Awareness of cervical cancer and prevalence of human papillomavirus and other sexually transmitted infections among women in rural Nepal.: Implications for future cervical cancer prevention in Nepal
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Cervical cancer is a leading cause of cancer deaths among women in Nepal. Limited information is available on public awareness on cervical cancer, the prevalence of its causative agents and associated risk factors. No national screening program for cervical cancer is yet commenced in Nepal. The aims of this thesis were to explore the knowledge of cervical cancer among Nepalese women, to investigate the feasibility and impact of community-based education on cervical cancer awareness, to determine the prevalence of human papillomavirus (HPV) infection and other selected sexually transmitted infections (STIs) and their risk factors among married women in rural Nepal. The study was conducted in Kavre district which is located in the Central region of Nepal, south-east of Kathmandu. Members of women’s groups were enrolled to explore knowledge and impact of health education on cervical screening. Examination of prevalence of HPV and selected STIs and their associated risk factors were carried out through a large population-based, cross-sectional study among married women residing in five villages. We observed low knowledge of cervical cancer and its prevention among the participants, and we demonstrated that the women’s attitude to cervical screening can be changed through communitybased education. HPV infection was the most common STIs with overall prevalence of 14.4% (7.9% high-risk types).The five most common high-risk types were HPV -18 (2.2%), -51 (1.2%), -59 (1.1%), -31 (0.9%), and -16 (0.8%). The prevalence of other STIs (T. vaginalis, C. trachomatis, hepatitis B infection and syphilis) were low, and no cases of gonorrhea or HIV infection were detected. High-risk HPV infection was associated with current smoking and formal education, while trichomoniasis was associated with reproductive age and high cast/ ethnicity. Being married to a husband with at least one previous marriage was found to be a risk factor for both infections. There was no association between genitourinary symptoms and laboratory confirmed STIs. The study findings are crucial to understand Nepal’s cervical cancer burden and to make preventive strategies to reduce cervical cancer burden and sexually transmitted infections in Nepal.