Sefonias Getachew

Prevalence and associated factors of persistent precancerous lesions among women treated for cervical lesions in Addis Ababa, Ethiopia

Abstract Background Cervical cancer is one of the leading causes of cancer-related deaths among Ethiopian women, despite being largely preventable. Women treated for precancerous cervical lesions remain at elevated risk of developing invasive cancer, yet little is known about the burden and predictors of persistent lesions following treatment in resource-limited settings. Materials and Methods We conducted a cross-sectional study among 242 women who underwent ablative or excisional therapy for precancerous cervical lesions at 3 clinics in Addis Ababa between November 2022 and December 2023. Data were collected using structured questionnaires and clinical records. Logistic regression analysis was used to identify factors associated with persistent lesions, reported as adjusted odds ratios (AORs) with 95% CIs. Results Of the 242 women treated, 104 (43.0%; 95% CI, 37.2-49.6%) experienced persistent lesions within 1 year. Persistent lesion rates were highest among women initially screened with a Pap smear (97.4%) compared to visual inspection with acetic acid (VIA) (21.9%) and HPV DNA testing (14.7%). Independent predictors of persistent lesions included an age of ≥50 years (AOR = 5.4; 95% CI, 1.56-18.93), being married (AOR = 2.5; 95% CI, 1.15-5.44), an HIV-positive status (AOR = 5.0; 95% CI, 1.41-20.3), and Pap smear as the initial screening modality (AOR = 4.9; 95% CI, 1.04-23.15). Conclusion Nearly half of the women treated for precancerous cervical lesions experienced persistent disease within 1 year, particularly those who were older, married, HIV-positive, or initially screened by Pap smear. These findings raise concerns about the effectiveness of current treatment and screening strategies.

Follow-up rescreening uptake and persistent positive rates among women after positive cervical cancer screening results in Ethiopia: a longitudinal cross-sectional study

Objective To assess cervical cancer screening positivity rates, follow-up rescreening uptake 1 year after treatment and persistent positivity among women with initial positive screening results in Ethiopia. The study also explored reasons for loss to follow-up and preferences for reminder strategies. Design Longitudinal cross-sectional study. Settings 10 primary healthcare facilities in Oromia and southern and central Ethiopia. Participants From November 2022 to April 2024, 17 586 women screened for cervical cancer. Of these 768 (4.4%) had positive screening results, and 515 women treated at the primary level were included to assess follow-up rescreening uptake. An additional 139 women who did not return for follow-up were interviewed to identify reasons for non-uptake and reminder preferences. Result Of the 515 women included in the analysis, 179 (34.8%, 95% CI: 30.6% to 38.8%) returned for follow-up rescreening. Among those re-screened, the persistent visual inspection with acetic acid (VIA) positivity rate was 16.1% (95% CI: 11.0% to 21.7%). Factors significantly associated with follow-up rescreening uptake included age over 40 (adjusted OR (AOR): 2.5; 95% CI: 1.34 to 5.00), urban residence (AOR: 1.7; 95% CI: 1.15 to 2.58), secondary or higher education (AOR: 2.0; 95% CI: 1.06 to 4.12) and HIV-positive status (AOR: 2.4; 95% CI: 1.27 to 4.87). Among the 139 women contacted, the main reasons for non-uptake were lack of time, forgetting appointments, visiting another facility and pregnancy. Regarding preferred reminders, 93% favoured text messages and all agreed to phone calls or home visits. Conclusion One-third of women adhered to follow-up rescreening after a positive cervical cancer screening in Ethiopia, revealing a considerable gap since those women had a three times higher chance of being VIA positive compared with the first screening. Older age, urban residence, higher education and HIV-positive status were significantly linked to follow-up rescreening uptake. Addressing barriers such as time constraints and forgotten appointments through tailored reminder strategies is essential for improving the follow-up rescreening uptake. Contextualised interventions can strengthen rescreening for finding those women at very high risk for cervical lesions and strengthen cervical cancer prevention in Ethiopia. Trial registration number NCT06515301 .

Predictors of advanced-stage presentation among patients with a diagnosis of breast and cervical cancer in Ethiopia

Abstract Background Breast and cervical cancers are the most common causes of cancer incidence and mortality in women in Africa. Women with breast and cervical cancers in Sub-Saharan Africa are frequently diagnosed with their disease at advanced stages. Delays in seeking health, diagnosis, and treatment are contributing factors to high mortality in Ethiopia. This study aimed to assess predictors of advanced stage presentation among patients with breast and cervical cancer attending public hospitals in Addis Ababa, Ethiopia. Methods A cross-sectional study was conducted with a total of 418 patients at Tikur Anbessa specialized hospital and Saint Pauls’ Hospital Millennium Medical College from October to November 2021. Stages III and IV were considered advanced stages. Data were collected by reviewing medical records and face-to-face interviews with a structured questionnaire. Bivariate and multivariable analyses were performed to examine the association between independent and outcome variables. Results A total of 269 patients with breast cancer and 149 patients with cervical cancer were included in the study, and the mean age was 44 years (SD = 10.9 years) and 50 years (SD = 11.2) years, respectively. About 66.9% of breast cancers and 71.1% of cervical cancers were diagnosed at an advanced disease stage. Rural residence (adjusted odds ratio [AOR] = 2.041, 95% CI, 1.108-3.758), indirect referral (AOR = 3.8, 95% CI, 1.485-9.946), financial difficulty (AOR = 10, 95% CI,1.859-56.495), and cancer screening recommended during their visit (AOR = 4.029 95% CI, 1.658-10.102) were independent predictors of advanced-stage presentation. Conclusions This study revealed a high prevalence of advanced-stage breast and cervical cancer diagnosis in Ethiopia, like data collected 10 years ago, despite the introduction of a cancer control plan in 2015. For better implementation, interventions should aim to improve referral pathways, adapt screening and early detection services, and increase cancer awareness at the community level in a culturally accepted way.

Key Interventions to Improve the Follow-up Adherence Post Cervical Precancerous Lesion Treatment in Ethiopia

The goal of this pragmatic randomized control trial is to evaluate the effectiveness of three interventions in improving follow-up adherence among women treated for suspicious cervical lesions in primary healthcare settings in Ethiopia. The interventions include structured nurse-led telephone call reminders, home-visit reminders led by health extension workers, and application-based automated SMS text reminders. The main questions it aims to answer are: * Does structured nurse-led telephone call reminders improve follow-up adherence among women treated for suspicious cervical lesions compared to standard care? * Does home-reminder visits led by a Health Extension Worker (HEW) improve follow-up adherence among women treated for suspicious cervical lesions compared to standard care? * Does app-based automated SMS reminders improve follow-up adherence among women treated for suspicious cervical lesions compared to standard care? Structured Nurse-Led Telephone Call Reminders * Participants will receive proactive phone call reminders for scheduled follow-up visits. * The intervention includes three rounds: initially at 4 months post-recruitment, then every 4 months for HIV-negative women over a year, and every 2 months for 6 months for women living with HIV. Home-Reminder Visits Led by HEW Health Extension Workers (HEWs) will conduct door-to-door visits to remind participants of their scheduled follow-up appointments. • Door-to-door Visits will occur initially at 4 months (for HIV-negative women) and 2 months (for HIV-positive women) post-recruitment, then every 2 months for 6 months for HIV-positive and every 4 months for 12 months for HIV-negative participants. App-Based Automated SMS Reminders * Participants will receive SMS-based reminders for their follow-up visits. * The intervention consists of three rounds: initial texts at 4 months and 2 months post-recruitment for HIV-negative and HIV-positive women, respectively, followed by reminders every 2 months for 6 months for HIV-positive women and every 4 months for 12 months for HIV-negative women.