Prevalence of high-risk human papillomavirus infection and associated factors among women of reproductive age attending a rural teaching hospital in western Uganda.

BACKGROUND: High-risk HPV is considered a major risk factor for the development of cervical cancer, the most common malignancy among women in Uganda. However, there is a paucity of updated epidemiological data on the extent of the burden and factors associated with hr-HPV infection among women of reproductive age. The aim of this study was to determine the prevalence and genotype distribution of hr-HPV and associated factors among women of reproductive age attending a rural teaching hospital in western Uganda. METHODS: We conducted a cross-sectional study from April to June 2022. A total of 216 women of reproductive age attending the gynecological outpatient clinic were consecutively enrolled. Interviewer-administered questionnaires were used to collect participant characteristics, cervical specimens were collected by clinicians, and molecular HPV testing was performed using the Cepheid Xpert HPV DNA test. Descriptive statistics followed by binary logistic regression were conducted using SPSS version 22. RESULTS: The prevalence of hr-HPV was 16.67%. Other hr-HPV types other than HPV 16 and 18 were predominant, with a prevalence of 10.6%; HPV 18/45 (2.31%), HPV 16 (0.46%), and 3.24% of the study participants had more than one hr-HPV genotype. On multivariate logistic regression, an HIV-positive status (aOR = 7.06, CI: 2.77-10.65, p = 0.007), having 3 or more sexual partners in life (aOR = 15.67, CI: 3.77-26.14, p = 0.008) and having an ongoing abnormal vaginal discharge (aOR = 5.37, CI: 2.51-11.49, p = 0.002) were found to be independently associated with hr-HPV infection. CONCLUSIONS AND RECOMMENDATIONS: The magnitude of hr-HPV is still high compared to the global prevalence. HIV-positive women and those in multiple sexual relationships should be prioritized in cervical cancer screening programs. The presence of abnormal vaginal discharge in gynecology clinics should prompt HPV testing.

Risk factors for recurrence of pelvic organ prolapse after vaginal surgery among Ugandan women: a prospective cohort study.

INTRODUCTION AND HYPOTHESIS: This study was aimed at determining the recurrence rate and risk factors for the recurrence of pelvic organ prolapse (POP), at 1 year post-vaginal reconstructive surgery in a resource-limited setting. METHODS: We enrolled women who underwent vaginal surgery for POP at the urogynecology unit of Mbarara Regional Referral Hospital (MRRH) in southwestern Uganda between December 2018 and February 2020. The surgeries that were performed include anterior colporrhaphy for cystocele, posterior colporrhaphy for rectocele, vaginal hysterectomy with vault suspension for uterine prolapse, and cervicopexy in those with uterine prolapse where uterine-sparing surgery was desired. The women were followed up for a period of 1 year after surgery. Pelvic examinations in lithotomy position under maximum strain were carried out to assess for recurrence using the Pelvic Organ Quantification (POP-Q) system. Recurrence was defined as a prolapse of ≥POP-Q stage II. Descriptive analyses and multivariate log binomial regression were performed to determine risk factors for recurrence. RESULTS: Of the 140 participants enrolled, 127 (90.7%) completed the follow-up at 1 year. The recurrence rate was 25.2% (32 out of 127). Most (56.3%) of the recurrences occurred in the anterior compartment and in the same site previously operated. Women aged <60 years (RR = 2.34; 95% CI: 1.16-4.72; p = 0.018) and those who had postoperative vaginal cuff infection (RR = 2.54; 95% CI: 1.5-4.3; p = 0.001) were at risk of recurrence. CONCLUSION: Recurrence of POP was common. Younger women, and those with postoperative vaginal cuff infection, were more likely to experience recurrent prolapse after vaginal repair.