Perception Acceptance and Utilization of Human Papillomavirus Vaccine Among Residents of Anambra State, Nigeria

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In May 2024, in line with the introduction of HPV vaccines into the Nigerian Expanded Program on Immunization (EPI) schedule, Anambra State introduced the HPV vaccines to its Routine Immunization services with the support of NPHCDA, WHO, UNICEF and other partners. This study examined the perception, acceptance, and utilization of HPV vaccines among residents of Anambra State to identify factors influencing uptake. Using a descriptive survey research design, data were collected from 360 respondents including parents, caregivers, adolescents, and healthcare workers across six Local Government Areas via a structured, validated questionnaire. Data were collected through personal administration of copies of the instrument to the respondents after getting consent from each respondents. Data collected were analyzed using descriptive statistics of frequency count, simple percentage, mean and standard deviation. Results indicated moderate awareness of HPV (63.9%) and the HPV vaccine (58.3%), though misconceptions persisted and only 38.9% knew the recommended vaccination age. HPV vaccines were available in 55% of health facilities, with gaps in trained personnel and supply. Vaccine acceptance was moderate, with 59.4% willing to receive it and 55.8% willing to recommend it, yet concerns about side effects, fertility, and misconceptions about early sexual activity contributed to hesitancy. Utilization was low, with only 35.6% reporting vaccination of their wards. Schools and health centers were the primary vaccination sites, while challenges such as hesitancy, stock-outs, and access barriers affected delivery. The study concludes that awareness and acceptance are moderate, but utilization remains suboptimal due to knowledge gaps, misconceptions, healthcare workforce limitations, and access issues. Targeted interventions include awareness campaigns, school-based programs, healthcare worker training, and consistent vaccine supply are recommended to enhance coverage and reduce HPV-related disease burden in Anambra State. Human Papillomavirus HPV vaccine perception acceptance utilization Anambra State immunization INTRODUCTION Human Papillomavirus (HPV) is one of the most prevalent sexually transmitted infections (STIs) worldwide, with significant public health implications. The virus is linked to a spectrum of conditions, ranging from benign warts to malignancies, most notably cervical cancer (WHO, 2025). According to the World Health Organization (WHO), HPV infections account for approximately 5% of all cancers globally (WHO, 2023). More than 200 HPV types have been identified, with over 40 affecting the anogenital region (Bosch et al., 2003). High-risk HPV types, particularly HPV 16 and 18, are responsible for approximately 70% of cervical cancer cases (Adewale et al., 2023). Epidemiological data indicate that over 90% of sexually active men and 80% of sexually active women will acquire an HPV infection at some point in their lifetime (HPV and Cancer, 2017). In most cases, the immune system clears the infection naturally. However, persistent HPV infections, particularly those involving high-risk strains, are the leading cause of cervical cancer and are also associated with cancers of the vulva, vagina, mouth/throat, penis, and anus (de Martel et al., 2019). In 2019 alone, HPV-related cancers were estimated at 620,000 cases in women and 70,000 cases in men worldwide (de Martel et al., 2019). The prevalence of HPV is strongly influenced by age, sexual behavior patterns, and geographic differences, with the highest incidence occurring within the first few years after the onset of sexual activity (Bruni et al., 2017). To mitigate the burden of HPV-related diseases, public health interventions such as educational campaigns, safe sex practices, and early vaccination programs have been prioritized. The development of HPV vaccines—Gardasil-9, Cervarix, and Gardasil—has been a major advancement in preventing HPV-related infections and their sequelae. These vaccines, targeting high-risk HPV strains, have demonstrated significant efficacy in reducing the incidence of HPV-related diseases (Harper et al., 2006). Anambra State has been on the forefront on the fight against Cervical cancer with the wife of the Governor- Dr. Mrs. Nonye Soludo leading by conducting screening of over 18,000 women of child-bearing age in 2023 having a positivity rate of 2.8%. The program targeted women of childbearing age through; women development platforms, religious organizations, community engagements, women august meeting programs and more. In May 2024, Anambra State, through the National Primary Health Care Development Agency (NPHCDA) in partnership with WHO and UNICEF, introduced the HPV vaccine (Gardasil-9) into its Expanded Program on Immunization (EPI). This initiative aimed to achieve nationwide routinization, similar to the successful routinization of the COVID-19 and Rotavirus vaccines. The COVID-19 vaccine rollout in Anambra recorded high uptake, with over 2 million individuals vaccinated. The success of this program was largely attributed to strategic interventions, including multiple rounds of supplementary immunization activities (SIAs) before routinization, robust funding, aggressive awareness and mobilization campaigns (ACSM), and visible health impacts that reinforced public trust. Similarly, the Rotavirus vaccine has been well-received, with over 300,000 children immunized annually with at least one dose. The high acceptance of the Rotavirus vaccine is primarily linked to the significant disease burden in children and the financial relief it offers caregivers, who previously relied on costly out-of-pocket purchases for immunization. Human Papilloma Virus (HPV) is a major public health concern globally, and as such, people should have adequate perception, high acceptance, and effective utilization of HPV vaccines, as these vaccines are proven to significantly reduce the incidence of HPV infections and associated cancers (World Health Organization [WHO], 2022). Proper awareness and positive attitudes toward HPV vaccination would enable individuals, especially adolescents and young adults, to make informed decisions about immunization, thereby contributing to a reduction in morbidity and mortality associated with HPV-related diseases. However, the present situation in Anambra State indicates a significant gap in vaccine uptake. Despite the availability of HPV vaccines, studies suggest that misinformation, cultural beliefs, low awareness, and negative perceptions hinder effective utilization. This has contributed to the continued spread of HPV infections, leading to increased risk of cervical cancer among women and continued public health challenges in the region (Onyeka et al., 2020). Given this disparity between the ideal and current scenarios, there is a pressing need to investigate the perception, acceptance, and utilization of HPV vaccines in Anambra State. Understanding the factors influencing vaccine uptake will provide evidence-based insights for public health interventions aimed at improving vaccine coverage, reducing HPV transmission, and ultimately decreasing the burden of cervical cancer in the state. Objectives of the Study The main objective of this study is to assess the perception, acceptance and utilization of Human Papillomavirus (HPV) vaccines in the Nigerian Expanded Program on Immunization (EPI) schedule among residents of Anambra State. Other specific objectives of the study includes; To assess level of perception of the Human Papilloma Virus and HPV vaccine among parents, adolescents, and healthcare workers in Anambra State. To assess the availability of the HPV vaccines in health facilities in Anambra state. To assess acceptance of HPV vaccine among the study population. To examine the utilization patterns of the HPV vaccine in Anambra state. To provide evidence-based recommendations for improving HPV vaccine delivery, education, and acceptance in Anambra State and similar settings. METHODOLOGY This study employed a descriptive survey research design. A descriptive survey research design is a methodological approach used to collect, organize, analyze, and interpret data that describes the characteristics, opinions, behaviors, or attitudes of a population or phenomenon without manipulating any variables. The study was conducted in 6 LGAs across the 3 senatorial zones in Anambra State, Nigeria. The population of this study was 17, 372 which comprised Caregivers, Parents and Health Care Workers. From this population, a sample size of 360 was drawn using Kregcie and Morgan Table for Sample Size determination. A multistage sampling technique was employed for this study. In the first stage, the state was divided into 3 senatorial zones (Anambra Central, Anambra North and Anambra South) – 7 LGAs per zone. In the second stage, 2 LGAs were randomly selected from each of the senatorial zones. Data for this study were collected using structured questionnaire titled “Perception, Acceptance and Utilization of Human Papilloma Virus Vaccine Questionnaire. The questionnaire was designed and structured by the researchers and it was divided into 2 sections A and B. Section A contained the demographic characteristics of the respondents while B contained items on perception, acceptance and utilization of the Human Papilloma Virus Vaccine. The questionnaire was duly validated by experts and the reliability was established using Cronbach Alpha method. In the collection of data, copies of the structured questionnaire were administered to adolescents, caregivers and healthcare workers in the selected communities. This was done through direct administration with the help of 6 research assistants. Data collected were analyzed using descriptive statistics of frequency counts, simple percentage, mean and standard deviation. RESULTS AND DISCUSSION The results of the data analysis are discussed as follow; Socio-Demographic Characteristics of Respondents The table presents the socio-demographic characteristics of the respondents, covering age, gender, level of education, and employment status. With respect to age distribution, none of the respondents fell within the 0–5 years category (0.00%). The largest proportion of respondents were aged 16–30 years, accounting for 160 respondents (44.44%), indicating that the study population was predominantly young adults. This was followed by respondents aged 31–50 years with 96 individuals (26.67%). Those aged 6–15 years constituted 57 respondents (15.83%), while respondents aged 51 years and above were the least represented among the active age groups, with 47 respondents (13.06%). Overall, the age distribution suggests that the majority of participants were within the economically active and socially productive age brackets. In terms of gender, the distribution was relatively balanced. Female respondents slightly outnumbered their male counterparts, with 186 females (51.67%) compared to 174 males (48.33%). No respondent identified as “Other” (0.00%). This near-equal gender representation suggests that the findings of the study are unlikely to be significantly biased by gender imbalance. Regarding educational attainment, the majority of respondents had at least secondary education. Specifically, 155 respondents (43.06%) completed secondary school, making this the most dominant educational category. This was followed by those with higher education qualifications, who accounted for 94 respondents (26.11%). Respondents with primary education were 67 (18.61%), while those with no formal education constituted the smallest proportion, 44 respondents (12.22%). This distribution indicates a relatively moderate to high level of literacy among the respondents, which may positively influence their understanding of the issues addressed in the study. Concerning employment status, a higher proportion of respondents were self-employed, numbering 143 (39.72%), suggesting a strong presence of informal or entrepreneurial economic activities among the study population. Employed respondents accounted for 116 (32.22%), while 101 respondents (28.06%) were unemployed. This pattern implies a diverse economic background among participants, with a substantial proportion engaged in income-generating activities, which may have implications for their socio-economic perspectives and responses in the study. Table 1: Demographic characteristics of Respondents S/N Variable Category Frequency (n) Percentage (%) 1 Age 0–5 years 0 0.00 6–15 years 57 15.83 16–30 years 160 44.44 31–50 years 96 26.67 51+ years 47 13.06 2 Gender Male 174 48.33 Female 186 51.67 Other 0 0.00 3 Education Level No formal education 44 12.22 Primary School 67 18.61 Secondary 155 43.06 Higher Education 94 26.11 4 Employment Status Unemployed 101 28.06 Self-Employed 143 39.72 Employed 116 32.22 Level of Knowledge of Human Papilloma Virus (HPV) and HPV Vaccine among Parents, Adolescents, and Healthcare Workers in Anambra State Table 2 presents respondents’ level of knowledge of Human Papilloma Virus (HPV) and the HPV vaccine in Anambra State. Findings from Item 1 show that a majority of respondents had heard of HPV, with 230 respondents (63.9%) indicating awareness, while 130 respondents (36.1%) reported that they had never heard of HPV. This suggests a moderate level of general awareness of HPV among the study population, although a substantial proportion still lacks basic awareness. Among respondents who had heard of HPV (n = 230), the majority correctly identified HPV as Human Papilloma Virus, accounting for 185 respondents (80.4%). However, 28 respondents (12.2%) incorrectly described HPV as Hydrogen Peroxide Vaccine, while 17 respondents (7.4%) believed it to be Herpes Pustular Virus. This indicates that although awareness exists, misconceptions about the meaning of HPV persist among a notable minority of respondents. Regarding awareness of the HPV vaccine (Item 3), 210 respondents (58.3%) reported having heard about the vaccine, while 150 respondents (41.7%) had not. This finding shows that knowledge of the HPV vaccine is slightly lower than general awareness of HPV, pointing to gaps in vaccine-specific health education. Item 4 highlights the sources of information on HPV and the HPV vaccine. Since multiple responses were allowed, a total of 487 responses were recorded. Social media emerged as the most common source of information, accounting for 124 responses (25.5%). This was followed by healthcare workers with 102 responses (20.9%), television/radio with 78 responses (16.0%), and friends or family with 65 responses (13.3%). Schools accounted for 62 responses (12.7%), while religious groups contributed 41 responses (8.4%). Other sources were least reported, with 15 responses (3.1%). These findings indicate that both formal (healthcare workers, schools, mass media) and informal (social media, friends, family) channels play significant roles in disseminating HPV-related information, with social media being particularly influential. In terms of knowledge of the purpose of the HPV vaccine (Item 5), less than half of the respondents, 162 (45.0%), correctly stated that the vaccine prevents cervical cancer. Meanwhile, 48 respondents (13.3%) believed it prevents sexually transmitted diseases generally, and 74 respondents (20.6%) thought it boosts immunity. Notably, 76 respondents (21.1%) indicated that they did not know the purpose of the vaccine. This suggests that although some respondents are aware of the vaccine, detailed and accurate knowledge about its primary preventive role remains inadequate. Concerning knowledge of the recommended age for HPV vaccination (Item 6), only 140 respondents (38.9%) indicated that they knew the recommended age, while a majority of 220 respondents (61.1%) reported that they did not. This reflects a considerable knowledge gap that may negatively influence timely vaccine uptake. Among those who claimed to know the recommended age for HPV vaccination (n = 140), more than half correctly identified age 9 years as the appropriate age, with 79 respondents (56.4%). However, a substantial proportion provided incorrect age ranges, including under 5 years (7.1%), 6 years (8.6%), 7 years (12.9%), and 8 years (15.0%). This further underscores partial knowledge and confusion regarding vaccination guidelines. Item 8 shows that only 46 respondents (12.8%) were healthcare workers, while the majority, 314 respondents (87.2%), were non-healthcare workers. Among the healthcare workers (n = 46), 28 respondents (60.9%) reported having received training on HPV vaccination, whereas 18 (39.1%) had not. This indicates that a significant proportion of healthcare workers lack formal training on HPV vaccination. Finally, regarding confidence in providing HPV vaccine information (Item 10), 31 healthcare workers (67.4%) reported being confident, while 15 (32.6%) were not confident. Although the majority expressed confidence, the presence of a sizeable proportion lacking confidence highlights the need for continuous training and capacity building among healthcare workers to strengthen accurate information dissemination. Table 2: Level of knowledge of the Human Papilloma Virus and HPV vaccine among parents, adolescents, and healthcare workers in Anambra State S/N Item Response Options Frequency (n) Percentage (%) 1 Have you heard of HPV? Yes 230 63.9 No 130 36.1 2 What is HPV? (Asked only among those who said “Yes” to Item 1; n = 230) Human Papilloma Virus 185 80.4 Hydrogen Peroxide Vaccine 28 12.2 Herpes Pustular Virus 17 7.4 3 Have you heard about the HPV vaccine? Yes 210 58.3 No 150 41.7 4 Source of Information (Multiple Response Allowed; Total Responses = 487) Healthcare worker 102 20.9 Television/Radio 78 16.0 Social media 124 25.5 School 62 12.7 Religious group 41 8.4 Friends/Family 65 13.3 Other 15 3.1 5 Purpose of HPV Vaccine Prevents cervical cancer 162 45.0 Prevents STDs 48 13.3 Boosts immunity 74 20.6 Don’t know 76 21.1 6 Knowledge of Recommended Age for HPV Vaccination Yes 140 38.9 No 220 61.1 7 If Yes: Correct Age Range (n = 140) Under 5 years 10 7.1 6 years 12 8.6 7 years 18 12.9 8 years 21 15.0 9 years 79 56.4 8 Are you a health worker? Yes 46 12.8 No 314 87.2 9 Training on HPV Vaccination (Health Workers Only; n = 46) Yes 28 60.9 No 18 39.1 10 Confidence in Providing HPV Vaccine Information (Health Workers Only; n = 46) Yes 31 67.4 No 15 32.6 Availability of HPV Vaccines in Health Facilities in Anambra State Table 3 presents information on the availability and accessibility of HPV vaccination services within health facilities in Anambra State. Findings from Item 1 indicate that a majority of respondents, 265 (73.6%), reported the presence of a health facility offering routine immunization services within their settlement. However, 62 respondents (17.2%) stated that no such facility existed in their settlement, while 33 respondents (9.2%) were unsure. This suggests that although routine immunization services are available in most settlements, a notable proportion of respondents still lack access or awareness of such facilities. With regard to the availability of the HPV vaccine as part of routine immunization services (Item 2), only slightly more than half of the respondents, 198 (55.0%), indicated that the health facility in their settlement offers the HPV vaccine. In contrast, 101 respondents (28.1%) reported that the HPV vaccine was not available, while 61 respondents (16.9%) were not sure. This finding reveals gaps in the integration of HPV vaccination into routine immunization services across health facilities in the state. Item 3 examines the distance to the nearest health facility offering routine immunization services. Most respondents reported moderate proximity to such facilities, with 167 respondents (46.4%) living within 1–5 km. Additionally, 94 respondents (26.1%) lived less than 1 km from the nearest facility, suggesting relatively easy physical access for many participants. However, 68 respondents (18.9%) reported distances of 6–10 km, while 31 respondents (8.6%) lived more than 10 km away, indicating potential geographic barriers to accessing immunization services for a segment of the population. Concerning accessibility of the nearest routine immunization facility (Item 4), most respondents, 272 (75.6%), reported that the facility was accessible. Nevertheless, 51 respondents (14.2%) indicated that the facility was not accessible, and 37 respondents (10.3%) were uncertain. While accessibility appears generally favorable, the proportion reporting difficulties suggests that infrastructural, transportation, or operational challenges may still exist in some areas. Finally, Item 5 addresses the availability of trained routine immunization service providers in the nearest health facility. Slightly over half of the respondents, 213 (59.2%), affirmed the presence of trained personnel, while 89 respondents (24.7%) reported the absence of trained providers. Additionally, 58 respondents (16.1%) were not sure. This indicates that although trained immunization staff are present in many facilities, gaps in human resource capacity remain, which could affect the quality and consistency of HPV vaccine delivery. Table 3: Availability of the HPV vaccines in health facilities in Anambra State S/N Item Response Options Frequency (n) Percentage (%) 1 Is there a health facility offering routine immunization services in your settlement? Yes 265 73.6 No 62 17.2 Not sure 33 9.2 2 Is the health facility in your settlement offering HPV vaccine as part of routine immunization? Yes 198 55.0 No 101 28.1 Not sure 61 16.9 3 Distance to the nearest routine immunization health facility: Less than 1 km 94 26.1 1–5 km 167 46.4 6–10 km 68 18.9 More than 10 km 31 8.6 4 Is the nearest routine immunization facility accessible? Yes 272 75.6 No 51 14.2 Not sure 37 10.3 5 Are there trained routine immunization service providers in the nearest health facility? Yes 213 59.2 No 89 24.7 Not sure 58 16.1 Level of Acceptability of HPV Vaccine among the Study Population Table 4 presents the level of acceptability of the HPV vaccine among the study population, focusing on beliefs, willingness to accept and recommend the vaccine, concerns, and suggested measures to improve acceptance. Findings from Item 1 show that a majority of respondents perceived the HPV vaccine as safe. Specifically, 72 respondents (20.0%) strongly agreed and 118 respondents (32.8%) agreed that the vaccine is safe, giving a combined 52.8% positive perception. However, 84 respondents (23.3%) were neutral, while 54 (15.0%) disagreed and 32 (8.9%) strongly disagreed, indicating that a considerable proportion of respondents remain uncertain or skeptical about the safety of the vaccine. In terms of willingness to accept the HPV vaccine (Item 2), more than half of the respondents, 214 (59.4%), indicated willingness to accept the vaccine. Conversely, 92 respondents (25.6%) were unwilling to accept it, and 54 respondents (15.0%) were unsure. This suggests a moderate level of acceptability, though nearly two-fifths of the respondents expressed reluctance or uncertainty. Item 3 explores reasons for non-acceptance among respondents who were unwilling to accept the vaccine (n = 92), with multiple responses recorded. Side effects emerged as the most frequently cited reason, accounting for 42 responses (26.8%). This was followed by safety concerns (21.7%), fears about fertility effects (17.8%), cost (13.4%), and religious beliefs (12.1%). Other reasons accounted for 8.3% of responses. These findings indicate that concerns about adverse effects and long-term reproductive health are major barriers to HPV vaccine acceptance. Regarding the belief that the HPV vaccine encourages early sexual activity (Item 4), 57 respondents (15.8%) strongly agreed and 86 respondents (23.9%) agreed, totaling 39.7% who held this belief. In contrast, 78 respondents (21.7%) disagreed and 37 respondents (10.3%) strongly disagreed, while 102 respondents (28.3%) remained neutral. This reflects mixed perceptions, with a substantial proportion of respondents either endorsing or uncertain about this misconception. Item 5 addresses the belief that the HPV vaccine causes infertility in girls. Findings show that 48 respondents (13.3%) strongly agreed and 77 respondents (21.4%) agreed, resulting in 34.7% of respondents endorsing this belief. Meanwhile, 89 respondents (24.7%) disagreed and 50 respondents (13.9%) strongly disagreed, while 96 respondents (26.7%) were neutral. This indicates that misconceptions about infertility remain prevalent and may influence vaccine hesitancy. Concerning willingness to recommend the HPV vaccine to others (Item 6), 201 respondents (55.8%) expressed willingness to recommend the vaccine, while 79 respondents (21.9%) were unwilling and 80 respondents (22.2%) were unsure. This suggests that although more than half of the respondents support the vaccine, a significant proportion may not actively promote it within their social networks. Item 7 reveals that 169 respondents (46.9%) reported having concerns about the HPV vaccine, while 104 respondents (28.9%) reported no concerns and 87 respondents (24.2%) were unsure. This highlights the persistence of apprehension among nearly half of the study population. Among respondents who expressed concerns (n = 169), Item 8 shows that side effects were the most commonly cited concern, with 89 responses (32.6%), followed by safety issues (25.6%), fertility effects (15.4%), and cost (12.1%). Religious beliefs accounted for 8.4% of responses, while other concerns made up 5.9%. These findings mirror the reasons for non-acceptance and further emphasize the role of perceived health risks in shaping attitudes toward the vaccine. Finally, Item 9 presents suggested measures to increase HPV vaccine acceptance, with multiple responses recorded. Increased awareness programs were the most frequently suggested measure, accounting for 148 responses (28.9%). This was followed by school sensitization programs (23.6%), community leader involvement (16.0%), reduced cost (14.5%), and improved access to vaccination services (12.3%). Other measures constituted 4.7% of responses. These findings underscore the importance of health education, community engagement, affordability, and accessibility in improving HPV vaccine acceptance. Table 4: Level of Acceptability of HPV Vaccine among the Study Population S/N Item Response Options Frequency (n) Percentage (%) 1 Belief that HPV vaccine is safe Strongly agree 72 20.0 Agree 118 32.8 Neutral 84 23.3 Disagree 54 15.0 Strongly disagree 32 8.9 2 Willingness to accept the HPV vaccine Yes 214 59.4 No 92 25.6 Not sure 54 15.0 3 Reasons for non-acceptance (Among those who said “No”; n = 92; Multiple responses = 157) Safety concerns 34 21.7 Fertility effects 28 17.8 Religious beliefs 19 12.1 Side effects 42 26.8 Cost 21 13.4 Others 13 8.3 4 Belief that HPV vaccine encourages early sexual activity Strongly agree 57 15.8 Agree 86 23.9 Neutral 102 28.3 Disagree 78 21.7 Strongly disagree 37 10.3 5 Belief that HPV vaccine causes infertility in girls Strongly agree 48 13.3 Agree 77 21.4 Neutral 96 26.7 Disagree 89 24.7 Strongly disagree 50 13.9 6 Willingness to recommend the HPV vaccine to others Yes 201 55.8 No 79 21.9 Not sure 80 22.2 7 Concerns about the HPV vaccine Yes 169 46.9 No 104 28.9 Not sure 87 24.2 8 Main concerns about the HPV vaccine (Among those with concerns; n = 169; Multiple responses = 273) Safety 70 25.6 Fertility effects 42 15.4 Religious beliefs 23 8.4 Side effects 89 32.6 Cost 33 12.1 Others 16 5.9 9 Measures to increase HPV vaccine acceptance (Multiple responses = 512) More awareness programs 148 28.9 Community leader involvement 82 16.0 School sensitisation 121 23.6 Reduced cost 74 14.5 Improved access 63 12.3 Others 24 4.7 Utilization Patterns of the HPV Vaccine in Anambra State Table 5 presents information on the utilization patterns of the HPV vaccine among the study population in Anambra State, including uptake, dosing, place of administration, cost, reasons for non-utilization, and challenges in vaccine delivery. Findings from Item 1 indicate that only 128 respondents (35.6%) reported that their daughter or ward had received the HPV vaccine. In contrast, more than half of the respondents, 182 (50.6%), reported that their daughter or ward had not received the vaccine, while 50 respondents (13.9%) were unsure. This indicates a low level of HPV vaccine utilization within the study population despite moderate levels of awareness and acceptability. Among respondents whose daughter or ward had received the vaccine (n = 128), Item 2 shows that 41 respondents (32.0%) reported receipt of only one dose, while 36 respondents (28.1%) reported two doses. Only 28 respondents (21.9%) indicated that all recommended doses had been completed, and 23 respondents (18.0%) were not sure of the number of doses received. This suggests incomplete vaccination among many recipients, which may reduce the overall effectiveness of the vaccination program. Item 3 examines the place of vaccine administration, with multiple responses recorded. Schools were the most common site of vaccination, accounting for 59 responses (33.5%), followed by health centres with 48 responses (27.3%). Outreach programs contributed 26 responses (14.8%), private hospitals 22 responses (12.5%), and other locations 21 responses (11.9%). This finding highlights the importance of school-based and primary healthcare facilities in HPV vaccine delivery. Regarding prior information before vaccination (Item 4), 82 respondents (64.1%) reported that they were informed before their daughter or ward received the vaccine, while 46 respondents (35.9%) indicated that they were not informed. Although a majority received prior information, the sizeable proportion who were not informed may reflect gaps in communication and informed consent processes. With respect to cost (Item 5), most respondents, 91 (71.1%), reported that they did not pay for the vaccine, whereas 37 respondents (28.9%) indicated that they incurred costs. This suggests that while HPV vaccination is largely provided free of charge, financial barriers still exist for a segment of the population and may discourage uptake. Item 6 outlines reasons for non-receipt of the HPV vaccine among respondents who reported non-utilization (n = 182), with multiple responses recorded. Lack of awareness of the benefits of the vaccine was the most frequently cited reason, accounting for 59 responses (20.3%), followed closely by safety concerns (19.6%). Lack of access to health facilities accounted for 17.5% of responses, while poor knowledge of the vaccination schedule contributed 15.8%. Cost of vaccination (13.4%) and religious beliefs (7.6%) were also reported, with other reasons accounting for 5.8%. These findings indicate that informational gaps, safety fears, and access-related challenges are major barriers to HPV vaccine utilization. Item 7 shows that only 42 respondents (11.7%) were healthcare workers, while the majority, 318 respondents (88.3%), were non-healthcare workers. Among the healthcare workers (n = 42), Item 8 reveals that 24 respondents (57.1%) reported regular availability of HPV vaccines in their facilities, whereas 18 respondents (42.9%) reported irregular availability. This points to inconsistencies in vaccine supply within health facilities. Finally, Item 9 highlights challenges encountered in vaccine delivery as reported by healthcare workers, with multiple responses recorded. Vaccine hesitancy was the most commonly reported challenge, accounting for 23 responses (33.8%). This was followed by vaccine stock-outs (23.5%), stock-out of related commodities (17.6%), and cold-chain challenges (13.2%). Other challenges constituted 11.8% of responses. These challenges suggest systemic and demand-side barriers that may hinder effective HPV vaccine delivery. Table 5: Utilization patterns of the HPV vaccine in Anambra state. S/N Item Response Options Frequency (n) Percentage (%) 1 Has your daughter/ward received the HPV vaccine? Yes 128 35.6 No 182 50.6 Not sure 50 13.9 2 Number of doses received (Among those who answered Yes; n = 128) One 41 32.0 Two 36 28.1 All doses 28 21.9 Not sure 23 18.0 3 Place of vaccine administration (n = 128; Multiple responses = 176) School 59 33.5 Health centre 48 27.3 Outreach program 26 14.8 Private hospital 22 12.5 Other 21 11.9 4 Were you informed prior to vaccination? (n = 128) Yes 82 64.1 No 46 35.9 5 Did you have to pay for the vaccine? (n = 128) Yes 37 28.9 No 91 71.1 6 Reasons for non-receipt of vaccine (Among those who said “No” in Item 11; n = 182; Multiple responses = 291) Lack of access to health facility 51 17.5 Poor knowledge of schedule 46 15.8 Religious beliefs 22 7.6 Safety concerns 57 19.6 Cost of vaccination 39 13.4 Lack of awareness of benefits 59 20.3 Other 17 5.8 7 Are you a health worker? Yes 42 11.7 No 318 88.3 8 Regular availability of HPV vaccines (Among health workers; n = 42) Yes 24 57.1 No 18 42.9 9 Challenges encountered in vaccine delivery (Health workers only; n = 42; Multiple responses = 68) Vaccine hesitancy 23 33.8 Vaccine stock-out 16 23.5 Stock-out of commodities 12 17.6 Cold-chain challenges 9 13.2 Others 8 11.8 Discussion of Findings The findings indicated a moderate level of awareness of HPV and the HPV vaccine among parents, adolescents, and healthcare workers in Anambra State as misconceptions persist regarding its meaning. Awareness of the vaccine itself was somewhat lower, and detailed understanding of its primary role in preventing cervical cancer was limited. Knowledge of the recommended vaccination age was also insufficient, and many healthcare workers lacked formal training, reducing their confidence in providing accurate information. These patterns are consistent with studies in Nigeria and Ghana, which report moderate HPV awareness alongside gaps in vaccine knowledge, and evidence that misinformation and limited provider training can hinder uptake (Ohaeri et al., 2020; Adu et al., 2019; Wang et al., 2018). The findings revealed that regarding vaccine availability, most communities have health facilities offering routine immunization services, but notable gaps remain in both access and awareness, with some areas lacking facilities and others unsure of services. Confirmation of HPV vaccine availability was limited, indicating incomplete integration into routine immunization programs at the time of this study. While proximity to facilities generally supports access, a portion of the population faces distance barriers, compounded by challenges in accessibility and insufficient trained personnel. These findings echo previous research identifying gaps in vaccine availability and health workforce capacity as key barriers (Adepoju et al., 2021). This study also found that the acceptability of the HPV vaccine is moderately positive, with many respondents perceiving it as safe and expressing willingness to accept it. Nevertheless, concerns about side effects, safety, early sexual activity, and infertility contribute to hesitancy. These barriers align with findings from other studies highlighting safety concerns and parental misconceptions as significant factors influencing uptake (Kumakech et al., 2020; Nguyen et al., 2021). Interventions such as awareness campaigns, school programs, and community engagement have been recommended to improve acceptability, emphasizing the importance of health education and accessibility (Garland et al., 2016). The findings further revealed that vaccine utilization remains low among target age groups (girls 9-14years) with schools and health centers serving as primary delivery sites. These patterns reflect systemic and demand-side barriers, including lack of awareness, safety concerns, hesitancy, and irregular vaccine supply, consistent with observations in other Nigerian (Ogunwale et al., 2020; Animasahun et al., 2021). Conclusion Based on the findings of this study, it was concluded that there is a moderate awareness and acceptability of the HPV vaccine in Anambra State, but knowledge gaps, misconceptions, and healthcare workforce limitations persist. Vaccine utilization remains low due to misinformation, access barriers, hesitancy, and irregular supply. These therefore underscore the need for targeted interventions to improve knowledge, accessibility, and uptake. Recommendations: Government should implement comprehensive awareness campaigns and school-based programs to enhance knowledge of HPV and the vaccine’s role in preventing cervical cancer. Government with the support of partners should strengthen healthcare workforce capacity through formal training on HPV vaccination and communication strategies to improve confidence and service delivery. Government should ensure consistent vaccine supply and expand access points, particularly in underserved communities, to address distance and availability barriers. Health workers to create clear and culturally acceptable messages that frame HPV vaccination as a cancer prevention and public health intervention rather than a moral or behavioral issue. Health care providers to normalize integrating sensitization of HPV and other vaccine preventable diseases while rendering PHC services, community dialogues and development meetings with stakeholders. Government and partners to identify and appoint influential persons in the communities as statutory vaccine ambassadors and community mobilizers. They should be provided with information, education and communication (IEC) materials in local language highlighting the safety and benefit of HPV vaccine solely as a cancer preventing vaccine alongside other vaccine preventable diseases. Declarations Ethics approval This study was conducted in accordance with the Helsinki Declaration. This study was approved by the Anambra State Ministry of Health Planning, Research and Statistics Ethics Committee, with approval number MH/PRS/1244/Vol.209/74. Consent for Participation Written and verbal informed consent was obtained from all participants prior to their involvement in the study. Participation was voluntary, and confidentiality and anonymity were ensured throughout the research process. All procedures were conducted in accordance with ethical standards and the principles of the Declaration of Helsinki. Consent for publication Written informed consent to publish was obtained from the study participants before enrolment in the study. Data Availability All data generated or analyzed during this study are included in this manuscript. References Adepoju, E. G., Ilori, T., Olowookere, S. A., & Idowu, A. (2019). Targeting women with free cervical cancer screening: Challenges and lessons learnt from Osun state, southwest Nigeria. Pan African Medical Journal, 24 , 319. https://doi.org/10.11604/pamj.2016.24.319.9300 Adewole, I. E., Abodunrin, O., Akinsolu, F. T., Olagunju, M., Gambari, A. O., Raji, D. O., Idigbe, I. E., Njuguna, D. W., Salako, A. B., & Ezechi, O. C. (2023). Willingness to pay for HPV vaccine among women living with HIV in Nigeria. Vaccines, 11 (5), 928. https://doi.org/10.3390/vaccines11050928 Adu, K. R., Appiah-Kubi, A., Bell, S. G., Konney, T., Tawiah, A., Kobernik, E. K., & Lawrence, E. R. (2019). Attitudes and knowledge about HPV vaccination among Ghanaian women with cervical cancer. Reproductive, Female and Child Health , 2 , 11–18. Animasahun, O. F., Abioye-Kuteyi, E. A., Esan, O., & Afolabi, M. O. (2020). Knowledge of human papillomavirus and HPV vaccine among senior secondary school students in Nigeria. Population Medicine , 2, 127237 Bosch, F. X., Lorincz, A., Muñoz, N., Meijer, C. J., & Shah, K. V. (2002). The causal relation between human papillomavirus and cervical cancer. Journal of Clinical Pathology, 55 (4), 244–265. Bruni, L., Albero, G., Serrano, B., Mena, M., Gómez, D., Muñoz, J., … de Sanjosé, S. (2017). Human papillomavirus and related diseases report . HPV Information Centre. de Martel, C., Georges, D., Bray, F., Ferlay, J., & Clifford, G. M. (2019). Global burden of cancer attributable to infections in 2018: A worldwide incidence analysis. The Lancet Global Health, 8 (2), e180–e190. https://doi.org/10.1016/S2214-109X(19)30488-7 Egbon, M., Ojo, T., Aliyu, A., et al. (2022). Challenges and lessons from a school-based human papillomavirus (HPV) vaccination program for adolescent girls in a rural Nigerian community. BMC Public Health, 22 , 1611. https://doi.org/10.1186/s12889-022-13975-3 Emeribe, A. U., et al. (2021). The pattern of human papillomavirus infection and genotypes among Nigerian women from 1999 to 2019: A systematic review. Annals of Medicine, 53 (1), 1–14. Garland, S. M., Kjaer, S. K., Muñoz, N., Block, S. L., Brown, D. R., Dinubile, M. J., Lindsay, B. R., Kuter, B. J., Perez, G., Dominiak-Felden, G., Saah, A. J., Drury, R., Das, R., & Velicer, C. (2016). Impact and effectiveness of the quadrivalent human papillomavirus vaccine: A systematic review of 10 years of real-world experience. Clinical Infectious Diseases, 63 (4), 519–527. https://doi.org/10.1093/cid/ciw354 Harper, D. M., Franco, E. L., Wheeler, C. M., Moscicki, A. B., Romanowski, B., Roteli-Martins, C. M., … Dubin, G. (2006b). Sustained efficacy up to 4.5 years of a bivalent L1 virus-like particle vaccine against human papillomavirus types 16 and 18: Follow-up from a randomized control trial. The Lancet, 367 (9518), 1247–1255. Harper, D. M., Franco, E. L., Wheeler, C., Ferris, D. G., Jenkins, D., Schuind, A., … Dubin, G. (2006a). Efficacy of a bivalent L1 virus-like particle vaccine in prevention of infection with human papillomavirus types 16 and 18 in young women: A randomized controlled trial. The Lancet, 364 (9447), 1757–1765. HPV and Cancer. (2017). Retrieved from https://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hpv-and-cancer Kumakech, E., Andersson, S., Wabinga, H., Musubika, C., Kirimunda, S., & Berggren, V. (2017). Cervical cancer risk perceptions, sexual risk behaviors and sexually transmitted infections among bivalent human papillomavirus vaccinated and non-vaccinated young women in Uganda – 5-year follow-up study . BMC Women’s Health, 17, 40. https://doi.org/10.1186/s12905-017-0394-y Muñoz, N., Bosch, F. X., de Sanjose, S., Herrero, R., Castellsagué, X., Shah, K. V., … Meijer, C. J. (2003). Epidemiologic classification of human papillomavirus types associated with cervical cancer. New England Journal of Medicine, 348 (6), 518–527. Nguyen, N. Y., Okeke, E., Anglemyer, A., & Brock, T. (2020). Identifying perceived barriers to human papillomavirus vaccination as a preventative strategy for cervical cancer in Nigeria. Annals of Global Health, 86 (1), 118. https://doi.org/10.5334/aogh.2890 Nguyen, N. Y., Okeke, E., Anglemyer, A., & Brock, T. (2020). Identifying perceived barriers to human papillomavirus vaccination as a preventative strategy for cervical cancer in Nigeria. Annals of Global Health, 86 (1), Article 118. https://doi.org/10.5334/aogh.2890 Ogunwale, T., Ogunsola, E. A., Coker, M. O., Olayinka, S. A., Elegbede, W. A., Ojediran, J. O., Olajide, K. B., Sanni, S. B., Oluwadare, T. O., Inetagbo, O. T., Balogun, M. R., Owolabi, O. O., Anyadiegwu-Bello, C. C., Runsewe, O. A., Temitayo-Oboh, A. O., Soyannwo, T., Ogunsiji, O. B., & Banke-Thomas, A. (2024). HPV vaccine knowledge, attitude, and programme satisfaction among parents and caregivers of vaccine recipients in Ogun State, Nigeria. Reproductive Health, 21 , 179. https://doi.org/10.1186/s12978-024-01913-y Ohaeri, B., Adefolaju, A. O., & Onyeneho, C. A. (2020). Knowledge, attitudes and perceptions of Nigerian parents towards human papilloma virus (HPV) vaccines . European Journal of Midwifery, 4 (2). https://doi.org/10.18332/ejm/114886 Onyeka, N, N., Ezeanochie, M. C., & Olagbuji, B. N. (2000). Human papilloma virus vaccine: Determinants of acceptance by mothers for adolescents in Nigeria. African Journal of Reproductive Health, 18 (3), 154–158. Wang, X., Pan, J., Yan, B., et al. (2018). Inequities in human papillomavirus vaccination among children aged 9–14 years old under constrained vaccine supply in China. International Journal for Equity in Health, 23 , 112. https://doi.org/10.1186/s12939-024-02199-z World Health Organization. (2023). Human papillomavirus (HPV) and cancer . Retrieved from https://www.who.int/news-room/fact-sheets/detail/human-papilloma-virus-and-cancer World Health Organization. (2024, March). Human papillomavirus (HPV) and cancer . Retrieved from https://www.who.int/news-room/fact-sheets/detail/human-papilloma-virus-and-cancer Additional Declarations No competing interests reported. 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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-8977756","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":633584193,"identity":"d35b322c-2653-4438-9a45-6eb23356aac7","order_by":0,"name":"Afam Ben Obidike","email":"","orcid":"","institution":"Anambra State Ministry of Health","correspondingAuthor":false,"prefix":"","firstName":"Afam","middleName":"Ben","lastName":"Obidike","suffix":""},{"id":633584195,"identity":"ec34959a-05ef-4eb1-b91a-06272c53317a","order_by":1,"name":"Mohammed Bonos","email":"","orcid":"","institution":"World Health Organization - Nigeria","correspondingAuthor":false,"prefix":"","firstName":"Mohammed","middleName":"","lastName":"Bonos","suffix":""},{"id":633584197,"identity":"0ff118a8-9513-489a-b5d1-d6e9aa0180b6","order_by":2,"name":"Truth Chinonso Ezeudoye","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA70lEQVRIiWNgGAWjYJACZgiVAMQVIC5zA17lPAwMjM0ILWdAWhhJ0cLYBmIQ0GIvfcb8cUFFnZzB8eRjEh/n1UbztwO1/KjYhtsWvhzD5hln2IwNzjxLk5y57XjujMOMDYw9Z27j1sLDY9jM28aTuOFGjpk077ZjuQ1ALcyMbYS0/JOoB2v5O+dY7nzitDQYJBiAtDA21ORuIKjlDFvhbJ5jCYYzzzxLtuw5diB3I1DLQXx+Ye9h3vCZp6ZOnu948sEbP2rqcuedP3zwwY8K3FqQAYsEA8NhMOsAUeqBgPkDA0MdsYpHwSgYBaNgBAEA8NlY54HqGkEAAAAASUVORK5CYII=","orcid":"","institution":"World Health Organization - 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The virus is linked to a spectrum of conditions, ranging from benign warts to malignancies, most notably cervical cancer (WHO, 2025). According to the World Health Organization (WHO), HPV infections account for approximately 5% of all cancers globally (WHO, 2023). More than 200 HPV types have been identified, with over 40 affecting the anogenital region (Bosch et al., 2003). High-risk HPV types, particularly HPV 16 and 18, are responsible for approximately 70% of cervical cancer cases (Adewale et al., 2023).\u003c/p\u003e\n\u003cp\u003eEpidemiological data indicate that over 90% of sexually active men and 80% of sexually active women will acquire an HPV infection at some point in their lifetime (HPV and Cancer, 2017). In most cases, the immune system clears the infection naturally. However, persistent HPV infections, particularly those involving high-risk strains, are the leading cause of cervical cancer and are also associated with cancers of the vulva, vagina, mouth/throat, penis, and anus (de Martel et al., 2019). In 2019 alone, HPV-related cancers were estimated at 620,000 cases in women and 70,000 cases in men worldwide (de Martel et al., 2019). The prevalence of HPV is strongly influenced by age, sexual behavior patterns, and geographic differences, with the highest incidence occurring within the first few years after the onset of sexual activity (Bruni et al., 2017).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTo mitigate the burden of HPV-related diseases, public health interventions such as educational campaigns, safe sex practices, and early vaccination programs have been prioritized. The development of HPV vaccines\u0026mdash;Gardasil-9, Cervarix, and Gardasil\u0026mdash;has been a major advancement in preventing HPV-related infections and their sequelae. These vaccines, targeting high-risk HPV strains, have demonstrated significant efficacy in reducing the incidence of HPV-related diseases (Harper et al., 2006). Anambra State has been on the forefront on the fight against Cervical cancer with the wife of the Governor- Dr. Mrs. Nonye Soludo leading by conducting screening of over 18,000 women of child-bearing age in 2023 having a positivity rate of 2.8%. The program targeted women of childbearing age through; women development platforms, religious organizations, community engagements, women august meeting programs and more.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn May 2024, Anambra State, through the National Primary Health Care Development Agency (NPHCDA) in partnership with WHO and UNICEF, introduced the HPV vaccine (Gardasil-9) into its Expanded Program on Immunization (EPI). This initiative aimed to achieve nationwide routinization, similar to the successful routinization of the COVID-19 and Rotavirus vaccines. The COVID-19 vaccine rollout in Anambra recorded high uptake, with over 2 million individuals vaccinated. The success of this program was largely attributed to strategic interventions, including multiple rounds of supplementary immunization activities (SIAs) before routinization, robust funding, aggressive awareness and mobilization campaigns (ACSM), and visible health impacts that reinforced public trust.\u003c/p\u003e\n\u003cp\u003eSimilarly, the Rotavirus vaccine has been well-received, with over 300,000 children immunized annually with at least one dose. The high acceptance of the Rotavirus vaccine is primarily linked to the significant disease burden in children and the financial relief it offers caregivers, who previously relied on costly out-of-pocket purchases for immunization.\u003c/p\u003e\n\u003cp\u003eHuman Papilloma Virus (HPV) is a major public health concern globally, and as such, people should have adequate perception, high acceptance, and effective utilization of HPV vaccines, as these vaccines are proven to significantly reduce the incidence of HPV infections and associated cancers (World Health Organization [WHO], 2022). Proper awareness and positive attitudes toward HPV vaccination would enable individuals, especially adolescents and young adults, to make informed decisions about immunization, thereby contributing to a reduction in morbidity and mortality associated with HPV-related diseases.\u003c/p\u003e\n\u003cp\u003eHowever, the present situation in Anambra State indicates a significant gap in vaccine uptake. Despite the availability of HPV vaccines, studies suggest that misinformation, cultural beliefs, low awareness, and negative perceptions hinder effective utilization. This has contributed to the continued spread of HPV infections, leading to increased risk of cervical cancer among women and continued public health challenges in the region (Onyeka et al., 2020).\u003c/p\u003e\n\u003cp\u003eGiven this disparity between the ideal and current scenarios, there is a pressing need to investigate the perception, acceptance, and utilization of HPV vaccines in Anambra State. Understanding the factors influencing vaccine uptake will provide evidence-based insights for public health interventions aimed at improving vaccine coverage, reducing HPV transmission, and ultimately decreasing the burden of cervical cancer in the state.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjectives of the Study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe main objective of this study is to assess the perception, acceptance and utilization of Human Papillomavirus (HPV) vaccines in the Nigerian Expanded Program on Immunization (EPI) schedule among residents of Anambra State. Other specific objectives of the study includes;\u003c/p\u003e\n\u003col start=\"1\" type=\"1\"\u003e\n \u003cli\u003eTo assess level of perception of the Human Papilloma Virus and HPV vaccine among parents, adolescents, and healthcare workers in Anambra State.\u003c/li\u003e\n \u003cli\u003eTo assess the availability of the HPV vaccines in health facilities in Anambra state.\u003c/li\u003e\n \u003cli\u003eTo assess acceptance of HPV vaccine among the study population.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eTo examine the utilization patterns of the HPV vaccine in Anambra state.\u003c/li\u003e\n \u003cli\u003eTo provide evidence-based recommendations for improving HPV vaccine delivery, education, and acceptance in Anambra State and similar settings.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"METHODOLOGY","content":"\u003cp\u003eThis study employed a descriptive survey research design. A descriptive survey research design is a methodological approach used to collect, organize, analyze, and interpret data that describes the characteristics, opinions, behaviors, or attitudes of a population or phenomenon without manipulating any variables. The study was conducted in 6 LGAs across the 3 senatorial zones in Anambra State, Nigeria. The population of this study was 17, 372 which comprised Caregivers, Parents and Health Care Workers. From this population, a sample size of 360 was drawn using Kregcie and Morgan Table for Sample Size determination. A multistage sampling technique was employed for this study. In the first stage, the state was divided into 3 senatorial zones (Anambra Central, Anambra North and Anambra South) \u0026ndash; 7 LGAs per zone. In the second stage, 2 LGAs were randomly selected from each of the senatorial zones. Data for this study were collected using structured questionnaire titled \u0026ldquo;Perception, Acceptance and Utilization of Human Papilloma Virus Vaccine Questionnaire. The questionnaire was designed and structured by the researchers and it was divided into 2 sections A and B. Section A contained the demographic characteristics of the respondents while B contained items on perception, acceptance and utilization of the Human Papilloma Virus Vaccine. The questionnaire was duly validated by experts and the reliability was established using Cronbach Alpha method. In the collection of data, copies of the structured questionnaire were administered to adolescents, caregivers and healthcare workers in the selected communities. This was done through direct administration with the help of 6 research assistants. Data collected were analyzed using descriptive statistics of frequency counts, simple percentage, mean and standard deviation.\u003c/p\u003e"},{"header":"RESULTS AND DISCUSSION","content":"\u003cp\u003eThe results of the data analysis are discussed as follow;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSocio-Demographic Characteristics of Respondents\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe table presents the socio-demographic characteristics of the respondents, covering age, gender, level of education, and employment status. With respect to age distribution, none of the respondents fell within the 0–5 years category (0.00%). The largest proportion of respondents were aged 16–30 years, accounting for 160 respondents (44.44%), indicating that the study population was predominantly young adults. This was followed by respondents aged 31–50 years with 96 individuals (26.67%). Those aged 6–15 years constituted 57 respondents (15.83%), while respondents aged 51 years and above were the least represented among the active age groups, with 47 respondents (13.06%). Overall, the age distribution suggests that the majority of participants were within the economically active and socially productive age brackets.\u003c/p\u003e\n\u003cp\u003eIn terms of gender, the distribution was relatively balanced. Female respondents slightly outnumbered their male counterparts, with 186 females (51.67%) compared to 174 males (48.33%). No respondent identified as “Other” (0.00%). This near-equal gender representation suggests that the findings of the study are unlikely to be significantly biased by gender imbalance.\u003c/p\u003e\n\u003cp\u003eRegarding educational attainment, the majority of respondents had at least secondary education. Specifically, 155 respondents (43.06%) completed secondary school, making this the most dominant educational category. This was followed by those with higher education qualifications, who accounted for 94 respondents (26.11%). Respondents with primary education were 67 (18.61%), while those with no formal education constituted the smallest proportion, 44 respondents (12.22%). This distribution indicates a relatively moderate to high level of literacy among the respondents, which may positively influence their understanding of the issues addressed in the study.\u003c/p\u003e\n\u003cp\u003eConcerning employment status, a higher proportion of respondents were self-employed, numbering 143 (39.72%), suggesting a strong presence of informal or entrepreneurial economic activities among the study population. Employed respondents accounted for 116 (32.22%), while 101 respondents (28.06%) were unemployed. This pattern implies a diverse economic background among participants, with a substantial proportion engaged in income-generating activities, which may have implications for their socio-economic perspectives and responses in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1: Demographic characteristics of Respondents\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"558\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eS/N\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCategory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFrequency (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePercentage (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0–5 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6–15 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e15.83\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e16–30 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e160\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e44.44\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e31–50 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e26.67\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e51+ years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e13.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e174\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e48.33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e186\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e51.67\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eEducation Level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo formal education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12.22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePrimary School\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e18.61\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e155\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e43.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHigher Education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e26.11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eEmployment Status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e101\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e28.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSelf-Employed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e143\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e39.72\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eEmployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e116\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e32.22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eLevel of Knowledge of Human Papilloma Virus (HPV) and HPV Vaccine among Parents, Adolescents, and Healthcare Workers in Anambra State\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 2 presents respondents’ level of knowledge of Human Papilloma Virus (HPV) and the HPV vaccine in Anambra State. Findings from Item 1 show that a majority of respondents had heard of HPV, with 230 respondents (63.9%) indicating awareness, while 130 respondents (36.1%) reported that they had never heard of HPV. This suggests a moderate level of general awareness of HPV among the study population, although a substantial proportion still lacks basic awareness.\u003c/p\u003e\n\u003cp\u003eAmong respondents who had heard of HPV (n = 230), the majority correctly identified HPV as Human Papilloma Virus, accounting for 185 respondents (80.4%). However, 28 respondents (12.2%) incorrectly described HPV as Hydrogen Peroxide Vaccine, while 17 respondents (7.4%) believed it to be Herpes Pustular Virus. This indicates that although awareness exists, misconceptions about the meaning of HPV persist among a notable minority of respondents.\u003c/p\u003e\n\u003cp\u003eRegarding awareness of the HPV vaccine (Item 3), 210 respondents (58.3%) reported having heard about the vaccine, while 150 respondents (41.7%) had not. This finding shows that knowledge of the HPV vaccine is slightly lower than general awareness of HPV, pointing to gaps in vaccine-specific health education.\u003c/p\u003e\n\u003cp\u003eItem 4 highlights the sources of information on HPV and the HPV vaccine. Since multiple responses were allowed, a total of 487 responses were recorded. Social media emerged as the most common source of information, accounting for 124 responses (25.5%). This was followed by healthcare workers with 102 responses (20.9%), television/radio with 78 responses (16.0%), and friends or family with 65 responses (13.3%). Schools accounted for 62 responses (12.7%), while religious groups contributed 41 responses (8.4%). Other sources were least reported, with 15 responses (3.1%). These findings indicate that both formal (healthcare workers, schools, mass media) and informal (social media, friends, family) channels play significant roles in disseminating HPV-related information, with social media being particularly influential.\u003c/p\u003e\n\u003cp\u003eIn terms of knowledge of the purpose of the HPV vaccine (Item 5), less than half of the respondents, 162 (45.0%), correctly stated that the vaccine prevents cervical cancer. Meanwhile, 48 respondents (13.3%) believed it prevents sexually transmitted diseases generally, and 74 respondents (20.6%) thought it boosts immunity. Notably, 76 respondents (21.1%) indicated that they did not know the purpose of the vaccine. This suggests that although some respondents are aware of the vaccine, detailed and accurate knowledge about its primary preventive role remains inadequate.\u003c/p\u003e\n\u003cp\u003eConcerning knowledge of the recommended age for HPV vaccination (Item 6), only 140 respondents (38.9%) indicated that they knew the recommended age, while a majority of 220 respondents (61.1%) reported that they did not. This reflects a considerable knowledge gap that may negatively influence timely vaccine uptake.\u003c/p\u003e\n\u003cp\u003eAmong those who claimed to know the recommended age for HPV vaccination (n = 140), more than half correctly identified age 9 years as the appropriate age, with 79 respondents (56.4%). However, a substantial proportion provided incorrect age ranges, including under 5 years (7.1%), 6 years (8.6%), 7 years (12.9%), and 8 years (15.0%). This further underscores partial knowledge and confusion regarding vaccination guidelines.\u003c/p\u003e\n\u003cp\u003eItem 8 shows that only 46 respondents (12.8%) were healthcare workers, while the majority, 314 respondents (87.2%), were non-healthcare workers. Among the healthcare workers (n = 46), 28 respondents (60.9%) reported having received training on HPV vaccination, whereas 18 (39.1%) had not. This indicates that a significant proportion of healthcare workers lack formal training on HPV vaccination.\u003c/p\u003e\n\u003cp\u003eFinally, regarding confidence in providing HPV vaccine information (Item 10), 31 healthcare workers (67.4%) reported being confident, while 15 (32.6%) were not confident. Although the majority expressed confidence, the presence of a sizeable proportion lacking confidence highlights the need for continuous training and capacity building among healthcare workers to strengthen accurate information dissemination.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2: Level of knowledge of the Human Papilloma Virus and HPV vaccine among parents, adolescents, and healthcare workers in Anambra State\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eS/N\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eItem\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eResponse Options\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFrequency (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePercentage (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHave you heard of HPV?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e230\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e63.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e130\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e36.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eWhat is HPV? \u003cem\u003e(Asked only among those who said “Yes” to Item 1; n = 230)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHuman Papilloma Virus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e185\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e80.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHydrogen Peroxide Vaccine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHerpes Pustular Virus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHave you heard about the HPV vaccine?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e210\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e58.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e150\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e41.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSource of Information \u003cem\u003e(Multiple Response Allowed; Total Responses = 487)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHealthcare worker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e20.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTelevision/Radio\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e16.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSocial media\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e124\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e25.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSchool\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eReligious group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFriends/Family\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e13.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePurpose of HPV Vaccine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePrevents cervical cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e162\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e45.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePrevents STDs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e13.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBoosts immunity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e20.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDon’t know\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e21.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e6\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eKnowledge of Recommended Age for HPV Vaccination\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e140\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e38.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e220\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e61.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e7\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eIf Yes: Correct Age Range (n = 140)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUnder 5 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e15.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e56.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e8\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAre you a health worker?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e314\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e87.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e9\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTraining on HPV Vaccination \u003cem\u003e(Health Workers Only; n = 46)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e60.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e39.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e10\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eConfidence in Providing HPV Vaccine Information \u003cem\u003e(Health Workers Only; n = 46)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e67.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e32.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of HPV Vaccines in Health Facilities in Anambra State\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 3 presents information on the availability and accessibility of HPV vaccination services within health facilities in Anambra State. Findings from Item 1 indicate that a majority of respondents, 265 (73.6%), reported the presence of a health facility offering routine immunization services within their settlement. However, 62 respondents (17.2%) stated that no such facility existed in their settlement, while 33 respondents (9.2%) were unsure. This suggests that although routine immunization services are available in most settlements, a notable proportion of respondents still lack access or awareness of such facilities.\u003c/p\u003e\n\u003cp\u003eWith regard to the availability of the HPV vaccine as part of routine immunization services (Item 2), only slightly more than half of the respondents, 198 (55.0%), indicated that the health facility in their settlement offers the HPV vaccine. In contrast, 101 respondents (28.1%) reported that the HPV vaccine was not available, while 61 respondents (16.9%) were not sure. This finding reveals gaps in the integration of HPV vaccination into routine immunization services across health facilities in the state.\u003c/p\u003e\n\u003cp\u003eItem 3 examines the distance to the nearest health facility offering routine immunization services. Most respondents reported moderate proximity to such facilities, with 167 respondents (46.4%) living within 1–5 km. Additionally, 94 respondents (26.1%) lived less than 1 km from the nearest facility, suggesting relatively easy physical access for many participants. However, 68 respondents (18.9%) reported distances of 6–10 km, while 31 respondents (8.6%) lived more than 10 km away, indicating potential geographic barriers to accessing immunization services for a segment of the population.\u003c/p\u003e\n\u003cp\u003eConcerning accessibility of the nearest routine immunization facility (Item 4), most respondents, 272 (75.6%), reported that the facility was accessible. Nevertheless, 51 respondents (14.2%) indicated that the facility was not accessible, and 37 respondents (10.3%) were uncertain. While accessibility appears generally favorable, the proportion reporting difficulties suggests that infrastructural, transportation, or operational challenges may still exist in some areas.\u003c/p\u003e\n\u003cp\u003eFinally, Item 5 addresses the availability of trained routine immunization service providers in the nearest health facility. Slightly over half of the respondents, 213 (59.2%), affirmed the presence of trained personnel, while 89 respondents (24.7%) reported the absence of trained providers. Additionally, 58 respondents (16.1%) were not sure. This indicates that although trained immunization staff are present in many facilities, gaps in human resource capacity remain, which could affect the quality and consistency of HPV vaccine delivery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3: Availability of the HPV vaccines in health facilities in Anambra State\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eS/N\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eItem\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eResponse Options\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFrequency (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePercentage (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eIs there a health facility offering routine immunization services in your settlement?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e265\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e73.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e17.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot sure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eIs the health facility in your settlement offering HPV vaccine as part of routine immunization?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e198\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e55.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e101\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e28.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot sure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e16.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDistance to the nearest routine immunization health facility:\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eLess than 1 km\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e26.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1–5 km\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e167\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e46.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6–10 km\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e18.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMore than 10 km\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eIs the nearest routine immunization facility accessible?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e272\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e75.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e14.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot sure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e10.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAre there trained routine immunization service providers in the nearest health facility?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e213\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e59.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e24.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot sure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e16.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eLevel of Acceptability of HPV Vaccine among the Study Population\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 4 presents the level of acceptability of the HPV vaccine among the study population, focusing on beliefs, willingness to accept and recommend the vaccine, concerns, and suggested measures to improve acceptance. Findings from Item 1 show that a majority of respondents perceived the HPV vaccine as safe. Specifically, 72 respondents (20.0%) strongly agreed and 118 respondents (32.8%) agreed that the vaccine is safe, giving a combined 52.8% positive perception. However, 84 respondents (23.3%) were neutral, while 54 (15.0%) disagreed and 32 (8.9%) strongly disagreed, indicating that a considerable proportion of respondents remain uncertain or skeptical about the safety of the vaccine.\u003c/p\u003e\n\u003cp\u003eIn terms of willingness to accept the HPV vaccine (Item 2), more than half of the respondents, 214 (59.4%), indicated willingness to accept the vaccine. Conversely, 92 respondents (25.6%) were unwilling to accept it, and 54 respondents (15.0%) were unsure. This suggests a moderate level of acceptability, though nearly two-fifths of the respondents expressed reluctance or uncertainty.\u003c/p\u003e\n\u003cp\u003eItem 3 explores reasons for non-acceptance among respondents who were unwilling to accept the vaccine (n = 92), with multiple responses recorded. Side effects emerged as the most frequently cited reason, accounting for 42 responses (26.8%). This was followed by safety concerns (21.7%), fears about fertility effects (17.8%), cost (13.4%), and religious beliefs (12.1%). Other reasons accounted for 8.3% of responses. These findings indicate that concerns about adverse effects and long-term reproductive health are major barriers to HPV vaccine acceptance.\u003c/p\u003e\n\u003cp\u003eRegarding the belief that the HPV vaccine encourages early sexual activity (Item 4), 57 respondents (15.8%) strongly agreed and 86 respondents (23.9%) agreed, totaling 39.7% who held this belief. In contrast, 78 respondents (21.7%) disagreed and 37 respondents (10.3%) strongly disagreed, while 102 respondents (28.3%) remained neutral. This reflects mixed perceptions, with a substantial proportion of respondents either endorsing or uncertain about this misconception.\u003c/p\u003e\n\u003cp\u003eItem 5 addresses the belief that the HPV vaccine causes infertility in girls. Findings show that 48 respondents (13.3%) strongly agreed and 77 respondents (21.4%) agreed, resulting in 34.7% of respondents endorsing this belief. Meanwhile, 89 respondents (24.7%) disagreed and 50 respondents (13.9%) strongly disagreed, while 96 respondents (26.7%) were neutral. This indicates that misconceptions about infertility remain prevalent and may influence vaccine hesitancy.\u003c/p\u003e\n\u003cp\u003eConcerning willingness to recommend the HPV vaccine to others (Item 6), 201 respondents (55.8%) expressed willingness to recommend the vaccine, while 79 respondents (21.9%) were unwilling and 80 respondents (22.2%) were unsure. This suggests that although more than half of the respondents support the vaccine, a significant proportion may not actively promote it within their social networks.\u003c/p\u003e\n\u003cp\u003eItem 7 reveals that 169 respondents (46.9%) reported having concerns about the HPV vaccine, while 104 respondents (28.9%) reported no concerns and 87 respondents (24.2%) were unsure. This highlights the persistence of apprehension among nearly half of the study population.\u003c/p\u003e\n\u003cp\u003eAmong respondents who expressed concerns (n = 169), Item 8 shows that side effects were the most commonly cited concern, with 89 responses (32.6%), followed by safety issues (25.6%), fertility effects (15.4%), and cost (12.1%). Religious beliefs accounted for 8.4% of responses, while other concerns made up 5.9%. These findings mirror the reasons for non-acceptance and further emphasize the role of perceived health risks in shaping attitudes toward the vaccine.\u003c/p\u003e\n\u003cp\u003eFinally, Item 9 presents suggested measures to increase HPV vaccine acceptance, with multiple responses recorded. Increased awareness programs were the most frequently suggested measure, accounting for 148 responses (28.9%). This was followed by school sensitization programs (23.6%), community leader involvement (16.0%), reduced cost (14.5%), and improved access to vaccination services (12.3%). Other measures constituted 4.7% of responses. These findings underscore the importance of health education, community engagement, affordability, and accessibility in improving HPV vaccine acceptance.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4: Level of Acceptability of HPV Vaccine among the Study Population\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eS/N\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eItem\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eResponse Options\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFrequency (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePercentage (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBelief that HPV vaccine is safe\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eStrongly agree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e20.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAgree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e32.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNeutral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e23.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDisagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e15.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eStrongly disagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eWillingness to accept the HPV vaccine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e214\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e59.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e25.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot sure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e15.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eReasons for non-acceptance \u003cem\u003e(Among those who said “No”; n = 92; Multiple responses = 157)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSafety concerns\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e21.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFertility effects\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e17.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eReligious beliefs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSide effects\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e26.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCost\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e13.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBelief that HPV vaccine encourages early sexual activity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eStrongly agree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e15.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAgree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e23.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNeutral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e28.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDisagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e21.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eStrongly disagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e10.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBelief that HPV vaccine causes infertility in girls\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eStrongly agree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e13.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAgree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e21.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNeutral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e26.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDisagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e24.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eStrongly disagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e13.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e6\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eWillingness to recommend the HPV vaccine to others\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e201\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e55.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e21.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot sure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e22.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e7\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eConcerns about the HPV vaccine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e169\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e46.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e28.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot sure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e24.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e8\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMain concerns about the HPV vaccine \u003cem\u003e(Among those with concerns; n = 169; Multiple responses = 273)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSafety\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e25.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFertility effects\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e15.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eReligious beliefs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSide effects\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e32.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCost\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e9\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMeasures to increase HPV vaccine acceptance \u003cem\u003e(Multiple responses = 512)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMore awareness programs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e148\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e28.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCommunity leader involvement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e16.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSchool sensitisation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e121\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e23.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eReduced cost\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e14.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eImproved access\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eUtilization Patterns of the HPV Vaccine in Anambra State\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 5 presents information on the utilization patterns of the HPV vaccine among the study population in Anambra State, including uptake, dosing, place of administration, cost, reasons for non-utilization, and challenges in vaccine delivery. Findings from Item 1 indicate that only 128 respondents (35.6%) reported that their daughter or ward had received the HPV vaccine. In contrast, more than half of the respondents, 182 (50.6%), reported that their daughter or ward had not received the vaccine, while 50 respondents (13.9%) were unsure. This indicates a low level of HPV vaccine utilization within the study population despite moderate levels of awareness and acceptability.\u003c/p\u003e\n\u003cp\u003eAmong respondents whose daughter or ward had received the vaccine (n = 128), Item 2 shows that 41 respondents (32.0%) reported receipt of only one dose, while 36 respondents (28.1%) reported two doses. Only 28 respondents (21.9%) indicated that all recommended doses had been completed, and 23 respondents (18.0%) were not sure of the number of doses received. This suggests incomplete vaccination among many recipients, which may reduce the overall effectiveness of the vaccination program.\u003c/p\u003e\n\u003cp\u003eItem 3 examines the place of vaccine administration, with multiple responses recorded. Schools were the most common site of vaccination, accounting for 59 responses (33.5%), followed by health centres with 48 responses (27.3%). Outreach programs contributed 26 responses (14.8%), private hospitals 22 responses (12.5%), and other locations 21 responses (11.9%). This finding highlights the importance of school-based and primary healthcare facilities in HPV vaccine delivery.\u003c/p\u003e\n\u003cp\u003eRegarding prior information before vaccination (Item 4), 82 respondents (64.1%) reported that they were informed before their daughter or ward received the vaccine, while 46 respondents (35.9%) indicated that they were not informed. Although a majority received prior information, the sizeable proportion who were not informed may reflect gaps in communication and informed consent processes.\u003c/p\u003e\n\u003cp\u003eWith respect to cost (Item 5), most respondents, 91 (71.1%), reported that they did not pay for the vaccine, whereas 37 respondents (28.9%) indicated that they incurred costs. This suggests that while HPV vaccination is largely provided free of charge, financial barriers still exist for a segment of the population and may discourage uptake.\u003c/p\u003e\n\u003cp\u003eItem 6 outlines reasons for non-receipt of the HPV vaccine among respondents who reported non-utilization (n = 182), with multiple responses recorded. Lack of awareness of the benefits of the vaccine was the most frequently cited reason, accounting for 59 responses (20.3%), followed closely by safety concerns (19.6%). Lack of access to health facilities accounted for 17.5% of responses, while poor knowledge of the vaccination schedule contributed 15.8%. Cost of vaccination (13.4%) and religious beliefs (7.6%) were also reported, with other reasons accounting for 5.8%. These findings indicate that informational gaps, safety fears, and access-related challenges are major barriers to HPV vaccine utilization.\u003c/p\u003e\n\u003cp\u003eItem 7 shows that only 42 respondents (11.7%) were healthcare workers, while the majority, 318 respondents (88.3%), were non-healthcare workers. Among the healthcare workers (n = 42), Item 8 reveals that 24 respondents (57.1%) reported regular availability of HPV vaccines in their facilities, whereas 18 respondents (42.9%) reported irregular availability. This points to inconsistencies in vaccine supply within health facilities. Finally, Item 9 highlights challenges encountered in vaccine delivery as reported by healthcare workers, with multiple responses recorded. Vaccine hesitancy was the most commonly reported challenge, accounting for 23 responses (33.8%). This was followed by vaccine stock-outs (23.5%), stock-out of related commodities (17.6%), and cold-chain challenges (13.2%). Other challenges constituted 11.8% of responses. These challenges suggest systemic and demand-side barriers that may hinder effective HPV vaccine delivery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5: Utilization patterns of the HPV vaccine in Anambra state.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eS/N\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eItem\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eResponse Options\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFrequency (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePercentage (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHas your daughter/ward received the HPV vaccine?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e35.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e182\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e50.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot sure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e13.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNumber of doses received \u003cem\u003e(Among those who answered Yes; n = 128)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOne\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e32.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTwo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e28.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAll doses\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e21.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot sure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e18.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePlace of vaccine administration \u003cem\u003e(n = 128; Multiple responses = 176)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSchool\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e33.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHealth centre\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e27.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOutreach program\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e14.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePrivate hospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eWere you informed prior to vaccination? \u003cem\u003e(n = 128)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e64.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e35.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDid you have to pay for the vaccine? \u003cem\u003e(n = 128)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e28.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e71.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eReasons for non-receipt of vaccine \u003cem\u003e(Among those who said “No” in Item 11; n = 182; Multiple responses = 291)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eLack of access to health facility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e17.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePoor knowledge of schedule\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e15.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eReligious beliefs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSafety concerns\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e19.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCost of vaccination\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e13.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eLack of awareness of benefits\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e20.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAre you a health worker?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e318\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e88.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eRegular availability of HPV vaccines \u003cem\u003e(Among health workers; n = 42)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e57.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e42.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eChallenges encountered in vaccine delivery \u003cem\u003e(Health workers only; n = 42; Multiple responses = 68)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eVaccine hesitancy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e33.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eVaccine stock-out\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e23.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eStock-out of commodities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e17.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCold-chain challenges\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e13.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Discussion of Findings","content":"\u003cp\u003eThe findings indicated a moderate level of awareness of HPV and the HPV vaccine among parents, adolescents, and healthcare workers in Anambra State as misconceptions persist regarding its meaning. Awareness of the vaccine itself was somewhat lower, and detailed understanding of its primary role in preventing cervical cancer was limited. Knowledge of the recommended vaccination age was also insufficient, and many healthcare workers lacked formal training, reducing their confidence in providing accurate information. These patterns are consistent with studies in Nigeria and Ghana, which report moderate HPV awareness alongside gaps in vaccine knowledge, and evidence that misinformation and limited provider training can hinder uptake (Ohaeri et al., 2020; Adu et al., 2019; Wang et al., 2018).\u003c/p\u003e\n\u003cp\u003eThe findings revealed that regarding vaccine availability, most communities have health facilities offering routine immunization services, but notable gaps remain in both access and awareness, with some areas lacking facilities and others unsure of services. Confirmation of HPV vaccine availability was limited, indicating incomplete integration into routine immunization programs at the time of this study. While proximity to facilities generally supports access, a portion of the population faces distance barriers, compounded by challenges in accessibility and insufficient trained personnel. These findings echo previous research identifying gaps in vaccine availability and health workforce capacity as key barriers (Adepoju et al., 2021).\u003c/p\u003e\n\u003cp\u003eThis study also found that the acceptability of the HPV vaccine is moderately positive, with many respondents perceiving it as safe and expressing willingness to accept it. Nevertheless, concerns about side effects, safety, early sexual activity, and infertility contribute to hesitancy. These barriers align with findings from other studies highlighting safety concerns and parental misconceptions as significant factors influencing uptake (Kumakech et al., 2020; Nguyen et al., 2021). Interventions such as awareness campaigns, school programs, and community engagement have been recommended to improve acceptability, emphasizing the importance of health education and accessibility (Garland et al., 2016).\u003c/p\u003e\n\u003cp\u003eThe findings further revealed that vaccine utilization remains low \u0026nbsp;among target age groups (girls 9-14years) with schools and health centers serving as primary delivery sites. These patterns reflect systemic and demand-side barriers, including lack of awareness, safety concerns, hesitancy, and irregular vaccine supply, consistent with observations in other Nigerian (Ogunwale et al., 2020; Animasahun et al., 2021).\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eBased on the findings of this study, it was concluded that there is a moderate awareness and acceptability of the HPV vaccine in Anambra State, but knowledge gaps, misconceptions, and healthcare workforce limitations persist. Vaccine utilization remains low due to misinformation, access barriers, hesitancy, and irregular supply. These therefore underscore the need for targeted interventions to improve knowledge, accessibility, and uptake.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRecommendations:\u003c/strong\u003e\u003c/p\u003e\n\u003col start=\"1\" type=\"1\"\u003e\n \u003cli\u003eGovernment should implement comprehensive awareness campaigns and school-based programs to enhance knowledge of HPV and the vaccine’s role in preventing cervical cancer.\u003c/li\u003e\n \u003cli\u003eGovernment with the support of partners should strengthen healthcare workforce capacity through formal training on HPV vaccination and communication strategies to improve confidence and service delivery.\u003c/li\u003e\n \u003cli\u003eGovernment should ensure consistent vaccine supply and expand access points, particularly in underserved communities, to address distance and availability barriers.\u003c/li\u003e\n \u003cli\u003eHealth workers to create clear and culturally acceptable messages that frame HPV vaccination as a cancer prevention and public health intervention rather than a moral or behavioral issue.\u003c/li\u003e\n \u003cli\u003eHealth care providers to normalize integrating sensitization of HPV and other vaccine preventable diseases while rendering PHC services, community dialogues and development meetings with stakeholders.\u003c/li\u003e\n \u003cli\u003eGovernment and partners to identify and appoint influential persons in the communities as statutory vaccine ambassadors and community mobilizers. They should be provided with information, education and communication (IEC) materials in local language highlighting the safety and benefit of HPV vaccine solely as a cancer preventing vaccine alongside other vaccine preventable diseases.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;This study was conducted in accordance with the Helsinki Declaration. This study was approved by the Anambra State Ministry of Health Planning, Research and Statistics Ethics Committee, with approval number MH/PRS/1244/Vol.209/74.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Participation\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Written and verbal informed consent was obtained from all participants prior to their involvement in the study. Participation was voluntary, and confidentiality and anonymity were ensured throughout the research process. All procedures were conducted in accordance with ethical standards and the principles of the Declaration of Helsinki.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent to publish was obtained from the study participants before enrolment in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analyzed during this study are included in this manuscript.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAdepoju, E. G., Ilori, T., Olowookere, S. A., \u0026amp; Idowu, A. (2019). Targeting women with free cervical cancer screening: Challenges and lessons learnt from Osun state, southwest Nigeria. \u003cem\u003ePan African Medical Journal, 24\u003c/em\u003e, 319. https://doi.org/10.11604/pamj.2016.24.319.9300 \u003c/li\u003e\n\u003cli\u003eAdewole, I. E., Abodunrin, O., Akinsolu, F. T., Olagunju, M., Gambari, A. O., Raji, D. O., Idigbe, I. E., Njuguna, D. W., Salako, A. B., \u0026amp; Ezechi, O. C. (2023). \u003cem\u003eWillingness to pay for HPV vaccine among women living with HIV in Nigeria.\u003c/em\u003e \u003cem\u003eVaccines, 11\u003c/em\u003e(5), 928. https://doi.org/10.3390/vaccines11050928\u003c/li\u003e\n\u003cli\u003eAdu, K. R., Appiah-Kubi, A., Bell, S. G., Konney, T., Tawiah, A., Kobernik, E. K., \u0026amp; Lawrence, E. R. (2019). 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Inequities in human papillomavirus vaccination among children aged 9\u0026ndash;14 years old under constrained vaccine supply in China. \u003cem\u003eInternational Journal for Equity in Health, 23\u003c/em\u003e, 112. https://doi.org/10.1186/s12939-024-02199-z\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. (2023). \u003cem\u003eHuman papillomavirus (HPV) and cancer\u003c/em\u003e. Retrieved from https://www.who.int/news-room/fact-sheets/detail/human-papilloma-virus-and-cancer\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. (2024, March). \u003cem\u003eHuman papillomavirus (HPV) and cancer\u003c/em\u003e. Retrieved from https://www.who.int/news-room/fact-sheets/detail/human-papilloma-virus-and-cancer\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"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":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Human Papillomavirus, HPV vaccine, perception, acceptance, utilization, Anambra State, immunization","lastPublishedDoi":"10.21203/rs.3.rs-8977756/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8977756/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"Human Papillomavirus (HPV) is a leading cause of cervical and other anogenital cancers globally. In May 2024, in line with the introduction of HPV vaccines into the Nigerian Expanded Program on Immunization (EPI) schedule, Anambra State introduced the HPV vaccines to its Routine Immunization services with the support of NPHCDA, WHO, UNICEF and other partners. This study examined the perception, acceptance, and utilization of HPV vaccines among residents of Anambra State to identify factors influencing uptake. Using a descriptive survey research design, data were collected from 360 respondents including parents, caregivers, adolescents, and healthcare workers across six Local Government Areas via a structured, validated questionnaire. Data were collected through personal administration of copies of the instrument to the respondents after getting consent from each respondents. Data collected were analyzed using descriptive statistics of frequency count, simple percentage, mean and standard deviation. Results indicated moderate awareness of HPV (63.9%) and the HPV vaccine (58.3%), though misconceptions persisted and only 38.9% knew the recommended vaccination age. HPV vaccines were available in 55% of health facilities, with gaps in trained personnel and supply. Vaccine acceptance was moderate, with 59.4% willing to receive it and 55.8% willing to recommend it, yet concerns about side effects, fertility, and misconceptions about early sexual activity contributed to hesitancy. Utilization was low, with only 35.6% reporting vaccination of their wards. Schools and health centers were the primary vaccination sites, while challenges such as hesitancy, stock-outs, and access barriers affected delivery. The study concludes that awareness and acceptance are moderate, but utilization remains suboptimal due to knowledge gaps, misconceptions, healthcare workforce limitations, and access issues. Targeted interventions include awareness campaigns, school-based programs, healthcare worker training, and consistent vaccine supply are recommended to enhance coverage and reduce HPV-related disease burden in Anambra State.","manuscriptTitle":"Perception Acceptance and Utilization of Human Papillomavirus Vaccine Among Residents of Anambra State, Nigeria","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-04 09:25:08","doi":"10.21203/rs.3.rs-8977756/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2026-04-23T10:26:26+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-06T17:33:22+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-28T11:11:35+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-28T10:35:05+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Public Health","date":"2026-03-28T10:30:48+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a0dec749-2250-40e3-9f7d-f4b14ad5bdb6","owner":[],"postedDate":"May 4th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-04T09:25:08+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-04 09:25:08","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8977756","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8977756","identity":"rs-8977756","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}