Parental perception of and willingness to accept human papillomavirus vaccine for their children amongst civil servants in Ibadan

I Adeagbo; OO Sekoni; OF Owopetu

doi:10.4103/njhs.njhs_35_20

ORIGINAL ARTICLE

Year : 2023 | Volume : 23 | Issue : 1 | Page : 31-36

Parental perception of and willingness to accept human papillomavirus vaccine for their children amongst civil servants in Ibadan

I Adeagbo¹, OO Sekoni¹, OF Owopetu²
¹ Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
² Department of Community Medicine, University College Hospital, Ibadan, Oyo State, Nigeria

Date of Submission	13-Aug-2020
Date of Decision	14-Sep-2020
Date of Acceptance	21-Mar-2022
Date of Web Publication	17-Jul-2023

Correspondence Address:
Dr. O O Sekoni
Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Oyo State
Nigeria

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/njhs.njhs_35_20

Abstract

Introduction: Cervical cancer is the second-most common cancer amongst women worldwide and leading cancer in women in developing countries including Nigeria. However, utilisation of the human papillomavirus vaccine (HPV) is quite low, resulting in poor uptake of an important preventive measure to combat cervical cancer. This study was conducted to determine the parental perception of and willingness to accept the HPV vaccine for their children amongst civil servants in Ibadan.
Materials and Methods: A cross-sectional study was conducted amongst 400 civil servants in the Oyo state secretariat, Ibadan. Pre-tested interviewer-assisted questionnaires were distributed to the respondents to collect data for 6 weeks. Descriptive statistics including frequency and percentage for categorical variables and mean (standard deviation) for continuous variables were calculated.
Results: Almost half (50.3%) and 85% of the total respondents' had heard about the HPV vaccine and were willing to accept HPV vaccine for their children, respectively, while 87.7%, 86.7% and 85.7% of the respondents' were willing to accept HPV vaccine for their children in future if it was free, prescribed by a doctor and included in routine immunisation respectively. A high proportion (81.6%) of the total respondents had good perceptions of the vaccine and the majority of them identified knowledge, safety, effectiveness, cost, potency and fear of side effects of the vaccine as factors influencing its acceptability.
Conclusion: Despite the low awareness of the HPV vaccine amongst the study group, most parents had good perceptions regarding the vaccine and were willing to vaccinate their wards.

Keywords: Human papillomavirus vaccine, Ibadan, perception, willingness

How to cite this article:
Adeagbo I, Sekoni O O, Owopetu O F. Parental perception of and willingness to accept human papillomavirus vaccine for their children amongst civil servants in Ibadan. Niger J Health Sci 2023;23:31-6

How to cite this URL:
Adeagbo I, Sekoni O O, Owopetu O F. Parental perception of and willingness to accept human papillomavirus vaccine for their children amongst civil servants in Ibadan. Niger J Health Sci [serial online] 2023 [cited 2023 Sep 26];23:31-6. Available from: http://www.https://chs-journal.com//text.asp?2023/23/1/31/381740

Introduction

Globally, cervical cancer is a major public health concern with an incidence of more than 560,000 yearly and mortality of about 275,000 every year with more than 55% occurring in developing countries.^[1] Both the incidence and mortality rates of this disease have been increasing worldwide, and it was projected that there will be more than 720,000 new cases and about 400,000 cervical cancer deaths in 2025.^[1]

In Northern Nigeria, it is the most common cancer in women and the second to breast cancer in Southern Nigeria.^[2] About 23.7% of Nigerian women in the general population have been estimated to harbour cervical HPV infection.^[3] Cervical cancer has been linked with the infection of human papillomavirus (HPV), a virus that can be detected in over 99% of cases.^[4],[5] The HPV is the name given to a family of viruses; different types of HPV are classed as either high risk or low risk, depending on the conditions they cause. Some types of HPV cause genital warts while other types are associated with cervical cancer. In 99% of cases, cervical cancer occurs as a result of infection with high-risk types of HPV and often infection with the HPV causes no symptoms and is spread by sexual activity.^[6] In more than 90% of cases, the infection spontaneously resolves unaided in 2 years; however, 10% of the women will develop a persistent infection, and they are at increased risk of developing high-grade pre-cancerous lesions of the cervix and even cancer, including cancers of related organs.^[7]

Women harbouring the type 16 papillomavirus are at a higher risk for developing cervical cancer – A risk 434 times greater than women not harbouring this virus.^[7] Women who contract the virus are usually younger than 25 years of age. They contract a type of HPV that has no clinical manifestations, and they are therefore not aware of being infected.^[8] Thus, personal tragedies and great losses to the families and community at large occur from consequent mortality.^[9]

The HPV vaccine has been proven to be an effective preventive measure to reduce the public health burden of cervical cancer- and HPV-related diseases.^[10] The vaccine protects against HPV which infects at least 50% of sexually active people at some point in their lives but does not protect against all of the types of HPV. There are a few HPV vaccine brands that are nearly 100% effective in preventing disease caused by high-risk strains of HPV 16 and 18 which together account for 70% of all cervical cancers, as well as many cancers of the vagina and vulva (WebMD Network, 2015). Advisory Committee on Immunisation Practices globally recommends that all adolescents should begin receiving the HPV vaccine around 11–12 years of age.^[11] It is recommended for females ages 9–26 and males ages 11–26 to complete the three-shot series as soon as possible. The Centre for Disease Control also promotes early vaccination due to the vaccines' increased effectiveness before HPV exposure.

In the year 2009, the HPV vaccine was introduced in Nigeria to be a preventive measure to combat cervical cancer but the utilisation of the vaccines is quite low for various reasons including the cost is beyond the reach of average Nigerians and can only be afforded by a few privileged individuals.^[12] Considering the benefit of the vaccine, we sought to determine the parental perception of and willingness to accept the vaccine for their children amongst civil servants working in the state secretariat in Ibadan. The demographic for this study comprises a considerable proportion of the organised formal sector in Oyo State with varying socioeconomic and educational strata and is potential purchasers of the vaccine for their children.

Materials and Methods

This was a cross-sectional study conducted between August 2016 and September 2016 on parental perception of and willingness to accept the vaccine for their children amongst civil servants in Ibadan. Pre-tested, structured interviewer-assisted questionnaires were administered by four trained research assistants. Respondents were Oyo State civil servants working in all the ministries in the state secretariat. Civil servants who had no child and/or ward and those that their children/wards were above the age of vaccination (9–26 years) were excluded from this study. Systematic sampling was adopted to select participants for the study. The questionnaires were pre-tested amongst civil servants in Osun State secretariat, Osogbo, Nigeria, following which ambiguous questions were refined. The validated questionnaire had five sections. Section I entails information about socio-demographic characteristics of the respondents, section II contains information about HPV and HPV vaccine, section III has information about the perception of the HPV vaccine. After completion of this section, respondents were provided with one-page information about HPV and HPV vaccines to read before proceeding to section IV which contains information on the willingness to accept HPV vaccine and the last section entails information on factors influencing parental acceptance to the HPV vaccine.

Data entry, editing and analysis were done using SPSS version 20.0 (IBM Corp, Armonk, New York, USA), descriptive statistics including frequency and percentage for categorical variables, mean (standard deviation) for continuous variables and Chi-square test and logistic regression were utilised in the data analysis with α at 0.05. Approval for the study was obtained from the Oyo State Ethical Review Committee, Ministry of Health, Oyo State, before the commencement of the fieldwork.

Results

Four hundred and twenty-six questionnaires were administered and 412 were retrieved, (96.7% response rate); however, only 400 questionnaires were valid for analysis after sorting. In a total of 400 civil servants that participated in this study, 201 (50.2%) were male. The mean age of the respondents was 39.80 ± 8.78 years. Most of the respondents 153 (38.3%) were within the age group of 31–40 years. The majority of the respondents 374 (93.5%) were currently married and 328 (82%) had completed tertiary education and all the respondents had at least a child/ward. The socio-demographic characteristics of the respondents are presented in [Table 1].

Table 1: Sociodemographic characteristics of the respondents

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Furthermore, 201 (50.3%) of the total respondents had heard about the HPV vaccine, the sources of information about the vaccine mentioned by the respondents were the media, 84 (43%); physicians, 78 (39%); friends, 23 (11%) and family/relatives 14 (7%) as shown in [Figure 1].

Figure 1: Respondents' sources of information about HPV vaccine (n = 201). HPV: Human papilloma virus

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Majority of 164 (81.6%) of the respondents that had heard about the HPV vaccine stated that the vaccines offer protection against most cervical cancers. Most 148 (73.6%), 134 (66.7%) and 118 (58.7%) of them reported that one of the HPV vaccines offers protection against genital warts, the vaccines are most effective if given to people who have never had sex and the vaccine requires three doses, respectively.

Majority 323 (80.8%) of the respondents' agreed that the vaccine gives full protection against HPV and 244 (61.0) of the respondents' agreed that the vaccine has to be repeated. Majority 299 (74.5%), 260 (65.0%), 222 (58.8%) and 349 (87.3%) of the respondents' agreed that the vaccine is not well known, has adverse effects, cost and it is important to educate the child/ward on the benefits of the vaccine before vaccination, respectively. Contrarily, less than half 194 (48.5%) and 174 (43.3%) of the respondents' responded that their child/ward might have been exposed to coitus and that uptake of the vaccine may lead to early initiation of sexual activity as shown in [Table 2].

Table 2: Perceptions of the respondents to human papillomavirus vaccine

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Majority of 340 (85%) of the respondents were willing to accept the HPV vaccine for their children/wards, 35 (8.5%) were not willing to accept the vaccine and 25 (6.5%) are undecided as shown in [Figure 1] and [Figure 2]. Majority 57 (14.0%) out of 60 (15%) of those that were not willing to accept the HPV vaccine and were undecided had no reason for their decision regarding the vaccine acceptability. Majority of 351 (87.7%), 343 (85.7%) and 367 (86.7%) of the total respondents were willing to accept the HPV vaccine for their children and wards if it is cost-free, included in routine immunisation and prescribed by doctor respectively. Most 352 (88.0%), 364 (91.0%) and 338 (73.5%) of the respondents were willing to make additional efforts to understand the HPV vaccine, discuss the usefulness of HPV vaccine to their children/wards with health workers and make an appointment to have their children/wards get the vaccine in future, respectively. Majority of 294 (73.5%) of the respondents were not willing to do nothing to have their children/wards get the vaccine in future as shown in [Table 3].

Figure 2: Respondents' willingness to accept HPV vaccine. HPV: Human papilloma virus

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Table 3: Respondent's willingness to accept human papillomavirus vaccine in the future

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In the logistic regression associated with some socio-demographic characteristics of respondents, perception of HPV vaccine, knowledge of HPV vaccine and willingness to accept HPV vaccine, female respondents were 3.4 times more likely to accept HPV vaccine compared to their male counterparts (P = 0.001, odds ratio [OR] =3.40, 95% confidence interval [CI] =1.63–7.10). Respondents with good perception were 4.3 times more likely to accept HPV vaccine compared to respondents with poor perception (P = 0.000, OR = 4.28, 95% CI = 2.061–8.903) as shown in [Table 4] below. Information on factors influencing HPV vaccine acceptance was sought from the respondents. Majority 361 (90.3%) reported that knowledge about the HPV vaccine influences acceptance of HPV vaccine, 297 (74.3%), 326 (81.5%), 313 (78.3), 302 (75.5%), 300 (75.0%) and 327 (81.8) stated that fear of side effects of the vaccine, consideration on the effectiveness of the vaccine, cost, consideration about suffering from cervical cancer and/or genital warts, fear of whether the vaccine is potent and consideration of the safety of the vaccine, respectively influence the vaccine acceptability. Less than one-fifth 66 (16.5%) revealed that fear that the vaccine may not be available for long in the market is not a factor influencing the acceptability of the vaccine.

Table 4: Predictors of willingness to accept human papillomavirus vaccination for children

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Discussion

This study highlights the parental perception of and willingness to accept the HPV vaccine for their children/wards amongst civil servants in Ibadan. The study population consisted of parents who constitute a considerable proportion of the organised formal sector in Oyo State and comprised of individuals that were from varying socio-economic and educational levels and they were assumed to be potential buyers of the vaccine for their children. The awareness of the HPV vaccine amongst the study group was quite high with the main source of information being the media and they had good knowledge about the HPV vaccine. The results of this study are consistent with the study by Giede et al.^[13] on the acceptability of HPV vaccination amongst women attending the University of Saskatchewan Student Health Services, in Canada, that the majority of participants were aware of the HPV vaccine.

However, regarding socio-demographics and knowledge the results of this study contradict those from the study on knowledge and perception of HPV vaccine amongst antenatal women in a Nigerian tertiary hospital, Abuja^[14], where the level of literacy was high amongst the respondents as 58.8%, 36.6% and 7.8% of the surveyed respondents had tertiary, secondary and primary education, respectively while 2.8% of them had no formal education (compared to 82%, 13.5% and 4.5% of respondents with completed tertiary, secondary and primary education respectively in this current study) by Agida et al.^[14] that very few of the respondents knew HPV vaccine. Amongst the respondents, who knew about HPV and HPV vaccination, 18.2% and 23.4% of them had secondary and tertiary levels of education, respectively. Therefore, with increased levels of education, perhaps there are greater levels of awareness and sources for health information which may account for the higher levels of knowledge and willingness to accept the HPV vaccine.

This study also found that majority of the respondents had a good perception of the HPV vaccine. Similarly, there was a statistically significant association between perception and willingness to accept the HPV vaccine where respondents that had a good perception of the HPV vaccine were 4.3 times more likely to accept the HPV vaccine than respondents that had a poor perception. The result of this study agrees with the study by Zimet et al.^[15] amongst parents in Indianapolis, that the greater the parents' perception of the severity of the disease if not vaccinated and the greater their perception of the vaccine's efficacy, the more they were inclined to vaccinate their children.

The results of this study showed that more than four-fifths of the respondents were willing to accept the HPV vaccine for their children/wards after reading through one-page information about HPV and HPV vaccines. Data from this study also show that majority of the respondents were willing to accept the HPV vaccine for their children in the future, if it is free, included in routine immunisation, and prescribed by a doctor. The results of this study are in agreement with the study conducted on the acceptability of the HPV vaccine amongst Moroccan parents,^[16] where the HPV vaccine was acceptable to three-quarters of the mothers and two-thirds of the fathers. A study by Agida et al.,^[14] amongst antenatal attendees in a tertiary hospital in Abuja, Nigeria, where almost two-thirds of the respondents accepted that the vaccines could be administered to their teenage girls was also in agreement with the results of this study.

This study also found that female respondents' were more willing to accept HPV vaccine for their children or wards compared to their male counterparts and respondents who had completed tertiary education were more willing to accept HPV vaccine to do same compared to respondents who had completed secondary education and below and these were statistically significant.^[17] Also found similar results concerning women's willingness to accept HPV vaccination for their children. This finding suggests that higher levels of education attained by respondents had a role to play in perception, knowledge and willingness to accept the HPV vaccine.

Despite the information provided that enlightened the respondents about HPV and HPV vaccine, the majority of the respondents identified knowledge, safety, effectiveness, cost, potency and fear of side effects of the vaccine as factors influencing its acceptability. The result of the study concurs with the study conducted by Giede et al.^[13] on the acceptability of HPV vaccination amongst women attending the University of Saskatchewan Student Health Services, where participants identified cost, concerns over adverse effects and lack of knowledge as barriers to undergoing vaccination, respectively,^[18] also found that the most impact on parental intention to vaccinate their children is attitudes toward vaccination, the effect of vaccination, the price of vaccination and the risk involved in vaccination. In general, parents' inclination to vaccinate their adolescent children depends on their perception of the possible implications of refraining from doing so.

Conclusion

Health education and more awareness about the HPV vaccine in mass media, subsidising the cost of the vaccine, and inclusion of the vaccine in the expanded or routine immunisation programme has the potential to have a positive effect on HPV vaccine uptake. Furthermore, health professionals need to play a cogent role in educating the populace to improve knowledge and ensure clarification of misconception about the HPV vaccine for its uptake to be maximal.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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