{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T10:52:00Z","timestamp":1785840720051,"version":"3.56.0"},"reference-count":38,"publisher":"AOSIS","issue":"1","license":[{"start":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:00:00Z","timestamp":1785888000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Background:\u00a0Early cervical dysplasia screening can save women from death resulting from cervical cancer.\nObjective:\u00a0To evaluate and compare the diagnostic performance of the Papanicolaou (Pap) smear and visual inspection with acetic acid (VIA) against histopathology as the reference test.\nMethods:\u00a0We recruited 160 women aged 25\u201360 years who were undergoing early cervical screenings at the Meru teaching and referral hospital, from June to October 2024. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated by comparing VIA and Pap smear outcomes against histology (gold standard).\nResults:\u00a0Mean age of the study sample was 44.96 years (s.d. = 9.49). Eighteen (11%) had inflammation, 3 (1.9%) had squamous cell carcinoma against 11 (6.9%) detected by histology, and 14 (8.8%) had precancerous lesions. There was no statistical significance between age or number of pregnancies and histology-confirmed cervical lesions. Pap smear had a sensitivity of 100% (95% confidence interval [CI]: 86\u2013100), specificity of 94% (95%CI: 89\u201397), PPV of 76% (95%CI: 58\u201389), and NPV of 100% (95%CI: 97\u2013100). In comparison, VIA showed diagnostic performance with sensitivity of 72% (95%CI: 51\u201388), specificity of 81% (95%CI: 74\u201388), PPV of 42% (95%CI: 27\u201358), and NPV of 94% (95%CI: 88\u201398).\nConclusion:\u00a0Pap smear showed higher overall diagnostic accuracy than VIA in diagnosing cervical lesions. While less specific, VIA showed a high NPV, suggesting its potential in ruling out disease in low-resource settings. Although age and pregnancy showed no statistical significance with cervical dysplasia, more studies including characteristics are required.\nWhat this study adds:\u00a0Results provide updated evidence on the relative diagnostic performance of VIA and Pap smear, to guide cervical cancer screening strategies in settings with limited resources.<\/jats:p>","DOI":"10.4102\/ajlm.v15i1.3054","type":"journal-article","created":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T10:32:24Z","timestamp":1785839544000},"update-policy":"https:\/\/doi.org\/10.4102\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Evaluation of visual inspection with acetic acid and Pap smear tests in early cervical cancer screening among women in Meru County, Kenya"],"prefix":"10.4102","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-3446-1567","authenticated-orcid":false,"given":"Mary N.","family":"Chege","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/04kq7tf63","id-type":"ROR","asserted-by":"publisher"}],"name":"Mount Kenya University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-2785-8610","authenticated-orcid":false,"given":"Stanley","family":"Kang\u2019ethe","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/04kq7tf63","id-type":"ROR","asserted-by":"publisher"}],"name":"Mount Kenya University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-5159-0753","authenticated-orcid":false,"given":"Scolastica N.","family":"Kimani","sequence":"additional","affiliation":[{"name":"Department of Pathology, Faculty of Medicine, Meru Teaching and Referral Hospital, Meru, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2580","published-online":{"date-parts":[[2026,8,5]]},"reference":[{"key":"ref0","doi-asserted-by":"crossref","unstructured":"Kinoti NJ, Muturi M, Kamau L, Lwembe R. Human Papilloma virus types prevalence and their association with cervical dysplasia among HIV and non-HIV infected women attending reproductive health clinics in Eastern Kenya. Afri Health Sci. 2022;22(1):106\u2013114. https:\/\/doi.org\/10.4314\/ahs.v22i1.14","DOI":"10.4314\/ahs.v22i1.14"},{"key":"ref1","doi-asserted-by":"crossref","unstructured":"Cohen CM, Wentzensen N, Castle PE, et al. Racial and ethnic disparities in cervical cancer incidence, survival, and mortality by histologic subtype. J Clin Oncol. 2023;41(5):1059\u20131068. https:\/\/doi.org\/10.1200\/JCO.22.01424","DOI":"10.1200\/JCO.22.01424"},{"key":"ref2","doi-asserted-by":"crossref","unstructured":"Stelze D, Tanaka LF, Lee KK, et al. Estimates of the global burden of cervical cancer associated with HIV. Lancet. 2020;9(2):E161\u2013E169. https:\/\/doi.org\/10.1016\/S2214-109X(20)30459-9","DOI":"10.1016\/S2214-109X(20)30459-9"},{"key":"ref3","doi-asserted-by":"crossref","unstructured":"Swase TD, Fasogbon IV, Eseoghene IJ, et al. The impact of HPV\/HIV co-infection on immunosuppression, HPV genotype, and cervical cancer biomarkers. BMC Cancer. 2025;25:202. https:\/\/doi.org\/10.1186\/s12885-025-13516-2","DOI":"10.1186\/s12885-025-13516-2"},{"key":"ref4","doi-asserted-by":"crossref","unstructured":"Canfell K, Kim JJ, Brisson M, et al. Mortality impact of achieving WHO cervical cancer elimination targets: A comparative modelling analysis in 78 low-income and lower-middle-income countries. Lancet. 2020;395(10224):591\u2013603. https:\/\/doi.org\/10.1016\/S0140-6736(20)30157-4","DOI":"10.1016\/S0140-6736(20)30157-4"},{"key":"#cr-split#-ref5.1","unstructured":"Ferlay J, Ervik M, Lam F, et al. Global Cancer Observatory (GLOBOCAN 2022): Cancer today (version 1.1) [homepage on the Internet]. Lyon: International Agency for Research on Cancer"},{"key":"#cr-split#-ref5.2","unstructured":"2024 [cited 2025 Mar 28]. Available from: https:\/\/gco.iarc.fr\/today"},{"key":"ref6","doi-asserted-by":"crossref","unstructured":"Aziz H, Sattar AA, Mahmood H, Fatima S, Khurshid M, Faheem M. Prevalence of HPV types in HIV-positive and negative females with normal cervical cytology or dysplasia. J Clin Lab Anal. 2023;37(4):1\u20137. https:\/\/doi.org\/10.1002\/jcla.24851","DOI":"10.1002\/jcla.24851"},{"key":"ref7","doi-asserted-by":"crossref","unstructured":"Brisson M, Kim JJ, Canfell K, et al. Impact of HPV vaccination and cervical screening on cervical cancer elimination: A comparative modelling analysis in 78 low-income and lower-middle-income countries. Lancet. 2020;395(10224):575\u2013590. https:\/\/doi.org\/10.1016\/S0140-6736(20)30068-4","DOI":"10.1016\/S0140-6736(20)30068-4"},{"key":"ref8","doi-asserted-by":"crossref","unstructured":"Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209\u2013249. https:\/\/doi.org\/10.3322\/caac.21660","DOI":"10.3322\/caac.21660"},{"key":"ref9","doi-asserted-by":"crossref","unstructured":"Modibbo F, Iregbu KC, Okuma J, et al. Randomized trial evaluating self-sampling for HPV DNA based tests for cervical cancer screening in Nigeria. Infect Agent Cancer. 2017;12:11. https:\/\/doi.org\/10.1186\/s13027-017-0123-z","DOI":"10.1186\/s13027-017-0123-z"},{"key":"ref10","unstructured":"UNAIDS. The GAP report. Geneva: Joint United National Program on HIV\/AIDS (UNAIDS); 2014."},{"key":"ref11","doi-asserted-by":"crossref","unstructured":"Denny LA, Franceschi S, De Sanjose S, Heard I, Moscicki AB, Palefsky J. Human Papillomavirus, human immunodeficiency virus and immunosuppression. Vaccine. 2012;30(suppl 5):F168\u2013F174. https:\/\/doi.org\/10.1016\/j.vaccine.2012.06.045","DOI":"10.1016\/j.vaccine.2012.06.045"},{"key":"ref12","doi-asserted-by":"crossref","unstructured":"Sudenga SL, Rositch AF, Otieno A, Smith JS. Knowledge, attitudes, practices, and perceived risk of cervical cancer among Kenyan women: Brief report. Int J Gynecol Cancer. 2013;23(5):895\u2013899. https:\/\/doi.org\/10.1097\/IGC.0b013e31828e425c","DOI":"10.1097\/IGC.0b013e31828e425c"},{"key":"ref13","doi-asserted-by":"crossref","unstructured":"Denny L, De Sanjose S, Mutebi M, et al. Interventions to close the divide for women with breast and cervical cancer between low-income and middle-income countries and high-income countries. Lancet. 2016;389(10071):861\u2013870. https:\/\/doi.org\/10.1016\/S0140-6736(16)31795-0","DOI":"10.1016\/S0140-6736(16)31795-0"},{"key":"ref14","doi-asserted-by":"crossref","unstructured":"Koliopoulos G, Nyaga VN, Santesso N, et al. Cytology versus HPV testing for cervical cancer screening in the general population. Cochrane Database Syst Rev. 2017;8(8):CD008587. https:\/\/doi.org\/10.1002\/14651858.CD008587.pub2","DOI":"10.1002\/14651858.CD008587.pub2"},{"key":"ref15","unstructured":"Cochran WG. Sampling techniques (3rd ed.). New York, NY: John Wiley & Sons; 1977."},{"key":"ref16","unstructured":"Bartlett JE, Kotrlik JW, Higgins CC. Organizational research: Determining appropriate sample size in survey research. Inf Technol Learn Perform J. 2001;19:43\u201350."},{"key":"ref17","doi-asserted-by":"crossref","unstructured":"Kamal M. Pap Smear collection and preparation: Key points. Cytojournal. 2022;19:24. https:\/\/doi.org\/10.25259\/CMAS_03_05_2021","DOI":"10.25259\/CMAS_03_05_2021"},{"key":"ref18","doi-asserted-by":"crossref","unstructured":"Mungo C, Osongo CO, Ambaka J, Omoto J, Cohen CR. Efficacy of thermal ablation for treatment of biopsy-confirmed high-grade cervical precancer among women living with HIV in Kenya. Int J Cancer. 2023;153(12):1971\u20131977. https:\/\/doi.org\/10.1002\/ijc.34737","DOI":"10.1002\/ijc.34737"},{"key":"ref19","unstructured":"Jhungran A, Russell AH, Seiden MV, et al. Chapter 84: Cancers of the cervix, vulva, and vagina. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, editors. Abeloff\u2019s clinical oncology. 6th ed. Philadelphia, PA: Elsevier; 2020."},{"key":"ref20","unstructured":"Koss LG, Melamed MR, editors. The normal female genital tract. In: Koss\u2019 diagnostic cytology and its histopathologic bases. 5th ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2006, pp. 183\u2013225."},{"key":"ref21","unstructured":"Koss LG, Melamed MR, editors. Laboratory techniques. In: Koss\u2019 diagnostic cytology and its histopathologic bases. 5th ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2006, pp. 1569\u20131634."},{"key":"ref22","doi-asserted-by":"crossref","unstructured":"Belgaumi UI, Shetty P. Leishman giemsa cocktail as a new, potentially useful cytological technique comparable to Papanicolaou staining for oral cancer diagnosis. J Cytol. 2013;30:18\u201322. https:\/\/doi.org\/10.4103\/0970-9371.107507","DOI":"10.4103\/0970-9371.107507"},{"key":"ref23","doi-asserted-by":"crossref","unstructured":"Goel G, Halder A, Joshi D, Anil AC, Kapoor N. Rapid, Economic, Acetic Acid Papanicolaou Stain (REAP): An economical, rapid, and appropriate substitute to conventional Pap stain for staining cervical smears. J Cytol. 2020;37(4):170\u2013173. https:\/\/doi.org\/10.4103\/JOC.JOC_89_20","DOI":"10.4103\/JOC.JOC_89_20"},{"key":"ref24","unstructured":"Adnan Z, Khan AA, Nayyar S, Nayyar A, Anwar Z, Ahsan S. Diagnostic accuracy of Visual Inspection with Acetic Acid (VIA) and PAP smear in diagnosing cervical cancer, taking histopathology as gold standard. J Soc Obstet Gynaecol Pak. 2021;11(1):36\u201340."},{"key":"ref25","doi-asserted-by":"crossref","unstructured":"Denny L, Kuhn L, De Souza M, et al. Screen-and-treat approaches for cervical cancer prevention in low resource settings. JAMA. 2005;294(17):2173\u20132181. https:\/\/doi.org\/10.1001\/jama.294.17.2173","DOI":"10.1001\/jama.294.17.2173"},{"key":"ref26","doi-asserted-by":"crossref","unstructured":"Mremi A, Mchome B, Mlay J, et al. Performance of HPV testing, Pap smear and VIA in women attending cervical cancer screening in Kilimanjaro region, Northern Tanzania: a cross-sectional study nested in a cohort. BMJ Open. 2022;12(10):e064321. https:\/\/doi.org\/10.1136\/bmjopen-2022-064321","DOI":"10.1136\/bmjopen-2022-064321"},{"key":"ref27","doi-asserted-by":"crossref","unstructured":"Sarbhai V. & Aggarwal S. Cervical cancer screening: Comparing PAPs smear with VIA\/VILI in semiurban women of Delhi. Ind J Med Paediatr Oncol 2025; 46:200\u2013206. https:\/\/doi.org\/10.1055\/s-0044-1800949","DOI":"10.1055\/s-0044-1800949"},{"key":"ref28","doi-asserted-by":"crossref","unstructured":"Lohiya A, Daniel RA, Kumar D, et al. Effectiveness of Visual Inspection with Acetic Acid (VIA) screening on cervical cancer mortality and incidence \u2013 A systematic review and meta-analysis. Asian Pac J Cancer Prev. 2022;23(2):399\u2013407. https:\/\/doi.org\/10.31557\/APJCP.2022.23.2.399","DOI":"10.31557\/APJCP.2022.23.2.399"},{"key":"ref29","doi-asserted-by":"crossref","unstructured":"Nayar R, Wilbur DC. The Pap test and Bethesda 2014. Cancer Cytopathol. 2015;123(5):271\u2013281. https:\/\/doi.org\/10.1016\/j.jasc.2015.01.002","DOI":"10.1002\/cncy.21521"},{"key":"ref30","doi-asserted-by":"crossref","unstructured":"Bhattacharyya AK, Nath JD, Deka H. Comparative study between pap smear and visual inspection with acetic acid (via) in screening of CIN and early cervical cancer. J Midlife Health. 2015;6(2):53\u201358. https:\/\/doi.org\/10.4103\/0976-7800.158942","DOI":"10.4103\/0976-7800.158942"},{"key":"ref31","doi-asserted-by":"crossref","unstructured":"Arbyn M, Simon M, Peeters E, et al. 2020 list of human papillomavirus assays suitable for primary cervical cancer screening. Clin Microbiol Infect. 2021;27:1083\u20131095. https:\/\/doi.org\/10.1016\/j.cmi.2021.04.031","DOI":"10.1016\/j.cmi.2021.04.031"},{"key":"ref32","doi-asserted-by":"crossref","unstructured":"Rayner M, Welp A, Stoler MH, Cantrell LA. Cervical cancer screening recommendations: Now and for the future. Healthcare (Basel). 2023;11(16):2273. https:\/\/doi.org\/10.3390\/healthcare11162273","DOI":"10.3390\/healthcare11162273"},{"key":"ref33","doi-asserted-by":"crossref","unstructured":"Castellsagu\u00e9 X, Mu\u00f1oz N, Pitisuttithum, P. et al. End-of-study safety, immunogenicity, and efficacy of quadrivalent HPV (types 6, 11, 16, 18) recombinant vaccine in adult women 24\u201345 years of age. Br J Cancer. 2011;105(1): 28\u201337. https:\/\/doi.org\/10.1038\/bjc.2011.185","DOI":"10.1038\/bjc.2011.185"},{"key":"ref34","doi-asserted-by":"crossref","unstructured":"Mu\u00f1oz N, Franceschi S, Bosetti C, et al. The role of parity and HPV in cervical cancer risk: A pooled analysis of case-control studies. Lancet Oncol. 2002;359:1093\u20131101. https:\/\/doi.org\/10.1016\/S0140-6736(02)08151-5","DOI":"10.1016\/S0140-6736(02)08151-5"},{"key":"ref35","doi-asserted-by":"crossref","unstructured":"Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, Jemal A. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024;74(3):229\u2013263. https:\/\/doi.org\/10.3322\/caac.21834","DOI":"10.3322\/caac.21834"},{"key":"ref36","unstructured":"Ferlay J, Ervik M, Lam F, et al. Global cancer observatory: Cancer today [homepage on the Internet]. Lyon: International Agency for Research on Cancer; 2024 [cited 2025 Jul 23]. Available from: https:\/\/gco.iarc.who.int\/today"}],"container-title":["African Journal of Laboratory Medicine"],"original-title":[],"link":[{"URL":"https:\/\/ajlmonline.org\/index.php\/ajlm\/article\/view\/3054\/3602","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T10:33:11Z","timestamp":1785839591000},"score":1,"resource":{"primary":{"URL":"https:\/\/ajlmonline.org\/index.php\/ajlm\/article\/view\/3054"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,5]]},"references-count":38,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1,1]]}},"URL":"https:\/\/doi.org\/10.4102\/ajlm.v15i1.3054","relation":{},"ISSN":["2225-2002","2225-2010"],"issn-type":[{"value":"2225-2002","type":"print"},{"value":"2225-2010","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,5]]},"article-number":"a3054"}}