Genital human papillomavirus infection among women in Bangladesh: findings from a population-based survey.

Quamrun Nahar,Mustafizur Rahman,Sushil Kanta Dasgupta,Nazmul Alam,Laura Reichenbach,Jessica Yasmine Islam,Ashrafunnessa Ashrafunnessa,Farhana Sultana,Lena Marions,Mohammed Kamal,Anadil Alam,Fatema Khatun,Alejandro Cravioto,Xuefeng Liu

doi:10.1371/journal.pone.0107675

Abstract

BackgroundThere has been no population-based study on human papillomavirus (HPV) prevalence or its genotypes in Bangladesh; a country eligible for GAVI funding for HPV vaccine.MethodsWe used baseline survey data of a prospective cohort study that was conducted in one urban and one rural area of Bangladesh. A total of 997 urban and 905 rural married women, aged 13 to 64 years, were enrolled in the baseline during July-December, 2011. Information was collected on socio-demographic characteristics and potential risk factors for HPV infection followed by gynecological examination and collection of endocervical samples using the cervical cytobrush (Digene cervical sampler). HPV DNA testing was done by Polymerase Chain Reaction (PCR) using a consensus primer set.ResultsPrevalence of any HPV infection was 7.7% with no significant difference between urban and rural women. Most common high-risk genotypes were HPV16, HPV66, HPV18, HPV45, HPV31 and HPV53. Urban women working as housemaids or garment workers were at higher risk of any HPV infection (OR = 2.15, 95% CI: 1.13–4.11) compared to housewives. Rural women whose husband lived overseas were almost two times more likely to have any HPV infection (OR = 1.93; 95% CI 1.05–3.55) compared to women whose husbands lived with them.ConclusionThe prevalence of HPV infection among Bangladeshi women is similar to other regions of Asia. However, type-specific patterns are different. The study findings will inform the formulation of HPV vaccination policies in Bangladesh, monitoring the impact of vaccination programmes, and the identification of target populations for screening.

Highlights

Cervical cancer is a major public health problem worldwide
We report the results from a baseline survey of a population-based prospective cohort study of the type-specific and age-specific distribution of human papillomavirus (HPV) infection and its risk factors among ever-married women in an urban and a rural area of Bangladesh
When stratified by type of HPV infection, we found HR infection to decrease with age and to be relatively stable after 35 years, while LR infection decreased with age until 35–44 years and thereafter, increased in older women (45 years and older)

Summary

Introduction

Cervical cancer is a major public health problem worldwide. It is the fourth most common cancer in women with an estimated 527,624 new cases and 265,653 deaths in 2012 [1]. In Bangladesh, cervical cancer is the second most common cancer among females with an estimated 11,956 new cases and 6,582 deaths in 2012 [3]. More than half of the women were between 25 and 44 years of age with no significant difference in mean age between urban and rural women. A significant percentage of urban women worked as garment workers or housemaids (14%) compared to rural women (,1%; p,0.001). Urban women had a higher mean age at marriage compared to rural women (17.4 years versus 16.0 years; p = 0.000). While the majority of women resided with their husbands in both areas (88% of urban and 74% of rural women), a higher proportion of rural women had a husband living overseas (18%)

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Conclusion