Knowledge, attitudes, and practices of Saudi physicians regarding cervical cancer and the human papilloma virus vaccine

A systematic review and meta-analysis on parental uptake and willingness to vaccinate children against human papillomavirus in the Eastern Mediterranean Region

BACKGROUND

Despite the availability and benefits of the Human papillomavirus (HPV) vaccine, parental acceptance remains low in the eastern mediterranean region (EMR). Therefore, this meta-analysis aimed to estimate the pooled proportion of parental uptake and willingness to vaccinate their children with the HPV vaccine and their determinants in the EMR.

METHODS

We searched PubMed Central, PubMed Medline, Scopus, Web of Science, ProQuest, Google Scholar, and medRxiv according to PRISMA guidelines until the 5th of April 2024. We included all papers discussing parental uptake and willingness to vaccinate their children with the HPV vaccine in EMR without time or language limitations. The study risk of bias was assessed using the Newcastle-Ottawa Scale quality assessment tool. We pooled data using the random effect model. Leave one sensitivity analysis, subgroup analysis, and meta-regression were used to address heterogeneity.

RESULTS

Out of 1551 screened studies, thirty-three studies of 18,455 parents from 12 countries fully met the inclusion criteria and were eligible for meta-analysis. The pooled proportion of parental willingness for future HPV vaccination, based on 32 studies involving 17,815 parents was 61 % (95 % CI: 54-68 %, I2 = 99 %). Using meta-regression, the proportion of working parents, study quality, and geographical region explained approximately 52.46% of the observed heterogeneity. In contrast, based on 9 studies involving 5029 parents, the pooled proportion of parental uptake was 7 % (95 % CI: 5-10 %, I2 = 91 %). Using meta-regression, study quality and geographical region explained 71.42% of the observed heterogeneity.

CONCLUSION

Despite the high parental willingness for HPV vaccination, the uptake of the vaccine in EMR remains critically suboptimal and far behind the goal of the World Health Organization's cervical cancer elimination strategy. Urgent interventions are needed, including adding the vaccine to the national vaccination programs (NVPs) and tailoring parents-targeted awareness campaigns to improve knowledge and address barriers to vaccine uptake.

HPV vaccination knowledge, attitude, and practices among physicians in a teaching hospital, Karachi

Context

Cervical cancer is a global public health problem. It is the fourth most common cancer in women globally. Human papillomavirus (HPV) vaccine has reduced the incidence of HPV-related illness in the past decade. However, for the vaccination programs to be successful, recommendation by the primary care physicians is essential.

Aims

The aim of this study was to evaluate the knowledge, attitude, practices, and barriers toward HPV vaccination among physicians practicing at a teaching hospital in Karachi, Pakistan.

Settings and Design

This is a cross-sectional study carried out with a sample size of 165 among doctors practicing in Family medicine, Internal medicine, Pediatrics, and Gynecology outpatient clinics at a teaching hospital.

Methods and Material

Physicians were approached in outpatient clinics, and a pilot-tested coded questionnaire was filled by them. Statistical Analysis Used: Data were analyzed using SPSS version 19.

Results

Results show 22.4% males and 77.6% females participated in the study. 20% were internists, 35.2% were family physicians, 18.8% were pediatricians, and 26.1% were gynecologists. In terms of knowledge, 67.2% physicians showed good knowledge. In terms of attitude, it was found that 90.9% of physicians showed positive attitude toward prescribing HPV vaccine. However, only 37.5% physicians prescribed HPV vaccine to patients. Cost of vaccine, time constraints, and lack of knowledge among female patients were recognized as the most common barriers against prescribing the vaccine.

Conclusions

From these results, we can infer that overall practices of our physicians are lacking, with respect to prescribing the HPV vaccine. Positive attitude should be taken as an advantage, and overcoming the barriers should be considered as the next step for improvement of our practice.

Awareness and knowledge of human papillomavirus, vaccine acceptability and cervical cancer among college students in Saudi Arabia

Human papillomavirus (HPV) is the most prevalent sexually transmitted infection among teenagers and young adults. HPV vaccination and screening are vital preventive measures to reduce the incidence of HPV-related complications, including cervical cancer. Given the rising global incidence of cervical cancer, understanding the factors influencing awareness and knowledge among young adults in Saudi Arabia is essential for developing effective prevention strategies. This study investigates the levels of awareness, knowledge, and vaccine acceptability regarding HPV and cervical cancer among college students in Saudi Arabia. A cross-sectional study was conducted between May and September 2023 among 442 students in Saudi Arabia using a structured questionnaire to assess their knowledge and awareness of HPV, HPV vaccination, and cervical cancer. Multivariate logistic regression analysis was employed to examine the associations between predictor and dependent variables. Among participants, 54.1% were aware of HPV, and 66.5% had heard of cervical cancer. However, only 17% correctly identified HPV16 and HPV18 as high-risk genotypes for cervical cancer. Awareness of the HPV vaccine was reported by 36.2% of participants, with just 10% having received the vaccine. Female students exhibited significantly higher knowledge levels than males (p = .018). The primary barrier to vaccination was identified as a lack of education and awareness (80.1%). The study highlights a significant gap in knowledge and awareness regarding HPV, its vaccine, and cervical cancer among college students in Saudi Arabia. Targeted educational programs and awareness campaigns are essential to enhance understanding and promote preventive practices, including vaccination and regular screening.

Awareness and acceptance of human papillomavirus vaccine in the Middle East: A systematic review, meta-analysis, and meta-regression of 159 studies

Cervical cancer, closely linked to human papillomavirus (HPV) infection, is a major global health concern. Our study aims to fill the gap in understanding HPV vaccine awareness and acceptance in the Middle East, where national immunization programs are often lacking and cultural perceptions hinder acceptance. This systematic review and meta-analysis adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive literature search across several databases was conducted on 5 September 2023. We included quantitative studies on HPV vaccine awareness and acceptance in Middle Eastern countries. Data extraction and quality assessment were conducted independently by multiple reviewers to ensure accuracy. Statistical analyses, including subgroup analyses, were performed using R to calculate pooled estimates, assess heterogeneity, and publication bias. We reviewed 159 articles from 15 Middle Eastern countries, focusing on 93,730 participants, predominantly female and healthcare workers. HPV vaccine awareness was found to be 41.7% (95% CI 37.4%-46.1%), with higher awareness among healthcare workers. The pooled acceptance rate was 45.6% (95% CI 41.3%-50.1%), with similar rates between healthcare and non-healthcare workers. Our study highlights the critical need for increased HPV vaccine awareness and acceptance in the Middle East, emphasizing the importance of integrating the vaccine into national immunization programs and addressing cultural and religious factors to improve public health outcomes.

Human PapillomaVirus Vaccine Uptake: Attitudes and Practices Among Moroccan Physicians

In Morocco, cervical cancer is a serious public health problem with an estimated number of 2165 new cases and 1199 deaths in 2020. The human papillomavirus (HPV) vaccine has been available in Morocco since 2008. Few data are available on physicians' practices and attitudes toward HPV vaccine. Hence, this study aims to evaluate physicians' awareness and practice towards HPV vaccine and to highlight the main factors affecting physicians' recommendation of this vaccine in Morocco. We have carried out a structured interviewer-administered questionnaire with 500 physicians in different Moroccan regions between March 2019 and March 2020. This study showed an insufficient level of awareness of the two most common types of HPV associated with cervical cancer (36.6%). The rate of HPV vaccine recommendation did not exceed 16.6%. However, more than 63% of participants who were aware of HPV vaccine were willing to recommend it for their future eligible patients. Age (p value < 0.01), sector of activity (p value < 0.01), awareness of the two most common types of HPV associated with genital warts (p value = 0.02), of the vaccine schedules (p value = 0.03), and of the commercial name of this vaccine (p value < 0.01), were significant factors influencing physicians' recommendation of HPV vaccine. Our results showed that, older age (above 51 years old) was associated with negative attitude towards the recommendation of this vaccine (OR: 0.17, 0.06-0.46 CI 95%). Practice in public sector was positively associated with recommendation of HPV vaccine (OR: 7.54, 3.38-16.80 CI 95%). Who were aware of the two most common types of HPV associated with genital warts were more likely to recommend HPV vaccine (OR: 3.36, 1.31-8.65 CI 95%). In the same line, participants, who were also more likely to recommend the vaccine, were those who were aware of HPV vaccine schedules (OR: 6.07, 3.51-10.50 IC 95%); participants who were aware of the commercial name of the HPV vaccine were more likely to recommend the vaccine (OR: 10.04, 5.02-20.09 IC 95%). Indeed, raising physicians' awareness is urgently needed to improve HPV vaccine coverage within Moroccan population.

Assessment of Knowledge, Awareness, and Practices of Human Papillomavirus Infection and Vaccination Among Medical and Dental Students: A Cross-Sectional Study

Introduction Human papillomavirus (HPV) is the most common causative agent for cervical cancer (CC) in women. Despite extensive initiatives, the acceptance and implementation of vaccinations have remained inadequate, hindering a significant impact on public health outcomes. This study aimed to provide a comprehensive assessment of the knowledge, awareness, and practices (KAP) scores of medical and dental students regarding HPV infection and vaccination. Materials and methods A cross-sectional online survey was conducted among 580 students, including 290 Bachelor of Dental Surgery (BDS) students and 290 Bachelor of Medicine, Bachelor of Surgery (MBBS) students. The questionnaire comprised four distinct sections: the demographic section encompassed variables including age, gender, academic year, field of study, and vaccination status. The knowledge assessment section featured eight multiple-choice inquiries, the awareness assessment incorporated eight multiple-choice items, and the practice assessment consisted of four questions using a 5-point Likert scale. Google Forms links, accompanied by a set of instructions and consent forms, were randomly dispatched via WhatsApp to the participants. Data was subjected to statistical analysis. Results A total of 416 responses were obtained (180 BDS and 236 MBBS), amounting to a 71.2% response rate. MBBS participants had a significantly higher mean knowledge score of 7.14 than BDS participants (6.38) (p = 0.001). Males exhibited a significantly higher mean knowledge score than females (p = 0.009). Across the study years, the highest mean knowledge score was observed among first-year students, with a significant difference among years (p = 0.001). For awareness scores, MBBS participants had a significantly higher mean score of 6.90, compared to the BDS participants of 6.36 (p = 0.001). Regarding practice, MBBS participants had a significantly higher mean score of 16.02 than BDS participants of 15.18 (p = 0.001). The study year displayed the strongest correlation with knowledge (r = 0.39), while the correlations with awareness (r = 0.13) and practice (r = 0.01) were found to be weak. Conclusions Low KAP scores were observed in both medical and dental students for HPV infection, CC, and vaccination.

Predictors of Human Papillomavirus (HPV) Vaccine Acceptability Among Physicians, Their Knowledge on Cervical Cancer, and Factors Influencing Their Decision to Recommend It

Introduction

In Saudi Arabia, the HPV vaccine is administered to young females through school-based immunization programs; however, the program's efficacy depends on parental consent, with physicians acting as primary determinants in parental decision-making regarding HPV vaccination.

Methods

In this cross-sectional study, we recruited 128 physicians and assessed their knowledge and attitudes toward cervical cancer, HPV, and the HPV vaccine, and unraveled predictors of HPV vaccine acceptability and factors that would influence recommending the vaccine.

Results

Although the major factor that influenced recommending the vaccine negatively was the fear of vaccine side effects, a positive influence of the physician's personal reading (91%), recommendations from colleagues (88%), and government directives (87%) provided reassurance and increased confidence in recommending the vaccine. Longer clinical experience and institutional awareness were found to be a predictors of favorable recommendation of HPV vaccination. Physicians in vaccine-related medical specialty with more than 4 years of experience were 5 to 6 times more likely to have positive attitude and better knowledge regarding HPV and HPV vaccination. A notable finding was that participants who reported knowing a woman suffering from cervical cancer had more positive attitudes compared to those who did not.

Discussion

This study identified physicians' personal reading, peer recommendations, and government directives as factors affecting the physicians' decision to recommend HPV vaccine, and found that longer clinical experience and institutional awareness were predictors influencing physicians to recommend the vaccine. It also emphasizes on the influence of healthcare providers in promoting the HPV vaccination and the need for designing interventions targeting specific demographic and professional groups that would be more effective in improving better knowledge and promoting positive attitudes towards these critical public health issues.

Barriers and Enablers of Cervical Cancer Screening Among Saudi Women

BACKGROUND

Cervical cancer is a significant global health issue, with low screening uptake rates in many regions, including Saudi Arabia. This study sought to understand the barriers and enablers of cervical cancer screening among Saudi women, particularly in Makkah, Saudi Arabia.

OBJECTIVES

To identify barriers and enablers influencing cervical cancer screening uptake among Saudi women.

METHODS

This cross-sectional study was conducted in Makkah, Saudi Arabia, among 418 Saudi women aged 21-65. A questionnaire collected data on demographics, reproductive health, service utilization, and attitudes toward cervical cancer screening. Statistical tests such as the chi-square test and Mann-Whitney test were used for inferential analyses to determine significance, with a p-value of less than 0.05 considered significant.

RESULTS

 The study identified significant factors influencing cervical cancer screening uptake, including age, marital status, and household monthly income (p<0.001, p<0.001, and p=0.018, respectively). Health conditions such as hypertension, dyslipidemia, and miscarriage history also showed significant associations with screening uptake (p<0.001, p=0.009, and p<0.001, respectively). Additionally, the availability of screening services and encouragement from healthcare providers were linked to higher screening rates (p<0.001 and p=0.006, respectively). However, perceived benefits, barriers, susceptibility, and seriousness were not significantly associated with screening uptake (p>0.05).

CONCLUSIONS

The study identified several demographic and healthcare service utilization factors influencing cervical cancer screening uptake among Saudi women. These findings can be instrumental in informing public health measures, awareness campaigns, and healthcare policies aimed at increasing cervical cancer screening rates in Saudi Arabia.

The Impact of an Educational Program on the Awareness and Knowledge of Human Papilloma Virus (HPV) Vaccine Among Secondary School Girls in Saudi Arabia

BACKGROUND

 The objectives were to assess the effectiveness of the educational program in enhancing students' understanding of the human papillomavirus (HPV) vaccine, correcting misconceptions, and increasing overall awareness. Additionally, the study aimed to identify factors influencing knowledge improvement and willingness to be vaccinated against HPV, including prior knowledge, information sources, session attendance, and school type.

METHODS

In this study, 148 participants were enrolled from secondary schools in Saudi Arabia, and data were collected through pre- and post-educational session assessments, logistic regression analyses, and qualitative investigations. Educational sessions focused on key aspects of the HPV vaccine, including its preventive benefits, administration details, and side effects, tailored to address common misconceptions and enhance understanding among students.

RESULTS

 The study revealed significant improvements in students' knowledge post-educational sessions, particularly in key areas such as cervical cancer prevention, gender recommendations, vaccine administration, and side effect awareness. Prior knowledge, information sources, session attendance, and school type significantly influenced knowledge enhancement and willingness to be vaccinated against HPV. The qualitative analysis provided additional insights into challenges, perceptions, and misconceptions surrounding HPV vaccination, underlining the significance of targeted education and cultural sensitivity in promoting vaccination uptake.

CONCLUSION

 The findings underscored the effectiveness of the educational intervention in enhancing HPV vaccine awareness, dispelling myths, and fostering informed decision-making among Saudi Arabian adolescent populations. The study emphasizes the critical role of tailored educational programs in correcting misconceptions, promoting accurate knowledge, and ultimately increasing vaccination acceptance for improved public health outcomes and disease prevention efforts. Ongoing efforts are essential to sustain and expand educational initiatives to enhance HPV vaccine understanding and adolescent uptake.

Actions speak louder than words; pediatricians, gynecologists, nurses, and other mothers' perspectives on the human papillomavirus vaccine: an Istanbul multicenter study

Introduction

Gynecologists and pediatricians have an essential duty to prevent cervical cancer. In this study, we compared the compliance of gynecologists (n = 22) and pediatricians (n = 49) with nurse/midwife (n = 66) and non-medical moms (n = 120) with regards to cervical cancer precautions.

Methods

A questionnaire was used to gather data on their demographics, personal vaccination and screening practices, children's immunization status, and awareness of cervical cancer prevention.

Results

The findings demonstrated that gynecologists and pediatricians were better than others at understanding the risk factors and prevention of cervical cancer. It was noted that compared to other groups, physician mothers and their offspring had higher vaccination rates (n = 13, 18.3%; n = 10, 29.4%, respectively). Medical professionals typically provided thorough and accurate answers to informational questions. More frequent Pap smear tests were performed by gynecologists. It was noted that mothers who worked as pediatricians and nurses/midwives neglected their own screening needs.

Discussion

This questionnaire survey sought to ascertain Istanbul's health professionals' present opinions regarding HPV vaccination. Healthcare professionals should be the first to receive information on HPV vaccination and cervical cancer incidence reduction. The public could then readily use them as an example.

Knowledge About Cervical Cancer and Awareness About Human Papillomavirus Vaccination Among Medical Students at the Northern Border University, Arar, Kingdom of Saudi Arabia

Objectives To evaluate the knowledge and awareness about cervical cancer and human papillomavirus (HPV) vaccination among medical undergraduates at Northern Border University. Methods It was a cross-sectional study done on students selected conveniently from the College of Medicine, Northern Border University, Arar. The data were collected regarding knowledge about HPV infection and vaccine awareness using a validated questionnaire. Results A total of 200 students responded to the questionnaires, with 104 (52%) being male students and 120 (60%) being clinical years of MBBS. The mean knowledge score was 17.12 ± 2.73 out of 24, which was labeled as moderate knowledge about cervical cancer and HPV. Almost two-thirds of the students responded correctly to the etiology and risk factors of cervical cancer, while only half of the students knew the correct screening intervals for cervical cancer. The awareness of students about the HPV vaccine was deficient, and the mean score was estimated to be 4.20 ± 0.79 out of nine. Female students and students in clinical years showed significantly better understanding and awareness about cervical cancer and its vaccine and showed greater vaccine acceptability as compared to male students and students in preclinical years. Conclusion The present study shows moderate knowledge about cervical cancer but deficient awareness of medical students about the HPV vaccine. However, the students were willing to get educated about cervical cancer and its vaccine and showed a favorable opinion towards vaccinating the schoolgirls and educating their patients as future physicians. The information can be considered a benchmark on knowledge and awareness levels and can be utilized to modify medical curricula and develop efficient awareness programs.

HPV Vaccine Uptake, Willingness to Receive, and Causes of Vaccine Hesitancy: A National Study Conducted in Saudi Arabia Among Female Healthcare Professionals

Background

Epidemiological evidence has shown that human papillomavirus (HPV) is the most frequent cause of sexually transmitted infection, and vaccination is an essential measure to prevent associated diseases and complications. This study aimed to assess the HPV vaccine uptake and its associated factors as well as HPV vaccine hesitancy by female healthcare workers (HCWs) in Saudi Arabia.

Methods

This online, questionnaire-based, cross-sectional study involved female HCWs in Saudi Arabia between July and October 2022. The study tool included questions about sociodemographic, occupational, and reproductive characteristics, uptake of HPV vaccination, and reasons of hesitancy. Chi-squared and t-tests were used for bivariate analyses, and multivariable logistic regression was used to adjust for confounders.

Results

The total number of participants was 1857. Around 20% of HCWs received at least one dose of the HPV vaccine, and around 45% were willing to take it this year. Lower odds of vaccine uptake were reported among older participants and those with a higher level of education. However, nurses, HCWs with a previous HPV infection, those with a family history of cervical cancer, or those with a previous cervical cancer screening test had higher odds of receiving the vaccine. On the other hand, older participants and diploma degree holders were less willing to take the HPV vaccine. Higher odds of willingness were reported in married HCWs, those with a previous HPV infection, those who received a previous HPV vaccine dose, or those who were screened for cervical cancer. Lack of knowledge and some misconceptions were the most reported reasons for hesitancy.

Conclusion

Certain factors that affect HCWs personal decisions to take the vaccine were identified. By targeting these issues, epidemiologists, public health officials and women's health care providers can work to increase HPV vaccine uptake and reduce the burden of HPV-related diseases in this population.

Knowledge, attitude, and practices regarding human papilloma virus vaccination among physicians in Qatar

BACKGROUND

The human papilloma virus is a global problem that affects sexually active women and men, with cervical cancer being the most serious associated disease. Most cervical cancer cases can be prevented by vaccination against the human papilloma virus early in life. The objective of this study was to assess the knowledge, attitudes, and practices among physicians working in Qatar, regarding the human papilloma virus, infection, and prevention using vaccines.

STUDY-DESIGN

This was a cross-sectional study using quantitative data collection.

METHODOLOGY

An online survey targeting physicians working in Qatar was conducted, using a web-based pretested questionnaire. The questionnaire comprised four sections capturing a few demographic details, 33 questions in the Knowledge Section, 12 questions eliciting the attitude, and 14 practice-related questions. Mean knowledge score was calculated and those with a score more than the mean score were considered to have sufficient knowledge. Association between knowledge and attitude/practices/independent variables were looked for using bivariate and multivariate analysis. Logistic regression was used to identify the predictors for recommending human papilloma virus vaccines.

RESULTS

Of the 557 physicians who participated, 83.7% had sufficient knowledge, but only 69.1% knew that human papilloma virus vaccines were available in Qatar. The majority (89.4%) knew that human papilloma virus infection could be asymptomatic and 96.1% knew at least one symptom; 77% believed the human papilloma virus vaccine would substantially decrease the chances of human papilloma virus infection and related cancers and 46.5% felt physicians were less motivated to promote the human papilloma virus vaccine. The perceived barriers to community acceptance of the human papilloma virus vaccine were lack of awareness regarding the relationship between human papilloma virus and cervical cancer (61.6%), doubts regarding efficacy (32.5%), fear regarding safety (26.9%), concern that the human papilloma virus vaccination may encourage risky sexual behavior (26.8%), and perceived low-risk (23.3%) and cost (24.6%). Only 21.5% commonly discussed sexual health with their clients. More than one-third were not interested in recommending the human papilloma virus vaccine. Bivariate analysis showed nationality, specialization, discussing with patients, and recommending vaccine to be significantly associated with knowledge. Bivariate and regression analysis identified that female gender and physician's religion were significant predictors to recommend the human papilloma virus vaccine.

CONCLUSION

Most physicians have good knowledge. Less than one-fourth commonly discussed sexual health with their clients. More than one-third were not interested in recommending the human papilloma virus vaccine. This issue might affect the human papilloma virus vaccination program implementation if not well addressed.

Knowledge, Attitude, and Practice on Cervical Cancer Prevention among Female University Students in AlKharj, Saudi Arabia

Background

Cervical Cancer (CC) is the fourth most frequent malignancy worldwide among females with significant death rates. It ranks as the 8th most frequent cancer in Saudi female. CC is preventable, with likelihood of full treatment by early detection, because of its long pre-invasive period. Lack of awareness and practice on CC prevention and screening increase the risk of disease.

Objective

to examine knowledge, attitude, and practice on CC prevention among Saudi female university students.

Methods

A facility-based cross-sectional study with a convenience sample included 594 female university students studying at health and non-health colleges of Prince Sattam bin Abdulaziz University in Al-Kharj City, Saudi Arabia. All female students were asked to complete an online questionnaire on knowledge, attitude, and practice on CC prevention.

Results

A total of 594 respondents to the questionnaire, 88.7% of them had unsatisfactory knowledge about CC. Out of a total of 27 points, students' knowledge mean score was 9.3 ± 6.4. Conversely the majority of students (94.4%) had positive attitude toward CC; the mean attitude score was 34.52 ± 5.04 out of 45. Regarding students practice, less than 7% of students were vaccinated against HPV and only 3.7% were screened for cancer cervix. Married females, health colleges students, and high attitude score were significant predictors for the students' knowledge about cancer cervix (P < 0.05).

Conclusion

Majority of the respondents displayed lack of knowledge; however, they had a positive attitude toward CC. Very alarmingly, almost all of students had inadequate practice regarding CC prevention. So, the study recommends developing and implementing educational programs and strategies for female university students to improve their knowledge and practice related to cervix cancer. Results of this study provide evidence that can help in formulating effective awareness strategies and educational programs for women that would help in CC prevention.

Determinants of human papillomavirus vaccine hesitancy among Lebanese parents

INTRODUCTION

Human papillomavirus (HPV) is the most common sexually transmitted infection. HPV is responsible for cancer of cervix uteri. Despite its safety and immunogenicity, HPV vaccine hesitancy is one of the most challenging topics that pediatricians face.

METHODS

We aimed to describe the impact of knowledge, attitude, and practice towards vaccines in general, on practice related to HPV vaccination in Lebanon. A questionnaire addressed to parents of students (3-18 years of age) was distributed in 2 public and 2 private schools randomly selected from the greater Beirut area during the school year 2017-2018. Questionnaires covered knowledge, attitude, and practices of vaccination in general and HPV vaccine in particular.

RESULTS

Out of 400 distributed questionnaires, 306 (76.5%) were returned. Of the 185 parents aware of HPV vaccine, 60% hadn't given or were not planning to give the HPV vaccine to their children. Of parents not in favor of HPV vaccine, 7.5 thought that vaccines aren't necessary versus none among those in favor of HPV vaccine(p = 0.02). Thirteen percent of those not in favor of HPV vaccine thought that vaccines are not safe versus 2.7% in the group in favor (p = 0.02). An effect of gender on vaccine acceptance was noted: mothers vs fathers and daughters vs sons. Lack of recommendation by pediatricians and the thought that too little is known about the vaccine were the most selected reasons for parents not wanting to vaccinate their children against HPV, whereas cost and religious and cultural beliefs seemed to have no impact.

CONCLUSION

Most parents in our study did not vaccinate or weren't willing to vaccinate their children against HPV even when they were in favor of vaccines in general. Physician recommendation was shown to be one of the most important predictors of vaccination. Effort should be put into educating parents about the importance of the vaccine and its well-established safety and efficacy regardless of gender. Lebanese physicians should also be educated and empowered to recommend HPV vaccine more strongly and consistently.

Awareness and knowledge of physicians and residents on the non-sexual routes of human papilloma virus (HPV) infection and their perspectives on anti-HPV vaccination in Jordan

BACKGROUND AND OBJECTIVES

Although penetrative sex is the most common route of HPV infection, there is strong evidence of non-sexual modes of transmission. As the first of its kind, this study aimed to investigate the knowledge and awareness of Jordanian physicians on such routes.

METHODS

A questionnaire was conducted among a national Jordanian sample of physicians from Jordanian health sectors. The survey included questions assessing participants' knowledge on HPV, non-sexual routes of infection and HPV vaccines. Physicians' attitudes towards HPV screening and vaccination were covered. Statistical analysis was carried out using SAS 9.4, ANOVA, post-hoc Tukey-Honest test and Kruskal-Wallis test. All significant differences were set at α = 0.05.

RESULTS

A total of 412 participants completed the survey. Physicians showed a huge deficit in knowledge on nonsexual routes of HPV transmission. They agreed that the most and least common routes of non-sexual transmission are skin to mucosa (64%) and contaminated water (15%), respectively. Females showed significantly better knowledge in all aspects of HPV transmission and vaccination (p<0.0001) and more positive attitudes towards HPV screening and vaccination compared to males (p = 0.03). Age group ≤ 25 and academic physicians demonstrated higher knowledge on HPV vaccines compared to their counterparts in non-academic places (p = 0.002). Specialty and experience seemed to have no impact on knowledge or attitudes of participants. Higher knowledge physicians had more positive attitude towards vaccination and screening compared to lower knowledge fellows (p<0.001).

CONCLUSIONS

The noteworthy findings of this study is the extremely low level of knowledge on non-sexual routes of HPV infection among Jordanian physicians. Increasing the level of awareness of physicians and healthcare workers on these routes and their association with cervical and other cancers through university curricula and other reliable sources is strongly recommended.

Natural and synthetic drugs and formulations for intravaginal HPV clearance

BACKGROUND

Except for a few preventative Human Papillomavirus (HPV) vaccines, there is currently no cure for HPV infection. There are a number of cutting-edge strategies and potent medications or herbal formulations that can be applied topically for early clearance of HPV infection before HPV DNA gets integrated into host cell genome. This is facilitated due to cervical cancer having distinct and well-recognized long precancerous stages.

OBJECTIVES

This review aims to outline every possible medication and formulation, both natural and synthetic, that can be applied topically as intravaginal application to help remove HPV infection at an early precancerous stage.

RESULTS

Several anti-HPV/HPV clearance compounds and formulations for high-grade lesions are undergoing clinical trials. However, the majority of compounds are still in the early stages of development and require additional research to become viable HPV clearance candidates. Synthetic drugs may be more promising because they may have a more targeted effect; however, they may also have significant adverse effects. On the other hand, natural medications are safer to use. They are less specific, but have minimal to no adverse effects.

CONCLUSIONS

This article may serve as a valuable resource of information for managing and preventing precancerous carcinogenic HPV infections. Research could be directed toward developing candidate drugs to make evidence-based decisions about advancing them to clinical trials and, eventually, to the market for potential use in the prevention and control of cervical cancer, which is almost always preventable or even curable if detected early.

Knowledge, Attitude, and Practice of Vaccination Among Parents in Jeddah City, Saudi Arabia

Background Vaccine misconception plays an important role in delaying vaccination for children, which can lead to serious health problems. Assessing the knowledge, attitude, and practice (KAP) and potential associated factors among Saudi parents of preschool and school-age children and adolescents for all types of vaccines would help increase vaccine coverage. Methodology This cross-sectional, questionnaire-based survey was performed among parents in Jeddah, Saudi Arabia. The study enrolled all Saudi parents visiting primary healthcare centers (PHC) in Jeddah with their children aged 3-18 years old. A self-administered questionnaire in Arabic was used to assess KAP. Descriptive statistics were performed, and the chi-square test was used to assess the association between KAP and sociodemographic factors with significance set at p-values <0.05. Results Out of 301 participants, 68.1% were mothers, and 55.8% of children were female. The largest percentage (81.7%) of the parents were aged between 31 and 50 years old. Although 94.4% of the parents agreed or strongly agreed that childhood vaccines protect their children from serious diseases, 26.6% of parents agreed or strongly agreed that vaccines can potentially cause autism, and 18.6% believed they could lead to learning difficulties. Most parents (67.4%) were in favor of vaccination, while others were hesitant about vaccinating their children and believed in alternative methods of disease prevention. About one-third knew other parents who did not vaccinate their children for religious, ideological, or cultural reasons. Sociodemographic factors such as gender (p = 0.042), educational level (p = 0.017), nationality (p = 0.001), and first child (p = 0.013) had some influence on parents' beliefs and knowledge about vaccination, while the number of children (child order) (p = 0.022) and parents' education level were associated with hesitancy (p = 0.028). Conclusions These findings show that most parents had good KAP toward vaccination, influenced by sociodemographic factors. However, there is a need to address vaccination hesitancy by acting on identified contributing factors.

Knowledge about human papillomavirus transmission and prevention among physicians in Rio de Janeiro state, Brazil

OBJECTIVE

This study aimed to assess physicians' knowledge about human papillomavirus infection and its prevention.

METHODS

Descriptive web-based survey with 15 objective questions targeted to physicians affiliated with the Regional Council of Medicine from Rio de Janeiro state, Brazil. Participants were invited by e-mail and the Council social networks, between January and December 2019.

RESULTS

The study sample had 623 participants, with a median age of 45 years, predominantly women (63%). The most frequent specialties were Obstetrics and Gynecology (21.1%), Pediatrics (11.2%), and Internists (10.5%). Concerning human papillomavirus knowledge, 27.9% of the participants were able to identify accurately all possible forms of transmission, and none of them could recognize all the risk factors of infection. Nevertheless, 95% recognized that asymptomatic infection could occur in both sexes. Regarding knowledge about clinical manifestations, diagnosis, and screening, only 46.5% were able to identify all human papillomavirus-related cancers, 42.6% were aware of the periodicity of Pap smears, and 39.4% indicated that serological test was not adequate for diagnosis. The recommended age group for human papillomavirus vaccination was recognized by 94% of the participants, as well as the need for a Pap smear and the use of condoms, even after vaccination.

CONCLUSIONS

There is good knowledge about prevention and screening for human papillomavirus infections; many gaps were identified regarding transmission, risk factors, and associated diseases among physicians in Rio de Janeiro state.

Knowledge, Attitudes and Practices Towards Human Papillomavirus Vaccination Among Medical Doctors at a Tertiary Hospital: A Cross Sectional Study

Background

Human papillomavirus (HPV) infection is a common sexually transmitted disease, characterised by persistent infection with high-risk strains leading to malignant conditions such as cervical cancer. The HPV vaccine is a well-known primary preventive measure for HPV infections. Previous studies have shown that medical doctors’ vaccine recommendation is one of the key strategies in improving HPV vaccine uptake. In 2019, Zambia rolled out the free national HPV vaccination program targeting 14-year-old girls. However, the annual coverage for HPV vaccination is variable, with rates as low as 33% for 2021.

Materials and Methods

We conducted a cross-sectional study between September and December 2020 at the University Teaching Hospitals in Lusaka, Zambia. We used analysis of variance to assess the mean differences in the overall scores for knowledge, attitude and practices towards the HPV vaccine. In addition, we used structural equation modelling (SEM) to test the traditional education theory as medical doctors’ HPV vaccine knowledge, attitude, and practices cover several facets, and SEM can model latent variables.

Results

We enrolled 121 medical doctors, of whom 67 (44.6%) were male. The majority, 76 (62.8%), were registrars and 79 (65.3%) had more than ten years of clinical experience. The overall mean knowledge, attitude, and practice score of the HPV vaccine mean (SD) were 70.2 (15.1), 72.1 (18.5) and 77.1 (28.9), respectively. More than half of the medical doctors would advise anyone eligible to take the HPV vaccine 66 (54.6%). There was a positive correlation between attitude and practice towards the HPV vaccine (β = .03, P = .017). Conversely, there was no evidence of a correlation between overall HPV knowledge and attitude (β = .01, P = .670) and rank of the medical doctors (β = −7.87, P = .355).

Conclusion

Knowledge was high with good attitudes and practices among medical doctors, which are vital in vaccine recommendation and subsequent uptake.

Impact of Parental Knowledge and Beliefs on HPV Vaccine Hesitancy in Kenya-Findings and Implications

Cervical cancer can be prevented by human papillomavirus (HPV) vaccination. However, parents can have concerns about vaccinating their daughters. Consequently, there is a need to identify prevalence and risk factors for HPV vaccine hesitancy among parents in Kenya. A descriptive cross-sectional study was conducted among parents with children aged 9−14 years attending a leading referral hospital in Kenya. Data on sociodemographic traits, HPV knowledge, beliefs and vaccine hesitancy were collected. Out of 195 participants, 183 (93.5%) were aged >30 years. Thirty-four (46.4%) of males and 39 (35.1%) of females did not know that the vaccine is given to prevent HPV infection. Encouragingly, levels of vaccine acceptance were high (90%) although one-third (37.9%) had a negative perception about the effectiveness of the vaccine, with vaccine hesitancy attributed to safety concerns (76%) and feelings that the child was too young (48%). Positive beliefs and knowledge of the vaccine were positively associated with parental willingness to vaccinate their children. Low levels of parenteral education and a younger age among mothers were negatively associated with willingness to vaccinate. Most parents (59%) would consult their daughters before vaccination, and 77% (n = 150) recommended early sex education. Despite low knowledge levels, there was high parental willingness to have their children vaccinated.

Knowledge, attitudes, and practices among Indonesian urban communities regarding HPV infection, cervical cancer, and HPV vaccination

Background

Few studies explored Indonesian understanding of cervical cancer (CC) and the human papillomavirus (HPV) vaccination. We aimed to investigate the association between knowledge, attitudes, and practices (KAP) and socio-demographical influences related to HPV, CC, and vaccination among Indonesian urban citizens.

Methods

We conducted an online survey during March 2020-August 2021 using the Snowball sampling technique. The socio-demographic characteristic and KAP responses were collected via Google Forms from 400 respondents in Jakarta. The knowledge and attitudes were divided into HPV and CC (aspect 1) and HPV vaccination (aspect 2). Correlation between KAP scores was performed using Spearman’s test, and multiple logistic regression analyses were conducted to determine KAP predictors.

Results

Indonesian urban citizens in Jakarta were found to have poor knowledge in individual aspects of the inquiry but moderate knowledge overall, good attitude in inquiry both in each aspect and overall, and unsatisfying practices. Overall, in the general population, men, and women respectively: 50.8%, 32.4%, and 53.6% had good knowledge; 82.0%, 75.2%, and 84.4% expressed positive attitude; and 30.3%, 15.2%, and 35.6% applied favorable practice regarding questions inquired. Knowledge was weakly correlated towards attitude (ρ = 0.385) but moderately correlated with practice (ρ = 0.485); attitude was moderately correlated with practice (ρ = 0.577), all results: p<0.001. Significant odds ratio (OR) for predictors to good knowledge were female sex (OR = 2.99), higher education (OR = 2.91), and higher mother’s education (OR = 2.15). Factors related to positive attitudes were higher mother’s education (OR = 4.13), younger age (OR = 1.86), and better results in the knowledge inquiries (OR = 2.96). Factors that suggested better practices were female sex (OR = 2.33), being employed (OR = 1.68), excellent knowledge scores (OR = 4.56), and positive attitudes expressions (OR = 8.05). Having done one vaccination dose and intention to receive vaccines were significantly influenced by good KAP.

Conclusions

KAP had inter-association to successful CC and HPV prevention programs, and socio-demographical characteristics are critical to influencing better KAP.

Knowledge, attitudes, and perception toward human papillomavirus among health profession students: A cross-sectional study in King Saud Bin Abdulaziz University for Health Sciences

BACKGROUND

Human papillomavirus (HPV) infection is the major risk factor for cervical cancer (CC) in women of reproductive age. Despite advances in treatment and prevention of CC by HPV vaccination, very few women utilize them because of a lack of awareness about HPV.

MATERIALS AND METHODS

We conducted this cross-sectional study among Health Professions Students (HPS) at King Saud Bin Abdul Aziz University for Health Sciences, Jeddah. Data were collected using a predesigned and validated study questionnaire to assess the knowledge, attitude, and perception of HPS toward HPV.

RESULTS

A total of 580 HPS responded to the survey; 128 (22.1%) were male, while 452 (77.9%) were female with the mean age ± standard deviation 20.36 ± 1.74 years. There was no significant difference between males and females related to screening of HPV and CC (82.8%; 82.3%). A minority (30.3%) of participants thought that HPV infection leads to CC, while 38.3% did not know about it. Furthermore, knowledge about HPV screening and vaccination was poor.

CONCLUSIONS

Students from the college of medicine had more knowledge and awareness about HPV (34.9%, P < 0.001). Thus, it is important to implement effective education programs, curricular activities, and awareness campaigns for health professions to augment the learning process effectively.

Cervical Cancer and Its Screening: Assessing the Knowledge, Awareness, and Perception among Health and Allied Students

Background. Cervical cancer (CC) is the fourth most common cancers affecting women. It being preventable, a robust and effective national education cum screening program is the key to curb its increasing incidence. Objectives. This cross-sectional study was designed to investigate the knowledge, awareness, and perceptions (KAP) towards CC etiology, its signs and symptoms and risk factors among Health Professions Students’ (HPSs) in King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Jeddah Campus. Methods. Data was collected using predesigned and validated study questionnaire. The respondents’ KAP were compared across gender, colleges, and levels of education. Data analysis was done using SPSS v 20.0 (IBM Corporation) at 95% CI. Results. A total of 580 HPS responded to the survey, 128 (22.1%) were males, while 452 (77.9%) were females with the mean   age ± SD 20.36 ± 1.74 years. Although 70% of the respondents had heard about CC, but only 27.9% and 18.6% knew that CC is common among women and it is transmissible, respectively. Additionally, the knowledge of relationship between viral infection and vaccination was also dismal (34.1%) and only 18.6% of the students had knowledge that CC was a transmissible disease. Interestingly, students from college of medicine had more knowledge and awareness about CC ( p < 0.05 ). Conclusions. Since HPSs had considerable low knowledge about CC, we identify the dire need to implement an effective education programs, curricular activities, and awareness campaigns for HPSs as well as general population to augment the learning process effectively.

Knowledge and Attitude Towards Human Papillomavirus Vaccine and Associated Factors Among Mothers Who Have Eligible Daughters in Debre Markos Town, Northwest Ethiopia

Purpose

This study aimed to assess knowledge and attitude towards the human papillomavirus vaccine and associated factors among mothers who have eligible daughters.

Methods

A community-based cross-sectional study with a total sample of 601 study participants was conducted in Debre Markos town from February to March 2021. The study participants were selected using a multistage sampling technique from mothers who have eligible daughters. The data was collected using an interview administration questionnaire. The data were entered into EPI data version 3.1 then, exported to SPSS version 25 for analysis. Variables with a p-value of < 0.25 in bivariate were a candidate for multivariate and those variables with a p-value of <0.05 in multivariate binary logistic regression were considered as a statistically significant factor for knowledge and attitude of the HPV vaccine.

Results

A total of 601 study participants with a response rate of 100% were included in the study. Among participants in this study, 47.6% have good knowledge and 77.4% have a positive attitude towards the HPV vaccine. Knowledge of mothers about HPV vaccine was affected by having degree and above (adjusted odds ratio (AOR) =7.687; 95% CI=1.837–32.168; p=0.005), did not hear about HPV vaccine (AOR=0.172; 95% CI=0.098–0.302; P=0.000), and positive attitude towards HPV vaccine (AOR=2.959; 95% CI=1.580–5.539; P=0.001). Attitude of mothers towards HPV vaccine was affected by did not hear about HPV vaccine (AOR=0.285; 95% CI=0.163–0.499; P=000), and good knowledge about HPV vaccine (AOR=2.705; 95% CI=1.454–5.035; 0.002).

Conclusion

Knowledge of mothers who have eligible daughters about HPV vaccine was low. Maternal educational level, hearing about the HPV vaccine, and attitude towards HPV vaccine were significantly associated predictors with knowledge towards HPV vaccine. However, the attitude was high and factors associated with attitudes towards the HPV vaccine were knowledge about the HPV vaccine and hearing about the HPV vaccine. An integrated work should be considered by Debre Markos town health office with other non-governmental organizations working on health and health-related issues to improve knowledge about the importance of HPV vaccine for mothers who have eligible daughters.

Knowledge about cervical cancer and awareness about human papillomavirus vaccination among medical students in Jordan

Objectives

To assess the knowledge about cervical cancer and HPV infection and the awareness towards and perceived barriers of HPV vaccination amid medical students in Jordan.

Methods

The present study is a cross-sectional survey that was conducted for a period of three months in the College of Medicine at six different universities in Jordan. Third-year to sixth-year students from these medical colleges in Jordan were invited to participate in the study.

Results

There were 504 students that took part in the study with 42.3% being males and 57.7% females. The mean knowledge score of students in our survey was 21.4 ± 4.4 out of 34, which was categorized as a moderate level of knowledge regarding cervical cancer and HPV. Only 40.5% knew about the availability of the HPV vaccine in Jordan, and 65.9% accepted the idea that it is necessary to introduce the HPV vaccine for school girls in Jordan.

Conclusions

This study highlights that there is inadequate knowledge about cervical cancer and its screening among medical students in Jordan. Despite the limited awareness about the HPV vaccine among the study’s participants, there is a favorable opinion towards the introduction of the vaccine for school girls in Jordan. The data provide a benchmark on the level of knowledge about cervical cancer and awareness about HPV, which can be used to formulate an effective awareness program.

Differentiated Impact of Politics- and Science-Oriented Education on Pro-Environmental Behavior: A Case Study of Chinese University Students

The purpose of this study is to understand the differentiated impact of politics- and science-oriented education on pro-environmental behavior among university students. A questionnaire was designed and sent to more than 14,000 university students from 152 universities in China using the snowball sampling method. In the questionnaire, the environmental knowledge was divided innovatively into two parts: Science-oriented knowledge spread by traditional environmental education and politics-oriented knowledge spread through political education. The structural equation model was used to understand the conduction path of pro-environmental knowledge, attitude, and behavior. It shows that politics-oriented knowledge has a quicker and stronger effect on improving behavior than science-oriented knowledge. Moreover, there is a significant positive correlation between science- and politics-oriented knowledge. However, the attitude is positively influenced by science-oriented knowledge, instead of politics-oriented knowledge. It suggests that traditional environmental education and political education should be integrated to promote the pro-environmental behavior of university students indirectly and directly, which may provide an opportunity for pro-environmental political education in other countries. The study contributes important theoretical and practical implications for environmental education and sustainable development.

Knowledge and Attitude Toward Human Papillomavirus Infection and Vaccination among Thai Women: A Nationwide Social Media Survey

Objectives:

This study was performed first to assess Thai women’s knowledge and attitude toward Human papillomavirus (HPV) infection and vaccination and second to find out factors associated with knowledge in this regard.

Methods:

The survey announcement was advertised via Facebook from 17 May 2019 to 14 June 2019 to recruit women aged 18-26 years living in Thailand. A score below 5 out of total score of 10 on the survey was considered as a poor level of knowledge. Multivariate analysis was applied to identify factors associated with HPV infection and vaccination knowledge.

Results:

A total of 1,175 participants were recruited. The participants’ median age was 22 years. Approximately, 46% of the participants had poor level of knowledge regarding HPV infection and vaccination. Factors associated with poor knowledge included low educational level (adjusted OR, 1.35; 95% CI 1.04-1.77), low family income (adjusted OR, 2.14; 95% CI 1.65-2.78), being Christian (adjusted OR, 4.04; 95% CI 1.22-13.40), being engaged in sexual intercourse (adjusted OR, 0.75; 95%CI 0.58-0.97), and being unvaccinated against HPV infection (adjusted OR, 5.74; 95% CI 3.07-10.74).

Conclusion:

Nearly half of the Thai women who participated in the survey had poor level of knowledge regarding HPV infection and vaccination, indicating a need for more effective health education intervention. Factors associated with knowledge included socioeconomic status and sexual behavior.

Human papillomavirus and its vaccination: Knowledge and attitudes among female university students in Saudi Arabia

Context:

College students worldwide have low levels of knowledge on human papillomavirus (HPV)-related diseases, highlighting the lack of awareness about HPV infection. To date, no study has examined the level of knowledge of cervical cancer and the HPV vaccine in the northern region of Saudi Arabia.

Aim:

This study aimed to assess the level of knowledge of cervical cancer and its risk factors, as well as HPV vaccine acceptance among female students in Saudi Arabia enrolled in health colleges.

Methods:

A descriptive cross-sectional survey was conducted using a valid and reliable self-administered questionnaire. The questionnaire was completed by 966 female students enrolled at the University of Hail, northern region of Saudi Arabia, with a response rate of 83.5%. The main outcome measure was the identification of the knowledge gap pertaining to HPV infection and its prophylactic vaccine.

Results:

The findings highlighted a lack of knowledge about cervical cancer, Pap smears, and HPV vaccine among most female university students. The knowledge score positively correlated to the duration of education. Students enrolled in applied medical science and medical colleges showed significantly higher knowledge scores, as did students in their senior academic years. Vaccine uptake barriers included concerns about its side effects and a lack of information.

Conclusions:

Our findings can be used to formulate effective future awareness programs in the northern region of Saudi Arabia. A larger number of educational programs are required to enlighten Saudi women about cervical cancer and its prophylactic vaccine, including the benefits of screening programs and prevention strategies.