Jorge De Avila

Major and Classification

Health Promotion and Disease Prevention Studies

Faculty Mentor

Victoria Cortessis, Ph.D.


Keck School of Medicine, Preventive Medicine

McNair Project

“Defaulting to Medical Follow-Up After an Abnormal Pap Smear Cytology in Malawi Women”

Project Abstract

The cervical cancer incident rate has doubled in the past few years in Malawi to 75.9 cases per 100,000 women. With many screening and prevention strategies successfully lowering the progression to disease in resource-dense nations, it is important to investigate which types of interventions may work in resource-limited Malawi. The purpose of this study was to help identify variables creating barriers for women from adhering to colposcopy. Out of 1,210 Malawi women who were screened during a ten day intervention, 124 had an abnormal cytology, resulting in 77 women needing a colposcopy. The outcome measure was the completion of colposcopy after an abnormal cytology of HSIL or graver. Several variables were assessed in a questionnaire and fit into a logistic regression model. In total, 31.2% of the women requiring a colposcopy did not return. In the univariate analysis married women (OR: 0.37, p value: 0.18) and women with a previous Pap smear (OR: 0.35, p value: 0.16) were less likely to default to colposcopy however, these variables were not significant in the multivariate analysis. In the multivariate model, women who identified as Chewa (OR: 4.70, p value: 0.13) and Lomwe (OR: 3.22, p value: 0.16) were more likely to default to colposcopy than women who identified as Manganja. Using a social ecological framework we can better inform interdisciplinary scholars to develop an intervention to tackle risk factors; Chewa and Lomwe women may be facing obstacles at multiple levels such as built environments or cultural norms placing them at higher risk.