Cervical human papillomavirus infection in accra, Ghana

Ab Domfeh,Pfk Ayeh-Kumi,Rk Gyasi,Hb Armah,Ek Wiredu,Aa Adjei,Y Tettey,Tk Adiku

doi:10.4314/gmj.v42i2.43596

Abstract

This study was aimed at estimating the human papillomavirus (HPV) prevalence and its determinants among a sample of Ghanaian women. Cross-sectional observational study. Gynaecology outpatient clinic of the Korle-Bu Teaching Hospital, Accra, Ghana; the largest tertiary care gynaecology outpatient clinic in Ghana. Convenient sample of 75 consenting women visiting the clinic. Information was obtained through personal interviews using structured questionnaire, Pap smears obtained, and laboratory testing of cervical exfoliated cells was performed. HPV DNA was detected using a GP5+/6+ polymerase chain reaction assay. These data were analyzed using both univariate and bivariate techniques. The mean age of participants was 33.3 years (standard deviation, 9.2) and the percentage of lifetime monogamy was 21.3%. The crude HPV DNA prevalence was 10.7%. Unlike most populations studied so far, HPV prevalence was high not only among young women, but also in middle and old age. Independent HPV determinants were being illiterate (prevalence odds ratio [POR], 13.9; 95% confidence interval [95%CI], 1.9-100) and reporting more than three lifetime sexual partners (POR, 4.6; 95% CI, 1.0-22.2). The study indicates a high crude prevalence of HPV in a largely polygamous Ghanaian population with a high crude prevalence in older age groups, which may be a distinctive feature of polygamous populations where HPV transmission continues into middle age and cervical cancer incidence is very high.

Highlights

Human papillomaviruses (HPVs) are aetiological agents of cervical intraepithelial neoplasia and cervical cancer
Fifty-six percent (42 out of 75) had heard of cervical cancer, but only one study participant knew it is caused by HPV infection
Polymerase chain reaction (PCR)-based assays, similar to that employed in this study, showed HPV prevalence of 44% in Nairobi, Kenya,24 40% in rural Mozambique,18 34% in Northwestern Tanzania,19,23 31% in Harare, Zimbabwe,20 26.3% in Ibadan, Nigeria,7 18% in Dakar and Pikene, Senegal,[22] and 15.4% in South Africa.[21]

Summary

Introduction

Human papillomaviruses (HPVs) are aetiological agents of cervical intraepithelial neoplasia and cervical cancer. Cervical cancer is the most common female malignancy in subSaharan Africa.[1] The incidence of cervical cancer in sub-Saharan Africa is among the highest worldwide, with the available age-standardised rates ranging from 19.9 per 100,000 in Ibadan, Nigeria,[1] through 35.7 per 100,000 in Bamako, Mali, to 41.7 per 100,000 in Kyadondo, Ugandan.[2] The prevalence of cervical HPV infection varies greatly worldwide. Population-based HPV prevalence surveys have shown a 13-fold variation in sexually-active women aged 15-65 years, ranging from 2.0% in Hanoi, North Vietnam,3 3.0% in Barcelona, Spain,4 14.8% in Bogota, Columbia,[5] through 17.7% in Concordia, Argentina,[6] to the highest of 26.3% in Ibadan, Nigeria,[7] a West African neighbour of Ghana

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