Determinant of HPV Vaccine uptake among children aged 9-14 years


Doctoral Thesis / Dissertation, 2020

48 Pages


Excerpt

Table of Contents

Definition of terms

List of abbreviations

List of tables

List of figures

CHAPTER ONE
1.1 Background of the study
1.2 Problem statement
1.3 Study objectives
1.3.1 General objective
1.3.2 Specific Objectives
1.4 Research questions
1.5 Conceptual frame
1.6 Significance of the study
1.7 Scope of the study
1.7.1 Geographical Scope
1.7.2 Time Scope

Chapter Two
Literature Review
2.1 Introduction
2.2 Level of uptake of human papilloma vaccine
2.3 The caregiver’s factors
2.4 Health system factors and uptake of HPV vaccine

Chapter Three
Methodology
3.1 Introduction
3.2 Study design
3.3 Study area
3.4 Sources of data
3.5 Study Population
3.6 Inclusion criteria
3.7 Exclusion criteria
3.7.1 Sampling method
3.7.2 Sample size estimation
3.8 Study variables
3.8.1. Dependent variable
3.8.2 The independent variables
3.9 Data Collection method
3.10 Data collection tools
3.11 Data management
3.12 Data analysis plan
3.13 Ethical considerations
3.14 Dissemination of Results

Chapter Four

Results

Chapter Five

Discussion

Chapter Six

Conclusions And Recommendations

References

APPENDIX I: CONSENT FORM

APPENDIX II: QUESTIONNAIRE

Definition of terms

Immunization: This is the process of protecting a person from a specific disease by introduction of a specific antigen to stimulate the body immunity (producing antibodies)

Uptake: refers to reception of the service by the intended group of individual, in this study it means the number of girls aged 9-14 years who have received the HPV vaccine.

Knowledge: Is the understanding of something that a person acquires through experience or training.

Attitude: Feeling towards something. It can be positive or negative

Vaccination: This is the process of introduction of antigens to the individual’s body in order to cause the production of immunity.

Vaccine: Is a special preparation of antigenic substances that can be used to stimulate the development of anti-bodies to confer immunity against specific diseases.

Antigen: Any substance that may be specifically bound by antibody molecule.

Belief: This refers to a strong feeling about something which may or may not be attached to individual’s cultural origin.

List of abbreviations

HPV: Human papilloma virus.

HPVV: Human papilloma virus vaccines

AEFI: Adverse Effects Following Immunization

CDC: Centers for Disease Control

DCM : Diploma in Clinical Medicine

HC: Health Centre

HCIV: Health Centre four

CIU: Clarke International University.

MDG: Millennium Development Goals

MFPED: Ministry of Finance Planning and Economic Development

MOH: Ministry of Health

MOHDR: Ministry of Health and Demographic Report

NDP: National Development Plan

NPI: National Program on Immunization

OPD : Outpatient department

UBOS: Uganda Bureau of Statistics

UDHS: Uganda Demographics and Health Survey

UNEPI: Uganda Nation Expanded Program on Immunization

UNICEF: United Nations International Children Emergency Fund

WHO: World Health Organization

IARC: International Agency for Research on Cancer

List of tables

Table 1:Frequency table showing the distribution of the caregiver's demographic status

Table 2: Caregiver determinants of uptake of HPV vaccine among children of 9-14 years

Table 3:Caregiver determinants of uptake of HPV virus vaccine among girls of 9-14 years

Table 4:Health facility determinants of uptake of HPV virus vaccine among girls of 9-14 years

Table 5: Factors associated with uptake of HPV vaccine among girls of 9-14 years at multivariate analysis

List of figures

Figure 1:Conceptual frame work determinants of human papilloma virus vaccine uptake among girls aged (9-14 years) in Bukomansimbi Sub County in Bukomansimbi District

Figure 2:Level of uptake of HPV vaccine among girls of 9-14 years in Bukomansimbi Sub-County, Bukomansimbi district

CHAPTER ONE

1.1 Background of the study

Human papillomavirus (HPV) infection is now a well-established cause of cervical cancer which ranks as the fourth most frequent cancer among women in the World More than 270 000 women die of cervical cancer worldwide every year and over 85% of these deaths occur in low and middle income countries (WHO, 2017).

The latest statistics published by the International Agency for Research on Cancer (IARC), the specialized cancer agency of the World Health Organization, shows that cervical cancer occupies the fourth position in the list of the most common cancers affecting women all over the world, preceded by breast, colorectal, and lung cancers. More specifically, the estimated incidence of cervical cancer was of 527,624 new cases in 2012. In the same year, cervical cancer was responsible for 265,653 deaths in the world, which constituted the fourth most common cause of cancer death worldwide. Cervical cancer is often defined as a disease of disparity, because it differently affects poor and wealthy countries: at least 80% of cervical cancer deaths occur in developing countries. However, disparities also occur within a single country, as is the case of the USA, where Hispanic and African American women have, respectively, 2 and 1.5 times more risk of developing cancer than non-Hispanic White women. In Europe, the incidence and mortality rates of cervical cancer vary considerably within the region. (Victoria F et al, 2015)

Since 2006, two human papillomavirus vaccines (HPVV) have been licensed globally, aimed at preventing cervical cancer: Cervarix, a bivalent vaccine that targets papillomavirus 16 and 18, and Gardasil, which additionally targets papillomavirus 6 and 11. Types 16 and 18 are responsible for around 70% of all cervical cancer cases, whereas types 6 and 11 are responsible for about 90% of anogenital warts. Immunization as a three-dose series against the human papillomavirus (especially before sexual onset) is recommended as primary prevention method of certain HPV infections, in order to reduce the incidence of cervical cancer and other anogenital cancer. However, worldwide coverage remains unequal and uptake varies widely. In USA HPV-16 and HPV-18 are responsible for 70% of cervical cancers and most non cervical HPV-associated cancers. A recent study found that more than 40% of females aged 14 to 59 years were HPV positive, and nearly 30% of infections were with high-risk types. Approximately 26 200 cancers per year are attributable to HPV 17 400 among females, many of which could be preventable with appropriate use of current or future vaccines. (Dawn Met al, 2014)

The possible risk factors for HPV infection include; Young age, single women, immune suppressed females, females of poor socio economic status, multiple sexual partners, multiparity and housewives were at higher risk of HPV infection. Preventive strategies for cervical cancer in low-resource settings should target women aged 30-50 years for HPV screening, and should focus treatment and follow-up on HPV-16/18-positive women. (Catarino R et al 2016)

In Nigeria, there were estimates 527,624 new cases and 265,672 deaths in 2012. The majority of cases are squamous cell carcinoma followed by adenocarcinomas, about 14,089 new cervical cancer cases are diagnosed annually. Cervical cancer ranks as the 2nd leading cause of female cancer in Nigeria. Cervical cancer is the 2nd most common female cancer in women aged 15 to 44 years. (Bruni L et al 2017).

In Kenya, Cervical cancer poses a high burden on women’s health due to its high incidence and the poor prognosis of most patients. This elevated incidence rate is related to the high prevalence of HIV, the low screening coverage (only 3.2 % of all women in Kenya are screened every 3 years), and the absence of the Human Papillomavirus vaccine in the national vaccination program. If the HPV vaccine becomes available in Kenya, it would provide women on-going protection against several high-risk HPV types (Heleen et al 2016).

Currently HPV prevalence in Uganda is estimated to be at 27.3% and incidence data indicates that every year 3915 women are diagnosed with cervical cancer, and mortality data shows that every year 2275 women die from the killer disease. The HPV vaccination implementation started in October 2015 after a conclusive pilot study that was carried out in 2008 in the two districts of Ibanda and Nakasongola. This is implemented in the context of routine immunization programs as per the Uganda National Expanded Program on Immunization (UNEPI) guidelines.

WHO supported the government of Uganda by introducing cancer of cervix-screening in regional hospitals like Gulu, Arua, Soroti and recommends a comprehensive approach to cervical cancer control through the following means; WHO recommends vaccination for girls aged 9-13 years as this is the most cost-effective public health measure against cervical cancer, Education about safe sexual practices, including delayed start of sexual activity, Promotion and provision of condoms for those already engaged in sexual activity, Warnings about tobacco use, which often starts during adolescence, and which is an important risk factor for cervical and other cancers; and Male circumcision. The proportion of girls immunized with hpv vaccine in that age bracket in Uganda (%) = 61% (MOH Uganda, 2017)

However, there has been little uptake of this vaccination program by the target groups of 9-13 year old girls in the communities and the primary four girls in schools. Therefore, this study will be aims at assessing factors affecting uptake of HPV vaccination among girls aged (9-14) in Bukomansimbi Sub County

1.2 Problem statement.

The ministry of health Uganda adopted WHO guideline on routine immunization which was included in UNEPI and ensures that all girls at the age 11-15 to receive full dose in order to have full protection how ever since the introduction of the HPV vaccine in November 2015,There has been low uptake of the vaccine in Uganda with 33.6% prevalence among women combined with low screening uptake , this lead country being one of the highest cervical cancer with incidence rate of 47.5 per 100,000 per year (Caroly Nakisige,Melissa schwart,Anthony O.Ndira,2017)

At Bukomansimbi Sub County the target population of girl to be vaccinated according to the Bukomansimbi medical center records was 200 girls in the age bracket, many girls do not complete their doses as shown by the vaccination records book, girls normally hide a way during the time of vaccination and parents discourage their girls from receiving the HPV vaccine due to ignorance.

Since infection by HPV is the leading predisposing factor and cause of cancers of the cervix, vagina, and vulva in women this leads to the high expenditures for the family to spend on medical expenses, government on the other hand loses too much to treat.

1.3 Study objectives

1.3.1 General objective

To determine the factors associate with uptake of human papilloma virus vaccine in Bukomansimbi Sub-County, -Bukomansimbi district

1.3.2 Specific Objectives

1. To determine the level of uptake of human papilloma vaccine among girls of 9-14 years in Bukomansimbi Sub County - Bukomansimbi district.
2. To assess the caregiver determinants of uptake of human papilloma virus vaccine among children of 9-14 years in Bukomansimbi Sub County - Bukomansimbi district.
3. To investigate the health facility determinants of uptake of human papilloma virus vaccine among girls of 9-14 years in Bukomansimbi sub-county in Bukomansimbi district.

1.4 Research questions

1. What is the level of human papilloma virus vaccine uptake among girls aged 9-14 years in Bukomansimbi Sub County-Bukomansimbi district?
2. What are the caregivers’ factors affecting uptake of human papilloma virus vaccine among girls of 9-14 years in Bukomansimbi Sub County - Bukomansimbi district.
3. What are the health care factors affecting uptake of human papilloma virus vaccine among girls of 9-14 years in Bukomansimbi sub-county in Bukomansimbi district?

1.5 Conceptual frame

Abbildung in dieser Leseprobe nicht enthalten

Figure 1:Conceptual frame work determinants of human papilloma virus vaccine uptake among girls aged (9-14 years) in Bukomansimbi Sub County in Bukomansimbi District.

The conceptual diagram shows variables affecting completion of HPV vaccinations among girls aged (8-17) years. The variables are categorized into dependent and independent variables. Uptake of HPV vaccination is a dependent variable meaning it does not influence on the other variables. Independent variables are: Health System factors and Care givers’ factor. Health System factors include: health facility related factors that encompass availability of vaccines, knowledge of the health worker, the distance of the health facility health care provider recommendation, preventive health, health care insurance and school involvement.

Another independent variable is caregivers related factors in the study include: Age, sex, perceived benefit, perceived severity, Attitude, Level of education, Socio economic status, believes and Previous experience.

1.6 Significance of the study

The study shared information on the knowledge and practices of HPV vaccination among children 7 – 18 years in Bukomansimbi sub-county.

The study also helped the stakeholders (health workers and MOH) to get ways on how to improve the progress of HPV vaccination strategy in Uganda.

The research viewed as a working document that attempts to synthesize the currently available information about HPV vaccination in the field of maternal health promotion.

The study also serves as an academic requirement for the researcher’s award of Diploma in Clinical Medicine from Clarke international university.

1.7 Scope of the study

1.7.1 Geographical Scope

This study was aimed at assessing factors affecting uptake of HPV vaccination among girls aged (9-14) within Bukomansimbi Sub County-Bukomansimbi District – Uganda

1.7.2 Time Scope

The study was conducted for duration of 2 month from October-December 2020 from the stage of analysis, data collection and Dissemination of Results.

Chapter Two

Literature Review

2.1 Introduction

This chapter is about the thoughts and views of other scholars in relation to the topic identified by the researcher therefore; the purpose of this chapter is to review previous studies in relation to the factors affecting uptake of HPV vaccination among girls aged (9-14 years)under my study .It will be discussed according to the objectives.

2.2 Level of uptake of human papilloma vaccine

Human papillomavirus (HPV) is the most prevalent sexually transmitted infection in the world. HPV infection accounts for the majority of cervical and vaginal cancers among women, an attempt is done to increase the uptake of HPV vaccines among school girls in order to decrease the morbidity and mortality caused by HPV. . At the global view the study was carried by Peter A Newmanet al 2018 to examine factors associated with parents’ uptake of human papillomavirus (HPV) vaccines in their studies they sampled 840 838 of parents across 15 countries who were assessed on uptake of HPV vaccines for their children (≤18 years). They performed random-effects meta-analysis to examine factors associated with parent's uptake of HPV vaccines for their children. Later on the interpretation of the data they found that the pooled proportion of parent’s uptake of HPV vaccines for their children was 41.5% (range: 0.7%–92.8%), twofold higher for girls (46.5%) than for boys (20.3%).

A study was done to find out the factors affecting uptake of HPV vaccine in USA The 2013 was used where a total sample of 33 girls were selected , of which 18 (54%) had adequate provider data to confirm immunization status. On analysis of the results the study found that the vaccination completion rate was 26%. Among girls 13–17 years, 19% initiated, but did not complete the vaccine (Kristin L Johnson , Meng-Yun Lin , Howard Cabral ,2013.)

At the regional perspective studies were equally done to find out the level of uptake of HPV vaccine uptake among the girl.

In Nigeria, a cross-sectional study was conducted among 296 female adolescent senior secondary school students in Ibadan, Nigeria. Respondents were selected using purposive sampling method and data were collected using self-administered questionnaire ,the reason for this purposive sampling method it covers wide range where it gives the ability to gather large amount of information by using a range of different technique. Most 142 of the respondents were between ages 15-17years. On the interpretation of the results only 12 of the respondents have received the HPV vaccine. (Chizoma M Ndikom,2017)

A sample size of 225 participants was studied in a longitudinal plot study on HPV vaccination program in Eldoret among mothers of eligible girls in Kenya on randomly selected girls eligible for vaccination .Through the Gardasil Access Program (GAP) the study found that 31 % had their daughter vaccinated against cervical cancer with one dose or more 72 % of them had received 3 doses. (Heleen Vermandere et al, 2016)

According to a study done in Mbale district eastern part of Uganda involving 407 participants aged 9-15 years revealed that national coverage stands at 17% against target coverage of 80% since the vaccine's introduction in 2015.(Juilet nabirye et al 2017) ,The study used a Bennet'scluster survey method which was appropriate in that require little statistical expertise due to sample data set is smaller and also not expensive

According to the study done by Newman et al 2018 in 15 countries at the global view the HPV uptake is at range of 0.7 to 92.8%. In developed countries the uptake of HPV vaccine was ranging from 26 to 73% with japan having the highest uptake rate of 73% and USA 26%.

In developing countries, the uptake of HPV was also ranging from 80.4% with Nigeria being the lowest with 4% followed by Uganda by 17% with Tanzania leading at 80.4%.

The study is therefore seeking to find out the factors affecting uptake of HPV vaccination in Bukomansimbi sub county in Bukomansimbi-Uganda

2.3 The caregiver’s factors

HPV vaccination determines the increase of uptake or decrease of the uptake of HPV vaccination activities hence the reduction or the increase in the morbidity and mortality caused by HPV globally. This objective therefore seeks to reviews the available literature to ascertain the caregivers factors that affect uptake of HPV vaccine.

Globally in Seventy-nine cross sectional studies on 840 838 were recruited using a a cluster random sampling method in parents across 15 countries using the a cross sectional study design. the caregiver’s factors varied markedly. Of Sixty two n = 654100 measured the similar correlated uptake for HPV uptake for their children and they were included in their meta-analysis.

Factors positively associated with parent’s uptake of HPV vaccine for their children were parental HPV vaccine decision-maker, mother as HPV vaccine decision maker versus both parents r = 0.34 95% CI 0.23 to 0.44. The study realized that the recommendation of the mother or both parents played significant role in determining the factors affecting uptake of HPV vaccine p value 0.03. Of the study population 2 reported influence from the mother was important in completing the HPV vaccination schedule p value 0.001 compared to where the parents did not recommend p value 0.053. on the other hand n=4 reported that parent’s vaccine beliefs also affected the uptake of HPV vaccine the parents who strongly believed that the vaccine was necessary for their girls could easily take their girls for vaccination against HPV p value 0.001 compared to those who did not belief that the vaccines had a vital role in protecting their girls against morbidity and mortality of HPV n=342 and the p value 0.084 (Or=0.17 (95% CI 0.10 to 0.24).(Peter A Newman et al 2018)

In addition to that a retrospective study was done by Newman etal , 2018, they carried it non school going girl at community level where they enrolled 580 participants on the study using a cluster random sampling method. Attitudes and intentions to vaccinate the child for HPV n=14 (r=0.31 (95% CI 0.17 to 0.43) had a significant association with uptake of HPV vaccine p value 0.0001. In addition to that knowledge was equally associated with increased rate of the uptake of HPV vaccines p value 0.002. Parents who were knowledgeable n=10 reported to have taken their girls for the HPV vaccine compared to those who did not have knowledge about the vaccine and its importance n= 301 p value 0.06. Similarly the child’s age and the perceived benefit played a role in determining the HPV uptake. The age bracket of 12 to 14 was significantly associated with high uptake of HPV vaccine up take p value 0.002 n= 342 compared to the age bracket 7 to 11 n=206 who had the drop rate of 41.6% p value 0.83. ( Peter A Newman ,2018)

The previous experience about the side effects was another variable that had significant association with the uptake of HPV vaccine. Girls who received bad side effects of the vaccines like painful injection could easily drop out from the continual dosage of the vaccines n= 502 p value 0.002 compared to their counterpart who did not experienced bad side effects n= 462 p value 0.53. The participants who were at urban area had good uptake of HPV vaccine p vale 0.003, n= 103 compared to those in rural area n= 42 p value 0.61( Peter A Newman .2018)

The global survey in the 15 counties therefore showed that all the variables studied in parents or child’s factors had significant association with the uptake of HPV vaccine.

In USA, a cross sectional study done on population sample of 450 participants that were recruited using simple random sampling. The study found that approximately 50 % of caregivers of unvaccinated teens were somehow or very likely to vaccinate their children in the next 12 months, while nearly 80 % intended to complete the series. This suggested uptake and adherence behaviors were driven by different factors. The major variables that were determining the uptake level of education of the study population. Unvaccinated rates were higher among girls of mothers with higher levels of educational attainment [AOR = 1.95, 95 % CI (1.18, 3.22) for mothers with 12-year education. Girls who had education of less than 12 years that lower primary and lower secondary n=36 did not complete their vaccination schedule as recommended p value 0.74 compared to the girls who had attained education of more than 12 years that is to say college, and graduates n= 24 p value of 0.0001.

The age of the girl on the other hand was another factor determining the uptake of HPV vaccine. Girls of age bracket of 13 to 17 n=97 had good HPV vaccine uptake p value 0.0001 compared to the girls below the age bracket. When it came to the socio demographic variable, location of the study population did not have significant impact on the uptake of the HPV vaccine. P value 0.81 both the participants in urban and rural n= 302 and n= 210 respectively had the same uptake for the vaccine. But however the level of income had direct association with the uptake of HPV vaccine p value 0.002. Those with adequate income of more than 520 dollars per month had their girls complete the schedule n= 94 compared to the parents with the income of lower than 520dollars n=125 p value 0.07.

According to the same study done by Kristinet al, 2013 on the same study population, beliefs n=67, attitude n=92 and previous experience n=26 reported these variables did not determine the uptake of HPV vaccine. P value 0.08, 0.67 and 0.56 respectively.

Similarly in Japan of 567 respondents that were enrolled in across sectional study using a simple random method. The questionnaires were dispatched to the participants and the response rate was 46%. On the Meta analysis of the data the results found that the age and the perceived benefit of the HPV vaccine had good significant impact on determining the uptake of HPV vaccine p value 0.0027. 187 out of 254 were at the age bracket of 15 to 20 during the study. they perceived that the vaccine was beneficial in preventing the risks like getting cancer of the cervix so they completed all their vaccination schedule as contrary to those below the age of 15 n= 86 who did not complete their HPV vaccination since they did not perceive the benefit of the HPV vaccine.

Besides that educational level was another factor that was in play in determining the uptake of HPV vaccine p value 0.004. The participants that were had attained higher level of education from college and above n=72 completed their three doses of the HPV vaccine compared to those who had attained education of less than college. The major socio demographic factor that determined the uptake rate was income. P value 0.0029.the setting of the stay of the study population urban n=79 and rural n=21 did not have significant impact on determining the uptake of HPV vaccines a among the study population p value 0.57 and 0.06 respectively. On the other hand, previous experience and attitude did not also determined the uptake of HPV vaccine in japan n=13 and p value 0.83.

Belief had significant correlation with determining the uptake of HPV vaccine p value 0.0004. 36 of the study population stated that the vaccine was beneficial for their girls so they could recommend their girls to complete the three doses of HPV vaccine.

Regionally in African countries, the studies of the same kind were done to ascertain the determinants of the uptake of HPV vaccines.

In addition to that, a retrospective study was done on the study population of 287 participants tha were selected using cluster random sampling in both public and private school in Kenya by HelenVermandereetal 2017.They analyzed the data collected from 287 participants. The factors that were significant to the uptake of HPV vaccines were beliefs, p value 0.002, The attitude was not significantly associated with willingness to take the HPV vaccination (p = 0.185) n=102

The education of the parents was a factor that played much in determining the parent’s ability in recommending their girls in taking the HPV vaccination doses. The parents who had attained the level of education from primary seven and above n= 251 could freely allow their girls to on the HPV vaccination p value 0.002 compare to those who had studied primary seven and below n=32 who reported that their girls could not take the vaccines because they did not know the use. In addition the previous experience on the HPV vaccine among girls discouraged them from getting the next doses 43 of the study population reported that the injection was painful so discouraging many girl hence determining the vaccine uptake. P value 0.005. Besides that sociodemographic factors like level of income did equally influenced the uptake of HPV vaccine p value 0.05. n-= 46 reported that they could not take their girls for the vaccination since they did not have money for the exercise p value 0.63. This is in contrary to those who could afford the cost involved in getting the HPV vaccine n= 71.

A 14% higher odds of administration of all three doses was found for girls who had a male guardian (p = 0.04; CI: 1.0–1.3). A marginal association was observed between Pap test knowledge of the guardian and third HPV vaccine (OR: 1.2; p: 0.08; CI: 1.0–1.4).

In Tanzania Cluster-Randomized Trial was done to determine the factors affecting the uptake of HPV vaccine. There were 2180 eligible girls in schools randomized to class-based and age-based delivery, respectively Vaccine coverage for dose 1 was not significantly higher with the class-based strateg. The attitude of the parents towards that vaccine 63%.parents attitude there fore played a significant role in determining the uptake of hpv vaccine. Overall, 848 girls (15.3%) did not receive dose 1. Parent refusal (6.7%) and absence from school on the day of vaccination (6.3%) were the main reasons for failure to receive dose 1. Reasons differed significantly by school type (P < .001). Parent refusal was the major reason for not vaccinating in private schools and urban government schools 95.2% and 52.9% of vaccine no recipients, respectively), whereas absence from school 59.2% was the main reason in rural government schools. the demographic variable did not have significant impact on the uptake of HPV vaccine p value 0.06 , n= 2059/2838 (72.6). Parents who had studied up to upper primary n 432 easily encouraged their girls to take the HPV vaccine p value 0.00012, as was opposing to those that had studied secondary and college n 32 p value 0.94. Beliefs on the sides on the side effects of the HPV vaccine being painful n 67 was the other factor that was in the interplay in determining the uptake of HPV vaccine P value 0.02. Girls who did not believe on the side effects easily could take the HPV vaccine compared to those with strongly belief. However religion and cultural influence had no significant impact on the uptake of HPV vaccine P value 0.00052.( Kathy J Baisley , Aura Andreasen , Julia Irani,2012)

In Uganda a cross sectional study was done in the eastern part of Uganda in mabale district, where 476 school grils were enrolled in the study using a simple random sampling. Questionires were dispatched and in the analysis of the data the study found that age of the care giver had no significant association with completion of HPV vaccination p value 0.01 n=35, the factor that had direct significant association with the uptake of hpv vaccines were education of the parents, n= 103 care givers who had upper primary education and above had good rate of their girls completing the hpv vaccination p value 0.003. Beliefs about the bad intentions of hpv vaccination contributed to lack of completion to the vaccination schedule n=87 p value 0.0013. parents who had poor attitude and low house hold income on other hand had significant association on completion of hpv vaccination by their girls. p value 0.007 and 0.009.previous experience, perceived benefit gender and location of the parent did not have significant impact on the up take of hpv vaccination n=46, n=19, n=68, n=31 p values 0.54, 0.1.0.067 and 0.43 respectively.(Nabirye et al 2017)

In conclusion of the parents factors, determine the factors affecting uptake of HPV differently depending on the country of the participant of the study population. In developed countries, age and the perceived benefit, education where those in college and graduates had significance, socio demographic variables rural versus urban and income status, attitude and previous experience where the major variables influencing the uptake of HPV vaccine. This was contrary to developing countries where awareness, beliefs education level of the parent where lower levels of the education had significance over the dominant factors.

The study therefore seeks to find how the parents factors affecting uptake of HPV vaccination in Bukomansimbi sub county in Bukomansimbi-Uganda

2.4 Health system factors and uptake of HPV vaccine

Globally a cross sectional study was done to fine out health system factors affecting the uptake of hpv vaccine at community level for non school going girls . 385 participants were enrolled using a cluster random sampling. Questionnaires were distributed to the study group and alter the data was analyzed. Health care provider recommendation has showed to be a strong predictor of vaccination for a wide range of vaccines p value 0.0021 n=63. The knowledge of the health worker, distance of the health facility did not have significant association with completion of hpv vaccine p value 0.08. However in insurance played a significant role in completion of the hpv vaccination n=125 p value 0.002.vaccine supply and school involvement did not play a significant role p values 0.068 and 0.5 respectively.

Globally in USA, a restrsopective study was done on primary school girl where again 543 participants were selected using a simple random method. Receiving a physician’s recommendation or discussing the HPV vaccine with a physician n=125 was associated with vaccine acceptance and initiation in numerous studies p value 0.003. Furthermore, knowledge of the health workers did not determined the uptake of the hpv vaccine n=121 p value0.03. the distance of the health facility and vaccine supply on the other hand did not have significant association with the uptake of hpv vaccine p value 0.96 and 0.453 respectively. The dominant variable that had significant association with the uptake of hpv was insurance n=302 and p value 0.002. School involvement had no significant relation with the uptake of hpv. ( Dawn M. Holman,Katherine B. Roland, 2013)

In Japan a cross sectional study design was performed carried out on 560 secondary school girls that were enrolled using a simple random method. The study found out that HPV vaccine recommendation by the health worker was significantly in increasing the initiation and completion of the uptake of the vaccine N 103 p = 0.0027. This raised rate of intending to recommend the HPV vaccine for teenagers, from 65.2% to 70.1%. 87 of the respondents stated that knowledge of the health workers was not significant in the enhancing the initiation or completion of the HPV vaccine. In the situation where the girls or parents had to pay more for the HPV vaccine, 54 of the parents reported that they could not take their girls for the vaccine because of the cost p value 0.08 compared to those who were insured n 68 and can afford to pay the vaccine value 0.0021. 84 respondents stated that School involvement did not determine the uptake of HPV vaccine in japan p value 0.09 since the vaccines was not provided at schools vaccine the distance of the health facility and vaccine supply did not have significant association with the uptake of hpv vaccine in Japan p value 0.067 and 0.31 respectively. (Masaaki Sawada, 2017)

A prospective cohort study in determining factors affecting Uptake of three doses of HPV vaccine by primary school girls in Eldoret, Kenya involving 3000 girls aged 9 to 14 years from 40 schools that were selected using a cluster random sampling method. Recommendation from the health care provider did not have a significant impact on the uptake of hpv vaccine p value 0.7 n= 150

Administration of second dose of HPV and HPV knowledge by health worker were both strong predictors of taking the third dose of HPV vaccine (OR: 61.1; p < 0.001; 95% CI = 40.9–91.0) and (OR: 1.2;p = 0.008; 95%CI 1.1–1.5) respectively. A Mann Whitney test revealed that distance to health facility was a statistically significant barrier (p.0.01).

Distance of the health facility n= 78, vaccine supply, n=180 and insurance n=79 did not have significant association with uptake of hpv vaccine during the time of the study p values 0.8, pvalue 0.87 and p value 0.2 respectively. The school involvement had significant impact on completion of hpv vaccination n=46 p value 0.004.(Hillary Mabeya, etal 2018)

The cluster-randomized cross sectional study was conducted in the city of Mwanza and the neighboring district of Misungwi in northwest Tanzania. The girls who were enrolled on the study was 5250 in total. The study found out that health worker recommendation did have a significant role in determining the completion of hpv vaccine n=321 p value 0.09. Knowledge of the health worker played a significant association influencing the uptake of hpv vaccine. Distance of the hospital, vaccine supply and school involvement had a significant correlation with the uptake of hpv vaccination in the areas of study, p values 0.003, p value 0.021 and p values 0.02 respectively.

In Uganda a cross sectional study was done 56 (14%) of 407 adolescents school girls who were selected from 56 villages,using a simple random sampling reported vaccine uptake. 182 (52·3%) of 348 reported lack of awareness about the HPV vaccine as the major reason for not having received it. Receiving vaccines from outreach clinics (p=0·02), having many options from which to receive the vaccine (p=0·002), getting an explanation on possible side-effects from health worker (p=0·024), and receiving the vaccine alongside other services (p=0·024) were positively associated with uptake.

The distance of the health facility played a very significant role in the uptake of hpv vaccine p value 0.04 n0 142. Insurance had no significant impact on the uptake of hpv vaccine however vaccines supply and school involvement were another dominant factors that were significantly associated with the uptake of the hpv vaccine among the study population in Uganda. p values 0.009 and 0.0015 respectively. (Nabirye,et al 2020)

In summary the health care factors had different impact on determining factors affecting uptake of HPV vaccines. In developed like japan and USA the dominant variables were health workers recommendation knowledge of the health workers and the health care insurance. In Tanzania the major determining variable studied was school involvement and in Kenya and Uganda was dominated by knowledge of the health worker, school involvement and the distance of the health facility.

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Title
Determinant of HPV Vaccine uptake among children aged 9-14 years
College
Clark University
Author
Year
2020
Pages
48
Catalog Number
V1296593
ISBN (Book)
9783346759559
Language
English
Keywords
determinant, vaccine
Quote paper
Dr Ndayisaba Corneille (Author), 2020, Determinant of HPV Vaccine uptake among children aged 9-14 years, Munich, GRIN Verlag, https://www.grin.com/document/1296593

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Title: Determinant of HPV Vaccine uptake among children aged 9-14 years



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