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Cervical Cancer and Human Papillomavirus Vaccine Awareness Among Married Bhutanese Refugee and Nepali Women in Eastern Nepal

  • Madhav P. BhattaEmail author
  • Derek C. Johnson
  • Mingma Lama
  • Bipu Maharjan
  • Pema Lhaki
  • Sadeep Shrestha
Original Paper
  • 27 Downloads

Abstract

This study examined the sexually transmitted infections (STIs), cervical cancer, and human papillomavirus virus (HPV) vaccine-related awareness and knowledge among married Bhutanese refugee and Nepali women living in eastern Nepal. Participants were recruited from a women’s health camp in Jhapa District in eastern Nepal. A demographic and health survey with questions on STIs, cervical cancer and HPV vaccine was administered to consenting participants. Women who were born in Bhutan or living in the United Nations administered refugee camps were classified as Bhutanese. Of the 630 participants, 14.3% of participants were Bhutanese and the mean age was 38.8 ± 8.2 years. A higher proportion of Bhutanese than Nepali women reported a lack of cervical cancer awareness (42.0% vs. 30.7%; p = 0.036). Only 21.5% of the participants knew HPV as the cause of cervical cancer; 13.9% were aware of an HPV vaccine; and 96% reported that they would have their children vaccinated against HPV if the vaccine was available free of cost to them. In multivariable analyses, the lack of awareness about STIs was directly associated with the lack of cervical cancer awareness [odds ratio (OR) 4.50; 95% confidence interval (CI) 2.99–6.77] and inversely associated with HPV-vaccine awareness [OR 0.53; 95% CI 0.29–0.97]. Low cervical cancer and HPV vaccine awareness and knowledge among Nepali and Bhutanese women in eastern Nepal highlight the need for increasing awareness and knowledge in the context of STIs and reproductive health education. Increasing awareness and knowledge of HPV, its role in cervical cancer, and prevention modalities is a first critical step for implementing successful targeted primary cervical cancer prevention measures focused on behavior modification and vaccine administration.

Keywords

Cervical cancer Human papillomavirus Vaccination Nepal Bhutanese refugees Knowledge Awareness Risk factors 

Notes

Acknowledgements

Preliminary findings from this study were presented at the International Papillomavirus Society Conference in Cape Town, South Africa, February 28–March 4, 2017. We thank the participants, without whose participation this study would not have been possible. We also thank the staff of NFCC International who organized the health camp and assisted with data collection. The study was supported in part by pilot funds from the College of Public Health, Kent State University and the Department of Epidemiology, School of Public Health, University of Alabama at Birmingham. Derek Johnson was supported by a National Institutes of Health Cancer Prevention and Control Training Grant (R25CA47888).

Compliance with Ethical Standards

Conflict of interest

The authors have no conflicts of interest to declare.

Ethical Approval

The Institutional Review Boards of Kent State University, the University of Alabama at Birmingham, and the Nepal Health Research Council approved the study protocol.

References

  1. 1.
    International Agency for Research on Cancer. (2019). Nepal: Human Papillomavirus and Related Cancers, Fact Sheet 2018. Retrieved September 27, 2019, from https://hpvcentre.net/statistics/reports/NPL_FS.pdf.
  2. 2.
    International Agency for Research on Cancer. (2019). Bhutan: Human Papillomavirus and Related Cancers, Fact Sheet 2018. Retrieved September 27, 2019, from https://hpvcentre.net/statistics/reports/BTN_FS.pdf.
  3. 3.
    Crosbie, E. J., Einstein, M. H., Franceschi, F., & Kitchener, H. C. (2013). Human papillomavirus and cervical cancer. Lancet, 382(9895), 889–899.CrossRefGoogle Scholar
  4. 4.
    National Cancer Institute. (2019). Human Papillomavirus (HPV) Vaccines. Retrieved September 27, 2019, from https://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hpv-vaccine-fact-sheet.
  5. 5.
    Devarapalli, P., Labani, S., Nagarjuna, N., Panchal, P., & Asthana, S. (2018). Barriers affecting uptake of cervical cancer screening in low and middle income countries: A systematic review. Indian Journal of Cancer, 55(4), 318–326.CrossRefGoogle Scholar
  6. 6.
    Catarino, C., Petignat, P., Dongui, G., & Vassilakos, P. (2015). Cervical cancer screening in developing countries at a crossroad: Emerging technologies and policy choices. Journal of Global Oncology, 6(6), 281–290.Google Scholar
  7. 7.
    Bradford, L., & Goodman, A. (2013). Cervical cancer screening and prevention in low-resource settings. Clinical Obstetrics and Gynecology, 56(1), 76–87.CrossRefGoogle Scholar
  8. 8.
    Darj, E., Chalise, P., & Shakya, S. (2019). Barriers and facilitators to cervical cancer screening in Nepal: A qualitative study. Sexual & Reproductive Healthcare, 20, 20–26.CrossRefGoogle Scholar
  9. 9.
    Thapa, N., Maharjan, M., Petrini, M. A., Shah, R., Shah, S., Maharjan, N., et al. (2018). Knowledge, attitude, practice and barriers of cervical cancer screening among women living in mid-western rural, Nepal. Journal of Gynecologic Oncology, 29(4), e57.  https://doi.org/10.3802/jgo.2018.29.e57.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Ranjit, A., Gupta, S., Shrestha, R., Kushner, A. L., Nwomeh, B. C., & Groen, R. S. (2016). Awareness and prevalence of cervical cancer screening among women in Nepal. International Journal of Gynecology & Obstetrics, 134(1), 37–40.CrossRefGoogle Scholar
  11. 11.
    Johnson, D., Bhatta, M. P., Gurung, S., Aryal, S., Lhaki, P., & Shrestha, S. (2014). Knowledge and awareness of human papillomavirus (HPV), cervical cancer and HPV vaccine among women in two distinct Nepali communities. Asian Pacific Journal of Cancer Prevention, 15(19), 8287–8293.CrossRefGoogle Scholar
  12. 12.
    Haworth, R. J., Margalit, R., Ross, C., Nepal, T., & Soliman, A. S. (2014). Knowledge, attitudes, and practices for cervical cancer screening among the Bhutanese refugee community in Omaha, Nebraska. Journal of Community Health, 39(5), 872–878.CrossRefGoogle Scholar
  13. 13.
    Dhendup, T., & Tshering, P. (2014). Cervical cancer knowledge and screening behaviors among female university graduates of year 2012 attending national graduate orientation program, Bhutan. BMC Women’s Health, 14(1), 44.  https://doi.org/10.1186/1472-6874-14-44.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    United Nations High Commissioner for Refugees. (2015). UNHCR Nepal Fact sheet. Kathmandu (pp. 1–2). Retrieved September 27, 2019 from http://un.info.np/Net/NeoDocs/View/2482.
  15. 15.
    Central Bureau of Statistics. (2014). Government of Nepal National Planning Commission. Population Atlas of Nepal. Retrieved September 27, 2019 from https://cbs.gov.np/catalog/atlas/.
  16. 16.
    Government of Nepal National Planning Commission. (2014). Nepal Human Development Report 2014. Retrieved September 28, 2019 from http://www.npc.gov.np/images/download/NHDR_Report_2014.pdf.
  17. 17.
    United Nations Higher Commissioners for Refugees. Global Focus—Nepal. Retrieved September 27, 2019 from http://reporting.unhcr.org/node/10316.
  18. 18.
    Bhatta, M. P., Johnson, D. C., Lama, M., Aryal, S., Lhaki, P., & Shrestha, S. (2017). High-risk human papillomavirus infection and abnormal cervical cytology among Nepali and Bhutanese refugee women living in eastern Nepal. BMC Infectious Diseases, 17(1), 73.  https://doi.org/10.1186/s12879-017-2186-2.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Johnson, D., Bhatta, M. P., Smith, J. S., Kempf, M. C., Broker, T. R., Vermund, S., H., et al (2014). Assessment of high-risk human papillomavirus infections using clinician- and self-collected cervical sampling methods in rural women from Far Western Nepal. PLoS One, 9(6), e101255.CrossRefGoogle Scholar
  20. 20.
    Jonson, D., Lhaki, P., Bhatta, M. P., Smith, J. S., Kempf, M. C., Smith, J. S., et al. (2016). Spousal migration and human papillomavirus infection among women in rural Western Nepal. International Health, 8(4), 261–268.CrossRefGoogle Scholar
  21. 21.
    United Nations High Commissioners for Refugees. (2015). Resettlement of Bhutanese refugees surpasses 100,000 mark. Retrieved from September 27, 2019 from www.unhcr.org/en-us/news/latest/2015/11/564dded46/resettlement-bhutanese-refugees-surpasses-100000-mark.html.
  22. 22.
    Kue, J., Hanegan, H., & Tan, A. (2017). Perceptions of cervical cancer screening, screening behavior, and post-migration living difficulties among Bhutanese-Nepali refugee women in the United States. Journal of Community Health, 42(6), 1079–1089.CrossRefGoogle Scholar
  23. 23.
    Lor, B., Ornelas, I. J., Magarati, M., Do, H. H., Zhang, Y., Jackson, J. C., et al. (2018). We should know ourselves: Burmese and Bhutanese refugee women's perspectives on cervical cancer screening. Journal of Health Care for Poor and Underserved, 29(3), 881–897.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Madhav P. Bhatta
    • 1
    Email author
  • Derek C. Johnson
    • 2
  • Mingma Lama
    • 3
  • Bipu Maharjan
    • 3
  • Pema Lhaki
    • 3
  • Sadeep Shrestha
    • 2
  1. 1.College of Public HealthKent State UniversityKentUSA
  2. 2.Department of Epidemiology, School of Public HealthUniversity of Alabama at BirminghamBirminghamUSA
  3. 3.NFCC InternationalKathmanduNepal

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