Characteristics of Study Participants
Mean age of participants was 38 years (SD=±9) and ranging from 21-65. Forty-two percent (n=188) of women fell between 31-40 years of age. Only two participants were above 60 years of age. Three hundred thirty-three (74.3%) were married. One hundred ninety-four (44.5%) had sexual debut at age 10-17 years old. Thirty-nine (8.8%) were primigravida, 339(74.1%) multigravida, and 163(38.3%) had two or / more lifetime partners. Seventy-eight (17.7%) had history of STIs and 47(10.8%) were HIV patients on ART follow -up at Jimma University’s TB-HIV clinic (Table 1).
Table 1: Abnormal intraepithelial lesion by LBC, by demographic characteristic, Jimma, 2018.
Characteristics
|
N (%)
|
Liquid based cytology (LBC) Result
|
NILM
|
LSIL
|
HSIL
|
n(%)
|
n(%)
|
n(%)
|
Age
|
21-30
|
105(25.06)
|
97 (92.38)
|
8 (7.62)
|
0(0.00)
|
31-40
|
179(42.72)
|
144(80.45)
|
30(16.76)
|
5(2.79)
|
41-50
|
102(24.34)
|
53(51.96)
|
39(38.24)
|
10(9.80)
|
51-60
|
31(7.40)
|
11(35.48)
|
18(58.06)
|
2(6.45)
|
>=61
|
2(0.48)
|
0(0.00)
|
2(100.00)
|
0(0.00)
|
Occupation
|
Government worker
|
159(38.8)
|
100(62.89)
|
46(28.93)
|
13(8.18)
|
Merchant
|
30(7.3)
|
25(83.33)
|
4(13.33)
|
1(3.33)
|
Student
|
11(2.7)
|
10(90.91)
|
1(9.09)
|
0(0.0)
|
House wife
|
164(40.1)
|
127(77.44)
|
34(20.73)
|
3(1.83)
|
Other
|
45(11)
|
36(80.00
|
9(20.00)
|
0(0.00)
|
Educational Status
|
Illiterate
|
84(20.14)
|
57(67.86)
|
26(30.95)
|
1(1.19)
|
Primary
|
110(26.38)
|
91(82.73)
|
15(13.64)
|
4(3.64)
|
Secondary
|
91(21.82)
|
66(72.53)
|
23(25.27)
|
2(2.20)
|
University
|
132(31.65)
|
90(68.18)
|
32(24.24)
|
10(7.58)
|
Marital Status
|
Married
|
313(74.88)
|
240(76.68)
|
62(19.81)
|
11(3.51)
|
Single
|
23(5.50)
|
20(86.96)
|
3(13.04)
|
0(0.00)
|
Divorced
|
28(6.70)
|
22(78.57)
|
5(17.86)
|
1(3.57)
|
Other
|
54(12.92
|
23(42.59)
|
26(48.15)
|
5(9.26)
|
Parity
|
Nulligravida
|
34 (8.17)
|
29(85.29)
|
3(8.82)
|
2(5.88)
|
Primigravida
|
70 (16.83)
|
55 (78.57)
|
13 (18.57)
|
2 (2.86)
|
Multigravida
|
312 (75.00)
|
219 (70.19)
|
80 (25.64)
|
13 (4.17)
|
Menstrual Bleeding Pattern
|
Irregular
|
151(37.1)
|
131(86.75)
|
18(11.92)
|
2(1.32)
|
Regular
|
120(29.48)
|
111(92.50)
|
9(7.50 )
|
0(0.00)
|
Menopause
|
136(33.42)
|
53(38.97)
|
68(50.00)
|
15(11.03)
|
Postcoital bleeding
|
No
|
377(93.32)
|
268(71.09)
|
92(24.40)
|
17(4.51)
|
Yes
|
27(6.68)
|
24(88.89)
|
3(11.11)
|
0(0.00)
|
Age of first sexual intercourse
|
10-17
|
183(44.74)
|
132(72.13)
|
45(24.59)
|
6(3.28)
|
>=18
|
226 (55.26)
|
166(73.45)
|
49(21.68)
|
11(4.87)
|
Use of contraceptive
|
No
|
305(73.14)
|
203(66.56)
|
87(28.52)
|
15(4.92)
|
Yes
|
112(26.86)
|
100(89.29)
|
10(8.93)
|
2(1.79)
|
Current sexual partner
|
No
|
138(33.17)
|
87(63.04)
|
43(31.16)
|
8(5.80)
|
Yes
|
278(66.83)
|
216(77.700
|
53(19.06)
|
9(3.24)
|
Condom use during sexual intercourse
|
No
|
392(94.23)
|
282(71.94)
|
95(24.23)
|
15(3.83)
|
Yes
|
24(5.77)
|
21(87.50)
|
1(4.17)
|
2(8.33)
|
Alcohol use
|
No
|
384(93.20)
|
276(71.88)
|
91(23.70)
|
17(4.43)
|
Yes
|
28(6.80)
|
24(85.71)
|
4(14.29)
|
0(0)
|
Smoking
|
No
|
417(99.52)
|
303(72.66)
|
97(23.26)
|
17(4.08)
|
Yes
|
2(0.48)
|
2(100)
|
0(0.00)
|
0(0.00)
|
Chronic corticosteroid use
|
No
|
396(96.82)
|
292(73.74)
|
87(21.97)
|
17 (4.29
|
Yes
|
13(3.18)
|
6(46.15
|
7(53.85)
|
0(0.00)
|
Number of life time sexual partner
|
1
|
247(61.75)
|
174(70.45)
|
63(25.51)
|
10(4.05)
|
>=2
|
153(38.25)
|
116(75.82)
|
30(19.610
|
7(4.58)
|
History of sexually transmitted diseases
|
No
|
339(82.48)
|
246(72.57)
|
80(23.60)
|
13(3.83)
|
Yes
|
72(17.52)
|
53(73.61)
|
16(22.22)
|
3(4.17)
|
HIV status
|
Non-reactive
|
135(33.09)
|
104(77.04)
|
26(19.26)
|
5(3.70)
|
Reactive
|
43(10.54)
|
29(67.44)
|
10(23.26)
|
4(9.30)
|
Unknown
|
230(56.37)
|
163(70.87)
|
59(25.65)
|
8(3.48)
|
Family history of cancer
|
No
|
350(94.85)
|
254(72.57)
|
80(22.86)
|
16(4.57)
|
Yes
|
19(5.15)
|
14(73.68)
|
5(26.32)
|
0(0.00)
|
Pelvic examination
|
Abnormal
|
7(1.78)
|
5(71.43)
|
1(14.29)
|
1(14.29)
|
Normal
|
386(98.22)
|
284(73.58)
|
86(22.28)
|
16(4.15)
|
SCJ visible
|
No
|
120(33.06)
|
60(50.00)
|
47(39.17)
|
13(10.83)
|
Yes
|
243(66.94)
|
207(85.19)
|
32(13.17)
|
4(1.65)
|
Intraepithelial Lesion Screening by LBC and VIA
Of 448 participating women, 28(6.3%) were missing LBC results, 1(0.22%) had inadequate sample. The remaining 419(93.5%) women had LBC results, 294(65.6%) had VIA results and 272(60.7%) had both LBC and VIA results.
Among women screened using LBC, 305(72.8%) were negative for intraepithelial lesion or malignancy (NILM), 97(23.2%) had LSIL and 17(4.1%) had HSIL. No ASC-US, ASC-H or squamous carcinoma was present. Cervical lesions, either LSIL or HSIL was present in 114 (27.2%) women. Presence of cervical lesions were generally lower in younger and older aged women compared to middle aged women. Among women with cervical lesions, 8 (7%) were below the age of 31 and 2(1.75%) were over 60. Of the remaining women, 70(30.7%) were 31-40, 49(43%) were 41-50, and 20(17.54%) were 51-60 years. Thirty-nine (40%) of the women with LSIL and 10(59%) with HSIL were between the 41-50 years of age. Among the 419 women tested using LBC, 120(33.1%) women had invisible SCJ during examination. Of these, 60(50%) had either LSIL or HSIL [Table 1].
Two hundred seventy-two (60.7%) women were screened using both LBC and VIA. Among women screened using VIA, 18(6.1%) tested positive. Eleven (4.7%) of the 18 that tested positive by VIA were among the 236 (86.8%) cases recorded as NILM by using LBC. Of the 36 (12.1%) women who had either LSIL or HSIL using LBC, 30 (83.3 %) tested negative using VIA. No women with HSIL tested positive using VIA. There was no agreement between the two screening tests using kappa measurement (kappa value=0.155, p=0.006) [Table 2].
Table 2: Cervical lesion abnormality among women screened by both LBC and VIA, Jimma, 2018
LBC Result
|
VIA Test Result
|
Total
|
Kappa value
|
P-value
|
Negative
|
Positive
|
0.155
|
0.006
|
n(%)
|
n(%)
|
N(%)
|
NILM
|
225(95.34)
|
11(4.66)
|
236(100)
|
LSIL or HSIL
|
30(83.33)
|
6(16.67)
|
36(100)
|
Total
|
255(93.75)
|
17(6.25)
|
272(100)
|
|
|
Characteristics of HIV Patients
A total of 47 HIV patients on ART who visited Jimma University Cervical Cancer Clinic were screened for cervical lesions. Of these, 21(45.7%) were married, 15(31.9%) were primigravida, 28(59.6%) multigravida, 23(48.9%) and had sexual debut between the ages of 11-17. Thirty-two (68.1%) had multiple sexual partners and 15(32%) had history of STIs.
Twenty-eight (59.6%) and 43(91.5%) HIV-positive women were tested with VIA and LBC, respectively. Only two HIV-patients were positive for VIA. Whereas, 14(32.6%) had either LSIL or HSIL on the LBC test. Of these women, 10(23.3%) and 4(9.3%) had LSIL and HSIL, respectively. Among HIV patients between the ages of 41-50, 7(77.78%) had intraepithelial lesions. Half of HIV-patients with interepithelial lesions were between the ages of 41-50.
Predictors of Abnormal Cytology by LBC
Bivariate logistic regression analysis revealed that parity, age and condom use during sexual intercourse were candidates for multivariate regression at p=<0.25. Multivariate regression revealed that age was an independent predictor of LSIL or HSIL. Odds of being positive for cervical squamous-extraepithelial lesions were higher in women older than 31 years of age.
Women aged 51-60 were more likely to have abnormal intraepithelial lesion compared to women aged 21-30 (AOR= 20.9,95%CI=[7.2-60.9], p=0.00) [Table 3].
Table 3: Predictors of abnormal cervical cytology using LBC, Jimma, 2018.
Characteristics
|
N(%)
|
LBC Result
|
COR(95%:CI)
|
P-Value
|
AOR(95%: CI)
|
P-Value
|
NILM
|
LSIL or HSIL
|
n (%)
|
n(%)
|
Parity
|
Nulligravida
|
34(8.17)
|
29(85.29)
|
5(14.71)
|
1(ref.)
|
|
1
|
|
primigravida
|
70(16.83)
|
55(78.57)
|
15 (21.43)
|
1.6(0.52-4.8)
|
0.42
|
1.4 (0.43-4.9)
|
0.56
|
Multigravida
|
312(75)
|
219(70.19)
|
93(29.81)
|
2.5(0.9-6.6)
|
0.07
|
1.1 (0.38-3.3)
|
0.85
|
Age
|
21-30
|
105(25.06)
|
97(92.38)
|
8(7.62)
|
1(ref.)
|
|
1
|
|
31-40
|
179(42.72)
|
144(80.45)
|
35(19.55)
|
2.9(1.3-6.6)
|
0.00
|
2.9(1.3- 6.8)
|
0.00
|
41-50
|
102(24.34)
|
53(51.96)
|
49(48.04)
|
11.2(4.9-25.4)
|
0.00
|
11.4(4.8-26.9)
|
0.00
|
51-60
|
31(7.40)
|
11(35.48)
|
20(64.52)
|
22.0(7.8-61.5)
|
0.00
|
20.9(7.2-60.9)
|
0.00
|
>=61
|
2(0.48)
|
0(0.00)
|
2(100.00)
|
1
|
|
|
|
Condom Use
|
No
|
392 (94.23)
|
282 (71.94)
|
110 (28.06)
|
2.7 (0.79-9.3)
|
0.12
|
1
|
|
Yes
|
24 (5.77)
|
21 (87.50)
|
3(12.50)
|
1(ref)
|
|
1.9(0.52-6.9)
|
0.33
|