Uptake of three doses of HPV vaccine by primary school girls in Eldoret, Kenya; a prospective cohort study in a malaria endemic setting

Abstract

BackgroundAll women are potentially at risk of developing cervical cancer at some point in their life, yet it is avoidable cause of death among women in Sub- Saharan Africa with a world incidence of 530,000 every year. It is the 4th commonest cancer affecting women worldwide with over 260,000 deaths reported in 2012. Low resource settings account for over 75% of the global cervical cancer burden. Uptake of HPV vaccination is limited in the developing world. WHO recommended that 2 doses of HPV vaccine could be given to young girls, based on studies in developed countries. However in Africa high rates of infections like malaria and worms can affect immune responses to vaccines, therefore three doses may still be necessary. The aim of this study was to identify barriers and facilitators associated with uptake of HPV vaccine.MethodsA cross-sectional survey was conducted at Eldoret, Kenya involving 3000 girls aged 9 to 14 years from 40 schools. Parents/guardians gave consent through a questionnaire.ResultsOf all 3083 the school girls 93.8% had received childhood vaccines and 63.8% had a second HPV dose, and 39.1% had a third dose. Administration of second dose and HPV knowledge were both strong predictors of completion of the third dose. Distance to the hospital was a statistically significant risk factor for non-completion (P: 0.01).ConclusionsDistance to vaccination centers requires a more innovative vaccine-delivery strategy and education of parents/guardians on cervical screening to increase attainment of the HPV vaccination.

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

“…The WHO recommends vaccination of multiple cohorts of the primary population at the introduction of the program. Bhutan, Bolivia, Brazil, Cambodia, Cameroon, Haïti, India, Kenya, Lesotho, Malaysia, Nepal, Peru, Rwanda, Uganda, and Vietnam targeted school-based, hospital-facility, and community-based delivery models or mixed model that reported very low attrition from receiving the full three doses [27,34,40,45,47]. Our pooled estimates suggest that among countries that started with overall high uptake, the uptake of vaccination was significantly higher in demonstration projects.…”

“…In Malaysia, the average compliance in completion of the third dose in the national school-based vaccination program between 2010 and 2016 was 99.0% [45]. However, even in a demonstration project in Kenya, higher percentages of non-compliance were reported with 63.8% receiving the second dose and only 39.1% completing the third dose [34].…”

“…The vaccination programs were initiated as demonstration or pilot projects that covered selected regions of the country where vaccines were delivered through a mix of school-, community-, or facility based-programs between 2008 and 2017. Data on the uptake from demonstration projects were reported from Bhutan [27], Cambodia [29,32], Vietnam [33], Cameroon [25,32], Ghana [51], Kenya [34,38], Lesotho [32], Malawi [35], Bolivia [32], Haïti [32] and Peru [33]. The compliance to dosing schedules in demonstration projects in Bhutan, Bolivia, Cambodia, Cameroon, Haïti, Lesotho, and Nepal in 2009À2010 was 96.1% between the first and the second dose, 94.5% between the second and third dose, and 90.9% between the first and the third dose [32].…”

Biopsychosocial risk factors and knowledge of cervical cancer among young women: A case study from Kenya to inform HPV prevention in Sub-Saharan Africa

“…The Tanzanian data was based on a 2011–12 survey, whereas the Nigerian sample was of high school students from 13 to 25 years, surveyed in 2018. There is ample evidence linking the lack of awareness of cervical cancer among young women in Sub-Saharan Africa to low uptake of cervical cancer prevention services, such as HPV vaccination and cancer screening [ 20 , 37 , 38 ], which leads to presentations of advanced cervical cancer and late treatment [ 11 , 23 ]. In fact, even if there was an awareness of cervical cancer as the KDHS data indicates (76.2% of women 15–49 years), over 80% had never been screened [ 20 ].…”

“…While previous studies on determinants of cervical cancer awareness in Kenya have focused on the provided results for women in the reproductive age-group (15–49 years) [ 20 ], and cervical cancer determinants in older women [ 19 , 21 ] there are limited population based studies that focus on the issues and needs of younger women in the pre-screening age groups (15–24 years). Similarly, primary HPV vaccination in Kenya has targeted adolescents aged 9–14 years [ 22 , 23 ]; hence the 15-24-year-olds are less catered for by programs.…”