Navigating the Divide – Demographic and Individual Predictors of Low HPV Vaccine Uptake in Rural Uganda

Navigating the Divide – Demographic and Individual Predictors of Low HPV Vaccine Uptake in Rural Uganda | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF comment Navigating the Divide – Demographic and Individual Predictors of Low HPV Vaccine Uptake in Rural Uganda Mbonigaba Rukarama Evarist, Ronald Arineitwe Kibonire This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7596350/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Despite the critical role of Human Papillomavirus (HPV) vaccination in preventing cervical cancer, adolescent girls in many Ugandan districts, including Rukiga, exhibit persistently low completion rates for the two-dose series. This study aimed to identify demographic and individual-level factors associated with the low uptake of the HPV vaccination series among adolescent girls in Rukiga District, Uganda. Methods: A cross-sectional study employing mixed methodologies was conducted with 292 adolescent girls and their caregivers in Rukiga District between September and November 2022. Multivariate logistic regression was utilized to identify demographic, individual health and community determinants of completing the two-dose HPV vaccine regimen. Qualitative data were gathered through in-depth interviews with 11 health workers and 10 Village Health Team members to explore individual-level, health system and community barriers to vaccine uptake from the perspective of implementers. Results: The study found that only 27.49% of eligible girls completed the two-dose HPV vaccination series. Caregivers' gender was a significant predictor of uptake, with girls cared for by mothers having greater odds of completion (AOR = 1.70, 95% CI: 1.05-2.74, p = 0.030). Caregivers without formal education (AOR = 0.19, 95% CI: 0.05-0.74, p = 0.033) and peasant farmers (AOR = 0.49, p = 0.013) were less likely to vaccinate their daughters. Key individual barriers included change of residence (AOR = 0.50, p = 0.001) and school absenteeism/dropout (AOR = 0.73, p = 0.037), both significantly reducing uptake. Qualitative findings highlighted additional individual challenges such as misunderstanding regarding vaccine safety, insufficient health worker training, vaccine stockouts, long clinic wait times, and widespread community mistrust of government health initiatives. Conclusion: The low completion of the HPV vaccine series in Rukiga District is substantially influenced by identifiable demographic characteristics, particularly caregiver education and relationship to the child, and critical individual-level barriers such as mobility and school attendance. Targeted interventions are needed to empower mothers, enhance health literacy among less-educated and peasant caregivers, and implement flexible vaccination strategies to reach mobile and out-of-school adolescents. HPV vaccination low uptake adolescent girls Rukiga District Uganda caregivers individual factors demographic characteristics school absenteeism health literacy 1. Introduction/Background Cervical cancer remains a major global public health issue, ranking fourth in incidence and mortality among women worldwide [ 1 , 2 , 3 ]. It disproportionately affects women in low- and middle-income countries, with Sub-Saharan Africa bearing the highest incidence and a significant portion of the global burden [ 4 , 5 ]. Around 90% of related deaths occur in developing regions due to limited access to screening, vaccination and treatment. Persistent infection with high-risk HPV types, mainly HPV16 and HPV18, accounts for about 80% of cases globally [ 5 ]. These trends emphasize the need for improved prevention through HPV vaccination, screening, and early treatment, especially in high-burden areas [ 6 , 7 ]. In Uganda, cervical cancer is the leading cause of cancer-related deaths among women, making up nearly 40% of all female cancer cases [ 8 ]. The country’s cervical cancer incidence and mortality rates (56.7 and 40.1 per 100,000 women) are significantly above global averages [ 8 , 9 ]. Uganda began HPV vaccine demonstrations in 2006 and integrated it into routine immunization in 2015. While the first dose uptake is high, completion of the two-dose schedule remains low due to poor follow-up, weak record systems, vaccine shortages, low staff motivation, misinformation, and limited community involvement [ 10 ]. In Rukiga District, first-dose coverage is strong through school outreach, but second-dose uptake has dropped, with a 23.49% dropout rate, threatening full protection for girls aged 9–14 [ 11 ]. Identifying the demographic, individual, health system, and community-level factors contributing to low HPV vaccine uptake is essential for developing effective interventions in high-burden rural areas like Rukiga [ 12 ]. Key influences include caregiver characteristics, household conditions, and adolescent girls’ personal beliefs such as fear of injection. This study aims to explore these determinants to inform policy decisions and enhance completion of the HPV vaccine series 2. Methods 2.1 Research Approach and Study Design: This study employed a cross-sectional mixed-methods approach, combining quantitative and qualitative data collection to comprehensively assess HPV vaccination uptake [13,14,15]. The cross-sectional design was chosen for its efficiency in assessing relationships between variables at a single point in time, providing a snapshot of the factors influencing HPV vaccine uptake. 2.2 Study Setting: The study was conducted in Rukiga District in southwestern Uganda, which borders Ntungamo District, the Republic of Rwanda, Kabale District, Rubanda District, and Rukungiri District. It has a total land area of 426.3 km² and a total population of 132,355 people by sex, with 29,495 total households and a population density of 268/km² [16]. The district was purposefully chosen due to its HPV vaccination program implementation, rural setting, limited access to health facilities, and integration into Uganda's Expanded Program for Immunization. Two sub-counties were selected because of their lower vaccination rates and accessibility issues. 2.3 Study Population and Sampling: Quantitative Study: The quantitative population included parents and guardians of adolescent girls aged 9-14 years eligible to receive the HPV vaccine. They were chosen because they are ultimately in charge of making decisions about whether or not to accept or refuse the vaccine among their children, even when vaccination is provided in school-based programs. Minors (under 18) were excluded as primary respondents since vaccination would have to be given at school hours when they would be away from their parents or other caregivers [17,18]. Qualitative Study: Key informants for the qualitative part of this study consisted of health workers and Village Health Team (VHT) members [12,19] Health workers directly implement vaccination service delivery, while VHTs represent the immediate linkage of the health system to the population, providing health education and addressing myths and misconceptions. 2.3.1 Sampling Technique/Method: A multistage sampling approach was used. Two sub-counties characterized by lower HPV vaccination rates and accessibility challenges were purposively selected. Parishes within these sub-counties were chosen through simple random sampling, and villages were then randomly selected. Households with adolescent girls aged 9 to 14 years, based on Village Health Team records, were selected proportionally to village size, followed by systematic random sampling, resulting in a final sample of 292 parents or caregivers. For qualitative data, 11 health workers involved in EPI and HPV vaccination, and 10 VHT members from the selected villages, were purposively sampled. 2.3.2 Sample Size and Determination: The sample size for the quantitative study was calculated using Cochrane’s equation, assuming a 95% confidence level and a P value of 0.05. n0=Z 2 pq/ e 2 Where: n0 = required sample size Z = Z-score (1.96 for 95% CI) p = estimated proportion (0.5 for maximum variability) e = Desired level of precision (0.05) q=1−p This yielded n0=385. For a finite population (N=1200 households), the Cochran sample size correction was applied: n=1+N(n0−1) /n0 Substituting the values: n=1+1200(385−1) /385=1+1200(384) /385=1+0.32/385=1.32/385=291.666667=292 Thus, 292 households were included in the study as the adjusted sample size to select the parents and caregivers of the eligible adolescent girls. 2.3.3 Inclusion and Exclusion Criteria: Inclusion: Parents or primary caregivers of adolescent girls aged 9-14 years found at home from selected sub-counties in Rukiga District who provided informed consent. Exclusion: Households where caregivers had significant cognitive or hearing impairments, and child-headed households, due to challenges in obtaining reliable responses. 2.4 Study Variables: Dependent variable: Low uptake of HPV vaccination series. Independent variables: Individual level barriers: Inadequate knowledge, absenteeism, dropping out of school, change of residence, poor infrastructure, fear of injection, caregiver discouragement, and peer discouragement. 2.5 Data Collection Methods: A mixed-methods approach was used, combining semi-structured interviewer-administered questionnaires for quantitative data and Key Informant Interviews (KIIs) for qualitative data. Ten trained research assistants conducted household visits, and the semi-structured design allowed for standardized responses and in-depth insights. 2.5.1 Development of Interview Guides: The questionnaire and interview guides were developed specifically for this study, drawing from a comprehensive review of existing literature on HPV vaccine uptake and adapting relevant items from tools used in similar studies to enhance content validity. These instruments were designed by the principal investigator, translated into the predominant local language spoken in the study area, and subsequently back-translated into English to ensure linguistic and conceptual accuracy [30]. These tools were newly developed for this research and have not been previously published elsewhere. 2.5.2 Pre-testing Tools: Tools were piloted in Kashaki Village, an external site, with 40 parents/caretakers and in-depth interviews with three health workers and two VHT members. Pre-testing ensured clarity, cultural appropriateness, and allowed for revisions and standardization of the tools. Interviews were conducted in Rukiga or Runyankole for parents/caretakers, and English for health workers. 2.5.3 Recruitment and Training of Research Assistants: Ten research assistants with good knowledge of English and Rukiga-Runyankole, medical backgrounds, and interview experience were recruited and trained. They were supervised daily to ensure accuracy and completeness of data collection. 2.5.4 Data Collection Tools and Field Editing: Data was collected using pre-tested semi-structured questionnaires and checklists. Field editing was performed daily to ensure accuracy, completeness, and address non-responses. 2.6 Validity and Reliability of the Research Instrument:2.6.1 Quantitative Data: Validity: Content validity was ensured through expert consultations and literature review, and construct validity was assessed through pilot testing. Face validity was ensured by involving VHT members in reviewing the instrument for clarity, cultural appropriateness, and relevance. Reliability: Confirmed through Cronbach’s alpha (0.72 to 0.83), indicating good internal consistency, and test-retest reliability (0.82) showing strong stability over time [20]. 2.6.2 Qualitative Data: Validity: Member checking was employed by presenting preliminary results to selected participants to confirm accuracy of interpretations. Reliability: Intercoder reliability was applied, with multiple researchers independently coding transcripts and resolving discrepancies through consensus. 2.7 Data Quality Control: Quality control was ensured through adequate questionnaires, proper identification of key informants, training of research assistants, daily supervision, review, and entry of data. 2.8 Data Management and Analysis: Quantitative Data Analysis: Data was checked for completeness and accuracy, entered into Epi-Info, and then transferred to SPSS for analysis. Univariate analysis generated frequency tables and descriptive parameters. Bivariate analysis compared the dependent variable with independent variables using confidence intervals and p-values. Multivariable logistic regression analysis adjusted for confounding and determined factors associated with HPV vaccine uptake, including all variables from bivariate analysis regardless of their initial p-values, to account for potential confounders or clinically/theoretically significant variables. Qualitative Data Analysis: Open-ended responses were systematically coded by allocating them to frequent themes, allowing structured interpretation and identification of trends and patterns between participant responses. 2.9 Ethical Consideration: Approval was obtained from Kabale University and Mbarara University Research Ethics Committee. Permission was also sought from the Rukiga District Health Officer. Respondents were informed about the study objectives and process and informed consent was obtained with participation being voluntary and confidentiality maintained. 3. Results Of the 292 respondents, 42.8% were aged 41–50, and 36.6% were 31–40 years old. All participants were from rural areas (100%). The majority of respondents were female (93.5%), mothers (72.9%), peasants (80.8%), and married (84.9%). Most adolescent daughters were aged 11–13 (60.3%), followed by 14–15 years (21.9%). The overall completion rate for the two-dose HPV vaccination series was 27.49%. 3.1 Demographic Characteristics and HPV Vaccine Uptake: Bivariate Analysis of Key Variables (Table 1): Variable Category n COR 95% CI p-value Age of caretaker 20–30 (ref) 35 1.00 — — 31–40 107 1.31 0.65–2.65 0.451 41–50 125 1.62 0.82–3.21 0.165 50+ 25 1.12 0.39–3.25 0.837 Daughter’s age 8–10 (ref) 46 1.00 — — 11–13 176 2.01 1.10–3.67 0.023 14–15 64 1.54 0.72–3.28 0.264 16–18 6 0.79 0.13–4.87 0.805 Area of residence Rural (ref) 292 1.00 — — Gender of caretaker Male (ref) 19 1.00 — — Female 273 1.47 0.48–4.53 0.506 Caretaker relationship Mother (ref) 213 1.00 — — Grandparent 17 0.76 0.24–2.40 0.636 House help/maid 10 0.39 0.10–1.52 0.176 Father 19 0.88 0.28–2.78 0.831 Aunt 5 1.10 0.22–5.53 0.902 Brother 6 0.42 0.07–2.52 0.343 Sister 22 1.09 0.43–2.79 0.853 Education level None (ref) 8 1.00 — — Primary 192 2.52 0.56–11.40 0.230 Secondary 68 2.91 0.62–13.70 0.177 Tertiary 24 3.83 0.74–19.75 0.107 Occupation of caretaker Peasant (ref) 236 1.00 — — Business 31 1.53 0.71–3.29 0.274 Employed 20 2.23 0.92–5.39 0.076 Maid 5 0.63 0.07–5.38 0.677 Marital status Single (ref) 20 1.00 — — Married 248 1.87 0.82–4.29 0.135 Divorced 19 1.22 0.38–3.97 0.738 Widow 5 0.99 0.12–7.87 0.991 According to table 1 above, the bivariate analysis looked at the relationship between demographic factors and HPV vaccine uptake among teenage girls aged 9 to 14 in Rukiga District. Although many demographic characteristics had no statistically significant relationship with vaccine uptake, some trends appeared that require additional investigation. The age of the adolescent daughter had a significant impact on uptake, with girls aged 11 to 13 being twice as likely to have received the vaccine as those aged 8 to 10 (COR = 2.01; 95% CI: 1.10–3.67; p = 0.023). Employed caregivers showed a borderline significance with higher uptake (COR = 2.23; p = 0.076) compared to peasants. Higher education levels were associated with greater vaccination probabilities, though not statistically significant at the bivariate level; caregivers with tertiary education were nearly four times as likely to ensure their daughters received vaccinations than those without formal education (COR = 3.83; p = 0.107). Multivariable Logistic Regression Analysis (Table 2) Factor Category Variable Variable Option n OR (95% CI) P-value Demographic Factors Age of Caretaker 20–30 35 0.65 (0.32–1.31) 0.220 31–40 107 0.94 (0.56–1.58) 0.820 41–50 125 1.42 (0.85–2.36) 0.180 50+ (Ref) 12 1.00 – Gender of Caretaker Female 149 2.18 (0.85–5.57) 0.096 Male (Ref) 7 1.00 – Caretaker Relationship Mother 128 1.70 (1.05–2.75) 0.030 Others (Ref) 28 1.00 – Education Level None 2 0.19 (0.04–0.87) 0.033 Primary 96 0.50 (0.30–0.83) 0.007 Secondary+ (Ref) 61 1.00 – Occupation Peasant 111 0.49 (0.28–0.87) 0.013 Employed/Business (Ref) 31 1.00 – Marital Status Married 134 1.43 (0.73–2.80) 0.280 Not Married (Ref) 22 1.00 – Distance to Health Center Distance to Health Center < 1 km 1 Not estimable – 1–3 km (Ref) 110 1.00 – 4–6 km 31 0.96 (0.53–1.74) 0.892 ≥ 6 km 13 1.03 (0.43–2.44) 0.947 Not aware 1 0.87 (0.05–15.4) 0.921 Class Level P2 3 0.89 0.17–4.54 0.87 P3 61 0.95 0.51–1.78 0.83 P4 (Reference) 107 1.00 (Ref) – 1.00 P5 62 0.93 0.49–1.75 0.78 P6 34 1.05 0.49–2.25 0.87 P7 25 1.12 0.48–2.61 0.74 Individual Factors Inadequate knowledge about HPV Yes 207 1.28 (0.89–1.84) 0.114 No 85 0.64 – Change of residence Yes 110 0.50 (0.37–0.69) 0.001 No 182 2.14 – Absenteeism / dropout Yes 175 0.73 (0.59–0.91) 0.037 No 117 2.27 – Caregiver discouragement Yes 182 0.85 (0.69–1.05) 0.222 No 110 1.69 – Poor road infrastructure Yes 209 1.39 (0.92–2.10) 0.108 No 83 0.72 – Fear of injection Yes 201 1.21 (0.83–1.77) 0.311 No 91 0.82 – Peer/Caregiver discouragement Yes 197 1.17 (0.79–1.72) 0.420 No 95 0.85 – Health System Factors Poor records management Yes 194 0.95 (0.72–1.26) 0.109 No 98 1.11 – Limited knowledge by health workers Yes 191 0.94 (0.70–1.24) 0.043 No 101 1.15 – No gov’t program for out of school girls Yes 198 0.97 (0.73–1.29) 0.035 No 94 1.06 – Shortage/cold chain issues Yes 193 1.75 (1.04–2.93) 0.004 No 99 0.52 – Untimely transport Yes 214 0.93 (0.74–1.17) 0.574 No 78 1.25 – Low staff motivation Yes 125 1.06 (0.80–1.41) 0.645 No 77 0.86 – Understaffing Yes 168 1.97 (1.05–3.68) 0.006 No 124 0.58 – Community Factors Rumors / misconceptions Yes 198 1.45 0.033 No 94 0.58 – Religious/cultural opposition Yes 176 1.59 0.031 No 116 0.62 – Mistrust of government Yes 176 1.80 0.009 No 116 0.58 – Busy stakeholder schedules Yes 177 1.29 0.190 No 115 0.73 – Long waiting time Yes 185 0.75 0.046 No 107 2.20 – Knowledge Factors Heard about HPV Yes 269 4.65 (1.89–11.45) 0.001 No 23 1.00 – Knowledge of eligible age Correct (9–14 yrs) 170 2.29 (1.47–3.56) < 0.001 Belief that vaccination is right Yes 262 3.57 (1.52–8.41) 0.003 Knowledge of correct doses Correct (2 doses) 74 2.20 (1.25–3.88) 0.005 Number of doses received One dose 149 1.20 (0.80–1.80) 0.370 Two doses (Ref) 98 1.00 – Don’t know 45 0.62 (0.35–1.12) 0.110 Source : Primary data, 2022 Note : Values that are significant are those with p values < 0.05 (p < 0.05). Since the sample size was limited, not estimable values from bivariate tables (such as those for distances less than one kilometer) were eliminated. Interpretation The results of a multivariate logistic regression analysis evaluating the variables linked to teenage girls' HPV vaccine uptake are shown in Table 2 above. Caretaker Relationship : Caregivers who were mothers had a significantly higher likelihood of having their daughters vaccinated (AOR = 1.70, 95% CI: 1.05–2.75, p = 0.030), indicating that maternal engagement increases vaccine uptake. Education Level : Lower education levels were significantly associated with lower vaccination rates. Caregivers with no formal education (AOR = 0.19, p = 0.033) and primary education (AOR = 0.50, p = 0.007) had significantly lower odds of low vaccine uptake compared to those with secondary education or higher. Occupation : Peasant caretakers had a considerably lower odds of low vaccine uptake compared to employed or business caregivers (AOR = 0.49, p = 0.013). Class Grade : Girls in Primary Four had the highest uptake (AOR = 1.00) while those in Primary Five (AOR = 0.19, p < 0.001) and Primary Six and Seven (AOR = 0.16, p < 0.001) had substantially reduced odds of vaccination. Other demographic factors, such as caretaker's age, gender, marital status, and distance to the health center, did not show statistically significant associations with HPV vaccine uptake in the multivariable model. 3.2 Individual Factors Associated with Low Uptake: Quantitative Findings (Table 3): Statement Variable option n (%) Inadequate knowledge about Human PapillomaVirus (HPV) can lead to low uptake. Yes 207 (70.9) No 85 (29.1) Change of residence from one location to another may lead to low uptake of the Human PapillomaVirus vaccine. Yes 110 (37.7) No 182 (62.3) Absenteeism and dropout from school Yes 175 (59.9) No 117 (40.1) Girls at the age of vaccination refuse to get vaccinated due to discouragement from caregivers. Yes 182 (62.3) No 110 (37.7) Poor roads that limit access to some schools may limit routine childhood vaccination. Yes 209 (71.6) No 83 (28.4) Fear of injection may discourage eligible children from getting vaccinated. Yes 201 (68.8) No 91 (31.2) Discouragement from vaccination by caregivers or peers. Yes 197 (67.5) No 95 (32.5) Source: Primary data, 2022 According to table three above, iinadequate knowledge about HPV was identified as a contributing factor by 70.9% of respondents. While 62.3% did not believe changing residence, absenteeism, or school dropout necessarily led to low uptake, 62.3% reported girls refusing the vaccine due to caregiver discouragement. Poor road conditions were cited as a barrier by 71.6%. Fear of injection was noted by 68.8%. Discouragement from caregivers or peers was believed to contribute by 67.5%. Bivariate Analysis (Table 4) Individual factor Variable Option N OR P-value Inadequate knowledge about HPV can lead to low uptake Yes 207 1.28 0.114 No 85 0.64 Change of residence may lead to low uptake Yes 110 0.50 0.001 No 182 2.14 Absenteeism and dropout from school Yes 175 0.73 0.037 Girls refuse vaccination due to caregiver discouragement Yes 182 0.85 0.222 No 110 1.69 Poor road infrastructure Yes 209 1.39 0.108 No 83 0.72 Fear of injection Yes 201 1.21 0.311 No 91 0.83 Discouragement from caregivers or peers Yes 197 1.17 0.420 No 95 0.85 Source: Primary data, 2022 From table four above, change of residence (OR = 0.50, p = 0.001) and school absenteeism (OR = 0.73, p = 0.037) were significant factors linked with lower odds of HPV vaccine completion. Multivariable Logistic Regression Analysis (Table 5) Factor Category Variable Variable Option n OR (95% CI) P-value Demographic Factors Age of Caretaker 20–30 35 0.65 (0.32–1.31) 0.220 31–40 107 0.94 (0.56–1.58) 0.820 41–50 125 1.42 (0.85–2.36) 0.180 50+ (Ref) 12 1.00 – Gender of Caretaker Female 149 2.18 (0.85–5.57) 0.096 Male (Ref) 7 1.00 – Caretaker Relationship Mother 128 1.70 (1.05–2.75) 0.030 Others (Ref) 28 1.00 – Education Level None 2 0.19 (0.04–0.87) 0.033 Primary 96 0.50 (0.30–0.83) 0.007 Secondary+ (Ref) 61 1.00 – Occupation Peasant 111 0.49 (0.28–0.87) 0.013 Employed/Business (Ref) 31 1.00 – Marital Status Married 134 1.43 (0.73–2.80) 0.280 Not Married (Ref) 22 1.00 – Distance to Health Center Distance to Health Center < 1 km 1 Not estimable – 1–3 km (Ref) 110 1.00 – 4–6 km 31 0.96 (0.53–1.74) 0.892 ≥ 6 km 13 1.03 (0.43–2.44) 0.947 Not aware 1 0.87 (0.05–15.4) 0.921 Class Level P2 3 0.89 0.17–4.54 0.87 P3 61 0.95 0.51–1.78 0.83 P4 (Reference) 107 1.00 (Ref) – 1.00 P5 62 0.93 0.49–1.75 0.78 P6 34 1.05 0.49–2.25 0.87 P7 25 1.12 0.48–2.61 0.74 Individual Factors Inadequate knowledge about HPV Yes 207 1.28 (0.89–1.84) 0.114 No 85 0.64 – Change of residence Yes 110 0.50 (0.37–0.69) 0.001 No 182 2.14 – Absenteeism / dropout Yes 175 0.73 (0.59–0.91) 0.037 No 117 2.27 – Caregiver discouragement Yes 182 0.85 (0.69–1.05) 0.222 No 110 1.69 – Poor road infrastructure Yes 209 1.39 (0.92–2.10) 0.108 No 83 0.72 – Fear of injection Yes 201 1.21 (0.83–1.77) 0.311 No 91 0.82 – Peer/Caregiver discouragement Yes 197 1.17 (0.79–1.72) 0.420 No 95 0.85 – Health System Factors Poor records management Yes 194 0.95 (0.72–1.26) 0.109 No 98 1.11 – Limited knowledge by health workers Yes 191 0.94 (0.70–1.24) 0.043 No 101 1.15 – No gov’t program for out of school girls Yes 198 0.97 (0.73–1.29) 0.035 No 94 1.06 – Shortage/cold chain issues Yes 193 1.75 (1.04–2.93) 0.004 No 99 0.52 – Untimely transport Yes 214 0.93 (0.74–1.17) 0.574 No 78 1.25 – Low staff motivation Yes 125 1.06 (0.80–1.41) 0.645 No 77 0.86 – Understaffing Yes 168 1.97 (1.05–3.68) 0.006 No 124 0.58 – Community Factors Rumors / misconceptions Yes 198 1.45 0.033 No 94 0.58 – Religious/cultural opposition Yes 176 1.59 0.031 No 116 0.62 – Mistrust of government Yes 176 1.80 0.009 No 116 0.58 – Busy stakeholder schedules Yes 177 1.29 0.190 No 115 0.73 – Long waiting time Yes 185 0.75 0.046 No 107 2.20 – Knowledge Factors Heard about HPV Yes 269 4.65 (1.89–11.45) 0.001 No 23 1.00 – Knowledge of eligible age Correct (9–14 yrs) 170 2.29 (1.47–3.56) < 0.001 Belief that vaccination is right Yes 262 3.57 (1.52–8.41) 0.003 Knowledge of correct doses Correct (2 doses) 74 2.20 (1.25–3.88) 0.005 Number of doses received One dose 149 1.20 (0.80–1.80) 0.370 Two doses (Ref) 98 1.00 – Don’t know 45 0.62 (0.35–1.12) 0.110 Source : Primary data, 2022 The regression analysis in the table 5 above revealed that a change of residence significantly reduced the likelihood of HPV vaccine uptake (AOR = 0.50, 95% CI: 0.37–0.69, p = 0.001). Similarly, school absenteeism or dropout was associated with lower odds of vaccination (AOR = 0.73, p = 0.037). Other individual factors such as inadequate knowledge about HPV, caregiver discouragement, poor road infrastructure, fear of injection, and negative peer or caregiver influence did not show statistically significant associations in the multivariable model. Qualitative Data Analysis (Thematic Presentation, Table 6) Theme Subtheme Categories Individual-Level Barriers Lack of Awareness Among Caregivers - Uncertainty about vaccination eligibility (e.g., belief that only girls below 10 qualify). - Limited knowledge about the HPV vaccine. Absenteeism and School Dropout - School absence due to unpaid fees, household responsibilities, or early menstruation. - Some parents keep children home for farm work. Relocation and School Transfers - Families frequently relocate, disrupting vaccine follow-ups. - Parents are often uninformed about vaccination continuity Physical Barriers - Hard-to-reach areas with poor road networks limit vaccine access. Fear of Injection Pain -Adolescents hesitate to complete the HPV vaccination Negative Influence from Caregivers or Peers -Care givers hold misconceptions. -Peers sharing stories of adverse effects or express skepticism Health facility barriers Limited Knowledge Among Healthcare Workers, VHTs, and Teachers - Unclear understanding of HPV vaccination guidelines. Cold Chain and Logistical Challenges - Shortages of ice packs limit the number of doses transported. - Some facilities lack refrigeration for proper vaccine storage. Inadequate Community Engagement and Mobilization - Shortages of ice packs limit the number of doses transported. - Some facilities lack refrigeration for proper vaccine storage Inadequate Community Engagement and Mobilization - Seasonal activities prevent girls from accessing vaccine information. - Many families remain unaware of vaccination campaigns. Transportation Challenges - Lack of reliable transport disrupts vaccine delivery. - Canceled or delayed vaccination sessions cause frustration. Expectations of Monetary Incentives - Healthcare workers and teachers are demotivated by inadequate allowances Staff Shortages - Limited personnel available for vaccination services. Unfriendly Behavior from Healthcare Workers - Some healthcare workers exhibit rude or discouraging attitudes. Community Level Barriers Rumors and Misconceptions Beliefs that the vaccine promotes early sexual activity. - Concerns about infertility and reproductive health risks. Traditional and Religious Beliefs - Perceptions that vaccination contradicts cultural or religious norms. - Some believe being vaccinated violates traditional rules. The qualitative findings from table 6 above, expanded on these results, highlighting several individual-level barriers. Many caregivers lacked accurate knowledge about HPV vaccination, with some believing it was only intended for girls under 10 years old a misconception confirmed by healthcare workers. School absenteeism and dropout, driven by factors such as unpaid fees, household duties, farm work, and early menstruation, limited girls’ access to school-based vaccination programs. Frequent changes in residence and school transfers disrupted follow-up and contributed to missed doses. Physical barriers, particularly poor rural road infrastructure, made reaching vaccination sites difficult. Fear of injection pain, often amplified by peer accounts, also discouraged completion of the vaccination series. Additionally, caregiver and peer discouragement, sometimes fueled by myths about infertility or adverse effects, undermined trust in the vaccine and reduced uptake 4. Discussion The low HPV vaccine uptake in Rukiga District is significantly influenced by a complex interplay of demographic characteristics and individual consistent with the Health Belief Model (HBM) [12]. 4.1 Caregiver Relationship and Gender: Maternal involvement emerged as a critical demographic predictor, with daughters of mothers as primary caregivers having significantly higher odds of completing the HPV vaccine series (AOR = 1.70, p = 0.030) [21,22]. This aligns with the HBM's "cues to action" and "self-efficacy" constructs, as mothers often serve as trusted guides who clarify vaccine-related questions and provide emotional support, thereby alleviating worries and countering misinformation. This finding is consistent with previous research by [23] which emphasize the crucial role of maternal influence in vaccination acceptability. However, the effectiveness of maternal engagement can be moderated by broader socioeconomic factors, as observed by [24] in Gulu, Uganda, where lower uptake was noted among girls with single or unmarried mothers due to financial pressures and caregiving difficulties. This suggests a need for targeted interventions that empower mothers through education while also addressing structural barriers in vulnerable households. 4.2 Caregiver Education and Occupation: Caregiver education significantly impacted HPV vaccine uptake. Caregivers with no formal education (AOR = 0.19, p = 0.033) and primary education (AOR = 0.50, p = 0.007) were significantly less likely to vaccinate their daughters compared to those with secondary education or higher [25]. Qualitative data revealed that more educated caregivers tend to access accurate health information and possess a better understanding of vaccination benefits which boosts confidence in vaccine decisions. This aligns with the HBM’s emphasis on reduced perceived barriers and increased self-efficacy among educated individuals. This supports findings from [25,26]. Similarly, occupation played a role, with peasant farmers having significantly lower odds of vaccine uptake (AOR = 0.49, p = 0.013) compared to employed caregivers. This is likely due to economic constraints and lower health literacy, reinforcing perceived obstacles within the HBM framework. These results underscore the critical need for accessible, culturally appropriate health education tailored for low-literacy populations and flexible vaccination hours to accommodate working and farming caregivers. 4.3 Class Grade Absenteeism and Change of Residence: The class grade of the adolescent girl was a significant predictor of HPV vaccine uptake. Girls in Primary Four, the targeted class, showed the highest uptake (AOR = 1.00) while those in Primary Five (AOR = 0.19, p < 0.001) and Primary Six and Seven (AOR = 0.16, p < 0.001) had substantially reduced odds of vaccination [27]. This highlights the effectiveness of school-based programs in specific grades acting as "cues to action" and increasing perceived susceptibility and benefits. However, school absenteeism (AOR = 0.73, p = 0.037) and changes in residence (AOR = 0.50, p = 0.001) significantly hindered HPV vaccine completion [28]. Qualitative findings clarified that factors such as menstruation, unpaid school fees, and household responsibilities contributed to absenteeism, while family relocations disrupted vaccination continuity. These interruptions increase perceived barriers and weaken cues to action and self-efficacy within the HBM. These findings are consistent with [27,28]. This necessitates flexible vaccination strategies, including catch-up clinics and interoperable digital health records, to track and reach mobile and out-of-school populations. 4.4 Individual Beliefs and Perceived Barriers: While not always statistically significant in the multivariable model, qualitative data strongly indicated the presence of psychological and perceptual barriers at the individual level associated with low uptake of HPV vaccine uptake. Fear of injection pain, negative peer influence and caregiver discouragement due to misinformation and cultural fears (e.g., regarding fertility) were frequently cited [29]. These beliefs act as significant "perceived barriers" within the HBM, increasing anticipated discomfort or harm and reducing confidence in vaccination. Although quantitative analysis did not find statistical significance for these specific individual factors in the final model (e.g., fear of injection: AOR=1.21, p=0.311) their prominence in qualitative accounts suggests they are crucial underlying determinants that affect self-efficacy and cues to action. 5. Conclusion Low HPV vaccine series completion in Rukiga District is primarily driven by caregiver knowledge gaps, socioeconomic disparities, and systemic limitations in health service delivery [10,12]. The vital role of mothers (AOR = 1.70; p = 0.030) underscores the importance of gender-sensitive health education. Socioeconomic disparities linked to caregiver education (AOR = 0.19 for no formal education; p = 0.033) and occupation (AOR = 0.49 for peasants; p = 0.013) exacerbate uptake challenges. Crucially, individual barriers such as change of residence (AOR = 0.50; p = 0.001) and school absenteeism (AOR = 0.73; p = 0.037) disrupt vaccination continuity [12]. These findings highlight that improving HPV vaccine coverage requires integrated interventions that specifically target caregivers through enhanced health literacy, leverage maternal influence, and implement flexible vaccination strategies to reach mobile and out-of-school adolescents. 6. Recommendations 6.1 Short-Term Recommendations (0–12 Months) To improve vaccine uptake, targeted, culturally sensitive educational campaigns should focus on mothers and female guardians, as maternal status increases vaccination odds. Simplified IEC materials tailored to low-literacy caregivers should be delivered via trusted community channels to close knowledge gaps. School absenteeism’s impact on access can be mitigated through school-based monitoring and local leader follow-ups. Additionally, SMS reminder systems and mobile tracking tools are vital to support adolescents from mobile households in completing vaccine doses on time. 6.2 Medium-Term Recommendations (1–3 Years) National policy should shift from grade-based to age-based HPV vaccination to include mobile and out-of-school adolescents. Scheduling vaccination during off-peak farming seasons, aligned with agricultural calendars, will improve uptake among peasant farming households who currently have lower vaccination rates. 6.3 Implementation Considerations To maximize SMS reminder effectiveness, challenges like limited phone access, poor network coverage, and privacy must be addressed by introducing voice calls, printed reminders, and community follow-ups through VHTs, especially in rural and mobile populations. 6.4 Stakeholder-Specific Recommendations The Ministry of Health should revise HPV vaccination policy to age-based eligibility, with success measured by district adoption rates. VHTs should lead community outreach and follow-up for missed doses, tracked by session numbers and caregiver knowledge improvement. Schools should integrate HPV education into health curricula and organize catch-up vaccination days to increase completion rates. 7. Study Limitations The cross-sectional design limits causal inference between factors and vaccine uptake. Self-reported caregiver data may be affected by recall and social desirability biases. Findings are specific to one district, limiting generalizability across Uganda’s diverse settings. Interviewer bias cannot be fully excluded despite training. The study mainly reflects caregiver perspectives; including adolescent girls, facility managers, and policymakers would provide a more comprehensive view. 8. Future Research Directions Future studies should explore male caregiver involvement in vaccination decisions across rural and urban settings, education levels, and HPV information exposure using mixed methods to identify engagement opportunities. Implementation science research comparing school- and clinic-based vaccine delivery, with or without SMS reminders, should assess effectiveness and cost-efficiency via cluster randomized trials to guide program design and resource allocation. 9. Cultural and Contextual Considerations: This study deepens the understanding of how Uganda’s cultural and religious environment shapes HPV vaccine uptake. The finding that religious engagement enhances vaccination (AOR = 0.62) may reflect the trusted role of churches and mosques in health communication and alignment between cancer prevention and religious values of protecting life. This contrasts with some Western contexts, where religious narratives have occasionally impeded vaccine uptake. Future interventions should therefore be locally tailored, building partnerships with faith-based organizations to foster vaccine acceptance. 10. Application and Policy Connections The results are in line with Uganda's 2025 Health Sector Development Plan (HSDP), namely the 25% increase in adolescent immunization coverage. Specific connections include strengthening cooperation with the education sector for school-based delivery, assisting Village Health Teams (VHTs) with tracking and awareness initiatives for community outreach, and resolving obstacles for nomadic and out-of-school populations to ensure fair access. Example of an Implementation Framework: Making the Switch to Age-Based Vaccination : Administrative changes, such as updating Ministry of Health and Education joint protocols and school records with birth dates, are necessary. Capacity building involves teaching medical staff age verification and educating educators on new standards and referral channels. Monitoring coverage by age groups (lasting one year) and comparing uptake between girls who attend school and those who do not is essential. Launching trial projects in two to three districts to assess reach, adoption, and sustainability using the RE-AIM paradigm is recommended prior to nationwide implementation. Abbreviations AOR Adjusted Odds Ratio COR Crude Odds Ratio EPI Expanded Programme on Immunization and vaccination HBM Health Belief Model HPV Human Papilloma Virus MUST Mbarara University of Science and Technology UNCS Uganda National Council for Science and Technology OR Odds Ratio REC Research Ethics Committee SPSS Statistical Package for the Social Sciences VHT Village Health Team Declarations Ethics Approval and Consent to Participate . This study was conducted in accordance with the Declaration of Uganda National Council for Science and Technology and all applicable ethical guidelines for research involving human participants. Clearance to conduct this study was obtained from the Department of community at Kable, under registration number 2018/MPH/1659/W. Further ethical approval was granted by office of District Health officer Rukiga District and final clearance for data collection was obtained from the Uganda National Council for Science and Technology (UNCST), reference number MUST-2022-511. Informed consent was obtained from all participants prior to their involvement in the study. Consent for Publication . The researchers obtained written consent to use quotes from participants in publications. Data Availability . The primary study document, including the detailed information and dataset used and analyzed, is available upon reasonable request from the corresponding author. Competing Interests . The authors hereby declare that they have no competing interests. Funding . No external funding was received for this work Authors’ Contributions . Mbonigaba Rukarama Evarist (MRE) conceptualized the study, designed the study framework, led data collection and interpretation, prepared the manuscript, and reviewed the paper. He is the principal investigator. Ronald Arineitwe Kibonire (RAK), as co-author, provided guidance throughout the study's conception, design, data collection, and analysis phases, reviewed the manuscript, and offered valuable feedback for refinement. Acknowledgements . We express our gratitude to the community of Rubanda for their participation in this study. Our sincere thanks go to the Office of the District Health Officer of Rukiga District for granting us permission to conduct the research in the district. We also extend special appreciation to the health facility staff of the selected facilities of Rukiga District and VHT members for their support in coordinating and mobilizing respondents for the study and even also giving their views as participants. 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Obstetrics and Gynecology Clinics, 49(4), 771-781. Dzinamarira, T., Moyo, E., Dzobo, M., Mbunge, E., & Murewanhema, G. (2023). Cervical cancer in sub-Saharan Africa: an urgent call for improving accessibility and use of preventive services. International Journal of Gynecological Cancer, 33(4), 592-597. Amin, S., & Ashraf, F. (2024). Beyond the Glass Ceiling: Leveraging Impression Management for Women's Career Success. NUML International Journal of Business & Management, 19(2). Natalie Anumolu, Kia Lechleitner, Nisha Patel, Andrew Mijumbi, C. Jankowski, R. Anguzu, S. Kasasa, Rachel Weber, Julia Dickson-Gomez, C. Banura, K. Beyer Journal of global health reports·2022 Kajabwangu, R., Bajunirwe, F., Izudi, J., Bazira, J., Farjardo, Y., Ssedyabane, F., ... & Ngonzi, J. (2024). Magnitude and trends in cervical cancer at Mbarara Regional Referral Hospital in South Western Uganda: Retrospective analysis of data from 2017–2022. PLOS Global Public Health, 4(1), e0002848. Patrick, L., Bakeera-Kitaka, S., Rujumba, J., & Malande, O. O. (2022). Encouraging improvement in HPV vaccination coverage among adolescent girls in Kampala, Uganda. PloS one, 17(6), e0269655. District Health Information Software 2 (DHIS2)(2024). Rukiga District HPV vaccination data. Ministry of Health, Uganda. Rujumba, J., Akugizibwe, M., Basta, N. E., & Banura, C. (2021). Why don’t adolescent girls in a rural Uganda district initiate or complete routine 2-dose HPV vaccine series: Perspectives of adolescent girls, their caregivers, healthcare workers, community health workers and teachers. PloS one, 16(6), e0253735. Wang, W., Kothari, S., Baay, M., Garland, S. M., Giuliano, A. R., Nygård, M., ... & Sundström, K. (2022). Real-world impact and effectiveness assessment of the quadrivalent HPV vaccine: a systematic review of study designs and data sources. Expert Review of Vaccines, 21(2), 227-240. Agimas, M. C., Adugna, D. G., Derseh, N. M., Kassaw, A., Kassie, Y. T., Abate, H. K., & Mekonnen, C. K. (2024). Uptake of human papilloma virus vaccine and its determinants among females in East Africa: a systematic review and meta-analysis. BMC Public Health, 24(1), 842. Asgedom, Y. S., Kebede, T. M., Seifu, B. L., Mare, K. U., Asmare, Z. A., Asebe, H. A., ... & Kassie, G. A. (2024). Human papillomavirus vaccination uptake and determinant factors among adolescent schoolgirls in sub-Saharan Africa: A systematic review and meta-analysis. Human vaccines & immunotherapeutics, 20(1), 2326295. Rukiga NHPC, 2024. https://statistics.ubos.org/nphc/drilldown?subregion Mihretie, G. N., Liyeh, T. M., Ayele, A. D., Belay, H. G., Yimer, T. S., & Miskr, A. D. (2022). Knowledge and willingness of parents towards child girl HPV vaccination in Debre Tabor Town, Ethiopia: a community-based cross-sectional study. Reproductive health, 19(1), 136. Davies, C., Stoney, T., Hutton, H., Parrella, A., Kang, M., Macartney, K., ... & Skinner, S. R. (2021). School-based HPV vaccination positively impacts parents’ attitudes toward adolescent vaccination. Vaccine, 39(30), 4190-4198. Humnesa, H., Aboma, M., Dida, N., & Abebe, M. (2022). Knowledge and attitude regarding human papillomavirus vaccine and its associated factors among parents of daughters age between 9-14 years in central Ethiopia, 2021. Journal of Public Health in Africa, 13(3), 2129. Jahrami, H., Trabelsi, K., Saif, Z., Manzar, M. D., Bahammam, A. S., & Vitiello, M. V. (2023). Reliability generalization meta-analysis of the Athens Insomnia Scale and its translations: Examining internal consistency and test-retest validity. Sleep Medicine, 111, 133-145. Chido-Amajuoyi, O. G., Talluri, R., Jackson, I., Shete, S. S., Fokom Domgue, J., & Shete, S. (2022). The influence of parent–child gender on intentions to refuse HPV vaccination due to safety concerns/side effects, national immunization survey–Teen, 2010–2019. Human Vaccines & Immunotherapeutics, 18(5), 2086762. Mansfield, L. N., Chung, R. J., Silva, S. G., Merwin, E. I., & Gonzalez-Guarda, R. M. (2022). Social determinants of human papillomavirus vaccine series completion among US adolescents: a mixed-methods study. SSM-population health, 18, 101082. Gray, A., & Fisher, C. B. (2023). Factors associated with HPV vaccine acceptability and hesitancy among black mothers with young daughters in the United States. Frontiers in Public Health, 11, 1124206. Aruho, C., Mugambe, S., Baluku, J. B., & Taremwa, I. M. (2022). Human papillomavirus vaccination uptake and its predictors among female adolescents in Gulu Municipality, Northern Uganda. Adolescent Health, Medicine and Therapeutics, 77-91. Agha, S., & Nsofor, I. (2025). HPV vaccine uptake among adolescent girls in Nigeria: The complex role of caregivers’ education. PLoS One, 20(7), e0325684. Agha, S., Bernard, D., Francis, S., Fareed, A., & Nsofor, I. (2024). Determinants of human papillomavirus vaccine acceptance among caregivers in Nigeria: a fogg behavior model-based approach. Vaccines, 12(1), 84. Bitariho, G. K., Tuhebwe, D., Tigaiza, A., Nalugya, A., Ssekamatte, T., & Kiwanuka, S. N. (2023). Knowledge, perceptions and uptake of human papilloma virus vaccine among adolescent girls in Kampala, Uganda; a mixed-methods school-based study. BMC pediatrics, 23(1), 368. Dionne, M., Étienne, D., Witteman, H. O., Sauvageau, C., & Dube, E. (2024). Impact of interventions to improve HPV vaccination acceptance and uptake in school-based programs: Findings of a pilot project in Quebec. Vaccine, 42(18), 3768-3773. MacDonald, S. E., Kenzie, L., Letendre, A., Bill, L., Shea-Budgell, M., Henderson, R., ... & Nelson, G. (2023). Barriers and supports for uptake of human papillomavirus vaccination in Indigenous people globally: A systematic review. PLOS Global Public Health, 3(1), e0001406. Mbonigaba Rukarama Evarist. (2025). factors associated with low uptake of human papilloma virus (HPV) vaccination series in adolescent girls in Rukiga district. (research dissertation-not published, Questionnaire and Interview Guide). Kabale University. research dissertation submitted in partial fulfilment for the requirements of the award of master’s degree of public health of Kabale University.july, 2025. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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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-7596350","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"comment","associatedPublications":[],"authors":[{"id":514084429,"identity":"793adb1b-3dc2-4094-a453-7da076eb18f1","order_by":0,"name":"Mbonigaba Rukarama Evarist","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAyklEQVRIiWNgGAWjYFACHiA2YGDgB7ETCkjRItkA0mJAtBaQrgMMEL0EAb/Y2YOPCwps7I3Pr0788MCAQZ5f7AB+LZKz85KNZxikJW678XazBNBhhjNnJ+DXYnA7x0yax+BwgtmNsxtAWhIMbhPQYg/R8t/eeMbZzT+I0mIgDdZygHEDf+824myRuA30C49BcuKMG7zbLBIMJAj7hX927sHHPH/s7Pn7z26++aPCRp5fmoAWJPvAKiWIVQ627wApqkfBKBgFo2AkAQBAUz/aTNcgHQAAAABJRU5ErkJggg==","orcid":"","institution":"Kabale University","correspondingAuthor":true,"prefix":"","firstName":"Mbonigaba","middleName":"Rukarama","lastName":"Evarist","suffix":""},{"id":514084431,"identity":"e8881526-e3c3-48ea-b6bc-586b76948dd0","order_by":1,"name":"Ronald Arineitwe Kibonire","email":"","orcid":"","institution":"Kabale University","correspondingAuthor":false,"prefix":"","firstName":"Ronald","middleName":"Arineitwe","lastName":"Kibonire","suffix":""}],"badges":[],"createdAt":"2025-09-12 04:23:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7596350/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7596350/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":91402778,"identity":"b8e9b4b4-84bf-48c4-bc7a-3d3c9d82194e","added_by":"auto","created_at":"2025-09-16 07:17:36","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2275064,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7596350/v1/a26dc5fe-84c1-4b9f-b7f7-ed03342d69de.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Navigating the Divide – Demographic and Individual Predictors of Low HPV Vaccine Uptake in Rural Uganda","fulltext":[{"header":"1. Introduction/Background","content":"\u003cp\u003eCervical cancer remains a major global public health issue, ranking fourth in incidence and mortality among women worldwide [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. It disproportionately affects women in low- and middle-income countries, with Sub-Saharan Africa bearing the highest incidence and a significant portion of the global burden [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Around 90% of related deaths occur in developing regions due to limited access to screening, vaccination and treatment. Persistent infection with high-risk HPV types, mainly HPV16 and HPV18, accounts for about 80% of cases globally [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. These trends emphasize the need for improved prevention through HPV vaccination, screening, and early treatment, especially in high-burden areas [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn Uganda, cervical cancer is the leading cause of cancer-related deaths among women, making up nearly 40% of all female cancer cases [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The country\u0026rsquo;s cervical cancer incidence and mortality rates (56.7 and 40.1 per 100,000 women) are significantly above global averages [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Uganda began HPV vaccine demonstrations in 2006 and integrated it into routine immunization in 2015. While the first dose uptake is high, completion of the two-dose schedule remains low due to poor follow-up, weak record systems, vaccine shortages, low staff motivation, misinformation, and limited community involvement [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. In Rukiga District, first-dose coverage is strong through school outreach, but second-dose uptake has dropped, with a 23.49% dropout rate, threatening full protection for girls aged 9\u0026ndash;14 [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIdentifying the demographic, individual, health system, and community-level factors contributing to low HPV vaccine uptake is essential for developing effective interventions in high-burden rural areas like Rukiga [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Key influences include caregiver characteristics, household conditions, and adolescent girls\u0026rsquo; personal beliefs such as fear of injection. This study aims to explore these determinants to inform policy decisions and enhance completion of the HPV vaccine series\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cp\u003e\u003cstrong\u003e2.1 Research Approach and Study Design:\u003c/strong\u003e This study employed a cross-sectional mixed-methods approach, combining quantitative and qualitative data collection to comprehensively assess HPV vaccination uptake [13,14,15]. The cross-sectional design was chosen for its efficiency in assessing relationships between variables at a single point in time, providing a snapshot of the factors influencing HPV vaccine uptake.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2 Study Setting:\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe study was conducted in Rukiga District in southwestern Uganda, which borders Ntungamo District, the Republic of Rwanda, Kabale District, Rubanda District, and Rukungiri District. It has a total land area of 426.3 km² and a total population of 132,355 people by sex, with 29,495 total households and a population density of 268/km² [16]. The district was purposefully chosen due to its HPV vaccination program implementation, rural setting, limited access to health facilities, and integration into Uganda's Expanded Program for Immunization. Two sub-counties were selected because of their lower vaccination rates and accessibility issues.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3 Study Population and Sampling:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQuantitative Study:\u003c/strong\u003e The quantitative population included parents and guardians of adolescent girls aged 9-14 years eligible to receive the HPV vaccine. They were chosen because they are ultimately in charge of making decisions about whether or not to accept or refuse the vaccine among their children, even when vaccination is provided in school-based programs. Minors (under 18) were excluded as primary respondents since vaccination would have to be given at school hours when they would be away from their parents or other caregivers [17,18].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQualitative Study:\u003c/strong\u003e Key informants for the qualitative part of this study consisted of health workers and Village Health Team (VHT) members [12,19] Health workers directly implement vaccination service delivery, while VHTs represent the immediate linkage of the health system to the population, providing health education and addressing myths and misconceptions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3.1 Sampling Technique/Method:\u003c/strong\u003e A multistage sampling approach was used. Two sub-counties characterized by lower HPV vaccination rates and accessibility challenges were purposively selected. Parishes within these sub-counties were chosen through simple random sampling, and villages were then randomly selected. Households with adolescent girls aged 9 to 14 years, based on Village Health Team records, were selected proportionally to village size, followed by systematic random sampling, resulting in a final sample of 292 parents or caregivers. For qualitative data, 11 health workers involved in EPI and HPV vaccination, and 10 VHT members from the selected villages, were purposively sampled.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3.2 Sample Size and Determination:\u003c/strong\u003e The sample size for the quantitative study was calculated using Cochrane’s equation, assuming a 95% confidence level and a P value of 0.05.\u003c/p\u003e\n\u003cp\u003en0=Z\u003csup\u003e2\u003c/sup\u003epq/ e\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eWhere:\u003c/p\u003e\n\u003cp\u003en0 = required sample size\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eZ = Z-score (1.96 for 95% CI)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ep = estimated proportion (0.5 for maximum variability)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ee = Desired level of precision (0.05)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eq=1−p\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis yielded n0=385.\u003c/p\u003e\n\u003cp\u003eFor a finite population (N=1200 households), the Cochran sample size correction was applied:\u003c/p\u003e\n\u003cp\u003en=1+N(n0−1) /n0\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSubstituting the values:\u003c/p\u003e\n\u003cp\u003en=1+1200(385−1) /385=1+1200(384) /385=1+0.32/385=1.32/385=291.666667=292\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThus, 292 households were included in the study as the adjusted sample size to select the parents and caregivers of the eligible adolescent girls.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3.3 Inclusion and Exclusion Criteria:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion:\u003c/strong\u003e Parents or primary caregivers of adolescent girls aged 9-14 years found at home from selected sub-counties in Rukiga District who provided informed consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eExclusion:\u003c/strong\u003e Households where caregivers had significant cognitive or hearing impairments, and child-headed households, due to challenges in obtaining reliable responses.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.4 Study Variables:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDependent variable:\u003c/strong\u003e Low uptake of HPV vaccination series.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIndependent variables:\u003c/strong\u003e Individual level barriers: Inadequate knowledge, absenteeism, dropping out of school, change of residence, poor infrastructure, fear of injection, caregiver discouragement, and peer discouragement.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.5 Data Collection Methods:\u003c/strong\u003e A mixed-methods approach was used, combining semi-structured interviewer-administered questionnaires for quantitative data and Key Informant Interviews (KIIs) for qualitative data. Ten trained research assistants conducted household visits, and the semi-structured design allowed for standardized responses and in-depth insights.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.5.1 Development of Interview Guides:\u003c/strong\u003e The questionnaire and interview guides were developed specifically for this study, drawing from a comprehensive review of existing literature on HPV vaccine uptake and adapting relevant items from tools used in similar studies to enhance content validity. These instruments were designed by the principal investigator, translated into the predominant local language spoken in the study area, and subsequently back-translated into English to ensure linguistic and conceptual accuracy [30]. These tools were newly developed for this research and have not been previously published elsewhere.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.5.2 Pre-testing Tools:\u003c/strong\u003e Tools were piloted in Kashaki Village, an external site, with 40 parents/caretakers and in-depth interviews with three health workers and two VHT members. Pre-testing ensured clarity, cultural appropriateness, and allowed for revisions and standardization of the tools. Interviews were conducted in Rukiga or Runyankole for parents/caretakers, and English for health workers.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.5.3 Recruitment and Training of Research Assistants:\u003c/strong\u003e Ten research assistants with good knowledge of English and Rukiga-Runyankole, medical backgrounds, and interview experience were recruited and trained. They were supervised daily to ensure accuracy and completeness of data collection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.5.4 Data Collection Tools and Field Editing:\u003c/strong\u003e Data was collected using pre-tested semi-structured questionnaires and checklists. Field editing was performed daily to ensure accuracy, completeness, and address non-responses.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.6 Validity and Reliability of the Research Instrument:2.6.1 Quantitative Data:\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eValidity:\u003c/strong\u003e Content validity was ensured through expert consultations and literature review, and construct validity was assessed through pilot testing. Face validity was ensured by involving VHT members in reviewing the instrument for clarity, cultural appropriateness, and relevance.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eReliability:\u003c/strong\u003e Confirmed through Cronbach’s alpha (0.72 to 0.83), indicating good internal consistency, and test-retest reliability (0.82) showing strong stability over time [20].\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003e2.6.2 Qualitative Data:\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eValidity:\u003c/strong\u003e Member checking was employed by presenting preliminary results to selected participants to confirm accuracy of interpretations.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eReliability:\u003c/strong\u003e Intercoder reliability was applied, with multiple researchers independently coding transcripts and resolving discrepancies through consensus.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003e2.7 Data Quality Control:\u003c/strong\u003e Quality control was ensured through adequate questionnaires, proper identification of key informants, training of research assistants, daily supervision, review, and entry of data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.8 Data Management and Analysis:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQuantitative Data Analysis:\u003c/strong\u003e Data was checked for completeness and accuracy, entered into Epi-Info, and then transferred to SPSS for analysis. Univariate analysis generated frequency tables and descriptive parameters. Bivariate analysis compared the dependent variable with independent variables using confidence intervals and p-values. Multivariable logistic regression analysis adjusted for confounding and determined factors associated with HPV vaccine uptake, including all variables from bivariate analysis regardless of their initial p-values, to account for potential confounders or clinically/theoretically significant variables.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQualitative Data Analysis:\u003c/strong\u003e Open-ended responses were systematically coded by allocating them to frequent themes, allowing structured interpretation and identification of trends and patterns between participant responses.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.9 Ethical Consideration:\u003c/strong\u003e Approval was obtained from Kabale University and Mbarara University Research Ethics Committee. Permission was also sought from the Rukiga District Health Officer. Respondents were informed about the study objectives and process and informed consent was obtained with participation being voluntary and confidentiality maintained.\u003c/p\u003e"},{"header":"3. Results","content":"\u003cp\u003eOf the 292 respondents, 42.8% were aged 41\u0026ndash;50, and 36.6% were 31\u0026ndash;40 years old. All participants were from rural areas (100%). The majority of respondents were female (93.5%), mothers (72.9%), peasants (80.8%), and married (84.9%). Most adolescent daughters were aged 11\u0026ndash;13 (60.3%), followed by 14\u0026ndash;15 years (21.9%). The overall completion rate for the two-dose HPV vaccination series was 27.49%.\u003c/p\u003e\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003e3.1 Demographic Characteristics and HPV Vaccine Uptake: Bivariate Analysis of Key Variables (Table\u0026nbsp;1):\u003c/h2\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003en\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eCOR\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e95% CI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge of caretaker\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20\u0026ndash;30 (ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e31\u0026ndash;40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e107\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.65\u0026ndash;2.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.451\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e41\u0026ndash;50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e125\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.82\u0026ndash;3.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.165\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e50+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.39\u0026ndash;3.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.837\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDaughter\u0026rsquo;s age\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8\u0026ndash;10 (ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11\u0026ndash;13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e176\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.10\u0026ndash;3.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.023\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14\u0026ndash;15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.72\u0026ndash;3.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.264\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16\u0026ndash;18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.13\u0026ndash;4.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.805\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eArea of residence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRural (ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e292\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender of caretaker\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale (ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e273\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.48\u0026ndash;4.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.506\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCaretaker relationship\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMother (ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e213\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGrandparent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.24\u0026ndash;2.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.636\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHouse help/maid\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.10\u0026ndash;1.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.176\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFather\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.28\u0026ndash;2.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.831\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAunt\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.22\u0026ndash;5.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.902\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBrother\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.07\u0026ndash;2.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.343\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSister\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.43\u0026ndash;2.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.853\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEducation level\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNone (ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePrimary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e192\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.56\u0026ndash;11.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.230\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSecondary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.62\u0026ndash;13.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.177\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTertiary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.74\u0026ndash;19.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.107\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOccupation of caretaker\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePeasant (ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e236\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBusiness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.71\u0026ndash;3.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.274\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEmployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.92\u0026ndash;5.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.076\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMaid\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.07\u0026ndash;5.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.677\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarital status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSingle (ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e248\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.82\u0026ndash;4.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.135\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDivorced\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.38\u0026ndash;3.97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.738\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWidow\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.12\u0026ndash;7.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.991\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAccording to table 1 above, the bivariate analysis looked at the relationship between demographic factors and HPV vaccine uptake among teenage girls aged 9 to 14 in Rukiga District. Although many demographic characteristics had no statistically significant relationship with vaccine uptake, some trends appeared that require additional investigation.\u003c/p\u003e\u003cp\u003eThe age of the adolescent daughter had a significant impact on uptake, with girls aged 11 to 13 being twice as likely to have received the vaccine as those aged 8 to 10 (COR\u0026thinsp;=\u0026thinsp;2.01; 95% CI: 1.10\u0026ndash;3.67; p\u0026thinsp;=\u0026thinsp;0.023). Employed caregivers showed a borderline significance with higher uptake (COR\u0026thinsp;=\u0026thinsp;2.23; p\u0026thinsp;=\u0026thinsp;0.076) compared to peasants. Higher education levels were associated with greater vaccination probabilities, though not statistically significant at the bivariate level; caregivers with tertiary education were nearly four times as likely to ensure their daughters received vaccinations than those without formal education (COR\u0026thinsp;=\u0026thinsp;3.83; p\u0026thinsp;=\u0026thinsp;0.107).\u003c/p\u003e\u003cp\u003e\u003cb\u003eMultivariable Logistic Regression Analysis (Table\u0026nbsp;2)\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabb\" border=\"1\"\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFactor Category\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eVariable Option\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003en\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eOR (95% CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDemographic Factors\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAge of Caretaker\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20\u0026ndash;30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.65 (0.32\u0026ndash;1.31)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.220\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e31\u0026ndash;40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e107\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.94 (0.56\u0026ndash;1.58)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.820\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e41\u0026ndash;50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e125\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.42 (0.85\u0026ndash;2.36)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.180\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e50+ (Ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGender of Caretaker\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e149\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.18 (0.85\u0026ndash;5.57)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.096\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMale (Ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCaretaker Relationship\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMother\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e128\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.70 (1.05\u0026ndash;2.75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.030\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eOthers (Ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEducation Level\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.19 (0.04\u0026ndash;0.87)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.033\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePrimary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.50 (0.30\u0026ndash;0.83)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.007\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSecondary+ (Ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOccupation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePeasant\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e111\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.49 (0.28\u0026ndash;0.87)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.013\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eEmployed/Business (Ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMarital Status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e134\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.43 (0.73\u0026ndash;2.80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.280\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNot Married (Ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDistance to Health Center\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDistance to Health Center\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;1 km\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNot estimable\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u0026ndash;3 km (Ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e110\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4\u0026ndash;6 km\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.96 (0.53\u0026ndash;1.74)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.892\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;6 km\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.03 (0.43\u0026ndash;2.44)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.947\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNot aware\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.87 (0.05\u0026ndash;15.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.921\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eClass Level\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.17\u0026ndash;4.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.87\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.51\u0026ndash;1.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.83\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP4 (Reference)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e107\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.00 (Ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.49\u0026ndash;1.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.78\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.49\u0026ndash;2.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.87\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.48\u0026ndash;2.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.74\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIndividual Factors\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInadequate knowledge about HPV\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e207\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.28 (0.89\u0026ndash;1.84)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.114\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eChange of residence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e110\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.50 (0.37\u0026ndash;0.69)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e182\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAbsenteeism / dropout\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e175\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.73 (0.59\u0026ndash;0.91)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.037\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e117\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCaregiver discouragement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e182\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.85 (0.69\u0026ndash;1.05)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.222\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e110\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePoor road infrastructure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e209\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.39 (0.92\u0026ndash;2.10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.108\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFear of injection\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e201\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.21 (0.83\u0026ndash;1.77)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.311\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePeer/Caregiver discouragement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e197\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.17 (0.79\u0026ndash;1.72)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.420\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHealth System Factors\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePoor records management\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e194\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.95 (0.72\u0026ndash;1.26)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.109\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLimited knowledge by health workers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e191\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.94 (0.70\u0026ndash;1.24)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.043\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e101\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo gov\u0026rsquo;t program for out of school girls\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e198\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.97 (0.73\u0026ndash;1.29)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.035\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eShortage/cold chain issues\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e193\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.75 (1.04\u0026ndash;2.93)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.004\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUntimely transport\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e214\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.93 (0.74\u0026ndash;1.17)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.574\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLow staff motivation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e125\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.06 (0.80\u0026ndash;1.41)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.645\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUnderstaffing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e168\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.97 (1.05\u0026ndash;3.68)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.006\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e124\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCommunity Factors\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRumors / misconceptions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e198\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.033\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReligious/cultural opposition\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e176\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.031\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e116\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMistrust of government\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e176\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.009\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e116\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBusy stakeholder schedules\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e177\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.190\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e115\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLong waiting time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e185\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.046\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e107\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKnowledge Factors\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHeard about HPV\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e269\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.65 (1.89\u0026ndash;11.45)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eKnowledge of eligible age\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCorrect (9\u0026ndash;14 yrs)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e170\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.29 (1.47\u0026ndash;3.56)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBelief that vaccination is right\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e262\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.57 (1.52\u0026ndash;8.41)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.003\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eKnowledge of correct doses\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCorrect (2 doses)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.20 (1.25\u0026ndash;3.88)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.005\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNumber of doses received\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eOne dose\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e149\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.20 (0.80\u0026ndash;1.80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.370\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTwo doses (Ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDon\u0026rsquo;t know\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.62 (0.35\u0026ndash;1.12)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.110\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cb\u003eSource\u003c/b\u003e: Primary data, 2022\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cb\u003eNote\u003c/b\u003e:\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eValues that are significant are those with p values\u0026thinsp;\u0026lt;\u0026thinsp;0.05 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eSince the sample size was limited, not estimable values from bivariate tables (such as those for distances less than one kilometer) were eliminated.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eInterpretation\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe results of a multivariate logistic regression analysis evaluating the variables linked to teenage girls' HPV vaccine uptake are shown in Table\u0026nbsp;2 above.\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eCaretaker Relationship\u003c/b\u003e: Caregivers who were mothers had a significantly higher likelihood of having their daughters vaccinated (AOR\u0026thinsp;=\u0026thinsp;1.70, 95% CI: 1.05\u0026ndash;2.75, p\u0026thinsp;=\u0026thinsp;0.030), indicating that maternal engagement increases vaccine uptake.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eEducation Level\u003c/b\u003e: Lower education levels were significantly associated with lower vaccination rates. Caregivers with no formal education (AOR\u0026thinsp;=\u0026thinsp;0.19, p\u0026thinsp;=\u0026thinsp;0.033) and primary education (AOR\u0026thinsp;=\u0026thinsp;0.50, p\u0026thinsp;=\u0026thinsp;0.007) had significantly lower odds of low vaccine uptake compared to those with secondary education or higher.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eOccupation\u003c/b\u003e: Peasant caretakers had a considerably lower odds of low vaccine uptake compared to employed or business caregivers (AOR\u0026thinsp;=\u0026thinsp;0.49, p\u0026thinsp;=\u0026thinsp;0.013).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eClass Grade\u003c/b\u003e: Girls in Primary Four had the highest uptake (AOR\u0026thinsp;=\u0026thinsp;1.00) while those in Primary Five (AOR\u0026thinsp;=\u0026thinsp;0.19, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and Primary Six and Seven (AOR\u0026thinsp;=\u0026thinsp;0.16, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) had substantially reduced odds of vaccination.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eOther demographic factors, such as caretaker's age, gender, marital status, and distance to the health center, did not show statistically significant associations with HPV vaccine uptake in the multivariable model.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003e3.2 Individual Factors Associated with Low Uptake: Quantitative Findings (Table\u0026nbsp;3):\u003c/h2\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabc\" border=\"1\"\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStatement\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVariable option\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eInadequate knowledge about Human PapillomaVirus (HPV) can lead to low uptake.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e207 (70.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e85 (29.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eChange of residence from one location to another may lead to low uptake of the Human PapillomaVirus vaccine.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e110 (37.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e182 (62.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eAbsenteeism and dropout from school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e175 (59.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e117 (40.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eGirls at the age of vaccination refuse to get vaccinated due to discouragement from caregivers.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e182 (62.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e110 (37.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ePoor roads that limit access to some schools may limit routine childhood vaccination.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e209 (71.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e83 (28.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eFear of injection may discourage eligible children from getting vaccinated.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e201 (68.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e91 (31.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eDiscouragement from vaccination by caregivers or peers.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e197 (67.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e95 (32.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"3\"\u003e\u003cb\u003eSource: Primary data, 2022\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAccording to table three above, iinadequate knowledge about HPV was identified as a contributing factor by 70.9% of respondents. While 62.3% did not believe changing residence, absenteeism, or school dropout necessarily led to low uptake, 62.3% reported girls refusing the vaccine due to caregiver discouragement. Poor road conditions were cited as a barrier by 71.6%. Fear of injection was noted by 68.8%. Discouragement from caregivers or peers was believed to contribute by 67.5%.\u003c/p\u003e\u003cp\u003e\u003cb\u003eBivariate Analysis (Table\u0026nbsp;4)\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabd\" border=\"1\"\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIndividual factor\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVariable Option\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eOR\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInadequate knowledge about HPV can lead to low uptake\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e207\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.114\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChange of residence may lead to low uptake\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e110\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e182\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAbsenteeism and dropout from school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e175\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.037\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGirls refuse vaccination due to caregiver discouragement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e182\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.222\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e110\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePoor road infrastructure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e209\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.108\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFear of injection\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e201\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.311\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiscouragement from caregivers or peers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e197\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.420\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cb\u003eSource: Primary data, 2022\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eFrom table four above, change of residence (OR\u0026thinsp;=\u0026thinsp;0.50, p\u0026thinsp;=\u0026thinsp;0.001) and school absenteeism (OR\u0026thinsp;=\u0026thinsp;0.73, p\u0026thinsp;=\u0026thinsp;0.037) were significant factors linked with lower odds of HPV vaccine completion.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMultivariable Logistic Regression Analysis (Table\u0026nbsp;5)\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabe\" border=\"1\"\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFactor Category\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eVariable Option\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003en\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eOR (95% CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDemographic Factors\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAge of Caretaker\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20\u0026ndash;30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.65 (0.32\u0026ndash;1.31)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.220\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e31\u0026ndash;40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e107\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.94 (0.56\u0026ndash;1.58)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.820\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e41\u0026ndash;50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e125\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.42 (0.85\u0026ndash;2.36)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.180\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e50+ (Ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGender of Caretaker\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e149\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.18 (0.85\u0026ndash;5.57)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.096\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMale (Ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCaretaker Relationship\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMother\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e128\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.70 (1.05\u0026ndash;2.75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.030\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eOthers (Ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEducation Level\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.19 (0.04\u0026ndash;0.87)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.033\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePrimary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.50 (0.30\u0026ndash;0.83)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.007\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSecondary+ (Ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOccupation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePeasant\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e111\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.49 (0.28\u0026ndash;0.87)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.013\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eEmployed/Business (Ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMarital Status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e134\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.43 (0.73\u0026ndash;2.80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.280\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNot Married (Ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDistance to Health Center\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDistance to Health Center\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;1 km\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNot estimable\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u0026ndash;3 km (Ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e110\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4\u0026ndash;6 km\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.96 (0.53\u0026ndash;1.74)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.892\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;6 km\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.03 (0.43\u0026ndash;2.44)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.947\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNot aware\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.87 (0.05\u0026ndash;15.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.921\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eClass Level\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.17\u0026ndash;4.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.87\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.51\u0026ndash;1.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.83\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP4 (Reference)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e107\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.00 (Ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.49\u0026ndash;1.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.78\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.49\u0026ndash;2.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.87\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.48\u0026ndash;2.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.74\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIndividual Factors\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInadequate knowledge about HPV\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e207\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.28 (0.89\u0026ndash;1.84)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.114\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eChange of residence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e110\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.50 (0.37\u0026ndash;0.69)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e182\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAbsenteeism / dropout\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e175\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.73 (0.59\u0026ndash;0.91)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.037\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e117\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCaregiver discouragement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e182\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.85 (0.69\u0026ndash;1.05)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.222\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e110\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePoor road infrastructure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e209\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.39 (0.92\u0026ndash;2.10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.108\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFear of injection\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e201\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.21 (0.83\u0026ndash;1.77)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.311\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePeer/Caregiver discouragement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e197\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.17 (0.79\u0026ndash;1.72)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.420\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHealth System Factors\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePoor records management\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e194\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.95 (0.72\u0026ndash;1.26)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.109\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLimited knowledge by health workers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e191\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.94 (0.70\u0026ndash;1.24)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.043\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e101\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo gov\u0026rsquo;t program for out of school girls\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e198\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.97 (0.73\u0026ndash;1.29)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.035\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eShortage/cold chain issues\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e193\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.75 (1.04\u0026ndash;2.93)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.004\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUntimely transport\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e214\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.93 (0.74\u0026ndash;1.17)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.574\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLow staff motivation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e125\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.06 (0.80\u0026ndash;1.41)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.645\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUnderstaffing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e168\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.97 (1.05\u0026ndash;3.68)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.006\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e124\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCommunity Factors\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRumors / misconceptions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e198\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.033\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReligious/cultural opposition\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e176\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.031\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e116\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMistrust of government\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e176\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.009\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e116\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBusy stakeholder schedules\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e177\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.190\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e115\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLong waiting time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e185\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.046\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e107\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKnowledge Factors\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHeard about HPV\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e269\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.65 (1.89\u0026ndash;11.45)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eKnowledge of eligible age\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCorrect (9\u0026ndash;14 yrs)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e170\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.29 (1.47\u0026ndash;3.56)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBelief that vaccination is right\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e262\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.57 (1.52\u0026ndash;8.41)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.003\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eKnowledge of correct doses\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCorrect (2 doses)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.20 (1.25\u0026ndash;3.88)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.005\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNumber of doses received\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eOne dose\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e149\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.20 (0.80\u0026ndash;1.80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.370\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTwo doses (Ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDon\u0026rsquo;t know\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.62 (0.35\u0026ndash;1.12)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.110\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cb\u003eSource\u003c/b\u003e: Primary data, 2022\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe regression analysis in the table 5 above revealed that a change of residence significantly reduced the likelihood of HPV vaccine uptake (AOR\u0026thinsp;=\u0026thinsp;0.50, 95% CI: 0.37\u0026ndash;0.69, p\u0026thinsp;=\u0026thinsp;0.001). Similarly, school absenteeism or dropout was associated with lower odds of vaccination (AOR\u0026thinsp;=\u0026thinsp;0.73, p\u0026thinsp;=\u0026thinsp;0.037). Other individual factors such as inadequate knowledge about HPV, caregiver discouragement, poor road infrastructure, fear of injection, and negative peer or caregiver influence did not show statistically significant associations in the multivariable model.\u003c/p\u003e\u003cp\u003e\u003cb\u003eQualitative Data Analysis (Thematic Presentation, Table\u0026nbsp;6)\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabf\" border=\"1\"\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTheme\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSubtheme\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCategories\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIndividual-Level Barriers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLack of Awareness Among Caregivers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e- Uncertainty about vaccination eligibility (e.g., belief that only girls below 10 qualify).\u003c/p\u003e \u003cp\u003e- Limited knowledge about the HPV vaccine.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAbsenteeism and School Dropout\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e- School absence due to unpaid fees, household responsibilities, or early menstruation.\u003c/p\u003e \u003cp\u003e- Some parents keep children home for farm work.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRelocation and School Transfers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e- Families frequently relocate, disrupting vaccine follow-ups.\u003c/p\u003e \u003cp\u003e- Parents are often uninformed about vaccination continuity\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePhysical Barriers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e- Hard-to-reach areas with poor road networks limit vaccine access.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFear of Injection Pain\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-Adolescents hesitate to complete the HPV vaccination\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNegative Influence from Caregivers or Peers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-Care givers hold misconceptions.\u003c/p\u003e\u003cp\u003e-Peers sharing stories of adverse effects or express skepticism\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"7\" rowspan=\"8\"\u003e\u003cp\u003eHealth facility barriers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLimited Knowledge Among Healthcare Workers, VHTs, and Teachers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e- Unclear understanding of HPV vaccination guidelines.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCold Chain and Logistical Challenges\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e- Shortages of ice packs limit the number of doses transported.\u003c/p\u003e \u003cp\u003e- Some facilities lack refrigeration for proper vaccine storage.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInadequate Community Engagement and Mobilization\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e- Shortages of ice packs limit the number of doses transported.\u003c/p\u003e \u003cp\u003e- Some facilities lack refrigeration for proper vaccine storage\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInadequate Community Engagement and Mobilization\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e- Seasonal activities prevent girls from accessing vaccine information.\u003c/p\u003e \u003cp\u003e- Many families remain unaware of vaccination campaigns.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTransportation Challenges\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e- Lack of reliable transport disrupts vaccine delivery.\u003c/p\u003e \u003cp\u003e- Canceled or delayed vaccination sessions cause frustration.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eExpectations of Monetary Incentives\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e- Healthcare workers and teachers are demotivated by inadequate allowances\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStaff Shortages\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e- Limited personnel available for vaccination services.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUnfriendly Behavior from Healthcare Workers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e- Some healthcare workers exhibit rude or discouraging attitudes.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eCommunity Level Barriers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRumors and Misconceptions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBeliefs that the vaccine promotes early sexual activity.\u003c/p\u003e\u003cp\u003e- Concerns about infertility and reproductive health risks.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTraditional and Religious Beliefs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e- Perceptions that vaccination contradicts cultural or religious norms.\u003c/p\u003e \u003cp\u003e- Some believe being vaccinated violates traditional rules.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe qualitative findings from table 6 above, expanded on these results, highlighting several individual-level barriers. Many caregivers lacked accurate knowledge about HPV vaccination, with some believing it was only intended for girls under 10 years old a misconception confirmed by healthcare workers. School absenteeism and dropout, driven by factors such as unpaid fees, household duties, farm work, and early menstruation, limited girls\u0026rsquo; access to school-based vaccination programs. Frequent changes in residence and school transfers disrupted follow-up and contributed to missed doses. Physical barriers, particularly poor rural road infrastructure, made reaching vaccination sites difficult. Fear of injection pain, often amplified by peer accounts, also discouraged completion of the vaccination series. Additionally, caregiver and peer discouragement, sometimes fueled by myths about infertility or adverse effects, undermined trust in the vaccine and reduced uptake\u003c/p\u003e\u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThe low HPV vaccine uptake in Rukiga District is significantly influenced by a complex interplay of demographic characteristics and individual consistent with the Health Belief Model (HBM) [12].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.1 Caregiver Relationship and Gender:\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eMaternal involvement emerged as a critical demographic predictor, with daughters of mothers as primary caregivers having significantly higher odds of completing the HPV vaccine series (AOR = 1.70, p = 0.030) [21,22]. This aligns with the HBM\u0026apos;s \u0026quot;cues to action\u0026quot; and \u0026quot;self-efficacy\u0026quot; constructs, as mothers often serve as trusted guides who clarify vaccine-related questions and provide emotional support, thereby alleviating worries and countering misinformation. This finding is consistent with previous research by [23] which emphasize the crucial role of maternal influence in vaccination acceptability. However, the effectiveness of maternal engagement can be moderated by broader socioeconomic factors, as observed by [24] in Gulu, Uganda, where lower uptake was noted among girls with single or unmarried mothers due to financial pressures and caregiving difficulties. This suggests a need for targeted interventions that empower mothers through education while also addressing structural barriers in vulnerable households.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.2 Caregiver Education and Occupation:\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eCaregiver education significantly impacted HPV vaccine uptake. Caregivers with no formal education (AOR = 0.19, p = 0.033) and primary education (AOR = 0.50, p = 0.007) were significantly less likely to vaccinate their daughters compared to those with secondary education or higher [25]. Qualitative data revealed that more educated caregivers tend to access accurate health information and possess a better understanding of vaccination benefits which boosts confidence in vaccine decisions. This aligns with the HBM\u0026rsquo;s emphasis on reduced perceived barriers and increased self-efficacy among educated individuals. This supports findings from [25,26]. Similarly, occupation played a role, with peasant farmers having significantly lower odds of vaccine uptake (AOR = 0.49, p = 0.013) compared to employed caregivers. This is likely due to economic constraints and lower health literacy, reinforcing perceived obstacles within the HBM framework. These results underscore the critical need for accessible, culturally appropriate health education tailored for low-literacy populations and flexible vaccination hours to accommodate working and farming caregivers.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.3 Class Grade Absenteeism and Change of Residence:\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eThe class grade of the adolescent girl was a significant predictor of HPV vaccine uptake. Girls in Primary Four, the targeted class, showed the highest uptake (AOR = 1.00) while those in Primary Five (AOR = 0.19, p \u0026lt; 0.001) and Primary Six and Seven (AOR = 0.16, p \u0026lt; 0.001) had substantially reduced odds of vaccination [27]. This highlights the effectiveness of school-based programs in specific grades acting as \u0026quot;cues to action\u0026quot; and increasing perceived susceptibility and benefits. However, school absenteeism (AOR = 0.73, p = 0.037) and changes in residence (AOR = 0.50, p = 0.001) significantly hindered HPV vaccine completion [28]. Qualitative findings clarified that factors such as menstruation, unpaid school fees, and household responsibilities contributed to absenteeism, while family relocations disrupted vaccination continuity. These interruptions increase perceived barriers and weaken cues to action and self-efficacy within the HBM. These findings are consistent with [27,28]. This necessitates flexible vaccination strategies, including catch-up clinics and interoperable digital health records, to track and reach mobile and out-of-school populations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.4 Individual Beliefs and Perceived Barriers:\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eWhile not always statistically significant in the multivariable model, qualitative data strongly indicated the presence of psychological and perceptual barriers at the individual level associated with low uptake of HPV vaccine uptake. Fear of injection pain, negative peer influence and caregiver discouragement due to misinformation and cultural fears (e.g., regarding fertility) were frequently cited [29]. These beliefs act as significant \u0026quot;perceived barriers\u0026quot; within the HBM, increasing anticipated discomfort or harm and reducing confidence in vaccination. Although quantitative analysis did not find statistical significance for these specific individual factors in the final model (e.g., fear of injection: AOR=1.21, p=0.311) their prominence in qualitative accounts suggests they are crucial underlying determinants that affect self-efficacy and cues to action.\u0026nbsp;\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eLow HPV vaccine series completion in Rukiga District is primarily driven by caregiver knowledge gaps, socioeconomic disparities, and systemic limitations in health service delivery [10,12]. The vital role of mothers (AOR = 1.70; p = 0.030) underscores the importance of gender-sensitive health education. Socioeconomic disparities linked to caregiver education (AOR = 0.19 for no formal education; p = 0.033) and occupation (AOR = 0.49 for peasants; p = 0.013) exacerbate uptake challenges. Crucially, individual barriers such as change of residence (AOR = 0.50; p = 0.001) and school absenteeism (AOR = 0.73; p = 0.037) disrupt vaccination continuity [12]. These findings highlight that improving HPV vaccine coverage requires integrated interventions that specifically target caregivers through enhanced health literacy, leverage maternal influence, and implement flexible vaccination strategies to reach mobile and out-of-school adolescents.\u003c/p\u003e"},{"header":"6. Recommendations","content":"\u003cp\u003e\u003cstrong\u003e6.1 Short-Term Recommendations (0–12 Months)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo improve vaccine uptake, targeted, culturally sensitive educational campaigns should focus on mothers and female guardians, as maternal status increases vaccination odds. Simplified IEC materials tailored to low-literacy caregivers should be delivered via trusted community channels to close knowledge gaps. School absenteeism’s impact on access can be mitigated through school-based monitoring and local leader follow-ups. Additionally, SMS reminder systems and mobile tracking tools are vital to support adolescents from mobile households in completing vaccine doses on time.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e6.2 Medium-Term Recommendations (1–3 Years)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNational policy should shift from grade-based to age-based HPV vaccination to include mobile and out-of-school adolescents. Scheduling vaccination during off-peak farming seasons, aligned with agricultural calendars, will improve uptake among peasant farming households who currently have lower vaccination rates.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e6.3 Implementation Considerations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo maximize SMS reminder effectiveness, challenges like limited phone access, poor network coverage, and privacy must be addressed by introducing voice calls, printed reminders, and community follow-ups through VHTs, especially in rural and mobile populations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e6.4 Stakeholder-Specific Recommendations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Ministry of Health should revise HPV vaccination policy to age-based eligibility, with success measured by district adoption rates. VHTs should lead community outreach and follow-up for missed doses, tracked by session numbers and caregiver knowledge improvement. Schools should integrate HPV education into health curricula and organize catch-up vaccination days to increase completion rates.\u003c/p\u003e"},{"header":"7. Study Limitations","content":"\u003cp\u003eThe cross-sectional design limits causal inference between factors and vaccine uptake. Self-reported caregiver data may be affected by recall and social desirability biases. Findings are specific to one district, limiting generalizability across Uganda\u0026rsquo;s diverse settings. Interviewer bias cannot be fully excluded despite training. The study mainly reflects caregiver perspectives; including adolescent girls, facility managers, and policymakers would provide a more comprehensive view.\u003c/p\u003e"},{"header":"8. Future Research Directions","content":"\u003cp\u003eFuture studies should explore male caregiver involvement in vaccination decisions across rural and urban settings, education levels, and HPV information exposure using mixed methods to identify engagement opportunities. Implementation science research comparing school- and clinic-based vaccine delivery, with or without SMS reminders, should assess effectiveness and cost-efficiency via cluster randomized trials to guide program design and resource allocation.\u003c/p\u003e"},{"header":"9. Cultural and Contextual Considerations:","content":"\u003cp\u003eThis study deepens the understanding of how Uganda\u0026rsquo;s cultural and religious environment shapes HPV vaccine uptake. The finding that religious engagement enhances vaccination (AOR\u0026thinsp;=\u0026thinsp;0.62) may reflect the trusted role of churches and mosques in health communication and alignment between cancer prevention and religious values of protecting life. This contrasts with some Western contexts, where religious narratives have occasionally impeded vaccine uptake. Future interventions should therefore be locally tailored, building partnerships with faith-based organizations to foster vaccine acceptance.\u003c/p\u003e"},{"header":"10. Application and Policy Connections","content":"\u003cp\u003eThe results are in line with Uganda's 2025 Health Sector Development Plan (HSDP), namely the 25% increase in adolescent immunization coverage. Specific connections include strengthening cooperation with the education sector for school-based delivery, assisting Village Health Teams (VHTs) with tracking and awareness initiatives for community outreach, and resolving obstacles for nomadic and out-of-school populations to ensure fair access.\u003c/p\u003e\u003cp\u003e\u003cb\u003eExample of an Implementation Framework: Making the Switch to Age-Based Vaccination\u003c/b\u003e:\u003c/p\u003e\u003cp\u003eAdministrative changes, such as updating Ministry of Health and Education joint protocols and school records with birth dates, are necessary. Capacity building involves teaching medical staff age verification and educating educators on new standards and referral channels. Monitoring coverage by age groups (lasting one year) and comparing uptake between girls who attend school and those who do not is essential. Launching trial projects in two to three districts to assess reach, adoption, and sustainability using the RE-AIM paradigm is recommended prior to nationwide implementation.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eAOR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eAdjusted Odds Ratio\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCOR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eCrude Odds Ratio\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eEPI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eExpanded Programme on Immunization and vaccination\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eHBM\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eHealth Belief Model\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eHPV\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eHuman Papilloma Virus\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eMUST\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eMbarara University of Science and Technology\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eUNCS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eUganda National Council for Science and Technology\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eOR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eOdds Ratio\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eREC\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eResearch Ethics Committee\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eSPSS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eStatistical Package for the Social Sciences\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eVHT\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eVillage Health Team\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;This study was conducted in accordance with the Declaration of Uganda National Council for Science and Technology and all applicable ethical guidelines for research involving human participants. Clearance to conduct this study was obtained from the Department of community at Kable, under registration number 2018/MPH/1659/W. Further ethical approval was granted by office of District Health officer Rukiga District and final clearance for data collection was obtained from the Uganda National Council for Science and Technology (UNCST), reference number MUST-2022-511. Informed consent was obtained from all participants prior to their involvement in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe researchers obtained written consent to use quotes from participants in publications.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The primary study document, including the detailed information and dataset used and analyzed, is available upon reasonable request from the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The authors hereby declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;No external funding was received for this work\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ Contributions\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Mbonigaba Rukarama Evarist (MRE) conceptualized the study, designed the study framework, led data collection and interpretation, prepared the manuscript, and reviewed the paper. He is the principal investigator. Ronald Arineitwe Kibonire (RAK), as co-author, provided guidance throughout the study's conception, design, data collection, and analysis phases, reviewed the manuscript, and offered valuable feedback for refinement.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;We express our gratitude to the community of Rubanda for their participation in this study. Our sincere thanks go to the Office of the District Health Officer of Rukiga District for granting us permission to conduct the research in the district. We also extend special appreciation to the health facility staff of the selected facilities of Rukiga District and VHT members for their support in coordinating and mobilizing respondents for the study and even also giving their views as participants.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eLi, Z., Liu, P., Yin, A., Zhang, B., Xu, J., Chen, Z., ... \u0026amp; Song, K. (2025). Global landscape of cervical cancer incidence and mortality in 2022 and predictions to 2030: The urgent need to address inequalities in cervical cancer. International Journal of Cancer, 157(2), 288-297.\u003c/li\u003e\n \u003cli\u003ePimple, S., \u0026amp; Mishra, G. (2022). Cancer cervix: Epidemiology and disease burden. Cytojournal, 19, 21.\u003c/li\u003e\n \u003cli\u003eSingh, D., Vignat, J., Lorenzoni, V., Eslahi, M., Ginsburg, O., Lauby-Secretan, B., ... \u0026amp; Vaccarella, S. (2023). 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PloS one, 17(6), e0269655.\u003c/li\u003e\n \u003cli\u003eDistrict Health Information Software 2 (DHIS2)(2024). Rukiga District HPV vaccination data. Ministry of Health, Uganda.\u003c/li\u003e\n \u003cli\u003eRujumba, J., Akugizibwe, M., Basta, N. E., \u0026amp; Banura, C. (2021). Why don\u0026rsquo;t adolescent girls in a rural Uganda district initiate or complete routine 2-dose HPV vaccine series: Perspectives of adolescent girls, their caregivers, healthcare workers, community health workers and teachers. PloS one, 16(6), e0253735.\u003c/li\u003e\n \u003cli\u003e\u0026nbsp;Wang, W., Kothari, S., Baay, M., Garland, S. M., Giuliano, A. R., Nyg\u0026aring;rd, M., ... \u0026amp; Sundstr\u0026ouml;m, K. (2022). Real-world impact and effectiveness assessment of the quadrivalent HPV vaccine: a systematic review of study designs and data sources. Expert Review of Vaccines, 21(2), 227-240.\u003c/li\u003e\n \u003cli\u003e\u0026nbsp;Agimas, M. C., Adugna, D. G., Derseh, N. M., Kassaw, A., Kassie, Y. T., Abate, H. K., \u0026amp; Mekonnen, C. K. (2024). Uptake of human papilloma virus vaccine and its determinants among females in East Africa: a systematic review and meta-analysis. BMC Public Health, 24(1), 842.\u003c/li\u003e\n \u003cli\u003eAsgedom, Y. S., Kebede, T. M., Seifu, B. L., Mare, K. U., Asmare, Z. A., Asebe, H. A., ... \u0026amp; Kassie, G. A. (2024). Human papillomavirus vaccination uptake and determinant factors among adolescent schoolgirls in sub-Saharan Africa: A systematic review and meta-analysis. Human vaccines \u0026amp; immunotherapeutics, 20(1), 2326295.\u003c/li\u003e\n \u003cli\u003eRukiga NHPC, 2024. https://statistics.ubos.org/nphc/drilldown?subregion\u003c/li\u003e\n \u003cli\u003eMihretie, G. N., Liyeh, T. M., Ayele, A. D., Belay, H. G., Yimer, T. S., \u0026amp; Miskr, A. D. (2022). Knowledge and willingness of parents towards child girl HPV vaccination in Debre Tabor Town, Ethiopia: a community-based cross-sectional study. Reproductive health, 19(1), 136.\u003c/li\u003e\n \u003cli\u003eDavies, C., Stoney, T., Hutton, H., Parrella, A., Kang, M., Macartney, K., ... \u0026amp; Skinner, S. R. (2021). School-based HPV vaccination positively impacts parents\u0026rsquo; attitudes toward adolescent vaccination. Vaccine, 39(30), 4190-4198.\u003c/li\u003e\n \u003cli\u003eHumnesa, H., Aboma, M., Dida, N., \u0026amp; Abebe, M. (2022). Knowledge and attitude regarding human papillomavirus vaccine and its associated factors among parents of daughters age between 9-14 years in central Ethiopia, 2021. Journal of Public Health in Africa, 13(3), 2129.\u003c/li\u003e\n \u003cli\u003eJahrami, H., Trabelsi, K., Saif, Z., Manzar, M. D., Bahammam, A. S., \u0026amp; Vitiello, M. V. (2023). Reliability generalization meta-analysis of the Athens Insomnia Scale and its translations: Examining internal consistency and test-retest validity. Sleep Medicine, 111, 133-145.\u003c/li\u003e\n \u003cli\u003eChido-Amajuoyi, O. G., Talluri, R., Jackson, I., Shete, S. S., Fokom Domgue, J., \u0026amp; Shete, S. (2022). The influence of parent\u0026ndash;child gender on intentions to refuse HPV vaccination due to safety concerns/side effects, national immunization survey\u0026ndash;Teen, 2010\u0026ndash;2019. Human Vaccines \u0026amp; Immunotherapeutics, 18(5), 2086762.\u003c/li\u003e\n \u003cli\u003eMansfield, L. N., Chung, R. J., Silva, S. G., Merwin, E. I., \u0026amp; Gonzalez-Guarda, R. M. (2022). Social determinants of human papillomavirus vaccine series completion among US adolescents: a mixed-methods study. SSM-population health, 18, 101082.\u003c/li\u003e\n \u003cli\u003eGray, A., \u0026amp; Fisher, C. B. (2023). Factors associated with HPV vaccine acceptability and hesitancy among black mothers with young daughters in the United States. Frontiers in Public Health, 11, 1124206.\u003c/li\u003e\n \u003cli\u003eAruho, C., Mugambe, S., Baluku, J. B., \u0026amp; Taremwa, I. M. (2022). Human papillomavirus vaccination uptake and its predictors among female adolescents in Gulu Municipality, Northern Uganda. Adolescent Health, Medicine and Therapeutics, 77-91.\u003c/li\u003e\n \u003cli\u003eAgha, S., \u0026amp; Nsofor, I. (2025). HPV vaccine uptake among adolescent girls in Nigeria: The complex role of caregivers\u0026rsquo; education. PLoS One, 20(7), e0325684.\u003c/li\u003e\n \u003cli\u003eAgha, S., Bernard, D., Francis, S., Fareed, A., \u0026amp; Nsofor, I. (2024). Determinants of human papillomavirus vaccine acceptance among caregivers in Nigeria: a fogg behavior model-based approach. Vaccines, 12(1), 84.\u003c/li\u003e\n \u003cli\u003eBitariho, G. K., Tuhebwe, D., Tigaiza, A., Nalugya, A., Ssekamatte, T., \u0026amp; Kiwanuka, S. N. (2023). Knowledge, perceptions and uptake of human papilloma virus vaccine among adolescent girls in Kampala, Uganda; a mixed-methods school-based study. BMC pediatrics, 23(1), 368.\u003c/li\u003e\n \u003cli\u003eDionne, M., \u0026Eacute;tienne, D., Witteman, H. O., Sauvageau, C., \u0026amp; Dube, E. (2024). Impact of interventions to improve HPV vaccination acceptance and uptake in school-based programs: Findings of a pilot project in Quebec. Vaccine, 42(18), 3768-3773.\u003c/li\u003e\n \u003cli\u003eMacDonald, S. E., Kenzie, L., Letendre, A., Bill, L., Shea-Budgell, M., Henderson, R., ... \u0026amp; Nelson, G. (2023). Barriers and supports for uptake of human papillomavirus vaccination in Indigenous people globally: A systematic review. PLOS Global Public Health, 3(1), e0001406.\u003c/li\u003e\n \u003cli\u003eMbonigaba Rukarama Evarist. (2025). factors associated with low uptake of human papilloma virus (HPV) vaccination series in adolescent girls in Rukiga district. (research dissertation-not published, Questionnaire and Interview Guide). Kabale University. research dissertation submitted in partial fulfilment for the requirements of the award of master\u0026rsquo;s degree of public health of Kabale University.july, 2025.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"HPV vaccination, low uptake, adolescent girls, Rukiga District, Uganda, caregivers, individual factors, demographic characteristics, school absenteeism, health literacy","lastPublishedDoi":"10.21203/rs.3.rs-7596350/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7596350/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Despite the critical role of Human Papillomavirus (HPV) vaccination in preventing cervical cancer, adolescent girls in many Ugandan districts, including Rukiga, exhibit persistently low completion rates for the two-dose series. This study aimed to identify demographic and individual-level factors associated with the low uptake of the HPV vaccination series among adolescent girls in Rukiga District, Uganda.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A cross-sectional study employing mixed methodologies was conducted with 292 adolescent girls and their caregivers in Rukiga District between September and November 2022. Multivariate logistic regression was utilized to identify demographic, individual health and community determinants of completing the two-dose HPV vaccine regimen. Qualitative data were gathered through in-depth interviews with 11 health workers and 10 Village Health Team members to explore individual-level, health system and community barriers to vaccine uptake from the perspective of implementers.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The study found that only 27.49% of eligible girls completed the two-dose HPV vaccination series. Caregivers' gender was a significant predictor of uptake, with girls cared for by mothers having greater odds of completion (AOR = 1.70, 95% CI: 1.05-2.74, p = 0.030). Caregivers without formal education (AOR = 0.19, 95% CI: 0.05-0.74, p = 0.033) and peasant farmers (AOR = 0.49, p = 0.013) were less likely to vaccinate their daughters. Key individual barriers included change of residence (AOR = 0.50, p = 0.001) and school absenteeism/dropout (AOR = 0.73, p = 0.037), both significantly reducing uptake. Qualitative findings highlighted additional individual challenges such as misunderstanding regarding vaccine safety, insufficient health worker training, vaccine stockouts, long clinic wait times, and widespread community mistrust of government health initiatives.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e The low completion of the HPV vaccine series in Rukiga District is substantially influenced by identifiable demographic characteristics, particularly caregiver education and relationship to the child, and critical individual-level barriers such as mobility and school attendance. Targeted interventions are needed to empower mothers, enhance health literacy among less-educated and peasant caregivers, and implement flexible vaccination strategies to reach mobile and out-of-school adolescents.\u003c/p\u003e","manuscriptTitle":"Navigating the Divide – Demographic and Individual Predictors of Low HPV Vaccine Uptake in Rural Uganda","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-15 08:05:42","doi":"10.21203/rs.3.rs-7596350/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f3c4450f-c747-4f20-82ab-e2b245db1b8d","owner":[],"postedDate":"September 15th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-26T14:13:28+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-15 08:05:42","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7596350","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7596350","identity":"rs-7596350","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}