Project – An assessment of the uptake of Human Papillomavirus Vaccine (HPV) among women of childbearing age

CHAPTER ONE

INTRODUCTION

• Background to the Study

The uptake of the Human Papillomavirus (HPV) vaccine has been a subject of global public health focus, particularly among women of childbearing age. HPV is one of the most common sexually transmitted infections, with certain strains leading to cervical cancer, the fourth most common cancer among women globally (World Health Organization [WHO], 2020). Vaccination against HPV has been proven to be highly effective in reducing the incidence of cervical cancer (Joura et al., 2015). However, the rates of HPV vaccine uptake among women of childbearing age remain varied, influenced by numerous socio-economic, cultural, and healthcare-related factors. Research indicates that while many countries have introduced HPV vaccination programs, the uptake in various regions remains inconsistent, with particular concerns about low uptake among older women, particularly those who are not in the target age group for initial vaccination (WHO, 2020).

One of the primary barriers to HPV vaccine uptake among women of childbearing age is the lack of awareness and understanding of the benefits of the vaccine. A study conducted by Ali et al. (2019) found that many women were not aware of the vaccine’s potential in preventing HPV-related diseases such as cervical cancer. Additionally, a study by Reiter et al. (2015) highlighted the misconception that the vaccine is only relevant for younger women or those who have never been sexually active, leading to hesitation or refusal to vaccinate among older women or those already sexually active. In many instances, the lack of clear communication from healthcare providers exacerbates these misconceptions, resulting in missed opportunities for vaccination.

In contrast, some studies have found that higher levels of education and greater healthcare access correlate with increased HPV vaccination uptake. According to a study by Perkins et al. (2016), women who had higher levels of education and greater access to healthcare resources were more likely to be informed about the vaccine and its benefits, leading to higher rates of vaccination. Similarly, women who received recommendations from healthcare providers were more likely to opt for vaccination, suggesting the critical role that healthcare providers play in encouraging vaccine uptake (Dempsey et al., 2015). This points to the importance of public health education campaigns and improving access to healthcare as strategies to increase HPV vaccine uptake among women of childbearing age.

Cultural factors also significantly influence HPV vaccine uptake. A study by Rosario et al. (2019) indicated that cultural beliefs, including perceptions of sexual health and HPV, may affect a woman’s decision to vaccinate. In some cultures, there is a stigma associated with discussions about sexual health, leading to discomfort in talking about the HPV vaccine, which could prevent women from seeking vaccination. Additionally, social norms regarding sexual behavior may impact whether women perceive the vaccine as relevant or necessary. These cultural barriers suggest that HPV vaccination programs need to incorporate culturally sensitive approaches that engage communities and respect local values while providing accurate health information.

Health policy and programmatic interventions also play a crucial role in determining vaccine uptake. Many countries have adopted national HPV vaccination programs targeted at young women, with recommendations typically made before the age of 26. However, these age-specific guidelines often exclude women of childbearing age who may still benefit from vaccination. A review by Chirenje et al. (2020) emphasized the importance of expanding eligibility criteria for vaccination programs to include women beyond the typical target age group, noting that there may be significant benefits to vaccinating women who are at risk for HPV infections but have not yet developed HPV-related diseases. This broadening of vaccine eligibility could help increase coverage and reduce the overall burden of HPV-related cancers among women globally.

Furthermore, while the HPV vaccine has proven to be an effective tool in preventing HPV-related diseases, uptake among women of childbearing age remains suboptimal. Factors such as lack of awareness, misconceptions about the vaccine, limited access to healthcare, cultural barriers, and age restrictions in vaccination programs contribute to low vaccination rates in this population. Addressing these barriers through improved education, culturally sensitive outreach, and policy changes could significantly enhance HPV vaccine uptake and contribute to reducing the global burden of HPV-related diseases among women of childbearing age.

• Statement of the Problem

Human Papillomavirus (HPV) is a prevalent sexually transmitted infection, with certain strains leading to serious health conditions such as cervical cancer, which remains a significant global public health issue, particularly for women. Despite the proven efficacy of the HPV vaccine in preventing these diseases, the uptake of the vaccine among women of childbearing age remains suboptimal in many regions. This is especially concerning, given that the vaccine is most effective when administered before exposure to HPV, typically in younger women, yet there is mounting evidence suggesting that older women may still benefit from vaccination. As HPV is prevalent across all sexually active women, low vaccination rates in this demographic increase the risk of cervical cancer and other HPV-related diseases, thus underscoring the need for urgent attention to this issue.

A significant gap exists in understanding the factors influencing HPV vaccine uptake among women of childbearing age. While younger women have been the primary focus of vaccination campaigns, older women, particularly those who are already sexually active or have children, have been largely excluded from these initiatives. This exclusion is based on the assumption that older women may not benefit from vaccination, but emerging research suggests that women beyond the typical target age group still remain at risk for HPV infections. Therefore, the lack of targeted efforts to include women of childbearing age in vaccination programs represents a critical gap in addressing the broader public health challenge of reducing HPV-related diseases. Without proper interventions, these women continue to face the risk of developing preventable diseases that could otherwise be mitigated by vaccination.

Moreover, cultural, educational, and socio-economic barriers further complicate the uptake of the HPV vaccine among this demographic. In many societies, there are prevailing misconceptions about the vaccine, with a notable number of women of childbearing age unaware of its availability and its role in preventing HPV-related cancers. Many women also face cultural stigmas or discomfort discussing sexual health, which impacts their willingness to seek out the vaccine. Additionally, socio-economic factors such as limited access to healthcare services and financial constraints further exacerbate the problem. These barriers not only contribute to low vaccine uptake but also perpetuate health inequities, particularly among marginalized or lower-income women who may not have the same access to health information or healthcare providers who can advocate for vaccination.

The problem is further compounded by the varying levels of support from healthcare professionals. Research has shown that recommendations from healthcare providers are one of the strongest predictors of whether a woman will get vaccinated. However, many healthcare providers do not actively promote HPV vaccination, particularly among women of childbearing age. This lack of proactive communication and counseling results in missed opportunities to educate women about the vaccine’s benefits, particularly for those who may not be familiar with the risks of HPV or the potential for vaccine effectiveness even after sexual debut. As a result, the vaccine remains underutilized, and many women remain unaware of the preventive health measures they could take to reduce their risk of cervical cancer and other HPV-related diseases.

In many countries, vaccination programs are age-restricted, which limits access for women who fall outside of the typical target age groups, generally under 26 years old. This policy framework does not account for the fact that women of childbearing age who have not been vaccinated may still benefit from the vaccine. A lack of policy flexibility and a failure to expand eligibility for the HPV vaccine may inadvertently exclude women who are at risk of HPV infections. This oversight not only impedes public health efforts to reduce HPV-related cancers but also fails to recognize the broader need for a more inclusive approach to vaccination that accounts for the realities of women’s health across the lifespan.

The failure to address these issues results in a situation where women of childbearing age continue to experience an increased risk of developing HPV-related cancers, which could be avoided through vaccination. The problem is multifaceted, with underlying issues such as lack of awareness, cultural barriers, healthcare access disparities, and restrictive vaccination policies contributing to the low uptake of the HPV vaccine. As a result, there is an urgent need for comprehensive public health strategies that target women across a broader age spectrum, engage healthcare providers in proactive vaccine promotion, and address cultural and socio-economic barriers to ensure that all women have access to the life-saving benefits of the HPV vaccine.

1.3. Aim and Objectives of the Study

The aim of the study is to assess the uptake of Human Papillomavirus Vaccine (HPV) among women of childbearing age in Ilemona. The specific objectives are:

1. To determine the awareness level of HPV and its vaccine among women of childbearing age.
2. To assess the factors influencing the decision to uptake the HPV vaccine among women.
3. To evaluate the accessibility and availability of the HPV vaccine in healthcare facilities.
4. To analyze the knowledge and perception of the HPV vaccine among women of childbearing age.

1.4. Research Questions

The research questions are buttressed below:

1. What is the level of awareness of HPV and its vaccine among women of childbearing age?
2. What factors influence the decision to uptake the HPV vaccine among women?
3. How accessible and available is the HPV vaccine in healthcare facilities for women of childbearing age?
4. What is the knowledge and perception of the HPV vaccine among women of childbearing age?

1.5. Research Hypothesis

The hypothetical statement of the study is buttressed below:

Ho: Awareness level of HPV will not affect women of childbearing age.

H1: Awareness level of HPV will affect women of childbearing age.

1.6. Significance of the Study

The significance of this study lies in its potential to provide crucial insights into the factors influencing the uptake of the Human Papillomavirus (HPV) vaccine among women of childbearing age in Ilemona. HPV is a major cause of cervical cancer, a leading cause of cancer-related mortality among women globally. However, despite the availability of an effective vaccine to prevent HPV infections, the uptake of the vaccine in many parts of the world, including local communities such as Ilemona, remains suboptimal. By assessing the factors that contribute to low vaccination rates in this specific population, this study could identify barriers to vaccine uptake that are unique to the region, contributing to targeted public health interventions that could reduce the burden of cervical cancer in the area.

This study holds particular significance for public health policy and practice in Ilemona, a community where health resources may be limited and access to preventive healthcare services may be more challenging compared to urban areas. By understanding the reasons behind the low HPV vaccine uptake in Ilemona, policymakers can tailor interventions that are culturally appropriate and address the specific challenges faced by women in rural or underserved areas. Such interventions may include awareness campaigns, improved access to healthcare facilities, and stronger recommendations from healthcare providers, all of which could increase vaccination coverage. This could ultimately lead to a significant reduction in the incidence of cervical cancer and other HPV-related diseases, thus improving women’s health outcomes in the region.

Moreover, the findings of this study could contribute to global efforts to eliminate cervical cancer, a goal set by the World Health Organization (WHO). The WHO has emphasized the importance of increasing HPV vaccination coverage to reduce the global burden of cervical cancer, which disproportionately affects women in low- and middle-income countries. By assessing the uptake of the HPV vaccine in Ilemona, the study will provide a localized understanding of vaccine acceptance and barriers, which could be extrapolated to similar communities across sub-Saharan Africa. These insights would be vital in shaping strategies that can accelerate the achievement of the WHO’s global cervical cancer elimination goals, helping to reduce disparities in cancer prevention between high and low-resource settings.

This study also has the potential to address gaps in the existing literature on HPV vaccine uptake among women of childbearing age, particularly in rural settings. While there has been significant research on HPV vaccination among adolescent girls, there is a dearth of studies focusing on older women who may still benefit from vaccination. Women of childbearing age, especially those who are sexually active or have had children, are often excluded from vaccination programs or are not targeted by public health campaigns. By focusing on this demographic, the study will contribute to the growing body of knowledge that challenges the age restrictions commonly placed on HPV vaccination programs, providing evidence for the importance of extending vaccination programs to include women beyond the typical target age group.

Additionally, this research will provide a deeper understanding of the socio-economic, cultural, and healthcare-related factors that influence vaccine uptake in Ilemona. These factors may include cultural beliefs about sexual health, the role of community leaders, access to healthcare services, financial constraints, and educational levels. Understanding how these variables interact in shaping vaccine decisions can help healthcare providers and public health professionals better communicate the importance of the HPV vaccine to women in Ilemona. The study will also shed light on the potential role of family support, peer influence, and healthcare provider recommendations in influencing vaccine uptake, offering valuable insights into how social networks and healthcare systems can be leveraged to improve vaccination rates.

Finally, the study’s significance extends to its potential impact on the future of HPV vaccination campaigns in rural and underserved areas. By assessing the local context of Ilemona, this research will offer recommendations for more effective, region-specific vaccination programs. The results could inform the design of tailored health promotion strategies that incorporate community engagement, culturally relevant messaging, and accessible healthcare delivery models, which could be replicated in similar regions. As such, this study could serve as a model for other rural communities in Nigeria and beyond, guiding future efforts to improve vaccine uptake and ultimately contribute to the global fight against HPV-related cancers.

1.7. Scope of the Study

The study assesses the uptake of Human Papillomavirus Vaccine (HPV) among women of childbearing age in Ilemona, Kwara State.

1.8. Operational Definition of Terms

1. Assessment: Assessment refers to the process of evaluating or measuring something in order to understand its nature, quality, or condition. In the context of this study, an assessment refers to the systematic collection and evaluation of data to understand the factors influencing the uptake of the HPV vaccine among women of childbearing age.
2. Uptake: Uptake refers to the act of accepting, adopting, or starting to use something. In this case, it specifically refers to the rate or level at which women of childbearing age receive or choose to be vaccinated with the HPV vaccine. Uptake can be influenced by various factors such as awareness, access, or recommendations from healthcare providers.
3. Human Papillomavirus (HPV): Human Papillomavirus (HPV) is a group of more than 200 related viruses, some of which can cause infections in the genital area and are associated with several cancers, particularly cervical cancer in women. HPV is primarily transmitted through sexual contact, and certain types of HPV are considered high-risk because they can lead to cancer or other serious health conditions.
4. Women: Women refer to adult human females. In the context of this study, “women” refers specifically to adult females, particularly those within the age group of childbearing age, who are the focus of the study on HPV vaccine uptake.
5. Childbearing Age: Childbearing age refers to the period in a woman’s life when she is capable of becoming pregnant. This age range typically spans from adolescence (around age 12) to around age 50, though fertility can vary among individuals. In many studies, childbearing age is often defined as the age range from 18 to 45, although it can differ depending on cultural or healthcare guidelines. This is the population targeted in studies assessing the uptake of the HPV vaccine, as they may still be at risk of HPV infections and HPV-related diseases.

Project – An assessment of the uptake of Human Papillomavirus Vaccine (HPV) among women of childbearing age