Vaginal douching in Zambia: a risk or benefit to women in the fight against cervical cancer: a retrospective cohort study

Background Cervical cancer was the most commonly diagnosed cancer and the leading cause of cancer related deaths in 2013 among women in Zambia. We determined factors associated with vaginal douching with any solution other than water and examined its role as a risk factor for abnormal cervical lesions among Zambian women. Methods We conducted a retrospective cohort study using data from the Cervical Cancer Prevention Program in Zambia among 11,853 women (15 years or older) who had screened for cervical cancer from 6 provinces of Zambia. Stata version 15 was used to analyze the data. Investigator led stepwise logistic regression was used to estimate adjusted odds ratios and 95% confidence intervals for various characteristics, with vaginal douching with any solution as primary outcome and abnormal cervical lesions as secondary outcome. Results Douching with any solution other than water was practiced by 8.1% (n = 960) of the study participants. Older women (35-44 and 45 years or older) vs young women (15-24 years old) were less likely to douche with a solution (AOR 0.74; 95% CI: 0.57-0.97, p = 0.027 and AOR 0.65; 95% CI: 0.49-0.87, P = 0.004), respectively, and so were women in informal employment compared to housewives (AOR 0.72; 95% CI: 0.58-0.89, p = 0.002). Odds of douching were higher among women with secondary vs. no formal education (AOR 1.64; 95% CI: 1.15-2.35, P = 0.007), and among women who used condoms sometimes compared to those who never with their regular sexual partners (AOR 1.19; 95% CI: 1.01-1.40, PP = 0.037). About 12.2% of study participants had abnormal cervical lesions. The use of either vinegar, ginger, lemon, salt or sugar solution was associated with increased risk of abnormal cervical lesions (AOR 7.37; 95% CI: 1.43-38.00, p = 0.017) compared to using water. Conclusion We find an association between douching with a solution and a woman's age, educational attainment, occupation and condom use. Vaginal douching with either vinegar, ginger, lemon, salt or sugar solution was associated with increased risk for abnormal cervical lesions. We recommend further research on ever vs never douching and the risk for abnormal cervical lesions.