J Gynecol Oncol.  2018 Sep;29(5):e64. 10.3802/jgo.2018.29.e64.

Burden of cervical neoplasia in mid-western rural Nepal: a population-based study

Affiliations
  • 1Department of Gynecological Oncology, Zhongnan Hospital of Wuhan University, Hubei Cancer Clinical Study Center, Hubei Key Laboratory of Tumor Biological Behaviors Wuhan, China. chb2105@163.com
  • 2Karnali Academy of Health Sciences, Jumla, Nepal.
  • 3Department of Pathology, Patan Hospital, Patan Academy of Health Sciences, Lalitpur, Nepal.
  • 4HOPE School of Nursing, Zhongnan Hospital of Wuhan University, Wuhan, China.
  • 5Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA.
  • 6Department of Haemato-Pathology, Zhongnan Hospital of Wuhan University, Wuhan, China.
  • 7Department of Obstetrics and Gynecology, Karnali Academy of Health Sciences, Jumla, Nepal.

Abstract


OBJECTIVE
To assess the burden of cervical neoplasia in mid-western rural, Nepal using cytology, visual inspection with acetic acid (VIA) and visual inspection with Lugol's iodine (VILI). METHOD: A cross-sectional, population-based study was conducted. Total of 2,279 married, non-pregnant women aged 20-65 years participated in a screening clinic from May 2016 to January 2017. All eligible women completed self-report of socio-demographic and reproductive health data followed by screening tests. Biopsies were obtained from areas on the cervix assessed by VIA and or VILI to be abnormal. Final disease was confirmed by biopsy report.
RESULTS
A total of 96.09% (n=2,190) women were eligible for this study with mean age 32.78±9.33 years. The overall rate of positive cytology, VIA, and VILI were 3.69%, 12.45%, and 16.89%, respectively. Sixty-two cases were biopsy proven cervical neoplasia. Altogether 78 (3.69%) cases were cytologically abnormal: 25 (1.18%) were atypical squamous cells of undetermined significance, 33 (1.56%) were low-grade squamous intraepithelial lesion, 11 (0.52%) were high-grade squamous intraepithelial lesion, and 9 (0.42%) were squamous cell carcinoma. Illiterate women appeared to be at higher risk for cervical neoplasia (p < 0.001). Similarly, age ≥ 46 years (p < 0.013), participant's multiple marriages or sexual partners (p < 0.005), and positive human immunodeficiency virus status (p < 0.001) were significantly associated with abnormal cytology.
CONCLUSION
Based on cytology report, there is 3.69% prevalence of cervical neoplasia among women in a rural region of mid-western, Nepal. A "screen and treat" approach would be more attractive in low resource settings.

Keyword

Cervical Intraepithelial Neoplasia; Cytology; Rural Nepal; Prevalence; Mass Screening

MeSH Terms

Acetic Acid
Atypical Squamous Cells of the Cervix
Biopsy
Carcinoma, Squamous Cell
Cervical Intraepithelial Neoplasia
Cervix Uteri
Female
HIV
Humans
Iodine
Marriage
Mass Screening
Methods
Nepal*
Prevalence
Reproductive Health
Sexual Partners
Squamous Intraepithelial Lesions of the Cervix
Acetic Acid
Iodine
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