title: Prevalence and risk factors for cervical cancer and pre-cancerous lesions in Rwanda.
abstract: BACKGROUND
  Cervical cancer prevalence in Rwanda has not been well-described. Visual inspection with acetic acid or Lugol solution has been shown to be effective for cervical cancer screening in low resource settings. The aim of the study is to understand the prevalence and risk factors for cervical cancer and pre- cancerous lesions among Rwandan women between 30 and 50 old undergoing screening.
  
  
  METHODS
  This cross-sectional analytical study was done in 3 districts of Rwanda from October 2010 to June 2013. Women aged 30 to 50 years screened for cervical cancer by trained doctors, nurses and midwives. Prevalence of pre-cancerous and cancerous cervical lesions was determined. Bivariate and multivariate logistic regressions were used to assess risk factors associated with cervical cancer.
  
  
  RESULTS
  The prevalence of pre-cancer and invasive cervical cancer was 5.9% (95% CI 4.5, 7.5) and 1.7% (95% CI 0.9, 2.5), respectively. Risk factors associated with cervical cancer in multivariate analysis included initiation of sexual activity at less than 20 years (OR=1.75; 95% CI=(1.01, 3.03); being unmarried (single, divorced and widowed) (OR=3.29; 95% CI=( 1.26, 8.60)); Older age of participants (OR= 0.52; 95% CI= (0.28, 0.97)), older age at the first pregnancy (OR=2.10; 95% CI=(1.20, 3.67) and higher number of children born (OR=0.42; 95%CI =(0.23, 0.76)) were protective.
  
  
  CONCLUSIONS
  Cervical cancer continues to be a public health problem in Rwanda, but screening using VIA is practical and feasible even in rural settings.
authors.affiliation: Rwanda Biomedical Center, Kigali, Rwanda.
authors.forename: Jean Damascène
authors.initials: JD
authors.lastname: Makuza
authors.affiliation: Rwanda Biomedical Center, Kigali, Rwanda.
authors.forename: Sabin
authors.initials: S
authors.lastname: Nsanzimana
authors.affiliation: Rwanda Biomedical Center, Kigali, Rwanda.
authors.forename: Marie Aimee
authors.initials: MA
authors.lastname: Muhimpundu
authors.affiliation: Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Lydia Eleanor
authors.initials: LE
authors.lastname: Pace
authors.affiliation: University of Rwanda, College of Medicine and Other Health Sciences, School of Public Health, Rwanda.
authors.forename: Joseph
authors.initials: J
authors.lastname: Ntaganira
authors.affiliation: Institute of Human Virology and Division of Infectious Diseases, University of Maryland School of Medicine, Baltimore, Maryland, USA.
authors.forename: David James
authors.initials: DJ
authors.lastname: Riedel
mesh_terms: D000328:Adult; D000367:Age Factors; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D015995:Prevalence; D012307:Risk Factors; D012432:Rwanda / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology
keywords: Rwanda; VIA; cervical cancer; screening