Prevalence of cervical dysplasia and associated risk factors among women presenting at a primary care clinic in Nigeria

Background: Cervical cancer is a global burden, with increasing incidence and mortality especially in developing countries where there are no clearly define national protocols or guidelines for effective screening and prompt treatment of cervical dysplasia (precancerous condition of the cervix). Most screening facilities are located in the tertiary hospitals, which are mostly not readily accessible to patients because of fear and bureaucracy of accessing services at these tertiary hospitals. In Nigeria, cervical cancer is the second most common female malignancy after breast cancer and national guidelines on effective screening is not readily available. At the general outpatients′ Clinic, University College Hospital, Ibadan, screening is not well-established and patients are referred to the gynecology clinic for papanicolaou (Pap) smear, which result in poor compliance as a result of the protocol involved. Aim: To asess the prevalence and risk factors for abnormal cervical cancer screening amongst patients of the Primary Care Clinic at UCH, Ibadan, towards justifying expansion of cervical cancer screening service points in tertiary health institutions in Nigeria. Subjects and Methods: A cross-sectional study using the self-administered structured questionnaire on questions relating to the socio-demographic characteristics and lifestyle behavior including sexual history, after which Pap smear and visual inspection of the cervix with acetic acid were performed. Two hundred and eighty consented women aged 20-65 years were interviewed by one of the researchers between June and August 2012 using interviewer-administered structured questionnaires. The questionnaire sought information on their sociodemographic characteristics, and lifestyle behavior including sexual history, after which Pap smear and visual inspection of the cervix with acetic acid were done, respectively, for all the respondents at no cost. The results were analyzed using Statistical Package for Social Sciences (SPSS) version 11. Cross-tabulation was used to explore statistical associations between categorical variables. Variables were summarized using frequency distribution, means, proportions, and findings were presented in tables, histograms and pie charts. Chi-square statistic was used to assess the association between categorical variables. The level of significance was set at P < 0.05. Result: The mean age of the women was 42.5 (11.1) years, and their modal age was 30-39 years. The majority, 92.2% (258/280) of the women were Yoruba. Two hundred and twenty-eight (81.4%) of the women were married with majority 149 (65.4%) in the monogamous union. Two hundred and thirteen (76.1%) of the women had abnormal cervical cytology. One hundred and sixty-six (77.9%) of the women with abnormal cytology had inflammatory smears, 33 (15.5%) and 6 (2.8%) had mild and moderate dysplasia, respectively, while the remaining 8 (3.8%) had atypical cells. The prevalence of cervical dysplasia among all the women was 13.9% (39/280), with mild dysplasia accounting for 11.8% (33/280) of the total population. Atypical smears were found in 2.9% (8/280) of them. Histological findings suggestive of human papillomavirus (HPV) were found in 22 of the 33 (66.7%) women who had mild dysplasia and 1 of the 6 (16.7%) women who had moderate dysplasia. There was significant association between abnormal cervical cytology and age (P = 0.03), as well as suggested HPV infection findings (P < 0.001). Visual inspection of the cervix with 5% acetic acid revealed that 46 of the 280 (16.4%) women had an aceto white area, while a prevalence of 47 (16.8%) was found with Pap smear, though visual inspection was found not to be as sensitive in detecting dysplasia. The prevalence of cervical dysplasia among the women was 13.9%, with mild dysplasia accounting for 11.8% of the total population. Atypical smears were found in 2.9% of them. There was a significant association between abnormal cervical cytology and increasing age (P = 0.03), as well as histological findings of HPV infection (P < 0.001). Conclusion: Cervical dysplasia was found to be a common health problem among women attending the primary care clinic. This underscores the need for the provision of screening service at the clinic and effective health education to promote preventive practices and inculcate screening culture among women.