Factors associated with parental intention to allow their adolescent girls receive human papilloma virus vaccine in Bwaise II Slum, Kawempe division, Kampala District

Abstract

Introduction: Cervical cancer is the third most common cancer among women in the world, vast majority occurs in Sub-Saharan Africa and it is the leading cause of cancer mortality among women in Uganda. Although it is preventable with HPV vaccination, Uganda’s coverage ever since it was introduced in 2015 remains below national target of 85%. Similarly, Kawempe division has not achieved much with current coverage at 44.6% and it is believed that parents influence this coverage since in Uganda parents make the final decision on their children’s uptake of the vaccine.

General Objective: To determine the factors associated with parental intention to allow their unvaccinated adolescent girls to receive HPV vaccine in Bwaise II slum, Kawempe Division, Kampala District.

Method: We conducted a cross-sectional study, using both quantitative and qualitative methods. Using simple random sampling method, we selected 380 households with parents of girls aged 10-14 years who had not received HPV vaccine in Bwaise II slum. Pre-tested questionnaires were administered by trained research assistants to these parents. Qualitative data was collected using key informant interviews (KII) and focus group discussions (FGD). The KIs included health workers and community leaders, while FGDs included parents from selected households. Quantitative data was analyzed using StataCorp v16.0 while qualitative data was analyzed using thematic content analysis, aided by Atlas ti. 8.

Results: This was a community based cross-sectional study conducted between April and May 2020 among 380 households with girls aged 10 to 14 years who had not received HPV vaccine in Bwaise II slum, Kawempe Division. Majority (70.8%, 269/380) of the respondents were female and nearly two thirds (65.0%, 247/380) being from the 25 – 49 years age group. The overall parental intention to allow HPV vaccination was 67.6% (257/380) (95% CI 62.67 – 72.31). Knowledge about the HPV vaccine (aPR = 1.17, 95%CI 1.02 – 1.33, p value = 0.025), positive attitude (aPR = 1.20, 95% CI 1.04 – 1.40, p value = 0.013) and parental self-efficacy (aPR = 2.30, 95% CI 1.79 – 2.95, p value <0.001) were associated with parental intention to allow vaccination of their daughters aged 10 to 14 years. Unawareness, misconceptions, religious & cultural beliefs, adverse events and disruption of the health system by COVID-19 were the major barriers to HPV vaccination.

Conclusions and recommendations: The overall parental intention to allow HPV vaccination was more than average. Knowledge about the HPV vaccine, parental attitude and parental self-efficacy were associated with parental intention to allow vaccination of their daughters aged 10 to 14 years. Unawareness, misconceptions, religious & cultural beliefs, adverse events and disruption of the health system by COVID-19 were the major barriers to HPV vaccination. Massive HPV vaccination community sensitization and health education need to be conducted in slums by the Ministry of Health using mass media, community outreaches and partner supported activities to create awareness and build positive attitudes to improve the parental intention and thereby increasing HPV vaccine uptake. The Ministry of Health also needs to generate more temporary HPV vaccination sites since the health system has been disrupted by the COVID-19 pandemic and students can no longer access the HPV vaccines from school.