Factors associated with HPV vaccination uptake in Uganda: a multi-level analysis

Abstract

Background: The cervical cancer burden in Uganda is high amidst low uptake of HPV vaccination. Identification of individual and community factors associated with HPV vaccination are imperative for directed interventions. Conversely, in most Low and Middle Income Countries (LMICs) including Uganda this problem has not been sufficiently studied as the influence of individual and contextual determinants remains undetermined in spite of their substantial effect on HPV vaccine uptake. The aim of the study was to identify individual (school attendance status, age of girls, ethnicity, and amount of media exposure) and community (socioeconomic disadvantages) factors associated with HPV vaccination. Methods: Based on a modified conceptual framework for health care utilization, hierarchical modelling was used to study 6093 girls, aged 10-14 years (level 1), nested within 686 communities (level 2) in Uganda by analyzing data from the 2016 Uganda Demographic and Health Survey. Results: Majority (78%) of the girls had not been vaccinated. A number of both individual and community factors were significantly associated with HPV vaccination. The Odds of HPV vaccination were higher among girls age; 11, 13, and 14 compared to girls age 10 years, attending school compared to girls not attending school, who were; foreigners, Iteso, Karamajong, Banyoro, Basoga, and other tribe compared to Baganda, living in families with 1-8 members compared to those living in families with 9 or more members and middle social economic status compared to poor wealth quintile. Conclusions: Both individual and community factors show a noticeable effect on HPV vaccination. If higher vaccination rates are to be achieved in Uganda, these factors should be addressed. Strategies aimed at reaching younger girls, street children, out of school girls, and girls with lower SES should be embraced in order to achieve high vaccination uptake.

Knowledge, perceptions and uptake of human papilloma virus vaccine among adolescent girls in Kampala Capital City Authority, Uganda; A cross-sectional school-based survey

“…The study estimated the level of uptake of HPV vaccination (receiving two doses of the vaccine) at 8.6%, which is signi cantly way below the targeted coverage of 80% (Ministry Of Health, 2010). This low uptake has also been reported in a study conducted in Northern Uganda (Kisaakye et al, 2018) and in a multi-level analysis of the 2016 Uganda Demographic and Health Survey conducted by Isabirye et al (2020).…”

Human papillomavirus vaccination uptake in low-and middle-income countries: a meta-analysis

“…Five studies reported the use of Cervarix between 2008 and 2017 in Cambodia, Malaysia, South Africa, and Uganda [26,29,36,42,52]. Five studies reported the use of Cervarix and Gardasil between 2009 and 2019 in Argentina, Brazil, China, Malaysia, and Nigeria [19,28,43,45,49,53].…”

Health facility assessments of cervical cancer prevention, screening, and treatment services in Gulu, Uganda

“…As of 2020, an estimated 74% of eligible girls have received at least 1 dose, and 30% of girls have completed the series [1]. Various individual and community factors impact vaccination uptake, with correlation between series completion and older age, higher attendance 10 at a school-based program, higher socioeconomic status (SES), and living in an urban location [16]. While this study and HFA evaluated the access to HPV vaccines through health facilities, the national vaccination program focused primarily on girls age 10 to 14 in schools and community outreach program, therefore the HFA may not accurately capture the vaccine accessibility in the country.…”

“…The copyright holder for this preprint this version posted June 27, 2022. ; https://doi.org/10.1101/2022.06.24.22276873 doi: medRxiv preprint 10 at a school-based program, higher socioeconomic status (SES), and living in an urban location [16]. While this study and HFA evaluated the access to HPV vaccines through health facilities, the national vaccination program focused primarily on girls age 10 to 14 in schools and community outreach program, therefore the HFA may not accurately capture the vaccine accessibility in the country.…”