Investigating Perceptions of Human Papillomavirus Vaccines Through Rapid Assessment in Nigerian Communities

Investigating Perceptions of Human Papillomavirus Vaccines Through Rapid Assessment in Nigerian Communities | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Investigating Perceptions of Human Papillomavirus Vaccines Through Rapid Assessment in Nigerian Communities Chizoba Wonodi, Rufai Garba Ahmed, Sulaiman Etamesor, Nwamaka Ezeanya, and 13 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7715117/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction: As Nigeria prepares to introduce the HPV vaccine into its its Expanded Programme on Immunization (EPI), concerns remain about state-level program readiness and community awareness. This study is a rapid assessment conducted to assess the knowledge, perception, and vaccination intention of adolescents and adults residing in the 16 states selected for the first phase of the HPV vaccine introduction. Methods: This cross-sectional rapid assessment involves data collection from 17,463 participants across the 16 phases 1 HPV vaccine introduction states. Data were collected using a combination of convenience and simple random sampling techniques. Trained professionals administered structured surveys through the Open Data Kit (ODK) on mobile devices. Collected data was cleaned, re-coded, and analysed using Chi-Square Test, Fisher’s Exact Test on open-source software R in the R-studio environment. Trend analysis was conducted using frequency distribution and charts. Findings : Results revealed a significant association between socio-demographic factors and knowledge about HPV and its vaccine, perceived susceptibility to HPV infection, as well as willingness to be vaccinated. The one-month trend analysis revealed a notable increase in knowledge (+12%), and perceived susceptibility (+9%). However, there was a slight decrease in willingness to be vaccinated (-1%) in the one month between the first and second assessment. Conclusion: This study provides valuable insights into the extent of knowledge, perception, and willingness to take the HPV vaccine. Despite improvements in knowledge and perceived susceptibility, there was a slight decrease in willingness to be vaccinated. This highlights challenges such as vaccine hesitancy which may impact overall acceptance. Cervical cancer HPV vaccine HPV Rapid Assessment Knowledge perception Intentions Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 1. Introduction Cervical cancer is the fourth most common cancer in women globally, affecting an estimated 604,000 women, with 342,000 deaths in 2020 alone. 1 90% of cervical cancer cases are found in low and middle-income countries such as those in sub-Saharan Africa, Southeast Asia and Central America [ 1 – 3 ]. Despite being vaccine-preventable, cervical cancer is the second leading cause of cancer-related deaths among women in Nigeria, accounting for an estimated 8000 deaths annually [ 4 – 6 ]. The HPV vaccines have been found to have high efficacy in preventing the cervical-cancer-causing strains of HPV, with a reported 80% reduction of cervical cancer cases from countries that have introduced the vaccine into their immunization program [ 7 – 10 ]. Furthermore, clinical trials have demonstrated sustained protection of over ten years following a single dose of the Gardasil Quadrivalent vaccine [ 11 – 13 ]. Aligning with the World Health Organization’s (WHO) global strategy for cervical cancer elimination, the Nigerian Government introduced the Gardasil Quadrivalent Human Papillomavirus (HPV) vaccine into the National Expanded Program for Immunization (EPI) in the 4th quarter of 2023, with the goal of vaccinating 80% of eligible adolescent girls [ 14 – 16 ].The Nigerian government decided to introduce a single-dose HPV vaccination into the routine immunization program, using a two-phased approach. The first phase was in 16 states and the second phase will be in the remaining 21 states. Phase one introduction featured a one-week Multi-Age Cohort (MAC) campaign in 16 states (Abia, Adamawa, Akwa Ibom, Bauchi, Bayelsa, Benue, Enugu, FCT, Jigawa, Kano, Kebbi, Lagos, Nasarawa, Ogun, Osun, Taraba). Phase two will feature MAC campaigns in the other 21 states in Q2 2024. These phases will be followed by a routinization into the Routine Immunization program. In preparation for the MAC campaigns, there was a disparity between the programmatic assessment of the states’ readiness dashboard and level of population awareness observed during field engagements with community gatekeepers. This was worrisome due to the cultural issues around the HPV vaccine introduction and lessons learned from the HPV vaccine introduction in other countries. It was important for the EPI managers to understand the level of knowledge and perceptions of the target age group and key stakeholders in communities, to objectively assess the readiness of these states to introduce the HPV vaccine and tailor strategies to influence HPV vaccine uptake 3 . To this end, the National Primary Healthcare Development Agency (NPHCDA) supported by the Word Health Organization (WHO) conducted a rapid assessment survey across the phase one implementing states. This rapid assessment was to gain insight that will support the decision matrix to determine the state’s readiness for the rollout of the HPV vaccine and enable the design of effective communication strategies to drive HPV vaccine uptake. Knowledge, positive attitudes and perceptions drive the intention to vaccinate. While several African countries, like Rwanda, Uganda, Senegal and South Africa, have introduced the HPV vaccines into their EPI schedule, studies have shown that the levels of awareness on HPV, cervical cancer, and HPV vaccines are consistently low in Africa. A search through literature showed significant knowledge and awareness gaps about HPV and the vaccine among both adolescents and adults, from studies conducted in different Nigerian states [ 17 – 20 ]. There is also a dearth in country-wide studies, which hinders effective decision making at the national level The study presented in this paper attempts to reduce the gap in literature, as well as provide a national focus on the level of knowledge, awareness and perception surrounding HPV, cervical cancer and HPV vaccine in Nigeria. The objectives of this are to examine the demographic factors associated with HPV vaccination knowledge, perceptions and intention, describe the level of knowledge, perceptions and intention about HPV and the vaccines amongst adolescents and adults in the 16 phase one states, and describe a one-month trend in HPV vaccine knowledge, attitude and perceptions amongst adults and adolescents in the 16 phase one states. The results from this study will be presented using the Health Belief Model (Fig. 1 ). This model predicts the likelihood of a health behaviour based on an individual's perceptions of disease severity and susceptibility to the disease, combined with perceived benefits and barriers to that behaviour. This study predicts willingness to be vaccinated against HPV by sociodemographic characteristics, knowledge and perceived susceptibility to HPV infection. 2. Methods 2.1. Study design and setting This cross-sectional study was conducted as a rapid assessment to gain insights from adolescents and adults on their knowledge, attitudes, and intention to receive the Human Papillomavirus (HPV) vaccine. The rapid assessment was done in the initial 16 initial phase one introduction states: Abia, Adamawa, Akwa Ibom, Bauchi, Bayelsa, Benue, Enugu, FCT, Jigawa, Kano, Kebbi, Lagos, Nasarawa, Ogun, Osun, and Taraba (Fig. 2 ). 2.2. Study population and sampling We adopted convenient and simple random sampling to select the survey respondents. Respondents were selected from all the Local Government Areas (LGAs) in the 16 phase one HPV introduction states. Three wards were conveniently selected from each LGA. From these wards, we leveraged on the WHO’s master list of settlements to select one settlement from each of the chosen wards randomly. In each settlement, we then sampled five girls aged 9–14 years, five caregivers, two school teachers, two traditional leaders, and two religious leaders. (A table showing the number of LGAs and wards is attached in Supplementary Material). 2.3. Instrument and data collection procedure Data collected during the survey includes the demographic characteristics of the respondents, knowledge about and attitudes towards HPV, cervical cancer, the vaccine introduction, and intention to vaccinate against HPV. Doctors and teachers were recruited and trained for two days as data collectors. Data collectors were trained on the methods of the study, sampling techniques, and how to administer the survey to respondents using Open Data Kit (ODK) on mobile devices. ODK was used to ensure consistency and standardization of the data collection process and streamline data administration across the diverse geographical regions under study. Utilizing professional data collectors and a standard digital data collection platform ensured comprehensive and consistent data gathering that adhered to the study's objectives. A total of 34,034 individuals were surveyed between September 9–21, 2023, and October 10–20, 2023. 2.4. Data analysis Post-data collection, the survey data was first cleaned using Microsoft Excel. Then, we did further recode of the items measuring knowledge about HPV/HPV vaccination, perceived susceptibility and willingness to be vaccinated against HPV. 1 point was assigned to “yes” answers, and 0 points for respondents who answered “no” or “I don’t know”. Internal consistency reliability of the six items measuring knowledge of HPV/HPV vaccination was evaluated using Cronbach’s alpha. The six items were summed, and a simple average was computed. 75% was used as a cut-off to indicate a high level of knowledge of HPV/HPV vaccination. Each item was used to measure the construct “Perceived susceptibility to HPV infection” and “Willingness to be vaccinated against HPV”. In describing the demographic characteristics of respondents, frequencies and proportions were presented for categorical variables, while mean and standard deviation were presented for continuous variables. Pearson’s Chi-squared test / Fisher’s exact test was used to assess the association between socio-demographic characteristics and outcome variables: knowledge of HPV/HPV vaccination, perceived susceptibility to HPV infection, and willingness to be vaccinated against HPV. p-value of 0.05 was used to determine a significant association. All quantitative analyses were conducted using the open-source software R (version 4.2.2) in the R-Studio environment. 2.5. Ethical considerations Ethical approval was not sought, as this was considered a public health survey to inform the HPV vaccine introduction. 3. Results 3.1. Demographic Distribution of Participants A total of 17,463 respondents participated in the first round of the cross-sectional survey (Table 1 ). The mean age of the respondents was 38 years (SD: 18). About 30.5% of the respondents were HPV vaccine eligible adolescents girls aged 9–14 years, 5.2% were aged 15–24 years, while the majority (64.2%) were aged 25 years and above. Females accounted for 63.8% of the survey respondents. For ethnicity, the Hausa ethnic group had the largest number of respondents, accounting for 31.6%, followed by Yoruba Yoruba (18.2%), Igbo (11.9%), and Ibibio (4.7%), with other ethnicities collectively making up 20.2%. On education, 12.7% had no formal education, 26.2% had primary education, 30.3% had secondary education, while 26.6% attained tertiary-level education. Most of the respondents, 67.5%, reside in rural areas 17.7% in urban areas and 14.8% in semi-urban areas.Kano state had the most respondents (12.1%), while Bayelsa state had the least (2.3%). Table 1 Demographic characteristics of survey respondents (n = 17,463) Characteristic n (%) Age Mean (SD) 34 (18) 9–14 5,334 (30.5%) 15–24 910 (5.2%) 25+ 11,219 (64.2%) Gender Female 11,134 (63.8%) Male 6,329 (36.2%) Ethnicity Hausa 5,512 (31.6%) Yoruba 3,170 (18.2%) Igbo 2,082 (11.9%) Ibibio 820 (4.7%) Tiv 726 (4.2%) Fulani 599 (3.4%) Annang 387 (2.2%) Idoma 320 (1.8%) Ijaw 312 (1.8%) Other 3,535 (20.2%) Respondent type Adolescent girls (9–14 yrs) 5,334 (30.5%) Caregiver 5,243 (30.0%) Teacher 2,095 (12.0%) Religious leader 2,063 (11.8%) Traditional leader 1,633 (9.4%) Health worker 1,095 (6.3%) Education No education 2,224 (12.7%) Primary 4,583 (26.2%) Secondary 5,299 (30.3%) Tertiary 4,652 (26.6%) Other 705 (4.0%) Residence Rural 11,786 (67.5%) Urban 3,091 (17.7%) Semi Urban 2,586 (14.8%) State Kano 2,117 (12.1%) Akwa Ibom 1,575 (9.0%) Osun 1,534 (8.8%) Jigawa 1,406 (8.1%) Nasarawa 1,245 (7.1%) Benue 1,079 (6.2%) Kebbi 1,013 (5.8%) Adamawa 1,005 (5.8%) Lagos 1,004 (5.7%) Bauchi 998 (5.7%) Ogun 970 (5.6%) Abia 878 (5.0%) Enugu 864 (4.9%) Taraba 795 (4.6%) FCT, Abuja 577 (3.3%) Bayelsa 403 (2.3%) 3.2. Socio-demographic characteristics associated with knowledge about HPV/HPV vaccination and perceived susceptibility to HPV infection The internal consistency reliability test of the six knowledge items yielded a Cronbach’s alpha of 0.857. As shown in Table 2 , we found that the socio-demographic characteristics are significantly associated with knowledge about HPV/HPV vaccination (p value < 0.05). Knowledge about HPV/HPV vaccination increased with increase in age; 22% of adults aged 25 and above were knowledgeable about HPV and HPV vaccination. A higher proportion of men (21%) know about HPV/HPV vaccination than women (15%). Knowledge of HPV/HPV vaccination increased with increase in level of education. Among the respondents, a higher proportion of health workers (65%) had knowledge of HPV/HPV vaccination than other respondents. All the socio-demographic characteristics are significantly associated with perceived susceptibility to HPV infection, except for gender. More people perceived themselves as susceptible to HPV infection than they knew about HPV and HPV infection. Table 2 Socio-demographic characteristics associated with knowledge about HPV/HPV vaccination and perceived susceptibility to HPV infection Socio-demographic characteristic Knowledge about HPV/HPV vaccination Perceived susceptibility to HPV infection High Low p-value 1 Yes No p-value 1 Age < 0.001 < 0.001 9–14 369 (6.9%) 4,965 (93%) 1,549 (29%) 3,785 (71%) 15–24 154 (17%) 756 (83%) 415(46%) 495 (54%) 25+ 2,462 (22%) 8,757 (78%) 4,809 (43%) 6,410 (57%) Gender < 0.001 0.4 Female 1,636 (15%) 9,498 (85%) 4,292 (39%) 6,842 (61%) Male 1,349 (21%) 4,980 (79%) 2,481 (39%) 3,848 (61%) Respondent type < 0.001 < 0.001 Adolescent girls (9–14 years) 369 (6.9%) 4,965 (93%) 1,549 (29%) 3,785 (71%) Caregiver 697 (13%) 4,546 (87%) 2,169 (41%) 3,074 (59%) Health worker 707 (65%) 388 (35%) 746 (68%) 349 (32%) Religious leader 354 (17%) 1,709 (83%) 722 (35%) 1,341 (65%) Teacher 500 (24%) 1,595 (76%) 966 (46%) 1,129 (54%) Traditional leader 358 (22%) 1,275 (78%) 621 (38%) 1,012 (62%) Education < 0.001 < 0.001 No education 177 (8.0%) 2,047 (92%) 686 (31%) 1,538 (69%) Primary 381 (8.3%) 4,202 (92%) 1,414 (31%) 3,169 (69%) Secondary 755 (14%) 4,544 (86%) 2,046 (39%) 3,253 (61%) Tertiary 1,558 (33%) 3,094 (67%) 2,322 (50%) 2,330 (50%) Other 114 (16%) 591 (84%) 305 (43%) 400 (57%) Religion 0.005 < 0.001 Christianity 1,477 (17%) 7,267 (83%) 2,862 (33%) 5,882 (67%) Islam 1,487 (18%) 7,006 (82%) 3,867 (46%) 4,626 (54%) Traditional 18 (8.7%) 188 (91%) 42 (20%) 164 (80%) Other 3 (15%) 17 (85%) 2 (10%) 18 (90%) Residence < 0.001 < 0.001 Rural 1,899 (16%) 9,887 (84%) 4,522 (38%) 7,264 (62%) Urban 624 (20%) 2,467 (80%) 1,294 (42%) 1,797 (58%) Semi Urban 462 (18%) 2,124 (82%) 957 (37%) 1,629 (63%) State < 0.001 < 0.001 Abia 123 (14%) 755 (86%) 306 (35%) 572 (65%) Adamawa 122 (12%) 883 (88%) 419 (42%) 586 (58%) Akwa Ibom 244 (15%) 1,331 (85%) 337 (21%) 1,238 (79%) Bauchi 298 (30%) 700 (70%) 624 (63%) 374 (37%) Bayelsa 46 (11%) 357 (89%) 78 (19%) 325 (81%) Benue 171 (16%) 908 (84%) 324 (30%) 755 (70%) Enugu 81 (9.4%) 783 (91%) 181 (21%) 683 (79%) FCT, Abuja 122 (21%) 455 (79%) 279 (48%) 298 (52%) Jigawa 245 (17%) 1,161 (83%) 647 (46%) 759 (54%) Kano 212 (10%) 1,905 (90%) 1,016 (48%) 1,101 (52%) Kebbi 80 (7.9%) 933 (92%) 335 (33%) 678 (67%) Lagos 242 (24%) 762 (76%) 421 (42%) 583 (58%) Nasarawa 271 (22%) 974 (78%) 549 (44%) 696 (56%) Ogun 106 (11%) 864 (89%) 289 (30%) 681 (70%) Osun 522 (34%) 1,012 (66%) 699 (46%) 835 (54%) Taraba 100 (13%) 695 (87%) 269 (34%) 526 (66%) Geopolitical zone < 0.001 < 0.001 North Central 564 (19%) 2,337 (81%) 1,152 (40%) 1,749 (60%) North East 520 (19%) 2,278 (81%) 1,312 (47%) 1,486 (53%) North West 537 (12%) 3,999 (88%) 1,998 (44%) 2,538 (56%) South East 204 (12%) 1,538 (88%) 487 (28%) 1,255 (72%) South South 290 (15%) 1,688 (85%) 415 (21%) 1,563 (79%) South West 870 (25%) 2,638 (75%) 1,409 (40%) 2,099 (60%) 1 Chi-squared/Fisher's exact test 3.3. Socio-demographic characteristics, and willingness to be vaccinated against HPV Willingness to be vaccinated against HPV increased with age (Table 3 ). More men were willing to let their wards be vaccinated (96%) than females. Females were either willing to be vaccinated or let their wards be vaccinated (90%). A higher proportion of Muslims were willing to get vaccinated against HPV (93%) than people of other religions. Intention to vaccinate was highest in the Northeast zone (96%). HPV vaccine intention increased with knowledge about HPV/HPV vaccination and perceived susceptibility to HPV infection. (A survey questions table showing the respondent’s intention to vaccinate against HPV is attached in Supplementary Material). Table 3 Socio-demographic characteristics, and willingness to be vaccinated against HPV Socio-demographic characteristic Willingness to be vaccinated against HPV Yes No Total p-value 1 Age < 0.001 9–14 4,549 (85%) 785 (15%) 5,334 (100%) 15–24 834 (92%) 76 (8.4%) 910 (100%) 25+ 10,672 (95%) 547 (4.9%) 11,219 (100%) Gender < 0.001 Female 9,981 (90%) 1,153 (10%) 11,134 (100%) Male 6,074 (96%) 255 (4.0%) 6,329 (100%) Ethnicity < 0.001 Annang 307 (79%) 80 (21%) 387 (100%) Fulani 534 (89%) 65 (11%) 599 (100%) Hausa 5,102 (93%) 410 (7.4%) 5,512 (100%) Ibibio 734 (90%) 86 (10%) 820 (100%) Idoma 311 (97%) 9 (2.8%) 320 (100%) Igbo 1,795 (86%) 287 (14%) 2,082 (100%) Ijaw 270 (87%) 42 (13%) 312 (100%) Tiv 650 (90%) 76 (10%) 726 (100%) Yoruba 2,989 (94%) 181 (5.7%) 3,170 (100%) Other 3,363 (95%) 172 (4.9%) 3,535 (100%) Respondent type < 0.001 Adolescent girls (9–14 years) 4,549 (85%) 785 (15%) 5,334 (100%) Caregiver 4,882 (93%) 361 (6.9%) 5,243 (100%) Health Worker 1,077 (98%) 18 (1.6%) 1,095 (100%) Religious Leader 1,954 (95%) 109 (5.3%) 2,063 (100%) Teacher 2,011 (96%) 84 (4.0%) 2,095 (100%) Traditional Leader 1,582 (97%) 51 (3.1%) 1,633 (100%) Education < 0.001 No Education 1,958 (88%) 266 (12%) 2,224 (100%) Primary 4,066 (89%) 517 (11%) 4,583 (100%) Secondary 4,880 (92%) 419 (7.9%) 5,299 (100%) Tertiary 4,497 (97%) 155 (3.3%) 4,652 (100%) Other 654 (93%) 51 (7.2%) 705 (100%) Religion < 0.001 Christianity 7,971 (91%) 773 (8.8%) 8,744 (100%) Islam 7,895 (93%) 598 (7.0%) 8,493 (100%) Traditional 173 (84%) 33 (16%) 206 (100%) Other 16 (80%) 4 (20%) 20 (100%) Residence 0.003 Rural 10,815 (92%) 971 (8.2%) 11,786 (100%) Urban 2,821 (91%) 270 (8.7%) 3,091 (100%) Semi Urban 2,419 (94%) 167 (6.5%) 2,586 (100%) States < 0.001 Abia 786 (90%) 92 (10%) 878 (100%) Adamawa 947 (94%) 58 (5.8%) 1,005 (100%) Akwa Ibom 1,385 (88%) 190 (12%) 1,575 (100%) Bauchi 968 (97%) 30 (3.0%) 998 (100%) Bayelsa 344 (85%) 59 (15%) 403 (100%) Benue 996 (92%) 83 (7.7%) 1,079 (100%) Enugu 691 (80%) 173 (20%) 864 (100%) FCT, Abuja 557 (97%) 20 (3.5%) 577 (100%) Jigawa 1,250 (89%) 156 (11%) 1,406 (100%) Kano 1,934 (91%) 183 (8.6%) 2,117 (100%) Kebbi 938 (93%) 75 (7.4%) 1,013 (100%) Lagos 908 (90%) 96 (9.6%) 1,004 (100%) Nasarawa 1,214 (98%) 31 (2.5%) 1,245 (100%) Ogun 926 (95%) 44 (4.5%) 970 (100%) Osun 1,453 (95%) 81 (5.3%) 1,534 (100%) Taraba 758 (95%) 37 (4.7%) 795 (100%) Geopolitical zone < 0.001 North Central 2,767 (95%) 134 (4.6%) 2,901 (100%) North East 2,673 (96%) 125 (4.5%) 2,798 (100%) North West 4,122 (91%) 414 (9.1%) 4,536 (100%) South East 1,477 (85%) 265 (15%) 1,742 (100%) South South 1,729 (87%) 249 (13%) 1,978 (100%) South West 3,287 (94%) 221 (6.3%) 3,508 (100%) Knowledge about HPV/HPV vaccination < 0.001 High 2,964 (99%) 21 (0.7%) 2,985 (100%) Low 13,091 (90%) 1,387 (9.6%) 14,478 (100%) Perceived susceptibility to HPV infection < 0.001 Yes 6,648 (98%) 125 (1.8%) 6,773 (100%) No 9,407 (88%) 1,283 (12%) 10,690 (100%) 1 Chi-squared/Fisher's exact test 3.4. One-month trend in knowledge about HPV/HPV vaccination, perceived susceptibility to HPV infection and HPV vaccination intention by state Figure 3 shows a one-month trend in knowledge about HPV and HPV vaccine across the 15 phase 1 states and the Federal Capital Territory (FCT). States such as Enugu (28%), and Benue (28%) experience the most substantial increase in knowledge about HPV and HPV vaccines, rising from 9% to 37% and 16% to 39% respectively. Other states such as Kano (+ 15%), Adamawa (+ 13%), and Osun (+ 13%) also showed noteworthy improvement in this knowledge. On average, there was a noteworthy 12% national increase in knowledge about HPV and HPV vaccines, from 17% in the first assessment to 29% in the second assessment conducted one month later. These results suggest that the advocacy and sensitization activities conducted by the NPHCDA during the one month were effective in enhancing awareness levels across these states. Figure 4 shows the one-month trend in perceived susceptibility to the human papillomavirus infection across the 15 phase one states and the FCT. Across these states, the analysis revealed a notable increase in the percentage of individuals who perceive themselves as susceptible to HPV infection. Benue, Kebbi, and Taraba states made an increase of 21%, 19% and 19% respectively, in the percentage of individuals who perceived themselves susceptible to HPV infection between the first and second assessments. States such as Enugu (+ 18%), Kano (+ 14%), Osun (+ 13%), Bayelsa (+ 13%), and Akwa Ibom (+ 13%) also demonstrated commendable improvement in the proportion that acknowledges their susceptibility to HPV infection. However, two states, Lagos (-5%) and Ogun (-4%) showed a notable decrease in people’s perceived susceptibility to HPV infection. Overall, across the states, there was a 9% increase in perceived susceptibility to HPV infection. Figure 5 shows the one-month trend in the willingness to be vaccinated with the HPV vaccine across the 15 phase-one states and the FCT. Among these states, Enugu (+ 17%) made the most substantial increase from 80% to an impressive 97%. Nasarawa maintained a consistent 98% willingness to receive the vaccines throughout the period. Adamawa saw a slight increase of 1%, moving from a relatively high 94% to 95%. However, states like Lagos (-23%), Ogun (-24%), Osun (-13%) and the FCT (-7%) saw a notable decrease in the percentage of people willing to take the HPV vaccine. Overall, there was a 1% national decrease from 92% in the first assessment to 91% in the second assessment. The decrease in willingness to take the vaccine may be influenced by factors such as vaccine hesitancy and shift in perception over time, possibly influenced by infodemics and conspiracy theories about the vaccines. 4. Discussion and conclusion Our study's primary objective was to investigate demographic factors linked with knowledge, perception, and intention related to HPV and HPV vaccination among adolescents and adults in the initial 16 phase one states. We aimed to delineate the extent of knowledge and perceptions regarding HPV and the vaccine. We also sought to analyse the evolving trend in HPV vaccine knowledge, attitudes, and perceptions over the one-month period. Among the 17,463 participants that took part in the survey, the majority were adults aged 25 years and above, with a mean age of 38 years. Adolescents aged 9 to 14 account for 30.5% of the total participant pool. Among the 16 states where data was collected, Kano had the highest number of participants at 12.1%, while Bayelsa had the lowest with only 2.3% of the participants. The analysis revealed a significant association between various socio-demographic factors and knowledge about HPV and HPV vaccination. There was a positive association between age and knowledge of HPV and HPV vaccines, with adults aged 25 and above having more knowledge. This result implies that older adults have been exposed to information about HPV and HPV vaccines over time due to consistent access to health-related materials. Also, older adults, especially those with higher levels of education may have benefited from extensive access to health education programs that expose them to HPV-related information. This aligns with the study of [ 20 ], who suggested that older adults who may have had more access to health information could have accumulated more information on HPV and HPV vaccination. The results also revealed a notable disparity in knowledge about HPV and its vaccine between sexes, with men having higher knowledge (21%) compared to women (15%). As expected, health workers show the highest knowledge (65%) when compared to other respondent types. The observed disparity between men and women in HPV-related knowledge may be attributed to various socio-cultural and health disparities prevalent in Nigeria. In many Nigerian societies, particularly in the Northern region, men generally have better access to education, which potentially results in better knowledge of health-related matters. Also, in these parts of the country, cultural norms significantly impact the dissemination of health-related information, with discussions relating to sexual health more open among men compared to women. This result may be unique as it deviates from existing literature that commonly reports men having lower knowledge about HPV and HPV vaccines than women [ 21 , 22 , 23 , 24 ]. This result underscores the unique socio-cultural context in Nigeria, where education and cultural norms such as religious practices, contribute to the pattern of knowledge distribution. The results of health workers having more knowledge than other demographic groups align with expectations. By virtue of their occupation, health workers receive extensive training in health care. This formal training equips them with a robust understanding of health practices, and better positions them to be well informed about HPV-related issues. Also, health workers are exposed to diverse health issues in their daily routine, providing them with firsthand experience of dealing with patients with health conditions including cervical cancer and other HPV-related infections. This exposure enables them to stay abreast of the latest developments in health. This finding is consistent with that of [ 25 ], who suggested that the professional training, work environment, and experience of health workers contribute to their high level of knowledge about HPV. Our analysis revealed that perceived susceptibility to HPV infection was generally higher than knowledge level. Additionally, socio-demographic characteristics were associated with perceived susceptibility. These results suggest that psychological factors or traits play a significant role in how people assess their vulnerability to illness or health risk. This perception may likely be shaped by various social factors such as individual exposure and cultural perceptions. The analysis also revealed a positive correlation between age and willingness to be vaccinated. The result that willingness increases with age aligns with the broader trend where older individuals have greater awareness of the potential risks associated with HPV and the benefits of vaccination. This may be attributed to prolonged exposure to educational materials and the accumulation of knowledge over time, because as individuals age, they tend to gather and accumulate experiences and knowledge, including those that relate to health risks. These experiences and accumulated knowledge may likely contribute to making them better understand the potential dangers associated with diseases including HPV and its vaccines. This assertion is supported by [ 26 ], who report that willingness to get vaccinated increases with age and knowledge. The result also highlights a gender-based disparity in willingness to be vaccinated. Men were more likely to give consent for their wards to be vaccinated compared to women's willingness to be vaccinated or to give consent to their wards to be vaccinated. This result may be rooted in socio-cultural, religious, and decision-making factors. Data for this study was mostly collected from the northern part of the country and in these societies, traditional gender roles shape the dynamics of family life, particularly when it comes to decision-making concerning the vaccination of children and even wives. Society and cultural norms dictate or prescribe that men are the primary decision-makers in matters that concern the well-being of the family [ 27 ]. Women differ to their husbands in making health-related decisions that concern members of their family [ 28 ]. Also, there are cases of educational disparities between men and women in these parts of the country, with men enjoying better access to educational opportunities than women [ 28 ]. This may result in men having better access to information on health-related matters and may inform their decision to give consent to their children to be vaccinated. Analyzed data also revealed that among religious groups, a higher proportion of Muslims expressed willingness to be vaccinated with the HPV vaccine compared to individuals of other faiths. Also, the intention to take the HPV vaccine was higher in the northeast compared to other regions in the country. The willingness to be vaccinated and the high intention to be vaccinated being from the northeast can be attributed to the endorsement of community gatekeepers and religious leaders. In the northern part of the country and amongst those practicing the Islamic faith, religious leaders and their institutions wield significant influence in various aspects of social life, including decision-making when it comes to health. [29] The high regard and influence of the religious leaders in the north suggests that their endorsement of the HPV vaccine may have significantly impacted the attitude and decision of the people to be vaccinated or give consent for their wards to be vaccinated. The National Primary Healthcare Development Agency (NPHCDA) recognizing the importance of religious leaders and gatekeepers, conducted extensive sensitization and advocacy visits to religious leaders and gatekeepers during the pre-introduction phase to sensitize and create awareness of the benefits of the HPV vaccine. This targeted effort may have reflected in the high willingness of the people to be vaccinated. We conducted two assessments with a one-month interval to gauge changes in knowledge of HPV and its vaccine, perceived susceptibility, and vaccination intention across the 16 phase-one states in the country. Results on knowledge revealed a notable increase in the national average by 12% from the first assessment to the second assessment. Notably states as Kano, Adamawa, and Osun also demonstrated significant improvement in knowledge across the country, which can be attributed to the efforts of the NPHCDA. During the one month after the first assessment, the NPHCDA conducted targeted awareness campaigns and educational initiatives by engaging with local communities through various channels such as community gatherings, and advocacy visits to community gatekeepers and religious leaders. Messages at these meetings were tailored to the specific context of each society. This direct interaction helped to facilitate a mere impactful communication of information on HPV-related matters. The NPHCDA also partnered with community influencers and healthcare professionals to enhance the credibility information distributed. The endorsement by these individuals contributed to improved understanding and trust. There was a 9% national increase in perceived susceptibility to HPV infection across the 16 phase-one states. States such as Benue, Kebbi, and Taraba showed the most significant improvement, with concerns over Lagos and Ogun as perceived susceptibility reduced. The advocacy, communication, and social mobilization (ACSM) activities efforts of the NPHCDA may have succeeded in making people more conscious of the risk associated with HPV infection and their vulnerability to the disease. These activities may have had a profound effect in states that had significant improvement such as Benue, Kebbi, and Taraba. States like Lagos and Ogun where we observed a decline raise concerns about the effectiveness of the ACSM activities conducted by the NPHCDA. This decline may be attributed to a lack of awareness of the potential risk of HPV and its related malignancies. Additionally, there was a 1% decrease in the national average on willingness to be vaccinated. Across the states, Enugu demonstrated an impressive increase in the willingness to be vaccinated by 17% from 80% to 97%. Nasarawa maintained a consistently impressive 98%. However, states such as Lagos, Ogun, Osun, and the FCT showed a concerning decrease in the willingness to be vaccinated. The notable decrease in willingness to be vaccinated may be influenced by several factors. Some people may not be aware or may lack the understanding of the benefits of HPV vaccination. This can contribute to scepticism and misconceptions about the vaccines. Perceptions could also change over time because of the spread of infodemics and conspiracy theories, which is common in Nigeria, especially during new vaccine introductions [ 30 ]. During these new vaccine introductions, there is a spread of misleading and false information about the safety, purpose, and potential side effects of the vaccine to be introduced, usually through social media and community platforms. These infodemics and conspiracy theories exploit existing fears and concerns of people, contributing to negative perceptions about the vaccines. 5. Limitations of the study This study had several limitations. First, no pretest was conducted to validate the study tools. This was because of the impromptu and urgent need for the assessment findings to inform strategies for the national HPV vaccination rollout. Secondly, we employed a randomized sampling method for the data collection, which may have introduced a potential bias that influences the study's outcomes. Both respondents and data collectors were selected using a random selection technique. Thirdly, the sampled population was generally receptive to vaccines. Fourthly, the uneven distribution of population numbers across states indicates inadequate coverage in data collection from various regions. Fifthly, we did not use the health belief model to design the study. This model was only used for the analysis and presentation of this paper. Finally, the short duration of the study limits the assessment of long-term knowledge retention and behavioral change on HPV vaccination. 6. Implications This study is a rapid assessment of knowledge, perception, and vaccination intention in the phase one HPV introduction states in Nigeria. There was an association between socio-demographic factors and knowledge about HPV, indicating the importance of tailored interventions. The one-month analysis showed a notable increase in knowledge and perceived susceptibility, but a decrease in intention to be vaccinated. This result calls for target interventions as there is still room for improvement. There is a need for an effective public health campaign that is aimed at raising awareness about HPV and its vaccination through tailored educational materials to suit different age groups. Tailored educational materials should be developed to cater to different age groups, with a particular emphasis on engaging adolescents and younger adults. Collaborative efforts between the National Primary Health Care Development Agency (NPHCDA) and the Ministry of Education are essential to integrate HPV education into school curricula, ensuring sustained awareness among students. Additionally, campaigns should utilize diverse delivery channels, including direct engagements with adolescents in schools and community outreaches for broader impact across communities The observed gender disparities observed across the 16 phase one states underscore the need for a gender-specific strategy in awareness and sensitization campaigns. It is very important to bridge the knowledge gap, especially among women. Tailored educational interventions must be developed to furnish women with information about the significance and necessity of HPV vaccines. Moreover, recognizing the pivotal role of men as decision-makers within families, targeted initiatives should be formulated to actively engage them in promoting vaccination. By involving men as advocates, we not only enhance their understanding of HPV but also empower them to become influential figures capable of championing HPV vaccination within their families and communities. The study highlights the important role of health workers in enhancing awareness and the dissemination of knowledge. There is a need to prioritize continuous training of health workers as they are key for advancing knowledge and advocating for HPV vaccination. Enhancing health worker’s knowledge through prioritized training which will allow them to serve as a reliable and trusted source of information about HPV and its vaccine. Also, the observed decrease in willingness or intention to be vaccinated in some states underscores the importance of addressing vaccine hesitancy. Targeted strategies must be implemented to dispel rumours and misinformation, address public concerns, and build trust in the efficacy and safety of HPV vaccines. Accurate and targeted educational campaigns should be developed to provide comprehensive information about HPV and the vaccines, emphasizing their benefits and efficacy. These campaigns should be tailored to specific demographics and delivered through various channels to reach diverse communities effectively. Additionally, community dialogue sessions involving community influencers and gatekeepers should be organized. Leveraging community-specific channels, such as local gatherings and religious institutions, will be instrumental in building confidence in the vaccines and addressing concerns directly within communities. Declarations Ethical approval: This rapid assessment was implemented by the National Primary Health Care Development Agency (NPHCDA) as part of government-led programmatic activities in preparation for the HPV vaccine introduction in Nigeria. Ethical approval was not sought as the assessment was considered a public health survey to inform programmatic decision making. Consent to participate: Written informed consent was obtained from all adult participants, and written informed assent and parental/guardian permission were obtained for participants below 18 years of age prior to data collection. Data availability statement: The datasets used and/or analysed during the current study available from the corresponding author on reasonable request Consent to publish: All authors have reviewed and approved of the final version of the manuscript and hereby given consent for submission and publication. All methods were carried out in accordance with relevant guidelines and regulations governing the conduct of programmatic public health assessments in Nigeria, ensuring adherence to ethical standards of data collection, participant consent, and confidentiality. Acknowledgements: We recognize the contributions of everyone who made the process that led to the development of this paper possible, Dr Muyi Aina, the executive director of National Primary Healthcare Board for approving the use of administrative data from DCL staff who made it possible for the documentation from the workshop. We are grateful to GAVI for funding the documentation workshop that led to the development of this paper. Author contributions: Conceptualization: C.W., E.H., R.G.A., D.A., A.B., N.E., P.A., S.E., L.A., P.F. and S. O.; methodology, C.W., A.D., G.H., I. O.,P.A.; formal analysis, N.E., A.A., T.A and P.A.; writing—original draft preparation, T. A., N.E., P.A.and P.F.; writing—review and editing, C.W., P.A., S.E., N.E., A.B., T.A; All authors have read and agreed to the published version of the manuscript. Funding: The authors declare that no funding was received for this study. The project was carried out within the framework of programmatic implementation led by the National Primary Healthcare Development Agency (NPHCDA). Clinical trial number: Not Applicable Competing interests: The authors have no financial and non-financial competing interest References World Health Organization Regional Office for Africa. (2023). Safeguarding the future of women and girls in Nigeria against cervical cancer. Retrieved December 17, 2024, from https://www.afro.who.int/countries/nigeria/news/safeguarding-future-women-and-girls-nigeria-against-cervical-cancer Singh D, Vignat J, Lorenzoni V, Eslahi M, Ginsburg O, Lauby-Secretan B, Arbyn M, Basu P, Bray F, Vaccarella S. Global estimates of incidence and mortality of cervical cancer in 2020: a baseline analysis of the WHO Global Cervical Cancer Elimination Initiative. Lancet Global Health. 2022;11(2):e197–206. https://doi.org/10.1016/s2214-109x(22)00501-0 . Hull R, Mbele M, Makhafola T, Hicks C, Wang S, Reis R, Mehrotra R, Kwitshana M, Kibiki Z, Bates G, D., Dlamini Z. Cervical cancer in low and middle income countries (Review). Oncol Lett. 2020;20(3):2058–74. https://doi.org/10.3892/ol.2020.11754 . World Health Organization. (2023). Cervical cancer. Retrieved December 16, 2024, from https://www.who.int/news-room/fact-sheets/detail/cervical-cancer Lawson O, Ameyan L, Tukur Z, Dunu S, Kerry M, Okuyemi OO, Yusuf Z, Fasawe O, Wiwa O, Hebert KS, Joseph JT, Nwokwu UE, Okpako O, Chime CI. Cervical cancer screening outcomes in public health facilities in three states in Nigeria. BMC Public Health. 2023;23(1). https://doi.org/10.1186/s12889-023-16539-1 . Mafiana JJ, Dhital S, Halabia M, Wang X. Barriers to uptake of cervical cancer screening among women in Nigeria: a systematic review. Afr Health Sci. 2022;22(2):295–309. https://doi.org/10.4314/ahs.v22i2.33 . Kreimer AR, Rodriguez AC, Hildesheim A, Herrero R, Porras C, Schiffman M, González P, Solomon D, Jiménez S, Schiller JT, Lowy DR, Quint W, Sherman ME, Schussler J, Wacholder S. Proof-of-Principle evaluation of the efficacy of fewer than three doses of a bivalent HPV16/18 vaccine. JNCI J Natl Cancer Inst. 2011;103(19):1444–51. https://doi.org/10.1093/jnci/djr319 . Machalek DA, Garland SM, Brotherton JML, Bateson D, McNamee K, Stewart M, Skinner SR, Liu B, Cornall AM, Kaldor JM, Tabrizi SN. Very low prevalence of vaccine human papillomavirus types among 18- to 35-Year old Australian women 9 years following implementation of vaccination. J Infect Dis. 2018;217(10):1590–600. https://doi.org/10.1093/infdis/jiy075 . Lei J, Ploner A, Elfström KM, Wang J, Roth A, Fang F, Sundström K, Dillner J, Sparén P. HPV vaccination and the risk of invasive cervical cancer. N Engl J Med. 2020;383(14):1340–8. https://doi.org/10.1056/nejmoa1917338 . Kaur P, Mehrotra R, Rengaswamy S, Kaur T, Hariprasad R, Mehendale SM, Rajaraman P, Rath GK, Bhatla N, Krishnan S, Nayyar A, Swaminathan S. Human papillomavirus vaccine for cancer cervix prevention: Rationale & recommendations for implementation in India. Indian J Med Res. 2017;146(2):153. https://doi.org/10.4103/ijmr.ijmr_1906_16 . Barnabas RV, Brown ER, Onono M, Bukusi EA, Njoroge B, Winer RL, Donnell D, Galloway D, Cherne S, Heller K, Leingang H, Morrison S, Rechkina E, McClelland RS, Baeten JM, Celum C, Mugo N. Single-dose HPV vaccination efficacy among adolescent girls and young women in Kenya (the KEN SHE Study): study protocol for a randomized controlled trial. Trials. 2021;22(1). https://doi.org/10.1186/s13063-021-05608-8 . Barnabas RV, Brown ER, Onono MA, Bukusi EA, Njoroge B, Winer RL, Galloway DA, Pinder LF, Donnell D, Wakhungu IN, Biwott C, Kimanthi S, Heller KB, Kanjilal DG, Pacella D, Morrison S, Rechkina EA, Cherne SL, Schaafsma TT, Ouma JA. Durability of single-dose HPV vaccination in young Kenyan women: randomized controlled trial 3-year results. Nat Med. 2023;29(12):3224–32. https://doi.org/10.1038/s41591-023-02658-0 . Whitworth HS, Gallagher KE, Howard N, Mounier-Jack S, Mbwanji G, Kreimer AR, Basu P, Kelly H, Drolet M, Brisson M, Watson-Jones D. Efficacy and immunogenicity of a single dose of human papillomavirus vaccine compared to no vaccination or standard three and two-dose vaccination regimens: A systematic review of evidence from clinical trials. Vaccine. 2019;38(6):1302–14. https://doi.org/10.1016/j.vaccine.2019.12.017 . Nigeria Immunization Technical Advisory Group (NGITAG). (2023). Updated HPV Technical Dossier on Quadrivalent HPV (Gardasil-4valent) 1 -dose Regimen. file:///C:/Users/info/Downloads/Documents/Updated%20HPV%20recommendation%20on%20i%20dose%20regimen%20Technical%20dossier.pdf World Health Organization. (2023, October 24). Nigeria to vaccinate 7.7 million girls against leading cause of cervical cancer . Partnership for Maternal, Newborn & Child Health. Retrieved December 13, 2023, from https://pmnch.who.int/news-and-events/news/item/24-10-2023-nigeria-to-vaccinate-7.7-million-girls-against-leading-cause-of-cervical-cancer Okolie EA, Aluga D, Anjorin S, Ike FN, Ani M, Nwadike BI. Addressing missed opportunities for cervical cancer screening in Nigeria: A nursing workforce approach. EcancerMedicalScience. 2022;16:1373. Ezeanochie M, Olasimbo P. Awareness and uptake of human papilloma virus vaccines among female secondary school students in Benin City, Nigeria. Afr Health Sci. 2020;20(1):45. https://doi.org/10.4314/ahs.v20i1.8 . Brown B, Folayan M. Barriers to uptake of human papilloma virus vaccine in Nigeria: A population in need. Nigerian Med J. 2015;56(4):301. https://doi.org/10.4103/0300-1652.165033 . Makwe CC, Anorlu RI, Odeyemi KA. Human papillomavirus (HPV) infection and vaccines: knowledge, attitude and perception among female students at the University of Lagos, Lagos, Nigeria. J Epidemiol global health. 2012;2(4):199–206. https://doi.org/10.1016/j.jegh.2012.11.001 . Ohaeri B, Adefolaju A, Onyeneho C. Knowledge, attitudes and perceptions of Nigerian parents towards human papilloma virus (HPV) vaccines. Eur J Midwifery. 2020b;4. https://doi.org/10.18332/ejm/114886 . Preston SM, Darrow WW. Are Men Being Left Behind (Or Catching Up)? Differences in HPV Awareness, Knowledge, and Attitudes Between Diverse College Men and Women. Am J Men's Health. 2019;13(6):1557988319883776. https://doi.org/10.1177/1557988319883776 . Jenkins L, Williams A, Brown S. (2023). Are Women Always Right? Comparing HPV Knowledge Between Men and Women. Curiosity: Interdisciplinary Journal of Research and Innovation. https://doi.org/10.36898/001c.73161 Chen L, Song Y, Ruan G, Zhang Q, Lin F, Zhang J, Wu T, An J, Dong B, Sun P. (n.d.). Knowledge and Attitudes Regarding HPV and Vaccination Among Chinese Women Aged 20 to 35 Years in Fujian Province: A Cross-Sectional Study . https://doi.org/10.1177/1073274818775356 Suk R, Montealegre JR, Nemutlu GS, Nyitray AG, Schmeler KM, Sonawane K, Deshmukh AA. Public knowledge of human papillomavirus and receipt of vaccination recommendations. JAMA Pediatr. 2019;173(11):1099. https://doi.org/10.1001/jamapediatrics.2019.3105 . Chawla PC, Chawla A, Chaudhary S. Knowledge, attitude & practice on human papillomavirus vaccination: A cross-sectional study among healthcare providers. Indian J Med Res. 2016;144(5):741–9. https://doi.org/10.4103/ijmr.IJMR_1106_14 . Gao D, Zhao G, Di J, Zhang X, Wang L. Knowledge of Cervical Cancer and HPV, and Willingness to Receive HPV Vaccination Among 20-45-Year-Old Women - Six Provinces, China, 2018. China CDC Wkly. 2023;5(9):201–5. https://doi.org/10.46234/ccdcw2023.036 . Yaya S, Okonofua F, Ntoimo L, Udenige O, Bishwajit G. Gender inequity as a barrier to women’s access to skilled pregnancy care in rural Nigeria: a qualitative study. Int health. 2019;11(6):551–60. Sinai I, Anyanti J, Khan M, Daroda R, Oguntunde O. Demand for women’s health services in northern Nigeria: a review of the literature. Afr J Reprod Health. 2017;21(2):96–108. Clements CJ, Greenough P, Shull D. How vaccine safety can become political-the example of polio in Nigeria. Curr Drug Saf. 2006;1(1):117–9. Wonodi, C., Obi-Jeff, C., Adewumi, F., Keluo-Udeke, S. C., Gur-Arie, R., Krubiner,C., … Faden, R. (2022). Conspiracy theories and misinformation about COVID-19 in Nigeria:Implications for vaccine demand generation communications. Vaccine, 40(13), 2114–2121.https://doi.org/10.1016/j.vaccine.2022.02.005. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7715117","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":546730310,"identity":"958ff50b-8688-4a9e-8fe5-6c77ed91a726","order_by":0,"name":"Chizoba Wonodi","email":"","orcid":"","institution":"International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health Baltimore","correspondingAuthor":false,"prefix":"","firstName":"Chizoba","middleName":"","lastName":"Wonodi","suffix":""},{"id":546730311,"identity":"a56e018f-fe28-4e75-bfdb-b3eee33ab4eb","order_by":1,"name":"Rufai Garba Ahmed","email":"","orcid":"","institution":"National Primary Healthcare Development Agency","correspondingAuthor":false,"prefix":"","firstName":"Rufai","middleName":"Garba","lastName":"Ahmed","suffix":""},{"id":546730312,"identity":"47d71186-dc95-4b83-a786-9bb1f20d4d4b","order_by":2,"name":"Sulaiman Etamesor","email":"","orcid":"","institution":"National Primary Healthcare Development Agency","correspondingAuthor":false,"prefix":"","firstName":"Sulaiman","middleName":"","lastName":"Etamesor","suffix":""},{"id":546730313,"identity":"ce8b8ab6-7a57-47d4-8665-8407addfe55a","order_by":3,"name":"Nwamaka Ezeanya","email":"data:image/png;base64,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","orcid":"","institution":"Women Advocates for Vaccine Access","correspondingAuthor":true,"prefix":"","firstName":"Nwamaka","middleName":"","lastName":"Ezeanya","suffix":""},{"id":546730314,"identity":"139175e0-e9ef-49c6-8122-79603fa5f621","order_by":4,"name":"Pius Angioha","email":"","orcid":"","institution":"Direct Consulting and Logistics","correspondingAuthor":false,"prefix":"","firstName":"Pius","middleName":"","lastName":"Angioha","suffix":""},{"id":546730315,"identity":"e83e3b39-da1d-4768-b8ec-8c82f3de1ddc","order_by":5,"name":"Aliyu Ladan","email":"","orcid":"","institution":"National Primary Healthcare Development Agency","correspondingAuthor":false,"prefix":"","firstName":"Aliyu","middleName":"","lastName":"Ladan","suffix":""},{"id":546730316,"identity":"6b68a3ce-e15f-40b5-ab7b-7a90e17d92a7","order_by":6,"name":"Aliyu Jalaluddeen Abdulkadir","email":"","orcid":"","institution":"National Primary Healthcare Development Agency","correspondingAuthor":false,"prefix":"","firstName":"Aliyu","middleName":"Jalaluddeen","lastName":"Abdulkadir","suffix":""},{"id":546730317,"identity":"c668434f-3747-40da-9fd6-89e67a2e224e","order_by":7,"name":"Ikechukwu Okpe","email":"","orcid":"","institution":"Sydani Group","correspondingAuthor":false,"prefix":"","firstName":"Ikechukwu","middleName":"","lastName":"Okpe","suffix":""},{"id":546730318,"identity":"9c827c2c-cd22-441f-ae22-3a487ec9433f","order_by":8,"name":"Lukman Abdulsalam","email":"","orcid":"","institution":"World Health Organization Country Office","correspondingAuthor":false,"prefix":"","firstName":"Lukman","middleName":"","lastName":"Abdulsalam","suffix":""},{"id":546730319,"identity":"91fde6ec-618f-434f-a09b-248d93ea1c90","order_by":9,"name":"Shola Oyeniyi","email":"","orcid":"","institution":"World Health Organization Country Office","correspondingAuthor":false,"prefix":"","firstName":"Shola","middleName":"","lastName":"Oyeniyi","suffix":""},{"id":546730320,"identity":"e66dc049-c349-4400-ace8-d596007affa8","order_by":10,"name":"Elizabeth Hassan","email":"","orcid":"","institution":"National Primary Healthcare Development Agency","correspondingAuthor":false,"prefix":"","firstName":"Elizabeth","middleName":"","lastName":"Hassan","suffix":""},{"id":546730321,"identity":"89fadbe9-8dcb-4d95-9d65-ecafdee8f6db","order_by":11,"name":"Amos Bassi","email":"","orcid":"","institution":"John Snow Inc.","correspondingAuthor":false,"prefix":"","firstName":"Amos","middleName":"","lastName":"Bassi","suffix":""},{"id":546730322,"identity":"0b6aec50-5e0b-4b2c-8c55-9b495fa952b9","order_by":12,"name":"Goodness Hadley","email":"","orcid":"","institution":"Women Advocates for Vaccine Access","correspondingAuthor":false,"prefix":"","firstName":"Goodness","middleName":"","lastName":"Hadley","suffix":""},{"id":546730323,"identity":"d42d8a86-25a5-488d-8dce-f26e0bd78fa1","order_by":13,"name":"Prince Friday","email":"","orcid":"","institution":"Clinton Health Access Health Initiative","correspondingAuthor":false,"prefix":"","firstName":"Prince","middleName":"","lastName":"Friday","suffix":""},{"id":546730324,"identity":"77247132-60f6-4c4e-98ca-957773cc897b","order_by":14,"name":"Abdulrasheed Abdulraheem","email":"","orcid":"","institution":"Direct Consulting and Logistics","correspondingAuthor":false,"prefix":"","firstName":"Abdulrasheed","middleName":"","lastName":"Abdulraheem","suffix":""},{"id":546730325,"identity":"7bf33dc3-b270-44a5-9619-febb2ede06db","order_by":15,"name":"Tosin Arogundade","email":"","orcid":"","institution":"Direct Consulting and Logistics","correspondingAuthor":false,"prefix":"","firstName":"Tosin","middleName":"","lastName":"Arogundade","suffix":""},{"id":546730326,"identity":"5470ac94-40b2-4872-95f0-63b02105e9f9","order_by":16,"name":"Daniel Ali","email":"","orcid":"","institution":"International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health Baltimore","correspondingAuthor":false,"prefix":"","firstName":"Daniel","middleName":"","lastName":"Ali","suffix":""}],"badges":[],"createdAt":"2025-09-25 16:53:26","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7715117/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7715117/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":96557239,"identity":"b2d9c180-19ab-42b5-a116-e94566592cb8","added_by":"auto","created_at":"2025-11-23 11:52:45","extension":"json","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":16456,"visible":true,"origin":"","legend":"","description":"","filename":"254c2379eeec439a949698a7269bdb6d.json","url":"https://assets-eu.researchsquare.com/files/rs-7715117/v1/b66c96402aa45a48da8ba270.json"},{"id":96557241,"identity":"2ba91a46-6c1a-4983-8785-c5d268d2b5f3","added_by":"auto","created_at":"2025-11-23 11:52:45","extension":"xml","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":165017,"visible":true,"origin":"","legend":"","description":"","filename":"254c2379eeec439a949698a7269bdb6d1enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7715117/v1/ab78c1dbdef5464a70c3e509.xml"},{"id":96605267,"identity":"0b26fba0-e612-40aa-bca5-a53b8f72dd78","added_by":"auto","created_at":"2025-11-24 09:21:54","extension":"jpeg","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":28904,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7715117/v1/099715bc91ca27b94305bac6.jpeg"},{"id":96557246,"identity":"b56298f0-2036-44cc-80ed-125e55de9c95","added_by":"auto","created_at":"2025-11-23 11:52:46","extension":"png","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":155928,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7715117/v1/79cd90eece64dfb75bd42a06.png"},{"id":96557248,"identity":"5f3e0b49-0f0c-440a-99cc-1ae841b142a7","added_by":"auto","created_at":"2025-11-23 11:52:46","extension":"png","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":31222,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-7715117/v1/d093772d444067cd66d06fb0.png"},{"id":96605456,"identity":"64d14c5c-5a06-474d-a919-499841e823b6","added_by":"auto","created_at":"2025-11-24 09:23:06","extension":"png","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":29403,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-7715117/v1/01b5955015b381b9db29b679.png"},{"id":96557252,"identity":"8b18f832-a31f-4249-ae45-8d728d534929","added_by":"auto","created_at":"2025-11-23 11:52:46","extension":"png","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":26474,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage5.png","url":"https://assets-eu.researchsquare.com/files/rs-7715117/v1/b245831240636953e73db189.png"},{"id":96604695,"identity":"72ab716c-b413-42b2-9997-33ee713c97ee","added_by":"auto","created_at":"2025-11-24 09:14:36","extension":"png","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":19904,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7715117/v1/1df6f64c67edba655a88a738.png"},{"id":96604800,"identity":"9b8392f5-8a62-416c-84c5-20642604a943","added_by":"auto","created_at":"2025-11-24 09:15:05","extension":"png","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":58835,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7715117/v1/e8d0c21215ba46cd805de005.png"},{"id":96604892,"identity":"8aab2730-467a-41fc-92cd-de6a59691a4b","added_by":"auto","created_at":"2025-11-24 09:15:42","extension":"png","order_by":9,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":24223,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-7715117/v1/a489e0e45d3eb1859ecb4c26.png"},{"id":96557256,"identity":"768a43d4-d6ee-48b0-ab78-185be331a7d8","added_by":"auto","created_at":"2025-11-23 11:52:46","extension":"png","order_by":10,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":22753,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-7715117/v1/107fa9cac76d72ebf379f41d.png"},{"id":96557251,"identity":"35e5a716-2661-4770-b5e3-d714eb7cf74b","added_by":"auto","created_at":"2025-11-23 11:52:46","extension":"png","order_by":11,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":20770,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage5.png","url":"https://assets-eu.researchsquare.com/files/rs-7715117/v1/b15965a8b0045f7c33512ed9.png"},{"id":96557253,"identity":"c0fc773c-832d-4850-8860-311a4e7261de","added_by":"auto","created_at":"2025-11-23 11:52:46","extension":"xml","order_by":12,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":163235,"visible":true,"origin":"","legend":"","description":"","filename":"254c2379eeec439a949698a7269bdb6d1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7715117/v1/fd93cee6f50d818479af5f2a.xml"},{"id":96557255,"identity":"4cc50012-ba6f-40f4-846b-ff7f971f248a","added_by":"auto","created_at":"2025-11-23 11:52:46","extension":"html","order_by":13,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":167371,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7715117/v1/7cffe4a2c02cff1a35643832.html"},{"id":96557238,"identity":"cb473681-9832-4fa4-a7f7-e08033ac9c2e","added_by":"auto","created_at":"2025-11-23 11:52:45","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":28904,"visible":true,"origin":"","legend":"\u003cp\u003eConceptual Framework (Health Belief Model)\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7715117/v1/d90a76e8ffd478ca285ffe37.jpeg"},{"id":96557242,"identity":"062bfe18-0979-4728-91a8-311f8ca812ca","added_by":"auto","created_at":"2025-11-23 11:52:46","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":155928,"visible":true,"origin":"","legend":"\u003cp\u003eNigeria’s Phase 1 \u0026amp; 2 HPV Vaccine Introduction States\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7715117/v1/43a3302baea0ed9b60935cd3.png"},{"id":96557240,"identity":"1ea52b6a-2164-47d4-a219-19c0d08c17ec","added_by":"auto","created_at":"2025-11-23 11:52:45","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":31222,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eOne-month trend in knowledge about HPV and HPV vaccine\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-7715117/v1/43cb4ce691a5244be169c906.png"},{"id":96605680,"identity":"62b995cd-a56e-4db5-9b61-3f0798e9d650","added_by":"auto","created_at":"2025-11-24 09:23:48","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":29403,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eOne-month trend in perceived susceptibility to HPV infection\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-7715117/v1/cd636457bccf98ae0bed3908.png"},{"id":96557245,"identity":"a895f55a-a4ac-4c14-9588-6cf4a5948161","added_by":"auto","created_at":"2025-11-23 11:52:46","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":26474,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eOne-month trend in willingness to get vaccinated against HPV\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage5.png","url":"https://assets-eu.researchsquare.com/files/rs-7715117/v1/a1a3dc640a02c268c0364720.png"},{"id":101847188,"identity":"71b3bb96-d7e3-4106-8c31-1c915af7b5c4","added_by":"auto","created_at":"2026-02-04 09:28:20","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2033387,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7715117/v1/a51c2cf7-7283-4e7b-8f86-371df6b001a8.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Investigating Perceptions of Human Papillomavirus Vaccines Through Rapid Assessment in Nigerian Communities","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eCervical cancer is the fourth most common cancer in women globally, affecting an estimated 604,000 women, with 342,000 deaths in 2020 alone.\u003csup\u003e1\u003c/sup\u003e 90% of cervical cancer cases are found in low and middle-income countries such as those in sub-Saharan Africa, Southeast Asia and Central America [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Despite being vaccine-preventable, cervical cancer is the second leading cause of cancer-related deaths among women in Nigeria, accounting for an estimated 8000 deaths annually [\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. The HPV vaccines have been found to have high efficacy in preventing the cervical-cancer-causing strains of HPV, with a reported 80% reduction of cervical cancer cases from countries that have introduced the vaccine into their immunization program [\u003cspan additionalcitationids=\"CR8 CR9\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Furthermore, clinical trials have demonstrated sustained protection of over ten years following a single dose of the Gardasil Quadrivalent vaccine [\u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAligning with the World Health Organization\u0026rsquo;s (WHO) global strategy for cervical cancer elimination, the Nigerian Government introduced the Gardasil Quadrivalent Human Papillomavirus (HPV) vaccine into the National Expanded Program for Immunization (EPI) in the 4th quarter of 2023, with the goal of vaccinating 80% of eligible adolescent girls [\u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].The Nigerian government decided to introduce a single-dose HPV vaccination into the routine immunization program, using a two-phased approach. The first phase was in 16 states and the second phase will be in the remaining 21 states. Phase one introduction featured a one-week Multi-Age Cohort (MAC) campaign in 16 states (Abia, Adamawa, Akwa Ibom, Bauchi, Bayelsa, Benue, Enugu, FCT, Jigawa, Kano, Kebbi, Lagos, Nasarawa, Ogun, Osun, Taraba). Phase two will feature MAC campaigns in the other 21 states in Q2 2024. These phases will be followed by a routinization into the Routine Immunization program.\u003c/p\u003e\u003cp\u003eIn preparation for the MAC campaigns, there was a disparity between the programmatic assessment of the states\u0026rsquo; readiness dashboard and level of population awareness observed during field engagements with community gatekeepers. This was worrisome due to the cultural issues around the HPV vaccine introduction and lessons learned from the HPV vaccine introduction in other countries. It was important for the EPI managers to understand the level of knowledge and perceptions of the target age group and key stakeholders in communities, to objectively assess the readiness of these states to introduce the HPV vaccine and tailor strategies to influence HPV vaccine uptake\u003csup\u003e3\u003c/sup\u003e. To this end, the National Primary Healthcare Development Agency (NPHCDA) supported by the Word Health Organization (WHO) conducted a rapid assessment survey across the phase one implementing states. This rapid assessment was to gain insight that will support the decision matrix to determine the state\u0026rsquo;s readiness for the rollout of the HPV vaccine and enable the design of effective communication strategies to drive HPV vaccine uptake.\u003c/p\u003e\u003cp\u003eKnowledge, positive attitudes and perceptions drive the intention to vaccinate. While several African countries, like Rwanda, Uganda, Senegal and South Africa, have introduced the HPV vaccines into their EPI schedule, studies have shown that the levels of awareness on HPV, cervical cancer, and HPV vaccines are consistently low in Africa. A search through literature showed significant knowledge and awareness gaps about HPV and the vaccine among both adolescents and adults, from studies conducted in different Nigerian states [\u003cspan additionalcitationids=\"CR18 CR19\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. There is also a dearth in country-wide studies, which hinders effective decision making at the national level\u003c/p\u003e\u003cp\u003eThe study presented in this paper attempts to reduce the gap in literature, as well as provide a national focus on the level of knowledge, awareness and perception surrounding HPV, cervical cancer and HPV vaccine in Nigeria. The objectives of this are to examine the demographic factors associated with HPV vaccination knowledge, perceptions and intention, describe the level of knowledge, perceptions and intention about HPV and the vaccines amongst adolescents and adults in the 16 phase one states, and describe a one-month trend in HPV vaccine knowledge, attitude and perceptions amongst adults and adolescents in the 16 phase one states. The results from this study will be presented using the Health Belief Model (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). This model predicts the likelihood of a health behaviour based on an individual's perceptions of disease severity and susceptibility to the disease, combined with perceived benefits and barriers to that behaviour. This study predicts willingness to be vaccinated against HPV by sociodemographic characteristics, knowledge and perceived susceptibility to HPV infection.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.1. Study design and setting\u003c/h2\u003e\u003cp\u003eThis cross-sectional study was conducted as a rapid assessment to gain insights from adolescents and adults on their knowledge, attitudes, and intention to receive the Human Papillomavirus (HPV) vaccine. The rapid assessment was done in the initial 16 initial phase one introduction states: Abia, Adamawa, Akwa Ibom, Bauchi, Bayelsa, Benue, Enugu, FCT, Jigawa, Kano, Kebbi, Lagos, Nasarawa, Ogun, Osun, and Taraba (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.2. Study population and sampling\u003c/h2\u003e\u003cp\u003eWe adopted convenient and simple random sampling to select the survey respondents. Respondents were selected from all the Local Government Areas (LGAs) in the 16 phase one HPV introduction states. Three wards were conveniently selected from each LGA. From these wards, we leveraged on the WHO\u0026rsquo;s master list of settlements to select one settlement from each of the chosen wards randomly. In each settlement, we then sampled five girls aged 9\u0026ndash;14 years, five caregivers, two school teachers, two traditional leaders, and two religious leaders. (A table showing the number of LGAs and wards is attached in Supplementary Material).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e2.3. Instrument and data collection procedure\u003c/h2\u003e\u003cp\u003eData collected during the survey includes the demographic characteristics of the respondents, knowledge about and attitudes towards HPV, cervical cancer, the vaccine introduction, and intention to vaccinate against HPV.\u003c/p\u003e\u003cp\u003eDoctors and teachers were recruited and trained for two days as data collectors. Data collectors were trained on the methods of the study, sampling techniques, and how to administer the survey to respondents using Open Data Kit (ODK) on mobile devices. ODK was used to ensure consistency and standardization of the data collection process and streamline data administration across the diverse geographical regions under study. Utilizing professional data collectors and a standard digital data collection platform ensured comprehensive and consistent data gathering that adhered to the study's objectives. A total of 34,034 individuals were surveyed between September 9\u0026ndash;21, 2023, and October 10\u0026ndash;20, 2023.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003e2.4. Data analysis\u003c/h2\u003e\u003cp\u003ePost-data collection, the survey data was first cleaned using Microsoft Excel. Then, we did further recode of the items measuring knowledge about HPV/HPV vaccination, perceived susceptibility and willingness to be vaccinated against HPV. 1 point was assigned to \u0026ldquo;yes\u0026rdquo; answers, and 0 points for respondents who answered \u0026ldquo;no\u0026rdquo; or \u0026ldquo;I don\u0026rsquo;t know\u0026rdquo;. Internal consistency reliability of the six items measuring knowledge of HPV/HPV vaccination was evaluated using Cronbach\u0026rsquo;s alpha. The six items were summed, and a simple average was computed. 75% was used as a cut-off to indicate a high level of knowledge of HPV/HPV vaccination. Each item was used to measure the construct \u0026ldquo;Perceived susceptibility to HPV infection\u0026rdquo; and \u0026ldquo;Willingness to be vaccinated against HPV\u0026rdquo;.\u003c/p\u003e\u003cp\u003eIn describing the demographic characteristics of respondents, frequencies and proportions were presented for categorical variables, while mean and standard deviation were presented for continuous variables. Pearson\u0026rsquo;s Chi-squared test / Fisher\u0026rsquo;s exact test was used to assess the association between socio-demographic characteristics and outcome variables: knowledge of HPV/HPV vaccination, perceived susceptibility to HPV infection, and willingness to be vaccinated against HPV. p-value of 0.05 was used to determine a significant association. All quantitative analyses were conducted using the open-source software R (version 4.2.2) in the R-Studio environment.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003e2.5. Ethical considerations\u003c/h2\u003e\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003cp\u003ewas not sought, as this was considered a public health survey to inform the HPV vaccine introduction.\u003c/p\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003e3.1. Demographic Distribution of Participants\u003c/h2\u003e\u003cp\u003eA total of 17,463 respondents participated in the first round of the cross-sectional survey (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The mean age of the respondents was 38 years (SD: 18). About 30.5% of the respondents were HPV vaccine eligible adolescents girls aged 9\u0026ndash;14 years, 5.2% were aged 15\u0026ndash;24 years, while the majority (64.2%) were aged 25 years and above. Females accounted for 63.8% of the survey respondents. For ethnicity, the Hausa ethnic group had the largest number of respondents, accounting for 31.6%, followed by Yoruba Yoruba (18.2%), Igbo (11.9%), and Ibibio (4.7%), with other ethnicities collectively making up 20.2%.\u003c/p\u003e\u003cp\u003eOn education, 12.7% had no formal education, 26.2% had primary education, 30.3% had secondary education, while 26.6% attained tertiary-level education. Most of the respondents, 67.5%, reside in rural areas 17.7% in urban areas and 14.8% in semi-urban areas.Kano state had the most respondents (12.1%), while Bayelsa state had the least (2.3%).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDemographic characteristics of survey respondents (n\u0026thinsp;=\u0026thinsp;17,463)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMean (SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e34 (18)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e9\u0026ndash;14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5,334 (30.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e15\u0026ndash;24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e910 (5.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e25+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11,219 (64.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11,134 (63.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6,329 (36.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEthnicity\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHausa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5,512 (31.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYoruba\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3,170 (18.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIgbo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2,082 (11.9%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIbibio\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e820 (4.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTiv\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e726 (4.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFulani\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e599 (3.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAnnang\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e387 (2.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIdoma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e320 (1.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIjaw\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e312 (1.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3,535 (20.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eRespondent type\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAdolescent girls (9\u0026ndash;14 yrs)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5,334 (30.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCaregiver\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5,243 (30.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTeacher\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2,095 (12.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eReligious leader\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2,063 (11.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTraditional leader\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1,633 (9.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHealth worker\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1,095 (6.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEducation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2,224 (12.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4,583 (26.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSecondary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5,299 (30.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTertiary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4,652 (26.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e705 (4.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eResidence\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRural\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11,786 (67.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUrban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3,091 (17.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSemi Urban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2,586 (14.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eState\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKano\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2,117 (12.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAkwa Ibom\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1,575 (9.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOsun\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1,534 (8.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJigawa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1,406 (8.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNasarawa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1,245 (7.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBenue\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1,079 (6.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKebbi\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1,013 (5.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAdamawa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1,005 (5.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLagos\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1,004 (5.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBauchi\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e998 (5.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOgun\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e970 (5.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAbia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e878 (5.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEnugu\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e864 (4.9%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTaraba\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e795 (4.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFCT, Abuja\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e577 (3.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBayelsa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e403 (2.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003e3.2. Socio-demographic characteristics associated with knowledge about HPV/HPV vaccination and perceived susceptibility to HPV infection\u003c/h2\u003e\u003cp\u003eThe internal consistency reliability test of the six knowledge items yielded a Cronbach\u0026rsquo;s alpha of 0.857. As shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, we found that the socio-demographic characteristics are significantly associated with knowledge about HPV/HPV vaccination (p value\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Knowledge about HPV/HPV vaccination increased with increase in age; 22% of adults aged 25 and above were knowledgeable about HPV and HPV vaccination. A higher proportion of men (21%) know about HPV/HPV vaccination than women (15%). Knowledge of HPV/HPV vaccination increased with increase in level of education. Among the respondents, a higher proportion of health workers (65%) had knowledge of HPV/HPV vaccination than other respondents.\u003c/p\u003e\u003cp\u003eAll the socio-demographic characteristics are significantly associated with perceived susceptibility to HPV infection, except for gender. More people perceived themselves as susceptible to HPV infection than they knew about HPV and HPV infection.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSocio-demographic characteristics associated with knowledge about HPV/HPV vaccination and perceived susceptibility to HPV infection\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eSocio-demographic characteristic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eKnowledge about HPV/HPV vaccination\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e\u003cp\u003ePerceived susceptibility to HPV infection\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHigh\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ep-value\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep-value\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e9\u0026ndash;14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e369 (6.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4,965 (93%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1,549 (29%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3,785 (71%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e15\u0026ndash;24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e154 (17%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e756 (83%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e415(46%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e495 (54%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e25+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2,462 (22%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8,757 (78%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4,809 (43%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e6,410 (57%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1,636 (15%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9,498 (85%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4,292 (39%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e6,842 (61%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1,349 (21%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4,980 (79%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2,481 (39%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3,848 (61%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eRespondent type\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAdolescent girls (9\u0026ndash;14 years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e369 (6.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4,965 (93%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1,549 (29%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3,785 (71%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCaregiver\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e697 (13%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4,546 (87%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2,169 (41%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3,074 (59%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHealth worker\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e707 (65%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e388 (35%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e746 (68%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e349 (32%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eReligious leader\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e354 (17%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1,709 (83%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e722 (35%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1,341 (65%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTeacher\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e500 (24%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1,595 (76%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e966 (46%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1,129 (54%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTraditional leader\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e358 (22%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1,275 (78%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e621 (38%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1,012 (62%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEducation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e177 (8.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2,047 (92%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e686 (31%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1,538 (69%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e381 (8.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4,202 (92%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1,414 (31%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3,169 (69%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSecondary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e755 (14%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4,544 (86%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2,046 (39%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3,253 (61%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTertiary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1,558 (33%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3,094 (67%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2,322 (50%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2,330 (50%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e114 (16%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e591 (84%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e305 (43%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e400 (57%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eReligion\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.005\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChristianity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1,477 (17%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7,267 (83%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2,862 (33%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5,882 (67%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIslam\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1,487 (18%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7,006 (82%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3,867 (46%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4,626 (54%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTraditional\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18 (8.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e188 (91%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e42 (20%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e164 (80%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 (15%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17 (85%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2 (10%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e18 (90%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eResidence\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRural\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1,899 (16%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9,887 (84%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4,522 (38%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e7,264 (62%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUrban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e624 (20%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2,467 (80%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1,294 (42%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1,797 (58%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSemi Urban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e462 (18%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2,124 (82%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e957 (37%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1,629 (63%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eState\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAbia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e123 (14%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e755 (86%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e306 (35%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e572 (65%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAdamawa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e122 (12%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e883 (88%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e419 (42%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e586 (58%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAkwa Ibom\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e244 (15%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1,331 (85%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e337 (21%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1,238 (79%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBauchi\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e298 (30%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e700 (70%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e624 (63%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e374 (37%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBayelsa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e46 (11%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e357 (89%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e78 (19%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e325 (81%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBenue\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e171 (16%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e908 (84%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e324 (30%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e755 (70%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEnugu\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e81 (9.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e783 (91%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e181 (21%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e683 (79%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFCT, Abuja\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e122 (21%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e455 (79%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e279 (48%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e298 (52%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJigawa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e245 (17%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1,161 (83%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e647 (46%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e759 (54%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKano\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e212 (10%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1,905 (90%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1,016 (48%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1,101 (52%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKebbi\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e80 (7.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e933 (92%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e335 (33%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e678 (67%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLagos\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e242 (24%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e762 (76%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e421 (42%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e583 (58%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNasarawa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e271 (22%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e974 (78%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e549 (44%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e696 (56%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOgun\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e106 (11%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e864 (89%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e289 (30%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e681 (70%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOsun\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e522 (34%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1,012 (66%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e699 (46%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e835 (54%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTaraba\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e100 (13%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e695 (87%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e269 (34%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e526 (66%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGeopolitical zone\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNorth Central\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e564 (19%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2,337 (81%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1,152 (40%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1,749 (60%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNorth East\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e520 (19%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2,278 (81%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1,312 (47%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1,486 (53%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNorth West\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e537 (12%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3,999 (88%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1,998 (44%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2,538 (56%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSouth East\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e204 (12%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1,538 (88%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e487 (28%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1,255 (72%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSouth South\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e290 (15%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1,688 (85%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e415 (21%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1,563 (79%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSouth West\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e870 (25%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2,638 (75%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1,409 (40%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2,099 (60%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003csup\u003e1\u003c/sup\u003eChi-squared/Fisher's exact test\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003e3.3. Socio-demographic characteristics, and willingness to be vaccinated against HPV\u003c/h2\u003e\u003cp\u003eWillingness to be vaccinated against HPV increased with age (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). More men were willing to let their wards be vaccinated (96%) than females. Females were either willing to be vaccinated or let their wards be vaccinated (90%). A higher proportion of Muslims were willing to get vaccinated against HPV (93%) than people of other religions. Intention to vaccinate was highest in the Northeast zone (96%). HPV vaccine intention increased with knowledge about HPV/HPV vaccination and perceived susceptibility to HPV infection. (A survey questions table showing the respondent\u0026rsquo;s intention to vaccinate against HPV is attached in Supplementary Material).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSocio-demographic characteristics, and willingness to be vaccinated against HPV\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eSocio-demographic characteristic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u003cp\u003eWillingness to be vaccinated against HPV\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep-value\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e9\u0026ndash;14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4,549 (85%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e785 (15%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5,334 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e15\u0026ndash;24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e834 (92%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e76 (8.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e910 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e25+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10,672 (95%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e547 (4.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11,219 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9,981 (90%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1,153 (10%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11,134 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6,074 (96%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e255 (4.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6,329 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEthnicity\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAnnang\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e307 (79%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e80 (21%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e387 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFulani\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e534 (89%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e65 (11%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e599 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHausa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5,102 (93%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e410 (7.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5,512 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIbibio\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e734 (90%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e86 (10%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e820 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIdoma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e311 (97%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9 (2.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e320 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIgbo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1,795 (86%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e287 (14%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2,082 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIjaw\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e270 (87%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e42 (13%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e312 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTiv\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e650 (90%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e76 (10%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e726 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYoruba\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2,989 (94%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e181 (5.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3,170 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3,363 (95%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e172 (4.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3,535 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eRespondent type\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAdolescent girls (9\u0026ndash;14 years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4,549 (85%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e785 (15%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5,334 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCaregiver\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4,882 (93%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e361 (6.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5,243 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHealth Worker\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1,077 (98%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18 (1.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1,095 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eReligious Leader\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1,954 (95%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e109 (5.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2,063 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTeacher\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2,011 (96%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e84 (4.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2,095 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTraditional Leader\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1,582 (97%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e51 (3.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1,633 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEducation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo Education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1,958 (88%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e266 (12%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2,224 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4,066 (89%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e517 (11%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4,583 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSecondary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4,880 (92%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e419 (7.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5,299 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTertiary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4,497 (97%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e155 (3.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4,652 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e654 (93%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e51 (7.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e705 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eReligion\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChristianity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7,971 (91%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e773 (8.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8,744 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIslam\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7,895 (93%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e598 (7.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8,493 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTraditional\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e173 (84%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e33 (16%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e206 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16 (80%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (20%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eResidence\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.003\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRural\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10,815 (92%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e971 (8.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11,786 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUrban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2,821 (91%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e270 (8.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3,091 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSemi Urban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2,419 (94%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e167 (6.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2,586 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eStates\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAbia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e786 (90%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e92 (10%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e878 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAdamawa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e947 (94%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e58 (5.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1,005 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAkwa Ibom\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1,385 (88%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e190 (12%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1,575 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBauchi\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e968 (97%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30 (3.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e998 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBayelsa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e344 (85%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e59 (15%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e403 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBenue\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e996 (92%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e83 (7.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1,079 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEnugu\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e691 (80%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e173 (20%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e864 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFCT, Abuja\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e557 (97%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20 (3.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e577 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJigawa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1,250 (89%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e156 (11%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1,406 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKano\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1,934 (91%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e183 (8.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2,117 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKebbi\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e938 (93%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e75 (7.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1,013 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLagos\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e908 (90%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e96 (9.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1,004 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNasarawa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1,214 (98%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e31 (2.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1,245 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOgun\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e926 (95%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e44 (4.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e970 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOsun\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1,453 (95%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e81 (5.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1,534 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTaraba\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e758 (95%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e37 (4.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e795 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGeopolitical zone\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNorth Central\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2,767 (95%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e134 (4.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2,901 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNorth East\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2,673 (96%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e125 (4.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2,798 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNorth West\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4,122 (91%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e414 (9.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4,536 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSouth East\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1,477 (85%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e265 (15%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1,742 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSouth South\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1,729 (87%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e249 (13%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1,978 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSouth West\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3,287 (94%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e221 (6.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3,508 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eKnowledge about HPV/HPV vaccination\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigh\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2,964 (99%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21 (0.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2,985 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13,091 (90%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1,387 (9.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14,478 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePerceived susceptibility to HPV infection\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6,648 (98%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e125 (1.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6,773 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9,407 (88%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1,283 (12%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10,690 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003csup\u003e1\u003c/sup\u003eChi-squared/Fisher's exact test\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e3.4. One-month trend in knowledge about HPV/HPV vaccination, perceived susceptibility to HPV infection and HPV vaccination intention by state\u003c/b\u003e\u003c/p\u003e\u003cp\u003eFigure \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows a one-month trend in knowledge about HPV and HPV vaccine across the 15 phase 1 states and the Federal Capital Territory (FCT). States such as Enugu (28%), and Benue (28%) experience the most substantial increase in knowledge about HPV and HPV vaccines, rising from 9% to 37% and 16% to 39% respectively. Other states such as Kano (+\u0026thinsp;15%), Adamawa (+\u0026thinsp;13%), and Osun (+\u0026thinsp;13%) also showed noteworthy improvement in this knowledge. On average, there was a noteworthy 12% national increase in knowledge about HPV and HPV vaccines, from 17% in the first assessment to 29% in the second assessment conducted one month later. These results suggest that the advocacy and sensitization activities conducted by the NPHCDA during the one month were effective in enhancing awareness levels across these states.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eFigure \u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e shows the one-month trend in perceived susceptibility to the human papillomavirus infection across the 15 phase one states and the FCT. Across these states, the analysis revealed a notable increase in the percentage of individuals who perceive themselves as susceptible to HPV infection. Benue, Kebbi, and Taraba states made an increase of 21%, 19% and 19% respectively, in the percentage of individuals who perceived themselves susceptible to HPV infection between the first and second assessments. States such as Enugu (+\u0026thinsp;18%), Kano (+\u0026thinsp;14%), Osun (+\u0026thinsp;13%), Bayelsa (+\u0026thinsp;13%), and Akwa Ibom (+\u0026thinsp;13%) also demonstrated commendable improvement in the proportion that acknowledges their susceptibility to HPV infection. However, two states, Lagos (-5%) and Ogun (-4%) showed a notable decrease in people\u0026rsquo;s perceived susceptibility to HPV infection. Overall, across the states, there was a 9% increase in perceived susceptibility to HPV infection.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eFigure \u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e shows the one-month trend in the willingness to be vaccinated with the HPV vaccine across the 15 phase-one states and the FCT. Among these states, Enugu (+\u0026thinsp;17%) made the most substantial increase from 80% to an impressive 97%. Nasarawa maintained a consistent 98% willingness to receive the vaccines throughout the period. Adamawa saw a slight increase of 1%, moving from a relatively high 94% to 95%. However, states like Lagos (-23%), Ogun (-24%), Osun (-13%) and the FCT (-7%) saw a notable decrease in the percentage of people willing to take the HPV vaccine. Overall, there was a 1% national decrease from 92% in the first assessment to 91% in the second assessment. The decrease in willingness to take the vaccine may be influenced by factors such as vaccine hesitancy and shift in perception over time, possibly influenced by infodemics and conspiracy theories about the vaccines.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"4. Discussion and conclusion","content":"\u003cp\u003eOur study's primary objective was to investigate demographic factors linked with knowledge, perception, and intention related to HPV and HPV vaccination among adolescents and adults in the initial 16 phase one states. We aimed to delineate the extent of knowledge and perceptions regarding HPV and the vaccine. We also sought to analyse the evolving trend in HPV vaccine knowledge, attitudes, and perceptions over the one-month period. Among the 17,463 participants that took part in the survey, the majority were adults aged 25 years and above, with a mean age of 38 years. Adolescents aged 9 to 14 account for 30.5% of the total participant pool. Among the 16 states where data was collected, Kano had the highest number of participants at 12.1%, while Bayelsa had the lowest with only 2.3% of the participants.\u003c/p\u003e\u003cp\u003eThe analysis revealed a significant association between various socio-demographic factors and knowledge about HPV and HPV vaccination. There was a positive association between age and knowledge of HPV and HPV vaccines, with adults aged 25 and above having more knowledge. This result implies that older adults have been exposed to information about HPV and HPV vaccines over time due to consistent access to health-related materials. Also, older adults, especially those with higher levels of education may have benefited from extensive access to health education programs that expose them to HPV-related information. This aligns with the study of [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], who suggested that older adults who may have had more access to health information could have accumulated more information on HPV and HPV vaccination.\u003c/p\u003e\u003cp\u003eThe results also revealed a notable disparity in knowledge about HPV and its vaccine between sexes, with men having higher knowledge (21%) compared to women (15%). As expected, health workers show the highest knowledge (65%) when compared to other respondent types. The observed disparity between men and women in HPV-related knowledge may be attributed to various socio-cultural and health disparities prevalent in Nigeria. In many Nigerian societies, particularly in the Northern region, men generally have better access to education, which potentially results in better knowledge of health-related matters. Also, in these parts of the country, cultural norms significantly impact the dissemination of health-related information, with discussions relating to sexual health more open among men compared to women. This result may be unique as it deviates from existing literature that commonly reports men having lower knowledge about HPV and HPV vaccines than women [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. This result underscores the unique socio-cultural context in Nigeria, where education and cultural norms such as religious practices, contribute to the pattern of knowledge distribution.\u003c/p\u003e\u003cp\u003eThe results of health workers having more knowledge than other demographic groups align with expectations. By virtue of their occupation, health workers receive extensive training in health care. This formal training equips them with a robust understanding of health practices, and better positions them to be well informed about HPV-related issues. Also, health workers are exposed to diverse health issues in their daily routine, providing them with firsthand experience of dealing with patients with health conditions including cervical cancer and other HPV-related infections. This exposure enables them to stay abreast of the latest developments in health. This finding is consistent with that of [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], who suggested that the professional training, work environment, and experience of health workers contribute to their high level of knowledge about HPV.\u003c/p\u003e\u003cp\u003eOur analysis revealed that perceived susceptibility to HPV infection was generally higher than knowledge level. Additionally, socio-demographic characteristics were associated with perceived susceptibility. These results suggest that psychological factors or traits play a significant role in how people assess their vulnerability to illness or health risk. This perception may likely be shaped by various social factors such as individual exposure and cultural perceptions. The analysis also revealed a positive correlation between age and willingness to be vaccinated. The result that willingness increases with age aligns with the broader trend where older individuals have greater awareness of the potential risks associated with HPV and the benefits of vaccination. This may be attributed to prolonged exposure to educational materials and the accumulation of knowledge over time, because as individuals age, they tend to gather and accumulate experiences and knowledge, including those that relate to health risks. These experiences and accumulated knowledge may likely contribute to making them better understand the potential dangers associated with diseases including HPV and its vaccines. This assertion is supported by [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], who report that willingness to get vaccinated increases with age and knowledge.\u003c/p\u003e\u003cp\u003eThe result also highlights a gender-based disparity in willingness to be vaccinated. Men were more likely to give consent for their wards to be vaccinated compared to women's willingness to be vaccinated or to give consent to their wards to be vaccinated. This result may be rooted in socio-cultural, religious, and decision-making factors. Data for this study was mostly collected from the northern part of the country and in these societies, traditional gender roles shape the dynamics of family life, particularly when it comes to decision-making concerning the vaccination of children and even wives. Society and cultural norms dictate or prescribe that men are the primary decision-makers in matters that concern the well-being of the family [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Women differ to their husbands in making health-related decisions that concern members of their family [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Also, there are cases of educational disparities between men and women in these parts of the country, with men enjoying better access to educational opportunities than women [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. This may result in men having better access to information on health-related matters and may inform their decision to give consent to their children to be vaccinated.\u003c/p\u003e\u003cp\u003eAnalyzed data also revealed that among religious groups, a higher proportion of Muslims expressed willingness to be vaccinated with the HPV vaccine compared to individuals of other faiths. Also, the intention to take the HPV vaccine was higher in the northeast compared to other regions in the country. The willingness to be vaccinated and the high intention to be vaccinated being from the northeast can be attributed to the endorsement of community gatekeepers and religious leaders. In the northern part of the country and amongst those practicing the Islamic faith, religious leaders and their institutions wield significant influence in various aspects of social life, including decision-making when it comes to health.\u003csup\u003e[29]\u003c/sup\u003e The high regard and influence of the religious leaders in the north suggests that their endorsement of the HPV vaccine may have significantly impacted the attitude and decision of the people to be vaccinated or give consent for their wards to be vaccinated. The National Primary Healthcare Development Agency (NPHCDA) recognizing the importance of religious leaders and gatekeepers, conducted extensive sensitization and advocacy visits to religious leaders and gatekeepers during the pre-introduction phase to sensitize and create awareness of the benefits of the HPV vaccine. This targeted effort may have reflected in the high willingness of the people to be vaccinated.\u003c/p\u003e\u003cp\u003eWe conducted two assessments with a one-month interval to gauge changes in knowledge of HPV and its vaccine, perceived susceptibility, and vaccination intention across the 16 phase-one states in the country. Results on knowledge revealed a notable increase in the national average by 12% from the first assessment to the second assessment. Notably states as Kano, Adamawa, and Osun also demonstrated significant improvement in knowledge across the country, which can be attributed to the efforts of the NPHCDA. During the one month after the first assessment, the NPHCDA conducted targeted awareness campaigns and educational initiatives by engaging with local communities through various channels such as community gatherings, and advocacy visits to community gatekeepers and religious leaders. Messages at these meetings were tailored to the specific context of each society. This direct interaction helped to facilitate a mere impactful communication of information on HPV-related matters. The NPHCDA also partnered with community influencers and healthcare professionals to enhance the credibility information distributed. The endorsement by these individuals contributed to improved understanding and trust.\u003c/p\u003e\u003cp\u003eThere was a 9% national increase in perceived susceptibility to HPV infection across the 16 phase-one states. States such as Benue, Kebbi, and Taraba showed the most significant improvement, with concerns over Lagos and Ogun as perceived susceptibility reduced. The advocacy, communication, and social mobilization (ACSM) activities efforts of the NPHCDA may have succeeded in making people more conscious of the risk associated with HPV infection and their vulnerability to the disease. These activities may have had a profound effect in states that had significant improvement such as Benue, Kebbi, and Taraba. States like Lagos and Ogun where we observed a decline raise concerns about the effectiveness of the ACSM activities conducted by the NPHCDA. This decline may be attributed to a lack of awareness of the potential risk of HPV and its related malignancies.\u003c/p\u003e\u003cp\u003eAdditionally, there was a 1% decrease in the national average on willingness to be vaccinated. Across the states, Enugu demonstrated an impressive increase in the willingness to be vaccinated by 17% from 80% to 97%. Nasarawa maintained a consistently impressive 98%. However, states such as Lagos, Ogun, Osun, and the FCT showed a concerning decrease in the willingness to be vaccinated. The notable decrease in willingness to be vaccinated may be influenced by several factors. Some people may not be aware or may lack the understanding of the benefits of HPV vaccination. This can contribute to scepticism and misconceptions about the vaccines. Perceptions could also change over time because of the spread of infodemics and conspiracy theories, which is common in Nigeria, especially during new vaccine introductions [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. During these new vaccine introductions, there is a spread of misleading and false information about the safety, purpose, and potential side effects of the vaccine to be introduced, usually through social media and community platforms. These infodemics and conspiracy theories exploit existing fears and concerns of people, contributing to negative perceptions about the vaccines.\u003c/p\u003e"},{"header":"5. Limitations of the study","content":"\u003cp\u003eThis study had several limitations. First, no pretest was conducted to validate the study tools. This was because of the impromptu and urgent need for the assessment findings to inform strategies for the national HPV vaccination rollout. Secondly, we employed a randomized sampling method for the data collection, which may have introduced a potential bias that influences the study's outcomes. Both respondents and data collectors were selected using a random selection technique. Thirdly, the sampled population was generally receptive to vaccines. Fourthly, the uneven distribution of population numbers across states indicates inadequate coverage in data collection from various regions. Fifthly, we did not use the health belief model to design the study. This model was only used for the analysis and presentation of this paper. Finally, the short duration of the study limits the assessment of long-term knowledge retention and behavioral change on HPV vaccination.\u003c/p\u003e"},{"header":"6. Implications","content":"\u003cp\u003eThis study is a rapid assessment of knowledge, perception, and vaccination intention in the phase one HPV introduction states in Nigeria. There was an association between socio-demographic factors and knowledge about HPV, indicating the importance of tailored interventions. The one-month analysis showed a notable increase in knowledge and perceived susceptibility, but a decrease in intention to be vaccinated. This result calls for target interventions as there is still room for improvement.\u003c/p\u003e\u003cp\u003eThere is a need for an effective public health campaign that is aimed at raising awareness about HPV and its vaccination through tailored educational materials to suit different age groups. Tailored educational materials should be developed to cater to different age groups, with a particular emphasis on engaging adolescents and younger adults. Collaborative efforts between the National Primary Health Care Development Agency (NPHCDA) and the Ministry of Education are essential to integrate HPV education into school curricula, ensuring sustained awareness among students. Additionally, campaigns should utilize diverse delivery channels, including direct engagements with adolescents in schools and community outreaches for broader impact across communities\u003c/p\u003e\u003cp\u003eThe observed gender disparities observed across the 16 phase one states underscore the need for a gender-specific strategy in awareness and sensitization campaigns. It is very important to bridge the knowledge gap, especially among women. Tailored educational interventions must be developed to furnish women with information about the significance and necessity of HPV vaccines. Moreover, recognizing the pivotal role of men as decision-makers within families, targeted initiatives should be formulated to actively engage them in promoting vaccination. By involving men as advocates, we not only enhance their understanding of HPV but also empower them to become influential figures capable of championing HPV vaccination within their families and communities.\u003c/p\u003e\u003cp\u003eThe study highlights the important role of health workers in enhancing awareness and the dissemination of knowledge. There is a need to prioritize continuous training of health workers as they are key for advancing knowledge and advocating for HPV vaccination. Enhancing health worker\u0026rsquo;s knowledge through prioritized training which will allow them to serve as a reliable and trusted source of information about HPV and its vaccine.\u003c/p\u003e\u003cp\u003eAlso, the observed decrease in willingness or intention to be vaccinated in some states underscores the importance of addressing vaccine hesitancy. Targeted strategies must be implemented to dispel rumours and misinformation, address public concerns, and build trust in the efficacy and safety of HPV vaccines. Accurate and targeted educational campaigns should be developed to provide comprehensive information about HPV and the vaccines, emphasizing their benefits and efficacy. These campaigns should be tailored to specific demographics and delivered through various channels to reach diverse communities effectively. Additionally, community dialogue sessions involving community influencers and gatekeepers should be organized. Leveraging community-specific channels, such as local gatherings and religious institutions, will be instrumental in building confidence in the vaccines and addressing concerns directly within communities.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cu\u003eEthical approval:\u003c/u\u003e This rapid assessment was implemented by the National Primary Health Care Development Agency (NPHCDA) as part of government-led programmatic activities in preparation for the HPV vaccine introduction in Nigeria. Ethical approval was not sought as the assessment was considered a public health survey to inform programmatic decision making.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eConsent to participate:\u003c/u\u003e Written informed consent was obtained from all adult participants, and written informed assent and parental/guardian permission were obtained for participants below 18 years of age prior to data collection.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eData availability statement:\u003c/u\u003e The datasets used and/or analysed during the current study available from the corresponding author on reasonable request\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eConsent to publish:\u003c/u\u003e All authors have reviewed and approved of the final version of the manuscript and hereby given consent for submission and publication.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll methods were carried out in accordance with relevant guidelines and regulations governing the conduct of programmatic public health assessments in Nigeria, ensuring adherence to ethical standards of data collection, participant consent, and\u0026nbsp;confidentiality.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e We recognize the contributions of everyone who made the process that led to the development of this paper possible, Dr Muyi Aina, the executive director of National Primary Healthcare Board for approving the use of administrative data from DCL staff who made it possible for the documentation from the workshop. We are grateful to GAVI for funding the documentation workshop that led to the development\u0026nbsp;of\u0026nbsp;this\u0026nbsp;paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions:\u0026nbsp;\u003c/strong\u003eConceptualization:\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eC.W., E.H., R.G.A., D.A., A.B., N.E., P.A., S.E., L.A., P.F. and S. O.; methodology, C.W., A.D., G.H., I. O.,P.A.; \u0026nbsp;formal analysis, N.E., A.A., T.A and P.A.; writing\u0026mdash;original draft preparation, T. A., N.E., P.A.and P.F.; writing\u0026mdash;review and editing, C.W., P.A., S.E., N.E., A.B., T.A; All authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e The authors declare that no funding was received for this study. The project was carried out within the framework of programmatic implementation led by the National Primary Healthcare Development Agency (NPHCDA).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number:\u0026nbsp;\u003c/strong\u003eNot Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003eThe authors have no financial and non-financial competing interest\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization Regional Office for Africa. (2023). \u003cem\u003eSafeguarding the future of women and girls in Nigeria against cervical cancer.\u003c/em\u003e Retrieved December 17, 2024, from \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.afro.who.int/countries/nigeria/news/safeguarding-future-women-and-girls-nigeria-against-cervical-cancer\u003c/span\u003e\u003cspan address=\"https://www.afro.who.int/countries/nigeria/news/safeguarding-future-women-and-girls-nigeria-against-cervical-cancer\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSingh D, Vignat J, Lorenzoni V, Eslahi M, Ginsburg O, Lauby-Secretan B, Arbyn M, Basu P, Bray F, Vaccarella S. Global estimates of incidence and mortality of cervical cancer in 2020: a baseline analysis of the WHO Global Cervical Cancer Elimination Initiative. Lancet Global Health. 2022;11(2):e197\u0026ndash;206. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/s2214-109x(22)00501-0\u003c/span\u003e\u003cspan address=\"10.1016/s2214-109x(22)00501-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHull R, Mbele M, Makhafola T, Hicks C, Wang S, Reis R, Mehrotra R, Kwitshana M, Kibiki Z, Bates G, D., Dlamini Z. Cervical cancer in low and middle income countries (Review). Oncol Lett. 2020;20(3):2058\u0026ndash;74. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3892/ol.2020.11754\u003c/span\u003e\u003cspan address=\"10.3892/ol.2020.11754\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization. (2023). Cervical cancer. Retrieved December 16, 2024, from \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/news-room/fact-sheets/detail/cervical-cancer\u003c/span\u003e\u003cspan address=\"https://www.who.int/news-room/fact-sheets/detail/cervical-cancer\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLawson O, Ameyan L, Tukur Z, Dunu S, Kerry M, Okuyemi OO, Yusuf Z, Fasawe O, Wiwa O, Hebert KS, Joseph JT, Nwokwu UE, Okpako O, Chime CI. Cervical cancer screening outcomes in public health facilities in three states in Nigeria. BMC Public Health. 2023;23(1). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12889-023-16539-1\u003c/span\u003e\u003cspan address=\"10.1186/s12889-023-16539-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMafiana JJ, Dhital S, Halabia M, Wang X. Barriers to uptake of cervical cancer screening among women in Nigeria: a systematic review. Afr Health Sci. 2022;22(2):295\u0026ndash;309. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.4314/ahs.v22i2.33\u003c/span\u003e\u003cspan address=\"10.4314/ahs.v22i2.33\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKreimer AR, Rodriguez AC, Hildesheim A, Herrero R, Porras C, Schiffman M, Gonz\u0026aacute;lez P, Solomon D, Jim\u0026eacute;nez S, Schiller JT, Lowy DR, Quint W, Sherman ME, Schussler J, Wacholder S. Proof-of-Principle evaluation of the efficacy of fewer than three doses of a bivalent HPV16/18 vaccine. JNCI J Natl Cancer Inst. 2011;103(19):1444\u0026ndash;51. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1093/jnci/djr319\u003c/span\u003e\u003cspan address=\"10.1093/jnci/djr319\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMachalek DA, Garland SM, Brotherton JML, Bateson D, McNamee K, Stewart M, Skinner SR, Liu B, Cornall AM, Kaldor JM, Tabrizi SN. Very low prevalence of vaccine human papillomavirus types among 18- to 35-Year old Australian women 9 years following implementation of vaccination. J Infect Dis. 2018;217(10):1590\u0026ndash;600. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1093/infdis/jiy075\u003c/span\u003e\u003cspan address=\"10.1093/infdis/jiy075\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLei J, Ploner A, Elfstr\u0026ouml;m KM, Wang J, Roth A, Fang F, Sundstr\u0026ouml;m K, Dillner J, Spar\u0026eacute;n P. HPV vaccination and the risk of invasive cervical cancer. N Engl J Med. 2020;383(14):1340\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1056/nejmoa1917338\u003c/span\u003e\u003cspan address=\"10.1056/nejmoa1917338\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKaur P, Mehrotra R, Rengaswamy S, Kaur T, Hariprasad R, Mehendale SM, Rajaraman P, Rath GK, Bhatla N, Krishnan S, Nayyar A, Swaminathan S. Human papillomavirus vaccine for cancer cervix prevention: Rationale \u0026amp; recommendations for implementation in India. Indian J Med Res. 2017;146(2):153. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.4103/ijmr.ijmr_1906_16\u003c/span\u003e\u003cspan address=\"10.4103/ijmr.ijmr_1906_16\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBarnabas RV, Brown ER, Onono M, Bukusi EA, Njoroge B, Winer RL, Donnell D, Galloway D, Cherne S, Heller K, Leingang H, Morrison S, Rechkina E, McClelland RS, Baeten JM, Celum C, Mugo N. Single-dose HPV vaccination efficacy among adolescent girls and young women in Kenya (the KEN SHE Study): study protocol for a randomized controlled trial. Trials. 2021;22(1). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s13063-021-05608-8\u003c/span\u003e\u003cspan address=\"10.1186/s13063-021-05608-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBarnabas RV, Brown ER, Onono MA, Bukusi EA, Njoroge B, Winer RL, Galloway DA, Pinder LF, Donnell D, Wakhungu IN, Biwott C, Kimanthi S, Heller KB, Kanjilal DG, Pacella D, Morrison S, Rechkina EA, Cherne SL, Schaafsma TT, Ouma JA. Durability of single-dose HPV vaccination in young Kenyan women: randomized controlled trial 3-year results. Nat Med. 2023;29(12):3224\u0026ndash;32. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1038/s41591-023-02658-0\u003c/span\u003e\u003cspan address=\"10.1038/s41591-023-02658-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWhitworth HS, Gallagher KE, Howard N, Mounier-Jack S, Mbwanji G, Kreimer AR, Basu P, Kelly H, Drolet M, Brisson M, Watson-Jones D. Efficacy and immunogenicity of a single dose of human papillomavirus vaccine compared to no vaccination or standard three and two-dose vaccination regimens: A systematic review of evidence from clinical trials. Vaccine. 2019;38(6):1302\u0026ndash;14. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.vaccine.2019.12.017\u003c/span\u003e\u003cspan address=\"10.1016/j.vaccine.2019.12.017\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNigeria Immunization Technical Advisory Group (NGITAG). (2023). Updated HPV Technical Dossier on Quadrivalent HPV (Gardasil-4valent) 1 -dose Regimen. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003efile:///C:/Users/info/Downloads/Documents/Updated%20HPV%20recommendation%20on%20i%20dose%20regimen%20Technical%20dossier.pdf\u003c/span\u003e\u003cspan address=\"http://file:///C:/Users/info/Downloads/Documents/Updated%20HPV%20recommendation%20on%20i%20dose%20regimen%20Technical%20dossier.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization. (2023, October 24). \u003cem\u003eNigeria to vaccinate 7.7 million girls against leading cause of cervical cancer\u003c/em\u003e. Partnership for Maternal, Newborn \u0026amp; Child Health. Retrieved December 13, 2023, from \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pmnch.who.int/news-and-events/news/item/24-10-2023-nigeria-to-vaccinate-7.7-million-girls-against-leading-cause-of-cervical-cancer\u003c/span\u003e\u003cspan address=\"https://pmnch.who.int/news-and-events/news/item/24-10-2023-nigeria-to-vaccinate-7.7-million-girls-against-leading-cause-of-cervical-cancer\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOkolie EA, Aluga D, Anjorin S, Ike FN, Ani M, Nwadike BI. Addressing missed opportunities for cervical cancer screening in Nigeria: A nursing workforce approach. EcancerMedicalScience. 2022;16:1373.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEzeanochie M, Olasimbo P. Awareness and uptake of human papilloma virus vaccines among female secondary school students in Benin City, Nigeria. Afr Health Sci. 2020;20(1):45. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.4314/ahs.v20i1.8\u003c/span\u003e\u003cspan address=\"10.4314/ahs.v20i1.8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBrown B, Folayan M. Barriers to uptake of human papilloma virus vaccine in Nigeria: A population in need. Nigerian Med J. 2015;56(4):301. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.4103/0300-1652.165033\u003c/span\u003e\u003cspan address=\"10.4103/0300-1652.165033\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMakwe CC, Anorlu RI, Odeyemi KA. Human papillomavirus (HPV) infection and vaccines: knowledge, attitude and perception among female students at the University of Lagos, Lagos, Nigeria. J Epidemiol global health. 2012;2(4):199\u0026ndash;206. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jegh.2012.11.001\u003c/span\u003e\u003cspan address=\"10.1016/j.jegh.2012.11.001\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOhaeri B, Adefolaju A, Onyeneho C. Knowledge, attitudes and perceptions of Nigerian parents towards human papilloma virus (HPV) vaccines. Eur J Midwifery. 2020b;4. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.18332/ejm/114886\u003c/span\u003e\u003cspan address=\"10.18332/ejm/114886\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePreston SM, Darrow WW. Are Men Being Left Behind (Or Catching Up)? Differences in HPV Awareness, Knowledge, and Attitudes Between Diverse College Men and Women. Am J Men's Health. 2019;13(6):1557988319883776. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/1557988319883776\u003c/span\u003e\u003cspan address=\"10.1177/1557988319883776\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJenkins L, Williams A, Brown S. (2023). Are Women Always Right? Comparing HPV Knowledge Between Men and Women. Curiosity: Interdisciplinary Journal of Research and Innovation. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.36898/001c.73161\u003c/span\u003e\u003cspan address=\"10.36898/001c.73161\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChen L, Song Y, Ruan G, Zhang Q, Lin F, Zhang J, Wu T, An J, Dong B, Sun P. (n.d.). \u003cem\u003eKnowledge and Attitudes Regarding HPV and Vaccination Among Chinese Women Aged 20 to 35 Years in Fujian Province: A Cross-Sectional Study\u003c/em\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/1073274818775356\u003c/span\u003e\u003cspan address=\"10.1177/1073274818775356\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSuk R, Montealegre JR, Nemutlu GS, Nyitray AG, Schmeler KM, Sonawane K, Deshmukh AA. Public knowledge of human papillomavirus and receipt of vaccination recommendations. JAMA Pediatr. 2019;173(11):1099. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1001/jamapediatrics.2019.3105\u003c/span\u003e\u003cspan address=\"10.1001/jamapediatrics.2019.3105\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChawla PC, Chawla A, Chaudhary S. Knowledge, attitude \u0026amp; practice on human papillomavirus vaccination: A cross-sectional study among healthcare providers. Indian J Med Res. 2016;144(5):741\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.4103/ijmr.IJMR_1106_14\u003c/span\u003e\u003cspan address=\"10.4103/ijmr.IJMR_1106_14\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGao D, Zhao G, Di J, Zhang X, Wang L. Knowledge of Cervical Cancer and HPV, and Willingness to Receive HPV Vaccination Among 20-45-Year-Old Women - Six Provinces, China, 2018. China CDC Wkly. 2023;5(9):201\u0026ndash;5. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.46234/ccdcw2023.036\u003c/span\u003e\u003cspan address=\"10.46234/ccdcw2023.036\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYaya S, Okonofua F, Ntoimo L, Udenige O, Bishwajit G. Gender inequity as a barrier to women\u0026rsquo;s access to skilled pregnancy care in rural Nigeria: a qualitative study. Int health. 2019;11(6):551\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSinai I, Anyanti J, Khan M, Daroda R, Oguntunde O. Demand for women\u0026rsquo;s health services in northern Nigeria: a review of the literature. Afr J Reprod Health. 2017;21(2):96\u0026ndash;108.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eClements CJ, Greenough P, Shull D. How vaccine safety can become political-the example of polio in Nigeria. Curr Drug Saf. 2006;1(1):117\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWonodi, C., Obi-Jeff, C., Adewumi, F., Keluo-Udeke, S. C., Gur-Arie, R., Krubiner,C., \u0026hellip; Faden, R. (2022). Conspiracy theories and misinformation about COVID-19 in Nigeria:Implications for vaccine demand generation communications. Vaccine, 40(13), 2114\u0026ndash;2121.https://doi.org/10.1016/j.vaccine.2022.02.005.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Cervical cancer, HPV vaccine, HPV, Rapid Assessment, Knowledge, perception, Intentions","lastPublishedDoi":"10.21203/rs.3.rs-7715117/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7715117/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction:\u003c/strong\u003e As Nigeria prepares to introduce the HPV vaccine into its its Expanded Programme on Immunization (EPI), concerns remain about state-level program readiness and community awareness. This study is a rapid assessment conducted to assess the knowledge, perception, and vaccination intention of adolescents and adults residing in the 16 states selected for the first phase of the HPV vaccine introduction.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eThis cross-sectional rapid assessment involves data collection from 17,463 participants across the 16 phases 1 HPV vaccine introduction states. Data were collected using a combination of convenience and simple random sampling techniques. Trained professionals administered structured surveys through the Open Data Kit (ODK) on mobile devices. Collected data was cleaned, re-coded, and analysed using Chi-Square Test, Fisher’s Exact Test on open-source software R in the R-studio environment. Trend analysis was conducted using frequency distribution and charts.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFindings\u003c/strong\u003e: Results revealed a significant association between socio-demographic factors and knowledge about HPV and its vaccine, perceived susceptibility to HPV infection, as well as willingness to be vaccinated. The one-month trend analysis revealed a notable increase in knowledge (+12%), and perceived susceptibility (+9%). However, there was a slight decrease in willingness to be vaccinated (-1%) in the one month between the first and second assessment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThis study provides valuable insights into the extent of knowledge, perception, and willingness to take the HPV vaccine. Despite improvements in knowledge and perceived susceptibility, there was a slight decrease in willingness to be vaccinated. This highlights challenges such as vaccine hesitancy which may impact overall acceptance.\u003c/p\u003e","manuscriptTitle":"Investigating Perceptions of Human Papillomavirus Vaccines Through Rapid Assessment in Nigerian Communities","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-23 11:52:41","doi":"10.21203/rs.3.rs-7715117/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"79be4889-986c-4558-882e-44279c22badd","owner":[],"postedDate":"November 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-04T09:25:59+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-23 11:52:41","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7715117","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7715117","identity":"rs-7715117","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}