Knowledge of HPV and HPV vaccine among senior secondary school students in Nigeria: Implications on cancer prevention strategies, the CHANCE Study

From awareness to acceptance: understanding HPV and vaccine knowledge, attitudes and beliefs among university students in Punjab, Pakistan

Background

Human Papillomavirus (HPV) infections can lead to various cancers globally, and immunization can prevent HPV-associated cancers. This study intended to evaluate university students' knowledge, awareness, and attitudes/beliefs toward HPV and HPV vaccine uptake in Punjab, Pakistan.

Methods

A descriptive cross-sectional study was conducted in ten institutes across six cities using pre-validated questionnaires. Descriptive statistics and Rasch analysis were utilized to describe awareness levels, knowledge, and attitudes scores respectively. Regression analysis was utilized to explore association between demographic factors, knowledge levels, and attitudes/ beliefs. SPSS® (IBM, version 23.0) and Winstep® (version 3.75.0) software were used for analysis.

Results

Out of 1200 students approached, 1056 responded (response rate 88.0%). The mean age of students was 19.5 ± 0.5 years; 31.3% had heard about HPV, 16.4% were aware of the HPV vaccine's availability, and 2.3% were vaccinated against HPV. The mean Rasch knowledge score was -0.368 logits (SD: 0.893; SEM: 0.027), depicting below-average HPV knowledge. The mean Rasch attitudes/beliefs score was 0.049 logits (SD: 1.013; SEM: 0.031), which depicted positive attitudes towards HPV and its vaccination. Females (OR:1.742; 95%CI: 1.352-2.320), health-sciences students (OR: 1.692; 95%CI: 1.290-2.220), and urban residents (OR:1.621; 95%CI: 1.244-2.223) possessed positive attitudes towards HPV vaccination. Recommendations from physicians (Median: 4.0; IQR: 4.0-5.0) followed by parents (Median: 4.0; IQR: 3.0-5.0), and friends (Median: 4.0; IQR: 3.0-4.0) shaped vaccination decisions.

Conclusion

Despite their inadequate knowledge levels and poor vaccine uptake, students showed positive attitudes towards HPV vaccination. Awareness about HPV, including testing and vaccination, should be raised through community outreach programs, social media, and university curricula.

Predictors of willingness of HPV vaccine uptake across Eight States in Nigeria

BACKGROUND

The Nigerian Federal Government planned to launch the Human Papillomavirus (HPV) vaccine on September 25, 2023. We therefore aimed to assess caregiver awareness and willingness regarding HPV vaccine uptake for girls aged 9-14 across eight states (Abia, Adamawa, Bayelsa, Benue, Enugu, FCT, Jigawa, and Taraba), evaluating public readiness for the vaccine rollout.

METHODS

A cross-sectional telephone survey was conducted in the eight states using a structured questionnaire. Stratified random sampling was employed to ensure representation from each state's three senatorial districts. Adult participants' socio-demographic characteristics-including their relationship to the child, gender, settlement type (rural/urban), and age group-were analyzed. Local Government Area and Senatorial Zone were used solely for geographical representation. Awareness, perceived severity, susceptibility, and willingness for HPV vaccine uptake were calculated based on questionnaire responses. Descriptive statistics, correlation analyses, ordinal and linear regression, and mediation regression were applied to derive results.

RESULTS

Our findings indicated low general HPV awareness but high willingness for vaccine uptake among caregivers. Northern states exhibited higher awareness, perceived severity, susceptibility, and willingness compared to Southern states. Significant differences emerged across states in awareness and willingness, with positive correlations observed among awareness, severity, susceptibility, and willingness. Multiple linear regression revealed that awareness does not directly predict willingness, while mediation regression demonstrated that awareness indirectly influences willingness through severity and susceptibility. The study's implications were analyzed using the Health Belief Model (HBM).

CONCLUSION

Our survey found geopolitical disparities in HPV awareness and willingness across Nigeria. Future interventions should prioritize emphasizing the severity and susceptibility of HPV-related diseases, particularly in low-resource settings. Providing accurate information from trusted sources and addressing misconceptions through evidence-based strategies can enhance informed decision-making regarding HPV vaccination.

Human papillomavirus vaccination hesitancy among young girls in Ethiopia: factors and barriers to uptake

Background

Human papillomavirus (HPV) vaccinations protect against HPV infections. The infection might lead to vaginal cancer, vulvar cancer, genital warts, cervical intraepithelial neoplasia lesions, and cervical cancer. This study assessed hesitancy of HPV vaccination, associated factors, and barriers to vaccination among youth girls in Ethiopia.

Methods

An institutional-based cross-sectional study was conducted among female undergraduate students at the University of Gondar, College of Medicine and Health Sciences, between July and August 2022. The data was collected using a self-administered questionnaire. A simple random sampling method was used to recruit participants. The data were entered and analyzed with SPSS version 26. Descriptive statistics were used to describe the participants' demographic characteristics. Logistic regression was performed to identify the significant factors associated with acceptance of the HPV vaccine. A p-value <0.05 was considered statistically significant.

Results

The study included 423 participants with a mean age of 22.5 ± 6.7 years. Only more than one-third (35.2, 95% CI: 27.2-44.1) received the HPV vaccine. Currently, more than one-fourth (27.9, 95% Cl: 21.4-33.8) of participants are hesitant to receive the HPV vaccine. Higher monthly income (AOR = 1.52, 95% CI: 1.08-6.34), good knowledge of the HPV vaccine (AOR = 2.12, 95% CI: 1.12-4.87), and a positive attitude towards the vaccine (AOR = 3.03, 95% CI: 1.63-9.56) were significantly associated with acceptance of HPV vaccination. Safety concerns (63.1%), misinformation (42.8%), and parental concerns (42.3%) about the HPV vaccine were among the top perceived reported barriers to receiving the HPV vaccine.

Conclusion

This result showed that more than a quarter number of youth girls are still hesitant to receive HPV vaccinations. To increase vaccination acceptance, interventions should focus on awareness-raising programs about HPV infection and vaccines and addressing safety and parental concerns.

Awareness of cervical cancer risk factors and preventive approaches, and perceived causes of cervical cancer among secondary school girls: a cross-sectional study in Northern Uganda

BACKGROUND

The majority of women in low- and middle-income countries have low awareness of cervical cancer. This study sought to establish awareness of cervical cancer risk factors and preventive approaches, as well as sources of information and perceived causes of cervical cancer among secondary school girls in northern Uganda.

METHODS

This was a cross-sectional study conducted in rural northern Uganda. We collected data using an investigator administered pre-tested questionnaire. Analysis was done with STATA version 14.0. Multivariate analyses with logistic regressions models were used to determine magnitudes of association between independent and outcome variables. Odds ratios and accompanying 95% confidence intervals are reported. Statistical significance was considered if the two sided p-value <.05.

RESULTS

Most participants (97%; n = 624) had heard of cervical cancer before this study. The most common source of information about cervical cancer was friends (31.1%; n = 194). More than half of the participants (59%; n = 380) had heard about a vaccine that prevents cervical cancer, but only a third (33%; n = 124) had ever received a dose of the vaccine. The majority of participants (89%; n = 550) reported that cervical cancer could be prevented; however only half (52%; n = 290) knew that vaccination of girls aged 9-13 years could prevent cervical cancer. The majority of participants did not recognize the risk factors for cervical cancer; for example, only 15% (n = 98), 7% (n = 45), and 1.4% (n = 9) recognized early onset of sexual intercourse, infection by the human papillomavirus (HPV), and smoking respectively. On adjusting for age, students' class, and religion, students in schools with school health programs were twice (aOR = 2.24: 95%CI; 1.24-4.06) more likely to know that cervical cancer is preventable.

CONCLUSION

Secondary school girls need information on cervical cancer risk factors and approaches to prevention so that they may avoid exposures to the risk factors and promptly seek and undertake preventive approaches including HPV vaccinations.

The effect of peer education on high school students' knowledge levels regarding Human Papillomavirus (HPV) infection and vaccination

PURPOSE

This study aimed to explore the impact of the peer education model on adolescents' knowledge levels regarding Human Papillomavirus (HPV) infection and HPV vaccination.

DESIGN AND METHODS

The study was conducted quasi-experimentally in a pretest-posttest single-group design. The study sample consisted of 913 students enrolled in 9th, 10th, and 11th grades. The data of the study were collected between April and May 2023. Data were collected using the Demographic Information Form and the Human Papillomavirus Knowledge Scale (HPV-KS).

RESULTS

It was determined that 8.8 % of the students had previously received information about HPV, of which 50 % had received this information through the media, and only 0.3 % of them had received the HPV vaccine. Before peer education, the mean HPV-KS score among students was 1.14 ± 3.54, while after peer education, the mean score increased to 23.78 ± 8.32, and this difference was found to be statistically significant (p < 0.005). Thus, it has been observed that the peer education model effectively enhances the knowledge level regarding HPV and the HPV vaccine among high school students.

CONCLUSIONS

The use of this model will help young people take healthy steps regarding risky sexual health. Moreover, it is recommended that nurses utilize the peer education model to promote healthy lifestyle behaviors and enhance knowledge on various health-related topics among adolescents, who constitute a significant at-risk group.

PRACTICE IMPLICATIONS

It is recommended that nurses utilize the peer education model to promote healthy lifestyle behaviors and enhance knowledge on various health-related topics among adolescents, who constitute a significant at-risk group.

Varying behavioral differences and correlates of HPV infection among young adolescents in Benue state, Nigeria

BACKGROUND

Human Papillomavirus (HPV) infection is a significant public health concern globally, especially in low- and middle-income countries. In Africa, including Nigeria, HPV prevalence is high, contributing to a substantial burden of cervical cancer. Despite challenges, massive HPV vaccination campaigns in Africa show promise for preventing cervical cancer cases. In Benue State, Nigeria, limited research exists on several aspects of HPV knowledge and attitudes towards HPV among secondary school students. This study aims to bridge this gap by assessing HPV knowledge, prevention practices, willingness to uptake HPV vaccination, and associated attitudes and behaviors among secondary school students in the state.

METHODS

The cross-sectional study was conducted among adolescents aged 10-19 years in six secondary schools in three local government areas (LGAs) in Benue State, Nigeria. Two-stage sampling was used to select the LGAs and schools, with a final sample size of 591 students. The selected schools represent both junior and senior secondary school levels and span across the three senatorial districts of the state. Data were collected using a self-administered questionnaire covering sociodemographic characteristics, HPV knowledge, prevention practices, and willingness for HPV vaccination. Statistical analyses included univariate analyses and tests of association, with significance set at p < 0.05 or 0.001 depending on the level of the stringency of the evidence required. Data were analyzed using SPSS version 25.

RESULTS

Only 35.4% of the participants were males, and 86.8% were between the ages of 10 and 16. Only 24.7% acknowledged that HPV can be transmitted during sexual intercourse, and 36.2% recognized that HPV can be transmitted via skin-to-skin contact. 48.1% noted that HPV can cause cervical cancer. Half (50.9%) acknowledged that early sexual debut increases the risk of acquiring HPV, while only 28.1% recognized vaccination as a preventive strategy against HPV infection. Only 35% correctly stated the best time for the HPV vaccine. In assessing the practice of HPV prevention, 14.9% are in a sexual relationship and 10.3% admitted to not using condoms during sexual intercourse. Also, 11.8% have had STIs, and 27.2% have previously undergone HIV screening. Various bivariate analyses showed some varying behavioral differences and correlates of HPV infection among young adolescents in Benue State, Nigeria.

CONCLUSIONS

This study provides valuable insights into HPV knowledge, prevention practices, and willingness to uptake HPV vaccination among secondary school students in Benue State, Nigeria. The significance of the differences and correlates was discussed using themes. The research has unpacked complex relationships that could have public health implications for researchers and policymakers. Moreover, ten actionable policy recommendations were prescribed. Several interventions and areas for further study were proposed.

Examining barriers and facilitators of HPV vaccination in Nigeria, in the context of an innovative delivery model: a mixed-methods study

Background

More than 80% of cervical cancer cases diagnosed globally are in low-income and middle-income countries. In sub-Saharan Africa, where treatment facilities are widely unavailable, it is a leading cause of cancer deaths in women. Human papillomavirus (HPV) vaccination, which is known to prevent almost 90% of cases of cervical cancer, has low uptake in this region, and little is known about the behaviour of those who have been offered the HPV vaccine. This knowledge is critical to guide policy-makers in sub-Saharan Africa on how best to roll out the vaccine and ensure successful and sustainable HPV vaccination programmes.

Methods

To better understand uptake of the HPV vaccine among schoolgirls in Nigeria, we designed a mixed-methods convergent study, with a case-control quantitative arm that recruited caregivers of adolescent schoolgirls as cases (those who accepted vaccination) and controls (those who did not accept vaccination). For the qualitative study, we conducted 10 focus group discussions with of caregivers and 6 in-depth interviews with school administrators, vaccination sponsors and policy-makers.

Results

Those with high awareness of HPV vaccination had three times the odds of uptake (adjusted OR (aOR) 2.6, 95% CI 1.54 to 4.31, p=0.002). Giving HPV vaccines in school was also associated with uptake (aOR 3.1, 95% CI 1.54 to 6.43, p=0.002). Being offered free HPV vaccination was significant in the bivariate analysis (aOR 1.67, 95% CI 1.03 to 2.70, p=0.039) but was marginally significant in the multivariate analysis (aOR 0.63, 95% CI 0.37 to 1.06, p=0.086). Qualitative themes supported these findings, demonstrating that effective awareness and convenience of vaccination could encourage uptake. Key barriers to uptake included lack of affordability and limited availability of vaccines.

Conclusions

Effective awareness, administering HPV vaccines in school and subsidising HPV vaccination costs can improve uptake.

Prevalence and risk factors for high-risk human papillomavirus infection among women from three southern geopolitical zones of Nigeria

Introduction

Human Papillomavirus (HPV) infection is a risk factor for cervical cancer, the fourth most common cancer among women globally. Its burden is the highest in sub-Saharan Africa, with over 90% mortality. Interventions may fail without evidence-based data on stratified prevalence and risk factors among most at-risk women across Nigeria.

Methods

A cross-sectional comparative study, with participants recruited from the Nigerian Institute of Medical Research's Clinics, NGO outreaches, a cancer screening centre and a university teaching hospital. Questionnaires were self-administered. Trained medics performed sampling at healthcare facilities, and self-sampling was used at outreaches.

Results

Nine hundred eighty-five study participants were recruited. About 37% and 27% of the women knew about HPV and its vaccines, respectively, but only 6% confirmed vaccination with HPV vaccines. HPV prevalence was highest among women with unknown marital status (35.9%), single women (33.8%), widowed/divorced/separated women (30.3%), and married/cohabiting women (19.6%). HPV infection was significantly higher among women who take alcohol (odds=1.7 [95% CI: 1.2-2.4]) and women who smoke (odds=2.6 [95% CI: 1.4 - 4.6]. HPV strains detected included HPV16 (1.3%), HPV18 (1.5%), Low Risk (0.2%) and Other High-Risk groups (19.7%).

Conclusion

The inverse relationship between prevalence and education suggests interventions improving awareness and prevention would be impactful. Such interventions could also target HIV-positive women, women presenting with sexually-transmitted infections, who smoke and frequently drink alcohol.

"When you get the HPV vaccine, it will prevent cervical cancer; it will act as a shield": adolescent girls' knowledge and perceptions regarding the human papillomavirus vaccine in Zambia

Introduction

The human papillomavirus (HPV) vaccination is an important preventive measure for HPV-related conditions such as cervical cancer. In 2019, Zambia introduced a free national HPV vaccination program for 14-year-old girls. However, the adolescents' knowledge and perceptions regarding the HPV vaccine are not well understood. Therefore, this study aimed to understand adolescent girls' knowledge and perceptions regarding the HPV vaccine and discuss its acceptability and uptake implications.

Methods

We conducted a qualitative study in the Lusaka district between June 2021 and November 2021 using semi-structured interviews with adolescent girls aged 15-18 years regardless of their HPV vaccination status. Interviews were transcribed verbatim, and NVIVO 12 was used for data management and analysis. We coded transcripts deductively and inductively based on emerging themes. Perceptions were coded using the health belief model constructs.

Results

We interviewed 30 adolescent girls to reach saturation. Seventeen girls reported having received at least one dose of the HPV vaccine. Participants expressed variable knowledge and awareness about HPV and the HPV vaccine. Participants exhibited positive attitudes towards the HPV vaccine and perceived it as beneficial. However, there were multiple perceived barriers to vaccination, such as the need for parental consent, not being in school, concerns about vaccine side effects, and belief in myths and misinformation.

Conclusion

The adolescent girls in this study showed variable knowledge and positive attitudes toward the HPV vaccine despite the many perceived barriers. To support increased HPV vaccine acceptability and uptake among adolescent girls in Zambia, it is critical to actively engage stakeholders involved in HPV vaccination, such as adolescents and their parents, and debunk myths and misconceptions about HPV vaccination. Health education in schools and communities should be implemented to increase knowledge about HPV and HPV vaccination among adolescents and their parents.

Knowledge and attitude about human papillomavirus vaccine among female high school students at Jimma town, Ethiopia

BACKGROUND

The Human Papilloma Virus (HPV) is the primary causative agent of cervical cancer. HPV vaccination against human papillomavirus is more effective against cervical cancer. Therefore, this study aimed to investigate the knowledge and attitudes toward the human papillomavirus vaccines among female high-school students.

METHODOLOGY

This cross-sectional study was conducted among female high-school students in Jimma town, Ethiopia. Study participants were selected using a simple random sampling method. Self-administered interviews were conducted using a structured questionnaire. Data were entered using Epi-data version 3.5, exported and analyzed using the statistical package for the social sciences (SPSS) version 21. The Chi-squared (χ2) test was performed to determine the statistical significance between the outcome variable and independent variables.

RESULTS

A total of 366 students participated in this study with a response rate of 94.8%. Only half (52.7%) and nearly one-third (31.4%) of the respondents had good knowledge and positive attitudes toward HPV vaccination, respectively. The predictors that included parents' educational status (χ2 = 1.479, P = .003), students participating in school mini-media (χ2 = 1.519, P = .036), students who had a smartphone (χ2 = 2.118, P = .008), availability of radio or television (TV) at home (χ2 = 2.163, P = .049), and students who received information from social-media (χ2 = 2.15, P = .025) were significantly associated with knowledge of the HPV vaccine.

CONCLUSION

Overall knowledge and attitude toward HPV vaccination were low. All concerned bodies should work jointly to enhance the knowledge and attitudes of female students toward Human Papilloma Virus vaccination.

Challenges and lessons from a school-based human papillomavirus (HPV) vaccination program for adolescent girls in a rural Nigerian community

Background

Over 80% of new cervical cancer cases occur in women living in low- and middle-income countries. It is the second highest cause of female cancer deaths in Nigeria. School based vaccination programs are an effective strategy for delivering the HPV vaccine to adolescent girls. This study aims to understand the challenges to implementing school-based HPV vaccination programs, particularly in a remote rural setting where vaccine hesitancy is high.

Methods

A 22- item interviewer administered questionnaire was used to evaluate HPV knowledge and willingness to get the HPV vaccinate among 100 female secondary school students as part of an HPV vaccination pilot in a rural community in Kebbi State, Nigeria. Additionally, semi-structured interviews were used to assess community knowledge and attitudes on cervical cancer and HPV vaccination. Data collected were analyzed thematically to understand challenges and generate lessons for vaccine delivery in the study setting.

Results

Knowledge of HPV and cervical cancer among junior secondary school aged girls was fair with a mean score of 66.05%. For senior secondary school aged girls, the knowledge score ranged from 70 to 100% with a mean of 96.25% indicating good knowledge of HPV and cervical cancer. All participants (n = 100) received the first vaccine dose but due to COVID-19, 33 participants were not able to complete the vaccine dosage within the recommended 6-month schedule. Of the parents who provided consent, none could afford the vaccine out of pocket. Challenges to vaccine delivery included operational costs exacerbated by lack of adequate health workforce and infrastructure in the study setting.

Conclusion

An exploration of sociocultural perspectives and contextual realities is crucial to understanding the complexities of HPV vaccine introduction from the perspective of the target audience, and the local community. Strategies for introducing the HPV vaccine should address community concerns through effective communication, appropriate delivery, and targeted advocacy to make the vaccination program locally relevant. While school-based HPV immunization programs have been shown to be successful, adequate design, planning and monitoring is important. Additionally, considerations must be made to account for the high operational cost of vaccine delivery in rural, hard to reach areas where human resources and infrastructure are limited.

Knowledge of the Health Implications of Oral Sex among Registered Nurses in Nigeria: An Online Pilot Study

Introduction Oral sex is a pleasurable act that has its health implications, particularly sexually transmitted oral infections. In Nigeria, nurses constitute one of the at-risk population groups due to reports of risky sexual behavior among them. This study seeks to investigate the knowledge of nurses in Nigeria on the health implications of oral sex.

Methods This study was a survey of a pilot volunteer sample (n = 129) of registered nurses in Nigeria. The study tool was an anonymous questionnaire that was circulated electronically to nurses via social media platforms. Data collected was analyzed using the SPSS Version 20 software (IBM Corp, New York, New York, United States).

Results The majority (90.7%) of the 129 respondents had received training on oral health, 49.6% had engaged in oral sex before, and 58.1% were willing to engage in oral sex in future. History of previous oral health training was the only background characteristic found to be statistically significantly associated with the knowledge of oral sex-related health implications among nurses (p-value = 0.004); other characteristics (such as gender, age, and marital status) were not statistically significant (p-values >0.05). From multivariate analysis, history of oral health training was also found to be a statistically significant predictor of such knowledge (p-value = 0.015).

Conclusion Oral health knowledge is a significant determinant of the knowledge of oral sex-related health implications. This study also provides the preliminary evidence that forms the base on which further research should be conducted in this area.