{
  "abstract": "Background: Visual Inspection with Acetic acid (VIA) is widely used for detecting cervical (pre)cancer in resource-limited settings due to its simplicity and cost-effectiveness. However, the finding of cervical leukoplakia, poses diagnostic challenges. Methods: This retrospective observational study evaluated the prevalence, associated risk factors, and referral outcomes of cervical leukoplakia among 13,861 women previously screened for cervical cancer in Ghana between June 2016 and May 2024. Screening approaches included VIA alone, mobile colposcopy alone, or VIA/mobile colposcopy combined with other tests (HPV DNA testing and/or cytology). Results: Among 120 women (0.9%) with leukoplakia, 112 (93.3%) did not have acetowhitening on VIA/mobile colposcopy, and 21 (17.5%) received LEEP. The histopathology results ranged from no Cervical Intraepithelial Neoplasia (CIN) (15) to CIN I (2), CIN II (1), and CIN III (3). High-risk HPV positivity (aOR: 30.27; 95% CI: 3.56–257.37) and HIV infection (aOR: 8.27; 95% CI: 1.18–57.69) were associated with higher odds of leukoplakia in VIA-screened women. Conclusion: Leukoplakia can be clinically important without coexistence with acetowhitening. The association of leukoplakia with hrHPV and HIV, coupled with a high referral default and logistical barriers to biopsy and histopathology, calls for simplified management protocols and point-of-care triage tools for cervical screening in low-resource settings.",
  "abstract_shown": true,
  "affiliations": [
    "Cervical Cancer Prevention and Training Centre, Catholic Hospital, Battor, Ghana",
    "Department of Obstetrics and Gynaecology, Catholic Hospital, Battor, Ghana",
    "Department of Epidemiology and Biostatistics, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Ho, Volta Region, Ghana",
    "Volta Regional Health Directorate, Ghana Health Service, Ho, Volta Region, Ghana",
    "School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada",
    "University of Ghana Medical Centre, Accra, Ghana",
    "Central Laboratory, Catholic Hospital, Battor, Ghana",
    "Screen-and-Treat Research Group, Centre for Research in Applied Biology, School of Sciences, University of Energy and Natural Resources, Sunyani, Ghana",
    "Department of Family Medicine, Cape Coast Teaching Hospital, Cape Coast, Ghana"
  ],
  "article_type": "Research Article",
  "arxiv": null,
  "author_total": 13,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Kofi Effah"
    },
    {
      "affs": [
        1
      ],
      "name": "Ethel Tekpor"
    },
    {
      "affs": [
        2
      ],
      "name": "Maxwell Afetor"
    },
    {
      "affs": [
        3
      ],
      "name": "Joseph Emmanuel Amuah"
    },
    {
      "affs": [
        4
      ],
      "name": "Comfort Mawusi Wormenor"
    },
    {
      "affs": [
        5
      ],
      "name": "Annita Edinam Dugbazah"
    },
    {
      "affs": [
        6
      ],
      "name": "Stephen Danyo"
    },
    {
      "affs": [
        7
      ],
      "name": "Seyram Kemawor"
    },
    {
      "affs": [
        8
      ],
      "name": "Edna Sesenu"
    },
    {
      "name": "Christopher Nyamekye"
    },
    {
      "name": "Emmanuel Timmy Donkoh"
    },
    {
      "name": "Chrysantus Kubio"
    },
    {
      "name": "Kofi Adum-Attah"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/7t0abgaaxh69f.bib",
  "cited_by": 0,
  "doi": "10.1371/journal.pone.0345847",
  "fulltext_url": null,
  "id": "7t0abgaaxh69f",
  "issns": [
    "1932-6203"
  ],
  "landing_url": "https://doi.org/10.1371/journal.pone.0345847",
  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2713|Cervical Cancer and HPV Research"
    ],
    [
      "plos",
      "/Biology and life sciences/Cell biology/Cytology"
    ],
    [
      "plos",
      "/Biology and life sciences/Microbiology/Medical microbiology/Microbial pathogens/Viral pathogens/Papillomaviruses/HPV-1"
    ],
    [
      "plos",
      "/Biology and life sciences/Microbiology/Medical microbiology/Microbial pathogens/Viral pathogens/Papillomaviruses/Human papillomavirus"
    ],
    [
      "plos",
      "/Biology and life sciences/Organisms/Viruses/DNA viruses/Papillomaviruses/HPV-1"
    ],
    [
      "plos",
      "/Biology and life sciences/Organisms/Viruses/DNA viruses/Papillomaviruses/Human papillomavirus"
    ],
    [
      "plos",
      "/Biology and life sciences/Organisms/Viruses/Viral pathogens/Papillomaviruses/HPV-1"
    ],
    [
      "plos",
      "/Biology and life sciences/Organisms/Viruses/Viral pathogens/Papillomaviruses/Human papillomavirus"
    ],
    [
      "plos",
      "/Engineering and technology/Industrial engineering/Quality control/Visual inspection"
    ],
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      "/Medicine and health sciences/Clinical medicine/Signs and symptoms/Lesions"
    ],
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      "/Medicine and health sciences/Epidemiology/Medical risk factors/Cancer risk factors"
    ],
    [
      "plos",
      "/Medicine and health sciences/Oncology/Cancer risk factors"
    ],
    [
      "plos",
      "/Medicine and health sciences/Oncology/Cancers and neoplasms/Gynecological tumors/Cervical cancer"
    ],
    [
      "plos",
      "/Medicine and health sciences/Pathology and laboratory medicine/Anatomical pathology/Histopathology"
    ],
    [
      "plos",
      "/Medicine and health sciences/Pathology and laboratory medicine/Pathogens/Microbial pathogens/Viral pathogens/Papillomaviruses/HPV-1"
    ],
    [
      "plos",
      "/Medicine and health sciences/Pathology and laboratory medicine/Pathogens/Microbial pathogens/Viral pathogens/Papillomaviruses/Human papillomavirus"
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  ],
  "openalex": "W7212038533",
  "pdf_url": null,
  "pmcid": null,
  "pmid": null,
  "published": "2026-09-09",
  "publisher": "Public Library of Science",
  "ris": "https://research.draconitic.com/paper/7t0abgaaxh69f.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:17:56Z",
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      "source": "plos",
      "url": "https://doi.org/10.1371/journal.pone.0345847"
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  "subjects": [
    {
      "field": "biology",
      "origin": "plos:cell biology",
      "subfield": "cell-biology"
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    {
      "field": "biology",
      "origin": "plos:microbiology",
      "subfield": "microbiology"
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    {
      "field": "medicine",
      "origin": "plos:oncology",
      "subfield": "oncology"
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  "title": "Cervical leukoplakia in Ghana: Unveiling diagnostic challenges and informing low-resource screening strategies",
  "title_text": "Cervical leukoplakia in Ghana: Unveiling diagnostic challenges and informing low-resource screening strategies",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:17:56Z",
  "url": "https://research.draconitic.com/paper/7t0abgaaxh69f",
  "venue": "PLOS One",
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