Sociodemographic determinants of knowledge and attitude in the primary prevention of cervical cancer among University Tunku Abdul Rahman (UTAR) students in Malaysia: preliminary study of HPV vaccination

Determinants of cervical cancer knowledge and barriers to human papillomavirus vaccine uptake among female university students: A cross-sectional study

BACKGROUND

Cervical cancer is the second most common female cancer in Ghana. Cervical cancer is preventable through knowledge, vaccination against the human papillomavirus (HPV), screening and treatment of precancerous lesions.

OBJECTIVE

This study aimed to assess the determinants of cervical cancer knowledge and barriers to HPV vaccine uptake among female university students in Ghana.

DESIGN

An anonymous, online cross-sectional study was conducted from 25 June to 22 September 2024.

METHODS

The survey contained questions on demographic characteristics, cervical cancer risk factors, symptoms, HPV vaccination and barriers to vaccine uptake. Binomial logistic regression analysis was performed to predict the factors associated with knowledge of cervical cancer. A p-value of less than 0.05 was considered statistically significant.

RESULTS

A total of 1662 female university students responded to the online survey. The mean age of the respondents was 21.5 ± 2.03 years. Overall, the prevalence of inadequate knowledge of cervical cancer was 60.2%. The least recognised cervical cancer symptom was blood in the stool or urine (58.4%). Respondents who had a steady partner and living together had 3.59 times higher odds of inadequate knowledge of cervical cancer compared to respondents who were not dating. Muslim respondents had 2.13 times higher odds of inadequate knowledge of cervical cancer compared to Christian. Unvaccinated respondents had 3.85 times higher odds of inadequate knowledge of cervical cancer compared to those who had received the HPV vaccine. More than four-fifths (87.0%) of the respondents indicated that they had not been vaccinated against HPV. The major barriers to HPV vaccine uptake included: inadequate knowledge of the vaccine, fear of side effects, lack of knowledge about the vaccination site, fear of injection and doubts regarding the vaccine's efficacy.

CONCLUSION

Improving access to cervical cancer awareness and HPV vaccination among university students is a critical public health goal to reduce the incidence of cervical cancer. It is important to promote a free national school-based HPV vaccination programme. Multi-component school-based educational interventions, including traditional methods such as lectures, group discussions and digital tools like web-based educational platforms should be implemented to improve cervical cancer knowledge among university students.

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.

Awareness and knowledge associated to Human papillomavirus infection among university students in Morocco: A cross-sectional study

Worldwide, cervical cancer is a real health issue, however, gaps exist in the public’s awareness of the causal role of Human papillomavirus (HPV) in the development of this disease. This study aims to determine the level of awareness, knowledge and the associated factors on HPV among university students in Morocco. A cross-sectional study was conducted with a descriptive and analytical aim, among students attending Ibn Zohr University, in Agadir, Morocco. An interview questionnaire was used to collect information about the participants: demographic data, awareness and level of knowledge on HPV infection, and awareness of cervical cancer. Logistic regression analyses were used to determine the associated factors with awareness and level of knowledge on HPV. A total of 479 students participated in this study (mean age 21.82 ± 2.091). Most participants n = 391 (81.6%) were aware of cervical cancer, while only n = 7 (1.5%) identified HPV as a sexually transmitted infection. Among students, 10.0% (n = 48) were aware of HPV but only half of them n = 23 (47.9%) confirmed that HPV is associated with cervical cancer, and n = 29 (60.4%) showed low knowledge on HPV. Multivariate analysis revealed that HPV awareness has a strong association with a higher level of education (OR 4.04; 95% CI: 1.92–8.52), and with being a biology student (OR 5.20; 95% CI: 2.12–12.73), while high HPV knowledge was only associated with the female gender (OR 3.76; 95% CI: 1.01–13.92). The data suggest that university students in Morocco did not show sufficient knowledge of HPV infection and its consequences. This supports that earlier incorporation of sexual health education programs, especially related to HPV and cervical cancer, must be implemented in the university to reduce the burden of HPV-associated diseases among the population at risk.

Knowledge and Practice of Pap Smear and Vaccination Regarding Human Papillomavirus Among Female Medical Students in Karachi, Pakistan

Background: Cervical cancer is the leading cause of women’s death in developing countries. The change in the epidemiological trends has been attributed to mass screening with the help of a Pap smear. Objectives: This study aimed to determine the knowledge level and practice regarding a Pap smear and human papillomavirus (HPV) vaccination among female medical students in Karachi, Pakistan. Methods: In this cross-sectional study, 147 participants were selected through multistage stratified random sampling. The knowledge level was categorized as adequate if the participants answered 60% of the items. Questionnaire validity was determined through Cronbach’s alpha value (α = 0.69). Binary logistic regression was applied to determine the factors associated with the knowledge level among the students. A confidence interval (CI) of 95% was considered with a margin of error of 5% and a P-value of 0.05 as statistically significant. Results: Most students (60.5%) had adequate knowledge regarding a Pap smear and HPV vaccination. Only 3.4% of the students underwent a Pap smear test. The most common factors contributing to the knowledge level were marriage (OR = 2.98; 95% CI: 1.23 - 11.09; P = 0.003), first academic year of students (OR = 10.78; 95% CI: 1.03 - 12.01; P = 0.046), family history of cancer (OR = 2.76; 95% CI: 1.34 - 7.90; P = 0.004), and family income less than < 100000 Pakistani Rupee (OR = 5.45; 95% CI: 2.09 - 9.06; P = 0.005). Conclusions: Being medical students studying in the first academic year, family history of cancer, and family income less than 100000 Pakistani Rupee had significant effect on knowledge gap about a Pap smear and HPV vaccination. There is a need for an increased level of knowledge in this regard by addressing the risk factors contributing to the knowledge level.

Evaluation of Knowledge and Attitude Toward HPV and Vaccination Among Medical Staff, Medical Students, and Community Members in Fujian Province

Purpose

To evaluate the level of human papilloma virus (HPV)-related knowledge and vaccination willingness of people in Fujian Province, and to explore the factors influencing doctors’ recommendation of HPV vaccine.

Methods

We conducted two cross-sectional surveys in Fujian Province. The study cohort included 248 medical staff and medical students and 1001 community members. Descriptive statistics were used to identify the general demographics of the participants, along with their knowledge and attitudes regarding HPV and vaccination. Analyses were conducted to identify factors associated with willingness to vaccinate and willingness to recommend vaccination.

Results

The level of HPV knowledge in Fujian province was found to be low, but more than 80% of participants would like to accept HPV vaccine. Medical staff had a higher willingness to recommend HPV vaccine than students (OR= 4.696, CI: 2.698-8.175), which may be related to work experience and acceptance of vaccine price but not to knowledge level.

Conclusion

Knowledge of HPV in our community population appears to be lower than that in other regions in China. We suggest that a lack of knowledge may not be the main factor affecting the willingness to vaccinate, but we still needed to raise the level of knowledge about HPV to prevent misunderstandings. When the level of knowledge is high, education and per capita household income are not important factors influencing the willingness to vaccinate; only acceptance of vaccine prices significantly affects the willingness to vaccinate. Inclusion of the HPV vaccine in the national immunization program could help to alleviate public concerns regarding the vaccine to change present situation.