Precancerous cervical lesions and associated factors among women screened at two University Hospitals in N’Djamena, Chad

Precancerous cervical lesions and associated factors among women screened at two University Hospitals in N’Djamena, Chad | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Precancerous cervical lesions and associated factors among women screened at two University Hospitals in N’Djamena, Chad Lina Djonkreo, Richard Tagne Simo, Djelassem Ferdinand, Zita Aleyo, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8761374/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Background Human papillomavirus (HPV) infection is the main etiological factor of cervical cancer worldwide. In sub-Saharan Africa, including Chad, cervical cancer remains a major public health problem due to limited screening coverage and late diagnosis. Data on the burden of precancerous cervical lesions and associated risk factors are scarce in Chad. This study aimed to determine the prevalence of precancerous cervical lesions and identify associated factors among women screened in N’Djamena. Methods A hospital-based cross-sectional study was conducted in 2022 at two university hospitals in N’Djamena, Chad. Cervical samples were collected from women attending gynecological consultations and analyzed using liquid-based cytology, with results classified according to the 2014 Bethesda system. Sociodemographic characteristics, gynecological and obstetrical history, medical history, and behavioral factors were collected using a structured questionnaire. Univariate logistic regression was performed to estimate crude odds ratios (ORs) with 95% confidence intervals (CIs). Variables with p-values < 0.20 were entered into a multivariate logistic regression model to identify independent associated factors. Results A total of 310 women were included, of whom 58 presented precancerous cervical lesions, corresponding to a prevalence of 18.7%. Identified cytological abnormalities included atypical squamous cells of undetermined significance, atypical squamous cells—cannot exclude high-grade lesions, low-grade squamous intraepithelial lesions, high-grade squamous intraepithelial lesions, and atypical glandular cells. In univariate analysis, marital status was significantly associated with a reduced risk of precancerous lesions. Increased risks were observed among women with sexual debut before 18 years, a history of abortion, use of hormonal contraception, tobacco consumption, and positive serological status. In multivariate analysis, early sexual debut before 18 years (adjusted OR = 3.6; 95% CI: 1.9–7.3; p < 0.001) and history of abortion (adjusted OR = 3.1; 95% CI: 1.7–6.1; p < 0.001) remained independently associated with precancerous cervical lesions. Conclusions Precancerous cervical lesions were relatively common among women screened in N’Djamena. Early sexual initiation and a history of abortion were independently associated with lesion occurrence. These findings highlight the need to strengthen cervical cancer prevention strategies, particularly through early screening and targeted preventive interventions in Chad Cervical cancer Precancerous cervical lesions Human papillomavirus Liquid-based cytology Risk factors Chad Figures Figure 1 Introduction Cervical cancer remains a major global public health concern, particularly in low- and middle-income countries (LMICs), where it continues to be a leading cause of cancer-related morbidity and mortality among women[ 1 ], [ 2 ]. The disease is characterized by uncontrolled proliferation of cervical epithelial cells, which may progress to local invasion and distant metastasis if not detected at an early stage [ 3 ]. Persistent infection with high-risk human papillomavirus (HR-HPV) genotypes is widely recognized as the central etiological factor in cervical carcinogenesis, with a latency period that may extend from 10 to 20 years between initial infection and the development of invasive cancer [ 4 ], [ 5 ], [ 6 ] Globally, cervical cancer is the fourth most frequently diagnosed cancer among women, with approximately 660,000 new cases and more than 350,000 deaths reported in 2022 [ 7 ], [ 8 ]. The burden of the disease is unevenly distributed, with sub-Saharan Africa accounting for a disproportionate share of incidence and mortality. This disparity is largely attributed to limited access to preventive measures such as HPV vaccination, insufficient screening coverage, delayed diagnosis, and restricted treatment capacity [ 9 ], [ 10 ]. In countries with a low Human Development Index (HDI), cervical cancer is often the second most common cancer among women, following breast cancer, and is frequently diagnosed at advanced clinical stages, resulting in poor survival outcomes [ 7 ]. In Chad, cervical cancer represents the leading cause of cancer-related morbidity and mortality among women, surpassing breast cancer and constituting the most prevalent malignancy of the female reproductive system [ 11 ]. The disease typically develops through a prolonged pre-invasive phase characterized by cervical intraepithelial neoplasia (CIN). During this stage, timely detection and appropriate management of precancerous lesions can substantially reduce the risk of progression to invasive cervical cancer and related mortality [ 12 ], [ 13 ] Although HR-HPV infection is a necessary prerequisite for cervical cancer development, most infected women do not progress to precancerous or malignant lesions, indicating that HPV infection alone is insufficient to induce malignant transformation. Several cofactors influence HPV persistence and disease progression, including early sexual debut, multiple sexual partners, high parity, long-term hormonal exposure, tobacco use, immunosuppression, co-infection with other sexually transmitted infections, and adverse socio-environmental conditions [ 14 ], [ 15 ]. Despite the preventable nature of cervical cancer, epidemiological data on precancerous cervical lesions and their determinants remain scarce in Chad. Therefore, this study aimed to determine the prevalence of precancerous cervical lesions and identify associated factors among women screened at two university hospitals in N’Djamena, Chad. Materials and Methods Participants and ethical considerations The study was conducted from July to October 2022 at two university hospitals in N'Djamena, Chad: the University Hospital Center of Mother and Child and the University Hospital Center of Chad-China Friendship. A total of 310 women were recruited for the study. Women aged 18 and older, sexually active, with or without cancerous lesions, were included. Women experiencing bleeding on the sampling day, those with inflammatory or hemorrhagic smears, and women who had undergone hysterectomy were excluded from the study. The criteria for inclusion and exclusion were established to ensure that the results could be generalized to the female population of N'Djamena. Eligible women were informed about the purpose, detailed information, and procedures associated with the study. Only women who agreed to participate and signed the informed consent form were included. Sociodemographic information was collected, and cervical samples were obtained. The study protocol and procedures received approval from the Ethics Committee of the University Hospital Center of Mother and Child in Chad (Reference No. 122/CMT/PC/PM/MSPSN/SE/SG/CHU-ME/DAFM/SRH/2022). The research was conducted in compliance with international ethical standards, specifically the Declaration of Helsinki and its amendments. All participants were informed of their right to withdraw from the study at any time. Data collected during the study were anonymized and maintained in a confidential manner. Cervical specimen collection and cytology Cervical specimens were collected by a gynecologist using standard clinical procedures. Briefly, cervical exfoliated cell specimens were obtained for liquid-based cytological diagnosis using a cytobrush and an Ayres spatula. Sample slides were prepared using the liquid-based cytology method (BD SurePath™ liquid-based Pap test). Cytological classifications of precancerous lesions were performed on the slides and categorized according to the Bethesda 2014 system: (i) squamous cell abnormalities (Atypical squamous cells (ASC-US and ASC-H); low-grade squamous intraepithelial lesions (LSIL); high-grade squamous intraepithelial lesions (HSIL); and squamous cell carcinoma) and (ii) glandular cell abnormalities (atypical glandular cells (AGC) and adenocarcinoma)[ 16 ] Determination of factors associated with precancerous lesions A questionnaire was administered to participants to gather information on their sociodemographic data, gynecological history, and knowledge regarding cervical cancer. The responses obtained were used to identify factors associated with precancerous lesions. Data analysis Data were analyzed using R software. Univariate logistic regression was performed to estimate crude odds ratios (ORs) with 95% confidence intervals (CIs). Variables with p < 0.20 were included in a multivariate logistic regression model to identify independent risk factors. Results During the study period, a total of 382 patients consulted at the two university hospitals, of which 310 provided informed consent and underwent cervical cancer screening (CCU), resulting in a participation rate of 81.15%. The most represented age group among the participants was between 38 and 48 years, comprising 35.48% of the study population. The average age of the patients was 40 years, with a range spanning from 18 to 80 years. Prevalence and Characterization of Precancerous Lesions Among the 310 women included in our analysis, 58 were found to have precancerous cervical lesions during cervical cytology (CC) examinations, resulting in a prevalence of 18.71% for precancerous cervical lesions. Among the identified precancerous lesions, low-grade squamous intraepithelial lesions (LSIL) comprised 7.42% of the cases, while high-grade squamous intraepithelial lesions (HSIL) accounted for 1.94%. Additionally, other types of lesions represented 9.35% of the total findings. Notably, negative or normal results (NIL/M) constituted 81.29% of the cases (Fig. 1) . Figure: Prevalence and types of precancerous cervical lesions classified according to the bethesda system 2014 NIL/M : Negative for Intraepithelial Lesion or Malignancy; AGC : Atypical Glandular Cell; ASC-US : Atypical Squamous Cell of undetermined significance; ASC-H : Atypical Squamous Cell cannot exclude High grade squamous intraepithelial lesion; LSIL : Low grade Squamous Intraepithelial Lesion; HSIL : High-grade squamous intraepithelial lesion. Influence of sociodemographic characteristics on the development and type of precancerous lesions The analysis of the influence of socio-demographic factors (Table 1 ) on the occurrence of precancerous lesions shows that only marital status was associated with the appearance of lesions. Specifically, having been married was a protective factor, with a risk reduction of OR = 0.4 (CI: 0.2–0.9, p = 0.01) for married women, 0.2 (CI: 0.02–0.7, p = 0.03) for divorced women, and 0.1 (CI: 0.005-0.6, p = 0.04) for widowed women. Table 1 Influence of socio-demographic characteristics on the occurrence of precancerous lesions. Variables Presence of precancerous lesions Unadjusted OR (95% CI) p-value Adjusted OR (95% CI) p-value No(%) Yes(%) participants 252 58 / / Age category, years 18–30 52(20.6) 29(50) 1 (ref) 31–40 58(23.01)) 29(50) 0.9 (0.5–1.7) 0.7 41–50 88(34.9) 0(0) 0(/) 1 > 50 54(21.4) 0(0) 0(/) 1 Residence Rural 56 17 1 (ref) Urban 196 41 0.7 (0.4–1.3) 0.3 Marital status Single 21 12 1 (ref) Divorced 21 2 0.2 (0.02–0.7) 0.03* Maried 194 43 0.4 (0.2–0.9) 0.01* Widowed 16 1 0.1 (0.005-0.6) 0.04* Profession Civil servant 52 12 1 (ref) Farmer 13 3 1(0.1–3.7) 1 Housewife 114 23 0.9(0.4–1.9) 0.7 Small-business-owner 40 5 0.5(0.2–1.6) 0.3 Student 27 12 1.9(0.8–4.9) 0.2 Unemployed 6 3 2.1(0.4–9.5) 0.3 Education Uneducated 132 26 1 (ref) Primary 10 1 0.5 (0.02–2.8) 0.5 Secondary 44 11 1.3(0.6–2.7) 0.6 Higher 66 20 1.5(0.8–2.9) 0.2 Data are n, n(%),OR=Odds ratio, * means statistical significance at 95%. ° means marginal significance at 95%. CI means confidence interval Influence of gynaecological and obstetrical history on the occurrence of precancerous lesions Regarding gynecological and obstetric factors (Table 2 ), the age of first sexual intercourse was significantly associated with the occurrence of lesions, with an increased risk of OR = 3.3 (CI: 1.7-5, p = 0.0005) for women who have their first intercourse before 18. Furthermore, a history of abortion was linked to an increased risk of OR = 2.7 (CI: 1.5–5.2, p = 0.001), and the use of hormonal contraceptives enhanced the risk of lesion onset with OR = 2.5 (CI: 1.3–5.1, p = 0.01). After conducting a multivariate logistic regression analysis, only two factors from the gynecological and obstetric group emerged as independent factors. Specifically, the age of first sexual intercourse was identified as an independent factor for the occurrence of precancerous lesions, with a risk of OR = 3.6 (CI: 1.9–7.3, p = 0.0001) for women who began sexual activity before the age of 18, and a risk of OR = 3.1 (CI: 1.7–6.1, p = 0.0004) for women who had aborted at least once. Table 2 Influence of gynaecological and obstetrical history on the occurrence of precancerous lesions Variables Presence of precancerous lesions Unadjusted OR (95% CI) p-value Adjusted OR (95% CI) p-value No(%) Yes(%) participants 252 58 / / Age of first sexual intercourse, years 2 159 41 1.4 (0.8–2.7) 0.2 Gestation Nulligravida 20 2 1 (ref) Primigravida 15 6 4 (0.8–30) 0.1 Paucigravida 53 14 2.6(0.7–17.8) 0.2 Multigravida 104 20 1.9(0.5–12.6) 0.4 Grand multigravida 60 16 2.6(0.7–17.8) 0.2 Parity 0 28 5 1 (ref) 1–3 90 23 1.4(0.5–4.6) 0.5 > 3 134 30 1.3(0.5–3.9) 0.7 Abortion No 28 5 1 (ref) Yes 90 23 2.7 (1.5–5.2) 0.001* 3.1 (1.7–6.1) 0.0004* History of cervical issues No 227 50 1 (ref) Yes 25 8 1.5 (0.6–3.3) 0.4 Contraception None 88 15 1 (ref) Mecanic 33 5 0.8 (0.3–2.5)) 0.8 Hormonal 71 30 2.5(1.3–5.1) 0.01* Other 60 8 0.8(0.3–1.9) 0.6 Traditional behaviour No 179 34 1 (ref) Vaginal dryness 73 24 1.7 (0.9–3.1) 0.06 Cervical cancer screening No 235 57 1 (ref) Yes 17 1 0.2 (0.01–1.2) 0.2 Data are n, n(%),OR=Odds ratio, * means statistical significance at 95%. ° means marginal significance at 95%. CI means confidence interval Influence of other factors on the precancerous lesions onset The analysis of medical history and behavioral factors (Table 3 ) revealed (despite a wide confidence interval) an increased risk of precancerous lesions associated with tobacco consumption, OR = 13.7 (CI: 1.7–279, p = 0.02). Additionally, a positive serological status increased the risk with OR = 2.8 (CI: 1-7.7, p = 0.04). Table 3 Influence of other factors on the precancerous lesions onset Variables Presence of precancerous lesions Unadjusted OR (95% CI) p-value Adjusted OR (95% CI) p-value No(%) Yes(%) participants 252 58 / / Alcohool consumption No 177 40 1 (ref) Yes 75 18 1.06 (0.6–1.9) 0.8 Tabac consumption No 251 55 1 (ref) Yes 1 3 13.7 (1.7–279) 0.02* Serologic status Negative 193 39 1 (ref) Positive 12 7 2.8 (1-7.7) 0.04* STI history No 149 30 1 (ref) Yes 84 26 1.5 (0.8–2.7) 0.2 Knowledge level Adequate 62 19 1 (ref) Inadequate 190 39 0.7 (0.4–1.3) 0.2 Data are n, n(%),OR=Odds ratio, * means statistical significance at 95%. ° means marginal significance at 95%. CI means confidence interval, STI: Sexual Transmitted Infections Discussion This study investigated the prevalence of precancerous cervical lesions and associated factors among women screened at two university hospitals in N’Djamena, Chad. The participation rate of 81.15% indicates a relatively high acceptance of cervical cancer screening in hospital settings, consistent with findings from other facility-based studies conducted in sub-Saharan Africa ([ 17 ], [ 18 ]. This suggests that tertiary healthcare facilities may play a critical role in improving screening uptake in contexts where organized population-based screening programs are limited [ 14 ]. The prevalence of precancerous cervical lesions observed in this study (18.7%) is high and comparable to rates reported in similar hospital-based studies across sub-Saharan Africa, while remaining substantially higher than those observed in high-income countries [ 9 ]. This elevated burden likely reflects persistent exposure to oncogenic human papillomavirus (HPV), low coverage of preventive interventions such as HPV vaccination, and delayed access to screening services. The predominance of low-grade squamous intraepithelial lesions suggests that a significant proportion of abnormalities were detected at an early stage. However, the presence of high-grade lesions underscores the continued risk of progression to invasive cervical cancer in the absence of adequate follow-up and treatment [ 19 ]. In the multivariate analysis, early age at first sexual intercourse emerged as a strong independent risk factor for precancerous cervical lesions. Women who initiated sexual activity before the age of 18 were significantly more likely to present cytological abnormalities. This finding is consistent with previous studies [ 20 ], [ 21 ] and can be explained by the biological vulnerability of the immature cervical epithelium, which is more susceptible to HPV acquisition and persistence, as well as by a longer cumulative exposure to oncogenic HPV types over the lifetime [ 15 ]. A history of abortion was also independently associated with precancerous cervical lesions. Although the underlying mechanisms are not fully elucidated, this association has been reported in other studies [ 22 ], [ 23 ] and may be related to cervical trauma, hormonal and immunological changes, or repeated gynecological interventions that could facilitate HPV persistence. Nevertheless, this finding should be interpreted with caution, as residual confounding by sexual behavior or access to reproductive health services cannot be entirely excluded. Several factors showed associations with precancerous lesions in univariate analyses but did not remain significant after adjustment. Marital status appeared to have a protective effect, which may reflect differences in sexual behavior patterns, partner stability, or cumulative HPV exposure [ 24 ]. Tobacco use and positive serological status were associated with increased risk; however, the wide confidence intervals observed, particularly for tobacco consumption, suggest limited statistical precision due to small subgroup sizes. Despite this limitation, these findings are biologically plausible and consistent with existing evidence linking smoking and immunosuppression to cervical carcinogenesis [ 25 ]. Although variables related to cervical cancer awareness and prior screening were assessed, they were not independently associated with lesion occurrence. Importantly, the very low proportion of women with a history of previous screening highlights substantial gaps in preventive healthcare services and underscores missed opportunities for early detection in this population, a situation commonly reported in low-resource settings [ 26 ]. This study has several limitations. Its hospital-based design may limit the generalizability of the findings to the broader female population of N’Djamena or Chad. The absence of HPV testing precluded direct assessment of HPV infection and genotype-specific risks. Despite these limitations, the study provides valuable baseline data from a setting where epidemiological information on precancerous cervical lesions remains scarce. The use of standardized cytological classification and multivariate analysis strengthens the reliability of the findings. Conclusion Precancerous cervical lesions are highly prevalent among women screened at two university hospitals in N’Djamena, Chad. Early initiation of sexual activity and a history of abortion were identified as key independent factors associated with lesion occurrence. These findings highlight the importance of addressing sexual and reproductive health determinants in cervical cancer prevention strategies. Strengthening organized cervical cancer screening programs, promoting early sexual health education, and expanding access to HPV vaccination are critical priorities to reduce the burden of cervical cancer in this high-risk population. Further population-based studies incorporating HPV testing are warranted to better inform national prevention and control strategies in Chad. Declarations Ethics approval and consent to participate The study protocol and procedures received approval from the Ethics Committee of the University Hospital Center of Mother and Child in Chad (Reference No. 122/CMT/PC/PM/MSPSN/SE/SG/CHU-ME/DAFM/SRH/2022). The research was conducted in compliance with international ethical standards, specifically the Declaration of Helsinki and its amendments. All participants were informed of their right to withdraw from the study at any time. Data collected during the study were anonymized and maintained in a confidential manner. Consent for publication Not applicable. Conflicts of interest The authors have no competing interests to declare that are relevant to the content of this article. Funding The authors did not receive support from any organization for the submitted work. Author Contribution LD conceived the study, coordinated data collection, and contributed to manuscript drafting. RTS contributed to the study design, performed the statistical analysis, interpreted the data, and critically revised the manuscript, DF, ZA, MAA, HTA, and AC participated in data collection, patient recruitment, and preliminary data analysis. PBT contributed to the conceptual framework of the study, supervised the research process, and critically reviewed the manuscript for intellectual content. All authors read and approved the final version of the manuscript. Acknowledgement Authors thank all the participants and the medical professionals in the University Hospital Center of Mother and Child and the University Hospital Center of Chad-China Friendship. who provided their support in the clinical part of the study and in data analysis Data availability The data that support the fndings of this study are available from the corresponding authors upon reasonable request. References Sahasrabuddhe VV, Parham GP, Mwanahamuntu MH, Vermund SH. Cervical Cancer Prevention in Low- and Middle-Income Countries: Feasible, Affordable, Essential. Cancer Prev Res. 2012;5(1):11–7. 10.1158/1940-6207.CAPR-11-0540 . Shrestha AD, Neupane D, Vedsted P, Kallestrup P. Cervical Cancer Prevalence, Incidence and Mortality in Low and Middle Income Countries: A Systematic Review. Asian Pac J Cancer Prev. 2018;19(2):319–24. 10.22034/APJCP.2018.19.2.319 . George N, Bhandari P, Shruptha P, Jayaram P, Chaudhari S, Satyamoorthy K. Multidimensional outlook on the pathophysiology of cervical cancer invasion and metastasis. Mol Cell Biochem. 2023;478(11):2581–606. 10.1007/s11010-023-04686-3 . Burd EM. Human papillomavirus and cervical cancer. Clin Microbiol Rev. 2003;16(1):1–17. 10.1128/CMR.16.1.1-17.2003 . Schiffman M, Castle PE, Jeronimo J, Rodriguez AC, Wacholder S. Human papillomavirus and cervical cancer. Lancet. 2007;370(9590):890–907. 10.1016/S0140-6736(07)61416-0 . Tagne Simo R, Djoko Nono AG, Fogang Dongmo HP, et al. Prevalence of precancerous cervical lesions and high-risk human papillomavirus types in Yaounde, Cameroon. J Infect Dev Ctries. 2021;15(9):1339–45. 10.3855/jidc.15218 . Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394–424. 10.3322/caac.21492 . Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209–49. 10.3322/caac.21660 . Arbyn M, Weiderpass E, Bruni L, et al. Estimates of incidence and mortality of cervical cancer in 2018: a worldwide analysis. Lancet Global Health. 2020;8(2):e191–203. 10.1016/S2214-109X(19)30482-6 . Ferede YA, Tassew WC, Zeleke AM. Precancerous cervical lesion and associated factors among HIV-infected women in Ethiopia: systematic review and meta- analysis. BMC Cancer. 2024;24(1):678. 10.1186/s12885-024-12462-9 . Getinet M, Jemal M, Baylie T, et al. High-risk human papillomavirus infection (HPV 16/18) and its determinants among women in East Gojjam Zone, Northwest Ethiopia: a population-based cross-sectional study, 2021. BMJ Open. 2025;15(7):e092760. 10.1136/bmjopen-2024-092760 . Basu P, Joshi S, Sankaranarayanan R. Human Papillomavirus (HPV) Testing for Secondary Prevention of Cervical Cancer. Curr Obstet Gynecol Rep. 2015;4(4):201–12. 10.1007/s13669-015-0133-z . Merera D, Jima GH. Precancerous Cervical Lesions and Associated Factors Among Women Attending Cervical Screening at Adama Hospital Medical College, Central Ethiopia. CMAR. 2021;13:2181–9. 10.2147/CMAR.S288398 . Bruni L, Albero G, Rowley J, et al. Global and regional estimates of genital human papillomavirus prevalence among men: a systematic review and meta-analysis. Lancet Global Health. 2023;11(9):e1345–62. 10.1016/S2214-109X(23)00305-4 . Moscicki AB, Schiffman M, Burchell A, et al. Updating the Natural History of Human Papillomavirus and Anogenital Cancers. Vaccine. 2012;30:F24–33. 10.1016/j.vaccine.2012.05.089 . Nayar R, Wilbur DC. The Bethesda System for Reporting Cervical Cytology: A Historical Perspective. Acta Cytol. 2017;61(4–5):359–72. 10.1159/000477556 . Ebu NI, Mupepi SC, Siakwa MP, Sampselle CM. Knowledge, practice, and barriers toward cervical cancer screening in Elmina, Southern Ghana. Int J Womens Health. 2015;7:31–9. 10.2147/IJWH.S71797 . Sankaranarayanan R, Budukh AM, Rajkumar R. Effective screening programmes for cervical cancer in low- and middle-income developing countries. Bull World Health Organ. 2001;79(10):954–62. Zampaoglou E, Boureka E, Gounari E, et al. Screening for Cervical Cancer: A Comprehensive Review of Guidelines. Cancers. 2025;17(13). 10.3390/cancers17132072 . Bosch FX, Lorincz A, Muñoz N, Meijer CJLM, Shah KV. The causal relation between human papillomavirus and cervical cancer. J Clin Pathol. 2002;55(4):244–65. Louie KS, de Sanjose S, Diaz M, et al. Early age at first sexual intercourse and early pregnancy are risk factors for cervical cancer in developing countries. Br J Cancer. 2009;100(7):1191–7. 10.1038/sj.bjc.6604974 . Khan MJ, Partridge EE, Wang SS, Schiffman M, Group ASC of USGSILTS (ALTS). Socioeconomic status and the risk of cervical intraepithelial neoplasia grade 3 among oncogenic human papillomavirus DNA-positive women with equivocal or mildly abnormal cytology. Cancer. 2005;104(1):61–70. 10.1002/cncr.21129 . Muñoz N, Franceschi S, Bosetti C, et al. Role of parity and human papillomavirus in cervical cancer: the IARC multicentric case-control study. Lancet. 2002;359(9312):1093–101. 10.1016/S0140-6736(02)08151-5 . Plummer M, Herrero R, Franceschi S, et al. Smoking and cervical cancer: pooled analysis of the IARC multi-centric case–control study. Cancer Causes Control. 2003;14(9):805–14. 10.1023/b:caco.0000003811.98261.3e . Kayar İ, Goc G, Cetin F, Birge Ö. Impact of Smoking on Cervical Histopathological Changes in High-Risk HPV-Positive Women: A Matched Case–Control Study. Medicina. 2025;61(2). 10.3390/medicina61020235 . Randall TC, Ghebre R. Challenges in Prevention and Care Delivery for Women with Cervical Cancer in Sub-Saharan Africa. Front Oncol. 2016;6:160. 10.3389/fonc.2016.00160 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 05 Mar, 2026 Editor invited by journal 09 Feb, 2026 Editor assigned by journal 02 Feb, 2026 Submission checks completed at journal 02 Feb, 2026 First submitted to journal 02 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8761374","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":603978058,"identity":"721d9003-aaff-4e65-b3b0-6ebf16e53784","order_by":0,"name":"Lina Djonkreo","email":"","orcid":"","institution":"University of N'Djamena, N'Djamena","correspondingAuthor":false,"prefix":"","firstName":"Lina","middleName":"","lastName":"Djonkreo","suffix":""},{"id":603978059,"identity":"e6405714-6f39-4d12-8824-ec90dbb26591","order_by":1,"name":"Richard Tagne Simo","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAxklEQVRIiWNgGAWjYBADORBx4AFxipnBpDFYSwIpWhIbQCRRWsz7zx/8+HWHTfr8sMMPgbbYyek2ENAicyOZWVr2TFruxttpBkAtycZmBwhokZBgZpCWbDucu3F2AkjLgcRtBLXwH2b+Ldn2P91wdvoHIrUwJLNJfmw7kCAvnUOsLRLJZtaMbcmGG6RzCg4kGBDjF/6Dj2/+bLOTl5+dvvnDhwo7OYJaQICZB0gYgFUaEKEcBBh/AAn5BiJVj4JRMApGwcgDACzmQ01xwdN5AAAAAElFTkSuQmCC","orcid":"","institution":"University of Ngaoundere","correspondingAuthor":true,"prefix":"","firstName":"Richard","middleName":"Tagne","lastName":"Simo","suffix":""},{"id":603978060,"identity":"0d893d75-7afd-4d81-a6fe-bcdd8eb24e64","order_by":2,"name":"Djelassem Ferdinand","email":"","orcid":"","institution":"University of N'Djamena, N'Djamena","correspondingAuthor":false,"prefix":"","firstName":"Djelassem","middleName":"","lastName":"Ferdinand","suffix":""},{"id":603978061,"identity":"a0140254-fad2-4d3e-b8f7-db9583b7b784","order_by":3,"name":"Zita Aleyo","email":"","orcid":"","institution":"University of N'Djamena, N'Djamena","correspondingAuthor":false,"prefix":"","firstName":"Zita","middleName":"","lastName":"Aleyo","suffix":""},{"id":603978062,"identity":"2c12e54c-7788-4612-918c-69ab05002e74","order_by":4,"name":"Moussa Adoum Aoudjali","email":"","orcid":"","institution":"University of N'Djamena, N'Djamena","correspondingAuthor":false,"prefix":"","firstName":"Moussa","middleName":"Adoum","lastName":"Aoudjali","suffix":""},{"id":603978063,"identity":"40cab779-26a9-4a3c-9339-b09ae309a47a","order_by":5,"name":"Hidir Tidjani Abakar","email":"","orcid":"","institution":"University of N'Djamena, N'Djamena","correspondingAuthor":false,"prefix":"","firstName":"Hidir","middleName":"Tidjani","lastName":"Abakar","suffix":""},{"id":603978064,"identity":"aa55b01f-a718-43e8-ac67-17d2c346adea","order_by":6,"name":"Adawaye Chatté","email":"","orcid":"","institution":"University of N'Djamena, N'Djamena","correspondingAuthor":false,"prefix":"","firstName":"Adawaye","middleName":"","lastName":"Chatté","suffix":""},{"id":603978065,"identity":"d2888ca4-a40f-48e5-a09e-3b87a2e610f4","order_by":7,"name":"Phelix Bruno Telefo","email":"","orcid":"","institution":"University of Dschang","correspondingAuthor":false,"prefix":"","firstName":"Phelix","middleName":"Bruno","lastName":"Telefo","suffix":""}],"badges":[],"createdAt":"2026-02-02 06:53:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8761374/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8761374/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":104442790,"identity":"f68cc31d-9f90-41da-8c5d-38b5ed67e57c","added_by":"auto","created_at":"2026-03-11 18:55:27","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":128926,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePrevalence and types of precancerous cervical lesions classified according to the bethesda system 2014\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNIL/M:\u003c/strong\u003e Negative for Intraepithelial Lesion or Malignancy; \u003cstrong\u003eAGC:\u003c/strong\u003e Atypical Glandular Cell; \u003cstrong\u003eASC-US:\u003c/strong\u003e Atypical Squamous Cell of undetermined significance; \u003cstrong\u003eASC-H\u003c/strong\u003e: Atypical Squamous Cell cannot exclude High grade squamous intraepithelial lesion; \u003cstrong\u003eLSIL\u003c/strong\u003e: Low grade Squamous Intraepithelial Lesion; \u003cstrong\u003eHSIL:\u003c/strong\u003e High-grade squamous intraepithelial lesion.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8761374/v1/0ad3b24edd8a78857e3029a7.jpeg"},{"id":104835476,"identity":"55f108d1-c979-4511-ad71-5fe691e301d2","added_by":"auto","created_at":"2026-03-17 17:45:16","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1638472,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8761374/v1/3f2fd2e1-ef4b-4625-b8e8-04acbdd57702.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Precancerous cervical lesions and associated factors among women screened at two University Hospitals in N’Djamena, Chad","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCervical cancer remains a major global public health concern, particularly in low- and middle-income countries (LMICs), where it continues to be a leading cause of cancer-related morbidity and mortality among women[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The disease is characterized by uncontrolled proliferation of cervical epithelial cells, which may progress to local invasion and distant metastasis if not detected at an early stage [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Persistent infection with high-risk human papillomavirus (HR-HPV) genotypes is widely recognized as the central etiological factor in cervical carcinogenesis, with a latency period that may extend from 10 to 20 years between initial infection and the development of invasive cancer [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eGlobally, cervical cancer is the fourth most frequently diagnosed cancer among women, with approximately 660,000 new cases and more than 350,000 deaths reported in 2022 [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The burden of the disease is unevenly distributed, with sub-Saharan Africa accounting for a disproportionate share of incidence and mortality. This disparity is largely attributed to limited access to preventive measures such as HPV vaccination, insufficient screening coverage, delayed diagnosis, and restricted treatment capacity [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. In countries with a low Human Development Index (HDI), cervical cancer is often the second most common cancer among women, following breast cancer, and is frequently diagnosed at advanced clinical stages, resulting in poor survival outcomes [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn Chad, cervical cancer represents the leading cause of cancer-related morbidity and mortality among women, surpassing breast cancer and constituting the most prevalent malignancy of the female reproductive system [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The disease typically develops through a prolonged pre-invasive phase characterized by cervical intraepithelial neoplasia (CIN). During this stage, timely detection and appropriate management of precancerous lesions can substantially reduce the risk of progression to invasive cervical cancer and related mortality [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eAlthough HR-HPV infection is a necessary prerequisite for cervical cancer development, most infected women do not progress to precancerous or malignant lesions, indicating that HPV infection alone is insufficient to induce malignant transformation. Several cofactors influence HPV persistence and disease progression, including early sexual debut, multiple sexual partners, high parity, long-term hormonal exposure, tobacco use, immunosuppression, co-infection with other sexually transmitted infections, and adverse socio-environmental conditions [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite the preventable nature of cervical cancer, epidemiological data on precancerous cervical lesions and their determinants remain scarce in Chad. Therefore, this study aimed to determine the prevalence of precancerous cervical lesions and identify associated factors among women screened at two university hospitals in N\u0026rsquo;Djamena, Chad.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eParticipants and ethical considerations\u003c/h2\u003e \u003cp\u003eThe study was conducted from July to October 2022 at two university hospitals in N'Djamena, Chad: the University Hospital Center of Mother and Child and the University Hospital Center of Chad-China Friendship. A total of 310 women were recruited for the study. Women aged 18 and older, sexually active, with or without cancerous lesions, were included. Women experiencing bleeding on the sampling day, those with inflammatory or hemorrhagic smears, and women who had undergone hysterectomy were excluded from the study.\u003c/p\u003e \u003cp\u003eThe criteria for inclusion and exclusion were established to ensure that the results could be generalized to the female population of N'Djamena. Eligible women were informed about the purpose, detailed information, and procedures associated with the study. Only women who agreed to participate and signed the informed consent form were included. Sociodemographic information was collected, and cervical samples were obtained.\u003c/p\u003e \u003cp\u003e The study protocol and procedures received approval from the Ethics Committee of the University Hospital Center of Mother and Child in Chad (Reference No. 122/CMT/PC/PM/MSPSN/SE/SG/CHU-ME/DAFM/SRH/2022). The research was conducted in compliance with international ethical standards, specifically the Declaration of Helsinki and its amendments. All participants were informed of their right to withdraw from the study at any time. Data collected during the study were anonymized and maintained in a confidential manner.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eCervical specimen collection and cytology\u003c/h3\u003e\n\u003cp\u003eCervical specimens were collected by a gynecologist using standard clinical procedures. Briefly, cervical exfoliated cell specimens were obtained for liquid-based cytological diagnosis using a cytobrush and an Ayres spatula. Sample slides were prepared using the liquid-based cytology method (BD SurePath\u0026trade; liquid-based Pap test). Cytological classifications of precancerous lesions were performed on the slides and categorized according to the Bethesda 2014 system: (i) squamous cell abnormalities (Atypical squamous cells (ASC-US and ASC-H); low-grade squamous intraepithelial lesions (LSIL); high-grade squamous intraepithelial lesions (HSIL); and squamous cell carcinoma) and (ii) glandular cell abnormalities (atypical glandular cells (AGC) and adenocarcinoma)[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/p\u003e\n\u003ch3\u003eDetermination of factors associated with precancerous lesions\u003c/h3\u003e\n\u003cp\u003eA questionnaire was administered to participants to gather information on their sociodemographic data, gynecological history, and knowledge regarding cervical cancer. The responses obtained were used to identify factors associated with precancerous lesions.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eData were analyzed using R software. Univariate logistic regression was performed to estimate crude odds ratios (ORs) with 95% confidence intervals (CIs). Variables with p\u0026thinsp;\u0026lt;\u0026thinsp;0.20 were included in a multivariate logistic regression model to identify independent risk factors.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eDuring the study period, a total of 382 patients consulted at the two university hospitals, of which 310 provided informed consent and underwent cervical cancer screening (CCU), resulting in a participation rate of 81.15%. The most represented age group among the participants was between 38 and 48 years, comprising 35.48% of the study population. The average age of the patients was 40 years, with a range spanning from 18 to 80 years.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003ePrevalence and Characterization of Precancerous Lesions\u003c/h2\u003e \u003cp\u003eAmong the 310 women included in our analysis, 58 were found to have precancerous cervical lesions during cervical cytology (CC) examinations, resulting in a prevalence of 18.71% for precancerous cervical lesions. Among the identified precancerous lesions, low-grade squamous intraepithelial lesions (LSIL) comprised 7.42% of the cases, while high-grade squamous intraepithelial lesions (HSIL) accounted for 1.94%. Additionally, other types of lesions represented 9.35% of the total findings. Notably, negative or normal results (NIL/M) constituted 81.29% of the cases (Fig.\u0026nbsp;1) .\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eFigure: Prevalence and types of precancerous cervical lesions classified according to the bethesda system 2014\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eNIL/M\u003c/b\u003e: Negative for Intraepithelial Lesion or Malignancy; \u003cb\u003eAGC\u003c/b\u003e: Atypical Glandular Cell; \u003cb\u003eASC-US\u003c/b\u003e: Atypical Squamous Cell of undetermined significance; \u003cb\u003eASC-H\u003c/b\u003e: Atypical Squamous Cell cannot exclude High grade squamous intraepithelial lesion; \u003cb\u003eLSIL\u003c/b\u003e: Low grade Squamous Intraepithelial Lesion; \u003cb\u003eHSIL\u003c/b\u003e: High-grade squamous intraepithelial lesion.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eInfluence of sociodemographic characteristics on the development and type of precancerous lesions\u003c/h3\u003e\n\u003cp\u003eThe analysis of the influence of socio-demographic factors (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) on the occurrence of precancerous lesions shows that only marital status was associated with the appearance of lesions. Specifically, having been married was a protective factor, with a risk reduction of OR\u0026thinsp;=\u0026thinsp;0.4 (CI: 0.2\u0026ndash;0.9, p\u0026thinsp;=\u0026thinsp;0.01) for married women, 0.2 (CI: 0.02\u0026ndash;0.7, p\u0026thinsp;=\u0026thinsp;0.03) for divorced women, and 0.1 (CI: 0.005-0.6, p\u0026thinsp;=\u0026thinsp;0.04) for widowed women.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eInfluence of socio-demographic characteristics on the occurrence of precancerous lesions.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ePresence of precancerous lesions\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eUnadjusted OR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAdjusted OR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes(%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eparticipants\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e252\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge category, years\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u0026ndash;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e52(20.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29(50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e31\u0026ndash;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58(23.01))\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29(50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.9 (0.5\u0026ndash;1.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e41\u0026ndash;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e88(34.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0(/)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54(21.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0(/)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eResidence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e196\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.7 (0.4\u0026ndash;1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDivorced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.2 (0.02\u0026ndash;0.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.03*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e194\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.4 (0.2\u0026ndash;0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.01*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWidowed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.1 (0.005-0.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.04*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eProfession\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCivil servant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFarmer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(0.1\u0026ndash;3.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHousewife\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e114\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.9(0.4\u0026ndash;1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmall-business-owner\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.5(0.2\u0026ndash;1.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.9(0.8\u0026ndash;4.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.1(0.4\u0026ndash;9.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUneducated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e132\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.5 (0.02\u0026ndash;2.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.3(0.6\u0026ndash;2.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.5(0.8\u0026ndash;2.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eData are n, n(%),OR=Odds ratio, * means statistical significance at 95%. \u0026deg; means marginal significance at 95%. CI means confidence interval\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eInfluence of gynaecological and obstetrical history on the occurrence of precancerous lesions\u003c/h3\u003e\n\u003cp\u003eRegarding gynecological and obstetric factors (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), the age of first sexual intercourse was significantly associated with the occurrence of lesions, with an increased risk of OR\u0026thinsp;=\u0026thinsp;3.3 (CI: 1.7-5, p\u0026thinsp;=\u0026thinsp;0.0005) for women who have their first intercourse before 18. Furthermore, a history of abortion was linked to an increased risk of OR\u0026thinsp;=\u0026thinsp;2.7 (CI: 1.5\u0026ndash;5.2, p\u0026thinsp;=\u0026thinsp;0.001), and the use of hormonal contraceptives enhanced the risk of lesion onset with OR\u0026thinsp;=\u0026thinsp;2.5 (CI: 1.3\u0026ndash;5.1, p\u0026thinsp;=\u0026thinsp;0.01).\u003c/p\u003e \u003cp\u003eAfter conducting a multivariate logistic regression analysis, only two factors from the gynecological and obstetric group emerged as independent factors. Specifically, the age of first sexual intercourse was identified as an independent factor for the occurrence of precancerous lesions, with a risk of OR\u0026thinsp;=\u0026thinsp;3.6 (CI: 1.9\u0026ndash;7.3, p\u0026thinsp;=\u0026thinsp;0.0001) for women who began sexual activity before the age of 18, and a risk of OR\u0026thinsp;=\u0026thinsp;3.1 (CI: 1.7\u0026ndash;6.1, p\u0026thinsp;=\u0026thinsp;0.0004) for women who had aborted at least once.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eInfluence of gynaecological and obstetrical history on the occurrence of precancerous lesions\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ePresence of precancerous lesions\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eUnadjusted OR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAdjusted OR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes(%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eparticipants\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e252\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge of first sexual intercourse, years\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e127\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.3 (0.2\u0026ndash;0.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.0005*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.6 (1.9\u0026ndash;7.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.0001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNber of sexual partners\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e159\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.4 (0.8\u0026ndash;2.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGestation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNulligravida\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimigravida\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (0.8\u0026ndash;30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePaucigravida\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.6(0.7\u0026ndash;17.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMultigravida\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e104\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.9(0.5\u0026ndash;12.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrand multigravida\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.6(0.7\u0026ndash;17.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eParity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u0026ndash;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.4(0.5\u0026ndash;4.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e134\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.3(0.5\u0026ndash;3.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAbortion\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.7 (1.5\u0026ndash;5.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.001*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.1 (1.7\u0026ndash;6.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.0004*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHistory of cervical issues\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNo\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e227\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eYes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.5 (0.6\u0026ndash;3.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eContraception\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNone\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMecanic\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.8 (0.3\u0026ndash;2.5))\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHormonal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.5(1.3\u0026ndash;5.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.01*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOther\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.8(0.3\u0026ndash;1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTraditional behaviour\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNo\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e179\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eVaginal dryness\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.7 (0.9\u0026ndash;3.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCervical cancer screening\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNo\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e235\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eYes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.2 (0.01\u0026ndash;1.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eData are n, n(%),OR=Odds ratio, * means statistical significance at 95%. \u0026deg; means marginal significance at 95%. CI means confidence interval\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eInfluence of other factors on the precancerous lesions onset\u003c/h2\u003e \u003cp\u003eThe analysis of medical history and behavioral factors (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e) revealed (despite a wide confidence interval) an increased risk of precancerous lesions associated with tobacco consumption, OR\u0026thinsp;=\u0026thinsp;13.7 (CI: 1.7\u0026ndash;279, p\u0026thinsp;=\u0026thinsp;0.02). Additionally, a positive serological status increased the risk with OR\u0026thinsp;=\u0026thinsp;2.8 (CI: 1-7.7, p\u0026thinsp;=\u0026thinsp;0.04).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eInfluence of other factors on the precancerous lesions onset\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ePresence of precancerous lesions\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eUnadjusted OR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAdjusted OR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes(%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eparticipants\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e252\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAlcohool consumption\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNo\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e177\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eYes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.06 (0.6\u0026ndash;1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTabac consumption\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNo\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e251\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eYes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.7 (1.7\u0026ndash;279)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.02*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSerologic status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNegative\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e193\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePositive\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.8 (1-7.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.04*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSTI history\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNo\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e149\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eYes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.5 (0.8\u0026ndash;2.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eKnowledge level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAdequate\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInadequate\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e190\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.7 (0.4\u0026ndash;1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003cem\u003eData are n, n(%),OR=Odds ratio, * means statistical significance at 95%. \u0026deg; means marginal significance at 95%. CI means confidence interval, STI: Sexual Transmitted Infections\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study investigated the prevalence of precancerous cervical lesions and associated factors among women screened at two university hospitals in N\u0026rsquo;Djamena, Chad. The participation rate of 81.15% indicates a relatively high acceptance of cervical cancer screening in hospital settings, consistent with findings from other facility-based studies conducted in sub-Saharan Africa ([\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. This suggests that tertiary healthcare facilities may play a critical role in improving screening uptake in contexts where organized population-based screening programs are limited [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe prevalence of precancerous cervical lesions observed in this study (18.7%) is high and comparable to rates reported in similar hospital-based studies across sub-Saharan Africa, while remaining substantially higher than those observed in high-income countries [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. This elevated burden likely reflects persistent exposure to oncogenic human papillomavirus (HPV), low coverage of preventive interventions such as HPV vaccination, and delayed access to screening services. The predominance of low-grade squamous intraepithelial lesions suggests that a significant proportion of abnormalities were detected at an early stage. However, the presence of high-grade lesions underscores the continued risk of progression to invasive cervical cancer in the absence of adequate follow-up and treatment [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the multivariate analysis, early age at first sexual intercourse emerged as a strong independent risk factor for precancerous cervical lesions. Women who initiated sexual activity before the age of 18 were significantly more likely to present cytological abnormalities. This finding is consistent with previous studies [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] and can be explained by the biological vulnerability of the immature cervical epithelium, which is more susceptible to HPV acquisition and persistence, as well as by a longer cumulative exposure to oncogenic HPV types over the lifetime [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eA history of abortion was also independently associated with precancerous cervical lesions. Although the underlying mechanisms are not fully elucidated, this association has been reported in other studies [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] and may be related to cervical trauma, hormonal and immunological changes, or repeated gynecological interventions that could facilitate HPV persistence. Nevertheless, this finding should be interpreted with caution, as residual confounding by sexual behavior or access to reproductive health services cannot be entirely excluded.\u003c/p\u003e \u003cp\u003eSeveral factors showed associations with precancerous lesions in univariate analyses but did not remain significant after adjustment. Marital status appeared to have a protective effect, which may reflect differences in sexual behavior patterns, partner stability, or cumulative HPV exposure [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Tobacco use and positive serological status were associated with increased risk; however, the wide confidence intervals observed, particularly for tobacco consumption, suggest limited statistical precision due to small subgroup sizes. Despite this limitation, these findings are biologically plausible and consistent with existing evidence linking smoking and immunosuppression to cervical carcinogenesis [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlthough variables related to cervical cancer awareness and prior screening were assessed, they were not independently associated with lesion occurrence. Importantly, the very low proportion of women with a history of previous screening highlights substantial gaps in preventive healthcare services and underscores missed opportunities for early detection in this population, a situation commonly reported in low-resource settings [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study has several limitations. Its hospital-based design may limit the generalizability of the findings to the broader female population of N\u0026rsquo;Djamena or Chad. The absence of HPV testing precluded direct assessment of HPV infection and genotype-specific risks. Despite these limitations, the study provides valuable baseline data from a setting where epidemiological information on precancerous cervical lesions remains scarce. The use of standardized cytological classification and multivariate analysis strengthens the reliability of the findings.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003ePrecancerous cervical lesions are highly prevalent among women screened at two university hospitals in N\u0026rsquo;Djamena, Chad. Early initiation of sexual activity and a history of abortion were identified as key independent factors associated with lesion occurrence. These findings highlight the importance of addressing sexual and reproductive health determinants in cervical cancer prevention strategies.\u003c/p\u003e \u003cp\u003eStrengthening organized cervical cancer screening programs, promoting early sexual health education, and expanding access to HPV vaccination are critical priorities to reduce the burden of cervical cancer in this high-risk population. Further population-based studies incorporating HPV testing are warranted to better inform national prevention and control strategies in Chad.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003cp\u003eThe study protocol and procedures received approval from the Ethics Committee of the University Hospital Center of Mother and Child in Chad (Reference No. 122/CMT/PC/PM/MSPSN/SE/SG/CHU-ME/DAFM/SRH/2022). The research was conducted in compliance with international ethical standards, specifically the Declaration of Helsinki and its amendments. All participants were informed of their right to withdraw from the study at any time. Data collected during the study were anonymized and maintained in a confidential manner.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConflicts of interest\u003c/strong\u003e \u003cp\u003eThe authors have no competing interests to declare that are relevant to the content of this article.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThe authors did not receive support from any organization for the submitted work.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eLD conceived the study, coordinated data collection, and contributed to manuscript drafting. RTS contributed to the study design, performed the statistical analysis, interpreted the data, and critically revised the manuscript, DF, ZA, MAA, HTA, and AC participated in data collection, patient recruitment, and preliminary data analysis. PBT contributed to the conceptual framework of the study, supervised the research process, and critically reviewed the manuscript for intellectual content. All authors read and approved the final version of the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003e Authors thank all the participants and the medical professionals in the University Hospital Center of Mother and Child and the University Hospital Center of Chad-China Friendship. who provided their support in the clinical part of the study and in data analysis\u003c/p\u003e\u003ch2\u003eData availability\u003c/h2\u003e \u003cp\u003eThe data that support the fndings of this study are available from the corresponding authors upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSahasrabuddhe VV, Parham GP, Mwanahamuntu MH, Vermund SH. Cervical Cancer Prevention in Low- and Middle-Income Countries: Feasible, Affordable, Essential. Cancer Prev Res. 2012;5(1):11\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1158/1940-6207.CAPR-11-0540\u003c/span\u003e\u003cspan address=\"10.1158/1940-6207.CAPR-11-0540\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShrestha AD, Neupane D, Vedsted P, Kallestrup P. Cervical Cancer Prevalence, Incidence and Mortality in Low and Middle Income Countries: A Systematic Review. Asian Pac J Cancer Prev. 2018;19(2):319\u0026ndash;24. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.22034/APJCP.2018.19.2.319\u003c/span\u003e\u003cspan address=\"10.22034/APJCP.2018.19.2.319\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGeorge N, Bhandari P, Shruptha P, Jayaram P, Chaudhari S, Satyamoorthy K. Multidimensional outlook on the pathophysiology of cervical cancer invasion and metastasis. Mol Cell Biochem. 2023;478(11):2581\u0026ndash;606. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s11010-023-04686-3\u003c/span\u003e\u003cspan address=\"10.1007/s11010-023-04686-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBurd EM. Human papillomavirus and cervical cancer. Clin Microbiol Rev. 2003;16(1):1\u0026ndash;17. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1128/CMR.16.1.1-17.2003\u003c/span\u003e\u003cspan address=\"10.1128/CMR.16.1.1-17.2003\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchiffman M, Castle PE, Jeronimo J, Rodriguez AC, Wacholder S. Human papillomavirus and cervical cancer. Lancet. 2007;370(9590):890\u0026ndash;907. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/S0140-6736(07)61416-0\u003c/span\u003e\u003cspan address=\"10.1016/S0140-6736(07)61416-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTagne Simo R, Djoko Nono AG, Fogang Dongmo HP, et al. Prevalence of precancerous cervical lesions and high-risk human papillomavirus types in Yaounde, Cameroon. J Infect Dev Ctries. 2021;15(9):1339\u0026ndash;45. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3855/jidc.15218\u003c/span\u003e\u003cspan address=\"10.3855/jidc.15218\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394\u0026ndash;424. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3322/caac.21492\u003c/span\u003e\u003cspan address=\"10.3322/caac.21492\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209\u0026ndash;49. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3322/caac.21660\u003c/span\u003e\u003cspan address=\"10.3322/caac.21660\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArbyn M, Weiderpass E, Bruni L, et al. Estimates of incidence and mortality of cervical cancer in 2018: a worldwide analysis. Lancet Global Health. 2020;8(2):e191\u0026ndash;203. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/S2214-109X(19)30482-6\u003c/span\u003e\u003cspan address=\"10.1016/S2214-109X(19)30482-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFerede YA, Tassew WC, Zeleke AM. Precancerous cervical lesion and associated factors among HIV-infected women in Ethiopia: systematic review and meta- analysis. BMC Cancer. 2024;24(1):678. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12885-024-12462-9\u003c/span\u003e\u003cspan address=\"10.1186/s12885-024-12462-9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGetinet M, Jemal M, Baylie T, et al. High-risk human papillomavirus infection (HPV 16/18) and its determinants among women in East Gojjam Zone, Northwest Ethiopia: a population-based cross-sectional study, 2021. BMJ Open. 2025;15(7):e092760. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1136/bmjopen-2024-092760\u003c/span\u003e\u003cspan address=\"10.1136/bmjopen-2024-092760\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBasu P, Joshi S, Sankaranarayanan R. Human Papillomavirus (HPV) Testing for Secondary Prevention of Cervical Cancer. Curr Obstet Gynecol Rep. 2015;4(4):201\u0026ndash;12. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s13669-015-0133-z\u003c/span\u003e\u003cspan address=\"10.1007/s13669-015-0133-z\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMerera D, Jima GH. Precancerous Cervical Lesions and Associated Factors Among Women Attending Cervical Screening at Adama Hospital Medical College, Central Ethiopia. CMAR. 2021;13:2181\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2147/CMAR.S288398\u003c/span\u003e\u003cspan address=\"10.2147/CMAR.S288398\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBruni L, Albero G, Rowley J, et al. Global and regional estimates of genital human papillomavirus prevalence among men: a systematic review and meta-analysis. Lancet Global Health. 2023;11(9):e1345\u0026ndash;62. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/S2214-109X(23)00305-4\u003c/span\u003e\u003cspan address=\"10.1016/S2214-109X(23)00305-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoscicki AB, Schiffman M, Burchell A, et al. Updating the Natural History of Human Papillomavirus and Anogenital Cancers. Vaccine. 2012;30:F24\u0026ndash;33. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.vaccine.2012.05.089\u003c/span\u003e\u003cspan address=\"10.1016/j.vaccine.2012.05.089\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNayar R, Wilbur DC. The Bethesda System for Reporting Cervical Cytology: A Historical Perspective. Acta Cytol. 2017;61(4\u0026ndash;5):359\u0026ndash;72. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1159/000477556\u003c/span\u003e\u003cspan address=\"10.1159/000477556\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEbu NI, Mupepi SC, Siakwa MP, Sampselle CM. Knowledge, practice, and barriers toward cervical cancer screening in Elmina, Southern Ghana. Int J Womens Health. 2015;7:31\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2147/IJWH.S71797\u003c/span\u003e\u003cspan address=\"10.2147/IJWH.S71797\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSankaranarayanan R, Budukh AM, Rajkumar R. Effective screening programmes for cervical cancer in low- and middle-income developing countries. Bull World Health Organ. 2001;79(10):954\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZampaoglou E, Boureka E, Gounari E, et al. Screening for Cervical Cancer: A Comprehensive Review of Guidelines. Cancers. 2025;17(13). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/cancers17132072\u003c/span\u003e\u003cspan address=\"10.3390/cancers17132072\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBosch FX, Lorincz A, Mu\u0026ntilde;oz N, Meijer CJLM, Shah KV. The causal relation between human papillomavirus and cervical cancer. J Clin Pathol. 2002;55(4):244\u0026ndash;65.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLouie KS, de Sanjose S, Diaz M, et al. Early age at first sexual intercourse and early pregnancy are risk factors for cervical cancer in developing countries. Br J Cancer. 2009;100(7):1191\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1038/sj.bjc.6604974\u003c/span\u003e\u003cspan address=\"10.1038/sj.bjc.6604974\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhan MJ, Partridge EE, Wang SS, Schiffman M, Group ASC of USGSILTS (ALTS). Socioeconomic status and the risk of cervical intraepithelial neoplasia grade 3 among oncogenic human papillomavirus DNA-positive women with equivocal or mildly abnormal cytology. Cancer. 2005;104(1):61\u0026ndash;70. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/cncr.21129\u003c/span\u003e\u003cspan address=\"10.1002/cncr.21129\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMu\u0026ntilde;oz N, Franceschi S, Bosetti C, et al. Role of parity and human papillomavirus in cervical cancer: the IARC multicentric case-control study. Lancet. 2002;359(9312):1093\u0026ndash;101. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/S0140-6736(02)08151-5\u003c/span\u003e\u003cspan address=\"10.1016/S0140-6736(02)08151-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePlummer M, Herrero R, Franceschi S, et al. Smoking and cervical cancer: pooled analysis of the IARC multi-centric case\u0026ndash;control study. Cancer Causes Control. 2003;14(9):805\u0026ndash;14. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1023/b:caco.0000003811.98261.3e\u003c/span\u003e\u003cspan address=\"10.1023/b:caco.0000003811.98261.3e\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKayar İ, Goc G, Cetin F, Birge \u0026Ouml;. Impact of Smoking on Cervical Histopathological Changes in High-Risk HPV-Positive Women: A Matched Case\u0026ndash;Control Study. Medicina. 2025;61(2). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/medicina61020235\u003c/span\u003e\u003cspan address=\"10.3390/medicina61020235\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRandall TC, Ghebre R. Challenges in Prevention and Care Delivery for Women with Cervical Cancer in Sub-Saharan Africa. Front Oncol. 2016;6:160. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3389/fonc.2016.00160\u003c/span\u003e\u003cspan address=\"10.3389/fonc.2016.00160\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Cervical cancer, Precancerous cervical lesions, Human papillomavirus, Liquid-based cytology, Risk factors, Chad","lastPublishedDoi":"10.21203/rs.3.rs-8761374/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8761374/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eHuman papillomavirus (HPV) infection is the main etiological factor of cervical cancer worldwide. In sub-Saharan Africa, including Chad, cervical cancer remains a major public health problem due to limited screening coverage and late diagnosis. Data on the burden of precancerous cervical lesions and associated risk factors are scarce in Chad. This study aimed to determine the prevalence of precancerous cervical lesions and identify associated factors among women screened in N\u0026rsquo;Djamena.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA hospital-based cross-sectional study was conducted in 2022 at two university hospitals in N\u0026rsquo;Djamena, Chad. Cervical samples were collected from women attending gynecological consultations and analyzed using liquid-based cytology, with results classified according to the 2014 Bethesda system. Sociodemographic characteristics, gynecological and obstetrical history, medical history, and behavioral factors were collected using a structured questionnaire. Univariate logistic regression was performed to estimate crude odds ratios (ORs) with 95% confidence intervals (CIs). Variables with p-values\u0026thinsp;\u0026lt;\u0026thinsp;0.20 were entered into a multivariate logistic regression model to identify independent associated factors.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 310 women were included, of whom 58 presented precancerous cervical lesions, corresponding to a prevalence of 18.7%. Identified cytological abnormalities included atypical squamous cells of undetermined significance, atypical squamous cells\u0026mdash;cannot exclude high-grade lesions, low-grade squamous intraepithelial lesions, high-grade squamous intraepithelial lesions, and atypical glandular cells. In univariate analysis, marital status was significantly associated with a reduced risk of precancerous lesions. Increased risks were observed among women with sexual debut before 18 years, a history of abortion, use of hormonal contraception, tobacco consumption, and positive serological status. In multivariate analysis, early sexual debut before 18 years (adjusted OR\u0026thinsp;=\u0026thinsp;3.6; 95% CI: 1.9\u0026ndash;7.3; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and history of abortion (adjusted OR\u0026thinsp;=\u0026thinsp;3.1; 95% CI: 1.7\u0026ndash;6.1; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) remained independently associated with precancerous cervical lesions.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003ePrecancerous cervical lesions were relatively common among women screened in N\u0026rsquo;Djamena. Early sexual initiation and a history of abortion were independently associated with lesion occurrence. These findings highlight the need to strengthen cervical cancer prevention strategies, particularly through early screening and targeted preventive interventions in Chad\u003c/p\u003e","manuscriptTitle":"Precancerous cervical lesions and associated factors among women screened at two University Hospitals in N’Djamena, Chad","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-11 18:55:23","doi":"10.21203/rs.3.rs-8761374/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2026-03-05T16:31:39+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-09T15:59:06+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-02T23:34:51+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-02T23:34:43+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Women's Health","date":"2026-02-02T06:33:19+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1bb13eb4-c6a0-465d-a378-87ef54f41fc3","owner":[],"postedDate":"March 11th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-11T18:55:23+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-11 18:55:23","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8761374","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8761374","identity":"rs-8761374","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}