Earlier menarche is associated with a higher prevalence of Herpes simplex type-2 (HSV-2) in young women in rural Malawi
- London School of Hygiene and Tropical Medicine, United Kingdom
- Karonga Prevention Study, Malawi
Figures
Figure 1
Multistate lifetables showing proportion of young women who are still virgins, have started sex but are unmarried, and are married, by age and age at menarche.
Karonga District, Malawi.
Figure 2
Prevalence of HSV-2 and HIV infection in women by age, Karonga District, Malawi.
https://doi.org/10.7554/eLife.01604.004
Figure 3
Association between age at menarche and (A) HSV-2 and (B) HIV, adjusted for current age.
Karonga District, Malawi.
Tables
Table 1
Risk factors for HSV2 and HIV infection in 15–30 year old women in a population survey, Karonga District, Malawi 2007–8
| HSV2 | HIV | |||||||
|---|---|---|---|---|---|---|---|---|
| n/N | % | OR (95% CI) | Age adjusted | n/N | % | OR (95% CI) | Age adjusted | |
| OR (95% CI) | OR (95% CI) | |||||||
| All | 870/3419 | 25.5 | 203/3651 | 5.6 | ||||
| Age | ||||||||
| 15–9 | 126/1240 | 10.2 | 1 | 18/1314 | 1.4 | 1 | ||
| 20–24 | 276/1072 | 25.8 | 3.1 (2.4–3.9) | 64/1128 | 5.7 | 4.3 (2.6–7.4) | ||
| 25–30 | 468/1107 | 42.3 | 6.5 (5.2–8.1) | 121/1209 | 10.0 | 8.0 (4.8–13.2) | ||
| Age at menarche | ||||||||
| <14 | 245/815 | 30.1 | 1 | 1 | 51/861 | 5.9 | 1 | 1 |
| 14 | 195/769 | 25.4 | 0.79 (0.63–0.99) | 0.89 (0.71–1.1) | 43/819 | 5.3 | 0.88 (0.60–1.3) | 1.0 (0.66–1.5) |
| 15 | 225/960 | 23.4 | 0.71 (0.58–0.88) | 0.71 (0.57–0.89) | 41/1030 | 4.0 | 0.66 (0.43–1.0) | 0.68 (0.44–1.0) |
| ≥16 | 157/622 | 25.2 | 0.79 (0.62–0.99) | 0.69 (0.54–0.89) | 51/665 | 7.7 | 1.3 (0.88–2.0) | 1.2 (0.81–1.8) |
| Age at first sex | ||||||||
| Never | 51/639 | 8.0 | 0.21 (0.15–0.29) | 0.48 (0.33–0.69) | 10/684 | 1.5 | 0.23 (0.12–0.44) | 0.69 (0.32–1.3) |
| <16 | 296/1014 | 29.2 | 1 | 1 | 66/1076 | 6.1 | 1 | 1 |
| 16–17 | 235/797 | 29.5 | 1.0 (0.83–1.2) | 0.99 (0.80–1.2) | 53/847 | 6.3 | 1.0 (0.70–1.4) | 0.99 (0.68–1.5) |
| 18+ | 273/930 | 29.4 | 1.0 (0.83–1.2) | 0.76 (0.62–0.93) | 71/1002 | 7.1 | 1.2 (0.82–1.7) | 0.90 (0.63–1.3) |
| Marital status | ||||||||
| Never | 76/826 | 9.2 | 1 | 1 | 19/885 | 2.2 | 1 | 1 |
| Current | 681/2330 | 29.2 | 4.1 (3.2–5.2) | 1.7 (1.3–2.3) | 133/2481 | 5.4 | 2.6 (1.6–4.2) | 0.78 (0.44–1.4) |
| Previous | 113/263 | 43.0 | 7.4 (5.3–10.4) | 3.4 (2.4–5.0) | 51/285 | 17.9 | 9.9 (5.8–17.2) | 3.2 (1.7–5.9) |
| Lifetime no. of partners | ||||||||
| 0 | 51/639 | 8.0 | 0.33 (0.24–0.46) | 0.76 (0.53–1.1) | 10/684 | 1.5 | 0.49 (0.25–0.98) | 1.4 (0.66–3.2) |
| 1 | 304/1475 | 20.6 | 1 | 1 | 46/1574 | 2.9 | 1 | 1 |
| 2 | 320/900 | 35.6 | 2.1 (1.8–2.6) | 2.0 (1.7–2.4) | 82/951 | 5.6 | 3.1 (2.2–4.5) | 2.9 (2.0–4.2) |
| 3 | 139/289 | 48.1 | 3.6 (2.7–4.6) | 3.2 (2.4–4.2) | 41/313 | 13.1 | 5.0 (3.2–7.8) | 4.4 (2.8–6.8) |
| ≥4 | 53/107 | 49.5 | 3.8 (2.5–5.6) | 3.5 (2.3–5.3) | 24/120 | 20.0 | 8.3 (4.9–14.2) | 7.4 (4.3–12.8) |
| Distance from road | ||||||||
| <1 km | 410/1589 | 25.8 | 1 | 1 | 100/1595 | 6.3 | 1 | 1 |
| >1 km | 460/1830 | 25.1 | 0.97 (0.83–1.1) | 0.94 (0.80–1.1) | 62/1835 | 3.4 | 0.52 (0.38–0.72) | 0.50 (0.36–0.70) |
| Schooling | ||||||||
| None/Primary 1–5 | 101/347 | 29.1 | 1 | 16/378 | 4.2 | 1 | 1 | |
| Primary 6–7 | 215/889 | 24.2 | 0.78 (0.59–1.0) | 0.88 (0.66–1.2) | 38/945 | 4.0 | 0.95 (0.52–1.7) | 1.1 (0.59–2.0) |
| Primary 8 | 271/1011 | 26.8 | 0.89 (0.68–1.2) | 0.89 (0.67–1.2) | 58/1069 | 5.4 | 1.3 (0.74–2.3) | 1.3 (0.75–2.4) |
| Secondary 1–3 | 218/860 | 25.4 | 0.83 (0.63–1.1) | 0.88 (0.65–1.2) | 70/916 | 7.6 | 1.9 (1.1–3.3) | 2.0 (1.2–3.6) |
| Secondary 4/Tertiary | 36/196 | 18.4 | 0.55 (0.36–0.84) | 0.42 (0.27–0.66) | 18/215 | 8.4 | 2.1 (1.0–4.1) | 1.8 (0.87–3.6) |
| Mother schooling | ||||||||
| <=Primary | 716/2861 | 25.0 | 1 | 1 | 151/3021 | 5.0 | 1 | 1 |
| Secondary | 80/352 | 22.7 | 0.88 (0.68–1.1) | 1.0 (0.76–1.3) | 30/382 | 7.9 | 1.6 (1.1–2.4) | 1.8 (1.2–2.8) |
| Father schooling | ||||||||
| <=Primary | 517/2046 | 25.3 | 1 | 1 | 94/2158 | 4.4 | 1 | 1 |
| Secondary | 260/1095 | 23.7 | 0.92 (0.78–1.1) | 0.96 (0.80–1.1) | 81/1166 | 7.0 | 1.6 (1.2–2.2) | 1.7 (1.3–2.3) |
| Housing quality | ||||||||
| 1 (Best) | 148/662 | 22.4 | 1 | 1 | 71/732 | 9.7 | 1 | 1 |
| 2 | 149/565 | 26.4 | 1.2 (0.96–1.6) | 1.2 (0.89–1.5) | 32/598 | 5.4 | 0.53 (0.34–0.81) | 0.48 (0.31–0.75) |
| 3 | 317/1238 | 25.6 | 1.2 (0.96–1.5) | 1.0 (0.96–1.3) | 60/1296 | 4.6 | 0.45 (0.32–0.65) | 0.38 (0.26–0.55) |
| 4 (Worst) | 227/843 | 26.9 | 1.3 (1.0–1.6) | 1.2 (0.96–1.6) | 38/903 | 4.2 | 0.41 (0.27–0.61) | 0.37 (0.25–0.56) |
| Occupation | ||||||||
| Farmer | 652/2229 | 29.3 | 1 | 1 | 143/2369 | 6.0 | 1 | 1 |
| In education | 63/720 | 8.8 | 0.23 (0.18–0.31) | 0.55 (0.40–0.76) | 10/767 | 1.3 | 0.21 (0.11–0.39) | 0.58 (0.28–1.2) |
| Not working | 23/77 | 29.9 | 1.0 (0.63–1.7) | 1.1 (0.66–1.9) | 8/88 | 9.1 | 1.6 (0.74–3.3) | 1.6 (0.77–3.5) |
| Other | 102/272 | 37.5 | 1.5 (1.1–1.9) | 1.3 (1.0–1.7) | 38/293 | 13.0 | 2.3 (1.6–3.4) | 2.1 (1.4–3.1) |
| Times of insufficient food in household in last year | ||||||||
| No | 674/2575 | 26.2 | 1 | 1 | 162/2748 | 5.9 | 1 | 1 |
| Yes | 166/728 | 22.8 | 0.83 (0.69–1.0) | 0.83 (0.67–1.0) | 39/775 | 5.0 | 0.85 (0.59–1.2) | 0.85 (0.59–1.2) |
| Times when can’t afford soap in last year | ||||||||
| No | 519/2021 | 25.7 | 1 | 1 | 136/2166 | 6.3 | 1 | 1 |
| Yes | 321/1280 | 25.1 | 0.97 (0.82–1.1) | 0.97 (0.82–1.1) | 65/1355 | 4.8 | 0.75 (0.56–1.0) | 0.75 (0.55–1.0) |
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OR = odds ratio
Table 2
Association between age at menarche and HSV2 and HIV, adjusted for other variables, among 15–30 year-old women in Karonga District Malawi
| HSV2 (N = 3034)* | HIV (N = 3231)* | ||||||
|---|---|---|---|---|---|---|---|
| Adjusted for age | Also adjusted for socio-economic variables | Also adjusted for behavioural variables | Adjusted for age | Also adjusted for socio-economic variables | Also adjusted for behavioural variables | ||
| OR (95% CI) | OR (95% CI)† | OR (95% CI)‡ | OR (95% CI) | OR (95% CI)† | OR (95% CI)‡ | ||
| Age at menarche | |||||||
| <14 | 1 | 1 | 1 | 1 | 1 | 1 | |
| 14 | 0.91 (0.72–1.2) | 0.92 (0.73–1.2) | 0.92 (0.72–1.2) | 0.97 (0.63–1.5) | 0.94 (0.61–1.4) | 0.96 (0.62–1.5) | |
| 15 | 0.73 (0.58–0.91) | 0.76 (0.60–0.95) | 0.77 (0.61–0.98) | 0.68 (0.44–1.0) | 0.64 (0.41–0.98) | 0.65 (0.42–1.0) | |
| ≥16 | 0.70 (0.54–0.89) | 0.75 (0.58–0.97) | 0.77 (0.59–1.0) | 1.2 (0.79–1.8) | 1.1 (0.69–1.6) | 1.1 (0.70–1.7) | |
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*
To allow the effects of these potential mediators to be explored fully, the analysis is restricted to individuals with no missing data for the factors included.
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†
age, schooling, occupation, lack of food.
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‡
age, schooling, occupation, lack of food, marital status, lifetime number of partners.
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Earlier menarche is associated with a higher prevalence of Herpes simplex type-2 (HSV-2) in young women in rural Malawi
eLife 3:e01604.
https://doi.org/10.7554/eLife.01604
