3

RESULTS Prevalence of precancerous cervical lesion and

associated factors

Characteristics of the study participants Out of 342 screened women, 23 (6.7%) [95% CI: 4.4, 9.6]
were found to be positive for a precancerous cervical
The mean (±SD) age of the respondents included in this lesion. In the determination of factors associated with the
study was 32.95 (±6.94). The minimum and maximum prevalence of precancerous cervical lesion, a
ages were 24 and 56 years, respectively. The majority multivariable logistic regression model was fitted using
(68.1%) of the study participants were married. More than enter method and STI status was the only variable found
three fourth of the study participants were secondary and to have a significant association with the outcome
above by educational level. Regarding the reproductive variable. That is, study participants who were infected
characteristics, the median parity was 2 and the range of with STIs during the cervical cancer screening campaign
parity was 7 with minimum and maximum parities of 0 were nearly 50 times more likely to have precancerous
and 7, respectively. cervical lesion as compared to their counterparts
The majority of the study participants had a total parity [AOR=49.88 (95% CI: 16.59, 149.91)] (Table 2).
of less than four. Of the total study participants, 82 (24%)
had history of STI and 36 (10.5%) had a STI during the
date of data collection. Sixteen (4.7%) of the study DISCUSSION
participants were living with human immune deficiency
virus/acquired immune deficiency syndrome (HIV/AIDS) This study assessed the prevalence of precancerous
(Table 1). cervical lesion among women employee of Almeda
 Misgina et al. 49

Table 2. Logistic regression analysis of factors associated with precancerous cervical lesion among women working in Almeda
textile factory, North Ethiopia, 2015.

Precancerous cervical lesion

screening result
Characteristics COR (95% CI) AOR (95% CI)
Positive Negative
N (%) N (%)
Age
<35 17 (73.9) 201 (63.0) 1.66 (0.64,4.34) 1.63 (0.43, 6.22)
>35 6 (26.1) 118 (37.0) 1 1

Marital status
Married 19 (82.6) 214 (67.1) 2.33 (0.77,7.02) 2.63 (0.68, 10.15)
Single 4 (17.4) 105 (32.9) 1 1

Educational status
Primary 5 (21.7) 78 (24.5) 0.86 (0.31,2.39) 1.21 (0.29, 5.10)
Secondary and above 18 (78.3) 241 (75.5) 1 1

Parity
<4 20 (87.0) 279 (87.5) 0.96 (0.27,3.36) 0.86 (0.13, 5.59)
>4 3 (13.0) 40 (12.5) 1 1

History of STI
Yes 8 (34.8) 74 (23.2) 1.77 (0.72,4.33) 1.16 ( 0.34, 3.97)
No 15(65.2) 245 (76.8) 1 1

Current STI status

Positive 17 (73.9) 19 (6.0) 44.74 (15.82,126.55) 49.88 (16.59,149.91)
Negative 6 (26.1) 300 (94.0) 1 1

PITC test
Positive 1 (4.3) 15 (4.7) 0.92 (0.12,7.30) 0.29 (0.02, 3.61)
Negative 22 (95.7) 304 (95.3) 1 1

Textile factory, North Ethiopia. Results of this study could significantly avert the progress of precancerous
showed that the prevalence of precancerous cervical cervical lesion to invasive cervical cancer among women.
lesion was 6.7% [95% CI: 4.4, 9.6]. This finding is in line However, none of the study participants were ever
with the study conducted in Rwanda (Makuza et al., screened for precancerous cervical lesion before this
2015), in which the prevalence was 5.9%. However, the study conducted. This would let the precancerous lesion
finding of the current study is lower than the study done progress to invasive cancer which is very costly. This
among HIV-infected women in Southern Ethiopia by results in high cost due to the progress of precancerous
Gedefaw et al. (2013) , in which the prevalence was lesion to invasive cancer (Mvundura and Tsu, 2014).
22.1%. Similarly, it is lower than the study done among This study also assessed factors associated with
HIV-infected women in Kenya by Memiah et al. (2012), in precancerous cervical lesion among the study participants
which the prevalence was 26.7%. This discrepancy may and the findings revealed that women who were infected
be due to the difference in the study population. In the with sexually transmitted diseases were more likely to
present study, the participants were not in HIV infected develop precancerous cervical lesion than their
population, whereas the two studies were carried out in counterparts. This finding is consistent with the finding of
HIV infected population who are at a higher risk of a similar study done in Southern Ethiopia (Gedefaw et al.,
developing cervical cancer (Frisch et al., 2000; De Vuyst 2013), in which women who had a history of STIs were
et al., 2008). This finding suggests the need to access more likely to develop precancerous as well as invasive
community-based precancerous cervical lesion screening cervical cancer lesion than their counterparts. This finding
service integrated with health system by referral which implies that cervical cancer screening service should
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