Introduction
Materials and methods
Study design, setting and population
Sample size
Sampling
Data collection tools and techniques
Study variables and measurement
Quality control and assurance
Data management and analysis
Results
Socio-demographic characteristics of the respondents
Variable | Description | Frequency (n = 524) | Percentage (%) |
---|---|---|---|
Age (in years) (mean = 12.9, S. D = ± 0.84)
| 10–12 | 189 | 36.1 |
13–14 | 335 | 63.9 | |
Class
| Primary five | 4 | 0.8 |
Primary six | 11 | 2.1 | |
Primary seven | 509 | 97.1 | |
Religion
| Catholic | 166 | 31.7 |
Anglican | 111 | 21.2 | |
Muslim | 100 | 19.1 | |
Pentecostal | 87 | 16.6 | |
Others (specify) | 60 | 11.5 | |
Residence area
| Urban | 502 | 95.8 |
Peri-urban | 22 | 4.2 | |
Father’s occupation
| Doctor/healthcare provider | 27 | 5.2 |
Public employed | 97 | 18.5 | |
Private employed | 121 | 23.1 | |
Self-employed | 266 | 50.8 | |
Retired/unemployed | 13 | 2.5 | |
Mother’s occupation
| Doctor/healthcare provider | 27 | 5.2 |
Public employed | 57 | 10.9 | |
Private employed | 83 | 15.8 | |
Self-employed | 310 | 59.2 | |
Retired/unemployed | 47 | 9.0 | |
Ever had sexual intercourse
| No | 487 | 92.9 |
Yes | 37 | 7.1 |
Knowledge and awareness of HPV vaccination
Variable | Description | Frequency (n = 524) | Percentage (%) |
---|---|---|---|
There is a vaccine that protects against HPV | Yes | 370 | 70.6 |
No | 31 | 5.9 | |
I don’t know | 123 | 23.5 | |
The HPV vaccine reduces chances of getting cervical cancer | Yes | 349 | 66.6 |
No | 31 | 5.9 | |
I don’t know | 144 | 27.5 | |
Once vaccinated, women no longer have to be screened for cervical cancer | Yes | 148 | 28.2 |
No | 147 | 28.1 | |
I don’t know | 229 | 43.7 | |
The target age group for the HPV vaccine in Uganda | 10 years and above | 360 | 68.7 |
I don’t know | 164 | 31.3 | |
The HPV vaccine is only for sexually active people | Yes | 89 | 17.0 |
No | 227 | 43.3 | |
I don’t know | 208 | 39.7 | |
The HPV vaccine is most effective if given to people who have never had sex | Yes | 134 | 25.6 |
No | 125 | 23.9 | |
I don’t know | 265 | 50.6 | |
Number of HPV vaccine doses given in Uganda | Two doses | 287 | 54.8 |
I don’t know | 237 | 45.2 | |
Interval between HPV vaccine doses | 6 months | 247 | 47.1 |
I don’t know | 277 | 52.9 | |
Level of knowledge | High knowledge level | 266 | 50.8 |
Low knowledge level. | 258 | 49.2 |
“I don’t remember properly but I think they are either 3 or 4 or 2 doses. I don’t know. When they (health workers) came here last time, they took girls for the first dose then they came for the second dose. I don’t know if that was all. I am not sure whether 3 or 4, they did not tell us or the girls. So I don’t think the girls know” (Key informant, teacher)“Well, those nurses who came said they wanted children of 14 years and in some cases, they said they wanted people who were still producing. So, I don’t know who is recommended but I think sexually active women are recommended.” (Key informant, teacher)
“You can receive it (HPV vaccine) when you are about 9 to 12 years. It is preferred that you receive the vaccine when you are a virgin. It is given before sexual contact. The vaccine is given to females and males, and they are given two doses. The second interval is after six months after the first interval.” (Participant 1, FGD Adolescent girls)
Factors associated with the level of knowledge regarding HPV vaccination
Variable | Level of knowledge | PR at 95% CI | aPR at 95% CI | P-values | |
---|---|---|---|---|---|
High (n = 266) | Low (n = 258) | ||||
% | % | ||||
Age
| |||||
10–12 | 50.8 | 49.2 | 1 | ||
13–14 | 50.8 | 49.3 | 1.00 (0.84–1.19) | ||
Class
| |||||
Primary five | 75.0 | 25.0 | 1 | 1 | |
Primary six | 90.9 | 9.1 | 1.21 (0.67–2.20) | 1.20 (0.84–1.39) | 0.542 |
Primary seven | 49.7 | 50.3 | 0.67 (0.37–1.18) | 0.69 (0.79–1.48) | 0.183 |
Religion
| |||||
Catholic | 47.6 | 32.4 | 1 | 1 | |
Anglican | 56.8 | 43.2 | 1.19 (0.95–1.50) | 1.21 (0.99–1.51) | 0.097 |
Muslim | 49.0 | 51.0 | 1.03 (0.80–1.33) | 1.06 (0.71–1.71) | 0.657 |
Pentecostal | 65.5 | 34.5 | 1.34 (1.10–1.72) | 1.38 (1.11–1.71) |
0.004*
|
Others (specify) | 30.0 | 70.0 | 0.63 (0.42–0.96) | 0.66 (0.44-1.00) | 0.052 |
Residence area
| |||||
Urban | 52.2 | 47.8 | 1 | 1 | |
Peri-urban | 18.2 | 81.8 | 0.35 (0.14–0.85) | 0.38 (0.16–0.90) |
0.028*
|
Father’s occupation
| |||||
Healthcare provider | 59.3 | 40.7 | 1 | ||
Public employed | 56.7 | 43.3 | 0.96 (0.67–1.37) | ||
Private employed | 54.6 | 45.5 | 0.92 (0.65–1.31) | ||
Self-employed | 45.9 | 54.1 | 0.77 (0.55–1.09) | ||
Retired/unemployed | 53.9 | 46.2 | 0.91 (0.50–1.64) | ||
Mother’s occupation
| |||||
Healthcare provider | 55.6 | 44.4 | 1 | ||
Public employed | 54.4 | 45.6 | 0.98 (0.65–1.48) | ||
Private employed | 50.6 | 49.4 | 0.91 (0.61–1.36) | ||
Self-employed | 49.0 | 50.9 | 0.88 (0.62–1.26) | ||
Retired/unemployed | 55.3 | 44.7 | 1.00 (0.65–1.52) | ||
Ever had sexual intercourse
| |||||
No | 50.7 | 49.3 | 1 | ||
Yes | 51.4 | 48.7 | 1.01 (0.73–1.40) |
Perceptions of HPV vaccination
Variable | Description | Frequency (n = 524) | Percentage (%) |
---|---|---|---|
Getting the HPV vaccine would be beneficial to a teenage girl or boy’s future health | Agree | 257 | 49.1 |
Neutral | 140 | 26.7 | |
Disagree | 127 | 24.2 | |
HPV vaccination is not necessary because a Pap test can be done to rule out cervical cancer | Agree | 93 | 17.8 |
Neutral | 241 | 46.0 | |
Disagree | 190 | 36.3 | |
I believe it would be difficult and embarrassing for me to ask for the HPV vaccine because it is associated with a sexually transmitted infection | Agree | 91 | 17.4 |
Neutral | 123 | 23.5 | |
Disagree | 310 | 59.2 | |
If other people knew I received the HPV vaccine, I would be embarrassed | Agree | 146 | 27.9 |
Neutral | 75 | 14.3 | |
Disagree | 303 | 57.8 | |
Knowing the risks of HPV, I intend on taking the HPV vaccine in the future | Agree | 361 | 68.9 |
Neutral | 94 | 17.9 | |
Disagree | 69 | 13.2 | |
The HPV vaccine is effective in preventing cervical cancer | Agree | 282 | 53.8 |
Neutral | 144 | 27.5 | |
Disagree | 98 | 18.7 | |
I will take the vaccine because I feel at risk of getting HPV | Agree | 370 | 70.6 |
Neutral | 103 | 19.7 | |
Disagree | 51 | 9.7 | |
I feel the vaccine will keep me safe from cervical Cancer | Agree | 400 | 76.3 |
Neutral | 91 | 17.4 | |
Disagree | 33 | 6.3 | |
I feel it is better to be vaccinated before becoming sexually active | Agree | 390 | 74.4 |
Neutral | 87 | 16.6 | |
Disagree | 47 | 9.0 | |
I feel only sexually active girls should get the vaccine | Agree | 146 | 27.9 |
Neutral | 108 | 20.6 | |
Disagree | 270 | 51.5 | |
HPV vaccine may have long negative effects on me | Agree | 122 | 23.3 |
Neutral | 234 | 44.7 | |
Disagree | 168 | 32.1 | |
I would be willing to recommend the HPV vaccine to others | Agree | 381 | 72.7 |
Neutral | 80 | 15.3 | |
Disagree | 63 | 12.0 | |
I would be willing to receive the HPV vaccination if offered for free? | Agree | 422 | 80.5 |
Neutral | 57 | 10.9 | |
Disagree | 45 | 8.6 | |
If no/disagree why? | Possible side effects | 19 | 18.6 |
Low awareness of HPV | 30 | 29.4 | |
Not being at risk | 30 | 29.4 | |
Cost | 3 | 2.9 | |
Others (specify) | 20 | 19.6 | |
Perception of girls | Positive perception | 252 | 48.1 |
Negative perception | 272 | 51.9 |
“They (Parents) have got all sorts of beliefs originating from people out there. People tell parents that, “you people, your children are going to be barren because of the vaccine.” So, somebody thinks about that and has to pick between cancer and infertility for their children. When girls are drawn into all this, it affects their perceptions too” (Key informant, teacher)“Yeah, usually there are superstitions within the community and among girls that the government does not want the girls to produce many children” (Key informant, Parent)“Some parents are against the vaccine because of their political views. Some are anti-government and think that whatever program the government brings could be detrimental to their children’s health.” (Key informant, teacher)“For me I wanted but when I brought the letter home, (consent form) and gave it to my parents, my mother told me that I should not go to school that day; that she talked with the teacher on my behalf.” (Participant 5, FGD Adolescent girl)
Factors associated with perceptions toward HPV vaccination
Variable | HPV perceptions | PR at 95% CI | aPR at 95% CI | P-values | |
---|---|---|---|---|---|
Positive (n = 252) | Negative (n = 272) | ||||
% | % | ||||
Age
| |||||
10–12 | 16.6 | 53.4 | 1 | ||
13–14 | 49.0 | 51.0 | 1.05 (0.87–1.26) | ||
Class
| |||||
Primary five | 75.0 | 25.0 | 1 | ||
Primary six | 90.9 | 9.1 | 1.21 (0.67–2.20) | 0.94 (0.37–2.36) | 0.891 |
Primary seven | 47.0 | 53.1 | 0.63 (0.35–1.11) | 0.74 (0.30–1.85) | 0.519 |
Religion
| |||||
Catholic | 44.6 | 55.4 | 1 | ||
Anglican | 54.1 | 46.0 | 1.21 (0.95–1.54) | 1.11 (0.90–1.38) | 0.333 |
Muslim | 48.0 | 52.0 | 1.08 (0.83–1.40) | 1.09 (0.85–1.39) | 0.511 |
Pentecostal | 59.8 | 40.2 | 1.34 (1.05–1.70) | 1.15 (0.94–1.41) | 0.175 |
Others (specify) | 30.0 | 70.0 | 0.67 (0.44–1.03) | 0.86 (0.59–1.24) | 0.425 |
Residence area
| |||||
Urban | 49.0 | 51.0 | 1 | ||
Peri-urban | 27.3 | 72.7 | 0.56 (0.28–1.11) | 0.84 (0.42–1.67) | 0.621 |
Father’s occupation
| |||||
Healthcare provider | 59.3 | 40.7 | 1 | 1 | |
Public employed | 47.4 | 52.6 | 0.80 (0.55–1.17) | 0.84 (0.60–1.18) | 0.315 |
Private employed | 53.7 | 46.3 | 0.91 (0.64–1.29) | 0.95 (0.70–1.27) | 0.713 |
Self-employed | 45.1 | 54.9 | 0.76 (0.54–1.07) | 0.90 (0.68–1.20) | 0.474 |
Retired/unemployed | 38.5 | 61.5 | 0.65 (0.30–1.38) | 0.71 (0.39–1.30) | 0.271 |
Mother’s occupation
| |||||
Healthcare provider | 59.3 | 40.7 | 0.85 (0.55–1.32) | ||
Public employed | 47.4 | 52.6 | 1 | ||
Private employed | 53.7 | 46.3 | 1.08 (0.74–1.59) | ||
Self-employed | 45.1 | 54.9 | 0.80 (0.56–1.15) | ||
Retired/unemployed | 38.5 | 61.5 | 0.84 (0.53–1.33) | ||
Ever had sexual intercourse
| |||||
No | 49.1 | 50.9 | 1 | ||
Yes | 35.1 | 64.9 | 0.72 (0.46–1.12) | 0.71 (0.46–1.10) | 0.125 |
Knowledge level
| |||||
Low knowledge level | 22.9 | 77.1 | 1 | ||
High knowledge level | 72.6 | 27.4 | 3.17 (2.51–4.02) | 3.02 (2.37–3.84) |
0.000*
|
HPV vaccination status
Variable | Description | Frequency (n = 524) | Percentage |
---|---|---|---|
Ever received the HPV vaccine | Yes | 144 | 27.5 |
No | 380 | 72.5 | |
Number of HPV vaccine doses received | 0 | 380 | 72.5 |
1 | 99 | 18.9 | |
2 or more | 45 | 8.6 | |
Completed HPV vaccination schedule | Yes | 45 | 8.6 |
No | 479 | 91.4 | |
Age at which the respondent got the first shot (in years) (n = 144) (mean = 11.3, S.D = 1.1) | 10–12 | 122 | 84.7 |
13–14 | 22 | 15.3 | |
Reasons for not receiving the vaccine (n = 380) | I am not aware of HPV vaccination | 183 | 48.2 |
I don’t know where to access the vaccine | 108 | 28.4 | |
I don’t have time | 11 | 2.9 | |
I don’t see the need | 11 | 3.2 | |
Fear of side effects | 25 | 6.6 | |
Others | 41 | 10.8 |
“We organize the venue for vaccination in school, encourage children to get immunized and allow health workers to vaccinate children. We also feed them, in most cases when they come, they take breakfast here. We support their activities.” (Key informant, Teacher)“I haven’t taken her for HPV vaccination. We’ve all been reluctant to do so because we have concerns about the side effects” (key informant, Parent)
Factors associated with HPV vaccination status
Variable | HPV vaccination status | PR at 95% CI | aPR at 95% CI | P-values | |
---|---|---|---|---|---|
Yes (n = 144) | No (n = 380) | ||||
% | % | ||||
Age
| |||||
10–12 | 29.1 | 70.9 | 1 | ||
13–14 | 26.6 | 73.4 | 0.91 (0.69–1.21) | ||
Class
| |||||
Primary five | 25.0 | 75.0 | 1 | 1 | |
Primary six | 72.7 | 27.3 | 2.90 (0.51–16.53) | 0.94 (0.37–2.36) | 0.891 |
Primary seven | 26.5 | 73.5 | 1.06 (0.19–5.84) | 0.74 (0.30–1.85) | 0.519 |
Residence area
| |||||
Urban | 28.5 | 71.5 | 1 | ||
Peri-urban | 4.6 | 95.5 | 0.16 (0.02–1.09) | 0.26 (0.041-1.60) | 0.145 |
Father’s occupation
| |||||
Doctor/healthcare provider | 48.2 | 91.3 | 1 | 1 | |
Public employed | 33.0 | 51.9 | 0.69 (0.42–1.11) | 1.14 (0.73–1.80) | 0.561 |
Private employed | 27.3 | 67.0 | 0.57 (0.35–0.92) | 0.87 (0.59–1.29) | 0.493 |
Self-employed | 23.3 | 72.7 | 0.48 (0.31–0.76) | 0.53 (0.31–1.05) | 0.096 |
Retired/unemployed | 30.8 | 76.7 | 0.64 (0.26–1.58) | 1.00 (0.49–2.03) | 0.997 |
Mother’s occupation
| |||||
Public employed | 24.6 | 75.4 | 1 | 1 | |
Doctor/healthcare provider | 51.9 | 48.2 | 2.11 (1.18–3.78) | 1.94 (1.10–3.41) |
0.021*
|
Private employed | 22.9 | 77.1 | 0.93 (0.51–1.70) | 0.89 (0.49–1.62) | 0.712 |
Self-employed | 25.5 | 74.5 | 1.04 (0.63–1.70) | 1.21 (0.75–1.96) | 0.433 |
Retired/unemployed | 38.3 | 61.7 | 1.56 (0.87–2.79) | 1.55 (0.92–2.62) | 0.102 |
Ever had sexual intercourse
| |||||
No | 28.1 | 71.9 | 1 | ||
Yes | 18.9 | 81.1 | 0.67 (0.34–1.33) | 0.71 (0.46–1.10) | 0.125 |
Knowledge level
| |||||
Low level of knowledge | 12.8 | 87.2 | 1 | ||
High knowledge level | 41.7 | 58.3 | 3.26 (2.30–4.63) | 1.79 (1.21–2.63) |
0.003*
|
Perceptions
| |||||
Negative | 11.4 | 88.6 | 1 | ||
Positive | 44.8 | 55.2 | 3.93 (2.75–5.63) | 2.87 (1.93–4.27) |
P ≤ 0.001*
|
“Some schools seek for parental consent before giving the vaccine and some parents also fear to give the consent because they are not aware of what would come next (side effects)” (key informant, Teacher)“Sensitization is lacking. People are not aware that this vaccine is available and the healthcare facilities that offer this vaccine are not very common. You find the health centers or medical facilities that have those vaccines are fewer, which might affect uptake. People think that they are supposed to pay some money to access the vaccine and they don’t know that it’s free of charge. It’s now up to the government to do some bit of sensitization. You find that most parents are illiterate. The illiterates may not understand the benefits, so we need more sensitization about it.” (Key informant, Parent)