Factors influencing the Uptake of Human Papillomavirus Vaccine in Tana River County, Kenya

Abstract

The global disease burden of cervical cancer is unevenly distributed worldwide. It is borne in sub-Saharan Africa where concerning trends in increasing cervical cancer incidence and mortality rates have been reported. Of the 117,316 new cervical cancer cases and 76,745 deaths recorded within the African region in 2022, 5845 cases and 3591 associated deaths were reported from Kenya. Despite the availability of HPV vaccines for primary prevention, the uptake remains low, hindering progress towards cervical cancer elimination. Our study sought to determine the factors that influence the uptake of the HPV vaccine in Tana River County, Kenya since its incorporation in the expanded immunization program in 2019. The aim was to contribute to evidence-based strategies to achieve the target of vaccinating 90% of adolescent girls with the HPV vaccine by age 15 by 2030. Using a community-based cross-sectional descriptive-analytical design, quantitative methods collected data from caregivers of girls aged 9 years to 14 years, with a sample size of 378 derived using the Fisher et al. (1995) formula and proportionate sampling from the three sub-counties. A pre-test study involved 38 community health volunteers with daughters aged 9 years to 14 years. Convenience sampling was employed, and structured questionnaires were used for data collection. The results recorded an uptake of 56.9%. It also revealed significant knowledge gaps: many respondents mistakenly viewed eating khat (61.6%), poor hygiene (73.4%), chronic UTIs (85.6%), and having an IUD (60.8%) as risk factors for cervical cancer. Only 47.9% knew smoking is a risk factor, 31.1% knew HPV affects both men and women, 36.4% correctly identified cervical cancer symptoms, and only 44.0% knew it is curable. Additionally, 47.9% were unaware that the HPV vaccine is most effective before sexual debut. Statistical analyses, employing chi-square tests, unveiled significant relationships between various knowledge indicators and vaccine uptake. Specifically, awareness of cervical cancer as a prevalent issue in Kenya (p = 0.009), understanding the preventive role of HPV vaccination (p < 0.001), and dispelling misconceptions, such as the vaccine causing infertility (p = 0.044), were all associated with higher uptake rates. Furthermore, knowledge of risk factors, such as smoking's link to cervical cancer, (p = 0.006), HPV being transmitted through sexual contact (p =0.042), Start of sexual activity early increases the risk of cervical cancer (p= 0.003), Having multiple partners increasing the risk of cervical cancer (p= 0.018) was also positively correlated with vaccine uptake. Moreover, cultural and religious factors emerged as significant predictors of vaccine uptake. Statistical analyses demonstrated a strong association between cultural beliefs (p = 0.006), religious affiliations (p = 0.016), and HPV vaccine uptake, highlighting the need for culturally sensitive vaccination campaigns. The findings underscore the necessity of comprehensive education campaigns to improve awareness and dispel myths surrounding cervical cancer and HPV vaccination, particularly in underserved communities like Tana River County. In conclusion, the study emphasizes the role of education, cultural sensitivity, and community engagement in enhancing HPV vaccine uptake. Recommendations include intensified health education efforts by the Ministry of Health to ensure widespread awareness and acceptance of HPV vaccination as a crucial strategy in cervical cancer prevention.