Magnitude of precancerous cervical lesions in a fragile and conflict-affected setting: the case of Tigray region, Ethiopia

Abstract

Cervical cancer remains a major public health concern, ranking as the fourth leading cause of cancer-related deaths among women globally and the second in Ethiopia. Limited access to routine screening, exacerbated by the Tigray war (November 2020–November 2022), has contributed to delayed detection and treatment. This study aimed to identify factors associated with precancerous cervical lesions among women screened in a fragile and conflict-affected setting. A facility-based cross-sectional study was conducted among 6,279 women who underwent cervical cancer screening using Visual Inspection with Acetic Acid (VIA) at public health institutions in Mekelle, Tigray, between July 15, 2023, and January 15, 2024. Data were collected using the KOBO toolbox, and logistic regression was used to assess associations between VIA positivity and demographic and behavioral risk factors. Among participants, 975 (15.5%) tested VIA positive (diagnosed with precancerous lesions), 5175 (82.4%) tested VIA negative, and 129 (2.1%) were suspicious of cancer. Women with secondary education (grades 9–12) had lower odds of VIA positivity compared to illiterate women (AOR = 0.74; 95% CI: 0.58–0.93). Higher odds were observed in women with ≥ 2 sexual partners (AOR = 1.93; 95% CI: 1.65–2.25), early sexual debut (< 18 years) (AOR = 2.84; 95% CI: 2.44–3.20), history of painful intercourse (AOR = 1.67; 95% CI: 1.31–2.13), sexually transmitted infections (AOR = 1.80; 95% CI: 1.45–2.23), and post-coital bleeding (AOR = 2.55; 95% CI: 1.37–4.75). Follow-up screening visits were associated with lower VIA positivity (AOR = 0.55; 95% CI: 0.42–0.7). Despite the end of the Tigray war, persistent risk factors and reduced screening access remain associated with patterns of cervical cancer detection. Strengthening screening programs and expanding HPV vaccination—especially for high-risk groups—is essential to reduce cervical cancer burden in the region.