Medicaid Cancer Foundation, Abuja, Nigeria.
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
BMC Public Health. 2022 Aug 24;22(1):1611. doi: 10.1186/s12889-022-13975-3.
Over 80% of new cervical cancer cases occur in women living in low- and middle-income countries. It is the second highest cause of female cancer deaths in Nigeria. School based vaccination programs are an effective strategy for delivering the HPV vaccine to adolescent girls. This study aims to understand the challenges to implementing school-based HPV vaccination programs, particularly in a remote rural setting where vaccine hesitancy is high.
A 22- item interviewer administered questionnaire was used to evaluate HPV knowledge and willingness to get the HPV vaccinate among 100 female secondary school students as part of an HPV vaccination pilot in a rural community in Kebbi State, Nigeria. Additionally, semi-structured interviews were used to assess community knowledge and attitudes on cervical cancer and HPV vaccination. Data collected were analyzed thematically to understand challenges and generate lessons for vaccine delivery in the study setting.
Knowledge of HPV and cervical cancer among junior secondary school aged girls was fair with a mean score of 66.05%. For senior secondary school aged girls, the knowledge score ranged from 70 to 100% with a mean of 96.25% indicating good knowledge of HPV and cervical cancer. All participants (n = 100) received the first vaccine dose but due to COVID-19, 33 participants were not able to complete the vaccine dosage within the recommended 6-month schedule. Of the parents who provided consent, none could afford the vaccine out of pocket. Challenges to vaccine delivery included operational costs exacerbated by lack of adequate health workforce and infrastructure in the study setting.
An exploration of sociocultural perspectives and contextual realities is crucial to understanding the complexities of HPV vaccine introduction from the perspective of the target audience, and the local community. Strategies for introducing the HPV vaccine should address community concerns through effective communication, appropriate delivery, and targeted advocacy to make the vaccination program locally relevant. While school-based HPV immunization programs have been shown to be successful, adequate design, planning and monitoring is important. Additionally, considerations must be made to account for the high operational cost of vaccine delivery in rural, hard to reach areas where human resources and infrastructure are limited.
超过 80%的新宫颈癌病例发生在中低收入国家的女性中。在尼日利亚，宫颈癌是导致女性癌症死亡的第二大原因。基于学校的疫苗接种计划是向少女提供 HPV 疫苗的有效策略。本研究旨在了解在远程农村地区实施基于学校的 HPV 疫苗接种计划所面临的挑战，特别是在疫苗犹豫率较高的地区。
作为在尼日利亚 Kebbi 州农村社区进行 HPV 疫苗接种试点的一部分，我们使用了一份由 22 个项目组成的访谈式问卷，评估了 100 名女中学生对 HPV 的认识和接种 HPV 疫苗的意愿。此外，我们还使用半结构式访谈评估了社区对宫颈癌和 HPV 疫苗接种的知识和态度。收集的数据进行了主题分析，以了解在研究环境中疫苗接种面临的挑战并为疫苗接种提供经验教训。
初中阶段女孩对 HPV 和宫颈癌的认识一般，平均得分为 66.05%。对于高中阶段的女孩，知识得分范围在 70%至 100%之间，平均得分为 96.25%，表明她们对 HPV 和宫颈癌有较好的认识。所有参与者（n=100）都接种了第一剂疫苗，但由于 COVID-19，33 名参与者无法在推荐的 6 个月时间内完成疫苗接种。在提供同意的父母中，没有人能够自费负担疫苗费用。疫苗接种面临的挑战包括运营成本增加，这是由于研究环境中缺乏足够的卫生人力和基础设施造成的。
从目标受众和当地社区的角度出发，探索社会文化观点和背景现实对于理解 HPV 疫苗引入的复杂性至关重要。引入 HPV 疫苗的策略应通过有效的沟通、适当的接种和有针对性的宣传来解决社区的关切，使接种计划与当地情况相关。虽然基于学校的 HPV 免疫接种计划已被证明是成功的，但充分的设计、规划和监测是很重要的。此外，必须考虑到在人力资源和基础设施有限的偏远农村地区疫苗接种的高运营成本。
