RISK FACTORS FOR CERVICAL CANCER AND PREVALENCE OF PRECANCEROUS CERVICAL CHANGES AMONG SEXUALLY ACTIVE WOMEN IN LAGOS STATE

Abstract

Cervical cancer is the second commonest cancer amongst women globally. Early diagnosis of precancerous cervical changes (PCC) can prevent the disease. Most studies done in Nigeria on cervical cancer are facility based; hence the need for a population based survey. This study was designed to determine the population-based prevalence of PCC and identified its risk factors among women Iiving in Lagos State, Nigeria. A cross-sectional study involving 332 women who were randomly selected from three LGAs using, a four stage sampling technique (involving. the Senatorial Districts, Local Governments, wards and houses) was carried out. Study participants were women above 15 years of age who were sexually active and with no previous diagnosis of cervical cancer. Data were collected using a 48 item, interviewer administered semi-structured questionnaire on respondents' socio-demographic characteristics, knowledge and utilization of cervical cancer screening services and risk factors of cervical cancer. Knowledge score was computed (maximum score of 16 and minimum score of 0) and respondents scoring 12 to 16 points were graded as having good knowledge. Oral contraceptive (OCP) use was defined as using OCP for ≥ 1 year, early coitarche as first sexual intercourse at >18 years, multiple risks as having 3 or more risk factors and high education as having tertiary education. Visual inspection with Acetic Acid (VIA) and Visual Inspection with Lugol's lodine (VILI) were done to screen for precancerous changes in the cervix. Data were analysed using frequencies, proportions, Chi square statistic, prevalence odd ratio (POR) and logistic regression. Level of significance was set at p = 0.05 Respondents' age was 39.0 ±10.0 years. Many were married (227: 68.6%).Thirteen percent (43) had PCC. Prevalence of PCC risk factors were:- grandmultiparity (36; 13.4%); total lifetime partners of ≥4 (45; 14.6%); OCP use (140; 44.3%): early coitarche (67; 20.2%): multiple risks (34; 10.2%) and history of previous sexually transmitted infection (76; 24.1%). Only (135) 41.9% of respondents had heard of cervical cancer 32.3% of whom had good knowledge of the disease. Radio was the most (65.9%) common source of information. Only 11(3.3%) of respondents had ever had cervical cancer screening. Multiparity [POR 4.27 (1.95-9.39)], early coitarche [POP I5.72 (7.52-32.83)] multiple sexual partners [POR 18.68 (8.76-39.84) and multiple risks [POR 14.46 (6.53-32.03)] were associated with fining PCC. Respondents with low education level were four times less likely to have a good knowledge of the disease compared with those with high education. [POR 0.24 (0.08-0.68). Multiple sexual partners and early coitarche predicted the likelihood of having PCC [AOR 9.69 (3.29-28.50) and AOR 7.93 (3.20-19.6), respectively].The prevalence of precancerous cervical changes was high. Women who had multiple sexual partners or early coitarche are more likely to have precancerous cervical changes. There was poor knowledge and low utilisation of cervical cancer screening services, Health education programmes on safe sexual practices and benefits of screening for cervical cancer need to be enhanced.