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Meta-Analysis
. 2024 Dec 11:12:1453704.
doi: 10.3389/fpubh.2024.1453704. eCollection 2024.

Uptake and determinants of HPV vaccination in South Asia: a systematic review and meta-analysis

Khola Noreen  1 , Samina Naeem Khalid  2 , Manal Abdulaziz Murad  3 , Mukhtiar Baig  4 , Shahzad Ali Khan  2
Affiliations
Meta-Analysis

Uptake and determinants of HPV vaccination in South Asia: a systematic review and meta-analysis

Khola Noreen et al. Front Public Health. .

Abstract

Background: Cervical cancer burden in South Asia is among the highest globally. Due to the lack of national immunization programs, the prevalence of human papillomavirus (HPV) infection and vaccine uptake remains unknown. This systematic review and meta-analysis aim to determine the prevalence of HPV vaccine uptake in South Asia.

Methods: We conducted a comprehensive search of MEDLINE (via PubMed), Embase, the Cochrane Library, and the Web of Science, covering the period from inception to May 20, 2024. We included observational studies reporting HPV vaccine uptake in South Asia, without any language filters or restrictions. The search strategy involved MeSH terms and relevant keywords related to "Papillomavirus Infections," "Vaccination," and "Uptake." MetaXL and STATA were used to perform a proportional meta-analysis and meta-regression analysis.

Results: Out of 3,913 articles identified, 17 articles (10,585 participants) were included in the systematic review. The pooled prevalence of vaccine uptake was 8% (95% CI 1-21). There was high heterogeneity between studies (I 2 = 100%). The pooled prevalence of adequate knowledge of the HPV vaccine was 41% (95% CI 28-55, I 2 = 99%). The pooled prevalence of a favorable attitude toward the HPV vaccine was 56% (95% CI 47-66, I 2 = 98%). In the univariate meta-regression model, good knowledge significantly predicted HPV vaccine uptake (p = 0.003), while no covariates were found to be significant predictors of attitudes toward HPV vaccine uptake.

Conclusion: The findings of this meta-analysis indicate a low pooled prevalence of HPV vaccine uptake (8%) in South Asian countries. The pooled prevalence of adequate knowledge and a favorable attitude toward the vaccine were 41 and 56%, respectively. In the univariate meta-regression model, knowledge of the HPV vaccine uptake was the only significant predictor of vaccine uptake.

Systematic review registration: Systematic review is registered at Prospero through the link https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024547393.

Keywords: HPV vaccination; South Asia; cervical cancer; meta-analysis; vaccination determinants.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flowchart.
Figure 2
Figure 2
Quality assessment of included studies.
Figure 3
Figure 3
Forest plot for the prevalence of HPV vaccine uptake.
Figure 4
Figure 4
Forest plot depicting subgroup analysis by country for the prevalence of HPV vaccine uptake.
Figure 5
Figure 5
Forest plot depicting subgroup analysis by occupation for the prevalence of HPV vaccine uptake.
Figure 6
Figure 6
Forest plot for the prevalence of HPV vaccine knowledge.
Figure 7
Figure 7
Forest plot depicting subgroup analysis by country for the prevalence of HPV vaccine knowledge.
Figure 8
Figure 8
Forest plot depicting subgroup analysis by occupation for the prevalence of HPV vaccine knowledge.
Figure 9
Figure 9
Forest plot for prevalence of attitude toward HPV vaccine.
Figure 10
Figure 10
Forest plot depicting subgroup analysis by country for the prevalence of attitude toward HPV vaccine.
Figure 11
Figure 11
Forest plot depicting subgroup analysis by occupation for prevalence of attitude toward HPV vaccine.
Figure 12
Figure 12
Bubble plot depicting the significant association between knowledge of HPV vaccine and vaccine uptake (p = 0.003).
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