title: Differences in patterns of high-risk human papillomavirus infection between urban and rural low-resource settings: cross-sectional findings from Mali.
abstract: BACKGROUND
  The burden of cervical cancer is disproportionately high in low-resource settings. With limited implementation of human papillomavirus (HPV) vaccines on the horizon in the developing world, reliable data on the epidemiology of high-risk HPV (HR-HPV) infection in distinct geographic populations is essential to planners of vaccination programs. The purpose of this study was to determine whether urban patterns of HR-HPV occurrence can be generalized to rural areas of the same developing country, using data from Mali, West Africa, as an example.
  
  
  METHODS
  Urban and rural women in Mali participated in a structured interview and clinician exam, with collection of cervical samples for HPV DNA testing, to determine HR-HPV prevalence and correlates of infection. Correlates were assessed using bivariate analysis and logistic regression.
  
  
  RESULTS
  A total of 414 women (n=202 urban women; n=212 rural women) were recruited across both settings. The prevalence of HR-HPV infection in rural women was nearly twice that observed in urban women (23% v. 12%). Earlier age of sexual debut and fewer pregnancies were associated with HR-HPV infection among urban women, but not rural women. Twenty-six percent of urban women who had sexual intercourse by age 14 had an HR-HPV infection, compared to only 9% of those who had later sexual debut (p<0.01). Overall, age, income, and polygamy did not appear to have a relationship with HR-HPV infection.
  
  
  CONCLUSIONS
  Compared to urban women, rural women were significantly more likely to be infected with high-risk HPV. The patterns and risk factors of HR-HPV infection may be different between geographic areas, even within the same developing country. The high prevalence in both groups suggests that nearly all rural women and most urban women in Mali will be infected with HR-HPV during their lifetime, so the effects of risk factors may not be statistically apparent. To control HPV and cervical cancer in West Africa and the rest of the developing world, planners should prioritize vaccination in high-burden areas.
authors: Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA.
authors: Nicholas H
authors: NH
authors: Schluterman
authors: Samba O
authors: SO
authors: Sow
authors: Cheick B
authors: CB
authors: Traore
authors: Kamate
authors: K
authors: Bakarou
authors: Rokiatou
authors: R
authors: Dembelé
authors: Founé
authors: F
authors: Sacko
authors: Patti E
authors: PE
authors: Gravitt
authors: J Kathleen
authors: JK
authors: Tracy
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008302:Mali / Q000453:epidemiology; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000175:diagnosis* / Q000453:epidemiology*; D011203:Poverty / Q000706:statistics & numerical data*; D015995:Prevalence; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data*; D012725:Sexual Behavior / Q000706:statistics & numerical data; D014505:Urban Population / Q000706:statistics & numerical data*; D016387:Women's Health; D055815:Young Adult
references: Br J Cancer. 2009 Apr 7;100(7):1191-7
references: 19277042
references: N Engl J Med. 2007 May 10;356(19):1908-10
references: 17494923
references: Vaccine. 2007 Nov 1;25 Suppl 3:C1-230
references: 18068032
references: BJOG. 2012 Jan;119(2):220-6
references: 21895956
references: Bull World Health Organ. 2008 Nov;86(11):830-8
references: 19030688
references: Am J Epidemiol. 1989 Sep;130(3):486-96
references: 2763994
references: Arch Sex Behav. 2003 Feb;32(1):41-53
references: 12597271
references: Clin Infect Dis. 2011 Mar 1;52(5):641-5
references: 21252142
references: J Clin Microbiol. 2011 Dec;49(12):4185-9
references: 21998422
references: Trop Med Int Health. 2011 Nov;16(11):1432-8
references: 21749583
references: Cancer Prev Res (Phila). 2012 Jan;5(1):24-9
references: 22219163
references: J Clin Microbiol. 2007 Jul;45(7):2130-7
references: 17494721
references: Trop Med Int Health. 2009 Oct;14(10):1287-302
references: 19772550
references: Lancet Infect Dis. 2007 Jul;7(7):453-9
references: 17597569
references: Int J Cancer. 2004 Jul 20;110(6):907-13
references: 15170675
references: Bull World Health Organ. 2001;79(10):954-62
references: 11693978
references: Vaccine. 2008 Aug 19;26 Suppl 10:K1-16
references: 18847553
references: N Engl J Med. 2003 Feb 6;348(6):518-27
references: 12571259
references: Int J Epidemiol. 2002 Feb;31(1):202-9
references: 11914322
references: Infect Agent Cancer. 2011 Jul 29;6:12
references: 21801395
references: Lancet. 2005 Sep 17-23;366(9490):991-8
references: 16168781
references: Stud Fam Plann. 2008 Dec;39(4):263-80
references: 19248714