Study Population

The datasets without identifiers were extracted from the SPSS files of the

“Individual Recode” type of the Haitian DHS survey. This dataset consisted of a sample size of 10,757 women aged 15 to 49 years old.

3.3. Study Design and Measures

This is a cross-sectional study conducted to assess the distribution of socio-

demographic and economic predictors among high-risk group women for cervical cancer. Pubmed was used to identify co-risk factors associated to cervical cancer. The following key words were used: Uterine cervical neoplasmas, risk factors. Socio- demographic factors and economic predictors to health services were also identified the key word that was used was: accessibility to health services, developing countries. Based on the findings of the literature review, the most relevant variables were selected and recoded. Since the DHS contains no information about cases of cervical cancer, a new

dichotomous proxy variable was created in order to categorize these women into low risk and high risk group to cervical cancer.

A. Predictors Variables:

These were variables informing about the socio-demographic and economic

characteristics of the women that might influence their decision to seek access to health services. They were selected based on the findings of the literature review. Five variables were selected and recoded (See table B).

Education: This variable was named “Education attainment” in the original dataset where

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“Complete primary”, 3= “Incomplete secondary”, 4= “Complete secondary” and 5= “Higher education”

This new variable was recoded into two categories: 0= “No education”, 1= “Educated”. Due to its small sample size the old category named “Higher education” (5) was

combined to the categories: “Incomplete primary education” (2), “Complete primary” (3), “Incomplete secondary” (3) and “Complete secondary” (4). The last category, which in this case was “1”, was considered as the reference group in the univariate analysis.

Wealth: This variable was computed from the variable named “wealth index”. The

“wealth index” variable was originally coded into five categories: 1= “Poorest”, 1= “Poorer”, 2= “Middle”, 3= “Richer”, 5= “Richest”. It was recoded into three categories: 0= “Poor”; 1= “Middle” and 2= “Rich”. The “Rich” group was used as the reference group in the univariate analysis.

Money: This is a new variable created from the variable that assessed whether or not

money was a big problem for a woman in order to go to the health center. Women who gave “no” as an answer to this question were coded as “0” and women who answer “yes” as an answer were coded as “1”. The first group was used as the reference group in the univariate analysis.

Residence: This variable was computed from the variable named “Type of place

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group which is the “Urban” group was used as the reference group in the univariate analysis.

Distance: This is a new variable that was created from the old variable that assessed if

distance was a major problem preventing women from getting a medical advice or treatment. For simplicity purpose it was called “Distance” and was recoded into two categories: 0= “No problem” 1= “Big problem”. The first group was used as the reference group in the univariate analysis.

B. Dependent variable:

The dependent variable was a newly created variable that was called “Risk” it was created to assess whether or not Haitian women were at high or low risk to cervical cancer from three newly created variables (See table C):

1) First a new variable called “Young age at first sexual intercourse” was created. This new variable was created from the old variable called: “Age at first sexual intercourse”. Women, who had their first sexual intercourse when they were less than 20 years old, were considered at higher risk for cervical cancer than the women who had their sexual intercourse at an older age. It was recoded 1= “First sex before 20” and 0= “First sex after 20”.

2) The second new variable, called “Sex partners”, was created from the old variable called: “Total lifetime number of sexual partners”. Women who had more than 2 lifetime sex partners were considered at higher risk for cervical cancer than women who had no lifetime sex partners or 2 lifetime sexual partners were

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considered at low risk. The new variable was therefore coded into 2 categories; 0= “Less or equal to two lifetime sex partners” and 1= “More than two lifetime sex partners”. The cutoff “two” was chosen because the mean number of lifetime sex partners of Haitian women was 2.04.

3) The third new variable, called: “Condom use”, was created from the old variable called: “Can woman ask partner to use condom?”, if the woman said “yes” for this question it was recoded as 0= “yes” and if she responds “no” to this question it was recoded as 1= “no”. A woman who is able to ask her partner to use condom can be considered less vulnerable to cervical cancer than a woman who feels that she in not empowered enough to ask this to her partner.

A new variable called “Risk” was computed and recoded into two categories: 0= “low risk to cervical cancer” and 1= “High risk to cervical cancer”. For a women to be in the first category she had to score “0” for the three above mentioned variables and for a woman to be in the second category she has to score “1” for the three above mentioned categories. This new variable called “Risk” was used as the dependent variable. (See table C)