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Shahnaz S, Fricovsky E, Anwar R, Arain MI. Cervical Cancer Awareness and Attitude Towards Cervical Cancer Screening and Human Papillomavirus Vaccines Among Urban Women of Karachi, Pakistan. Cureus 2023; 15:e42970. [PMID: 37671214 PMCID: PMC10475580 DOI: 10.7759/cureus.42970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2023] [Indexed: 09/07/2023] Open
Abstract
Cervical cancer is the second most common cancer among women under 50 years of age in Pakistan. The current study was designed to assess the level of awareness through educational outreach presentations about cervical cancer, Papanicolaou (Pap) smear test, and human papillomavirus (HPV) vaccination in Karachi, Pakistan. Women from different urban hospitals were enrolled. Participants participated in a 45-minute presentation on cervical cancer awareness led by student pharmacists from Nazeer Hussain University, Karachi. A pre-and post-test was administered to assess the impact of the intervention. Descriptive statistics were used to summarize the findings, and a t-test was used for matched comparison, and a p-value <0.05 for statistical significance. A total of 150 women participated in the study. The study found that Pakistani women living in urban settings were less knowledgeable about the causes of cervical cancer and prevention. After the presentation, we observed a 45% increase in knowledge, and 31% of participants said they would obtain a Pap smear test in the next six months. Supervised pharmacy student-led presentations on cervical cancer educational awareness that significantly impacted women participants. Pharmacists can play a key role in reducing cervical cancer deaths through increased awareness, education, prevention, and immunization.
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Affiliation(s)
| | - Eduardo Fricovsky
- Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, USA
| | | | - Mudassar Iqbal Arain
- Pharmacy, University of SIndh, Jamshoro, PAK
- Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, USA
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Hakimi S, Lami F, Allahqoli L, Alkatout I. Barriers to the HPV vaccination program in the Eastern Mediterranean region: a narrative review. J Turk Ger Gynecol Assoc 2023; 24:48-56. [PMID: 36583290 PMCID: PMC10019013 DOI: 10.4274/jtgga.galenos.2022.2022-6-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
Objective The human papillomavirus (HPV) vaccine is regarded as one of the most effective ways of preventing cervical cancer. Despite the massive burden of this disease, only two countries in the Eastern Mediterranean Region (EMR) have implemented a national HPV vaccination program. The aim of the present study was to assess the main barriers to the integration of HPV vaccination in the national vaccination programs of EMR countries. Material and Methods We performed a narrative review with no inclusion and exclusion criteria. The electronic databases we searched included Medline, Scopus, Embase, and Web of Science (last update; December 2021). The search was not subject to any limitation in terms of time or method. Studies that dealt with the obstacles or the needs of vaccination programs in EMR countries were included in the investigation. Results After a full-text screening, the report comprised of 31 studies from 15 EMR countries. All of the studies were descriptive. The most common barriers to HPV vaccination are the following: a) lack of knowledge and awareness, b) economic barriers in terms of the cost-effectiveness of the HPV vaccination program, c) social insecurity in conflict zones, d) cultural norms and religion. Conclusion EMR countries should focus on modifiable barriers to the vaccination program. Steps to improve HPV vaccination coverage in these countries should include enhancing social awareness and mobilization, ensuring the support of the Global Alliance for Vaccines and Immunization in eligible countries, using national resources in an optimal way, and addressing HPV vaccination in undergraduate medicine and paramedic curriculums.
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Affiliation(s)
- Sevil Hakimi
- Tabriz University of Medical Science, Research Center of Psychiatry and Behavioral Sciences, Tabriz, Iran
| | - Faris Lami
- Department of Family and Community Medicine, College of Medicine, University of Baghdad, Baghdad, Iraq
| | | | - Ibrahim Alkatout
- Department of Obstetrics and Gynecology, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany
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Rajkhowa P, Patil DS, Dsouza SM, Narayanan P, Brand H. Evidence on factors influencing HPV vaccine implementation in South Asia: A scoping review. Glob Public Health 2023; 18:2288269. [PMID: 38063361 DOI: 10.1080/17441692.2023.2288269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 11/08/2023] [Indexed: 12/18/2023]
Abstract
Cervical cancer is a significant public health concern globally, with low and middle-income countries bearing the highest burden, specifically the South Asian region. Therefore, the current scoping review aimed to highlight the factors influencing the implementation of human papillomavirus (HPV) vaccination in South Asia. Adopting the 'Arksey and O'Malley and Levac et al.' methodology, multiple electronic databases were searched to identify relevant records. The results were narratively synthesised and discussed, adopting the Consolidated Framework for Implementation Research (CFIR) model. We identified 527 records, which were assessed for eligibility based on title, abstract, and full text by three reviewers, followed by data extraction of 29 studies included for analysis in the review. Implementing HPV vaccination programs in South Asia faces various challenges, such as economic, health system, financial, health literacy, and sociocultural factors that hinder their successful implementation. To successfully implement the vaccine, a tailored risk communication strategy is necessary for these countries. Knowledge gained from the experience of South Asian nations in implementing the HPV vaccine can assist in policymaking in similar healthcare for advancing the implementation of HPV vaccination.
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Affiliation(s)
- Priyobrat Rajkhowa
- Department of Health Policy, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
- Department of International Health, Care and Public Health Research Institute - CAPHRI, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Divya Sussana Patil
- Public Health Evidence South Asia, Department of Health Information, Prasanna School of Public Health (PSPH), Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Sherize Merlin Dsouza
- Department of Health Policy, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
- Department of International Health, Care and Public Health Research Institute - CAPHRI, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Prakash Narayanan
- Department of Health Policy, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Helmut Brand
- Department of Health Policy, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
- Department of International Health, Care and Public Health Research Institute - CAPHRI, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Crippin T, Tounkara K, Squibb E, Beseme S, Barry K, Sangare K, Coulibaly S, Fané P, Bagayoko A, Koita OA, Teguété I, De Groot AS. A story-telling cloth approach to motivating cervical cancer screening in Mali. Front Public Health 2022; 10:1051536. [PMID: 36589936 PMCID: PMC9800037 DOI: 10.3389/fpubh.2022.1051536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 11/24/2022] [Indexed: 12/23/2022] Open
Abstract
Ninety percent of deaths from Cervical cancer (CC) caused by Human Papilloma Virus (HPV) occur in low- and middle-income countries. CC is the 2nd most common cause of cancer in women in West Africa, where 12,000 women develop cervical cancer and more than 6,000 die from the disease, annually. While HPV vaccination and CC screening have dramatically reduced the incidence of CC and mortality from CC in developed countries, prevention of CC in West Africa is often limited to visual inspection of the cervix and surgical intervention. In previous studies of CC in Mali, we demonstrated that knowledge about the link between HPV and CC is limited, and that screening for CC is often delayed until women are symptomatic. For this intervention, a story-telling cloth (West African-style printed pagne) was designed for use as a starting point for educational sessions run by community health workers. Community outreach using the cloth during 6 months of 2015 resulted in a 5-fold higher uptake of cervical cancer screening and increased awareness of the potential to vaccinate adolescents against CC. 3,271 women were motivated to visit one of five participating clinics for CC screening, where a mere 600 women had been screened during the previous year. This study shows that a comprehensive, visual, community-centered education campaign coupled with coordinated support for local clinics improves uptake of CC screening.
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Affiliation(s)
| | | | - Eliza Squibb
- GAIA Vaccine Foundation, Providence, RI, United States
| | - Sarah Beseme
- GAIA Vaccine Foundation, Providence, RI, United States
| | - Katherine Barry
- The Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Kotou Sangare
- Laboratory of Applied Molecular Biology, University of Sciences, Techniques, and Technologies, Bamako, Mali
| | | | - Pinda Fané
- Department of Regional Health, Bamako, Mali
| | | | - Ousmane A. Koita
- Laboratory of Applied Molecular Biology, University of Sciences, Techniques, and Technologies, Bamako, Mali
| | | | - Anne S. De Groot
- GAIA Vaccine Foundation, Providence, RI, United States,*Correspondence: Anne S. De Groot
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Masjedi MR, Soltanizadeh N, Ainy E. Perspectives of Medical Experts' on Health Culture for Human Papillomavirus (HPV) Vaccination Compared to Auxiliary Health Workers. Asian Pac J Cancer Prev 2022; 23:4093-4097. [PMID: 36579990 PMCID: PMC9971468 DOI: 10.31557/apjcp.2022.23.12.4093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The viewpoints of Shahid Beheshti University of Medical Sciences medical experts'' were compared with those of auxiliary health workers regarding health culture related to human papillomavirus vaccination in 2020. METHODS In this cross-sectional study, 220 medical experts' (gynecologists, cultural, psychological, infectious, dermatological, and educational) and auxiliary health workers were randomly selected and investigated. The required data were collected using a researcher-made questionnaire modeled on international questionnaires. These questionnaire contained demographic information on the subjects' age and sex as well as health culture was also assessed by measuring the knowledge, attitude, and practice of the subjects. RESULTS The mean age of the included medical experts' and auxiliary health workers was 38.0 3±8.3 and 35.2±7.5 years old, respectively. There was a significant difference in the knowledge of auxiliary health workers as 55.3 ± 3.8 in comparison with the medical experts' as 51.6 3± 6.3 (p <0.002). There was a significant difference on whether changing cultural attitudes about the need for vaccination could be effective on reducing sexually transmitted diseases between the auxiliary health workers and medical experts' (p <0.001). There was a significant difference in the knowledge of auxiliary health workers 55.3 ± 3.8 in comparison with the psychology and cultural experts' as 48.5± 6.3, 48.3± 6.8 (p<0.001) respectively. CONCLUSION Knowledge among the auxiliary health workers was significantly different from that of psychology and cultural experts' in relation to health culture for human papillomavirus vaccination. It was indicated that these experts need to upgrade their health culture knowledge to increase the rate of community participation in human papillomavirus vaccination.
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Affiliation(s)
- Mohammad Reza Masjedi
- Cancer Control Research Center, Cancer Control Foundation, Iran University of Medical Sciences, Tehran, Iran. ,Tobacco Control Research Center (TCRC), Iranian Anti-tobacco Association, Iran University of Medical Sciences, Tehran, Iran. ,Department of pulmonary medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Narges Soltanizadeh
- PhD in Cultural Management and Planning, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Elaheh Ainy
- Associate Professor, Safety Promtion and Injury Prevention Research Center of Shahid Beheshti University of Medical Sciences, Tehran, Iran. ,For Correspondence:
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Ejaz M, Ekström AM, Ahmed A, Haroon A, Ali D, Ali TS, Salazar M. Human Papillomavirus associated prevention: knowledge, attitudes, and perceived risks among men who have sex with men and transgender women in Pakistan: a qualitative study. BMC Public Health 2022; 22:378. [PMID: 35193544 PMCID: PMC8864907 DOI: 10.1186/s12889-022-12775-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 02/14/2022] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES Men who have sex with men (MSM) and transgender individuals are at higher risk of genital warts and anal cancer due to sexually transmitted human papillomavirus infection. This study explores MSM and transgender women's perceptions of Human papillomavirus (HPV) infection and HPV prevention strategies (screening and vaccination) in Pakistan. DESIGN A qualitative study using focus group discussions (FGD) with self-identified MSM, male sex workers and transgender women were conducted between March 2019 to August 2019 in Karachi, Pakistan. METHODS Participants were recruited from community-based organization (CBO) working for MSM and transgender women. A total of 38 men and 10 transgender women took part in 6 FGDs. Discussions were recorded, translated, transcribed verbatim and analyzed using content analysis. RESULTS Three themes were identified from the emerging analysis. These are, 1) Knowledge and risk perceptions about STIs and HPV, 2) Beliefs and attitudes towards HPV prevention, 3) Participant's recommendations for HPV vaccination and anal Pap screening. Participants described lack of knowledge of HPV and its health consequences as HIV is the only focus of attention of the government and the local CBOs. None of participants had heard about HPV prevention including vaccination and anal Pap screening for men but expressed a positive attitude towards prevention. Genital warts and anal cancer were perceived as severe potential consequences of a known risk behaviors. All participants stated they would be interested in taking an HPV vaccine but acknowledged that the provision of services for sexually transmitted infections (STI) are inadequate to meet the needs of key populations and are not prioritized by the government. The main perceived barriers to access HPV prevention included cost and challenges to access public health care services or openly discussing one's sexual orientation with health care providers. Participants generally preferred the CBO for more professional, unbiased staff attitudes that respect patients' integrity, confidentiality and privacy. Most participants thought that in case the government is non-cooperative, CBOs should work in the interest of HPV eradication and generate funds through international funding. CONCLUSIONS The findings from this study can help public health policy and researchers to understand this minority's perspective on HPV prevention. Given the low level of knowledge about HPV infection and its negative health consequences there is a need of HPV education combined with STI education and awareness through HPV brochures to educate the target population effectively.
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Affiliation(s)
- Muslima Ejaz
- Department of Global Public Health Karolinska Institutet, Stockholm, Sweden. .,Department of Community Health Sciences, the Aga Khan University, Karachi, Pakistan.
| | - Anna Mia Ekström
- Department of Global Public Health Karolinska Institutet, Stockholm, Sweden
| | - Alyan Ahmed
- Department of Community Health Sciences, the Aga Khan University, Karachi, Pakistan
| | - Aymen Haroon
- Department of Biostatistics and Epidemiology, School of Public Health, Boston University, Boston, Massachusetts, United States
| | - Dania Ali
- Department of Community Health Sciences, the Aga Khan University, Karachi, Pakistan
| | - Tazeen Saeed Ali
- Department of Community Health Sciences, the Aga Khan University, Karachi, Pakistan.,School of Nursing, the Aga Khan University, Karachi, Pakistan
| | - Mariano Salazar
- Department of Global Public Health Karolinska Institutet, Stockholm, Sweden
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Wong LP, Wong PF, Megat Hashim MMAA, Han L, Lin Y, Hu Z, Zhao Q, Zimet GD. Multidimensional social and cultural norms influencing HPV vaccine hesitancy in Asia. Hum Vaccin Immunother 2020; 16:1611-1622. [PMID: 32429731 PMCID: PMC7482900 DOI: 10.1080/21645515.2020.1756670] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 04/11/2020] [Indexed: 12/27/2022] Open
Abstract
HPV vaccine hesitancy in Asia is unique compared to Western countries due to multidimensional social-cultural norms that influence beliefs regarding vaccination. Reviews on HPV vaccine hesitancy in Asia lack of in-depth discussion regarding the traditional and social-cultural norms dimensions. This paper puts forward opinions in which culture, normative beliefs, and religion influence HPV vaccine hesitancy in Asian countries. Issues surrounding HPV hesitancy among parents, young adult women, adult women, men and the sexual and gender minority people in Asian countries were highlighted. The shortage of HPV vaccine supply would soon be reduced as some Asian countries are on the way to producing the HPV vaccine which production is currently dominated by Western European countries. The culture of favoring imported Western products among many in Asia and in addition to long-existing fake vaccine crisis pose a challenge for the newly emerging HPV vaccine produced in Asia. Some recommendations, research gaps, and future research needs were discussed.
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Affiliation(s)
- Li Ping Wong
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Pooi-Fong Wong
- Department of Pharmacology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Liyuan Han
- Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, Zhejiang, China
| | - Yulan Lin
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou, Fujian Province, China
- Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Zhijian Hu
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou, Fujian Province, China
- Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Qinjian Zhao
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, Xiamen, Fujian Province, China
| | - Gregory D. Zimet
- Department of Pediatrics, School of Medicine, Indiana University, Indianapolis, IN, U.S
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