Predictors of abnormal cervical lesions among women(15-49 years old) in Zambia: A cross-sectoral study

Abstract

Background: Cervical cancer has been identified as the second most common female malignancy and leading cause of death among women in the world. Despite concerted efforts through the Cervical Cancer Prevention Program in Zambia (CCPPZ), there has been observed low uptake of the service, with 80% of women presenting very late when only palliative care can be given. This study aimed at determining the predictors of abnormal cervical lesions among women (15-49 years old) in Zambia. Methods: The study was a cross-sectional study. 14,301 women (15-49 years old) from 6 provinces of Zambia were recruited. Secondary data from the CCPPZ was used for the study. SPSS version 21 was used for data analysis. Descriptive statistics using the chi2 test were used to explore proportions of women by their various socio-economic, demographic, medical and obstetric characteristics. Univariate logistic regression analysis was used to explore associations between the outcome variable (cervical lesions) and various predisposing factors. Finally, multiple logistic regression analysis was used to control for confounding, and thereby determine the predictors of abnormal cervical lesions in the final model. Results: The prevalence of abnormal cervical lesions was 10.7% (n=14,301). The predictors of abnormal cervical lesions were; education [AOR 0.684; 95% CI 0.505, 0.925; p=0.014] where women with tertiary education had a reduced risk compared to those with no formal education, marital status (married vs. never married) [AOR 0.776; 95%CI 0.624, 0.964; p= 0.022]. Other predictors were cigarette smoking (yes vs. no) [AOR 1.657; 95% CI 1.182, 2.322; p=0.003], condom use [0.652; 95% CI 0.434, 0.979; p=0.039] where women who always used a condom had a reduced risk compared to women who never used one, and HIV (positive vs. negative) [AOR 1.969; 95% CI 1.681, 2.305; p<0.001]. Conclusion: One in every ten women who screened for cervical cancer had abnormal cervical lesions. Education, marital status, smoking, condom use with regular partner and HIV status were significantly associated with having abnormal cervical lesions. There is, therefore, need for concerted efforts to design cervical cancer awareness programs targeting the high risk populations, including lobbying for a policy to make cervical cancer screening mandatory and routine for early detection and prevention of the development of cervical cancer.