FACTORS ASSOCIATED WITH ABNORMAL CERVICAL CYTOLOGY AMONG 6 POSTPARTUM WOMEN IN THE ACCRA METROPOLIS

Abstract

Background Cervical cancer is a growing global health issue that significantly increases morbidity and mortality among women, particularly those in sub-Saharan Africa. The extended pre-invasive stage of the disease characterized by cervical cytological abnormalities can be detected early and prevented from developing into invasive tumors with the aid of robust screening procedures such as Pap (Papanicolaou) smear. Ghana does not have a national programme on screening for cervical cancer. The postpartum period presents a golden opportunity for a Pap smear to be done as most women will go through this stage at least once in their lifetime and also, a large cohort of women can be evaluated at that time.

Aim To determine the prevalence and the types of abnormal cervical cytology as well as the associated factors among 6 weeks postpartum women in selected hospitals in the Accra Metropolis.

Methodology In this cross-sectional study, 370 women who were 6 weeks postpartum and attended postnatal clinics at Korle Bu Teaching Hospital and the Greater Accra Regional Hospital were assessed for the prevalence and the types of abnormal cervical cytology as well as the associated factors. Participants were recruited via consecutive sampling after ethical approval and informed consent had been obtained. Pretested researcher administered questionnaire was used to collect the socio-demographic, obstetric and gynaecologic characteristics of the participants. Conventional Pap smears were taken and analyzed for all the study participants. Those with abnormal results underwent colposcopy. Data collected were summarized and analyzed using Statistical Package for the Social Sciences version (SPSS) 20. Descriptive statistics such as frequencies, mean and standard deviation were used. Bivariate analysis and multivariate analysis with logistic regression were used to model associations between the dependent and independent variables. A p-value of <0.05 was considered statistically significant at a confidence interval of 95%. Results In all data on 370 participants were included in the analysis. The prevalence of abnormal cervical cytology among the participants was 39/370 (10.5%) at a confidence interval of 95% (7.6%-14.1%). ASCUS (Atypical Squamous Cell of Undetermined Significance) was the most common abnormal cervical cytology representing 31/370 (8.4%). A multiple logistic regression analysis showed that a history of Sexually Transmitted Infection (aOR = 34.88; 95% CI = 13.75 – 88.48; p < 0.001) and a history of irregular condom use (aOR = 4.95; 95% CI = 2.03 – 12.05; p < 0.001) were significantly associated with abnormal cervical cytology. Colposcopy was performed on all participants with abnormal cervical cytology, excluding ASCUS, and the results were adequate and normal.

Conclusion The prevalence of abnormal cervical cytology in the post-partum period is 10.5%. The factors associated with abnormal cervical cytology are a history of Sexually Transmitted Infection and a history of irregular condom use. Colposcopy was adequate and normal for all the participants who had abnormal cervical cytology. Efforts must be made to include routine cervical precancer screening in the care given to women during their six-week postpartum visit.