Knowledge, understanding, attitude, perception and views on HPV infection and vaccination among health care students and professionals in Malaysia

Uptake and determinants of HPV vaccination in South Asia: a systematic review and meta-analysis

Background

Cervical cancer burden in South Asia is among the highest globally. Due to the lack of national immunization programs, the prevalence of human papillomavirus (HPV) infection and vaccine uptake remains unknown. This systematic review and meta-analysis aim to determine the prevalence of HPV vaccine uptake in South Asia.

Methods

We conducted a comprehensive search of MEDLINE (via PubMed), Embase, the Cochrane Library, and the Web of Science, covering the period from inception to May 20, 2024. We included observational studies reporting HPV vaccine uptake in South Asia, without any language filters or restrictions. The search strategy involved MeSH terms and relevant keywords related to "Papillomavirus Infections," "Vaccination," and "Uptake." MetaXL and STATA were used to perform a proportional meta-analysis and meta-regression analysis.

Results

Out of 3,913 articles identified, 17 articles (10,585 participants) were included in the systematic review. The pooled prevalence of vaccine uptake was 8% (95% CI 1-21). There was high heterogeneity between studies (I 2 = 100%). The pooled prevalence of adequate knowledge of the HPV vaccine was 41% (95% CI 28-55, I 2 = 99%). The pooled prevalence of a favorable attitude toward the HPV vaccine was 56% (95% CI 47-66, I 2 = 98%). In the univariate meta-regression model, good knowledge significantly predicted HPV vaccine uptake (p = 0.003), while no covariates were found to be significant predictors of attitudes toward HPV vaccine uptake.

Conclusion

The findings of this meta-analysis indicate a low pooled prevalence of HPV vaccine uptake (8%) in South Asian countries. The pooled prevalence of adequate knowledge and a favorable attitude toward the vaccine were 41 and 56%, respectively. In the univariate meta-regression model, knowledge of the HPV vaccine uptake was the only significant predictor of vaccine uptake.

Systematic review registration

Systematic review is registered at Prospero through the link https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024547393.

Evaluation of female university students' knowledge, attitudes, and practices toward human papillomavirus infection and vaccination. Multicenter cross-sectional study

INTRODUCTION

Having good knowledge and a favorable attitude toward human papillomavirus (HPV) and HPV vaccinations is the cornerstone for increasing the use of HPV vaccinations and preventing cervical cancer. The objective of this study was to evaluate the level of knowledge, attitudes, and practices regarding HPV and HPV vaccinations, as well as to identify associated factors among female undergraduate health science students at both the University of Gondar (UoG) and Bahir Dar University (BDU), Amhara, Ethiopia.

METHODS

Institutional-based multicenter descriptive cross-sectional study was conducted from June 1, 2023, to July 30, 2023. A multistage sampling technique was used to select 633 female undergraduate health science students, and data were collected using a structured, self-administered questionnaire. The data were coded, entered in Epi-data, and exported to SPSS for analysis. Variables with a P-value < 0.25 in the bivariate analysis were inserted in a multivariate logistic regression model, and those with a P-value of < 0.05 in the multivariate binary logistic regression were considered statistically significant factors for knowledge, attitude, and practice regarding HPV and vaccine against it.

RESULTS

The study included 600 participants with a mean age of 20.8 ± 0.75 years. Using Bloom's cutoff points for the KAP study, among the participants, 436 (72.7%) had good knowledge about HPV, whereas 315 (52.5%) had good knowledge about HPV vaccinations. More than half of the participants, 359 (59.8%) heard about HPV vaccinations in Ethiopia. More than half of the participants, 342 (57%) had favorable attitudes toward HPV vaccinations. Only 261 (43.5%) participants believed the HPV vaccine was safe and effective. All participants had never been tested for HPV, and 471 (78.5%) refused to have their samples for regular HPV testing. The factors like ages between 21 and 23 years (AOR, 2.12, 95% CI: 1.22-3.09) and favorable attitudes toward HPV vaccinations (AOR: 1.88; 95%, CI: 1.15-3.41) were associated with the participant's knowledge about HPV vaccinations. Having good knowledge about the virus (AOR: 1.92; 95%, CI: 1.11-5.88) and its vaccine (AOR:1.60; 95%CI: 1.07-2.47) were factors associated with the attitude of the participants about HPV vaccinations. Additionally, HPV vaccination practice was significantly associated with the attitude of the participants toward HPV vaccinations (AOR: 1.85; 95%CI: 1.15-3.45), knowledge about HPV (AOR: 1.18; 95%CI: 0.55-5.50), and HPV vaccinations (AOR: 1.85; 95%CI: 1.08-2.44).

CONCLUSION

This study revealed that half of the students had good knowledge and a favorable attitude toward HPV vaccinations, but there was poor HPV vaccination practice. There is still a need for continued health education, training, and counseling services for students to strengthen HPV vaccination practices, improve students' attitudes and knowledge about the benefits of vaccination, and improve counseling abilities against HPV-induced cancer.

Factors Associated with HPV Knowledge Among Professionals in the City of Francisco Beltrão, Brazil

The human papilloma virus (HPV) is the most common sexually transmitted infection, affecting nearly 50% of the world population. HPV can lead to tissue damage and is associated with many types of cancers. Healthcare professionals' knowledge regarding HPV infection are essential in assuring favorable outcomes for those exposed to HPV, either in prevention or in intervention efforts. In this cross-sectional, population-based study, we explored the levels of HPV knowledge among health professionals in a Brazilian municipality. In total, 260 individuals (90% women), aged 21-66 years (Mean = 40.10 ± 9.30) participated in this investigation and responded to standard questionnaires measuring HPV knowledge as well as sociodemographic and occupational data. Regarding HPV knowledge, 85 (32.8%) individuals were considered to have sufficient knowledge (scored good or very good according to percentile classifications), whereas 174 (67.2%) were labeled as having insufficient knowledge. Mann-Whitney tests showed higher HPV knowledge among those who reported not having children (p = 0.05) and lower levels in the group of community health workers (CHW; p < 0.001). Logistic regression analyses showed that having children (OR = 0.50; 95%CI: 0.26, 0.96) and being a CHW (OR = 0.52; 95%CI: 0.28, 0.97) were independently associated with insufficient knowledge about HPV. In conclusion, data reported in this study might aid in understanding factors associated with HPV management given the evidence collected from healthcare professionals, suggesting strategies to promote both health education and promotion.

A Scoping Review of Knowledge, Awareness, Perceptions, Attitudes, and Risky Behaviors of Sexually Transmitted Infections in Southeast Asia

This scoping review synthesizes literature to examine the extent of research focusing on knowledge, awareness, perceptions, attitudes, and risky behaviors related to sexually transmitted infections (STIs) in Southeast Asia (SEA). The PRISMA-Scoping approach was adopted targeting articles published from 2018 to 2022, sought from CINALH, PubMed, Web of Science and Scopus. A process of screening and elimination resulted in a total of 70 articles reviewed. Most of the studies were conducted in Indonesia, Thailand, Vietnam, and Malaysia, with the majority focusing on HIV/AIDS. In general, studies examining knowledge, awareness, and risky behaviors related to STIs in SEA reported low levels across various cohorts. However, evidence suggests that these issues are more prominent among individuals with low levels of education or low socioeconomic status, those living in rural areas or those working in the sex/industrial sectors. Engaging in unsafe sex and having multiple partners are the key examples for risky sexual behavior, while fear of being rejected/discriminated/stigmatized and lacking STI awareness were identified as social risky behaviors in SEA. Overall, cultural, societal, economic and gender inequality (male dominance) greatly impact people's knowledge, awareness, perceptions, attitudes, and risky behaviors in SEA. Education is an important factor influencing healthy behavior; therefore, this scoping review calls for increased investment in educating vulnerable populations to prevent STIs, particularly in less-developed countries/regions of SEA.

Perception and knowledge of human papillomavirus (HPV) vaccine for cervical cancer prevention among fully vaccinated female university students in the era of HPV vaccination: a cross-sectional study

OBJECTIVE

To assess the perception and knowledge of cervical cancer prevention among fully vaccinated female university students in the era of human papillomavirus (HPV) vaccination.

DESIGN

Cross-sectional using a validated questionnaire.

SETTING

Face-to-face interview at a public university in Malaysia.

PARTICIPANTS

384 fully vaccinated female students were included in the study.

RESULTS

The total knowledge score in the questionnaire was 18 and was ranked according to score level into three groups: poor (score ≤5), moderate (score 6-10) and good (score ≥11). Mean score for knowledge of cervical cancer prevention was 8.24 (SD ±3.85), with 170 respondents (44.3%) scoring moderate knowledge level. The mean score for knowledge of HPV infection and its association with cervical cancer was 4.56±2.47, while the mean score for knowledge of HPV vaccination for cervical cancer prevention was 3.68 (SD ±1.98). A total of 186 (48.4%) respondents perceived that regular Pap smear was unnecessary after HPV vaccination. Respondents' perceived seriousness and susceptibility of HPV infection correlated well with knowledge of cervical cancer prevention. Two main reasons for their acceptance of HPV vaccine were self-health awareness and free vaccination.

CONCLUSION

The knowledge of HPV vaccination for cervical cancer prevention was average among vaccinated university students. Many of them had poor knowledge about Pap smear and did not consider regular Pap smear as an important cervical cancer screening tool following HPV vaccination. There is still a need for continued health education to improve the perception and knowledge about HPV infection and cervical cancer prevention among young adults in the community.

Attitude towards HPV Vaccination and the Intention to Get Vaccinated among Female University Students in Health Schools in Jordan

Cervical cancer is a leading cause of morbidity and mortality in women worldwide. The availability of prophylactic vaccines for high-risk types of human papillomavirus (HPV) infection represents an important advancement in the prevention of cervical cancer. In Jordan, the availability of the HPV vaccination is restricted to individuals who are willing to pay. The aim of the current study was to evaluate the willingness and attitude of female university students in health schools/faculties in Jordan to get HPV vaccination and their knowledge about the virus. A self-administered online questionnaire was distributed in October 2021, which comprised 27 items to evaluate HPV knowledge, history of HPV vaccination, intentions to get the HPV vaccine, and the reason(s) behind vaccine refusal for those who rejected vaccination. The study sample comprised 836 participants: medical students (39.7%), pharmacy students (26.0%), dental students (21.2%), and nursing students (13.2%). Only 524 participants had heard of HPV prior to the study (62.7%), of which 48.7% knew about the availability of HPV vaccines. The lowest level of HPV knowledge was observed among nursing students. Only 19/524 students reported a history of HPV vaccination (3.6%). The overall willingness to receive HPV vaccination if provided freely was 75.0%, while only 16.0% were willing to pay for the vaccine. The most common reason for HPV vaccine rejection was the perceived low risk to get HPV infection. Significantly higher intentions to get HPV vaccination were found among older participants and medical students. The embrace of vaccine conspiracy beliefs was associated with a significantly less willingness to get the HPV vaccination (p < 0.001). Dependence on the internet/social media as the source of HPV knowledge was associated with a significantly lower intention to get HPV vaccination (p = 0.002). The coverage of the HPV vaccination among female university students in health schools in Jordan appeared extremely low; however, three-fourths of the students who had heard of HPV were willing to receive the HPV vaccination if provided freely. Complacency appeared as a major factor for HPV vaccine rejection. Increasing the levels of knowledge and awareness of HPV infection and its association with cervical cancer through reliable sources is recommended. This can be helpful for the individual benefit of the students besides the potentially positive role they can play in community education. Countering vaccine conspiracy beliefs with proper education and awareness programs can be helpful to appraise the role of HPV vaccines in cancer prevention.

Knowledge, attitude, perception of Muslim parents towards vaccination in Malaysia

Malaysia is a predominant Muslim country and the recent surge in vaccine-preventable disease enticed us to conduct a survey to measure the Knowledge, Attitude and Perception of Muslim parents toward vaccination process. The data were collected under four segments such as demography, Knowledge, Attitude and Perception. The questionnaire had high internal consistency (0.823) for Cronbach's alpha. The sociodemographic determinants such as marital status (OR = 1.12; 0.91-1.38;p < .05), education level (college OR = 1.35; 1.12-1.64;p < .05, secondary OR = 1.22; 1.01-1.47;p < .05) and the occupation of parents (OR = 1.25; 1.07-1.45;p < .05) were observed affecting the Knowledge score significantly. Majority of Malaysian Muslim parents believed that "vaccine is not prohibited in Islam" and most of them also rejected the belief that "all vaccines are non halal and hence should be avoided". None of the sociodemographic determinants significantly affected the Attitude and Perception score of the Muslim parents. It was observed that the Attitude and Perception score did not establish any association with any of the socio-demographic determinants and hence the null hypothesis that Malaysian Muslim parents had positive Attitude and good Perception toward vaccination process was accepted.

Assessment of knowledge and attitude among postnatal mothers towards childhood vaccination in Malaysia

Aim: Mothers knowledge and attitude toward childhood vaccination influence uptake is the most adequate tool and preventive aspects to infectious disease epidemics. The present study assesses and measures knowledge and attitude of postnatal mothers toward vaccination.Methods and results: The present study adopted a cross-sectional study design, whereby 200 postnatal mothers were identified during their postnatal visit to clinics. The subjects were accessed using questionnaire to assess the level of knowledge and attitude of mothers regarding vaccination. The objectives were to study the level of knowledge, the attitude, and to find the association between knowledge and attitude of the study subjects. The data were analyzed using SPSS version 16. The results was analyzed through chi-square test. The association between age (p = .031), education (p = .021), occupation (p = .013), and knowledge score toward vaccination was found to be statistically significant. However, ethnicity (p = .127), employment (p = .197), and mode of delivery (p = .750) toward mothers vaccination knowledge were not significant for the study. Mothers education, age, and occupation were found to be associated with attitude toward childhood vaccination. No association was found between ethnicity, employment, and mode of delivery with attitude of childhood vaccination.Conclusion: More than half of the studied mothers had good knowledge scores on vaccination, more than two-thirds of the studied mothers had good attitude scores on vaccination. However, the religious misconception and fear of autism was the main cause of vaccine resistance in Malaysia.