Cervical cancer risk factors in eight west African countries: cross-sectional analysis of the demographic and health survey 2017–20

Abstract

BackgroundCervical cancer is the fourth most common cancer in women worldwide. We aimed to assess the burden of cervical cancer risk factors among women in eight west African countries. MethodsCross-sectional data from nationally representative samples of eight west African countries (Benin, Cameroon, Gambia, Guinea, Liberia, Mali, Nigeria, and Sierra Leone) as part of the demographic and health survey 2017–2020 were used. The interviewer-assisted survey assessed eight cervical cancer risk factors (smoking, early coitus, body-mass index, parity, early pregnancy, length of hormonal contraceptive use, multiple sexual partners, and sexually-transmitted infections). Data were analysed using descriptive statistics and Poisson regression. The Demographic and Health Service programme has ethical review documentation on the privacy and confidentiality of the respondents. We received authorisation to use the data from the Demographic and Health Service repository. FindingsA total of 128 173 women aged 15–49 years participated. Liberia had the highest number of risk factors (mean 3·05; SD 1·19), and Benin had the lowest (mean 2·20; SD 1·14). The mean age of first sexual intercourse was highest in Gambia at 18·15 years (95% CI 17·98–18·32) and lowest in Liberia at 15·72 years (15·62–15·81). Similarly, the highest mean age of first birth was 19·83 years (19·66–20·00) in Gambia, and the lowest is in Liberia at 18·69 years (18·54–18·83). Aside from Mali (45·9%), more than 50·0% of the women had at least two children. Age of first sexual intercourse, age of first birth, and parity were the most frequent risk factors across all the countries. Different age groups were significantly associated with the number of risk factors. Liberian women aged 30–34 years had the highest IRR of 30% (1·18–1·42; p<0·001) among all the countries. Women with the highest education level in Gambia and Nigeria had reduced risk. Limitations of the study included data collection from countries on different years and no human papillomavirus status data collection. InterpretationIdentification of age of first sexual intercourse, age of first birth, and parity as the most frequent risk factors of cervical cancer will support more focused public health interventions (such as human papillomavirus vaccination and cervical screening) in the countries that the data was collected from, as well as globally. FundingFederal Government of Nigeria.