Prevalence and factors associated with optimal uptake of Human Papilloma Virus vaccination among older adolescent girls (15 –19) in Wakiso district.

Abstract

Background: In 2020, the global incidence of cervical cancer (CC) was 13.3 per 100,000 populations. Of these, Africa had an incidence of 25.6 per 100,000 and Eastern Africa had the highest incidence at 40.1 per 100,000. Uganda has one of the highest CC incidences in the world at 47.5 per 100,000 populations. Although HPV vaccination is crucial to the reduction and prevention of these deaths, its uptake has been consistently low. Following the COVID-19 pandemic, these rates are likely to be even lower than previously estimated due to the lock down and diversion of resources. The optimal uptake of HPV vaccination in this context hasn’t been previously assessed.

Objectives: This study aimed to determine the prevalence of optimal uptake of HPV vaccination among older adolescents aged 15 –19 years in Wakiso district and the factors associated with the optimal uptake of HPV vaccination among adolescents older than 15 -19 years in Wakiso district.

Methodology: This was a Sequential Explanatory Mixed Method Study conducted in 2 selected sub counties in Nabweru Division and Namayumba Sub-county in Wakiso District and these were selected using purposive multistage sampling to cover one urban and one rural sub-county and the schools to be involved in the study. The study was a school-based study engaging adolescent girls 15 -19 years in secondary schools. Simple random sampling was used to obtain the specific students that participated in the study. Data was collected with an interviewer-administered questionnaire and analyzed using a modified Poisson regression with a 5 % level of significance.

Results: Only 18% of the older adolescent girls had been optimally (2 dozes) vaccinated. Participants who were in boarding section had lower HPV uptake compared to those in day section (aPR 0.63 95%CI 0.47-0.87). Participants with moderate or high level of Knowledge on HPV vaccination had a higher HPV vaccination uptake compared to those with low levels (aPR 7.36 95%CI 3.43-15.80) and (aPR 21.6 95%CI 10.77-43.43) respectively. Adolescent girls who lived either father or mother or others (aPR 1.68 95% CI 1.17-2.40) and (aPR 2.24 95% CI (1.53-3.29) respectively Qualitative findings revealed low knowledge levels among students, parents and teachers, stringent administrative school rules on vaccination as barrier to HPV vaccination while repetitive rescheduling of vaccination, availability of MOH HPV policies and health education are facilitators to HPV vaccination uptake.

Conclusion: Because optimal HPV vaccination is still low at 18%, more effort needs to be put into sensitization and education of all stakeholders including the adolescent girls themselves, teachers at all levels, parents with emphasis on mothers, opinion and religious leaders and the whole community to appreciate the importance of HPV vaccination for all girls in the fight to eliminate cervical cancer.