Cervical cancer risk perception and predictors of human papilloma virus vaccine acceptance among female university students in northern Nigeria

Exploring factors associated with preferences for human papillomavirus (HPV) self-sampling among racially- and ethnically-diverse women in Minnesota: A cross-sectional study

Pap tests are still underutilized by minority women due to limited awareness of cervical cancer screening (CCS), inadequate health care access, and cultural or religious beliefs. Human papillomavirus (HPV) self-sampling, a new CCS tool, has demonstrated potential to overcome some of these barriers. In 2021, women aged 30-65 years old were recruited across Minnesota to complete an online survey. The survey assessed five outcome measures related to HPV self-sampling: (1) awareness of test; (2) self-efficacy to conduct test; (3) location preference of test (clinic vs. home); 4) collector preference (self vs. clinician); and (5) preference of CCS strategy (HPV self-sampling vs. Pap test). Modified Poisson regressions tested associations between sociodemographic variables and outcomes. A total of 420 women completed the survey, of which 32.4% identified as Non-Hispanic white, 22.2% as Hispanic, 12.6% as Black/African-American, 28.3% as Asian, 1.9% as American Indian/Alaskan Native, and 1.4% as more than two races. Few women had heard of HPV self-sampling (6.5%), but a majority reported high self-efficacy to perform self-sampling (75.3%). Women also reported higher preferences for completing an HPV test in the clinic (52.2%) and for performing a self-collected HPV test themselves (58.7%), yet would choose a traditional Pap test over HPV self-sampling (56.0%). The low level of HPV self-sampling awareness, across all racial/ethnic groups, suggests a strong opportunity to promote widespread educational efforts around this new tool. Future HPV self-sampling research efforts should examine educational interventions targeted at healthcare providers to educate and encourage women on the importance of self-collection options.

Acceptance of Human Papillomavirus Vaccination and Associated Factors among Girls in Arba Minch Town, Southern Ethiopia, 2020

Background

Cervical cancer is Ethiopia's second biggest cause of cancer-related death among women. The introduction of human papilloma virus (HPV) vaccination is expected to have a significant impact on the burden of cervical cancer. In Ethiopia, particularly in our study area, little is known regarding girls' acceptance of HPV vaccination. Therefore, this study has assessed the acceptance of HPV vaccination and associated factors among girls in Arba Minch town, southern Ethiopia.

Methods

A school-based cross-sectional study was conducted on January 1, 2020. Based on convenience, Arba Minch town was purposefully selected. Stratification was done to stratify private and public schools, then simple random sampling to select sample schools from each, and finally, a proportional allocation of sample size to each school. The determinants and independent variables that influence the acceptance of the human papillomavirus vaccination were determined using a multivariable logistic regression model.

Results

This study's overall acceptance rate for study participants was 50.4% (95% CI) (45.9-55.2). Girls' age (AOR = 2.93, 95% CI (1.57_5.47), P value 0.001), mothers' educational level (secondary and more than secondary, AOR = 2.40, 95% CI (1.01_5.73), P value 0.048, and 3.64, 95% CI (1.61_8.25), P value 0.002, respectively), positive attitude (AOR = 5.22, 95% CI (2.96_9.19), Pvalue ≤ 0.001), good knowledge (AOR = 2.49, 95% CI (1.19_5.24), P value 0.001), and receiving childhood immunization (AOR = 14.85, 95% CI (8.58_25.72), Pvalue ≤ 0.001) were factors associated with girls' acceptance of the human papillomavirus vaccination. Conclusions and Recommendation. Only half of the study participants accepted HPV vaccination. Therefore, Arba Minch town health institutions should better boost the acceptance of HPV vaccination by improving the knowledge and attitudes of girls. Factors associated with girls' acceptance of HPV vaccination were age, mothers' educational status, positive attitude, knowledge of HPV vaccination, and receiving childhood immunization.

Correlates of human papillomavirus vaccine knowledge and acceptability among medical and allied health students in Northern Nigeria

Prior to its planned introduction, we investigated predictors of baseline knowledge and acceptability of HPV vaccination among medical and allied health care students in Kano, northern Nigeria. A total of 410 medical, dental and allied health students completed structured validated questionnaires. Knowledge scores and acceptability of HPV vaccine were determined and adjusted odds ratios (AOR) for predictors of HPV knowledge and acceptability were derived from multivariate logistic regression models. Overall, 3.7% (n = 15), 30.7% (n = 126) and 65.6% (n = 269) of respondents had good, moderate, and poor knowledge of HPV, respectively. The majority 334 (81.5%) were willing to accept the HPV vaccine, but only 18 (4.4%) had received at least one dose of the vaccine. Knowledge of HPV was better among females, younger (<20 years) medical students, students at higher levels of study, sexually experienced students, and condom users. HPV vaccine acceptance was higher among female students in the faculty of allied health with a family history of cervical cancer and good or moderate knowledge of HPV. In conclusion, most students were willing to receive HPV vaccination, despite their sub-optimal level of knowledge and low vaccine uptake. We recommend piloting the HPV vaccine in health colleges and recruiting early adopters as peer educators and advocates.IMPACT STATEMENTWhat is already known on this subject? Human Papilloma Virus (HPV) vaccine has been introduced in over 80 countries in the past decade, but evidence suggests low awareness of HPV infection and the vaccine, especially in developing countries. Nigeria proposes to introduce the HPV vaccine as part of the routine immunisation program in early 2021.What do the results of this study add? The majority of medical and allied health students in Kano, Nigeria, were willing to receive HPV vaccination, despite their sub-optimal level of knowledge and low vaccine uptake. Vaccine acceptance was predicted by the respondent's sex, course of study, family history of cervical cancer and knowledge of HPV.What are the implications of these findings for clinical practice and/or further research? The findings could inform program implementation and evaluation as HPV vaccine uptake is scaled up across Africa.

Awareness, acceptability and uptake of cervical cancer vaccination services among female secondary school teachers in Enugu, Nigeria: a cross-sectional study

INTRODUCTION

cervical cancer is a major cause of morbidity and mortality in women and vaccination of adolescents with human papilloma virus (HPV) vaccines is a major preventive strategy for this cancer. Despite the usefulness of cervical cancer vaccines, significant gaps still exist in the level of awareness and acceptability of the vaccine among women. This study aimed to determine the level of awareness, acceptability, and identify the factors associated with the uptake of this vaccine by female secondary school teachers in Enugu, Nigeria.

METHODS

a cross-sectional study of 377 female teachers in Enugu metropolis was undertaken between July and October 2017. A structured interviewer-administered pretested questionnaire was used for data collection and SPSS used for analysis.

RESULTS

less than half (41.9%) of the respondents had good knowledge of the cervical cancer vaccine. The majority of the respondents (93.6%) accepted the vaccine and will recommend it for their children and students. Only 14.6% and 9.0% of the respondents have taught their students about cervical cancer or HPV vaccines and had a programme in their school that addresses cervical cancer or cervical cancer vaccination respectively. Only 3.4% of the respondents have been vaccinated while 5.6% of their children or relatives have received the HPV vaccine. Previous vaccination of participants (p = 0.000), existing programmes addressing cervical cancer in schools of respondents (p = 0.000), participants having taught students about cervical cancer (p = 0.025) and high economic status (p = 0.013) significantly increased the likelihood of participants vaccinating their adolescent daughters/relatives. Extremes of age (p = 0.001) and being the head of their families (p = 0.002) significantly reduced the likelihood of the daughters/relatives to be vaccinated. Only previous history of vaccination of the respondents predicted the vaccination of their children and relatives (AOR = 6.069; 95% CI; < 0.0001-0.041).

CONCLUSION

the overall knowledge of the HPV vaccine was low but the acceptability was high among respondents who were aware of the vaccines. Vaccine uptake among children/family members of the respondents was low. The introduction of cervical cancer vaccination education of the teachers in the secondary schools will help improve cervical cancer vaccination and the uptake among adolescent´s populations in the country.

A scoping review: Facilitators and barriers of cervical cancer screening and early diagnosis of breast cancer in Sub-Saharan African health settings

To address gaps in access to cervical cancer screening and early diagnosis of breast cancer services in Sub-Saharan African (SSA), this scoping review was conducted to explore facilitators and barriers that exist on the patient-, provider-, and system-level. An extensive literature search was conducted in accordance with scoping review methodology and the Cochrane guidelines. Our search criteria were limited to original research studies conducted in community or clinical settings in SSA within the last 10 years (2010-2020). Themes found from this review included patient knowledge and provider education, access to screening services, trust, health-related behaviors, attitudes, values, and practices, community and social values, health infrastructure, resource allocation, and political will. Identified barriers included lack of knowledge about cervical and breast cancer among patients, gaps in education and training among providers, and lack of resources and health infrastructure at the facility level and within the overall health system. Facilitators included perceived risk of cancer, support and encouragement of the provider, and utilization of novel approaches in low-resource settings by health systems. To better address individual-, provider-, and health system and facility-based facilitators and barriers to care, there is a need for political and financial investment and further research on the health service delivery in specific national health systems, especially in the context of the global campaign to eliminate cervical cancer as a public health problem.

Multi-Theory Model and Predictors of Likelihood of Accepting the Series of HPV Vaccination: A Cross-Sectional Study among Ghanaian Adolescents

HPV vaccines are efficacious in preventing HPV related cancers. However, the vaccination uptake in Ghana is very low. Studies that utilize theoretical frameworks to identify contributory factors to HPV vaccination uptake in Ghana are understudied. We used multi-theory model (MTM) constructs to predict initiation and completion of HPV vaccination series in Ghanaian adolescents. Adolescents (n = 285) between the ages of 12 and 17 years old were recruited from four selected schools in Ghana to participate in the cross-sectional study. Linear regressions were used to analyze the data. Most participants were female (91.2%) and senior high school students (60.0%). Many of the participants had neither heard about HPV (92.3%) nor HPV vaccinations (95.4%). Significant predictors of adolescents’ likelihood of getting the first dose of HPV vaccination were perceived beliefs and change in a physical environment (p < 0.001), with each variable accounting for 6.1%and 8.8% of the variance respectively. Significant predictors of adolescents’ likelihood of completing HPV vaccination recommended series were perceived beliefs, practice for change, and emotional transformation (p < 0.001), with each variable accounting for 7.8%, 8.1%, and 1.1% of the variance respectively. Findings underscore important opportunities for developing educational interventions for adolescents in Ghana to increase the HPV vaccination uptake.

Knowledge and Awareness of Cervical Cancer and Human Papillomavirus among Female Students in an Ethiopian University: A Cross-sectional Study

Background:

Cervical cancer is causing a huge burden in Sub-Saharan Africa (SSA). It mainly affects women in their young ages making female university students at risk of cervical cancer. Knowledge and awareness about cervical cancer and human papillomavirus (HPV) in SSA including Ethiopia is very poor. We aimed to assess the knowledge and awareness of cervical cancer and HPV in University of Gondar (UOG) medicine and health science female students. A cross-sectional study was done.

Methods:

This study was conducted from April 1 to May 30, 2016 at UOG, College of Medicine and Health Sciences, Gondar, Northwest Ethiopia. Undergraduate female students were included in the study. A 14-item self-administered questionnaire was then provided to each of the participants to measure their level of knowledge and awareness about cervical cancer and HPV.

Results:

A total of 267 female students participated in the study (mean age 20.58 ± 1.22). More than half of the participants (59.6%) did not know the main cause of cervical cancer, whereas just about a fifth of them (19.5%) identified HPV as the main cause of cervical cancer. As high as 83.9% of the participants did not know other causes of cervical cancer. Binary logistic analysis revealed that students from midwifery (adjusted odds ratios [AOR] = 14.14, P < 0.05), anesthesiology (AOR = 9.66, P < 0.05) and medicine (AOR = 5.84, P < 0.05) departments were associated with knowledge of the main cause of cervical cancer.

Conclusions:

Knowledge about cervical cancer and its causes were found to be inadequate among higher education female students. Hence, awareness about cervical cancer, causes and its prevention, importance of screening and vaccination should be promoted through university's campaign, curricular changes, and community and research projects.

Knowledge of HPV and acceptability of HPV vaccine among women in western China: a cross-sectional survey

BACKGROUND

Since most cervical cancer cases are caused by persistent high-risk human papillomavirus (HR-HPV) infection, knowledge of HPV among women is essential for the prevent of cervical cancer. This study was aimed to assess knowledge among women in western China about HPV and its association with cervical cancer, and to assess their acceptance of HPV vaccination.

METHODS

A sample of healthy women undergoing routine physical examinations in the Health Management Center of West China Hospital, Sichuan University between January and December 2014 completed a questionnaire.

RESULTS

A total of 1300 questionnaires were distributed, and 1109 were completed and analyzed. Only 28.85% of respondents (n = 320) had heard of HPV; among this subgroup, only half (53.44%) knew that it causes cervical cancer, only 26 (8.13%) correctly answered all questions about HPV. Multivariate analysis showed that respondents who had heard of HPV were more likely than other respondents to have a family history of any cancer, to undergo regular Pap tests and to have completed at least secondary education. Half of all respondents (51.22%) reported that they would be willing to be vaccinated against HPV.

CONCLUSION

Although most women in western China lack basic knowledge about HPV, at least half are willing to take the HPV vaccine. Public health efforts to educate the public about HPV and its connection to cervical cancer should be strengthened and expanded.

Knowledge about cervical cancer screening and its practice among female health care workers in southern Ethiopia: a cross-sectional study

Background

Cervical cancer remains a major cause of morbidity and mortality among the women in the world. Early screening for cervical cancer is a key intervention in reduction of maternal deaths. Health care workers have a significant contribution to improve cervical cancer screening practice among women. Hence, this study aimed to assess the knowledge and practice of cervical cancer screening among female health care workers in southern Ethiopia.

Methods

Institution-based cross-sectional study was conducted during March and April, 2015. All hospitals in Hawassa city administration and Sidama zone were purposively selected. A simple random sampling technique was used to draw the health centers. After proportional allocations to their respective health facilities, a total of 367 female health workers were selected by simple random sampling technique. A structured and pretested questionnaire was used to collect the data. Data were entered to SPSS version 20.0 for further analysis. Logistic regression analyses were used to see the association of different variables.

Results

Out of the total respondents, 319 (86.9%) had a good level of knowledge on cervical cancer. Similarly, a majority of them, 329 (89.6%), 321 (87.5%), and 295 (80.4%), knew about the risk factors, symptoms, and outcomes of cervical cancer, respectively. More than two thirds of the respondents, 283 (77.1%), knew that there is a procedure used to detect premalignant cervical lesions and 138 (37.6%) of them mentioned visual inspection with acetic acid as a screening method. In this study, only 42 (11.4%) of the respondents were screened for cervical cancer (confidence interval [CI]: 8.7, 13.9). Being a physician (adjusted odds ratio [AOR] =0.12, 95% CI: 0.02, 0.79) and working in a cervical cancer screening center (AOR =0.14, 95% CI: 0.03, 0.68) had a lower odds of cervical cancer screening practices.

Conclusions

Significant numbers of health care workers were knowledgeable on cervical cancer. Cervical cancer screening among health care workers in southern Ethiopia was found to be low. Being a physician and working in a screening center had lower odds of cervical cancer screening practice. In spite of having adequate knowledge on cervical cancer the reasons for low practice of cervical cancer screening among health care workers needs to be investigated.

Knowledge, perceptions and acceptability of HPV vaccination among medical students in Chongqing, China

OBJECTIVES

To evaluate medical students' knowledge of HPV and HPV related diseases and assess their attitudes towards HPV vaccination.

METHODS

A total of 605 medical undergraduates from Chongqing Medical University in China were surveyed using a structured and pretested questionnaire on HPV related knowledge.

RESULTS

Some 68.9% of the medical students were females, and mean age was 21.6 (±1.00) years. Only 10.6% correctly answered more than 11 out of 14 questions on HPV related knowledge, 71.8% being willing to receive/ advise on HPV vaccination. Female students (OR: 2.69; 95% CI: 1.53-4.72) and students desiring more HPV education (OR: 4.24; 95% CI: 1.67-10.8) were more willing to accept HPV vaccination. HPV vaccination acceptability was observed to show a positive association with HPV related knowledge.

CONCLUSIONS

Our survey found low levels of HPV related knowledge and HPV vaccination acceptability among participating medical students. HPV education should be systematically incorporated into medical education to increase awareness of HPV vaccination.

Parental support for human papilloma virus vaccination by adolescents in Ibadan North Local Government Area, Ibadan, Nigeria

BACKGROUND

Despite changing sexual norms and mores generally perceived to be permissive of sexual expression, parents continue to serve as gateways to uptake of reproductive health services and commodities in our cultural settings. However, their support for adolescent uptake of human papilloma virus (HPV) vaccine are not well explored and documented. This study aims to assess parental knowledge and awareness of HPV infection and cervical cancer and their support for HPV vaccination for their adolescent children.

METHODS

In a descriptive cross sectional study 612 parents from in Ibadan North Local Government Area were interviewed using a pre-tested semi structured interviewer administered questionnaire to assess the awareness of HPV infection and cervical cancer as well as parental support for the vaccine.

RESULTS

Only a few of the respondents were aware of HPV infection (10.5%) and the HPV vaccine (6.5%), respectively. About 64.3% of those that were aware of HPV knew it can be transmitted through sexual intercourse. However, 78.4% supported the administration of the vaccine to their adolescent daughters. Reported reasons for not supporting HPV vaccination were high cost of the vaccine (32.2%) and lack of awareness of the vaccine (49.2%). Earning a monthly income above the minimum wage of 18,000 Naira increases the likelihood of parental support for HPV vaccination uptake for adolescents (p<0.001).

CONCLUSION

Ignorance and poverty remain as barriers to widespread coverage of the vaccine among adolescents. Health education and promotion on HPV infection and the HPV vaccine to the general public and subsidization of the vaccine to promote its uptake is advocated.

Mothers' willingness to pay for HPV vaccines in Anambra state, Nigeria: a cross sectional contingent valuation study

BACKGROUND

Human papilloma virus (HPV) vaccination in Nigeria will require substantial financing due to high cost of HPV vaccine and inexistence of structures to support adolescent vaccination. Alternative sources are needed to sustain the government funded HPV vaccination programme. This study assessed Nigerian mothers' willingness-to-pay (WTP) for HPV vaccine. We also compared the difference between the average WTP and estimated costs of vaccinating a pre-adolescent girl (CVG).

METHODS

We conducted a quantitative, cross-sectional, survey-based study in which 50 questionnaires were distributed to each of 10 secondary schools located in two rural and one urban city in Anambra state. The questionnaires were then randomly distributed to girls aged 9-12 years of age to give to their mothers. Contingent valuation approach using the payment card technique was used to estimate the average maximum WTP among the survey participants. Correlates of WTP for HPV vaccination were obtained using multivariate logistic regression. Estimated CVG was obtained by adapting cost of HPV vaccine delivery in Tanzania to the Nigerian setting.

RESULTS

A total of 438 questionnaires (88 %) were returned. The average WTP was US$ 11.68. This is opposed to estimated delivery cost of US$ 18.16 and US$ 19.26 for urban and rural populations respectively at vaccine price offered by the Vaccine Alliance (Gavi) and US$ 35.16 and US$ 36.26 for urban and rural populations respectively at the lowest obtainable public sector vaccine price. Demand for HPV vaccine was deemed high (91.6 %) and was significantly associated with respondents previously diagnosed of HPV infection.

CONCLUSION

Demand for HPV vaccine was high although short of estimated CVG. High demand for vaccine should be capitalized upon to increase vaccine uptake. Education on cervical cancer and provider-initiated vaccination should be promoted to increase vaccine uptake. Co-payment could be a feasible financing strategy in the event of national HPV vaccination.

Cervical cancer prevention and treatment research in Africa: a systematic review from a public health perspective

BACKGROUND

Women living in Africa experience the highest burden of cervical cancer. Research and investment to improve vaccination, screening, and treatment efforts are critically needed. We systematically reviewed and characterized recent research within a broader public health framework to organize and assess the range of cervical cancer research in Africa.

METHODS

We searched online databases and the Internet for published articles and cervical cancer reports in African countries. Inclusion criteria included publication between 2004 and 2014, cervical cancer-related content pertinent to one of the four public health categories (primary, secondary, tertiary prevention or quality of life), and conducted in or specifically relevant to countries or regions within the African continent. The study design, geographic region/country, focus of research, and key findings were documented for each eligible article and summarized to illustrate the weight and research coverage in each area. Publications with more than one focus (e.g. secondary and tertiary prevention) were categorized by the primary emphasis of the paper. Research specific to HIV-infected women or focused on feasibility issues was delineated within each of the four public health categories.

RESULTS

A total of 380 research articles/reports were included. The majority (54.6 %) of cervical cancer research in Africa focused on secondary prevention (i.e., screening). The number of publication focusing on primary prevention (23.4 %), particularly HPV vaccination, increased significantly in the past decade. Research regarding the treatment of precancerous lesions and invasive cervical cancer is emerging (17.6 %), but infrastructure and feasibility challenges in many countries have impeded efforts to provide and evaluate treatment. Studies assessing aspects of quality of life among women living with cervical cancer are severely limited (4.1 %). Across all categories, 11.3 % of publications focused on cervical cancer among HIV-infected women, while 17.1 % focused on aspects of feasibility for cervical cancer control efforts.

CONCLUSIONS

Cervical cancer research in African countries has increased steadily over the past decade, but more is needed. Tertiary prevention (i.e. treatment of disease with effective medicine) and quality of life of cervical cancer survivors are two severely under-researched areas. Similarly, there are several countries in Africa with little to no research ever conducted on cervical cancer.

Improving outcomes in cancer diagnosis, prevention and control: barriers, facilitators and the need for health literacy in Ibadan Nigeria

BACKGROUND

Cancers constitute a significant public health problem in Nigeria. Breast, cervix and prostate cancers are leading causes of cancer-related deaths. Changing diets, lifestyles, HIV/AIDS and macro-structural factors contribute to cancer morbidity and mortality. Poor health information linking cancer risk to individual behaviors, environmental pollutants and structural barriers undermine prevention/control efforts. Studies suggest increasing health literacy and empowering individuals to take preventive action will improve outcomes and mitigate impact on a weak health system.

METHODS

We obtained qualitative data from 80 men, women, and young adults in 11 focus groups to assess beliefs, risk-perceptions, preventive behaviors and perceptions of barriers and facilitators to cancer control in Ibadan, Nigeria and conducted thematic analysis.

RESULTS

Participants demonstrated awareness of cancers and mentioned several risk factors related to individual behaviors and the environment. Nonetheless, myths and misconceptions as well as micro, meso and macro level barriers impede prevention and control efforts.

CONCLUSION

Developing and implementing comprehensive context-relevant health literacy interventions in community settings are urgently needed.Copyright © 2016 John Wiley & Sons, Ltd.

Cervical cancer screening and HPV vaccine acceptability among rural and urban women in Kilimanjaro Region, Tanzania

OBJECTIVE

To determine cervical cancer screening coverage and the knowledge, attitudes and barriers toward screening tests among women in rural and urban areas of Tanzania, as well as explore how they view the acceptability of the HPV vaccine and potential barriers to vaccination.

SETTING

A cross-sectional study using interview-administered questionnaires was conducted using multistage random sampling within urban and rural areas in Kilimanjaro Region, Tanzania.

PARTICIPANTS

Women aged 18-55 were asked to participate in the survey. The overall response rate was 97.5%, with a final sample of 303 rural and 272 urban dwelling women.

PRIMARY AND SECONDARY OUTCOME MEASURES

Descriptive and simple test statistics were used to compare across rural and urban strata. Multivariate logistic regression models were used to estimate ORs and 95% CIs.

RESULTS

Most women (82%) reported they had heard of cervical cancer, while self-reported cervical cancer screening among women was very low (6%). In urban areas, factors associated with screening were: older age (OR=4.14, 95% CI 1.86 to 9.24 for ages 40-49, and OR=8.38, 95% CI 2.10 to 33.4 for >50 years), having health insurance (OR=4.15, 95% CI 1.52 to 11.4), and having knowledge about cervical cancer (OR=5.81, 95% CI 1.58 to 21.4). In contrast, among women residing in rural areas, only condom use (OR=6.44, 95% CI 1.12 to 37.1) was associated with screening. Women from both rural and urban areas had low vaccine-related knowledge; however, most indicated they would be highly accepting if it were readily available (93%).

CONCLUSIONS

The current proportion of women screened for cervical cancer is very low in Kilimanjaro Region, and our study has identified several modifiable factors that could be addressed to increase screening rates. Although best implemented concurrently, the availability of prophylactic vaccination for girls may provide an effective means of prevention if they are unable to access screening in the future.

HPV vaccine acceptability in Africa: a systematic review

OBJECTIVE

The objective of this study was to provide a systematic review of peer-reviewed literature on the factors associated with HPV vaccine acceptability among adults in African countries.

METHODS

A systematic search was conducted across five electronic databases: EMBASE, PsychINFO, CINAHL, Global Health and Ovid MEDLINE, to identify studies related to HPV vaccination acceptability in African countries (August 2013). The Health Belief Model was used to guide data abstraction and synthesis.

RESULTS

Fourteen unique studies representing ten sub-Saharan African countries were identified, with more than half published within the last two years. Acceptability of the HPV vaccine for daughters was high (range 59-100%); however, vaccine-related awareness and knowledge were low. Perceived barriers including accessibility and cost concerns were important for acceptance, as were cues to action from healthcare providers and governments.

CONCLUSIONS

This review suggests that acceptability of the HPV vaccine in countries in this region will be high. Broad knowledge gaps were highlighted regarding HPV and cervical cancer and these should be addressed. Education on the vaccine's effectiveness and reducing perceived barriers to vaccination would also be useful. Public endorsement by governments and healthcare providers will likely also increase acceptance.

University students' knowledge and attitudes regarding cervical cancer, human papillomavirus, and human papillomavirus vaccines in Turkey

OBJECTIVES

The current descriptive study aimed to determine university students' knowledge and attitudes regarding cervical cancer, human papillomavirus (HPV), and HPV vaccines in Turkey.

PARTICIPANTS

A total of 800 students participated.

METHODS

This study was carried out between September 1, 2012, and October 30, 2012, in 8 female dormitories.

RESULTS

In response to the question "What are cervical cancer risk factors?" 10.0% of students said HPV; 90.9% were unaware of how to protect themselves from HPV. Of the students, 99.7% had not had an HPV vaccination, only 32.6% wanted to get an HPV vaccination, and 20.7% did not want to be vaccinated, as they believe it "might have adverse effects."

CONCLUSIONS

The results of the present study show that female university students have low levels of awareness and knowledge toward cervical cancer risk factors, HPV, and HPV vaccination.

Determinants of acceptance and subsequent uptake of the HPV vaccine in a cohort in Eldoret, Kenya

The development of Human Papillomavirus (HPV) vaccines provides new opportunities in the fight against cervical cancer. Many acceptability studies have revealed high interest in these vaccines, but acceptance is only a precursor of behavior, and many factors, at personal, community and provider level, may inhibit the translation of willingness to vaccinate into actual uptake. Through a longitudinal study in Eldoret, Kenya, HPV vaccine acceptability was measured before a vaccination program (n = 287) and vaccine uptake, as reported by mothers, once the program was finished (n = 256). In between baseline and follow-up, a pilot HPV vaccination program was implemented via the GARDASIL Access Program, in which parents could have their daughter vaccinated for free at the referral hospital. The program was promoted at schools: Health staff informed teachers who were then asked to inform students and parents. Even though baseline acceptance was very high (88.1%), only 31.1% of the women reported at follow-up that their daughter had been vaccinated. The vaccine was declined by 17.7%, while another 51.2% had wanted the vaccination but were obstructed by practical barriers. Being well-informed about the program and baseline awareness of cervical cancer were independently associated with vaccine uptake, while baseline acceptance was correlated in bivariate analysis. Side effects were of great concern, even among those whose daughter was vaccinated. Possible partner disapproval lowered acceptance at baseline, and women indeed reported at follow-up that they had encountered his opposition. In Kenya, women prove to be very willing to have their daughter vaccinated against cervical cancer. However, in this study, uptake was more determined by program awareness than by HPV vaccine acceptance. School-based vaccination might improve coverage since it reduces operational problems for parents. In addition, future HPV vaccination campaigns should address concerns about side effects, targeting men and women, given both their involvement in HPV vaccination decision-making.

Cancer prevention in Africa: a review of the literature

Cancer is an emerging crisis in Africa. Cancer was the seventh leading cause of death in 2004. If not controlled, cancer incidence in Africa is expected to reach 1.28 million cases annually and claim 970,000 lives yearly by 2030. This paper presents a review of the literature on current cancer prevention approaches in Africa, and consists of cancer prevention studies conducted in African countries (e.g. South Africa and Nigeria) from PubMed, Scopus, and CINAHL databases. Common female cancers in Africa are breast and cervical cancer while prostate cancer is the most common neoplasm among African males. Other common cancers are liver, colorectal, and non-Hodgkin’s lymphoma. Mortality related to these cancers comes as a result of delays in screening and treatment, unfamiliarity with cancer and cancer prevention, inaccessibility and unaffordability of care, and inefficiency of healthcare systems. Cancer prevention efforts are deficient because many governments lack cancer prevention and control policies. Also contributing to the lack of cancer prevention and control policies are low levels of awareness, scarce human and financial resources, and inadequacy of cancer registries. Overall, governments grapple with limited funds and competing healthcare priorities. As cancer continues to increase in Africa, the need for rigorous interdisciplinary research on cancer etiology and monitoring in Africa has never been timelier. Cost-effective cancer prevention programs, coordination of donor funding, advocacy, and education should be aggressively pursued. The call for more collaborative approaches in research and policy is urgently needed.

Human Papillomavirus vaccination acceptability among female university students in South Africa

BACKGROUND

The objectives of this present study were to assess the awareness of cervical cancer and its risk factors among female undergraduates in South Africa, and to determine the their level of acceptability of Human Papillomavirus (HPV) vaccination.

MATERIALS AND METHODS

This cross-sectional study was conducted in March 2013 among 440 full time undergraduate female students.

RESULTS

Of those students who never had sex (n=163), 96 (58.9%) had ever heard of cervical cancer and only 12 students (12.5%) knew that HPV causes cervical cancer. More than a third (35.4%) of the students correctly said that sexual intercourse before age of 18 years is a risk factor for cervical cancer and 55.2% of the students knew about the Pap smear test which is used for screening cervical cancer. The majority (77.3%) were willing to accept HPV vaccination. Results revealed that students who knew about the Pap smear test, and were aware that having multiple sex partners, sexual intercourse before the age of 18 years, smoking and having contracted any STDs are risk factors for cervical cancer were more likely to accept HPV vaccination compared to other groups.

CONCLUSIONS

The general knowledge of South African female university students about cervical cancer is not sufficient but they have positive attitudes toward getting vaccinated with the HPV vaccine.

Knowledge and awareness of HPV vaccine and acceptability to vaccinate in sub-Saharan Africa: a systematic review

Objectives

We assessed the knowledge and awareness of cervical cancer, HPV and HPV vaccine, and willingness and acceptability to vaccinate in sub-Saharan African (SSA) countries. We further identified countries that fulfill the two GAVI Alliance eligibility criteria to support nationwide HPV vaccination.

Methods

We conducted a systematic review of peer-reviewed studies on the knowledge and awareness of cervical cancer, HPV and HPV vaccine, and willingness and acceptability to vaccinate. Trends in Diphtheria-tetanus-pertussis (DTP3) vaccine coverage in SSA countries from 1990–2011 were extracted from the World Health Organization database.

Findings

The review revealed high levels of willingness and acceptability of HPV vaccine but low levels of knowledge and awareness of cervical cancer, HPV or HPV vaccine. We identified only six countries to have met the two GAVI Alliance requirements for supporting introduction of HPV vaccine: 1) the ability to deliver multi-dose vaccines for no less than 50% of the target vaccination cohort in an average size district, and 2) achieving over 70% coverage of DTP3 vaccine nationally. From 2008 through 2011 all SSA countries, with the exception of Mauritania and Nigeria, have reached or maintained DTP3 coverage at 70% or above.

Conclusion

There is an urgent need for more education to inform the public about HPV, HPV vaccine, and cervical cancer, particularly to key demographics, (adolescents, parents and healthcare professionals), to leverage high levels of willingness and acceptability of HPV vaccine towards successful implementation of HPV vaccination programs. There is unpreparedness in most SSA countries to roll out national HPV vaccination as per the GAVI Alliance eligibility criteria for supporting introduction of the vaccine. In countries that have met 70% DTP3 coverage, pilot programs need to be rolled out to identify the best practice and strategies for delivering HPV vaccines to adolescents and also to qualify for GAVI Alliance support.

Multicenter study of human papillomavirus and the human papillomavirus vaccine: knowledge and attitudes among people of African descent

OBJECTIVE

To compare knowledge and attitudes of human papillomavirus (HPV) and the vaccine between different cultures of African descent.

METHODS

A cross-sectional survey of 555 African-Americans and Afro-Caribbeans residing in the US and the Bahamas (BHM) was conducted.

RESULTS

General knowledge about HPV and the HPV vaccine differed between the two countries significantly. Bahamian respondents were less likely to have higher numbers of correct knowledge answers when compared to Americans (Adjusted Odds Ratio [Adj. OR] 0.47, 95% Confidence Interval [CI] 0.30-0.75). Older age, regardless of location, was also associated with answering fewer questions correctly (Adj. OR 0.61, 95% CI 0.40-0.92). Attitudes related to HPV vaccination were similar between the US and BHM, but nearly 80% of BHM respondents felt that children should not be able to receive the vaccine without parental consent compared to 57% of American respondents.

CONCLUSIONS

Grave lack of knowledge, safety and cost concerns, and influence of parental restrictions may negatively impact vaccine uptake among African-American and Afro-Caribbean persons. Interventions to increase the vaccine uptake in the Caribbean must include medical provider and parental involvement. Effective strategies for education and increasing vaccine uptake in BHM are crucial for decreasing cervical cancer burden in the Caribbean.

Human papillomavirus (HPV) infection and vaccines: knowledge, attitude and perception among female students at the University of Lagos, Lagos, Nigeria

Aim: This study sought to determine knowledge of and attitude towards human papillomavirus (HPV) infection, HPV-related diseases and HPV vaccines among female undergraduate students at the University of Lagos.

Methods: A self-administered questionnaire was administered between May and July 2010, to 368 female students aged 16–29 years, who were selected from two faculties of the University of Lagos using two-stage sampling method. Data collected included: socio-demographic characteristics, sexual history, awareness and knowledge of HPV infection, cervical cancer and genital warts, and HPV vaccine; the perceived risk of acquiring genital HPV infection and developing cervical cancer or genital warts, and the willingness to receive an HPV vaccine.

Results: Only 64 (17.7%) and 52 (14.4%) of the students had ever heard of HPV infection and HPV vaccines respectively. The median HPV knowledge on a 15-item score was 2. Overall, only 11.1% knew that genital HPV infection can cause cervical cancer. Fourteen (6.9%) of those who were aware of cervical cancer agreed they were at risk of developing the disease. Of the 52 students who had heard of the HPV vaccine, 24 (46.2%) knew it was given for cervical cancer prevention and 30 (57.7%) expressed their willingness to receive the vaccine.

Conclusion: The knowledge of and the perceived susceptibility to HPV infection and HPV-related diseases among female students in the University of Lagos were generally low. The need for a well-designed HPV-educational program to bridge the knowledge gap cannot be overemphasized.