Community-Based Pre-Cancerous Cervical Screening Using Visual Inspection with Acetic Acid (VIA) in Urban of Hodeidah , Yemen

Abstract

Background: Cervical cancer remains a major public health concern in low-resource settings, where screening coverage is often inadequate. Visual inspection with acetic acid (VIA) offers a low-cost, accessible method for early detection of precancerous lesions, particularly in underserved urban populations.

Objective: This study aimed to determine the prevalence of precancerous cervical lesions and associated risk factors among women in Hodeidah, Yemen using VIA test .

Methodology : A retrospective study design was conducted among 143 women who underwent VIA screening in Hodeidah, Yemen. Data on demographic characteristics, socioeconomic status, behavioral exposures, reproductive history, clinical findings, and preventive measures were collected using structured questionnaires. VIA-positive women were referred for histopathological confirmation. Diagnostic indices—including sensitivity, specificity, predictive values, likelihood ratios, and accuracy—were calculated to assess VIA performance.

Results: The overall VIA positivity rate was 12.6% (18/143), pre-cancerous lesions were identified in 12 women (8.3%) through VIA, and histopathology confirmed 13 cervical cancer cases (9.1%). VIA demonstrated high diagnostic accuracy, with a sensitivity of 92.31%, specificity of 95.38%, and overall accuracy of 95.10%. VIA-positive women were more frequently aged 31–40 years (38.9%) and belonged to low-income groups (77.8%). Behavioral exposures such as smoking, qat chewing, and shamma use showed no clear association with VIA positivity. Moderate parity (1–4 births) was common among VIA-positive women (88.9%). Clinical symptoms, particularly post-coital bleeding (61.1% vs. 21.0%) and cervical ulcers (27.8% vs. 14.0%), showed strong associations with VIA positivity. Preventive measures were very limited, with only 2.8% vaccinated for HPV and 4.2% previously screened.

Conclusion: VIA proved to be a reliable, sensitive, and cost-effective method for detecting cervical pre-cancerous lesions, demonstrating strong diagnostic value in low-resource settings. Clinical symptoms—particularly post-coital bleeding and cervical ulceration—were more predictive of VIA positivity than behavioral or reproductive factors. Strengthening HPV vaccination and cervical cancer screening programs remains essential to improving early detection and reducing disease burden.