Methodological Assessment of a Review of Knowledge, Attitude and Practice about Human Papilloma Virus Vaccination in India.

A well-conducted review provides quality evidence to inform policy and practice. It is important that the review is as rigorous and as fully reported as possible if the evidence from the review is incorporated into clinical practice. We are writing in response to an article titled, ‘Evidence of Knowledge, Attitude, and Practice Regarding Human Papilloma Virus Vaccination at the Community Level in India: A Systematic Review and Meta-Analysis’ by Pal et al published in Asian Pacific Journal of Cancer Prevention in March 2024. There are some major methodological flaws in the paper that might have biased the conclusions drawn from the review to inform strategies to improve HPV vaccine uptake by the target population in India. There was clear evidence of substantial heterogeneity (I2=96.0%-100%) among the studies that were included in the meta-analysis. In addition, the outcomes measured were not specific. More ever, the authors did not strictly follow the PRISMA guidelines for screening. Furthermore, the data extraction process and the reasons for language restriction were not clear, all of which could contribute to biased results, lowering the validity of the findings.