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Cervical cancer disproportionately burdens Haitian women compared to other populations in the Western hemisphere. Certain agents used during 'twalet deba', a Haitian Creole term for vaginal hygiene practices (VP), have been associated with human papilloma virus (HPV) infection and cervical dysplasia. Namely, use of pigeon pea as a VP agent has been identified as a potential link to high-risk HPV infection. Thus, we sought to further examine social and behavioral profile of individuals who report using pigeon pea as a VP agent.
Methods
Community Health Workers administered surveys on VP to a total of N=464 women from two neighborhoods in rural Thomonde, Haiti in effort to address cervical cancer burden in Haiti through community-based participatory research. Univariate and multivariate logistic regression models were used to assess the association between self-reported use of pigeon pea with social and behavioral characteristics including tobacco use, initiation of VP, daily frequency of VP, and number of pregnancies, controlling for age, employment, and education.
Results
Of the sample, 44.4% of women reported using pigeon pea for twalet deba practices and 15.8% reported present use of tobacco. The majority of the sample was 31+ (85.9%), unemployed (86.1%), and reported completing some formal education (63.0%). Current tobacco use (OR=2.92, 95%CI=1.72, 4.97), older age (OR=1.96, 95%CI=1.12, 3.45), later VP initiation (OR=6.22, 95%CI=4.07, 9.49), higher VP frequency (OR=1.55, 95%CI=1.06, 2.26), and higher number of pregnancies (OR=1.08, 95%CI=1.01, 1.15) were significantly related to pigeon pea use in univariate analyses. After controlling for age, employment, and education, women who reported present tobacco use (OR=3.47, 95%CI=1.84, 6.53); initiation of VP during sexual debut or after marriage (OR=7.02, 95%CI=4.42, 11.13) compared to childhood; and frequency of VP more than twice daily (OR=2.03, 95%CI=1.29, 3.18) were more likely to report use of pigeon pea.
Conclusions
Numerous factors may influence the disproportionate burden of HPV-infection and related cancer in Haitian women. Results suggest the need to further examine risk pathways, including qualitative analysis, to develop culturally based understanding of traditional twalet deba feminine practice in Haitian women.