Department of Medical Microbiology, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
PLoS One. 2022 Sep 12;17(9):e0274466. doi: 10.1371/journal.pone.0274466. eCollection 2022.
Cervical cancer is an important public health problem in Ethiopia. However, the disease is not well characterized and studied in various parts of the country. This study was designed to describe the histopathological profile of cervical biopsies and to identify risk factors associated with high-grade cervical lesions and cancer (CIN2+C).
A cross-sectional study was conducted at Felege Hiwot Compressive Specialized Hospital (FHCSH) between 1 March 2019 and 30 October 2021. A structured questionnaire was used to collect data on the participants' demographic, reproductive and gynecologic history. From women presented with different degrees of cervical lesions, a senior gynecologist collected cervical swabs using (Digene HC2 DNA collection device: Qiagen, Hilden, Germany) for detection of high-risk Human papillomaviruses (HR-HPV) and punch biopsy for histopathological examinations. HR-HPVs were detected using the Abbott Alinity m system following the manufacturer protocol at the Institute of Virology, Leipzig University Hospital, Germany. Collected data entered and analyzed using SPSS version 25. A logistic regression model was used for both bivariable & multivariable analysis in order to determine the association between independent variables and CIN2+C. Statistical significance was set at a p-value <0.05.
In this study, 335 women were included; the mean age was at 46.5±11.4 years. Most were living in rural settings, 221(66%) and had no formal education, 259 (77.3%). More than half of the participants, 193(57.6%) were unaware of cervical cancer. The prevalence of HIV infection and previous history of cervical screening were 44(13.1%) and 93(27.8%), respectively. HR-HPVs were detected in 178(54.3%) of the participants. The majority of biopsies, 140(41.8%; 95%CI: 36.6-47.1%), were diagnosed as cervical carcinoma. Normal histology, cervicitis, cervical intraepithelial neoplasia (CIN)-1, CIN-2, and CIN-3 accounted for 74(22.1%), 30(9.0%), 40(11.9%), 12(3.6%), and 12(3.6%), respectively. High-grade lesions and cancer (CIN2+C) together accounted 164(49.0%; 95%CI: 43.6-54.2). Cervical cancer increased steadily with the age of the participants (p<0.001) in which women above the age of fifty were approximately four times more likely to develop CIN2+C than the younger ones (AOR: 3.73; 95%CI: 1.80-7.82; p<0.001). Likewise, no screening history in the last five years (AOR: 2.03; 95%CI: 1.05-3.92; p = 0.035) and being infected with HR-HPVs (AOR: 14.23; 95%CI: 7.9-25.64; p<0.001) were found significantly associated with CIN2+C.
The findings of this study revealed that cervical cancer continues to be an important women's health challenge in northwest Ethiopia. Postmenopausal women, who had no screening history within a five-year period and those women who tested positive for HR-HPV need special attention. It is important to increase the awareness of women about cervical cancer and actions for early detection of precancerous lesions should be expanded.
宫颈癌是埃塞俄比亚一个重要的公共卫生问题。然而，该国各地对该疾病的特征和研究并不充分。本研究旨在描述宫颈活检的组织病理学特征，并确定与高级别宫颈病变和癌症（CIN2+C）相关的风险因素。
本研究于 2019 年 3 月 1 日至 2021 年 10 月 30 日在 Felege Hiwot 综合专科医院（FHCSH）进行了一项横断面研究。使用结构化问卷收集参与者的人口统计学、生殖和妇科病史数据。从患有不同程度宫颈病变的女性中，一名高级妇科医生使用（Digene HC2 DNA 采集装置：Qiagen，Hilden，德国）收集宫颈拭子，用于检测高危型人乳头瘤病毒（HR-HPV），并进行活检进行组织病理学检查。在德国莱比锡大学医院的病毒学研究所，按照制造商的方案，使用 Abbott Alinity m 系统检测 HR-HPV。使用 SPSS 版本 25 输入和分析收集的数据。使用二变量和多变量分析的逻辑回归模型来确定独立变量与 CIN2+C 之间的关联。设定统计学显著性水平为 p 值<0.05。
本研究纳入了 335 名女性，平均年龄为 46.5±11.4 岁。大多数人居住在农村地区（221 人，66%），没有接受过正规教育（259 人，77.3%）。超过一半的参与者（193 人，57.6%）不知道宫颈癌。HIV 感染和之前的宫颈筛查史的患病率分别为 44 人（13.1%）和 93 人（27.8%）。在 178 名参与者（54.3%）中检测到 HR-HPV。大多数活检（140 人，41.8%；95%CI：36.6-47.1%）被诊断为宫颈癌。正常组织学、宫颈炎、宫颈上皮内瘤变（CIN）-1、CIN-2 和 CIN-3分别占 74 人（22.1%）、30 人（9.0%）、40 人（11.9%）、12 人（3.6%）和 12 人（3.6%）。高级别病变和癌症（CIN2+C）合计占 164 人（49.0%；95%CI：43.6-54.2%）。宫颈癌随着参与者年龄的增长而稳步增加（p<0.001），年龄在五十岁以上的女性发生 CIN2+C 的可能性是年轻女性的四倍左右（AOR：3.73；95%CI：1.80-7.82；p<0.001）。同样，在过去五年内没有进行筛查（AOR：2.03；95%CI：1.05-3.92；p = 0.035）和感染 HR-HPV（AOR：14.23；95%CI：7.9-25.64；p<0.001）与 CIN2+C 显著相关。
本研究结果表明，宫颈癌仍然是埃塞俄比亚西北部妇女健康的一个重要挑战。绝经后妇女、在过去五年内没有进行筛查的妇女以及 HR-HPV 检测阳性的妇女需要特别关注。提高妇女对宫颈癌的认识，并扩大对癌前病变的早期检测行动非常重要。
