{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T12:06:03Z","timestamp":1791893163711,"version":"4.3.4"},"reference-count":35,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2021,3,26]],"date-time":"2021-03-26T00:00:00Z","timestamp":1616716800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100007861","name":"University of Gondar","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100007861","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Cervical cancer remains one of the major public health challenges in low and middle-income countries including Ethiopia. There was a scarce of evidence regarding the effect of woman\u2019s socio-demographic characteristics and body mass index on the development of precancerous cervical lesions in Ethiopia. Therefore, the current study aimed at identifying the risk factors of precancerous cervical lesions among women visiting referral hospitals for cervical cancer screening in Amhara national regional state.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>A hospital-based case-control study was conducted from 22 December 2019 to 8 April 2020 among 200 women including 67 visual inspections with acetic acid (VIA) positive women (i.e., cases) and 133 visual inspections with acetic acid (VIA) negative women (i.e., controls). The study was conducted at randomly selected referral hospitals in Amhara national regional state. Data were collected mainly through face to face interview and chart review using structured questionnaire and checklist respectively. Data were then entered to EpiData version 4.6 and exported to SPSS version 25 for analysis. Binary logistic regression model was fitted and variables with p-value of &lt; 0.2 at bivariable logistic regression analysis were candidates for the multivariable analysis. Level of significance was claimed based on adjusted odds ratio (AOR) with 95% confidence interval (CI) at p-value of \u2264 0.05.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>This study illustrates that the odds of being positive for precancerous cervical lesion (PCL) were higher among women who had body mass index (BMI) of &lt;18.5 kg\/m2 (AOR = 3.83; 95% CI: 1.26, 8.76), early coitarche (AOR = 3.15; 95% CI: 1.50, 11.49, history of using oral contraceptive pills (AOR = 2.74; 95% CI: 1.6, 7.4), lifetime sexual transmitted infections (AOR = 3.73; 95% CI: 2.5, 12.28) and multiple sexual partners (AOR = 3.23; 95% CI: 1.82, 9.29). On the other hand, participants\u2019 BMI of \u226525 kg\/m2 (AOR = 0.46; 95% CI: 0.36, 0.75) and level of education of college and above (AOR = 0.29; 95% CI: 0.23, 0.77) were identified to be protective factors of PCL.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Most of the determinants of precancerous cervical lesions were modifiable and mainly related to women\u2019s socio-demographic characteristics, sexual behaviors and body mass index. Therefore, strengthening awareness on safe sexual practices and healthy life styles through information, education and communication (IEC), and behavioral change communication (BCC) would decrease the incidence of precancerous cervical lesions.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0249218","type":"journal-article","created":{"date-parts":[[2021,3,26]],"date-time":"2021-03-26T17:32:26Z","timestamp":1616779946000},"page":"e0249218","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":17,"title":["Risk factors of precancerous cervical lesions: The role of women\u2019s socio-demographic, sexual behavior and body mass index in Amhara region referral hospitals; case-control study"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2174-3797","authenticated-orcid":true,"given":"Birhan Tsegaw","family":"Taye","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhabaw Shumye","family":"Mihret","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haymanot Alem","family":"Muche","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,3,26]]},"reference":[{"key":"pone.0249218.ref001","unstructured":"Barbara L. Hoffman, John O. Schorge, Karen D. Bradshaw, Lisa M. Halvorson, Joseph I. Schaffer MMC. Wlliams Gynecology. Vol. 91, Third Edition. 2017. 399\u2013404 p."},{"key":"pone.0249218.ref002","first-page":"1","article-title":"Factors associated with cervical precancerous lesions among women screened for cervical cancer in Addis Ababa, Ethiopia: A case control study","volume":"39","author":"H Teame","year":"2018","journal-title":"PLoS One"},{"issue":"3","key":"pone.0249218.ref003","doi-asserted-by":"crossref","first-page":"46","DOI":"10.5897\/JPHE2016.0891","article-title":"Prevalence of precancerous cervical lesion and associated factors among women in North Ethiopia","volume":"9","author":"HM Kebede","year":"2017","journal-title":"J Public Heal Epidemiol"},{"key":"pone.0249218.ref004","author":"World Health Organization","year":"2013"},{"issue":"2","key":"pone.0249218.ref005","first-page":"1","article-title":"Cervical Cancer: Ethiopia\u00b4s Outlook","volume":"5","author":"NA Asseffa","year":"2017","journal-title":"J Gynecol Womens Heal"},{"key":"pone.0249218.ref006","doi-asserted-by":"crossref","DOI":"10.5772\/27200","article-title":"Cervical Cancer in Sub Sahara Africa","author":"A. Ntekim","year":"2012","journal-title":"Topics on Cervical Cancer With an Advocacy for Prevention"},{"key":"pone.0249218.ref007","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1016\/j.ijgo.2012.03.023","article-title":"International Journal of Gynecology and Obstetrics Cervical cancer prevention: New opportunities for primary and secondary prevention in the 21st century","volume":"119","author":"L. Denny","year":"2012","journal-title":"Int J Gynecol Obstet"},{"key":"pone.0249218.ref008","volume-title":"Latest Global Cancer Data","author":"IARC","year":"2018"},{"issue":"6","key":"pone.0249218.ref009","doi-asserted-by":"crossref","first-page":"394","DOI":"10.3322\/caac.21492","article-title":"Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"68","author":"F Bray","year":"2018","journal-title":"CA Cancer J Clin"},{"key":"pone.0249218.ref010","first-page":"1","article-title":"Estimated number of new cases in 2018, worldwide, females, all ages","volume":"876","author":"GLOBOCAN","year":"2018"},{"issue":"2","key":"pone.0249218.ref011","first-page":"82","article-title":"Coverage and factors associated with cervical cancer screening: results from a population-base WHO steps study","volume":"12","author":"G Terefe","year":"2017","journal-title":"Ethiopia. J Low Genit Tract Dis"},{"key":"pone.0249218.ref012","article-title":"National Cancer Control Plan 2016\u20132020","author":"Federal Ministry of Health","year":"2015","journal-title":"Disease Prevention and Control Directoriate"},{"issue":"1","key":"pone.0249218.ref013","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1186\/s13104-015-1594-x","article-title":"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 Womens Health.","volume":"8","author":"ZM Deksissa","year":"2015","journal-title":"BMC Res Notes"},{"issue":"1","key":"pone.0249218.ref014","first-page":"1","article-title":"Othieno Emmanue A. Prevalence of Cancerous and Pre-malignant Lesions of Cervical Cancer and their Association with Risk Factors as seen among women in the Regions of Uganda","volume":"2","author":"Julius Wandabwa AO Andrew Livex Okwi","year":"2017","journal-title":"J Clin Lab Med"},{"key":"pone.0249218.ref015","first-page":"1","article-title":"Prevalence and risk factors for cervical cancer and pre-cancerous lesions","volume":"22","author":"JD Makuza","year":"2015","journal-title":"Rwanda. Pan Afr Med J"},{"key":"pone.0249218.ref016","first-page":"103","article-title":"Trends of Cervical Cancer in Ethiopia","volume":"5","author":"S. Migbaru Abate","year":"2017","journal-title":"Gynecol Obstet"},{"issue":"1","key":"pone.0249218.ref017","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13104-018-3244-6","article-title":"Risk factors associated with precancerous cervical lesion among women screened at Marie Stops Ethiopia, Adama town, Ethiopia 2017: A case control study","volume":"11","author":"RT Kassa","year":"2018","journal-title":"BMC Res Notes"},{"issue":"Suppl 2","key":"pone.0249218.ref018","first-page":"17","article-title":"Determinant Factors of Visual Inspection with Acetic Acid (Via) Positive Lesions among Hiv Positive Women in Mekelle Hospital, Northern Ethiopia: a Case Control Study","author":"Z Gessesse","year":"2015","journal-title":"Ethiop Med J"},{"issue":"3","key":"pone.0249218.ref019","first-page":"87","article-title":"The Relationship between Age at Coitarche and Cervical Intraepithelial Changes Amongst Women Attending the Gynaecological Clinic at Jos UTH","volume":"4","author":"NS Monday","year":"2018","journal-title":"Am Inst Sci"},{"issue":"16","key":"pone.0249218.ref020","first-page":"1","article-title":"Prevalence and Predictors of Pap Smear Cervical Epithelial Cell Abnormality among HIV-Positive and Negative Women Attending Gynecological Examination in Cervical Cancer Screening Center at Debre Markos Referral Hospital, East Gojjam, Northwest Ethiopia","volume":"15","author":"G Melkamu","year":"2015","journal-title":"BMC Clin Pathol"},{"key":"pone.0249218.ref021","author":"Federal Democratic Republic of Ethiopia M of H","year":"2015","journal-title":"Guideline for Cervical Cancer Prevention and Control in Ethiopia"},{"key":"pone.0249218.ref022","author":"A Tesfa","year":"2011","journal-title":"Brief. Pathfinder International"},{"issue":"1","key":"pone.0249218.ref023","first-page":"54","article-title":"Comparison between Pap smear and visual inspection with acetic acid in screening of premalignant cervical intraepithelial lesion and subclinical early cancer cervix","volume":"6","author":"H Hassan","year":"2017","journal-title":"Int J Reprod Contraception, Obstet Gynecol"},{"issue":"1","key":"pone.0249218.ref024","doi-asserted-by":"crossref","first-page":"87","DOI":"10.9745\/GHSP-D-15-00325","article-title":"The Single-Visit Approach as a Cervical Cancer Prevention Strategy Among Women With HIV in Ethiopia: Successes and Lessons Learned","volume":"4","author":"N Shiferaw","year":"2016","journal-title":"Glob Heal Sci Pract"},{"issue":"1","key":"pone.0249218.ref025","first-page":"1","article-title":"Preventive Mechanisms and Treatment of Cervical Cancer in Ethiopia","volume":"1","author":"SK Tadesse","year":"2016","journal-title":"Open Access"},{"key":"pone.0249218.ref026","author":"Central Statistical Agency (CSA) [Ethiopia] and ICF","year":"2016","journal-title":"Ethiopia Demographic and Health Survey"},{"key":"pone.0249218.ref027","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1097\/CEJ.0000000000000164","article-title":"The association between BMI and cervical cancer risk: a","volume":"25","author":"J Poorolajal","year":"2016","journal-title":"Eur J Cancer Prev"},{"issue":"4","key":"pone.0249218.ref028","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1016\/j.gmit.2015.03.003","article-title":"The association between obesity and gynecological cancer","volume":"4","author":"Y. Feng","year":"2015","journal-title":"Gynecol Minim Invasive Ther"},{"issue":"11","key":"pone.0249218.ref029","first-page":"2552","article-title":"Obesity and the Likelihood of Sexual Behavioral Risk Factors for HPV and Cervical Cancer","volume":"16","author":"Christina C. Wee","year":"2010","journal-title":"Obes (Silver Spring)"},{"issue":"8","key":"pone.0249218.ref030","first-page":"4163","article-title":"Prevalence and Risk Assessment of Cervical Cancer Screening by Papanicolaou Smear and Visual Inspection with Acetic Acid for Pregnant Women at a Thai Provincial Hospital","volume":"17","author":"J Lertcharernrit","year":"2016","journal-title":"Asian Pac J Cancer Prev"},{"key":"pone.0249218.ref031","first-page":"1","article-title":"The influence of education on health: an empirical assessment of OECD countries for the period 1995\u20132015","volume":"5","author":"V Raghupathi","year":"2020","journal-title":"BMC Arch public Heal"},{"issue":"1","key":"pone.0249218.ref032","first-page":"44","article-title":"Prevalence and risk factors for cervical intraepithelial neoplasia in patients attending gynecological outpatient department of Tertiary care hospital in Pakistan","volume":"12","author":"CM Das","year":"2013","journal-title":"J Liaquat Univ Med Heal Sci"},{"issue":"1","key":"pone.0249218.ref033","first-page":"1","article-title":"Prevalence and risk factors for High-Risk Human Papillomavirus (hrHPV) infection among HIV-infected and Uninfected Rwandan women: Implications for hrHPV-based screening in Rwanda","volume":"9","author":"JDA Sinayobye","year":"2014","journal-title":"Infect Agent Cancer"},{"issue":"2","key":"pone.0249218.ref034","first-page":"41","article-title":"Pre-cancerous cervical lesion using visual inspection with acetic acid among women attending anti-retroviral therapy in Tigray","volume":"4","author":"Haftom Gebrehiwot W\/aregay SK and YB","year":"2017","journal-title":"Eur J Pharm Med Res Med Res"},{"issue":"3","key":"pone.0249218.ref035","first-page":"818","article-title":"Prevalence and Factors Associated with Cervical Premalignant Lesions in Women 25\u201365 Years Attending Gynaecology Clinic at Kampala International University Teaching Hospital","volume":"6","author":"Richard Mulumba","year":"2018","journal-title":"Appl Med Sci"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0249218","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,3,26]],"date-time":"2021-03-26T17:33:15Z","timestamp":1616779995000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0249218"}},"subtitle":[],"editor":[{"given":"Frank T.","family":"Spradley","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2021,3,26]]},"references-count":35,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2021,3,26]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0249218","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,3,26]]}}}