Department of Health Policy, Planning and Management Makerere University School of Public Health College of Health Sciences, P.O. Box 7072, Kampala, Uganda.
Department of Disease control and Environmental Health, University School of Public Health College of Health Sciences, Kampala, Uganda.
BMC Public Health. 2020 Feb 4;20(1):171. doi: 10.1186/s12889-020-8302-z.
Globally, cervical cancer is the fourth most common cancer in women with more than 85% of the burden in developing countries. In Uganda, cervical cancer has shown an increase of 1.8% per annum over the last 20 years. The availability of the Human Papillomavirus (HPV) vaccine presents an opportunity to prevent cervical cancer. Understanding how the health system influences uptake of the vaccine is critical to improve it. This study aimed to assess how the health systems is influencing uptake of HPV vaccine so as to inform policy for vaccine implementation and uptake in Mbale district, Eastern Uganda.
We conducted a cross sectional study of 407 respondents, selected from 56 villages. Six key informant interviews were conducted with District Health Officials involved in implementation of the HPV vaccine. Quantitative data was analyzed using Stata V.13. Prevalence ratios with their confidence intervals were reported. Qualitative data was audio recorded, transcribed verbatim and analyzed using MAXQDA V.12, using the six steps of thematic analysis developed by Braun and Clarke.
Fifty six (14%) of 407 adolescents self-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 = 0.02), getting an explanation on possible side-effects (p = 0.024), and receiving the vaccine alongside other services (p = 0.024) were positively associated with uptake. Key informants reported inconsistency in vaccine supply, inadequate training on HPV vaccine, and the lack of a clear target for HPV vaccine coverage as the factors that contribute to low uptake.
We recommend training of health workers to provide adequate information on HPV vaccine, raising awareness of the vaccine in markets, schools, and radio talk shows, and communicating the target to health workers. Uptake of the HPV vaccine was lower than the Ministry of Health target of 80%. We recommend training of health workers to clearly provide adequate information on HPV vaccine, increasing awareness about the vaccine to the adolescents and increasing access for girls in and out of school.
在全球范围内，宫颈癌是女性中第四常见的癌症，发展中国家的负担超过 85%。在乌干达，宫颈癌的发病率在过去 20 年中以每年 1.8%的速度增长。人乳头瘤病毒（HPV）疫苗的出现为预防宫颈癌提供了机会。了解卫生系统如何影响疫苗的接种率对于改善这一情况至关重要。本研究旨在评估卫生系统如何影响 HPV 疫苗的接种率，以便为在乌干达东部姆巴莱区实施和推广疫苗提供政策建议。
我们对来自 56 个村庄的 407 名受访者进行了横断面研究。对参与 HPV 疫苗实施的 6 名地区卫生官员进行了 6 次关键知情人访谈。使用 Stata V.13 分析定量数据。报告了比值比及其置信区间。使用 MAXQDA V.12 对定性数据进行录音、逐字转录和分析，使用 Braun 和 Clarke 开发的六个主题分析步骤进行分析。
407 名青少年中，有 56 名（14%）自我报告接种了疫苗。348 名未接种疫苗的人中，182 名（52.3%）报告缺乏对 HPV 疫苗的认识是未接种疫苗的主要原因。在上门诊所接种疫苗（p=0.02）、有多种接种疫苗的选择（p=0.02）、获得关于可能副作用的解释（p=0.024）以及与其他服务同时接种疫苗（p=0.024）与接种率呈正相关。知情人报告疫苗供应不一致、对 HPV 疫苗培训不足以及缺乏明确的 HPV 疫苗接种目标是导致接种率低的因素。
我们建议培训卫生工作者提供关于 HPV 疫苗的充分信息，在市场、学校和广播脱口秀中提高对疫苗的认识，并向卫生工作者传达目标。HPV 疫苗的接种率低于卫生部设定的 80%的目标。我们建议培训卫生工作者提供关于 HPV 疫苗的充分信息，提高青少年对疫苗的认识，并为在校和校外的女孩增加获得疫苗的机会。
