Cervical cancer screening in primary health care setting in Sudan: a comparative study of visual inspection with acetic acid and Pap smear

Figures & data

Figure 1 Flow chart of the study.

Abbreviation: VIA, visual inspection with the use of acetic acid.

Table 1 Characteristics of the participants in the screening for cervical cancer by VIA and Pap smear in Khartoum

Variable	Total (n = 934)	Screening		P value
		Negative (n = 815)	Positive (n = 119)
Age, years (mean ± SD)	34.9 ± 7.6	34.8 ± 7.6	32.8 ± 7.6	0.007
Age of sex initiation, years (mean ± SD)	20.1 ± 2.1	20.3 ± 2.0	19.8 ± 1.9	0.01
Number of deliveries (mean ± SD)	1.81 ± 2.3	1.71 ± 1.8	1.92 ± 2.1	0.2
Education level
No formal education	247 (26.4%)	216 (26.5%)	31 (26.0%)	0.01
Basic school	687 (73.6%)	599 (73.5%)	88 (74.0%)
Employment
Employed	338 (36.2%)	286 (35.1%)	52 (43.7%)	0.3
Unemployed	596 (63.8%)	529 (64.9%)	67 (56.3%)
Residence
Rural	354 (37.9%)	314 (38.5%)	40 (33.6%)	0.08
Urban	580 (62.1%)	501 (61.5%)	79 (66.4%)
Female genital mutilation
Yes	836 (89.5%)	732 (89.8%)	104 (87.4%)	0.5
No	98 (10.4%)	83 (10.2%)	15 (12.6%)
Contraceptive use
Yes	710 (76.0%)	620 (76.1%)	90 (10.4%)	0.9
No	224 (24.0%)	195 (23.9%)	29 (3.1%)
Delivery type
Nulliparous	329 (35.2%)	281 (34.5%)	48 (40.3%)	0.2
Parous	605 (64.8%)	534 (65.5%)	71 (59.7%)
Episiotomy
Yes	710 (76.0%)	624 (76.6%)	86 (72.3%)	0.3
No	224 (24.0%)	191 (23.4%)	33 (27.7%)
Cervical infection
No infection	848 (90.8%)	779 (95.6%)	69 (58.0%)	0.0001
Infected	86 (9.2%)	36 (4.4%)	50 (42.0%)

Abbreviations: SD, standard deviation; VIA, visual inspection with the use of acetic acid.

Table 2 Comparison between positive VIA, Pap smear tests, and characteristics of participants in Khartoum (n = 934)

Variable category	All test positive	Screening test		P value
		VIA	Pap smear
Number (%) of screening positive	119 (12.7%)	71 (7.6%)	48 (5.1%)	0.004
Continuous variable	(Mean ± SD)	(Mean ± SD)	(Mean ± SD)
Age, years (mean ± SD)	32.8 ± 7.6	32.3 ± 6.7	38.3 ± 6.3	0.0001
Age of sex initiation, years (mean ± SD)	19.8 ± 1.9	19.8 ± 1.9	20.3 ± 2.0	0.1
Number of deliveries (mean ± SD)	1.92 ± 2.1	1.71 ± 2	1.92 ± 2.3	0.5
Categorical variables	n (%)	n (%)	n (%)
Education level
No formal education	31 (26.0)	19 (26.8)	12 (25.0)	0.9
Formal education	88 (55.5)	52 (54.9)	36 (65.3)
Employement
Employed	52 (43.7)	29 (40.8)	23 (47.9)	0.5
Unemployed	67 (56.3)	42 (59.1)	25 (52.1)
Residence
Rural	40 (33.6)	23 (32.4)	17 (35.4)	0.8
Urban	79 (66.4)	48 (67.6)	31 (64.6)
Female genital mutilation
Yes	104 (87.4)	66 (93.0)	38 (79.2)	0.05
No	15 (12.6)	5 (7.0)	10 (20.8)
Contraceptive use
Yes	90 (10.4)	55 (77.5)	35 (72.9)	0.08
No	29 (3.1)	16 (22.5)	13 (27.1)
Delivery type
Nulliparous	46 (38.7)	30 (42.3)	16 (33.3)	0.9
Parous	73 (59.7)	41 (57.7)	32 (66.7)
Episiotomy
Yes	86 (72.3)	55 (77.5)	31 (64.6)	0.8
No	33 (27.7)	16 (22.5)	17 (35.4)
Cervical infection
No infection	69 (58.0)	47 (66.1)	22 (45.8)	0.04
Infected	50 (42.0)	24 (33.9)	26 (54.2)

Abbreviations: SD, standard deviation; VIA, visual inspection with the use of acetic acid.

Table 3 Comparison between VIA and Pap positive total women (n = 119) undergone colposcopy and histopathology

	Total (%)	VIA test n (%)	Pap smear n (%)	P value	Overlap both VIA and Pap positive (%)
Total screened positive	119	71 (7.5)	48 (5.1)	0.004	24 (20.2)
Total confirmed by colposcopy and biopsy	88 (73.9)	53 (74.6)	35 (72.9)	0.05	19 (79.2)
Classification of confirmed positive
CIN1	12 (13.6)	4 (7.5)	8 (22.9)	0.2*	10 (52.6)
CIN2	26 (29.5)	14 (26.4)	12 (34.3)	0.7	6 (31.6)
CIN3	28 (31.8)	16 (30.2)	12 (34.2)	0.4	2 (10.5)
Stage 1	22 (25.0)	19 (35.8)	3 (8.6)	0.001*	1 (5.3)

Note:

* Yates Chi-square test and P value.

Abbreviations: CIN, cervical intraepithelial neoplasia; VIA, visual inspection with the use of acetic acid.

Table 4 Comparison of VIA and Pap smear tests performance in Khartoum (934 women)

	VIA test	95% CI	Pap smear	95% CI	VIA/Pap	95% CI
Sensitivity	60.2	49.8–69.8	47.7	37.5–58.0	82.6	63.9–93.0
Specificity	41.9	26.4–59.2	83.8	68.9–92.3	92.2	83.0–96.6
Positive predictive value	74.6	63.3–83.3	87.5	75.3–94.1	79.2	59.5–90.8
Negative predictive value	27.1	16.6–41.0	40.3	30.0–51.4	93.7	84.8–97.5

Abbreviations: CI, confidence interval; VIA, visual inspection with the use of acetic acid.