Detection of pre-cervical cancer and its associated factors among cervical cancer suspected women in Bichena primary hospital in Amhara region, Ethiopia

Detection of pre-cervical cancer and its associated factors among cervical cancer suspected women in Bichena primary hospital in Amhara region, Ethiopia | 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 Detection of pre-cervical cancer and its associated factors among cervical cancer suspected women in Bichena primary hospital in Amhara region, Ethiopia Awoke Minwuyelet, Debas Belay This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6534651/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Purpose This study aimed to assess the prevalence of Human papillomavirus (HPV) infection, precervical cancer and its associated factors among women suspected of cervical cancer (CC) at Bichena Primary Hospital in the Amhara region, Ethiopia. Methods A cross-sectional study was conducted at Bichena Primary Hospital from January 2020 to June 2021. A total of 385 women suspected of CC were participated in this study. HPV infection was detected using the OncoE6™ Cervical test for HPV 16/18 antigens, and Visual Inspection with Acetic Acid (VIA) was used for precervical cancer detection. Additionally, a semi-structured questionnaire was also used to collect socio-demographic and clinical information. Data were analyzed using Statistical Package of Social Sciences (SPSS) version 23, and logistic regression was employing for analysing assocations between independent and dependent variables.Finally, the findings were presented in texts and tables. Results The overall prevalence of oncogenic HPV (HPV16/18) was 6.2% [95%, CI: 3.9–9.1], while VIA positivity was 3.6% [95%, CI: 2.1–5.7]. Multivariate logistic regression identified several significant predictors of precervical cancer due to HPV infection: age over fifty (AOR [95% CI = 1.65–191.8]), primary education (AOR [95% CI = 1.81–83.1]), early age at first sexual intercourse (AOR [95% CI = 1.04–22.01]), parity (three or more) (AOR [95% CI = 2.03–99.9]), history of sexually transmitted infections (STIs) (AOR [95% CI = 1.39–45.25]), and HIV/AIDS (AOR [95% CI = 1.6-44.29]). Early age at first sexual intercourse and history of STIs were associated factors for VIA positivity (P < 0.05). Conclusions HPV infection contributes significantly to CC in the study area, emphasizing its public health impact. Early sexual intercourse emerged as an independent predictor of VIA positivity and CC. As a result, to mitigate the risk of CC: early screening, treatment, and vaccination of high-risk groups of women for HPV infection are recommended. Cervical cancer Human papillomavirus OncoE6TM Cervical Test Visual inspection Introduction Cervical cancer (CC) is characterized by abnormal cell growth in the cervix and is a preventable disease. . CC is a global public health problem, with a particularly high burden in many low- to middle-income countries (LMICs)(1, 2).CC ranks as the fourth most common cancer in women worldwide, with an estimated 604,000 new cases and 342,000 deaths reported in 2020. Alarmingly, nearly 90% of CC deaths occur in LMICs due to inadequate screening and a higher prevalence of HPV infection (2, 3). Geographic variations, disparities and other factors contribute significantly to variations in CC prevalence, with more than half of all cases occurring in women aged over 45 years old (4, 5). Persistent infection with HPV is the primary cause of CC. Evidence overwhelmingly supports HPV infection as the leading global risk factor for CC (2). Most HPV infections resolve spontaneously without symptoms, while some HPV strains, such as HPV 16 and 18, can lead to cancer, accounting for 70% of CC cases and 99% of cervical tumors (6, 7). In Ethiopia, CC ranks as the second leading cause of cancer-related deaths among women aged 15 to 44 following breast cancer. According to the International Agency for Research on Cancer’s Information Center on HPV infection and Cancer in Ethiopia, current estimates indicate that every year 7,095 women are diagnosed with CC and 4,732 deaths due to diseases (8). High-income countries have successfully reduced CC rates by identifying and treating precancerous abnormalities early(9). In contrast, only about 5% of eligible women in LMICs undergo cytology-based screening for CC, presenting a significant barrier to prevention efforts (6). For example, in 2020, the Federal Ministry of Health in Ethiopia planned to detect and treat at least 80% of the appropriate target populations of pre-invasive CC cases however, the nine regions and two city administrations of Ethiopia report revealed lower rate of cervical screening (2.9%) (10). It also indicated only 10% of early stages, I and II patients have visited an oncology center (8, 11). Despite challenges related to sensitivity and specificity in some diagnostic tools, VIA remains a viable method for CC screening. To enhance diagnostic accuracy and early detection of CC, the Ethiopian Federal Ministry of Health recommends combining VIA with molecular HPV testing. Based on this recommendation, this study aimed to assess the prevalence of HPV infection, precervical cancer, and associated factors among women suspected of CC at Bichena Primary Hospital in the Amhara region, Ethiopia. Materials and Methods Study setting and Population An institution-based cross-sectional study was conducted from January 2020 to June 2021 in Bichena Primary Hospital. Bichena Primary Hospital is located 200 meters east of Bichena town. Bichena is situated 275 kilometers north of Addis Ababa, the capital of Ethiopia. The hospital servesfor Bichena town and Enemay district populations. It also serves populations who are referred from districts of Enarg Enawuga, Shebel Bernta, and Kuy health institutions. All women who visited Bichena Primary Hospital during the study period were the sources of the study population. CC-suspected women visiting outpatient clinics, family planning, Anti-retroviral treatment, emergency, and inpatient wards were the study populations. Women at age greater than 18 years old and suspected of CC were inclusion criteria. However, women who were pregnant and/or women who had undergone follow-up cancer examinations at current treatment facilities were excluded. Operational definition Cervical cancer suspected women refer to individuals who present with symptoms, signs, or risk factors that raise clinical suspicion of CC or its precursor stages (precervical cancer). These women typically undergo further diagnostic evaluation to confirm or rule out the presence of cervical abnormalities (12). The judgment criteria involve a comprehensive evaluation of these factors to determine the need for further investigation and management (13). Judgment Criteria for Suspected Cases: The judgment criteria for suspected cases of CC include various clinical indicators and risk factors. These include: Symptoms and Signs: Such as abnormal vaginal bleeding (especially post-coital bleeding), abnormal vaginal discharge, pelvic pain, or pain during sexual intercourse. High-Risk Factors: Including a history of HPV infection, particularly with high-risk HPV types such as HPV 16 and 18, multiple sexual partners, early age at first sexual intercourse, immunocompromised status (e.g., HIV-positive), and a history of sexually transmitted infections (STIs). Screening Test Results: Positive findings on CC screening tests such as Visual Inspection with Acetic Acid (VIA), or molecular tests detecting HPV DNA or HPV oncoproteins (e.g., HPV 16/18). Clinical Evaluation: Conducted by healthcare providers, who include physical examination findings such as abnormal cervical appearance during speculum examination, palpable pelvic masses, or enlarged lymph nodes suggestive of metastasis. Risk Assessment: Combining various risk factors and clinical findings to assess the likelihood of CC or its precursor lesions. Sample size and Sampling procedure The sample size was calculated using the single population proportion formula with the assumption of a 50% prevalence (P) of precervical cancer due to HPV infections. Based on this, the formula: N = (Zα/2)²p (1-p)/d²: where n = the sample size, Zα/2 = 1.96 at 95% confidence interval (CI), d = margin of error, p= prevalence of precervical cancer, 95% CI and margin of error (d) at 5% (standard value of 0.05). To account for the non-response rate (refusal), 10% of the calculated sample size was added. The final sample size employed for the diagnosis of HPV16 and/ or 18 antigens from CC suspected women was 385. Data collection and clinical diagnosis methods Data collection tools and procedures A semi-structured questionnaire, which was prepared in English and translated to the Amharic (local) language, was used to collect the socio-demographic factors of study participants. Socio-demographic characters, clinical and the risk factors associated with them were included in the questionnaire. Clinical diagnosis and procedures Women who visited wards: antiretroviral treatment, outpatient, inpatient, emergency, and family planning were clinically evaluated based on WHO guidelines (2021) (3). The suspected cases underwent VIA and molecular HPV testing. The medical laboratory department used the OncoE6 TM Cervical test to detect HPV onco6 serotypes 16 and 18 antigens from swab samples. Visual inspection using an acetic acid test (VIA): the cervix was cleaned with a cotton swab and then treated with a 5% acetic acid solution. Abnormal cervical tissues of suspected individual precancerous or cancerous lesions developed colour change within a minute. However, if cervical tissue was healthy, there wouldn't be any aceto-white lesions visible on the VIA (14). In addition, the Medical Laboratory Department in the hospital has used a quick molecular diagnosis test tool that detects HPV onco6 serotype 16 and 18 antigens. Swab sample diagnosis and procedures E6 HPV 16/18 oncoprotein test : is a molecular qualitative test that detects elevated levels of oncoprotein E6 expressed from cells infected by HPV subtypes 16 and/or 18. E6 oncoprotein is necessary for the oncoprotein transformation of cervical epithelial cells. If the test of a cervicovaginal specimen is positive it tells us a precancerous or cancerous lesion already has elevated levels of the oncoprotein E6, or there may be an increased risk of precancerous or cancerous lesions in the future (15). It also used to screen for prcervical cancer. Procedure: Cell lysates produced from samples of cervical swabs are used in the oncoE6TM cervical test. Using high-affinity Monoclonal Antibodies (MAbs) the E6 oncoprotein of HPV subtypes 16 and 18 are incubated with the lysate in this step. The specimen lysate and MAb-AP mix are added to a nitrocellulose test strip, which has two capture lines made up of immobilized MAbs to E6 16/18. This causes the capillary action to move through the test strip membrane. If HPV types 16 and/or 18's of E6 oncoprotein are present, a ternary complex (capture MAb-E6 detector MAb) may form. The ternary complex is visible as a purple line at the appropriate locations on the strip after the addition of an enzyme substrate (5). Data processing and analysis The filled-out questionnaire and laboratory results were manually cleaned, coded, checked for completeness and analyzed using SPSS version 23.Bivariate analysis was primarily used to determine which variables individually have an association with the dependent variable,followed by multivariable logistic regression to determine significant predictors of precervical cancer due to HPV infection. Ethical considerations An Ethical clearance letter was obtained from the management team and Ethical committee of Bichena Primary Hospital after the proposal submission. Similarly, the supportive letter was received from the chief executive officer of the hospital. Consent was also obtained from study participants before enrolled in the study. RESULTS Socio-demographic characteristics The study included a total of 385 participants. The mean age of study participants was 30.6 years, with a standard deviation (SD) of ± 9.3 (ranging from 17 to 80 years). The mean age of respondents at the time of the first marriage was 15.4 years, with an SD of ± 3.8 (ranging from 7 to 28 years). The majority of study participants were from rural areas (61.8%) and 40% had completed their diploma. Behavioural risk factors of participants More than 57% of participants had experienced childbirth, while only 20% had used family planning methods. Additionally, 46% reported initiating sexual activity before the age of 18. A small percentage of participants were HIV-positive (6.5%), and 3.6% had a history of sexually transmitted infections (STIs). None of the participants reported regular smoking (Table 1 ). Table 1 Socio-demographic Characteristics of women screened for HPV and VIA in Bichena primary Hospital, Northwest Ethiopia, 2020–2021. Socio-demographic Variables Category Frequency Percentage (%) Age group (years) 17–29 207 53.8 30–39 109 28.3 40–49 47 12.2 ≥ 50 22 5.7 Education status Illiterate 65 16.9 Grade 1–8 57 14.8 Grade 9–12 109 28.3 Graduated 154 40.0 Residence Urban 147 38.2 Rural 238 61.8 Age at first sexual intercourse < 18 178 46.2 ≥ 18 207 53.8 Family history about Cervical cancer Negative 243 63.1 Positive 9 2.3 Not known 133 34.5 Parity Parous 222 57.7 None parous 163 42.3 History of Sexual transmitted infection and / or tested positive Negative 371 96.4 Positive 14 3.6 Known positive and or tested positive for HIV ADIS Negative 360 93.5 Positive 25 6.5 Sexual partners < 3 291 75.6 ≥ 3 94 24.4 Family planning used Not used 79 20.5 Yes 306 79.5 Prevalence of Human papillomavirus infection Among the screened women, 6.2% (24/385) were tested positive for HPV infection. Based on serotype, 3.6% (14/385) were positive for HPV 16 antigens and 0.8% (3/385), 18 antigens. The prevalence of HPV infection varied significantly by age group, with the highest prevalence of HPV infection (18.18%) was observed among women older than 50 years, and the lowest prevalence (4.3%) was among women aged 17–29 years (P 0.05). HIV-positive women had a significantly higher prevalence of HPV infection (16%) compared to HIV-negative women (5.5%) (95% CI = 0.037–0.092, P = 0.001). Similarly, women with a history of STIs showed a higher prevalence of precervical cancer (57.14%) compared to women without such history ( Table S1, and Table 2 ). Among all participants, 9.9% had cervical lesions at the time of enrollment. A majority of these participants tested positive for both HPV infection and VIA ( Table S2 ). Table 2 Multivariate analysis of potentially associated factors of precervical cancer among screened women in Bichena primary Hospital, Northwest Ethiopia, 2020–2021. Risk factors HPV infection Total (%) OR (95%,CI) P value Positive (%) Negative (%) COR AOR Age (years) 17–29 9(4.35) 198(95.65) 207(53.8) 1 1 30–39 7(6.42) 102(93.58) 109(28.3) 1.51(0.55–4.18) 0.78(0.15–4.06) 0.77 40–49 4(8.51) 43(91.49) 47(12.2) 2.05(0.6–6.95) 2.25(0.29–17.5) 0.43 ≥ 50 4(18.18) 18(81.81) 22(5.7) 4.89(1.37–17.46) 4.16(1.65–191.8) 0.046 Residence Urban 12(8.16) 135(91.84) 147(38.2) 1 1 Rural 12(5.04) 226(94.96) 238(61.8) 0.59(0.26–1.37) 0.58(0.17–2.01) 0.39 Education status Illiterate 5(7.69) 60(92.31) 65(16.9) 4.19(0.97–18.10) 0.5(0.04–6.81) 0.6 Grade1-8 11(19.3) 46(80.70) 57(14.8) 12.04(3.22–44.9) 12.3(1.81–83.1) 0.01 Grade 9–12 5(4.59) 104(95.41) 109(28.3) 2.42(0.57–10.35) 4.9(0.42–58.8) 0.20 Diploma & above 3(1.95) 151(98.05) 154( 40 ) 1 Age at the 1st sexual intercourse <18yrs 20(11.24) 158(88.760 178(46.2) 6.42(2.42–19.17) 4.8(1.04–22.01) 0.044 ≥ 18yrs 4(1.93) 203(98.07) 207(53.8) 1 1 Parity category < 3 7(3.15) 215(96.84) 222(57.7) 1 1 ≥ 3 179(55.08) 146(44.92) 325(84.42) 3.58(1.45–8.84) 14.25(2.03–99.9) 0.007 STI history Yes 8(57.14) 6(42.86) 14(3.6) 29.58(9.17–95.42) 7.93(1.39–45.25) 0.02 No 16(4.31) 355(95.69) 371(96.4) 1 1 HIV infection posetive Yes 9( 36 ) 16(64) 25(6.49) 12.94(4.92–34.01) 8.42(1.6-44.29) 0.012 No 15(4.17) 345(95.83) 360(93.51 ) 1 1 Family planning used Yes 19(6.18) 287(93.49) 307(79.74) 0.98(.35-2.711) 14.19(0.62–28.15) 0.14 No 5(6.32) 74(93.67) 79(20.52) 1 1 Sexual partner < 3 10(3.44) 281(96.56) 29175.58) 1 1 ≥ 3 14(14.89) 80(85.10) 94(24.42) 4.92(2.11–11.49) 3.28(1.87–12.31) 0.048 HIV: Human Immunodefienecy Virus, STI: sexualy transmited Infection Likewise, women who initiated sexual activity before the age of 18 had a higher prevalence of VIA positivity (6.74%) compared to those who started at 18 or older (P < 0.05). Similarly, women with a history of STIs showed a higher prevalence of VIA positivity compared to those without such history (P < 0.05) (P < 0.05) (Table 3 ). Table 3 Multivariate analysis of potentially associated factors of VIA posetivity among screened women in Bichena primary Hospital, Northwest Ethiopia, 2020–2021. Risk factors VIA positivity Total (%) OR (95%,CI) P value Positive (%) Negative (%) COR AOR Age at the 1st sexual intercourse <18yrs 12(6.74) 166(93.26) 178(4.42) 7.41(1.64–33.57) 6.18(1.38–29.29) 0.018 ≥ 18yrs 2(0.97) 205(99.03) 207(53.77) 1 1 History and tested positive STI Yes 3(21.43) 11(78.57) 14(3.64) 8.92(2.18–36.59) 6.05(1.18–31.1) 0.032 No 11(3.06) 360(97.04) 371(96.36) 1 1 HIV Tested positive Yes 2 ( 8 ) 23(92) 25(6.49) 2.52(0.53–11.94) 0.98(0.15–6.63) 0.98 No 12(3.33) 348(96.67) 360(93.51) 1 1 Multivariable Logistic Regression of Associated Factors for Pre-cervical Cancer To control confounding variables, factors associated with HPV infection with a P value of < 0.25 in bivariate analysis were included in multivariable logistic regression. Age group, education status, parity, age at first sexual interaction, multiple sexual partners, history of STI, and HIV-positive individuals were identified as a significant associated factors for HPV infection (P < 0. 05)(Table 2 ). Similarly, women with STI histories or those who tested positive for STIs and the early age at the first sexual encounter were also identified as a significant associated factors for VIA (P < 0.05) (Table 3 ). Women in age groups of 50 and older had a 4 .16 times higher likelihood of HPV infection compared to women aged 17–29 years [95%, (CI = 1. 65–191.8)]. Additionally, women with primary educational status (grades 1–8) had a 12.3 times higher chance of HPV infection compared to women who had graduated (AOR [95% CI = 1.81–83.1)]. Likewise, women who had first sexual intercourse before 18 years old were 4.8 times more likely to be infected with HPV than those who did not (AOR [95%, CI= (1.04–22.01)]. In addition, women who had three or more sexual partners had a 3.28 times higher risk of contracting HPV than those who had fewer than three partners (AOR [95%, CI= (1.87–12.31)]. Moreover, women with three or more parties or had a 14. 25 times more likely to develop HPV infection compared to women with fewer parities (AOR [95%, CI = (2.03-99. 9)]). Additionally,, women with a history of STIs had 7.93 times more likely to have HPV infection compared to women without a history of STI (AOR [95%, CI = (1.39-45. 25)]). Similarly, women who tested positive for HIV were 8.42 times more likely to have HPV infection than those who tested negative for HIV (AOR[95%, CI =(1.6-44.29]) (Table 2 ). Conversely, women who experienced sexual intrcoure before the age of 18 years old had a 6.18 times higher chance of being positive for the VIA test than those who started at 18 or older [95%, CI=(1.38–29.29)]. Similarly, women with STI histories had a 6.05 times higher likelihood of having VIA-positive results than women without such histories (AOR [95%, CI = (1.18–31.1)] (Table 3 ). Discussion Cervical cancer, characterized by the abnormal growth of cervical tissue, can often be asymptomatic but detectable through screening. HPV infection remains the primary cause of CC, and preventive measures such as vaccination and early screening are crucial (16). In this study, we evaluated the prevalence of HPV 16 and/or 18 infections and its associated factors for pre-cervical cancer suspected women in Bichena primary hospitals in the Amhara region, Ethiopia. The overall prevalence of HPV infection was 6.2% (24/385) [95%, CI: 3.9–9.1]. This finding was comparable to previous studies conducted in different parts of Ethiopia: Amhara (7.1%) ( 17 ) and Mekele (6.7%) ( 18 ). However, the prevalence of HPV infection was lower than studies findings conducted in Ethiopia: southwest Ethiopia (12.9% ) ( 19 ), the Gurage zone (17.3%) ( 20 ) and other study findings conducted in Nigeria (16%) ( 21 ). Variations in prevalence may stem from differences in a research settings, ethnicity, socio-economic factors, geographical locations, and sexual behaviors, which all influence HPV epidemiology ( 22 ). Differences in diagnostic techniques also contribute to varying prevalence rates of HPV infection. Similarly, VIA positivity of this study was 3.6% (14/385) [95%, CI: 2.1–5.7]. This finding was also in line with study findings in Rwandan 1.7% ( 23 ). But it was lower than the study’s findings which conducted in different regions of Ethiopia: southern (16.5%) ( 19 ) and Amhara, Ethiopia (13.1%) ( 17 ). The discrepancy could be due to variations in test providers' abilities, as well as the underlying prevalence of other STDs and reproductive traits. Additionally, the prevalence may have increased in part as a result of the women's differing sexual behaviours. Pregnant women and those who had been diagnosed with cervical cancer were not included in this study. As a result, the prevalence of VIA positivity in our study could be underestimated. Among the study participants, 8.6% had precancerous lesions which align with a study finding from, in the Amhara region, Ethiopia which reported 38.6% of participants had precancerous lesions ( 24 ). However, this study finding was much lower than the studies findings in Jimma (67.1%) ( 25 ) and Hawassa Ethiopia (49.3%) ( 26 ). The discrepancy could result from different diagnostic approaches and test providers with varying levels of expertise. S significant associations were observed between HPV infection and age groups over 50 years old in this study. Similarly, study participants who were greater than 50 years old had a 4.16 greater likelihood of having HPV infection than those who were between the ages of 17–29. This finding was consistent with study findings in Amhara Ethiopia ( 17 , 27 ). Conversely, another study conducted in Lagos, Nigeria by Ashaka et al . (2022) reported higher HPV infection prevalence of among women aged 18–24 years compared to other age groups ( 28 ). However, a review conducted by Smith et al .(2008) showed that women with HPV infection is most commonly acquired during adolescence, and the peak incidence in middle-aged tends to vary by geographical area. Variations in HPV prevalence throughout age appear to reflect disparities in sexual behaviour between geographical regions ( 29 ). In addition, older people are more likely to acquire persistent HPV infections ( 30 ). Educational status also influenced HPV infection. The study participants with primary educational status were 12.3 times more likely to have HPV infection compared to those with higher education. Similarly, women with secondary educational status were 4.2 times more likely to have HPV infection compared to diploma and above women. Similar findings were reported in Ethiopia ( 17 , 31 ), as well as other countries: India ( 32 ) and Nepal ( 33 ). This may be because greater awareness lowers risk, whereas women who did not complete high school are at risk due to a lack of employment and exposure to different sexual partners that caused STIs and HIV /ADIS. This may also increase the risk of infection and development of CC. The current study also identified multi-parity as a significant risk factor for HPV infection. This was in line with the study conducted in Ethiopia ( 14 ). Studies aproved that high prevalence of cervical abnormalities during pregnancy promotes cervical lesions, making epithelial cells more susceptible to HPV infection ( 34 , 35 ). This might be a result of the negative effects of polygamy on these women, which include higher levels of husband promiscuity and contamination during childbirth. Similarly, early sexual activity increased the risk of HPV infection by 4.8 times, which is comparable to research conducted in Ethiopia ( 14 ), Nigeria ( 36 ) and Brazil ( 37 ). Conversely, a study conducted across Africa found no significant relationship between early sexual engagement and cervical cancer in subgroup analysis, but pooled analyses across ten studies revealed an association ( 38 ). This could be due to early sexual exposure causing physiologic changes and HPV infection in the cervical tissue. An earlier sexual debut age also suggests a longer period of sexual activity and a greater likelihood of having numerous sexual partners. A statistically significant association between VIA positivity and earlier sexual intercourse before the age of 18 years old was observed. Similar findings were carried out in Adma, Ethiopia ( 39 ) and Nigeria ( 40 ). On the contrary, another study conducted in the Oromia Region, Ethiopia indicated that initiating sexual intercourse at an early age (below 18 years old) had a 60% less chance of being positive for the VIA test ( 41 ). The difference in the prevalence of VIA of positivity may be due to differences in study participants, small sample sizes, study design, and the diagnostic skills of health professionals. However, most study suggests earlier sexual intercourse experiences lead to women's mortality related to CC. As a result, women under the age of 18 should either get vaccinated before having their first sexual contact or refrain from starting sexual activity at the later age of 18 years old ( 42 ). In this study, women with a history of STIs had statistically a stronger predictor of HPV infection and VIA positivity when compared to women who had no history of STIs. This finding was comparable with studies findings in Ethiopia ( 43 , 44 ). Similarly, multiple sexual partners also found as predictor of HPV infection, with women reporting three or more partners had a 4.9 times higher risk of HPV infection than those with fewer partners. This finding is consistent with other research findings in Ethiopia ( 45 – 47 ). These findings highlight the role of sexual behavior in invasive CC and early CC incidence. There was also a statistically significant association between women with HIV and HPV infection (36%). This finding was in line with studies conducted in South Africa ( 48 ), Senegal ( 49 ) and low- and middle-income nations all reported similar results ( 50 ). Conversely, in our study, HIV infection and VIA positivity didn’t have a significant association. However, many studies approved that HIV infection is the predictor of VIA positivity and precervical cancer ( 41 , 51 , 52 ). This might be attributed to the low number of HIV-positive women participated in our research compared to HIV-negative women. The molecular OncoE6™ Cervical test performed better than the VIA test in diagnosing the pathogenic states of study participants. The HPV positivity rate by molecular test of VIA-positive cases was 85.7%. Whereas only 50% of instances out of the total number of molecular test-positive cases were identified by VIA tests for cervical lesions. Similarly, another study recommends primarily HPV testing using molecular tools looks practical and should be explored as a primary screening test in low- and middle-income countries. VIA's low sensitivity makes it inappropriate as a triage test for HPV-positive women ( 53 , 54 ). Conclusion We found a 6.2% prevalence of HPV infection and 3.6% VIA positivity among the CC suspected women. Study participants at the age of 50 years old and more, primary education, early sexual contact, multiparty, STI positivity, and HIV positivity had statistically significant associations with HPV infection. Similarly, VIA positivity had a statistically significant association with early sexual intercourse at the age of below 18 years of old, and/or STI history. Therefore, prophylactic vaccination against HPV and early screening and treatment of pre-cancer lesions is recommended to prevent and control cervical cancer morbidity and mortality. Abbreviations AOR: Adjusted Odds Ratio, CC: Cervical cancer, CCS: Cervical Cancer Screening; CI: Confidence Interval, COR: Crude Odds Ratio, HIV: Human Immune Virus, HPV: Human Papilloma Virus, SPSS: Statistical Package for Social Science, STI: Sexually Transmitted Infections, VIA: Visual Inspection with Acetic acid. Declarations Acknowledgements We would like to thank the study participants and clinical and laboratory staff in Bichena primary hospitals. Authors’ Contributions A.M. Conceived the study, performed laboratory tests, and prepared the manuscript. D.B. performed a clinical examination and filled out the questionnaire. Both authors critically reviewed the manuscript. Funding No funding Availability of data and materials We have complete raw data at our disposal and can reach out to the corresponding author if requried. Ethics approval and consent to participat The study protocol was approved by the Institutional Ethics Committee or independent review board for the Hospital. We obtained ethical clearance (Ref No BPH/3/2929) from the Management and Ethical Committee of Bichena Primary Hospital. In addition, we also received a supportive letter (Ref No BPH/3/2948) from the Chief executive officer of Bichena Primary Hospital to conduct the study in the hospital. Verbal informed consent was obtained from study participants. All the authors of this paper agree to publish it in your journal. Competing interests The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. 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Int J Cancer Res Mol Mech. 2015(1(1):1–5. Mokhele I ED, Schnippel K, Swarts A, Smith JS, Firnhaber C. Awareness , perceived risk and practices related to cervical cancer and Pap smear screening : A cross- sectional study among HIV-positive women attending an urban HIV clinic in Johannesburg , South Africa. . SAMJ 2016(106(12)):1247–53. FMOH. National cancer control plan. 2016-2020. Ethiopia;. https://www.iccpportal.org/sites/default/files/plans/NCCP%20Ethiopia%20Final%20261015.pdf. Accessed Dec 2019. 2016. Gelibo T RL, Getachew T, Bekele A. . Coverage and factors associated with cervical Cancer screening : results from a population-based WHO steps Study in Ethiopia. . J Oncol Res Treat. 2017;2(1:1–5. Ayka ST. Determinants of screening practice for cervical cancer among women in Addis Ababa, Ethiopia: University of South Africa; 2020. Cibula D, Raspollini MR, Planchamp F, Centeno C, Chargari C, Felix A, et al. ESGO/ESTRO/ESP Guidelines for the management of patients with cervical cancer–Update 2023. Virchows Archiv. 2023;482(6):935-66. A.B. AMaT. Visual inspection with acetic acid in cervical cancer screening. Cancer Nursing, 2011. 34(2): p. 158–163. https://doi.org/10.1097/NCC.0b013e3181efe69f PMID: 21326031.15. Doorbar,J.Cline Sci 110,525-541(2006).16. Marth C LF, Mahner S, et al. Cervical cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2017;28(Suppl 4):iv72-iv83. Temesgen MM AT, Shiferaw B, Legesse S, Zeru T, Haile M, et al. Prevalence of oncogenic human papillomavirus (HPV 16/18) infection, cervical lesions and its associated factors among women aged 21–49 years in Amhara region, Northern Ethiopia. PLoS ONE 16(3): (2021).e0248949. https://doi.org/10.1371/ journal.pone.0248949. H. Bayu YB, A. Mulat, and A. Alemu,. “Cervical cancer screening service uptake and associated factors among age eligible women in Mekelle Zone, Northern Ethiopia, 2015: a community based study using health belief model,” PLoS ONE, vol. 11, no. 3, p. e0149908, 2016. A. Gedefaw AA, and G. A. Tessema. The prevalence of precancerous cervical cancer lesion among HIV-infected women in Southern Ethiopia: a cross-sectional study,” PLoS ONE, vol. 8, no. 12, Article ID e84519, 2013. Leyh-Bannurah S.-R. ea. Cervical human papillomavirus prevalence and genotype distribution among hybrid capture 2 positive women 15 to 64 years of age in the Gurage zone, rural Ethiopia. Infectious agents and cancer, 2014. 9: p. 33. https://doi.org/10.1186/1750-9378-9-33 PMID: 25320636. B.Utoo PU, S. Ngwan, S. Anzaku, and M. Daniel,. Cervical intraepithelial neoplasia: prevalence, risk factors, and utilization of screening services among an urban population in Nigeria,. Tropical Journal of Obstetrics and Gynaecology, vol. 33,no. 3, pp. 279–283, 2016. Tota JE C-DM, Richardson LA, Devries M, Franco EL,. Epidemiology and burden of HPV infection and related diseases: implications for prevention strategies. Preventive Medicine . 2011;53:S12-21. Makuza JD, Nsanzimana S, Muhimpundu MA, Pace LE, Ntaganira J, Riedel DJ. Prevalence and risk factors for cervical cancer and pre-cancerous lesions in Rwanda. Pan African Medical Journal. 2015. Temesgen MM, Alemu T, Shiferaw B, Legesse S, Zeru T, Haile M, et al. Prevalence of oncogenic human papillomavirus (HPV 16/18) infection, cervical lesions and its associated factors among women aged 21–49 years in Amhara region, Northern Ethiopia. . PLoS ONE. (2021);16(3). Bekele A., et al. Human papillomavirus type distribution among women with cervical pathology—a study over 4 years at Jimma Hospital, southwest Ethiopia. . Trop Med Int Health. 2010.;15(8): p. 890–3. Ameya G, F Y. Characteristics of cervical disease among symptomatic women with histopathological sample at Hawassa University referral hospital, Southern Ethiopia. BMC Women’s Health. 2017;17(91). Terefu Teka , MesfinKote , Gemechu Kejela a, Getachew T. Magnitude and Factors Associated with Precervical Cancer among Screened Women in Southern Ethiopia. Advances in Public Health. 2019;Volume 2019, Article ID 5049752, 8 pages. Ashaka OS OA, James AB, Adeyemi OO, Oladiji F, Adeniji KA, Okunade KS, Agbede OO. Prevalence and Risk Factors of Genital Human Papillomavirus Infections among Women in Lagos, Nigeria. Tropical Medicine and Infectious Disease . 2022;7(11):386. Smith JS MA, Rana RK, Pimenta JM. Age-specific prevalence of infection with human papillomavirus in females: a global review. Journal of Adolescent Health . 2008;43(4):S5-e1. Kang L.-N. ea. A prospective study of age trends of high-risk human papillomavirus infection in rural China. BMC infectious diseases, 2014. 14(1): p. 96. https://doi.org/10.1186/1471-2334-14-96 PMID: 24559293. S.M. A. Trends of Cervical Cancer in Ethiopia. Cervical Cancer 2016. F. Roopali GS, and G. Subash, . “Sociodemographic risk factors for cervical cancer in Jammu region of J and k state of India,” Indian Journal of Scientific Research, vol. 9, pp. 105–110, 2014. D. Gyenwali JP, and S. R. Onta,. “Factors associated with late diagnosis of cervical cancer in Nepal,” Asian Pacific Journal of Cancer Prevention, vol. 14, no. 7, pp. 4373–4377, 2013. Roman C AD, Hernández Y, Salazar ZK, Espinosa L, Campoverde E, Guallaizaca L, Merchán M, Sarmiento M, Brenner J. Biological, demographic, and health factors associated with HPV infection in Ecuadorian women. Frontiers in Public Health . 2023;11:1158270. Pimple S MG. Cancer cervix: Epidemiology and disease burden. Cytology Journal. 2022:19. B.Utoo PU, S. Ngwan, S. Anzaku, and M. Daniel. “Cervical intraepithelial neoplasia: prevalence, risk factors, and utilization of screening services among an urban population in Nigeria,” Tropical Journal of Obstetrics and Gynaecology, vol. 33,no. 3, pp. 279–283, 2016. S. Ferreira AF, and Koifman S., . “Genetic polymorphisms and environmental risk factors associated with cervical carcinogenesis in a cohort of Brazilian women with cervical lesions,” Toxicol Environtal Health, vol. 73, no. 13-14, pp. 888–900, 2010. Mekonnen AG MY. Early-onset of sexual activity as a potential risk of cervical cancer in Africa: A review of literature. PLOS Global Public Health . 2023;3(3):e0000941. R.T K. Risk factors associated with precancerous cervical lesion among women screened at Marie Stops Ethiopia, Adama town, Ethiopia 2017: a case control study. BMC research notes, 2018. 11 (1): p. 1–5. https://doi.org/10.1186/s13104-017-3088-5 PMID: 29291749. Adewuyi S. SS, and Rafindadi A. Sociodemographic and clinicopathologic characterization of cervical cancers in northern Nigeria. European journal of gynaecological oncology, 2008. 29(1): p. 61. PMID: 18386466. Tekalegn Y, Aman R, Woldeyohannes D, Sahiledengle B, S. D. Determinants of VIA positivity among women screened for cervical precancerous lesion in public hospitals of Oromia Region, Ethiopia: unmatched case-control study. International Journal of Women's Health . 2020:587-96. AC. S. Cancer Facts & Figures 2014. . Am Cancer Soc. 2014: 72. Wolday D. ea. HPV genotype distribution among women with normal and abnormal cervical cytology presenting in a tertiary gynecology referral Clinic in Ethiopia. Infectious agents and cancer, 2018. 13(1): p. 28. Temesgen MM AT, Shiferaw B, Legesse S, Zeru T, Haile M, et al. Prevalence of oncogenic human papillomavirus (HPV 16/18) infection, cervical lesions and its associated factors among women aged 21–49 years in Amhara region, Northern Ethiopia. PLoS ONE 16(3): e0248949. https://doi.org/10.1371/ journal.pone.0248949. H. Bayu YB, A. Mulat, and A. Alemu. “Cervical cancer screening service uptake and associated factors among age eligible women in Mekelle Zone, Northern Ethiopia, 2015: a community based study using health belief model,” PLoS ONE, vol. 11, no. 3, p. e0149908, 2016. A. Gedefaw AA, and G. A. Tessema,. “The prevalence of precancerous cervical cancer lesion among HIV-infected women in Southern Ethiopia: a cross-sectional study,” PLoS ONE, vol. 8, no. 12, Article ID e84519, 2013. Terefu Teka M, Gemechu Kejela a, Getachew T. Magnitude and Factors Associated with Precervical Cancer among Screened Women in Southern Ethiopia. Advances in Public Health. 2019;Volume 2019, Article ID 5049752, 8 pages. RS H, al e. HIV Infection as a Risk Factor for Cervical Cancer and Cervical Intraepithelial Neoplasia in Senegal. . Cancer Epidemiology, Biomarkers & Prevention. 2009;18(9):2442-6. JR M, al. e. HIV and pre-neoplastic and neoplastic lesions of the cervix in South Africa: a case-control study. . BMC Cancer. 2006;6:135. SE F, al. e. A Systematic Review of the Effects of Visual Inspection With Acetic Acid, Cryotherapy , and Loop Electrosurgical Excision Procedures for Cervical Dysplasia in HIV-Infected Women in Low- and Middle-Income Countries. . J Acquir Immune Defic Syndr. 2015;6(1): p 350-6. Namale G, Mayanja Y, Kamacooko O, Bagiire D, Ssali A, Seeley J, et al. Visual inspection with acetic acid (VIA) positivity among female sex workers: a cross-sectional study highlighting one-year experiences in early detection of pre-cancerous and cancerous cervical lesions in Kampala, Uganda. Infectious agents and cancer. 2021;16(1):31. Deksissa ZM, Tesfamichael FA. Prevalence and factors associated with VIA positive result among clients screened at Family Guidance Association of Ethiopia, south west area office, Jimma model clinic, Jimma, Ethiopia 2013: a cross-sectional study. BMC research notes . 2015;8(1):1-6. Orang’o EO, Were E, Rode O, Muthoka K, Byczkowski M, Sartor H, et al. Novel concepts in cervical cancer screening: a comparison of VIA, HPV DNA test and p16 INK4a/Ki-67 dual stain cytology in Western Kenya. Infectious Agents and Cancer . 2020;15:1-10. Symmons SM, Waller J, E. M. Testing positive for Human Papillomavirus (HPV) at primary HPV cervical screening: a qualitative exploration of women’s information needs and preferences for communication of results. Preventive Medicine Reports . 2021;24:101529. Additional Declarations No competing interests reported. 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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-6534651","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":449034742,"identity":"338d610b-cc47-4c19-91ef-7272a107dfab","order_by":0,"name":"Awoke Minwuyelet","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABFUlEQVRIiWNgGAWjYHACZiCWgDAfMDDU84MYCQXEaklgMEiQbAAxDAhqYUBoMTgAYuHRwj8j+bDBxxyLPIMbOYYPEir+5BmfX5344YEBgzy/2AGsWiRupCUnztwmUQzUYmyQcMag2OzG280SQIcZzpydgN2a2znGh3m3SSRuu5FjJpHYZsC47cbZDSAtCQa3sWuRB2n5C9Fi/iPxnwHj5hlnN//Ap8UAqCWZEWoLQ2KDQeIG/t5teG0xvP8s2RCoJnH/mWfFEgnHjI0lbvBus0gwkMDpF7kzhw9L/NxWlzizPXnjhw81cnL8/Wc33/xRYSPPL43D+wjAAY0LCbBKCULKQYD9AYTmP0CM6lEwCkbBKBhBAACVlGcLS0EnWAAAAABJRU5ErkJggg==","orcid":"","institution":"Bichena Primary Hospital","correspondingAuthor":true,"prefix":"","firstName":"Awoke","middleName":"","lastName":"Minwuyelet","suffix":""},{"id":449034743,"identity":"31383eb8-398b-4e88-95dd-b949cb10950f","order_by":1,"name":"Debas Belay","email":"","orcid":"","institution":"Bichena Primary Hospital","correspondingAuthor":false,"prefix":"","firstName":"Debas","middleName":"","lastName":"Belay","suffix":""}],"badges":[],"createdAt":"2025-04-26 11:23:04","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6534651/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6534651/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":81611284,"identity":"1db3e256-3d9e-42a8-98f0-2713a564e1d9","added_by":"auto","created_at":"2025-04-29 07:22:23","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1289416,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6534651/v1/0050bbe5-9541-4ac2-98b4-f4ea7bfaab99.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Detection of pre-cervical cancer and its associated factors among cervical cancer suspected women in Bichena primary hospital in Amhara region, Ethiopia","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCervical cancer (CC) is characterized by abnormal cell growth in the cervix and is a preventable disease. . CC is a global public health problem, with a particularly high burden in many low- to middle-income countries (LMICs)(1, 2).CC ranks as the fourth most common cancer in women worldwide, with an estimated 604,000 new cases and 342,000 deaths reported in 2020. Alarmingly, nearly 90% of CC deaths occur in LMICs due to inadequate screening and a higher prevalence of HPV infection (2, 3). Geographic variations, \u0026nbsp;disparities and other factors \u0026nbsp;contribute significantly to variations in CC prevalence, with more than half of all cases occurring in women aged over 45 years old (4, 5).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePersistent infection with HPV is the primary cause of CC. Evidence overwhelmingly supports HPV infection as the leading global risk factor for CC (2). Most HPV infections resolve spontaneously without symptoms, while some \u0026nbsp;HPV strains, such as HPV 16 and 18, can lead to cancer, accounting for 70% of CC cases and 99% of cervical tumors (6, 7).\u003c/p\u003e\n\u003cp\u003eIn Ethiopia, CC ranks as the second leading cause of cancer-related deaths among women aged 15 to 44 following breast cancer. According to the International Agency for Research on Cancer\u0026rsquo;s \u0026nbsp; Information Center on HPV infection and Cancer in Ethiopia, current estimates indicate that every year 7,095 women are diagnosed with CC and 4,732 deaths due to diseases (8).\u003c/p\u003e\n\u003cp\u003eHigh-income countries have successfully reduced CC rates by identifying and treating precancerous abnormalities early(9). In contrast, only about 5% of eligible women in LMICs undergo cytology-based screening for CC, presenting a significant barrier to prevention efforts (6). For example, in 2020, the Federal Ministry of Health in Ethiopia planned to detect and treat at least 80% of the appropriate target populations of pre-invasive CC cases however, the nine regions and two city administrations of Ethiopia report revealed lower rate of cervical screening (2.9%) (10). It also indicated only 10% of early stages, I and II patients have visited an oncology center (8, 11). Despite challenges related to sensitivity and specificity in some diagnostic tools, VIA remains a viable method for CC screening.\u003c/p\u003e\n\u003cp\u003eTo enhance diagnostic accuracy and early detection of CC, the Ethiopian Federal Ministry of Health recommends combining VIA with molecular HPV testing. Based on this recommendation, this study aimed to assess the prevalence of HPV infection, precervical cancer, and associated factors among women suspected of CC at Bichena Primary Hospital in the Amhara region, Ethiopia.\u0026nbsp;\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy setting and Population\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAn institution-based cross-sectional study was conducted from January 2020 to June 2021 in Bichena Primary Hospital. Bichena Primary Hospital is located 200 meters east of Bichena town. Bichena is situated 275 kilometers north of Addis Ababa, the capital of Ethiopia. The hospital servesfor Bichena town and Enemay district populations. It also serves populations who are referred from districts of Enarg Enawuga, Shebel Bernta, and Kuy health institutions.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;All women who visited Bichena Primary Hospital during the study period were the sources of the study population. CC-suspected women visiting outpatient clinics, family planning, Anti-retroviral treatment, emergency, and inpatient wards were the study populations. Women at age greater than 18 years old and suspected of CC were inclusion criteria. However, women who were pregnant and/or women who had undergone follow-up cancer examinations at current treatment facilities were excluded.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOperational definition\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCervical cancer suspected women refer to individuals who present with symptoms, signs, or risk factors that raise clinical suspicion of CC or its precursor stages (precervical cancer). These women typically undergo further diagnostic evaluation to confirm or rule out the presence of cervical abnormalities (12). The judgment criteria involve a comprehensive evaluation of these factors to determine the need for further investigation and management (13).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eJudgment Criteria for Suspected Cases:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe judgment criteria for suspected cases of CC include various clinical indicators and risk factors. These include:\u003c/p\u003e\n\u003col start=\"1\" type=\"1\"\u003e\n \u003cli\u003e\u003cstrong\u003eSymptoms and Signs:\u003c/strong\u003e Such as abnormal vaginal bleeding (especially post-coital bleeding), abnormal vaginal discharge, pelvic pain, or pain during sexual intercourse.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eHigh-Risk Factors:\u003c/strong\u003e Including a history of HPV infection, particularly with high-risk HPV types such as HPV 16 and 18, multiple sexual partners, early age at first sexual intercourse, immunocompromised status (e.g., HIV-positive), and a history of sexually transmitted infections (STIs).\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eScreening Test Results:\u003c/strong\u003e Positive findings on CC screening tests such as Visual Inspection with Acetic Acid (VIA), or molecular tests detecting HPV DNA or HPV oncoproteins (e.g., HPV 16/18).\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eClinical Evaluation:\u003c/strong\u003e Conducted by healthcare providers, who include physical examination findings such as abnormal cervical appearance during speculum examination, palpable pelvic masses, or enlarged lymph nodes suggestive of metastasis.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eRisk Assessment:\u003c/strong\u003e Combining various risk factors and clinical findings to assess the likelihood of CC or its precursor lesions.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eSample size and Sampling procedure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe sample size was calculated using the single population proportion formula with the assumption of a 50% prevalence (P) of precervical cancer due to HPV infections. Based on this, the formula: N = (Zα/2)²p (1-p)/d²: where n = the sample size, Zα/2 = 1.96 at 95% confidence interval (CI),\u0026nbsp;d = margin of error, p= prevalence of precervical cancer, 95% CI and margin of error (d) at 5% (standard value of 0.05). To account for the non-response rate (refusal), 10% of the calculated sample size was added. The final sample size employed for the diagnosis of HPV16 and/ or 18 antigens from CC suspected women was 385.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Data collection and clinical diagnosis methods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection tools and procedures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA semi-structured questionnaire, which was prepared in English and translated to the Amharic (local) language, was used to collect the socio-demographic factors of study participants. Socio-demographic characters, clinical and the risk factors associated with them were included in the questionnaire.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Clinical diagnosis and procedures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWomen who visited wards: antiretroviral treatment, outpatient, inpatient, emergency, and family planning were clinically evaluated based on WHO guidelines (2021)\u0026nbsp;(3).\u0026nbsp;The suspected cases underwent VIA and molecular HPV testing. The medical laboratory department used the OncoE6\u003csup\u003eTM\u003c/sup\u003e Cervical test to detect HPV onco6 serotypes 16 and 18 antigens from swab samples.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eVisual inspection using an acetic acid test\u003c/strong\u003e (VIA): the cervix was cleaned with a cotton swab and then treated with a 5% acetic acid solution. Abnormal cervical tissues of suspected individual precancerous or cancerous lesions developed colour change within a minute. However, if cervical tissue was healthy, there wouldn't be any aceto-white lesions visible on the VIA (14). In addition, the Medical Laboratory Department in the hospital has used a quick molecular diagnosis test tool that detects HPV onco6 serotype 16 and 18 antigens.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSwab sample diagnosis and procedures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eE6 HPV 16/18 oncoprotein test\u003c/strong\u003e: \u0026nbsp;is a molecular qualitative test that detects elevated levels of oncoprotein E6 expressed from cells infected by HPV subtypes 16 and/or 18. E6 oncoprotein is necessary for the oncoprotein transformation of cervical epithelial cells. If the test of a cervicovaginal specimen is positive it tells us a precancerous or cancerous lesion already has elevated levels of the oncoprotein E6, or there may be an increased risk of precancerous or cancerous lesions in the future (15). It also used to screen for prcervical cancer.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eProcedure:\u0026nbsp;\u003c/strong\u003e Cell lysates produced from samples of cervical swabs are used in the oncoE6TM cervical test. Using high-affinity Monoclonal Antibodies (MAbs) the E6 oncoprotein of HPV subtypes 16 and 18 are incubated with the lysate in this step. The specimen lysate and MAb-AP mix are added to a nitrocellulose test strip, which has two capture lines made up of immobilized MAbs to E6 16/18. This causes the capillary action to move through the test strip membrane. If HPV types 16 and/or 18's of E6 oncoprotein are present, a ternary complex (capture MAb-E6 detector MAb) may form. The ternary complex is visible as a purple line at the appropriate locations on the strip after the addition of an enzyme substrate (5).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData processing and analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe filled-out questionnaire and laboratory results were manually cleaned, coded, checked for completeness and analyzed using SPSS version 23.Bivariate analysis was primarily used to determine which variables individually have an association with the dependent variable,followed by multivariable logistic regression to determine significant predictors of precervical cancer due to HPV infection.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eEthical considerations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAn Ethical clearance letter was obtained from the management team and Ethical committee of Bichena Primary Hospital after the proposal submission. Similarly, the supportive letter was received from the chief executive officer of the hospital. Consent was also obtained from study participants before enrolled in the study.\u0026nbsp;\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eSocio-demographic characteristics\u003c/h2\u003e \u003cp\u003eThe study included a total of 385 participants. The mean age of study participants was 30.6 years, with a standard deviation (SD) of \u0026plusmn;\u0026thinsp;9.3 (ranging from 17 to 80 years). The mean age of respondents at the time of the first marriage was 15.4 years, with an SD of \u0026plusmn;\u0026thinsp;3.8 (ranging from 7 to 28 years). The majority of study participants were from rural areas (61.8%) and 40% had completed their diploma.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eBehavioural risk factors of participants\u003c/h2\u003e \u003cp\u003eMore than 57% of participants had experienced childbirth, while only 20% had used family planning methods. Additionally, 46% reported initiating sexual activity before the age of 18. A small percentage of participants were HIV-positive (6.5%), and 3.6% had a history of sexually transmitted infections (STIs). None of the participants reported regular smoking (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\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\u003e\u003cb\u003eSocio-demographic Characteristics of women screened for HPV and VIA in Bichena primary Hospital, Northwest Ethiopia, 2020\u0026ndash;2021.\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\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=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocio-demographic Variables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eAge group (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17\u0026ndash;29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e207\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e53.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30\u0026ndash;39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e109\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e28.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40\u0026ndash;49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eEducation status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIlliterate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGrade 1\u0026ndash;8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGrade 9\u0026ndash;12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e109\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e28.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGraduated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e154\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e40.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eResidence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e147\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e38.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e238\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e61.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAge at first sexual intercourse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e178\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e46.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e207\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e53.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eFamily history about Cervical cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNegative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e243\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e63.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePositive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot known\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e133\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e34.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eParity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eParous\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e222\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e57.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNone parous\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e163\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e42.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHistory of Sexual transmitted infection and / or tested positive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNegative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e371\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e96.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePositive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eKnown positive and or tested positive for HIV ADIS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNegative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e360\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e93.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePositive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSexual partners\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e291\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e75.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFamily planning used\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot used\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e306\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e79.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003ePrevalence of\u003c/b\u003e \u003cb\u003eHuman papillomavirus\u003c/b\u003e \u003cb\u003einfection\u003c/b\u003e\u003c/p\u003e \u003cp\u003eAmong the screened women, 6.2% (24/385) were tested positive for HPV infection. Based on serotype, 3.6% (14/385) were positive for HPV 16 antigens and 0.8% (3/385), 18 antigens.\u003c/p\u003e \u003cp\u003eThe prevalence of HPV infection varied significantly by age group, with the highest prevalence of HPV infection (18.18%) was observed among women older than 50 years, and the lowest prevalence (4.3%) was among women aged 17\u0026ndash;29 years (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Urban women also exhibited a higher prevalence of HPV infection (8.4%) compared to rural women (5%) (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). HIV-positive women had a significantly higher prevalence of HPV infection (16%) compared to HIV-negative women (5.5%) (95% CI\u0026thinsp;=\u0026thinsp;0.037\u0026ndash;0.092, P\u0026thinsp;=\u0026thinsp;0.001). Similarly, women with a history of STIs showed a higher prevalence of precervical cancer (57.14%) compared to women without such history (\u003cb\u003eTable S1, and\u003c/b\u003e Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Among all participants, 9.9% had cervical lesions at the time of enrollment. A majority of these participants tested positive for both HPV infection and VIA (\u003cb\u003eTable S2\u003c/b\u003e).\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\u003eMultivariate analysis of potentially associated factors of precervical cancer among screened women in Bichena primary Hospital, Northwest Ethiopia, 2020\u0026ndash;2021.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\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 \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e \u003cp\u003eRisk factors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eHPV infection\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTotal (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eOR (95%,CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePositive (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNegative (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAOR\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17\u0026ndash;29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9(4.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e198(95.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e207(53.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30\u0026ndash;39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7(6.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e102(93.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e109(28.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.51(0.55\u0026ndash;4.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.78(0.15\u0026ndash;4.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.77\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40\u0026ndash;49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(8.51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43(91.49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e47(12.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.05(0.6\u0026ndash;6.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.25(0.29\u0026ndash;17.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.43\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(18.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18(81.81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22(5.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.89(1.37\u0026ndash;17.46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.16(1.65\u0026ndash;191.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.046\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eResidence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12(8.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e135(91.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e147(38.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12(5.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e226(94.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e238(61.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.59(0.26\u0026ndash;1.37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.58(0.17\u0026ndash;2.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eEducation status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIlliterate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(7.69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60(92.31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e65(16.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.19(0.97\u0026ndash;18.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.5(0.04\u0026ndash;6.81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGrade1-8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11(19.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46(80.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e57(14.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12.04(3.22\u0026ndash;44.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e12.3(1.81\u0026ndash;83.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGrade 9\u0026ndash;12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(4.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e104(95.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e109(28.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.42(0.57\u0026ndash;10.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.9(0.42\u0026ndash;58.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDiploma \u0026amp; above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(1.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e151(98.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e154(\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e40\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAge at the 1st sexual intercourse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;18yrs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20(11.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e158(88.760\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e178(46.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6.42(2.42\u0026ndash;19.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.8(1.04\u0026ndash;22.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.044\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;18yrs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(1.93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e203(98.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e207(53.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eParity category\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7(3.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e215(96.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e222(57.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e179(55.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e146(44.92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e325(84.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.58(1.45\u0026ndash;8.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e14.25(2.03\u0026ndash;99.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSTI history\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8(57.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6(42.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14(3.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e29.58(9.17\u0026ndash;95.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7.93(1.39\u0026ndash;45.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16(4.31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e355(95.69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e371(96.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHIV infection posetive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9(\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e36\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16(64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25(6.49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12.94(4.92\u0026ndash;34.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e8.42(1.6-44.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.012\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15(4.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e345(95.83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e360(93.51 )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFamily planning used\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19(6.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e287(93.49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e307(79.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.98(.35-2.711)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e14.19(0.62\u0026ndash;28.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(6.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e74(93.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e79(20.52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSexual partner\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10(3.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e281(96.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e29175.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14(14.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e80(85.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e94(24.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.92(2.11\u0026ndash;11.49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3.28(1.87\u0026ndash;12.31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.048\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003eHIV: Human Immunodefienecy Virus, STI: sexualy transmited Infection\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eLikewise, women who initiated sexual activity before the age of 18 had a higher prevalence of VIA positivity (6.74%) compared to those who started at 18 or older (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Similarly, women with a history of STIs showed a higher prevalence of VIA positivity compared to those without such history (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\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\u003eMultivariate analysis of potentially associated factors of VIA posetivity among screened women in Bichena primary Hospital, Northwest Ethiopia, 2020\u0026ndash;2021.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\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 \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e\u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eRisk factors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eVIA positivity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTotal (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOR (95%,CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP\u003c/p\u003e \u003cp\u003evalue\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePositive (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNegative (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCOR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAOR\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ccolgroup cols=\"8\"\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 \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAge at the 1st sexual intercourse\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;18yrs\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12(6.74)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e166(93.26)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e178(4.42)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7.41(1.64\u0026ndash;33.57)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6.18(1.38\u0026ndash;29.29)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.018\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e\u0026ge;\u0026thinsp;18yrs\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e2(0.97)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e205(99.03)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e207(53.77)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eHistory\u0026nbsp;and tested positive STI\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eYes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e3(21.43)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e11(78.57)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e14(3.64)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e8.92(2.18\u0026ndash;36.59)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e6.05(1.18\u0026ndash;31.1)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.032\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eNo\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e11(3.06)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e360(97.04)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e371(96.36)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eHIV Tested positive\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eYes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e2\u003c/b\u003e(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e23(92)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e25(6.49)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e2.52(0.53\u0026ndash;11.94)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.98(0.15\u0026ndash;6.63)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.98\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eNo\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e12(3.33)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e348(96.67)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e360(93.51)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eMultivariable Logistic Regression of Associated Factors for Pre-cervical Cancer\u003c/h2\u003e \u003cp\u003eTo control confounding variables, factors associated with HPV infection with a \u003cem\u003eP\u003c/em\u003e value of \u0026lt;\u0026thinsp;0.25 in bivariate analysis were included in multivariable logistic regression. Age group, education status, parity, age at first sexual interaction, multiple sexual partners, history of STI, and HIV-positive individuals were identified as a significant associated factors for HPV infection (P\u0026thinsp;\u0026lt;\u0026thinsp;0. 05)(Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSimilarly, women with STI histories or those who tested positive for STIs and the early age at the first sexual encounter were also identified as a significant associated factors for VIA (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWomen in age groups of 50 and older had a 4 .16 times higher likelihood of HPV infection compared to women aged 17\u0026ndash;29 years [95%, (CI\u0026thinsp;=\u0026thinsp;1. 65\u0026ndash;191.8)]. Additionally, women with primary educational status (grades 1\u0026ndash;8) had a 12.3 times higher chance of HPV infection compared to women who had graduated (AOR [95% CI\u0026thinsp;=\u0026thinsp;1.81\u0026ndash;83.1)].\u003c/p\u003e \u003cp\u003eLikewise, women who had first sexual intercourse before 18 years old were 4.8 times more likely to be infected with HPV than those who did not (AOR [95%, CI= (1.04\u0026ndash;22.01)]. In addition, women who had three or more sexual partners had a 3.28 times higher risk of contracting HPV than those who had fewer than three partners (AOR [95%, CI= (1.87\u0026ndash;12.31)].\u003c/p\u003e \u003cp\u003eMoreover, women with three or more parties or had a 14. 25 times more likely to develop HPV infection compared to women with fewer parities (AOR [95%, CI = (2.03-99. 9)]). Additionally,, women with a history of STIs had 7.93 times more likely to have HPV infection compared to women without a history of STI (AOR [95%, CI = (1.39-45. 25)]). Similarly, women who tested positive for HIV were 8.42 times more likely to have HPV infection than those who tested negative for HIV (AOR[95%, CI =(1.6-44.29]) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eConversely, women who experienced sexual intrcoure before the age of 18 years old had a 6.18 times higher chance of being positive for the VIA test than those who started at 18 or older [95%, CI=(1.38\u0026ndash;29.29)]. Similarly, women with STI histories had a 6.05 times higher likelihood of having VIA-positive results than women without such histories (AOR [95%, CI = (1.18\u0026ndash;31.1)] (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eCervical cancer, characterized by the abnormal growth of cervical tissue, can often be asymptomatic but detectable through screening. HPV infection remains the primary cause of CC, and preventive measures such as vaccination and early screening are crucial (16). In this study, we evaluated the prevalence of HPV 16 and/or 18 infections and its associated factors for pre-cervical cancer suspected women in Bichena primary hospitals in the Amhara region, Ethiopia.\u003c/p\u003e \u003cp\u003eThe overall prevalence of HPV infection was 6.2% (24/385) [95%, CI: 3.9\u0026ndash;9.1]. This finding was comparable to previous studies conducted in different parts of Ethiopia: Amhara (7.1%) (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e17\u003c/span\u003e) and Mekele (6.7%) (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e18\u003c/span\u003e). However, the prevalence of HPV infection was lower than studies findings conducted in Ethiopia: southwest Ethiopia (12.9% ) (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e19\u003c/span\u003e), the Gurage zone (17.3%) (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e20\u003c/span\u003e) and other study findings conducted in Nigeria (16%) (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Variations in prevalence may stem from differences in a research settings, ethnicity, socio-economic factors, geographical locations, and sexual behaviors, which all influence HPV epidemiology (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Differences in diagnostic techniques also contribute to varying prevalence rates of HPV infection.\u003c/p\u003e \u003cp\u003eSimilarly, VIA positivity of this study was 3.6% (14/385) [95%, CI: 2.1\u0026ndash;5.7]. This finding was also in line with study findings in Rwandan 1.7% (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e23\u003c/span\u003e). But it was lower than the study\u0026rsquo;s findings which conducted in different regions of Ethiopia: southern (16.5%) (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e19\u003c/span\u003e) and Amhara, Ethiopia (13.1%) (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e17\u003c/span\u003e). The discrepancy could be due to variations in test providers' abilities, as well as the underlying prevalence of other STDs and reproductive traits. Additionally, the prevalence may have increased in part as a result of the women's differing sexual behaviours. Pregnant women and those who had been diagnosed with cervical cancer were not included in this study. As a result, the prevalence of VIA positivity in our study could be underestimated.\u003c/p\u003e \u003cp\u003eAmong the study participants, 8.6% had precancerous lesions which align with a study finding from, in the Amhara region, Ethiopia which reported 38.6% of participants had precancerous lesions (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e24\u003c/span\u003e). However, this study finding was much lower than the studies findings in Jimma (67.1%) (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e25\u003c/span\u003e) and Hawassa Ethiopia (49.3%) (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e26\u003c/span\u003e). The discrepancy could result from different diagnostic approaches and test providers with varying levels of expertise.\u003c/p\u003e \u003cp\u003eS significant associations were observed between HPV infection and age groups over 50 years old in this study. Similarly, study participants who were greater than 50 years old had a 4.16 greater likelihood of having HPV infection than those who were between the ages of 17\u0026ndash;29. This finding was consistent with study findings in Amhara Ethiopia (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e27\u003c/span\u003e). Conversely, another study conducted in Lagos, Nigeria by Ashaka \u003cem\u003eet al\u003c/em\u003e. (2022) reported higher HPV infection prevalence of among women aged 18\u0026ndash;24 years compared to other age groups (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e28\u003c/span\u003e). However, a review conducted by Smith \u003cem\u003eet al\u003c/em\u003e.(2008) showed that women with HPV infection is most commonly acquired during adolescence, and the peak incidence in middle-aged tends to vary by geographical area. Variations in HPV prevalence throughout age appear to reflect disparities in sexual behaviour between geographical regions (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e29\u003c/span\u003e). In addition, older people are more likely to acquire persistent HPV infections (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e30\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eEducational status also influenced HPV infection. The study participants with primary educational status were 12.3 times more likely to have HPV infection compared to those with higher education. Similarly, women with secondary educational status were 4.2 times more likely to have HPV infection compared to diploma and above women. Similar findings were reported in Ethiopia (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e31\u003c/span\u003e), as well as other countries: India (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e32\u003c/span\u003e) and Nepal (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e33\u003c/span\u003e). This may be because greater awareness lowers risk, whereas women who did not complete high school are at risk due to a lack of employment and exposure to different sexual partners that caused STIs and HIV /ADIS. This may also increase the risk of infection and development of CC.\u003c/p\u003e \u003cp\u003eThe current study also identified multi-parity as a significant risk factor for HPV infection. This was in line with the study conducted in Ethiopia (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Studies aproved that high prevalence of cervical abnormalities during pregnancy promotes cervical lesions, making epithelial cells more susceptible to HPV infection (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e35\u003c/span\u003e). This might be a result of the negative effects of polygamy on these women, which include higher levels of husband promiscuity and contamination during childbirth.\u003c/p\u003e \u003cp\u003eSimilarly, early sexual activity increased the risk of HPV infection by 4.8 times, which is comparable to research conducted in Ethiopia (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e), Nigeria (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e36\u003c/span\u003e) and Brazil (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e37\u003c/span\u003e). Conversely, a study conducted across Africa found no significant relationship between early sexual engagement and cervical cancer in subgroup analysis, but pooled analyses across ten studies revealed an association (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e38\u003c/span\u003e). This could be due to early sexual exposure causing physiologic changes and HPV infection in the cervical tissue. An earlier sexual debut age also suggests a longer period of sexual activity and a greater likelihood of having numerous sexual partners.\u003c/p\u003e \u003cp\u003eA statistically significant association between VIA positivity and earlier sexual intercourse before the age of 18 years old was observed. Similar findings were carried out in Adma, Ethiopia (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e39\u003c/span\u003e) and Nigeria (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e40\u003c/span\u003e). On the contrary, another study conducted in the Oromia Region, Ethiopia indicated that initiating sexual intercourse at an early age (below 18 years old) had a 60% less chance of being positive for the VIA test (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e41\u003c/span\u003e). The difference in the prevalence of VIA of positivity may be due to differences in study participants, small sample sizes, study design, and the diagnostic skills of health professionals. However, most study suggests earlier sexual intercourse experiences lead to women's mortality related to CC. As a result, women under the age of 18 should either get vaccinated before having their first sexual contact or refrain from starting sexual activity at the later age of 18 years old (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e42\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn this study, women with a history of STIs had statistically a stronger predictor of HPV infection and VIA positivity when compared to women who had no history of STIs. This finding was comparable with studies findings in Ethiopia (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e44\u003c/span\u003e). Similarly, multiple sexual partners also found as predictor of HPV infection, with women reporting three or more partners had a 4.9 times higher risk of HPV infection than those with fewer partners. This finding is consistent with other research findings in Ethiopia (\u003cspan additionalcitationids=\"CR46\" citationid=\"CR43\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e47\u003c/span\u003e). These findings highlight the role of sexual behavior in invasive CC and early CC incidence. There was also a statistically significant association between women with HIV and HPV infection (36%). This finding was in line with studies conducted in South Africa (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e48\u003c/span\u003e), Senegal (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e49\u003c/span\u003e) and low- and middle-income nations all reported similar results (\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e50\u003c/span\u003e). Conversely, in our study, HIV infection and VIA positivity didn\u0026rsquo;t have a significant association. However, many studies approved that HIV infection is the predictor of VIA positivity and precervical cancer (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e52\u003c/span\u003e). This might be attributed to the low number of HIV-positive women participated in our research compared to HIV-negative women.\u003c/p\u003e \u003cp\u003eThe molecular OncoE6\u0026trade; Cervical test performed better than the VIA test in diagnosing the pathogenic states of study participants. The HPV positivity rate by molecular test of VIA-positive cases was 85.7%. Whereas only 50% of instances out of the total number of molecular test-positive cases were identified by VIA tests for cervical lesions. Similarly, another study recommends primarily HPV testing using molecular tools looks practical and should be explored as a primary screening test in low- and middle-income countries. VIA's low sensitivity makes it inappropriate as a triage test for HPV-positive women (\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e54\u003c/span\u003e).\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eWe found a 6.2% prevalence of HPV infection and 3.6% VIA positivity among the CC suspected women. Study participants at the age of 50 years old and more, primary education, early sexual contact, multiparty, STI positivity, and HIV positivity had statistically significant associations with HPV infection. Similarly, VIA positivity had a statistically significant association with early sexual intercourse at the age of below 18 years of old, and/or STI history. Therefore, prophylactic vaccination against HPV and early screening and treatment of pre-cancer lesions is recommended to prevent and control cervical cancer morbidity and mortality.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAOR: Adjusted Odds Ratio, CC: Cervical cancer, CCS: Cervical Cancer Screening; CI: Confidence Interval, COR: Crude Odds Ratio, HIV: Human Immune Virus, HPV: Human Papilloma Virus, SPSS: Statistical Package for Social Science, STI: Sexually Transmitted Infections, VIA: Visual Inspection with Acetic acid.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank the study participants and clinical and laboratory staff in Bichena primary hospitals.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;A.M. Conceived the study, performed laboratory tests, and prepared the manuscript. D.B. performed a clinical examination and filled out the questionnaire. Both authors critically reviewed the manuscript. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe have complete raw data at our disposal and can reach out to the corresponding author if requried.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participat\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study protocol was approved by the Institutional Ethics Committee or independent review board for the Hospital. We obtained ethical clearance (Ref No BPH/3/2929) from the Management and Ethical Committee of Bichena Primary Hospital. In addition, we also received a supportive letter (Ref No BPH/3/2948) from the Chief executive officer of Bichena Primary Hospital to conduct the study in the hospital. Verbal informed consent was obtained from study participants. All the authors of this paper agree to publish it in your journal.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSung H FJ, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. . \u003cem\u003eA cancer Journal for Clinicians\u003c/em\u003e. 2021;71(3):209-49.\u003c/li\u003e\n\u003cli\u003eSingh D, Vignat J, Lorenzoni V, Eslahi M, Ginsburg O, Lauby-Secretan B, et al. Global estimates of incidence and mortality of cervical cancer in 2020: a baseline analysis of the WHO Global Cervical Cancer Elimination Initiative. \u003cem\u003eLancet Glob Healt\u003c/em\u003eh 2023;11: e197-206.\u003c/li\u003e\n\u003cli\u003eWHO. WHO guideline for screening and treatment of cervical pre-cancer lesions for cervical cancer prevention: use of mRNA tests for human papillomavirus (HPV), Geneva:. \u003cem\u003eWorld Health Organization\u003c/em\u003e. 2021; Licence: CC BY-NC-SA 3.0 IGO:https://iris.who.int/bitstream/handle/10665/350652/9789240040434-eng.pdf?sequence=1.\u003c/li\u003e\n\u003cli\u003eFMHO. 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Coverage and factors associated with cervical Cancer screening : results from a population-based WHO steps Study in Ethiopia. . J Oncol Res Treat. 2017;2(1:1\u0026ndash;5.\u003c/li\u003e\n\u003cli\u003eAyka ST. Determinants of screening practice for cervical cancer among women in Addis Ababa, Ethiopia: University of South Africa; 2020.\u003c/li\u003e\n\u003cli\u003eCibula D, Raspollini MR, Planchamp F, Centeno C, Chargari C, Felix A, et al. ESGO/ESTRO/ESP Guidelines for the management of patients with cervical cancer\u0026ndash;Update 2023. Virchows Archiv. 2023;482(6):935-66.\u003c/li\u003e\n\u003cli\u003eA.B. AMaT. Visual inspection with acetic acid in cervical cancer screening. Cancer Nursing, 2011. 34(2): p. 158\u0026ndash;163. https://doi.org/10.1097/NCC.0b013e3181efe69f PMID: 21326031.15. Doorbar,J.Cline Sci 110,525-541(2006).16. Marth C LF, Mahner S, et al. Cervical cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2017;28(Suppl 4):iv72-iv83.\u003c/li\u003e\n\u003cli\u003eTemesgen MM AT, Shiferaw B, Legesse S, Zeru T, Haile M, et al. Prevalence of oncogenic human papillomavirus (HPV 16/18) infection, cervical lesions and its associated factors among women aged 21\u0026ndash;49 years in Amhara region, Northern Ethiopia. PLoS ONE 16(3): (2021).e0248949. https://doi.org/10.1371/ journal.pone.0248949.\u003c/li\u003e\n\u003cli\u003eH. Bayu YB, A. Mulat, and A. Alemu,. \u0026ldquo;Cervical cancer screening service uptake and associated factors among age eligible women in Mekelle Zone, Northern Ethiopia, 2015: a community based study using health belief model,\u0026rdquo; PLoS ONE,\u003c/li\u003e\n\u003cli\u003evol. 11, no. 3, p. e0149908, 2016.\u003c/li\u003e\n\u003cli\u003eA. Gedefaw AA, and G. A. Tessema. The prevalence of precancerous cervical cancer lesion among HIV-infected women in Southern Ethiopia: a cross-sectional study,\u0026rdquo; PLoS ONE, vol. 8, no. 12, Article ID e84519, 2013.\u003c/li\u003e\n\u003cli\u003eLeyh-Bannurah S.-R. ea. Cervical human papillomavirus prevalence and genotype distribution among hybrid capture 2 positive women 15 to 64 years of age in the Gurage zone, rural Ethiopia. Infectious agents and cancer, 2014. 9: p. 33. https://doi.org/10.1186/1750-9378-9-33 PMID: 25320636.\u003c/li\u003e\n\u003cli\u003eB.Utoo PU, S. Ngwan, S. Anzaku, and M. Daniel,. Cervical intraepithelial neoplasia: prevalence, risk factors, and utilization of screening services among an urban population in Nigeria,. Tropical Journal of Obstetrics and Gynaecology, vol. 33,no. 3, pp. 279\u0026ndash;283, 2016.\u003c/li\u003e\n\u003cli\u003eTota JE C-DM, Richardson LA, Devries M, Franco EL,. Epidemiology and burden of HPV infection and related diseases: implications for prevention strategies. \u003cem\u003ePreventive Medicine\u003c/em\u003e. 2011;53:S12-21.\u003c/li\u003e\n\u003cli\u003eMakuza JD, Nsanzimana S, Muhimpundu MA, Pace LE, Ntaganira J, Riedel DJ. Prevalence and risk factors for cervical cancer and pre-cancerous lesions in Rwanda. Pan African Medical Journal. 2015.\u003c/li\u003e\n\u003cli\u003eTemesgen MM, Alemu T, Shiferaw B, Legesse S, Zeru T, Haile M, et al. Prevalence of oncogenic human papillomavirus (HPV 16/18) infection, cervical lesions and its associated factors among women aged 21\u0026ndash;49 years in Amhara region, Northern Ethiopia. . PLoS ONE. (2021);16(3).\u003c/li\u003e\n\u003cli\u003eBekele A., et al. Human papillomavirus type distribution among women with cervical pathology\u0026mdash;a study over 4 years at Jimma Hospital, southwest Ethiopia. . Trop Med Int Health. 2010.;15(8): p. 890\u0026ndash;3.\u003c/li\u003e\n\u003cli\u003eAmeya G, F Y. Characteristics of cervical disease among symptomatic women with histopathological sample at Hawassa University referral hospital, Southern Ethiopia. BMC Women\u0026rsquo;s Health. 2017;17(91).\u003c/li\u003e\n\u003cli\u003eTerefu Teka , MesfinKote , Gemechu Kejela a, Getachew T. Magnitude and Factors Associated with Precervical Cancer among Screened Women in Southern Ethiopia. Advances in Public Health. 2019;Volume 2019, Article ID 5049752, 8 pages.\u003c/li\u003e\n\u003cli\u003eAshaka OS OA, James AB, Adeyemi OO, Oladiji F, Adeniji KA, Okunade KS, Agbede OO. Prevalence and Risk Factors of Genital \u003cem\u003eHuman Papillomavirus\u003c/em\u003e Infections among Women in Lagos, Nigeria. \u003cem\u003eTropical Medicine and Infectious Disease\u003c/em\u003e. 2022;7(11):386.\u003c/li\u003e\n\u003cli\u003eSmith JS MA, Rana RK, Pimenta JM. Age-specific prevalence of infection with \u003cem\u003ehuman papillomavirus\u003c/em\u003e in females: a global review.\u003cem\u003e Journal of Adolescent Health\u003c/em\u003e. 2008;43(4):S5-e1.\u003c/li\u003e\n\u003cli\u003eKang L.-N. ea. A prospective study of age trends of high-risk human papillomavirus infection in rural China. BMC infectious diseases, 2014. 14(1): p. 96. https://doi.org/10.1186/1471-2334-14-96 PMID: 24559293.\u003c/li\u003e\n\u003cli\u003eS.M. A. Trends of Cervical Cancer in Ethiopia. Cervical Cancer 2016.\u003c/li\u003e\n\u003cli\u003eF. Roopali GS, and G. Subash, . \u0026ldquo;Sociodemographic risk factors for cervical cancer in Jammu region of J and k state of India,\u0026rdquo; Indian Journal of Scientific Research, vol. 9, pp. 105\u0026ndash;110, 2014.\u003c/li\u003e\n\u003cli\u003eD. Gyenwali JP, and S. R. Onta,. \u0026ldquo;Factors associated with late diagnosis of cervical cancer in Nepal,\u0026rdquo; Asian Pacific Journal of Cancer Prevention, vol. 14, no. 7, pp. 4373\u0026ndash;4377, 2013.\u003c/li\u003e\n\u003cli\u003eRoman C AD, Hern\u0026aacute;ndez Y, Salazar ZK, Espinosa L, Campoverde E, Guallaizaca L, Merch\u0026aacute;n M, Sarmiento M, Brenner J. Biological, demographic, and health factors associated with HPV infection in Ecuadorian women.\u003cem\u003e Frontiers in Public Health\u003c/em\u003e. 2023;11:1158270.\u003c/li\u003e\n\u003cli\u003ePimple S MG. Cancer cervix: Epidemiology and disease burden. Cytology Journal. 2022:19.\u003c/li\u003e\n\u003cli\u003eB.Utoo PU, S. Ngwan, S. Anzaku, and M. Daniel. \u0026ldquo;Cervical intraepithelial neoplasia: prevalence, risk factors, and utilization of screening services among an urban population in Nigeria,\u0026rdquo; Tropical Journal of Obstetrics and Gynaecology, vol. 33,no. 3, pp. 279\u0026ndash;283, 2016.\u003c/li\u003e\n\u003cli\u003eS. Ferreira AF, and Koifman S., . \u0026ldquo;Genetic polymorphisms and environmental risk factors associated with cervical carcinogenesis in a cohort of Brazilian women with cervical lesions,\u0026rdquo; Toxicol Environtal Health, vol. 73, no. 13-14, pp. 888\u0026ndash;900, 2010.\u003c/li\u003e\n\u003cli\u003eMekonnen AG MY. Early-onset of sexual activity as a potential risk of cervical cancer in Africa: A review of literature.\u003cem\u003e PLOS Global Public Health\u003c/em\u003e. 2023;3(3):e0000941.\u003c/li\u003e\n\u003cli\u003eR.T K. Risk factors associated with precancerous cervical lesion among women screened at Marie Stops Ethiopia, Adama town, Ethiopia 2017: a case control study. BMC research notes, 2018. 11 (1): p. 1\u0026ndash;5. https://doi.org/10.1186/s13104-017-3088-5 PMID: 29291749.\u003c/li\u003e\n\u003cli\u003eAdewuyi S. SS, and Rafindadi A. Sociodemographic and clinicopathologic characterization of cervical cancers in northern Nigeria. European journal of gynaecological oncology, 2008. 29(1): p. 61. PMID: 18386466.\u003c/li\u003e\n\u003cli\u003eTekalegn Y, Aman R, Woldeyohannes D, Sahiledengle B, S. D. Determinants of VIA positivity among women screened for cervical precancerous lesion in public hospitals of Oromia Region, Ethiopia: unmatched case-control study. \u003cem\u003eInternational Journal of Women\u0026apos;s Health\u003c/em\u003e. 2020:587-96.\u003c/li\u003e\n\u003cli\u003eAC. S. Cancer Facts \u0026amp; Figures 2014. . Am Cancer Soc. 2014: 72.\u003c/li\u003e\n\u003cli\u003eWolday D. ea. HPV genotype distribution among women with normal and abnormal cervical cytology presenting in a tertiary gynecology referral Clinic in Ethiopia. Infectious agents and cancer, 2018. 13(1): p. 28.\u003c/li\u003e\n\u003cli\u003eTemesgen MM AT, Shiferaw B, Legesse S, Zeru T, Haile M, et al. Prevalence of oncogenic human papillomavirus (HPV 16/18) infection, cervical lesions and its associated factors among women aged 21\u0026ndash;49 years in Amhara region, Northern Ethiopia. PLoS ONE 16(3): e0248949. https://doi.org/10.1371/ journal.pone.0248949.\u003c/li\u003e\n\u003cli\u003eH. Bayu YB, A. Mulat, and A. Alemu. \u0026ldquo;Cervical cancer screening service uptake and associated factors among age eligible women in Mekelle Zone, Northern Ethiopia, 2015: a community based study using health belief model,\u0026rdquo; PLoS ONE, vol. 11, no. 3, p. e0149908, 2016.\u003c/li\u003e\n\u003cli\u003eA. Gedefaw AA, and G. A. Tessema,. \u0026ldquo;The prevalence of precancerous cervical cancer lesion among HIV-infected women in Southern Ethiopia: a cross-sectional study,\u0026rdquo; PLoS ONE, vol. 8, no. 12, Article ID e84519, 2013.\u003c/li\u003e\n\u003cli\u003eTerefu Teka M, Gemechu Kejela a, Getachew T. Magnitude and Factors Associated with Precervical Cancer among Screened Women in Southern Ethiopia. Advances in Public Health. 2019;Volume 2019, Article ID 5049752, 8 pages.\u003c/li\u003e\n\u003cli\u003eRS H, al e. HIV Infection as a Risk Factor for Cervical Cancer and Cervical Intraepithelial Neoplasia in Senegal. . Cancer Epidemiology, Biomarkers \u0026amp; Prevention. 2009;18(9):2442-6.\u003c/li\u003e\n\u003cli\u003eJR M, al. e. HIV and pre-neoplastic and neoplastic lesions of the cervix in South Africa: a case-control study. . BMC Cancer. 2006;6:135.\u003c/li\u003e\n\u003cli\u003eSE F, al. e. A Systematic Review of the Effects of Visual Inspection With Acetic Acid, Cryotherapy , and Loop Electrosurgical Excision Procedures for Cervical Dysplasia in HIV-Infected Women in Low- and Middle-Income Countries. . J Acquir Immune Defic Syndr. 2015;6(1): p 350-6.\u003c/li\u003e\n\u003cli\u003eNamale G, Mayanja Y, Kamacooko O, Bagiire D, Ssali A, Seeley J, et al. Visual inspection with acetic acid (VIA) positivity among female sex workers: a cross-sectional study highlighting one-year experiences in early detection of pre-cancerous and cancerous cervical lesions in Kampala, Uganda. Infectious agents and cancer. 2021;16(1):31.\u003c/li\u003e\n\u003cli\u003eDeksissa ZM, Tesfamichael FA. Prevalence and factors associated with VIA positive result among clients screened at Family Guidance Association of Ethiopia, south west area office, Jimma model clinic, Jimma, Ethiopia 2013: a cross-sectional study. \u003cem\u003eBMC research notes\u003c/em\u003e. 2015;8(1):1-6.\u003c/li\u003e\n\u003cli\u003eOrang\u0026rsquo;o EO, Were E, Rode O, Muthoka K, Byczkowski M, Sartor H, et al. Novel concepts in cervical cancer screening: a comparison of VIA, HPV DNA test and p16 INK4a/Ki-67 dual stain cytology in Western Kenya.\u003cem\u003e Infectious Agents and Cancer\u003c/em\u003e. 2020;15:1-10.\u003c/li\u003e\n\u003cli\u003eSymmons SM, Waller J, E. M. Testing positive for \u003cem\u003eHuman Papillomavirus \u003c/em\u003e(HPV) at primary HPV cervical screening: a qualitative exploration of women\u0026rsquo;s information needs and preferences for communication of results. \u003cem\u003ePreventive Medicine Reports\u003c/em\u003e. 2021;24:101529.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"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, Human papillomavirus, OncoE6TM Cervical Test, Visual inspection","lastPublishedDoi":"10.21203/rs.3.rs-6534651/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6534651/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003ePurpose\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThis study aimed to assess the prevalence of \u003cem\u003eHuman papillomavirus\u003c/em\u003e (HPV) infection, precervical cancer and its associated factors among women suspected of cervical cancer (CC) at Bichena Primary Hospital in the Amhara region, Ethiopia.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e \u003cp\u003eA cross-sectional study was conducted at Bichena Primary Hospital from January 2020 to June 2021. A total of 385 women suspected of CC were participated in this study. HPV infection was detected using the OncoE6\u0026trade; Cervical test for HPV 16/18 antigens, and Visual Inspection with Acetic Acid (VIA) was used for precervical cancer detection. Additionally, a semi-structured questionnaire was also used to collect socio-demographic and clinical information. Data were analyzed using Statistical Package of Social Sciences (SPSS) version 23, and logistic regression was employing for analysing assocations between independent and dependent variables.Finally, the findings were presented in texts and tables.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe overall prevalence of oncogenic HPV (HPV16/18) was 6.2% [95%, CI: 3.9\u0026ndash;9.1], while VIA positivity was 3.6% [95%, CI: 2.1\u0026ndash;5.7]. Multivariate logistic regression identified several significant predictors of precervical cancer due to HPV infection: age over fifty (AOR [95% CI\u0026thinsp;=\u0026thinsp;1.65\u0026ndash;191.8]), primary education (AOR [95% CI\u0026thinsp;=\u0026thinsp;1.81\u0026ndash;83.1]), early age at first sexual intercourse (AOR [95% CI\u0026thinsp;=\u0026thinsp;1.04\u0026ndash;22.01]), parity (three or more) (AOR [95% CI\u0026thinsp;=\u0026thinsp;2.03\u0026ndash;99.9]), history of sexually transmitted infections (STIs) (AOR [95% CI\u0026thinsp;=\u0026thinsp;1.39\u0026ndash;45.25]), and HIV/AIDS (AOR [95% CI\u0026thinsp;=\u0026thinsp;1.6-44.29]). Early age at first sexual intercourse and history of STIs were associated factors for VIA positivity (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusions\u003c/b\u003e\u003c/p\u003e \u003cp\u003eHPV infection contributes significantly to CC in the study area, emphasizing its public health impact. Early sexual intercourse emerged as an independent predictor of VIA positivity and CC. As a result, to mitigate the risk of CC: early screening, treatment, and vaccination of high-risk groups of women for HPV infection are recommended.\u003c/p\u003e","manuscriptTitle":"Detection of pre-cervical cancer and its associated factors among cervical cancer suspected women in Bichena primary hospital in Amhara region, Ethiopia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-29 07:14:13","doi":"10.21203/rs.3.rs-6534651/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"117573696734219219065890767312925306000","date":"2026-05-14T11:09:46+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-12T06:43:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"51815810817122963498499950512431985585","date":"2025-06-05T07:16:16+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-29T01:37:50+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-04-28T10:32:34+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-04-28T00:58:37+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-28T00:57:01+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Women's Health","date":"2025-04-26T11:07:57+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":"17351c0e-835d-441b-9d7c-7354998a014b","owner":[],"postedDate":"April 29th, 2025","published":true,"recentEditorialEvents":[{"type":"reviewerAgreed","content":"117573696734219219065890767312925306000","date":"2026-05-14T11:09:46+00:00","index":80,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-05-29T01:53:10+00:00","versionOfRecord":[],"versionCreatedAt":"2025-04-29 07:14:13","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6534651","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6534651","identity":"rs-6534651","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}