Acceptability of the human papillomavirus vaccine among rural and urban women in the Kilimanjaro Region, Tanzania
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BACKGROUND: Cervical cancer is a global disease with a disproportionate burden among low- and middle-income countries. In Tanzania, cervical cancer is the most common female cancer and a prophylactic vaccine offering protection against four human papillomavirus (HPV) strains is a promising prevention method. The targeted age and sex, as well as the sexually transmitted nature and novelty of the vaccine, support the need for formative research on the knowledge, attitudes, and barriers toward vaccination. OBJECTIVES: The first objective of this thesis was to systematically review studies of HPV vaccine acceptability among African countries. The second and third objectives were to describe and determine the socio-demographic factors and HPV-related knowledge and attitudes associated with HPV vaccination and to identify the barriers to vaccination among a population-based sample of rural and urban women in the Kilimanjaro Region of Tanzania. METHODS: The literature was systematically reviewed by searching electronic databases, and a data abstraction form structured by the Health Belief Model was used to collect data and synthesize findings. For objectives 2 and 3, a cross-sectional study was conducted among rural (n=303) and urban (n=272) women aged 18-55. Differences in socio-demographic factors, knowledge, attitudes, and barriers were compared between groups, and multivariable models were used to identify associations among rural and urban women separately. RESULTS: Reviewed literature suggested that HPV vaccine-related knowledge was low, however predicted acceptance of the vaccine was high. Research on this topic was largely composed of cross-sectional studies in urban areas. Among rural women in the Kilimanjaro Region, independent associations with acceptance included variables related to cost, knowledge, access, and educational attainment. Among urban women, independent associations were related to social networks/norms and educational attainment. The most frequent perceived barriers to vaccination were cost, side effects, and safety. CONCLUSION: Educational programs on the HPV vaccine and cervical cancer are needed in Tanzania and in other areas of Africa. This research suggests that vaccine campaigns in the Kilimanjaro Region should focus on emphasizing financial and physical accessibility, peer acceptance, and safety, in addition to highlighting endorsement of the vaccine by healthcare providers and the government.