A population-based cross-sectional study of age-specific risk factors for high risk human papillomavirus prevalence in rural Nigeria

Megan A. Clarke, Julia C. Gage, Kayode O. Ajenifuja, Nicolas A. Wentzensen, Akinfolarin C. Adepiti, Sholom Wacholder, Robert D. Burk, Mark Schiffman

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background: Cervical cancer, caused by persistent infection with carcinogenic human papillomavirus (HR-HPV), is particularly prevalent in Sub-Saharan Africa and is associated with a high mortality rate. Some studies in West Africa, including our own, have found unusually high HR-HPV across all ages with a slight peak in older women. This increased prevalence at older ages may complicate screen-and-treat programs, which are implemented in regions where HPV prevalence declines with age and typically target women between 30-49 years. A better understanding of the determinants of high HR-HPV prevalence at older ages is needed. The goal of this study is to explore risk factors for HR-HPV prevalence by age among women in our population-based study in Irun, a rural town in southwestern Nigeria. Methods. 1,420 women were administered a clinic-based questionnaire regarding sexual and reproductive behavior, marital status (including co-wives), and malaria exposure. Logistic regression compared questionnaire responses and PCR positivity for a set of 13 carcinogenic HR-HPV types. Results were stratified by age (15-29, 30-45, 46-55, and 56+ years). Results: Birth control use and age at first pregnancy were associated with HR-HPV (p-value = 0.03 and 0.05, respectively). Early age at sexual debut and multiple sex partners were risks for HR-HPV, but did not reach significance (p-value = 0.1 and 0.07, respectively). Neither self-reported malaria nor presence of co-wives in the household was associated with HR-HPV (p-value = 0.85 and 0.24, respectively). In age sub-categories, early age at sexual debut was a significant risk factor for HR-HPV among women 35-45 years (p-value = 0.02). Early age at first pregnancy remained a significant risk factor for women aged 56+ years (p-value = 0.04). Greater than 2 sex partners and use of birth control were associated (though not significantly) with HR-HPV in women aged 30-45 (p-value = 0.08, respectively). Conclusions: In this high-risk region with elevated HR-HPV prevalence at older ages, we confirmed previously described, behavioral determinants of HR-HPV. There was no association with self-reported malaria or co-wives, which we had hypothesized might correlate with HR-HPV at older ages.

Original languageEnglish (US)
Article number12
JournalInfectious Agents and Cancer
Volume6
Issue number1
DOIs
StatePublished - 2011

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Nigeria
Cross-Sectional Studies
Population
Spouses
Malaria
Contraception
Reproductive Behavior
Pregnancy
Western Africa
Africa South of the Sahara
Sexual Partners
Marital Status
Uterine Cervical Neoplasms
Sexual Behavior
Logistic Models
Polymerase Chain Reaction
Mortality
Infection

ASJC Scopus subject areas

  • Infectious Diseases
  • Oncology
  • Epidemiology
  • Cancer Research

Cite this

Clarke, M. A., Gage, J. C., Ajenifuja, K. O., Wentzensen, N. A., Adepiti, A. C., Wacholder, S., ... Schiffman, M. (2011). A population-based cross-sectional study of age-specific risk factors for high risk human papillomavirus prevalence in rural Nigeria. Infectious Agents and Cancer, 6(1), [12]. https://doi.org/10.1186/1750-9378-6-12

A population-based cross-sectional study of age-specific risk factors for high risk human papillomavirus prevalence in rural Nigeria. / Clarke, Megan A.; Gage, Julia C.; Ajenifuja, Kayode O.; Wentzensen, Nicolas A.; Adepiti, Akinfolarin C.; Wacholder, Sholom; Burk, Robert D.; Schiffman, Mark.

In: Infectious Agents and Cancer, Vol. 6, No. 1, 12, 2011.

Research output: Contribution to journalArticle

Clarke, Megan A. ; Gage, Julia C. ; Ajenifuja, Kayode O. ; Wentzensen, Nicolas A. ; Adepiti, Akinfolarin C. ; Wacholder, Sholom ; Burk, Robert D. ; Schiffman, Mark. / A population-based cross-sectional study of age-specific risk factors for high risk human papillomavirus prevalence in rural Nigeria. In: Infectious Agents and Cancer. 2011 ; Vol. 6, No. 1.
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