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Nakayita RM, Benyumiza D, Nekesa C, Misuk I, Kyeswa J, Nalubuuka A, Murungi T, Udho S, Kumakech E. Factors associated with uptake of human papilloma virus vaccine among school girls aged 9-14 years in Lira City northern Uganda: a cross-sectional study. BMC Womens Health 2023; 23:362. [PMID: 37420225 PMCID: PMC10329291 DOI: 10.1186/s12905-023-02511-z] [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: 01/24/2023] [Accepted: 06/26/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND Cervical cancer is the most common Human Papilloma Virus (HPV)-related disease among women. Since 2008, HPV vaccination has been routinely recommended for pre-adolescent and adolescent girls in Uganda as the primary preventive measure for cervical cancer. However, in Uganda, most especially in Lira district, there is limited literature on HPV vaccination uptake and associated factors among girls aged 9-14years. This study assessed the uptake of HPV vaccine and associated factors among in-school girls aged 9-14 years in Lira City, northern Uganda. METHODS A cross-sectional study was conducted among 245 primary school girls aged 9-14 years in Lira City, northern Uganda. Multistage sampling technique was used to sample eligible participants and data was collected using interviewer administered questionnaire. Data was analysed using SPSS version 23.0. Descriptive statistics and multivariate logistic regression at 95% level of significance were used to identify the level of HPV vaccine uptake and predictors respectively. RESULTS HPV vaccination uptake was at 19.6% (95% CI,14.8-25.1) among the school girls aged 9-14 years in Lira City, northern Uganda. The mean age of the girls was 12.11 (± 1.651) years. Predictors that were independently associated with HPV vaccine uptake included; recommendation from health worker [aOR 9.09, 95% CI (3.19-25.88), P ≤ 0.001], taught about cervical cancer at school [aOR,12.56, 95% CI (4.60-34.28), P ≤ 0.001], and exposure to outreach clinics [aOR, 4.41, 95% CI (1.37-14.19), P = 0.013]. CONCLUSION The study found that one in five of the school girls in Lira City, northern Uganda. received HPV vaccine. Girls who were taught about cervical cancer at school, exposure to outreach clinics and received health worker recommendation had more odds of receiving HPV vaccine than their counter parts. The Ministry of Health should strengthen school based cervical cancer education, awareness raising about HPV vaccination and health worker recommendations to improve HPV vaccine uptake among school girls in Uganda.
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Affiliation(s)
- Renniter Mirembe Nakayita
- Department of Midwifery, Faculty of Nursing and Midwifery, Lira University, P.O. BOX 1035, Lira City, Uganda
| | - Deo Benyumiza
- Department of Midwifery, Faculty of Nursing and Midwifery, Lira University, P.O. BOX 1035, Lira City, Uganda.
| | - Catherine Nekesa
- Department of Midwifery, Faculty of Nursing and Midwifery, Lira University, P.O. BOX 1035, Lira City, Uganda
| | - Ivan Misuk
- Department of Midwifery, Faculty of Nursing and Midwifery, Lira University, P.O. BOX 1035, Lira City, Uganda
| | - Julius Kyeswa
- Department of Midwifery, Faculty of Nursing and Midwifery, Lira University, P.O. BOX 1035, Lira City, Uganda
| | - Aisha Nalubuuka
- Department of Midwifery, Faculty of Nursing and Midwifery, Lira University, P.O. BOX 1035, Lira City, Uganda
| | - Tom Murungi
- Department of Midwifery, Faculty of Nursing and Midwifery, Lira University, P.O. BOX 1035, Lira City, Uganda
| | - Samson Udho
- Department of Midwifery, Faculty of Nursing and Midwifery, Lira University, P.O. BOX 1035, Lira City, Uganda
| | - Edward Kumakech
- Department of Nursing, Faculty of Nursing and Midwifery, Lira University, P.O. Box 1035, Lira City, Uganda
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Waheed DEN, Bolio A, Guillaume D, Sidibe A, Morgan C, Karafillakis E, Holloway M, Van Damme P, Limaye R, Vorsters A. Planning, implementation, and sustaining high coverage of human papillomavirus (HPV) vaccination programs: What works in the context of low-resource countries? Front Public Health 2023; 11:1112981. [PMID: 37124764 PMCID: PMC10140426 DOI: 10.3389/fpubh.2023.1112981] [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: 11/30/2022] [Accepted: 03/17/2023] [Indexed: 05/02/2023] Open
Abstract
Cervical cancer due to human papillomavirus (HPV) infection is a leading cause of mortality among women in low-resource settings. Many Sub-Saharan African countries have introduced HPV vaccination programs at the national level in the last few years. However, countries are struggling to maintain sustainable coverage. This study focuses on the introduction and sustainability challenges, context-specific key lessons learned, and mechanisms of action to achieve high sustainable coverage from low and lower-middle-income countries (LLMICs) that have introduced HPV vaccination programs by collating evidence from a literature review and key informant interviews. Local data availability was a challenge across countries, with the lack or absence of registries, data collection and reporting mechanisms. Multi-sectoral coordination and early involvement of key stakeholders were cited as an integral part of HPV programs and facilitators for sustainable coverage. Key informants identified periodic sensitization and training as critical due to high staff turnover. Health workforce mobilization was fundamental to ensure that the health workforce is aware of the disease etiology, eligibility requirements, and can dispel misinformation. Schools were reported to be an ideal sustainable platform for vaccination. However, this required teachers to be trained, which was often not considered in the programs. District-level staff were often poorly informed and lacked the technical and logistic capacity to support vaccination rounds and data collection. To improve the sustainability of HPV vaccination programs, there is a need for timely microplanning, efficient preparedness assessment, assessing training approaches, periodic training, finding innovative ways to achieve equity and adoption of a bottom-up approach to ensure that processes between districts and central level are well-connected and resources are distributed efficiently.
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Affiliation(s)
- Dur-E-Nayab Waheed
- Centre for the Evaluation of Vaccination, University of Antwerp, Antwerp, Belgium
- *Correspondence: Dur-E-Nayab Waheed,
| | - Ana Bolio
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Dominique Guillaume
- Jhpiego, The Johns Hopkins University Affiliate, Baltimore, MD, United States
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Center for Infectious Disease and Nursing Innovation, School of Nursing, Johns Hopkins University, Baltimore, MD, United States
| | - Anissa Sidibe
- Department of Vaccine Programmes, Gavi, the Vaccine Alliance, Geneva, Switzerland
| | - Christopher Morgan
- Jhpiego, The Johns Hopkins University Affiliate, Baltimore, MD, United States
- Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Emilie Karafillakis
- Centre for the Evaluation of Vaccination, University of Antwerp, Antwerp, Belgium
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Megan Holloway
- Department of Vaccine Programmes, Gavi, the Vaccine Alliance, Geneva, Switzerland
| | - Pierre Van Damme
- Centre for the Evaluation of Vaccination, University of Antwerp, Antwerp, Belgium
| | - Rupali Limaye
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Alex Vorsters
- Centre for the Evaluation of Vaccination, University of Antwerp, Antwerp, Belgium
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Filho DST, Rocha CMR, Bacha E, Beltrão MC, Barros LMD, Andrade ÁNM, Valadares FT, Machado YN. HPV Vaccine: Integrative Review of National and International Guidelines. Health (London) 2022. [DOI: 10.4236/health.2022.1412091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Rujumba J, Akugizibwe M, Basta NE, Banura C. Why don't adolescent girls in a rural Uganda district initiate or complete routine 2-dose HPV vaccine series: Perspectives of adolescent girls, their caregivers, healthcare workers, community health workers and teachers. PLoS One 2021; 16:e0253735. [PMID: 34185805 PMCID: PMC8241119 DOI: 10.1371/journal.pone.0253735] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 06/12/2021] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Vaccination with the 2-dose HPV vaccine series among adolescent girls in Uganda remains low after almost 5 years since the vaccine was included into the routine national immunization program and barriers are not well understood. OBJECTIVE We explored barriers that prevent eligible girls from initiating or completing the recommended 2-dose HPV vaccine series in Oyam District, Northern Uganda. METHODS A qualitative study was conducted in Oyam District, Northern Uganda. Forty interviews were conducted with adolescent girls, their caregivers, Village Health Team Members, health workers and school administrators involved in HPV vaccination. All interviews were audio recorded and transcribed. NVivo version 11 was used for data management and content thematic approach for analysis guided by the Social Ecological Model. RESULTS At individual level, low levels of knowledge about the vaccine, girls' frequent mobility between vaccine doses, school absenteeism and drop out, fear of injection pain and discouragement from caregivers or peers were key barriers. At the health facilities level, reported barriers included: few healthcare workers, inadequate knowledge about HPV vaccine, limited social mobilization and community engagement to promote the vaccine, limited availability of the HPV vaccine, unreliable transportation, lack of reminder strategies after the first dose of the vaccine, lack of vaccination strategy for out-of-school girls and un-friendly behaviour of some healthcare workers. Concerns about safety and efficacy of the vaccine, negative religious and cultural beliefs against vaccination, rumors and misconceptions about the vaccine, mistrust in government intentions to introduce the new vaccine targeting girls, busy schedules and the gendered nature of care work were key community level barriers. CONCLUSION Our study revealed an interplay of barriers at individual, health facility and community levels, which prevent initiation and completion of HPV vaccination among adolescent girls. Strengthening HIV vaccination programs and ensuring high uptake requires providing appropriate information to the girls plus the community, school and health facility stakeholders; addressing cold chain challenges as well as adequate training of vaccinators to enable them respond to rumors about HPV vaccination.
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Affiliation(s)
- Joseph Rujumba
- Department of Pediatrics and Child Health, Makerere University, Kampala, Uganda
| | | | - Nicole E. Basta
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada
| | - Cecily Banura
- Child Health and Development Centre, Makerere University, Kampala, Uganda
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Soi C, Shearer J, Chilundo B, Muchanga V, Matsinhe L, Gimbel S, Sherr K. Global health systems partnerships: a mixed methods analysis of Mozambique's HPV vaccine delivery network actors. BMC Public Health 2020; 20:862. [PMID: 32503479 PMCID: PMC7275554 DOI: 10.1186/s12889-020-08958-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 05/19/2020] [Indexed: 02/03/2023] Open
Abstract
Background Global health partnerships have expanded exponentially in the last two decades with Gavi, the Vaccine Alliance considered the model’s pioneer and leader because of its vaccination programs’ implementation mechanism. Gavi, relies on diverse domestic and international partners to carry out the programs in low- and middle-income countries under a partnership engagement framework (PEF). In this study, we utilized mixed methods to examine Mozambique’s Gavi driven partnership network which delivered human papillomavirus (HPV) vaccine during the demonstration phase. Methods Qualitative tools gauged contextual factors, prerequisites, partner performance and practices while a social network analysis (SNA) survey measured the partnership structure and perceived added value in terms of effectiveness, efficiency and country ownership. Forty key informants who were interviewed included frontline Ministry of Health workers, Ministry of Education staff and supporting partner organization members, of whom 34 participated in the social network analysis survey. Results Partnership structure SNA connectivity measurement scores of reachability (100%) and average distance (2.5), were high, revealing a network of very well-connected HPV vaccination implementation collaborators. Such high scores reflect a network structure favorable for rapid and widespread diffusion of information, features necessary for engaging and handling multiple implementation scales. High SNA effectiveness and efficiency measures for structural holes (85%) and low redundancy (30%) coupled with high mean perceived effectiveness (97.6%) and efficiency (79.5%) network outcome scores were observed. Additionally, the tie strength average score of 4.1 on a scale of 5 denoted high professional trust. These are all markers of a collaborative partnership environment in which disparate institutions and organizations leveraged each entity’s comparative advantage. Lower perceived outcome scores for country ownership (24%) were found, with participants citing the prominent role of several out-of-country partner organizations as a major obstacle. Conclusions While there is room for improvement on the country ownership aspects of the partnership, the expanded, diverse and inclusive collaboration of institutions and organizations that implemented the Mozambique HPV vaccine demonstration project was effective and efficient. We recommend that the country adapt a similar model during national scale up of HPV vaccination.
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Affiliation(s)
- Caroline Soi
- Department of Global Health, University of Washington, Harris Hydraulics Laboratory, 1510 San Juan Road, Seattle, WA, 98195, USA. .,Health Alliance International, 1107 NE 45TH St #350, Seattle, WA, 98105, USA.
| | | | - Baltazar Chilundo
- Universidade Eduardo Mondlane, Av. Salvador Allende no. 702, Maputo, Mozambique
| | - Vasco Muchanga
- Universidade Eduardo Mondlane, Av. Salvador Allende no. 702, Maputo, Mozambique
| | - Luisa Matsinhe
- Health Alliance International, Rua Caetano Viegas no. 67, Maputo, Mozambique
| | - Sarah Gimbel
- Department of Global Health, University of Washington, Harris Hydraulics Laboratory, 1510 San Juan Road, Seattle, WA, 98195, USA.,Health Alliance International, 1107 NE 45TH St #350, Seattle, WA, 98105, USA.,Department of Family and Child Nursing, University of Washington, Magnuson Health Sciences Building, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Kenneth Sherr
- Department of Global Health, University of Washington, Harris Hydraulics Laboratory, 1510 San Juan Road, Seattle, WA, 98195, USA.,Health Alliance International, 1107 NE 45TH St #350, Seattle, WA, 98105, USA
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