Parental acceptance of human papillomavirus vaccine for female adolescents in Abia State, southeastern Nigeria: a pre-implementation study

Abstract

Introduction: cervical cancer is the second most common cancer amongst women in Nigeria, with an incidence rate of 26.2 per 100,000 and mortality rate of 14.3 per 1000 adult women. Vaccination is the primary prevention if initiated prior to Human Papillomavirus (HPV) infection. However, vaccine hesitancy remains a threat to the uptake of the HPV vaccine. This study identified the pattern and predictors of parental acceptance of HPV vaccines for their female adolescents in Abia State, Nigeria prior to state level introduction.

Methods: we conducted a community-based cross-sectional study between August and September 2023 among parents of female adolescents residing in Abia State. A multistage sampling technique was used to select the study respondents. An interviewer-based, semi-structured questionnaire was administered to the respondents. Analysis was done using IBM SPSS version 26. Univariate analysis was used to present the socio-demographic characteristics of the respondents in frequencies and proportions. The association between parental acceptance and the independent variables was assessed using the chi-square test. Logistic regression was used to identify the independent predictors of parental acceptance of HPV vaccination. The level of significance was 5%.

Results: a total of 1,016 respondents participated in this survey, with a mean age of 42.2 ± 10.5 years. The prevalence of parental HPV vaccine acceptance was 63.0% (95% CI: 59.8 - 66.0). The major sources of information on the HPV vaccine were the healthcare workers (43.0%) and social media (37.8%). Among respondents who would accept the HPV vaccine for their female adolescents, the commonest reason was for the prevention of HPV transmission (58.3%). Most of the respondents who declined willingness reported lack of information (63.9%), followed by fear of adverse effects (32.9%) as the triggers for non-acceptance of the vaccine. The most preferable source of HPV vaccine recommendation mentioned by the respondents were healthcare workers (92.7%). Female (aOR=1.44, 95% CI: 1.02 - 2.03), good knowledge of HPV infection (aOR=2.87, 95% CI: 1.82 - 4.53) and good knowledge of HPV vaccine (aOR=18.52, 95% CI: 10.52 - 32.61) were the predictors of HPV vaccine acceptance.

Conclusion: prior to the introduction of HPV vaccine into the routine immunization of Abia State, Nigeria, most parents surveyed indicated that they would accept HPV vaccine for their female adolescents. Sex, knowledge of HPV infection and HPV vaccine were the independent predictors of parental acceptance of HPV vaccine. We recommend the raising of awareness campaign on HPV vaccine benefits and safety, prioritizing healthcare workers and the social media as the major channels of communication to support HPV vaccination.

Keywords: Adolescents; Nigeria; cervical cancer; human papillomavirus infections; human papillomavirus vaccines.

Figure 1

sources of information on HPV vaccine among the respondents

Figure 2

reasons for acceptance of HPV vaccine for their female adolescents among the respondents (n=640)

Figure 3

reasons for non-acceptance of HPV vaccine for their adolescents among the respondents (n=376)

Figure 4

preferred sources of recommendations for parental HPV vaccine acceptance (n=1016)