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Open Access Research article

Risk factors for VIA positivity and determinants of screening attendances in Dar es Salaam, Tanzania

Crispin Kahesa12, Susanne Kruger Kjaer34, Twalib Ngoma2, Julius Mwaiselage2, Myassa Dartell13, Thomas Iftner5 and Vibeke Rasch16*

Author affiliations

1 Department of International Health, Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark

2 Ocean Road Cancer Institute, Dar es Salaam, Tanzania

3 Department of Virus, Lifestyle and Genes, Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark

4 Gynecologic Clinic, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark

5 Department of Experimental Virology, Universitaetsklinikum, Tuebingen, Germany

6 Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark

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Citation and License

BMC Public Health 2012, 12:1055  doi:10.1186/1471-2458-12-1055

Published: 7 December 2012

Abstract

Background

Tanzania is among the countries in the world where the cervical cancer incidence is estimated to be highest. Acknowledging an increase in the burden of cervical cancer, VIA was implemented as a regional cervical cancer screening strategy in Tanzania in 2002. With the aim of describing risk factors for VIA positivity and determinants of screening attendances in Tanzania, this paper present the results from a comparative analysis performed among women who are reached and not reached by the screening program”.

Methods

14 107 women aged 25–59 enrolled in a cervical cancer screening program in Dar es Salaam in the period 2002 – 2008. The women underwent VIA examination and took part in a structured questionnaire interview. Socioeconomic characteristics, sexual behavior, HIV status and high-risk (HR) HPV infection were determined in a subpopulation of 890 who participated and 845 who did not participate in the screening.

Results

Being widowed/separated OR=1.41 (95% CI: 1.17-1.66), of high parity OR=3.19 (95% CI: 1.84-5.48) of low education OR= 4.30 (95% CI: 3.50-5.31) and married at a young age OR=2.17 (95% CI: 1.37-3.07) were associated with being VIA positive. Women who participated in the screening were more likely to be HIV positive OR= 1.59 (95% CI. 1.14-2.25) in comparison with women who had never attended screening, while no difference was found in the prevalence of HR-HPV infection among women who had attended screening and women who had not attended screening.

Conclusion

Women who are widowed/separated, of high parity, of low education and married at a young age are more likely to be VIA positive and thus at risk of developing cervical cancer. The study further documents that a referral linkage between the HIV care and treatment program and the cervical cancer screening program is in place in the setting studied, where HIV positive were more likely to participate in the cervical cancer screening program than HIV negative women.

Keywords:
Cervical cancer; Screening; VIA; HPV; HIV; Tanzania