title: Prevalence and risk factors for cancer of the uterine cervix among women living in Kinshasa, the Democratic Republic of the Congo: a cross-sectional study.
abstract: BACKGROUND
  Cancer of the uterine cervix is the leading cause of cancer-related death among women in Sub-Saharan Africa, but information from the Democratic Republic of the Congo (DRC) is scarce. The study objectives were to: 1/ assess prevalence of (pre)cancerous cervical lesions in adult women in Kinshasa, 2/ identify associated socio-demographic and behavioural factors and 3/ describe human papillomavirus (HPV) types in cervical lesions.
  
  
  METHODS
  A cross-sectional study was conducted in Kinshasa. Between 2006 and 2013, four groups of women were recruited. The first two groups were included at HIV screening centres. Group 1 consisted of HIV-positive and group 2 of HIV-negative women. Group 3 was included in large hospitals and group 4 in primary health centres. Pap smears were studied by monolayer technique (Bethesda classification). Low- or high-grade squamous intraepithelial lesions or carcinoma were classified as LSIL+. HPV types were determined by INNO-LiPA®. Bivariate and multivariable analyses (logistic regression and generalised estimating equations (GEE)) were used to assess associations between explanatory variables and LSIL+.
  
  
  RESULTS
  LSIL+ lesions were found in 76 out of 1018 participants. The prevalence was 31.3 % in group 1 (n = 131 HIV-positive women), 3.9 % in group 2 (n = 128 HIV-negative women), 3.9 % in group 3 (n = 539) and 4.1 % in group 4 (n = 220). The following variables were included in the GEE model but did not reach statistical significance: history of abortion, ≥3 sexual partners and use of chemical products for vaginal care. In groups 3 and 4 where this information was available, the use of plants for vaginal care was associated with LSIL+ (adjusted OR 2.70 (95 % confidence interval 1.04 - 7.01). The most common HPV types among HIV-positive women with ASCUS+ cytology (ASCUS or worse) were HPV68 (12 out of 50 samples tested), HPV35 (12/50), HPV52 (12/50) and HPV16 (10/50). Among women with negative/unknown HIV status, the most common types were HPV52 (10/40), HPV35, (6/40) and HPV18 (5/40).
  
  
  CONCLUSIONS
  LSIL+ lesions are frequent among women in Kinshasa. The use of plants for vaginal care deserves attention as a possible risk factor for LSIL+. In this setting, HPV16 is not the most frequent genotype in samples of LSIL+ lesions.
authors.affiliation: Laboratory of Anatomopathology, General Reference Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo ; N.Goormaghtigh Institute of Pathology, Ghent University Hospital, De Pintelaan 185, Ghent, Belgium.
authors.forename: Catherine
authors.initials: C
authors.lastname: Ali-Risasi
authors.affiliation: Institute of Tropical Medicine, Nationalestraat 155, Antwerp, Belgium.
authors.forename: Kristien
authors.initials: K
authors.lastname: Verdonck
authors.affiliation: Department of Microbiology, Clinical Chemistry and Immunology, Ghent University Hospital, De Pintelaan 185, Ghent, Belgium ; Faculty of Medicine and Life Sciences, Hasselt University, Agoralaan Building D, Diepenbeek, Belgium.
authors.forename: Elizaveta
authors.initials: E
authors.lastname: Padalko
authors.affiliation: International Centre for Reproductive Health, Ghent University Hospital, De Pintelaan 185, Ghent, Belgium.
authors.forename: Davy
authors.initials: D
authors.lastname: Vanden Broeck
authors.affiliation: N.Goormaghtigh Institute of Pathology, Ghent University Hospital, De Pintelaan 185, Ghent, Belgium.
authors.forename: Marleen
authors.initials: M
authors.lastname: Praet
keywords: Cervical intraepithelial neoplasia; Cross-sectional studies; Democratic Republic of the Congo; Human papillomavirus; Risk factors