Prevalence and factors associated with visual inspection with acetic acid (VIA) positive cervical lesions among women attending antenatal at Kawempe Hospital

Abstract

Background: Cervical cancer is one of the most preventable and curable cancers if detected early. Cervical cancer is the leading cause of gynaecologic cancer death among women in Uganda. There are various cervical cancer screening methods, but most target the non-pregnant population. There is no opportunistic screening program targeting antenatal women in Uganda, yet available evidence shows a high 1st ANC attendance of up to 97%, but a low postnatal attendance of 54% within two days following delivery (UDHS 2016). Therefore, the antenatal period is a missed opportunity for screening. Objective: To determine the prevalence and factors associated with VIA positive lesions among women attending antenatal at Kawempe hospital Methods: The study was a hospital based cross sectional study targeting women attending antenatal clinic at Kawempe Hospital. 527 eligible participants were recruited using consecutive sampling method. We completed a structured interviewer administered questionnaire on bio data and factors associated with VIA positive result. Prevalence of VIA positive lesions was calculated using number with VIA positive lesions over total number screened. Bivariate and multivariate analysis were used to determine the factors associated with VIA positivity. Statistical significance was set at P<0.05. Results: Between November 2018 and May 2019, 527 participants were recruited and tested with VIA. The median age was 32 years, the median age at initiation of sexual intercourse was 18 years in our study. The prevalence of positive visual inspection with acetic acid amongst the 527 participants was 8.5% (n=45). In multivariate analysis, early sexual debut ≤16years was found to be an independent predictor increasing the risk of VIA positive by 2 times (AOR [95 % CI] = 2.0 [6.4- 11.3]) and tertiary education was found to reduce risk of VIA positivity Conclusion: Prevalence of VIA positives was found to be high and early age of sexual debut was found to increase the risk, while tertiary education was found to reduce the risk of VIA positivity. Recommendations: Pregnant women with history of sexual debut before 16 years be screened for cancer cervix, young girls should be educated against early sexual debut and efforts should be made to keep young girls in school.