Bhatta Madhav P, Johnson Derek C, Lama Mingma, Aryal Shilu, Lhaki Pema, Shrestha Sadeep
Department of Biostatistics, Environmental Health Sciences, and Epidemiology, College of Public Health Kent State University, PO Box 5190, Kent, OH, 44242, USA.
Department of Public Health & Community Medicine, Tufts University School of Medicine, Boston, MA, USA.
BMC Infect Dis. 2017 Jan 14;17(1):73. doi: 10.1186/s12879-017-2186-2.
Cervical cancer is the leading cause of cancer morbidity and mortality among women in Nepal and Bhutan. Data on high-risk human papillomavirus (HR-HPV) infection and cervical abnormalities among Nepali and Bhutanese women are sparse. The objectives of this study were to assess and compare the prevalence of HR-HPV infection and cervical abnormalities among Nepali and Bhutanese women living in Jhapa District in eastern Nepal; and examine the risk factors for HR-HPV infection and cervical abnormalities in those women.
Study participants were recruited from a women's health camp organized by NFCC-International, a Nepal-based non-governmental organization, in 2014. Consenting participants were administered a demographic and health questionnaire and cervico-vaginal specimens collected. Both self-collected and clinician-collected cervico-vaginal specimens were tested for HR-HPV infection. Cytologic exam was performed on clinician-collected samples and cervical cytology results were categorized according to the Bethesda classification. A participant was classified as a Bhutanese if they were either born in Bhutan or currently lived in one of the United Nations administered Bhutanese refugee camps in Jhapa; otherwise, the participant was classified as a Nepali.
Of the 647 study participants, 15.9% were Bhutanese women living in refugee camps and the overall age (± standard deviation) was 38.8 ± 8.2 years. The prevalence of HR-HPV infection was 8.9% and abnormal cervical cytology was 7.1% respectively, with no significant difference in HR-HPV positivity (p = 0.399) or abnormal cervical cytology (p = 0.698) between Nepali and Bhutanese women. Compared to women whose husbands had not migrated for employment, women whose husbands had migrated outside of the district had 3.30 times (95% Confidence Interval [CI]: 1.13-9.64) the odds of being HR-HPV positive and women whose husbands had migrated outside the country had 2.92 times (95% CI: 1.32-6.49) the odds of having abnormal cervical cytology.
HR-HPV positivity and abnormal cervical cytology were similar among Nepali and Bhutanese women. Husbands migrating for employment within or outside the country was a significant risk factor for high-risk HPV infection and cervical cytology, indicating the important role spousal behavior may play in HR-HPV acquisition and cervical abnormalities among these women.
宫颈癌是尼泊尔和不丹女性癌症发病和死亡的主要原因。关于尼泊尔和不丹女性高危人乳头瘤病毒（HR-HPV）感染及宫颈异常的数据稀少。本研究的目的是评估和比较居住在尼泊尔东部贾帕县的尼泊尔和不丹女性中HR-HPV感染及宫颈异常的患病率；并研究这些女性中HR-HPV感染及宫颈异常的危险因素。
研究参与者于2014年从尼泊尔非政府组织NFCC-国际组织的一个女性健康营招募。同意参与的参与者接受了人口统计学和健康问卷调查，并采集了宫颈阴道标本。对自我采集和临床医生采集的宫颈阴道标本均进行HR-HPV感染检测。对临床医生采集的样本进行细胞学检查，并根据贝塞斯达分类对宫颈细胞学结果进行分类。如果参与者出生在不丹或目前居住在贾帕县由联合国管理的不丹难民营之一，则被归类为不丹人；否则，该参与者被归类为尼泊尔人。
在647名研究参与者中，15.9%是居住在难民营的不丹女性，总体年龄（±标准差）为38.8±8.2岁。HR-HPV感染患病率分别为8.9%，宫颈细胞学异常患病率为7.1%，尼泊尔和不丹女性之间的HR-HPV阳性率（p = 0.399）或宫颈细胞学异常率（p = 0.698）无显著差异。与丈夫未外出务工的女性相比，丈夫在县外务工的女性HR-HPV阳性几率是其3.30倍（95%置信区间[CI]：1.13 - 9.64），丈夫出国务工的女性宫颈细胞学异常几率是其2.92倍（95% CI：1.32 - 6.49）。
尼泊尔和不丹女性的HR-HPV阳性率和宫颈细胞学异常情况相似。丈夫在国内或国外务工是高危HPV感染和宫颈细胞学异常的重要危险因素，表明配偶行为在这些女性HR-HPV感染和宫颈异常中可能起重要作用。
