title: High-risk human papillomavirus infection and abnormal cervical cytology among Nepali and Bhutanese refugee women living in eastern Nepal.
abstract: Cervical cancer is the leading cause of cancer morbidity and mortality among women in Nepal and Bhutan. Data on high-risk human papillomavirus (HR-HPV) infection and cervical abnormalities among Nepali and Bhutanese women are sparse. The objectives of this study were to assess and compare the prevalence of HR-HPV infection and cervical abnormalities among Nepali and Bhutanese women living in Jhapa District in eastern Nepal; and examine the risk factors for HR-HPV infection and cervical abnormalities in those women.
  
  
  
  Study participants were recruited from a women's health camp organized by NFCC-International, a Nepal-based non-governmental organization, in 2014. Consenting participants were administered a demographic and health questionnaire and cervico-vaginal specimens collected. Both self-collected and clinician-collected cervico-vaginal specimens were tested for HR-HPV infection. Cytologic exam was performed on clinician-collected samples and cervical cytology results were categorized according to the Bethesda classification. A participant was classified as a Bhutanese if they were either born in Bhutan or currently lived in one of the United Nations administered Bhutanese refugee camps in Jhapa; otherwise, the participant was classified as a Nepali.
  
  
  
  Of the 647 study participants, 15.9% were Bhutanese women living in refugee camps and the overall age (± standard deviation) was 38.8 ± 8.2 years. The prevalence of HR-HPV infection was 8.9% and abnormal cervical cytology was 7.1% respectively, with no significant difference in HR-HPV positivity (p = 0.399) or abnormal cervical cytology (p = 0.698) between Nepali and Bhutanese women. Compared to women whose husbands had not migrated for employment, women whose husbands had migrated outside of the district had 3.30 times (95% Confidence Interval [CI]: 1.13-9.64) the odds of being HR-HPV positive and women whose husbands had migrated outside the country had 2.92 times (95% CI: 1.32-6.49) the odds of having abnormal cervical cytology.
  
  
  
  HR-HPV positivity and abnormal cervical cytology were similar among Nepali and Bhutanese women. Husbands migrating for employment within or outside the country was a significant risk factor for high-risk HPV infection and cervical cytology, indicating the important role spousal behavior may play in HR-HPV acquisition and cervical abnormalities among these women.
authors.affiliation: Department of Biostatistics, Environmental Health Sciences, and Epidemiology, College of Public Health Kent State University, PO Box 5190, Kent, OH, 44242, USA. mbhatta@kent.edu.
authors.forename: Madhav P
authors.initials: MP
authors.lastname: Bhatta
authors.affiliation: Department of Public Health & Community Medicine, Tufts University School of Medicine, Boston, MA, USA.
authors.forename: Derek C
authors.initials: DC
authors.lastname: Johnson
authors.affiliation: NFCC, International, Kathmandu, Nepal.
authors.forename: Mingma
authors.initials: M
authors.lastname: Lama
authors.affiliation: Family Health Division, Nepal Ministry of Health, Kathmandu, Nepal.
authors.forename: Shilu
authors.initials: S
authors.lastname: Aryal
authors.affiliation: NFCC, International, Kathmandu, Nepal.
authors.forename: Pema
authors.initials: P
authors.lastname: Lhaki
authors.affiliation: Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Sadeep
authors.initials: S
authors.lastname: Shrestha
mesh_terms: D000328:Adult; D000368:Aged; D001631:Bhutan / Q000208:ethnology; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology* / Q000821:virology; D005260:Female; D006801:Humans; D008875:Middle Aged; D009390:Nepal / Q000453:epidemiology / Q000208:ethnology; D065006:Papanicolaou Test; D027383:Papillomaviridae; D030361:Papillomavirus Infections / Q000453:epidemiology* / Q000821:virology; D015995:Prevalence; D012036:Refugees / Q000706:statistics & numerical data*; D012307:Risk Factors; D013048:Specimen Handling / Q000379:methods; D065310:Squamous Intraepithelial Lesions of the Cervix / Q000453:epidemiology* / Q000821:virology; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000821:virology; D014626:Vaginal Smears; D016387:Women's Health; D055815:Young Adult
keywords: Abnormal cervical cytology; Bhutanese refugee; High-risk human papillomavirus; Nepal; Risk factors; Spousal migration