Knowledge on cervical cancer, human papilloma virus and vaccine, and attitudes towards immunisation following the introduction of vaccine to the National Immunisation Programme, Sri Lanka

Abstract

Background: The human papilloma virus (HPV) vaccine was introduced to the National Immunisation Programme of Sri Lanka in 2017. Although the vaccination uptake increased initially, there is no published data on the continued uptake of the vaccine. Uptake of the HPV vaccine in countries that were initially high have declined. Factors for low compliance could be poor knowledge and/or attitudes. Objectives: The aim of this study was to ascertain knowledge of cervical cancer, HPV and its vaccine, and the attitudes towards HPV immunisation in this post-vaccination era, as well as to identify areas that need strengthening. Methods: A cross-sectional, pre-tested questionnaire based survey of 1716 individuals over 18 years of age, from six districts in Sri Lanka, was conducted in 2019. Ethical approval was granted by the Ethics Review Committee, Faculty of Medical Sciences, University of Sri Jayewardenepura. SPSS statistical software was used for the analysis. A cut off of 50% was considered as a satisfactory level for knowledge and attitude. The Univariate Chi square analysis was used for associations between categorical variables. Odds ratios, with 95% confidence intervals determined the size of the effect of these factors on knowledge and attitudes of the participants. Results: Satisfactory knowledge (50% cut off) of cervical cancer, HPV and of vaccine was detected only in 54%, 20% and 19% participants respectively. Ninety-seven percent of those who were aware of the HPV vaccine (455/471) and 89% (1527/1716) of all participants were in favour of giving the vaccine to their daughters. Factors significantly affecting overall knowledge (all three domains) were age 30-65 years (OR 2.0; 95% CI 1.1,3.3), knowing a patient with cancer (OR 2.0; 95% CI 1.5,2.7) and undergoing cervical screening (OR 3.3; 95% CI 2.3,4.7). Good knowledge of vaccine was significantly associated (OR 4.3; 95% CI 1.3,15.1) with a favourable attitude towards vaccination. Conclusions: Despite overall poor knowledge, a favourable attitude was seen among the majority (89%) of respondents towards HPV vaccination.