1
|
Lubeya MK, Chibwesha CJ, Mwanahamuntu M, Mukosha M, Frank S, Kawonga M. "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. FRONTIERS IN HEALTH SERVICES 2023; 3:1208458. [PMID: 37780403 PMCID: PMC10534003 DOI: 10.3389/frhs.2023.1208458] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 08/23/2023] [Indexed: 10/03/2023]
Abstract
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.
Collapse
Affiliation(s)
- Mwansa Ketty Lubeya
- Department of Obstetrics and Gynaecology, School of Medicine, The University of Zambia, Lusaka, Zambia
- Women and Newborn Hospital, University Teaching Hospitals, Lusaka, Zambia
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Carla J. Chibwesha
- Clinical HIV Research Unit, Helen Joseph Hospital, Johannesburg, South Africa
| | - Mulindi Mwanahamuntu
- Department of Obstetrics and Gynaecology, School of Medicine, The University of Zambia, Lusaka, Zambia
- Women and Newborn Hospital, University Teaching Hospitals, Lusaka, Zambia
| | - Moses Mukosha
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Simone Frank
- School of Medicine, North Carolina Translational and Clinical Sciences (NC TraCS) Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Mary Kawonga
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Public Health Medicine, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| |
Collapse
|
2
|
Mabeya H, Odunga J, Broeck DV. Mothers of adolescent girls and Human Papilloma Virus (HPV) vaccination in Western Kenya. Pan Afr Med J 2021; 38:126. [PMID: 33912296 PMCID: PMC8051220 DOI: 10.11604/pamj.2021.38.126.21359] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 10/24/2019] [Indexed: 01/14/2023] Open
Abstract
Introduction human papilloma virus (HPV) which is preventable is the main cause of cervical cancer and it targets mostly young adolescents. The study was to determine the practice desire, attitude and knowledge of mothers of adolescent girls on HPV vaccination in Western Kenya. Methods this was a descriptive cross-sectional study design. Data was obtained using semi-structured questionnaires and analyzed using both descriptive and inferential statistics at 95% confidence level using the SPSS software version 22. A p-value ≤ 0.05 was considered statistically significant. Results ninety five percent of the mothers had intentions to vaccinate their daughters and also had a positive attitude and their response to HPV vaccination was significantly lower than those without intentions p=0.02, 95% CI, OR=0.48 (0.90-0.89). Vaccination against HPV was low at 9.4% with a mean age of 34 years. Our results found a high level of cervical cancer awareness (85.0%), HPV and vaccine awareness respectively (62.0%, and 64.0%). “Vaccination of my daughters will prompt early sexual activity and the cost of HPV vaccination being a barrier to vaccination” had a statistically significant influence on the practice of vaccination. Negative attitude to daughters´ early onset of sexual activity significantly reduced up take while positive attitude to cost of HPV vaccine significantly increased up take of HPV vaccination with p value of 0.007 and 0.04 respectively. Conclusion awareness of HPV and HPV vaccine prevention is low among mothers of adolescent girls in Western Kenya. There was a positive attitude and high desire towards the use of HPV vaccination therefore a need for awareness, policy and unify efforts to reduce cervical cancer burden.
Collapse
Affiliation(s)
- Hillary Mabeya
- Moi University, Eldoret, Kenya.,International Center of Reproductive Health, Ghent University, Ghent, Belgium
| | | | - Davy Vanden Broeck
- International Center of Reproductive Health, Ghent University, Ghent, Belgium.,Ghent University, Ghent, Belgium
| |
Collapse
|
3
|
Le XTT, Nguyen PTN, Do TTT, Nguyen TH, Le HT, Nguyen CT, Ha GH, Hoang CL, Tran BX, Latkin CA, Ho RC, Ho CS. Intention to Pay for HPV Vaccination among Women of Childbearing Age in Vietnam. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17093144. [PMID: 32365964 PMCID: PMC7246945 DOI: 10.3390/ijerph17093144] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 04/18/2020] [Accepted: 04/20/2020] [Indexed: 11/22/2022]
Abstract
The intention to pay for human papillomavirus (HPV) vaccination among women of childbearing age in Vietnam, where cervical cancer remains a significant public health concern, has been mostly lacking. To examine this issue, we conducted a cross-sectional study of 807 pregnant women in an urban and a rural district (Dong Da and Ba Vi) of Hanoi, Vietnam. The vast percentage of our respondents expressed a firm intention to vaccinate, especially women in rural areas (over 90.0%). However, on being informed of the current price of the HPV vaccine, their intention to vaccinate dropped to about one-fifth of overall respondents, i.e., only 4.4% of women in rural areas. It was also observed that the initial intention to get the HPV vaccination among women in the rural district was about ten times higher than that of women living in the metropolitan district. Those participants who had greater knowledge of cervical cancer and HPV vaccinations also had a significantly higher intention to vaccinate. Our findings underscore the need to develop a well-designed vaccination program in Vietnam and other countries in a similar situation to increase the adoption of HPV vaccination.
Collapse
Affiliation(s)
- Xuan Thi Thanh Le
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam; (X.T.T.L.); (P.T.N.N.); (T.T.T.D.); (T.H.N.); (H.T.L.); (B.X.T.)
| | - Phuong Thi Ngoc Nguyen
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam; (X.T.T.L.); (P.T.N.N.); (T.T.T.D.); (T.H.N.); (H.T.L.); (B.X.T.)
| | - Toan Thi Thanh Do
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam; (X.T.T.L.); (P.T.N.N.); (T.T.T.D.); (T.H.N.); (H.T.L.); (B.X.T.)
| | - Thang Huu Nguyen
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam; (X.T.T.L.); (P.T.N.N.); (T.T.T.D.); (T.H.N.); (H.T.L.); (B.X.T.)
| | - Huong Thi Le
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam; (X.T.T.L.); (P.T.N.N.); (T.T.T.D.); (T.H.N.); (H.T.L.); (B.X.T.)
| | - Cuong Tat Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang 550000, Vietnam;
- Faculty of Medicine, Duy Tan University, Da Nang 550000, Vietnam
| | - Giang Hai Ha
- Institute for Global Health Innovations, Duy Tan University, Da Nang 550000, Vietnam;
- Faculty of Pharmacy, Duy Tan University, Da Nang 550000, Vietnam
- Correspondence: ; Tel.: +84-86-9548-561
| | - Chi Linh Hoang
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City 700000, Vietnam; (C.L.H.); (R.C.M.H.)
| | - Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam; (X.T.T.L.); (P.T.N.N.); (T.T.T.D.); (T.H.N.); (H.T.L.); (B.X.T.)
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA;
| | - Carl A. Latkin
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA;
| | - Roger C.M. Ho
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City 700000, Vietnam; (C.L.H.); (R.C.M.H.)
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
- Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore 119077, Singapore
| | - Cyrus S.H. Ho
- Department of Psychological Medicine, National University Hospital, Singapore 119074, Singapore;
| |
Collapse
|
4
|
Subramanian S, Edwards P, Roberts ST, Musheke M, Mbizvo M. Integrated Care Delivery for HIV Prevention and Treatment in Adolescent Girls and Young Women in Zambia: Protocol for a Cluster-Randomized Controlled Trial. JMIR Res Protoc 2019; 8:e15314. [PMID: 31584004 PMCID: PMC6797972 DOI: 10.2196/15314] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/14/2019] [Accepted: 08/17/2019] [Indexed: 01/26/2023] Open
Abstract
Background Among countries in sub-Saharan Africa, Zambia has one of the highest incidences of HIV. Adolescent girls and young women (AGYW) are a particularly affected group because of their social and economic vulnerability. Objective The goal of this study is to test a multilevel package of interventions at the community and health system levels in Zambia in order to connect AGYW with a source of regular care, which will in turn allow for sustainable, successful implementation of regular HIV testing and adherence to antiretroviral treatment. Methods We will adapt prior tools to create the SHIELD (Support for HIV Integrated Education, Linkages to Care, and Destigmatization) intervention to educate and empower Zambian AGYW of 10-24 years of age and their families and to create community-based youth clubs to foster peer support. We will also develop integrated wellness care clinics to offer a youth-friendly environment that provides tailored clinical services. We will perform formative research, including focus groups and in-depth interviews, among AGYW, caregivers, and stakeholders to help inform the development and tailoring of the interventions. A cluster-randomized controlled trial will be implemented in Lusaka, with six clinic catchment areas randomized into three groups: zones with integrated wellness care clinics and SHIELD intervention, zones with only SHIELD intervention, and control zones with no intervention. We will assess HIV testing among the HIV-negative or unknown (HIV-/u) cohort, and retention in care along with viral load suppression will be evaluated in the HIV-positive (HIV+) cohort. We will use in-depth interviews and surveys to collect staff and stakeholder feedback after the trial. Cost-effectiveness of the interventions and return-on-investment impacts will be quantified using a microsimulation model. Results Interim results are expected in 2021, and the final results are expected in 2022. If this multilevel intervention is successful in establishing a comprehensive care continuum for HIV-affected AGYW, the Zambian Ministry of Health may advocate for expansion to additional settings to support national scale-up. Conclusions This integrated service delivery model can also be a platform to implement additional preventive services, so HIV-/u and HIV+ AGYW can receive comprehensive, integrated services. Trial Registration ClinicalTrials.gov NCT03995953; https://clinicaltrials.gov/ct2/show/NCT03995953 International Registered Report Identifier (IRRID) PRR1-10.2196/15314
Collapse
Affiliation(s)
| | - Patrick Edwards
- RTI International, Research Triangle Park, NC, United States
| | | | | | | |
Collapse
|
5
|
Nyambe A, Kampen JK, Baboo SK, Van Hal G. Knowledge, attitudes and practices of cervical cancer prevention among Zambian women and men. BMC Public Health 2019; 19:508. [PMID: 31054569 PMCID: PMC6500583 DOI: 10.1186/s12889-019-6874-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 04/18/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND In Zambia, cervical cancer screening was started in 2006 and the human papillomavirus vaccine was piloted in 2013. Nevertheless, cervical cancer remains the leading cancer. It is assumed that knowledge, social interaction, health behaviors and religion are factors that can influence screening and vaccination practices. This study addresses the question, what is the relationship between knowledge about cervical cancer, attitudes, self-reported behavior, and immediate support system, towards screening and vaccination of cervical cancer of Zambian women and men. The results of this study serve as a basis for future research, an input for improvement and adjustment of the existing prevention program and build on documented health behavior frameworks. METHODS A cross-sectional mixed methods study was conducted from February to May 2016. Two separate questionnaires were used to collect data from women (N = 300) and men (N = 300) residing in Chilenje and Kanyama (two townships in the capital city Lusaka). Respondent's knowledge of cervical cancer was operationalized by grading their ability to correctly identify causes and protective factors if they were aware of cervical cancer. Besides providing descriptive statistics of all study variables, we tested four research hypotheses concerning the link between knowledge, attitudes and practices suggested by the literature, by applying appropriate statistical tests (chi square test, analysis of variance, logistic regression). RESULTS Less than half of the respondents (36.8%) had heard of cervical cancer, 20.7% of women had attended screening and 6.7% of the total sample had vaccinated their daughter. Knowledge of causes and prevention was very low. There was a strong association between having awareness of cervical cancer and practicing screening (odds ratio = 20.5, 95% confidence interval = [9.214, 45.516]) and vaccination (odds ratio = 5.1, 95% confidence interval = [2.473, 10.423]). Social interactions were also found to greatly influence screening and vaccination behaviors. CONCLUSIONS The low level of knowledge of causes and prevention of cervical cancer suggests a need to increase knowledge and awareness among both women and men. Interpersonal interactions have great impact on practicing prevention behaviors, for instance, vaccination of daughters.
Collapse
Affiliation(s)
- Anayawa Nyambe
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
| | - Jarl K Kampen
- Biometris, Wageningen University, Wageningen, Netherlands, and StatUA (Core Facility for Statistical Analysis), University of Antwerp, Antwerp, Belgium
| | - Stridutt K Baboo
- Department of Public Health and Tropical Medicine, University of Zambia, Lusaka, Zambia
| | - Guido Van Hal
- Department of Epidemiology and Social Medicine, University of Antwerp, Antwerp, Belgium
| |
Collapse
|
6
|
Nyambe A, Kampen JK, Baboo SK, Van Hal G. The impact of the social environment on Zambian cervical cancer prevention practices. BMC Cancer 2018; 18:1242. [PMID: 30541491 PMCID: PMC6292082 DOI: 10.1186/s12885-018-5164-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 11/30/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Cervical cancer which is preventable by screening and vaccination is the most common cancer in Zambia among both the female and male population. In this article we aim to determine how the key players of the sociocultural and political environment recognize cervical cancer as a public health problem and therefore impact the provision of cervical cancer prevention services (screening and vaccination). METHODS Qualitative data in the form of interviews with stakeholders (health care providers, teachers and religious leaders), special interest groups (advocacy groups and non-governmental organizations) and policy makers, was collected as part of a mixed methods study from February to May 2016. RESULTS The views expressed by the respondents were coded into predetermined themes (cervical cancer in general, screening, vaccination) and an organizational chart of the administration of cervical cancer prevention services in Zambia was developed. CONCLUSIONS It is evident that the Zambian cervical cancer prevention system has targeted several areas and multiple sectors of society to reduce cervical cancer cases. However, awareness, knowledge, social support and facilities are factors that can be improved.
Collapse
Affiliation(s)
| | - Jarl K Kampen
- University of Antwerp, Antwerp, Belgium.,Wageningen University, Wageningen, Netherlands
| | | | | |
Collapse
|
7
|
Pugliese-Garcia M, Heyerdahl LW, Mwamba C, Nkwemu S, Chilengi R, Demolis R, Guillermet E, Sharma A. Factors influencing vaccine acceptance and hesitancy in three informal settlements in Lusaka, Zambia. Vaccine 2018; 36:5617-5624. [PMID: 30087047 PMCID: PMC6143480 DOI: 10.1016/j.vaccine.2018.07.042] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 07/06/2018] [Accepted: 07/17/2018] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Heterogeneous coverage threatens to compromise the effectiveness of immunization programs in Zambia. Demand-creation initiatives are needed to address this; however, there is incomplete understanding of why vaccine coverage is suboptimal. We investigated overarching perceptions on vaccine acceptability, hesitancy, and accessibility at three informal settlements in Lusaka, Zambia. METHODS Nested within a cholera vaccination uptake study, we sought to understand overarching perceptions on vaccines' hesitancy in three informal settlements in Lusaka, Zambia. We conducted 48 focus group discussions with a convenience sample of laypersons, lay healthcare workers, neighbourhood health committee members and vaccinators. RESULTS Both laypersons and community-based health actors reported high vaccine acceptance though several sources of hesitancy were reported. Traditional remedies, alcohol use and religious beliefs emerged as drivers of vaccine hesitancy, likely reinforced by a background of distrust towards western medicine. Also mentioned were previous adverse events, fear of injections and low perceived need for immunization. Limited understanding of how vaccines work and overlapping local terms for vaccine and other medical concepts created confusion and inaccurate views and expectations. Some reported refusing injections to avoid pain and perceived risk of infection. Discussants emphasised the importance of education and preferred mobile immunization campaigns, with weekend to reach those with poor access and delivered by a combination of professional and volunteer workers. CONCLUSIONS Vaccine hesitancy in Zambia is underpinned by many factors including personal experiences with vaccinations, alternative belief models, limited knowledge, deep misunderstanding about how vaccines work, and barriers to access. To overcome these, community-driven models that incorporate factual communication by professionals and operate outside of traditional hours, may help. Better research to understand community preferences for vaccine uptake could inform interventions to improve immunization coverage in Zambia.
Collapse
Affiliation(s)
- Miguel Pugliese-Garcia
- Centre for Infectious Disease Research in Zambia (CIDRZ), Plot # 34620, P.O. Box 34681, Lusaka 10101, Zambia.
| | | | - Chanda Mwamba
- Centre for Infectious Disease Research in Zambia (CIDRZ), Plot # 34620, P.O. Box 34681, Lusaka 10101, Zambia
| | - Sharon Nkwemu
- Centre for Infectious Disease Research in Zambia (CIDRZ), Plot # 34620, P.O. Box 34681, Lusaka 10101, Zambia
| | - Roma Chilengi
- Centre for Infectious Disease Research in Zambia (CIDRZ), Plot # 34620, P.O. Box 34681, Lusaka 10101, Zambia
| | | | | | - Anjali Sharma
- Centre for Infectious Disease Research in Zambia (CIDRZ), Plot # 34620, P.O. Box 34681, Lusaka 10101, Zambia
| |
Collapse
|
8
|
Williams MS, Kenu E, Dzubey I, Dennis-Antwi JA, Fontaine K. A qualitative study of cervical cancer and cervical cancer screening awareness among nurses in Ghana. Health Care Women Int 2018; 39:584-594. [DOI: 10.1080/07399332.2018.1424169] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
| | - Ernest Kenu
- Department of Epidemiology and Disease Control, University of Ghana, Legon, Ghana
| | | | | | - Kevin Fontaine
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, Alabama, USA
| |
Collapse
|
9
|
Cunningham MS, Skrastins E, Fitzpatrick R, Jindal P, Oneko O, Yeates K, Booth CM, Carpenter J, Aronson KJ. Cervical cancer screening and HPV vaccine acceptability among rural and urban women in Kilimanjaro Region, Tanzania. BMJ Open 2015; 5:e005828. [PMID: 25757944 PMCID: PMC4360576 DOI: 10.1136/bmjopen-2014-005828] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Melissa S Cunningham
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Emily Skrastins
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Ryan Fitzpatrick
- Faculty of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Priya Jindal
- Faculty of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Olola Oneko
- Kilimanjaro Christian Medical Center, Moshi, Tanzania, Africa
| | - Karen Yeates
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
- Faculty of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Christopher M Booth
- Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen's University, Kingston, Canada
| | - Jennifer Carpenter
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
- Faculty of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Kristan J Aronson
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
- Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen's University, Kingston, Canada
| |
Collapse
|
10
|
Perlman S, Wamai RG, Bain PA, Welty T, Welty E, Ogembo JG. Knowledge and awareness of HPV vaccine and acceptability to vaccinate in sub-Saharan Africa: a systematic review. PLoS One 2014; 9:e90912. [PMID: 24618636 PMCID: PMC3949716 DOI: 10.1371/journal.pone.0090912] [Citation(s) in RCA: 130] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 02/04/2014] [Indexed: 01/19/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Stacey Perlman
- Pathfinder International, Watertown, Massachusetts, United States of America
| | - Richard G. Wamai
- Northeastern University, Boston, Massachusetts, United States of America
| | - Paul A. Bain
- Countway Library of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Thomas Welty
- Cameroon Baptist Convention Health Services, Bamenda, Cameroon
| | - Edith Welty
- Cameroon Baptist Convention Health Services, Bamenda, Cameroon
| | - Javier Gordon Ogembo
- University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
- * E-mail:
| |
Collapse
|