Precancerous cervical lesions and associated factors among women screened at two University Hospitals in N’Djamena, Chad

Abstract Background Human papillomavirus (HPV) infection is the main etiological factor of cervical cancer worldwide. In sub-Saharan Africa, including Chad, cervical cancer remains a major public health problem due to limited screening coverage and late diagnosis. Data on the burden of precancerous cervical lesions and associated risk factors are scarce in Chad. This study aimed to determine the prevalence of precancerous cervical lesions and identify associated factors among women screened in N’Djamena. Methods A hospital-based cross-sectional study was conducted in 2022 at two university hospitals in N’Djamena, Chad. Cervical samples were collected from women attending gynecological consultations and analyzed using liquid-based cytology, with results classified according to the 2014 Bethesda system. Sociodemographic characteristics, gynecological and obstetrical history, medical history, and behavioral factors were collected using a structured questionnaire. Univariate logistic regression was performed to estimate crude odds ratios (ORs) with 95% confidence intervals (CIs). Variables with p-values < 0.20 were entered into a multivariate logistic regression model to identify independent associated factors. Results A total of 310 women were included, of whom 58 presented precancerous cervical lesions, corresponding to a prevalence of 18.7%. Identified cytological abnormalities included atypical squamous cells of undetermined significance, atypical squamous cells—cannot exclude high-grade lesions, low-grade squamous intraepithelial lesions, high-grade squamous intraepithelial lesions, and atypical glandular cells. In univariate analysis, marital status was significantly associated with a reduced risk of precancerous lesions. Increased risks were observed among women with sexual debut before 18 years, a history of abortion, use of hormonal contraception, tobacco consumption, and positive serological status. In multivariate analysis, early sexual debut before 18 years (adjusted OR = 3.6; 95% CI: 1.9–7.3; p < 0.001) and history of abortion (adjusted OR = 3.1; 95% CI: 1.7–6.1; p < 0.001) remained independently associated with precancerous cervical lesions. Conclusions Precancerous cervical lesions were relatively common among women screened in N’Djamena. Early sexual initiation and a history of abortion were independently associated with lesion occurrence. These findings highlight the need to strengthen cervical cancer prevention strategies, particularly through early screening and targeted preventive interventions in Chad