Prevalence and determinants of high risk human papillomavirus (HPV) among wives of migrant workers – A study in Far-West Nepal

Abstract

This dissertation research focuses on the risk factors associated with high-risk HPV infection (HR-HPV) and abnormal cervical cytology in Nepali women residing in Nepal’s Far-West district of Achham. The first part of this dissertation assesses the HR-HPV test concordance of self-collected vs. clinician-collected cervico-vaginal specimens. Of 261 women with both clinician- and self-collected cervical samples, 25 tested positive for HR-HPV, resulting in an overall HR-HPV prevalence of 9.6% (95% Confidence Interval [CI]: 6.3–13.8). The overall Kappa value for clinician- and self-collected tests was 0.64 (95% CI: 0.48–0.84), indicating a “good” level of agreement. The second part of this dissertation investigates the association between 251 women whose husband’s migrate for work and their high-risk HPV (HR-HPV) infection status and their abnormal cervical cytology status. Half of study participants (50.8%) had husbands who reported migrating for work at least once. Women 34 years and younger were significantly less likely to test positive for HR-HPV than women older than 34 years (OR 0.22, 95% CI 0.07–0.71). HR-HPV infection and abnormal cervical cytology status were not directly associated with a husband’s migration. The last part of this dissertation investigates the link between rates of sexually transmitted disease (STD) symptoms and geospatial differences among migrant workers using the Nepal Demographic Health Survey (NDHS). Data was restricted to 9,607 married women in the 2011 NDHS. Multivariate logistic regression models assessing the odds of reporting STD symptoms in the 2011 NDHS found that women whose husbands migrated for a year or more were more likely to report STD symptoms than women whose husbands were not currently migrating for work if they lived in Nepal’s Mid-West region (OR 1.93 95%CI 1.02–3.67) or Nepal’s Far-West region (OR 2.89 95%CI 1.24–6.73). The burden of increased risk factors for HR-HPV infection and abnormal cervical cytology could result in increases in HPV prevalence in the wives of Nepali migrant workers.