Abstract

BackgroundThe cervical cancer burden in Uganda is high amidst low uptake of HPV vaccination. Identification of individual and community factors associated with HPV vaccination are imperative for directed interventions. Conversely, in most Low and Middle Income Countries (LMICs) including Uganda this problem has not been sufficiently studied as the influence of individual and contextual determinants remains undetermined in spite of their substantial effect on HPV vaccine uptake. The aim of the study was to identify individual (school attendance status, age of girls, ethnicity, and amount of media exposure) and community (socioeconomic disadvantages) factors associated with HPV vaccination.MethodsBased on a modified conceptual framework for health care utilization, hierarchical modelling was used to study 6093 girls, aged 10–14 years (level 1), nested within 686 communities (level 2) in Uganda by analyzing data from the 2016 Uganda Demographic and Health Survey.ResultsMajority (78%) of the girls had not been vaccinated. A number of both individual and community factors were significantly associated with HPV vaccination. The Odds of HPV vaccination were higher among girls age; 11, 13, and 14 compared to girls age 10 years, attending school compared to girls not attending school, who were; foreigners, Iteso, Karamajong, Banyoro, Basoga, and other tribe compared to Baganda, living in families with 1–8 members compared to those living in families with 9 or more members and middle social economic status compared to poor wealth quintile.ConclusionsBoth individual and community factors show a noticeable effect on HPV vaccination. If higher vaccination rates are to be achieved in Uganda, these factors should be addressed. Strategies aimed at reaching younger girls, street children, out of school girls, and girls with lower SES should be embraced in order to achieve high vaccination uptake.

Highlights

  • The cervical cancer burden in Uganda is high amidst low uptake of Human Papilloma Virus (HPV) vaccination

  • More than two thirds (78%) had not received the HPV vaccine

  • The study findings show that community-level determinants partly account for the total variance in HPV vaccination the community-level determinants were sufficiently catered for by the Multivariable Multilevel Regression Analysis (MMLRA)

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Summary

Introduction

The cervical cancer burden in Uganda is high amidst low uptake of HPV vaccination. Identification of individual and community factors associated with HPV vaccination are imperative for directed interventions. Sub-Saharan Africa has the third highest incidence (17.5%) of cervical cancer cases after India (17.7%) and East and Central Asia (18.2%). The region shares the second largest number of global cervical cancer deaths (21.6%) after India (25.4%). It is the only region where cervical cancer is equivalent to breast cancer with each constituting a quarter of the global cancer burden [2, 6]. In Sub-Saharan Africa, the East African region registers the highest number of new cervical cancer cases (52613) [7]

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