Department of Midwifery, College of Medicine and Health Sciences, Debre Birhan University, Debre Birhan, Ethiopia.
Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
PLoS One. 2021 Mar 26;16(3):e0249218. doi: 10.1371/journal.pone.0249218. eCollection 2021.
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.
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.
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.
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.
宫颈癌仍然是包括埃塞俄比亚在内的中低收入国家面临的主要公共卫生挑战之一。关于埃塞俄比亚女性社会人口特征和体重指数对癌前宫颈病变发展的影响，证据有限。因此，本研究旨在确定在阿姆哈拉州立地区为宫颈癌筛查就诊的妇女中，癌前宫颈病变的危险因素。
这是一项 2019 年 12 月 22 日至 2020 年 4 月 8 日期间在阿姆哈拉州立地区的 200 名妇女中进行的基于医院的病例对照研究，包括 67 名醋酸视觉检查（VIA）阳性妇女（即病例）和 133 名醋酸视觉检查（VIA）阴性妇女（即对照）。该研究在阿姆哈拉州立地区随机选择的转诊医院进行。数据主要通过面对面访谈和使用结构化问卷和检查表分别进行病历回顾收集。然后将数据输入到 EpiData 版本 4.6 并导出到 SPSS 版本 25 进行分析。拟合二项逻辑回归模型，在双变量逻辑回归分析中 p 值<0.2 的变量为多变量分析的候选变量。基于调整后的优势比（AOR）和 95%置信区间（CI），声称具有统计学意义的水平为 p 值≤0.05。
本研究表明，体重指数（BMI）<18.5kg/m2（AOR=3.83；95%CI：1.26，8.76）、初次性交年龄较早（AOR=3.15；95%CI：1.50，11.49）、使用口服避孕药史（AOR=2.74；95%CI：1.6，7.4）、终生性传播感染（AOR=3.73；95%CI：2.5，12.28）和多个性伴侣（AOR=3.23；95%CI：1.82，9.29）的妇女，发生癌前宫颈病变的几率更高。另一方面，参与者 BMI≥25kg/m2（AOR=0.46；95%CI：0.36，0.75）和大学及以上学历（AOR=0.29；95%CI：0.23，0.77）被确定为癌前宫颈病变的保护因素。
大多数癌前宫颈病变的决定因素是可以改变的，主要与妇女的社会人口特征、性行为和体重指数有关。因此，通过信息、教育和交流（IEC）以及行为改变交流（BCC）加强对安全性行为和健康生活方式的认识，将降低癌前宫颈病变的发生率。
