Objective: To determine the prevalence of pre-malignant lesions of the cervix by visual inspection with Acetic acid (VIA) and cervical cytology method (Pap smear) in a rural based hospital Materials and Methods: The study was carried out among 30-65 years old married women in a rural based tertiary health care center. A pre-designed questionnaire wasadministered to collect information on socio-demographic and reproductive characteristic. They were tested for the presence of pre-malignant lesions of the cervix using Pap smear and VIA as screening tools. Results: The VIA test was positive among 8(3.6%) women and PAP smear was abnormal in 9(4.05%) of women. None of the patient who had abnormal PAP smear were VIA positive and vice versa Conclusion: The prevalence of pre-malignant lesions of the cervix by VIA was 3.6 % while 4.05% pre-malignant lesion was detected by Pap smear method.. Lack of education, awareness and poor follow up are the main factors behind failure of screening programs in a rural setting. In low-resource areas, VIA can be better than PAP smears for its ease of use and low cost, eliminating the need for follow-up visits.