Five hundred and fifteen (515) women volunteered to participate in this study across the three senatorial districts of Kaduna State, North West Nigeria. The result revealed that the prevalence of genital Human Papillomavirus and cervical dysplasia among the study population is 11.8% and 6.4% respectively. The prevalence of HPV among women is however lower in this study when compared to results in other parts of Nigeria which include 81.8% ,48.1% and 37% in Lagos (South West), Gombe (North East), and Abuja (Central) respectively [9], [10] and [11]. This difference could be attributed to the variation in the methodology and socio-cultural lifestyles of women in the different geographic regions.
The trend of HPV infection and cervical dysplasia among Nigerian women should be a concern to researcher and policy makers for a deliberate action to cub the menace in our society. The result of cervical dysplasia is slightly higher than the findings of [12] who documented 4.8% in a 5year review of patients who were screened for cervical cancer at Ahmadu Bello Teaching Hospital in Zaria between 2005 and 2010. They observed that the rates of CIN1, CIN2 and CIN3 were 3.6%, 0.8% and 0.4% respectively.
This prevalence of cervical dysplasia among apparently healthy women in Kaduna State is lower compared with studies in other parts of Nigeria which include cervical dysplasia rate of 11.8%, 12.0% and 12.2% in Ibadan, Uyo and Enugu respectively [13], [14] and [15]. However, it corroborate with 6.2% and 6.0% reported by [16] and [17] in similar studies done in Kaduna and Kano respectively. This infer that cervical dysplasia is more common among asymptomatic southern Nigerian women compared to their northern counterparts. This could be attributed to the variation in the socio-cultural lifestyles of women in the different regions.
An analysis of the association of socio-demography and socio-economic risk factors on cervical dysplasia among women in Kaduna State revealed that age, parity and economic class have significant effect on HPV infection and cervical dysplasia among the women who participated in the study with P- values of 0.043. 0.015 and 0.033 respectively. This finding agrees with the reports of [9] who observed a peak age specific prevalence rate of CIN in their study. This result however differ with the reports of by [19] and [11] in a similar HPV study in Lokoja and Abuja Nigeria, who reported a high HPV infection among younger women of less than 30 years old with decrease in rate of infection with age. This is probably because younger women including teenagers are more sexually active with multiple partners compared to the older women. These were consistent with previous reports [20] [21]. Age is an important factor because the chances of a woman developing cervical dysplasia increases with increasing age. According to [18], the mean age for developing dysplasia and carcinoma in situ ranged from 34.7 to 38.6 years and 39.6 to 43.5 years, respectively.
Muhammad et al. 2017 reported that 66.9% of apparently healthy married women who had cervical dysplasia, were from polygamous settings, implying that marital status and type of marriage play a significant role in rate of cervical dysplasia among women [22]. On the contrary, our study reveal that only 6.0% of the married women and 5.5% of those from polygamous homes had cervical dysplasia which was not statistically significant. The rate of cervical dysplasia among women from monogamous families is also high probably because many spouses may multiple partners and some women may already have contracted HPV even before they got married.
The educational status of the participants show that 38.6% of the women had a tertiary education and 27.9% were educated at secondary level. However, awareness of cervical cancer amongst them was low. This finding corroborates with to other studies in Nigeria, among women with similar social characteristics [23][24]. The high level of literacy among the participants does not translate to an adequate knowledge about cervical cancer prevention as majority of the participants know nothing about cervical dysplasia and the etiological agent viral infection or measures against HPV infection. This suggest that the women in the study population will require more awareness campaign to educate them on preventive measures and management of CD and other related conditions. It is expected that formal educational among females can help reduce rate of viral infection and cervical dysplasia since lower educational status will leave the women with low income jobs which can expose them to infection and cervical dysplasia.
This study revealed a high level of ignorance about cervical dysplasia and preventive measures for cervical cancer among the participating women across Kaduna state. Only 7.5% of the women know about cervical cancer vaccines while only a few have an idea of cervical cancer and cervical dysplasia respectively. According to [25], Poor access to health education and invasion of patients’ privacy was the major factors that impaired the utilization of cervical cancer screening. The study however stated that there is no relationship between level of education and rate of cervical dysplasia in Kaduna State.
An average woman in the state belong to the middle-income class of the economy. Of the 198 women in the low-income class, 38.4% had cervical dysplasia. The statistics analysis show socio-economic class of women is a strong risk factor for cervical dysplasia with a p-value of 0.009 especially in respect of their occupation and income. Most of the participants engaged with formal or civil service jobs had negative smears against women who are low-income earners as those engaged in trading, farming, self- employment and house wives. Lawal et al. 2017 reported that some women engaged in jobs that highly expose them to infections due low income earning [26].
The myths of the effect of hormonal contraceptives use and the risk of abnormal cytological changes in our society is significantly high and my hamper the uptake of hormonal contraceptive in our society. Women who have used oral contraceptives for 5 or more years have a higher risk of cervical cancer than women who have never used oral contraceptives [27]. About 36% of the women who were diagnosed of cervical dysplasia had one form of hormonal contraceptive in recent five years. However, the study shows that there is no significant association between use of hormonal contraceptives and cervical dysplasia. The prevalence of cervical dysplasia among subjects who did not use any or same kind of contraceptive were greater compared to their counterpart who had a form of hormonal contraceptive in recent years. This finding is contradicts the reports of [28] on cervical cytology of women on contraceptives in Calabar metropolis, Nigeria and that of [18 ] reported that more women who had used contraceptive pills had a greater prevalence of cervical dysplasia and atypical smear than those who had never used oral contraceptive pills. However it agrees with [29] who did not establish any association in a similar study among women in Enugu, South Eastern Nigeria. This variation may be as a result of the widely acceptance of use of contraceptives in southern Nigeria than women from the northern regions.
The burden of sexually transmitted infection is high among women suspected with cervical cancer [30] However, they were no statistical back up to this statement from our results. Of the 515 participants in this study, 19.2% indicated to have had a history of Sexually Transmitted Infection (STI)in two years out of which 7% and 13% had cervical dysplasia and HPV repectively. This is significantly low compared to the findings of [22] who reported over 61% history of STI among women with cervical dysplasia and HIV in their study in Kano. This is likely due to the low immune status of his study population as this study did not consider the HIV factor.
Ingestion of alcohol prove to have a significant influence on cervical dysplasia in this study despite the low number of women who indicated that they take alcohol. This is in agreement with [31],[32] and [33] who all documented that alcoholic women may be at higher risk for CD for lifestyle-related reasons (promiscuity, smoking, use of contraceptive hormones, and dietary deficiencies). Smoking appeared to increase the risk of cervical dysplasia by about 4 times greater than those that did not smoke and 1.4 times higher risk if they were secondary smokers [22]. Carcinogens in tobacco smoke can cause DNA damage that increases the likelihood of cancerous changes to cells [34]. However. this study did not find a significant relationship between smoking and cervical dysplasia probably because only one (1) of the six smokers in the study population had cervical dysplasia. A similar study in Enugu, South East Nigeria [35] also showed that one out of six smokers had cervical dysplasia among the 210 women studied.
It has been reported that multigravida women with parity of more than 5 children seem to develop cervical dysplasia when compared to those with low parity [23]. The study shows that 262 (50.9%) of the participants have had more than 4 children in their life time. The results indicate that parity is a significant risk factor for cervical dysplasia (P= 0.009) as 3.4% of the women having more than 4 children were positive for cervical dysplasia. High maternal parity has been recognized as an epidemiological risk factor associated with cervical cancer [33]. Some studies also suggest frequent vaginal deliveries makes local changes to cervical cells due to traumas during birth [37].
According to [36], age at first sexual intercourse and multiple sexual partners, increase the risk and place women at high risk of developing cervical cancer in northern Nigeria. It has been reported that 11.1% of women with cervical dysplasia were sexually exposed before 15 years of age [37]. Early marriage which depicts early coitarche is a common practice in Northern Nigeria, and this highly increases the vulnerability of a young girl to cancer of cervix due to the dynamic nature of transformation zone at an early age making it more prone to infections. On the contrary, result of this study did not find a statistical significance in the level of risk for HPV and cervical dysplasia among women who had first sexual intercourse at age below 15 in the study population as only 2 women in this category had HPV infection and none of the women was found with CD.
The prevalence of cervical dysplasia and atypical cells among women who had menarche before 15 years was 4.8%. Sexual exposure before the age of 18 years is said to predispose to cervical dysplasia [18]. This is because women who were exposed to sexual intercourse early have a greater tendency to having multiple sexual partners which expose them to HPV infection and CD. Early coitarche increases risk of HPV infection. The mechanism by which early coitarche is linked to cervical carcinogenesis is related to steroid hormonal influence on HPV infection and host immune response to HPV during preadolescence and adolescence. Early coitarche was a risk factor found to be statistically significant with a similar study in Kwara [38], however, the level of risk found in this study was not sufficient to uphold this claim. This could be due to the socio-cultural variations in the geographic locations.
Though obesity is associated with some malignancies, its association with cervical cancer is still inconclusive. This study shows that there was no significant relationship between Body Mass Index (BMI) and HPV infection or CD, as a significant number of women who had a healthy BMI were diagnosed of cervical dysplasia that could lead to cancer if they are not treated. Findings of this study contradicts reports of [39] and [40] who stated that obese women are at an increased risk of death from cervical cancer but the explanation for this is unknown. Okoro et al. 2020 observed an association between obesity and CEA in their study among obese and non-obese women at the cervical cancer screening clinic, UNTH Enugu, while Maruthur et al. 2009 reported an increase in the cervical cancer mortality observed in obese women [39][40]. They were however particular about white women and not negros after reviewing published studies in 2006 to evaluate the relationship between body weight and cervical cancer screening in the United States. Prior studies of the association between body weight and HPV infections have yielded conflicting results. Among female sexual workers in Spain, there was an inverse association between high-risk HPV prevalence and BMI. In contrast, a study based on the US National Health and Nutrition Examination Survey (NHANES) showed that BMI was not associated with prevalence of HPV The relationship between BMI and the risk of CD infection needs further evaluation.
In conclusion, the prevalence of Human Papillomavirus and Cervical Dysplasia among asymptomatic women in Kaduna State, Nigeria is 11.8% and 6.4% respectively. The risk factors for CD include age, socio-economic class, alcohol consumption and parity of more than 4. The later was also found to be a risk factor for HPV infection as well. These factors should be given attention in other to reduce the disease burden in the nation. High incidence of cervical dysplasia and cancer with considerable mortality in this region is an evidence of HPV infection abundance with the absence of the cervical screening and low public awareness of the problem. This suggests that periodic screening for CD among women of reproductive age could prove highly effective in identifying cervical pathology at a significant and highly treatable state among women in Kaduna State and Nigeria as a whole.