Cervical Cancer and Human Papillomavirus Vaccine Awareness Among Married Bhutanese Refugee and Nepali Women in Eastern Nepal

  • Madhav P. BhattaEmail author
  • Derek C. Johnson
  • Mingma Lama
  • Bipu Maharjan
  • Pema Lhaki
  • Sadeep Shrestha
Original Paper


This study examined the sexually transmitted infections (STIs), cervical cancer, and human papillomavirus virus (HPV) vaccine-related awareness and knowledge among married Bhutanese refugee and Nepali women living in eastern Nepal. Participants were recruited from a women’s health camp in Jhapa District in eastern Nepal. A demographic and health survey with questions on STIs, cervical cancer and HPV vaccine was administered to consenting participants. Women who were born in Bhutan or living in the United Nations administered refugee camps were classified as Bhutanese. Of the 630 participants, 14.3% of participants were Bhutanese and the mean age was 38.8 ± 8.2 years. A higher proportion of Bhutanese than Nepali women reported a lack of cervical cancer awareness (42.0% vs. 30.7%; p = 0.036). Only 21.5% of the participants knew HPV as the cause of cervical cancer; 13.9% were aware of an HPV vaccine; and 96% reported that they would have their children vaccinated against HPV if the vaccine was available free of cost to them. In multivariable analyses, the lack of awareness about STIs was directly associated with the lack of cervical cancer awareness [odds ratio (OR) 4.50; 95% confidence interval (CI) 2.99–6.77] and inversely associated with HPV-vaccine awareness [OR 0.53; 95% CI 0.29–0.97]. Low cervical cancer and HPV vaccine awareness and knowledge among Nepali and Bhutanese women in eastern Nepal highlight the need for increasing awareness and knowledge in the context of STIs and reproductive health education. Increasing awareness and knowledge of HPV, its role in cervical cancer, and prevention modalities is a first critical step for implementing successful targeted primary cervical cancer prevention measures focused on behavior modification and vaccine administration.


Cervical cancer Human papillomavirus Vaccination Nepal Bhutanese refugees Knowledge Awareness Risk factors 



Preliminary findings from this study were presented at the International Papillomavirus Society Conference in Cape Town, South Africa, February 28–March 4, 2017. We thank the participants, without whose participation this study would not have been possible. We also thank the staff of NFCC International who organized the health camp and assisted with data collection. The study was supported in part by pilot funds from the College of Public Health, Kent State University and the Department of Epidemiology, School of Public Health, University of Alabama at Birmingham. Derek Johnson was supported by a National Institutes of Health Cancer Prevention and Control Training Grant (R25CA47888).

Compliance with Ethical Standards

Conflict of interest

The authors have no conflicts of interest to declare.

Ethical Approval

The Institutional Review Boards of Kent State University, the University of Alabama at Birmingham, and the Nepal Health Research Council approved the study protocol.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Madhav P. Bhatta
    • 1
    Email author
  • Derek C. Johnson
    • 2
  • Mingma Lama
    • 3
  • Bipu Maharjan
    • 3
  • Pema Lhaki
    • 3
  • Sadeep Shrestha
    • 2
  1. 1.College of Public HealthKent State UniversityKentUSA
  2. 2.Department of Epidemiology, School of Public HealthUniversity of Alabama at BirminghamBirminghamUSA
  3. 3.NFCC InternationalKathmanduNepal

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