Magnitude and factors associated with the uptake of the HPV vaccine among adolescent girls aged 13-17 years in Sheema Municipality, Sheema District. A cross-sectional study

Magnitude and factors associated with the uptake of the HPV vaccine among adolescent girls aged 13-17 years in Sheema Municipality, Sheema District. 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A cross-sectional study Calvin Cherop, Farida Kigongo, Edgar Mulogo Mugema, Rashid Mugabe, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5910968/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction Human papilloma virus (HPV) is the most common sexually transmitted infection (STI). Globally, HPV affects millions of women in their late teens and early 20s. The use of the HPV vaccine is the only way to avert this trend. However, the uptake of HPV vaccination is reportedly low in Uganda. This study therefore assessed the magnitude and factors associated with the uptake of the HPV vaccine among adolescent girls aged 13–17 years in secondary schools in Sheema Municipality, Sheema District. Methods A cross-sectional study was conducted among 293 adolescent girls aged 13–17 years in secondary schools in the Sheema Municipality. A pretested questionnaire was used for data collection. A proportional sampling technique was used to determine the number of adolescent girls selected from each school. Simple random sampling was used to enrol the respondents in the study. The data were entered into Microsoft Excel and analysed using Stata version 14. Multivariate logistic regression was used to determine the factors associated with HPV vaccination uptake. Variables with p < 0.05 were considered significant. Results More than half (66%) of the participants had received the recommended two doses of the HPV vaccine. The factors associated with the uptake of the HPV vaccine included perceived risk of HPV (aOR = 1.73, 95% CI: [1.00–2.99], p = 0.048), receiving health education (aOR = 2.17, 95% CI: [1.23–3.83], p = 0.007), having parents/caretakers with secondary education (aOR:6.61, 95% CI: 1.57–27.8, p = 0.010), receiving tertiary education (aOR:5.56, 95% CI: 1.33–23.1, p = 0.019) and living in urban areas (aOR = 0.37, 95% CI: [0.21–0.65], p = 0.001). Conclusion This study revealed relatively high HPV vaccine uptake among adolescent girls, although it was still below the highest global rates. Completion of the HPV vaccine was more likely among those with educated parents, received health education, and those with perceived risk of HPV, whereas urban residency was linked to lower uptake. To improve vaccination rates, efforts should focus on increasing awareness through school-based health programs, conducting awareness campaigns on HPV risks and vaccine benefits, and addressing barriers to vaccine access in urban areas. Human papilloma virus adolescent girls uptake Figures Figure 1 Background Human papilloma virus (HPV) is the most common sexually transmitted infection (STI)(1). Almost all sexually active people are infected at some point in their lives, usually without symptoms (1). In 2018, approximately 43 million HPV infections occurred worldwide, with many cases affecting individuals in their late teens and early twenties (2). Sub-Saharan Africa has the highest prevalence of cervical HPV among women at 24%, followed by Latin America and the Caribbean at 16%, Eastern Europe at 14%, and Southeast Asia at 14% (1). HPV is a leading cause of cervical cancer, the fourth most common cancer among women globally (3). In 2022, cervical cancer accounted for approximately 660,000 new cases and 350,000 deaths globally (3), with low- and middle-income countries (LMICs) accounting for 84% of new cases and 90% of deaths (1). East Africa had the highest age-standardized cervical cancer mortality rate of 30 per 100,000 and the second-highest incidence rate of 40 per 100,000 in 2018 (4). In Uganda, cervical cancer is the most common cancer among women, with an age-standardized incidence rate (ASR) of 56.2 per 100,000 and a cancer-related death rate of 41.4 per 100,000 in 2020 (5). At least 95% of cervical cancer cases are caused by human papillomavirus (HPV) infections, which are transmitted primarily through sexual intercourse (6). Most sexually active women will be infected with HPV at some point in their lives, but nearly all will clear the infection within a year (7). Unfortunately, 12% of acute HPV infections persist and can develop into precancerous lesions or invasive cervical cancer over several decades (8). This well-established cause, along with the prolonged natural course of HPV infection, provides an opportunity for effective interventions to manage cervical cancer (9). The majority of cervical cancer cases are potentially preventable. The World Health Organization (WHO) emphasizes primary prevention, specifically vaccinating girls aged 9–14 years before exposure to sex or HPV, as a crucial step in preventing the onset of cervical cancer (10). It is estimated that the HPV vaccine can reduce cervical cancer deaths by two-thirds if uptake reaches 80%. In Uganda, HPV vaccines targeting HPV types 16 and 18 have been available since 2006 (11). The provision of the human papillomavirus (HPV) vaccine is aimed at primary prevention of cervical cancer, ensuring that the risk of HPV infection progressing to cervical cancer later in life is eliminated (12). In 2015, the Ministry of Health, through its strategic plan for cervical cancer prevention, committed to achieving 80% HPV vaccine coverage among eligible girls (13). HPV vaccination uptake in Uganda is as low as 19.6%, despite the high efficacy and safety of the vaccine compared with other vaccines (14). A number of studies have examined the predictors of HPV vaccination (15). Most of these studies are from developed economies. School status (16), being older (17), ethnicity (18), and medium social economic status (19) were significantly associated with HPV vaccination. Although a number of studies in developed countries have assessed the factors associated with the uptake of the HPV vaccine, studies in developing countries such as Uganda have limited studies. This study assessed the factors associated with the uptake of the HPV vaccine among adolescent girls aged 13–17 years in Sheema Municipality. Methods Study design and study setting This was a cross-sectional study that was conducted in government-aided secondary schools in Sheema Municipality. Sheema district is located 298 km southwest of Kampala, the capital city, and is bordered by Mbarara to the east, Bushenyi to the west and Buhweju to the north. Sheema Municipality comprises three (3) divisions, namely, the Kabwohe, Kagango and Sheema Central divisions. The 2024 estimated population of Sheema Municipality was approximately 252,275 (20). There are ten (10) government health facilities (1 HCIV, 2 HCIIIs, 7 HCIIs, 1 private not for profit HCIII and 1 private for profit HCIII) in the respective divisions in the Sheema Municipality. All these facilities offer static and outreach services in the community. With regard to vaccination, there are routine HPV vaccination sessions that are conducted in all primary schools in the catchment area and target girls who are 10 years old. Community outreaches are also conducted targeting girls who are out of school. Study population The study enrolled adolescent girls aged 13–17 years because they were expected to have completed the HPV vaccination schedule of two doses and who had consented to participate in the study, and we excluded those who were absent during data collection. Sample size This study used a formula developed by Kish & Leslie (1965) for cross-sectional studies to determine the sample size. $$\:n=\frac{{z}^{2}\times\:p\times\:q}{{d}^{2}}$$ n- Desired sample size P - The estimated proportion of girls who received complete doses of the HPV vaccine (22%) in a multilevel survey among Ugandan girls aged 10–14 years (21) Z - Critical value form for a standard normal distribution with α as the level of significance set to 0.05 Thus, the value of 1.96 d = is the margin of error, which is 5% $$\:n=\frac{{1.96}^{2}\times\:0.22\times\:0.78}{{0.05}^{2}}$$ $$\:\text{n}=264\:\text{r}\text{e}\text{s}\text{p}\text{o}\text{n}\text{d}\text{e}\text{n}\text{t}\text{s}\:$$ A 10% nonresponse rate was factored. Therefore, the final sample size was $$\:\text{n}=\frac{264}{0.9\:}$$ $$\:\text{n}=293\:\text{r}\text{e}\text{s}\text{p}\text{o}\text{n}\text{d}\text{e}\text{n}\text{t}\text{s}$$ Sampling procedure Simple random sampling technique was used to select four schools out of the 13 schools present in Sheema Municipality, Sheema District. Since Sheema Municipality has three divisions, at least one secondary school was randomly selected from each of the three divisions (Kabwohe, Sheema Central and Kagango Divisions). Probability Proportionate to size (PPS) sampling method was used to determine the number of adolescent girls who were included in the study from each school (Table 1 ). Table 1: Number of participants sampled from each school Data collection tools The researcher used a structured questionnaire that was divided into four main sections. The first section assessed the social demographic characteristics of the respondents, such as place of residence, age, living status of the parents, religion and the nature of the schools. The second section assessed health-related factors such as the availability of vaccines, accessibility of vaccines, awareness of HPV vaccines, attitudes of health workers, perceived side effects of HPV vaccines, perceived risk of acquiring HPV and attitudes towards the vaccine. The third section assessed caretaker/parent-related factors such as education level, occupation, marital status and income level. Data collection procedure Permission was sought from the Municipal Education Officer, which allowed the Principal Investigator (PI) to approach head teachers in each of the selected schools. At every school, permission to carry out the study was granted from the head teacher. Consent was sought from the head teachers since most of the study participants were younger than 18 years. The principal investigator and the research assistants moved to the schools, introduced themselves to the teachers, the students, their reasons for approaching them and then proceeded to collect the data. Upon entering the respective classes, the research team obtained informed consent from the teachers and the students. The researcher team then interviewed the participants who met the study inclusion criteria. The completed questionnaires were checked for completeness, after which the participants exited the study. Study variables The dependent variable was the uptake of the HPV vaccine. This was categorized as fully vaccinated or not fully vaccinated. Girls who received two doses of the HPV vaccine were considered fully vaccinated, which was in line with the recommendation of the Ministry of Health and those who received one or no dose at all were considered not fully vaccinated. This was confirmed by clearly describing the cards and showing the girl samples on the cards. Quality assurance The principal investigator hired research assistants who were trained prior to data collection. The questionnaire was pretested among secondary school girls in Kibingo Girls Secondary School who were not included in the study. The questionnaire was tested to determine whether it generated the intended data. Errors noted in the pre-test exercise, including the interview protocol, were corrected before actual data collection. The principal investigator constantly supervised the research assistants during data collection. The questionnaires were checked for completeness immediately after the interview. Data analysis Quantitative data were entered into a computer in Microsoft Excel and then exported to Stata version 14 for statistical analysis. Continuous variables such as age were entered as continuous data, whereas categorical variables such as place of residence and caretakers’ education level were coded. Frequency distributions for categorical variables were used to describe the demographic and socioeconomic characteristics of the adolescent girls. For continuous variables, standard deviations and means were used. Cross-tabulations using Pearson’s chi-square test was used to determine the distribution of the participants. Bivariate and multivariate logistic regression models were used to determine the factors associated with the uptake of the HPV vaccine. Crude and adjusted odds ratios with 95% confidence intervals are reported. The significance level for all the analyses was set at P ≤ 0.05. Results Socio-demographic characteristics of the respondents A total of 293 adolescent girls aged 13–17 years participated in the study. Most of the respondents were Anglicans (143, 48.8%), 289 (98.6%) had living parents, and 155 (52.9%) were residing in urban areas. Majority of the girls had parents who were married 258 (88.1%), 104 (35.5%) had secondary education level and 127 (43.3%) were businessmen/women (Table 2 ). Table 2 Socio-demographic characteristics of the respondents Variable Category Frequency (n) Percentage (%) Religion Anglicans 143 48.8 Catholics 113 38.6 Moslems 28 9.6 SDAs 9 3.1 Place of residence Rural 138 47.1 Urban 155 52.9 Parental living status Died 4 1.4 Living 289 98.6 Marital status of the parent/caretaker Divorced 7 2.4 Married 258 88.1 Cohabiting 11 3.8 Separated 17 5.8 Education level of the parent/caretaker No education 10 3.4 Primary 79 27.0 Secondary 104 35.5 Tertiary 100 34.1 Occupation of the parent/caretaker Farmer 31 10.6 Businessman/woman 127 43.3 Civil servant 126 43.0 Self employed 9 3.1 Health-related characteristics of the participants Majority of the participants had ever received the HPV vaccine 251 (85.7%), most of them 226 (90.0%) had received from outreaches, and 108 (43%) travelled for 1–3 kilometres. Majority of the respondents rated distance as moderate at 114 (45.4%) (Table 3 ). Table 3 Health-related characteristics of the participants Variable Category Frequency (n) Percentage (%) Ever received HPV vaccine No 42 14.3 Yes 251 85.7 Where HPV vaccine was obtained from Government health facility 16 6.4 Outreach 226 90.0 Private health facility 9 3.6 Distance to the health facility Less than 1Km 105 41.8 1–3 KM 108 43.0 Above 3 KM 38 15.1 Rating of the distance Near 107 42.6 Moderate 114 45.4 Far 30 12.0 Source of information Teachers 108 43.0 Health worker 119 47.4 Radio/Television 5 2.0 Other 19 7.6 Time rating Short 94 37.45 Moderate 92 36.7 Long 65 25.9 Uptake of the HPV vaccine In this study, 196 (66.89%) of the girls received a complete dose of the HPV vaccine (95% CI: 61.0–72.0) (Fig. 1 ). Bivariate analysis of social demographic factors associated with the uptake of the HPV vaccine among adolescent girls aged 13–17 years in Sheema Municipality, Sheema District. Compared with those living in rural areas, girls living in urban areas were 64% less likely to complete HPV vaccination (cOR = 0.36, 95% CI: [0.21–0.61], p = 0.001). Girls whose parents/caretaker had secondary education were 4.49 times more likely (cOR: 4.49, 95% CI: 1.17–17.1, p = 0.028), and those whose parents/caretaker had tertiary education were 4.05 times more likely (cOR: 4.05, 95% CI: 1.06–15.4, p = 0.041) to complete HPV vaccination (Table 4 ). Table 4 Bivariate analysis of socio-demographic factors associated with the uptake of the HPV vaccine among adolescent girls aged 13–17 years in Sheema Municipality, Sheema District. Variable HPV vaccination status cOR (95%CI) P value Incomplete n (%) Completed n (%) Religion SDAs 4 (4.1) 5 (2.6) Ref Anglicans 37 (38.1) 106 (54.1) 2.29 (0.58–8.99) 0.234 Catholics 38 (39.2) 75 (38.3) 1.57 (0.40–6.22) 0.514 Moslems 18 (39.6) 10 (5.0) 0.44 (0.96–2.04) 0.297 Place of residence Rural 30 (30.9) 108 (55.1) Ref Urban 67 (69.1) 88 (44.9) 0.36 (0.21–0.61) 0.001* Parental living status Died 1 (1.0) 3 (1.5) Ref Living 96 (99.0) 193 (98.5) 0.67 (0.68–6.52) 0.730 Marital status of parent/caretaker Divorced 4 (4.1) 3 (1.5) Ref Married 87 (89.7) 171 (87.2) 2.62 (0.57–11.9) 0.214 Cohabiting 3 (3.1) 8 (4.1) 3.55 (0.48–26.2) 0.214 Separated 3 (3.1) 14 (7.1) 6.22 (0.88–43.6) 0.066 Education level of parent/caretaker No education 6 (6.2) 4 (2.0) Ref Primary 38 (39.2) 41 (20.9) 1.61 (0.42–6.18) 0.481 Secondary 26 (26.8) 78 (39.8) 4.49 (1.17–17.1) 0.028* Tertiary 27 (27.8) 78 (37.2) 4.05 (1.06–15.4) 0.041* Occupation of parent/caretaker Farmer 12 (12.4) 19 (9.7) Ref Business 48 (49.5) 79 (40.3) 1.03 (0.46–2.32) 0.925 Civil servant 36 (49.5) 90 (45.9) 1.57 (0.69–3.58) 0.275 Self employed 1 (1.0) 8 (4.1) 5.05 (0.55–45.6) 0.149 Ref-Reference Category Bivariate analysis of the health service-related factors associated with the uptake of the HPV vaccine among adolescent girls aged 13–17 years in Sheema Municipality, Sheema District. Girls who perceived themselves at risk of HPV were 1.84 times more likely to complete the HPV vaccination compared to those who did not perceive any risk (cOR = 1.84, 95% CI: [1.12–3.02], p = 0.015). Compared with those who did not with perceived side effects of HPV vaccine, girls with perceived side effects of the HPV vaccine were 56% less likely to complete the HPV vaccination (cOR = 0.44, 95% CI: [0.23–0.84], p = 0.013). Compared with those who did not receive such education, girls who received health education about the HPV vaccine were 1.98 times more likely to complete the vaccination (cOR = 1.98, 95% CI: [1.17–3.34], p = 0.010) (Table 5 ). Table 5 Bivariate analysis of the health service-related factors associated with the uptake of the HPV vaccine among adolescent girls aged 13–17 years in Sheema Municipality, Sheema District. Variable Vaccination status cOR (95%CI) P Value Incomplete n (%) Completed n (%) Where HPV vaccine was obtained from Government 3 (5.5) 13 (6.6) Ref Outreach 51 (92.7) 175 (89.3) 0.79 (0.22–2.88) 0.721 Private Clinic 1 (1.8) 8 (4.1) 1.84 (0.16–20.9) 0.621 Distance to the health facility Less than 1Km 26 (47.3) 79 (40.3) 0.46 (0.16–1.30) 0.144 1–3 KM 24 (43.6) 84 (42.9) 0.53 (0.18–1.50) 0.234 Above 3 KM 5 (9.1) 33 (16.8) Ref Rating of the distance Far 7 (12.7) 23 (11.7 Ref Near 24 (43.6) 83 (42.4) 1.14 (0.43–2.97) 0.787 Moderate 24 (43.6) 90 (45.9) 1.05 (0.40–2.74) 0.917 Time rating Long 15 (27.3) 50 (25.5) Ref Short 15 (27.3) 79 (40.3) 0.80 (0.38–1.68) 0.562 Moderate 25 (45.5) 67 (34.2) 1.58 (0.71–3.51) 0.262 Perceived risk of HPV No 48 (49.5) 68 (34.7) Ref Yes 49 (50.5) 128 (65.3) 1.84 (1.12–3.02 0.015* Perceived side effects of HPV vaccine No 74 (76.3) 172 (87.8) Ref Yes 23 (23.7) 24 (12.4) 0.44 (0.23–0.84) 0.013* Received health education of HPV vaccine No 38 (39.2) 48 (24.5) Ref Yes 59 (60.8) 148 (75.5) 1.98 (1.17–3.34) 0.010* Ref-Reference Category Multivariate analysis of the factors associated with the uptake of the HPV vaccine among adolescent girls aged 13–17 years in Sheema Municipality, Sheema District. Participants who perceived themselves at risk of HPV were 1.73 times more likely to complete the HPV vaccination compared to those who did not perceive any risk (aOR = 1.73, 95% CI: [1.00–2.99], p = 0.048). Compared with those who did not receive health education, those who received health education about the HPV vaccine were 2.17 times more likely to complete the vaccination (aOR = 2.17, 95% CI: [1.23–3.83], p = 0.007). Participants whose parents/caretakers had higher education levels were significantly more likely to complete the HPV vaccination than those whose parents/caretakers had no education. Specifically, girls whose parents/caretakers had secondary education were 6.61 times more likely (aOR: 6.61, 95% CI: 1.57–27.8, p = 0.010), and those whose parents/caretakers had tertiary education were 5.56 times more likely (aOR: 5.56, 95% CI: 1.33–23.1, p = 0.019) to complete the vaccination. Participants living in urban areas were 63% less likely to complete the vaccination compared to those living in rural areas (aOR = 0.37, 95% CI: [0.21–0.65], p = 0.001) (Table 6 ). Table 6 Multivariate analysis of the factors associated with the uptake of the HPV vaccine among adolescent girls aged 13–17 years in Sheema Municipality, Sheema District. Variable Completed n (%) cOR (95%CI) P Value aOR (95%CI) P Value Perceived risk of HPV No 68 (34.7) Ref Ref Yes 128 (65.3) 1.84 (1.12–3.02 0.015* 1.73 (1.00-2.99) 0.048* Perceived side effects of HPV vaccine No 172 (87.8) Ref Ref Yes 24 (12.4) 0.44 (0.23–0.84) 0.013* 0.56 (0.27–1.15) 0.118 Received health education of HPV vaccine No 48 (24.5) Ref Ref Yes 148 (75.5) 1.98 (1.17–3.34) 0.010* 2.17 (1.23–3.83) 0.007* Education level No education 4 (2.0) Ref Ref Primary 41 (20.9) 1.61 (0.42–6.18) 0.481 2.60 (0.61–10.9) 0.193 Secondary 78 (39.8) 4.49 (1.17–17.1) 0.028* 6.61 (1.57–27.8) 0.010* Tertiary 78 (37.2) 4.05 (1.06–15.4) 0.041* 5.56 (1.33–23.1) 0.019* Place of residence Rural 108 (55.1) Ref Ref Urban 88 (44.9) 0.36 (0.21–0.61) 0.001* 0.37 (0.21–0.65) 0.001* Ref-Reference Category Discussion In this study, 66.8% of the girls aged 13--17 years had completed the recommended two doses of the HPV vaccine. This was, however, higher than what was reported in studies carried out among adolescents in Lira Uganda (17.4%) (15), Mbale district in Eastern Uganda (22)(14%) , Ugandan girls aged 10--14 years (21), Denmark (62%), Japan (48.2%), Germany (39.5%) (23) and the United States (14%) in the United States (24). On the other hand, other studies have reported markedly higher HPV completion rates than those reported in this study. For example, the uptake of the HPV vaccine was 91% in Scotland, the highest ever reported in the world (25), followed by Taiwan (90%) (26) and Prince Edward Island in Canada (85%) (27). In this study, the education level of parents/caregivers was significantly associated with the uptake of the HPV vaccine. Compared with those whose parents had illiterate parents, girls whose parents had secondary and tertiary education levels were more likely to receive the two recommended doses of the HPV vaccine. This finding is in agreement with that of a study conducted in Hong Kong, where girls whose mothers had a tertiary education were twice as likely to be vaccinated against HPV than those whose mothers were less educated (28). Similar findings were reported in Germany (19) and California (29). Ogilvie et al., explained that educated parents were more likely to conduct an information search over the internet than less educated parents were (30). In contrast to the findings of this study, a population-based evaluation of a publicly funded, school-based HPV vaccine program in British Columbia, Canada and Norway revealed that parents with higher education levels were less likely to vaccinate their children against HPV (31). Compared with those in rural areas, girls residing in urban areas were less likely to complete the recommended two doses of the HPV vaccine. A study carried out in Canada revealed a statistically significant relationship between the area of residence and the uptake of the HPV vaccine (32). In contrast, a systematic review and meta-analysis carried out in East Africa revealed that females from urban residences were more likely to receive the HPV vaccine than rural residents were (33). A multilevel study carried out in Uganda revealed no relationship between place of residence and HPV vaccine uptake (21). Participants who received health education about the HPV vaccine were more likely to complete the HPV vaccination than those who did not receive health education. These findings suggest that health education plays a critical role in improving vaccine uptake by increasing awareness, addressing misconceptions, and enhancing the perceived importance of vaccination. When individuals are informed about the benefits, risks, and importance of the HPV vaccine, they are more likely to trust the vaccination process and complete the required doses. A systematic review and meta-analysis conducted in East Africa reported similar results, showing that having good knowledge about the HPV vaccine positively influenced its uptake (33). This finding was also supported by a study of systematic reviews and meta-analyses among teenagers, which highlighted the positive impact of knowledge on HPV vaccine uptake (34) in Italy (35), China (36) and Ethiopia (37). This may be because knowledge plays a crucial role in the adoption of important prevention strategies. Understanding HPV infection and the HPV vaccine helps individuals make informed, evidence-based decisions about getting vaccinated. Participants who perceived themselves at risk of HPV were more likely to complete the HPV vaccination than those who did not perceive any risk. A similar study in Ethiopia revealed that participants who perceived themselves at risk of acquiring HPV were nearly five times more likely to receive the vaccine than those who did not perceive any risk. (38). Similarly, a study conducted in the USA revealed that sexually active college women were less likely to receive the HPV vaccine (39). This could be attributed to a low-risk perception, as indicated in the current study, where those who felt at higher risk were more likely to receive the vaccine. Conclusions and recommendations The uptake of the HPV vaccine among adolescent girls in this study was greater than that reported in several previous studies but still fell short of the highest reported rates worldwide. Girls with more educated parents, those who received health education, and those who perceived themselves at risk of HPV were more likely to complete the recommended two doses. However, urban residency was associated with lower rates of vaccine completion. Efforts should focus on increasing awareness through health education and integrating HPV vaccination education into school health programs to ensure that students and their parents receive adequate information. Awareness campaigns should be conducted to emphasize the risks of HPV infection and the protective benefits of vaccination. Finally, it is worth investigating the factors contributing to lower vaccine uptake in urban settings and developing strategies to improve access and acceptance. Limitations of the study Despite the great effort made, the study may still be subject to social desirability bias and recall bias. Since the HPV vaccine is administered through a school-based program, the findings may not be generalizable to out-of-school adolescents. Additionally, the cross-sectional study design limits the ability to establish cause‒and‒effect relationships. Abbreviations aOR Adjusted Odds Ratio CDC Centre for Disease Control CI Confidence Interval cOR Crude Odds Ratio HPV Human Papilloma Virus MOH Ministry of Health STI Sexually Transmitted Infections WHO World Health Organization PPS Probability Proportionate Sampling REC Research Ethics Committee Declarations Ethics approval and consent to participate. Ethical clearance to conduct the study was obtained from the Faculty Research Committee (FRC) and Mbarara University Research Ethics Committee (REC). Permission to conduct the study in the proposed study area was obtained from the Town Clerk and Municipal Education Officer of Sheema Municipality. Administrative clearance was obtained from the head teachers of different schools. We also obtained consent from the students under the guidance of their class teachers. During data collection, written informed consent was obtained from each respondent. The head teachers and teachers signed informed consent forms on behalf of those students younger than 18 years. For any reason, participants were allowed to drop out of the study at any time if they wished to. The researcher ensured the confidentiality of the data collected. Random codes were used in the questionnaires. The study was performed in accordance with the Declaration of Helsinki. Consent form publication Not applicable Data availability statement The dataset analysed during the current study is available upon request from the author. Competing interest No potential financial or nonfinancial interests were reported by the author(s). Funding This study was not supported by any specific grant. Author contributions CC, FK and EM conceptualized and designed the study, reviewed the relevant literature and wrote the manuscript. CC, BT and RM designed the questionnaire and conducted the data collection and analysis. EM reviewed the study and manuscript and guided the study. 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Factors influencing completion of multi-dose vaccine schedules in adolescents: a systematic review. BMC public health. 2016;16(1):1-17. Alberts CJ, van der Loeff MFS, Hazeveld Y, de Melker HE, van der Wal MF, Nielen A, et al. A longitudinal study on determinants of HPV vaccination uptake in parents/guardians from different ethnic backgrounds in Amsterdam, the Netherlands. BMC public health. 2017;17(1):1-12. Kumar VM, Whynes DK. Explaining variation in the uptake of HPV vaccination in England. BMC public health. 2011;11(1):1-7. Schülein S, Taylor KJ, König J, Claus M, Blettner M, Klug SJ. Factors influencing uptake of HPV vaccination among girls in Germany. BMC public health. 2016;16(1):1-8. NPHC. National Population and Housing Census 2024, https://www.ubos.org/wp-content/uploads/publications/National-Population-and-Housing-Census-2024-Preliminary-Report.pdf. 2024. Isabirye A, Mbonye M, Asiimwe JB, Kwagala B. Factors associated with HPV vaccination uptake in Uganda: a multi-level analysis. BMC Women's Health. 2020;20(1):1-11. Nabirye J, Okwi LA, Nuwematsiko R, Kiwanuka G, Muneza F, Kamya C, et al. Health system factors influencing uptake of Human Papilloma Virus (HPV) vaccine among adolescent girls 9-15 years in Mbale District, Uganda. BMC public health. 2020;20(1):171. Poethko-Müller C, Buttmann-Schweiger N. HPV vaccination coverage in German girls: results of the KiGGS study: first follow-up (KiGGS Wave 1). Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz. 2014;57(7):869-77. Laz TH, Rahman M, Berenson AB. An update on human papillomavirus vaccine uptake among 11–17 year old girls in the United States: National Health Interview Survey, 2010. Vaccine. 2012;30(24):3534-40. Potts A, Sinka K, Love J, Gordon R, McLean S, Malcolm W, et al. High uptake of HPV immunisation in Scotland–perspectives on maximising uptake. Eurosurveillance. 2013;18(39):20593. Lee C-C, Chen T-S, Wu T-Z, Huang L-M. A human papillomavirus public vaccination program in Taiwan: the Kinmen County experience. Journal of the Formosan Medical Association. 2012;111(12):682-5. McClure CA, MacSwain M-A, Morrison H, Sanford CJ. Human papillomavirus vaccine uptake in boys and girls in a school-based vaccine delivery program in Prince Edward Island, Canada. Vaccine. 2015;33(15):1786-90. Li SL, Lau YL, Lam TH, Yip PSF, Fan SYS, Ip P. HPV vaccination in Hong Kong: uptake and reasons for non-vaccination amongst Chinese adolescent girls. Vaccine. 2013;31(49):5785-8. Chao C, Velicer C, Slezak JM, Jacobsen SJ, editors. Correlates for completion of 3-dose regimen of HPV vaccine in female members of a managed care organization. Mayo Clinic Proceedings; 2009: Elsevier. Ogilvie G, Anderson M, Marra F, McNeil S, Pielak K, Dawar M, et al. A population-based evaluation of a publicly funded, school-based HPV vaccine program in British Columbia, Canada: parental factors associated with HPV vaccine receipt. PLoS Med. 2010;7(5):e1000270. Hansen BT, Campbell S, Burger E, Nygård M. Correlates of HPV vaccine uptake in school-based routine vaccination of preadolescent girls in Norway: A register-based study of 90,000 girls and their parents. Preventive medicine. 2015;77:4-10. Ogilvie GS, Remple VP, Marra F, McNeil SA, Naus M, Pielak KL, et al. Parental intention to have daughters receive the human papillomavirus vaccine. Cmaj. 2007;177(12):1506-12. Agimas MC, Adugna DG, Derseh NM, Kassaw A, Kassie YT, Abate HK, et al. Uptake of human papilloma virus vaccine and its determinants among females in East Africa: a systematic review and meta-analysis. BMC Public Health. 2024;24(1):842. Kessels SJ, Marshall HS, Watson M, Braunack-Mayer AJ, Reuzel R, Tooher RL. Factors associated with HPV vaccine uptake in teenage girls: a systematic review. Vaccine. 2012;30(24):3546-56. Cocchio S, Bertoncello C, Baldovin T, Fonzo M, Bennici SE, Buja A, et al. Awareness of HPV and drivers of HPV vaccine uptake among university students: a quantitative, cross‐sectional study. Health & social care in the community. 2020;28(5):1514-24. You D, Han L, Li L, Hu J, D. Zimet G, Alias H, et al. Human papillomavirus (HPV) vaccine uptake and the willingness to receive the HPV vaccination among female college students in China: a multicenter study. Vaccines. 2020;8(1):31. Addisu D, Gebeyehu NA, Belachew YY. Knowledge, attitude, and uptake of human papillomavirus vaccine among adolescent schoolgirls in Ethiopia: a systematic review and meta-analysis. BMC Women's Health. 2023;23(1):279. Hailu G, Wirtu D, Tesfaye T, Getachew M. Human papillomavirus vaccine uptake and associated factors among adolescent girls in high schools of Nekemte city, Western Ethiopia, 2020. BMC Women's Health. 2023;23(1):560. Barnard M, George P, Perryman ML, Wolff LA. Human papillomavirus (HPV) vaccine knowledge, attitudes, and uptake in college students: Implications from the Precaution Adoption Process Model. PloS one. 2017;12(8):e0182266. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5910968","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":408627511,"identity":"51050063-63a9-4949-84a6-459897fb43b3","order_by":0,"name":"Calvin Cherop","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9UlEQVRIiWNgGAWjYDACCQiVACErbIAkY+MB4rU8OJMG0tJAvBbGh22HwTy8WvhnNx/78HGHXR6/9OFjDxLYztutbT8MtKXGJhqnJXeOJc+ceSa5WLIvLd0gged28rYziUAtx9JyG3BoMZDIMWbmbTuQuOEMj5lEgsTtZLMDQC2MDYfxaMn/DNayH6zF4Fyy2fmHhLTkMENs4QFpSThgZ3aDgC0SN9KMGYF+SZxxhg3olwPJCWY3gLYk4PEL/4zkxwzAEEvs72E+9vDnPzt7s/PpDx98qLHBqQUMGCGybCAiEcxOwKccXYs9IcWjYBSMglEw8gAABLdlbwmcSokAAAAASUVORK5CYII=","orcid":"","institution":"Mbarara University of Science and Technology","correspondingAuthor":true,"prefix":"","firstName":"Calvin","middleName":"","lastName":"Cherop","suffix":""},{"id":408627512,"identity":"cefe8598-5feb-4596-a389-22cbad85d2cb","order_by":1,"name":"Farida Kigongo","email":"","orcid":"","institution":"Mbarara University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Farida","middleName":"","lastName":"Kigongo","suffix":""},{"id":408627513,"identity":"a3ebfb13-aaca-4006-a60a-bd3cfbd2b1f1","order_by":2,"name":"Edgar Mulogo Mugema","email":"","orcid":"","institution":"Mbarara University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Edgar","middleName":"Mulogo","lastName":"Mugema","suffix":""},{"id":408627514,"identity":"c1a70db9-3a41-4fdc-91ca-f02bd12d6881","order_by":3,"name":"Rashid Mugabe","email":"","orcid":"","institution":"Mbarara University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Rashid","middleName":"","lastName":"Mugabe","suffix":""},{"id":408627515,"identity":"38cf8c4a-5ccd-450e-af97-068d1b060434","order_by":4,"name":"Bridget Taremwa","email":"","orcid":"","institution":"Mbarara University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Bridget","middleName":"","lastName":"Taremwa","suffix":""},{"id":408627516,"identity":"7e56139c-7b87-4c44-aca2-b779bbc29a21","order_by":5,"name":"Evelyn Tusasirwe","email":"","orcid":"","institution":"Mbarara University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Evelyn","middleName":"","lastName":"Tusasirwe","suffix":""}],"badges":[],"createdAt":"2025-01-27 09:23:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5910968/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5910968/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":75314066,"identity":"db68b243-ba0e-4e2b-8c1a-bcd713bc8733","added_by":"auto","created_at":"2025-02-03 09:28:03","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":15951,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eA pie chart showing the proportion of girls who received the HPV vaccine\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5910968/v1/2ecde03c4cac5641b672859a.png"},{"id":75316546,"identity":"0a13a800-c638-4573-9690-afa1dc59f9ac","added_by":"auto","created_at":"2025-02-03 09:44:04","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1609262,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5910968/v1/5574b8b9-928f-4a9c-8e4e-20a8cdb3ac47.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Magnitude and factors associated with the uptake of the HPV vaccine among adolescent girls aged 13-17 years in Sheema Municipality, Sheema District. A cross-sectional study","fulltext":[{"header":"Background","content":"\u003cp\u003eHuman papilloma virus (HPV) is the most common sexually transmitted infection (STI)(1). Almost all sexually active people are infected at some point in their lives, usually without symptoms (1). In 2018, approximately 43\u0026nbsp;million HPV infections occurred worldwide, with many cases affecting individuals in their late teens and early twenties (2). Sub-Saharan Africa has the highest prevalence of cervical HPV among women at 24%, followed by Latin America and the Caribbean at 16%, Eastern Europe at 14%, and Southeast Asia at 14% (1).\u003c/p\u003e \u003cp\u003eHPV is a leading cause of cervical cancer, the fourth most common cancer among women globally (3). In 2022, cervical cancer accounted for approximately 660,000 new cases and 350,000 deaths globally (3), with low- and middle-income countries (LMICs) accounting for 84% of new cases and 90% of deaths (1). East Africa had the highest age-standardized cervical cancer mortality rate of 30 per 100,000 and the second-highest incidence rate of 40 per 100,000 in 2018 (4). In Uganda, cervical cancer is the most common cancer among women, with an age-standardized incidence rate (ASR) of 56.2 per 100,000 and a cancer-related death rate of 41.4 per 100,000 in 2020 (5).\u003c/p\u003e \u003cp\u003eAt least 95% of cervical cancer cases are caused by human papillomavirus (HPV) infections, which are transmitted primarily through sexual intercourse (6). Most sexually active women will be infected with HPV at some point in their lives, but nearly all will clear the infection within a year (7). Unfortunately, 12% of acute HPV infections persist and can develop into precancerous lesions or invasive cervical cancer over several decades (8). This well-established cause, along with the prolonged natural course of HPV infection, provides an opportunity for effective interventions to manage cervical cancer (9).\u003c/p\u003e \u003cp\u003eThe majority of cervical cancer cases are potentially preventable. The World Health Organization (WHO) emphasizes primary prevention, specifically vaccinating girls aged 9\u0026ndash;14 years before exposure to sex or HPV, as a crucial step in preventing the onset of cervical cancer (10). It is estimated that the HPV vaccine can reduce cervical cancer deaths by two-thirds if uptake reaches 80%. In Uganda, HPV vaccines targeting HPV types 16 and 18 have been available since 2006 (11). The provision of the human papillomavirus (HPV) vaccine is aimed at primary prevention of cervical cancer, ensuring that the risk of HPV infection progressing to cervical cancer later in life is eliminated (12). In 2015, the Ministry of Health, through its strategic plan for cervical cancer prevention, committed to achieving 80% HPV vaccine coverage among eligible girls (13). HPV vaccination uptake in Uganda is as low as 19.6%, despite the high efficacy and safety of the vaccine compared with other vaccines (14).\u003c/p\u003e \u003cp\u003eA number of studies have examined the predictors of HPV vaccination (15). Most of these studies are from developed economies. School status (16), being older (17), ethnicity (18), and medium social economic status (19) were significantly associated with HPV vaccination. Although a number of studies in developed countries have assessed the factors associated with the uptake of the HPV vaccine, studies in developing countries such as Uganda have limited studies. This study assessed the factors associated with the uptake of the HPV vaccine among adolescent girls aged 13\u0026ndash;17 years in Sheema Municipality.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003eStudy design and study setting\u003c/h2\u003e\n \u003cp\u003eThis was a cross-sectional study that was conducted in government-aided secondary schools in Sheema Municipality. Sheema district is located 298 km southwest of Kampala, the capital city, and is bordered by Mbarara to the east, Bushenyi to the west and Buhweju to the north. Sheema Municipality comprises three (3) divisions, namely, the Kabwohe, Kagango and Sheema Central divisions.\u003c/p\u003e\n \u003cp\u003eThe 2024 estimated population of Sheema Municipality was approximately 252,275 (20). There are ten (10) government health facilities (1 HCIV, 2 HCIIIs, 7 HCIIs, 1 private not for profit HCIII and 1 private for profit HCIII) in the respective divisions in the Sheema Municipality. All these facilities offer static and outreach services in the community. With regard to vaccination, there are routine HPV vaccination sessions that are conducted in all primary schools in the catchment area and target girls who are 10 years old. Community outreaches are also conducted targeting girls who are out of school.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eStudy population\u003c/h3\u003e\n\u003cp\u003eThe study enrolled adolescent girls aged 13\u0026ndash;17 years because they were expected to have completed the HPV vaccination schedule of two doses and who had consented to participate in the study, and we excluded those who were absent during data collection.\u003c/p\u003e\n\u003ch3\u003eSample size\u003c/h3\u003e\n\u003cp\u003eThis study used a formula developed by Kish \u0026amp; Leslie (1965) for cross-sectional studies to determine the sample size.\u003c/p\u003e\n\u003cdiv id=\"Equa\" class=\"Equation\"\u003e\n \u003cdiv class=\"mathdisplay\" id=\"FileID_Equa\" name=\"EquationSource\"\u003e$$\\:n=\\frac{{z}^{2}\\times\\:p\\times\\:q}{{d}^{2}}$$\u003c/div\u003e\n\u003c/div\u003e\n\u003cp\u003en- Desired sample size\u003c/p\u003e\n\u003cp\u003eP - The estimated proportion of girls who received complete doses of the HPV vaccine (22%) in a multilevel survey among Ugandan girls aged 10\u0026ndash;14 years (21)\u003c/p\u003e\n\u003cp\u003eZ - Critical value form for a standard normal distribution with \u0026alpha; as the level of significance set to 0.05 Thus, the value of 1.96\u003c/p\u003e\n\u003cp\u003ed\u0026thinsp;=\u0026thinsp;is the margin of error, which is 5%\u003c/p\u003e\n\u003cdiv id=\"Equb\" class=\"Equation\"\u003e\n \u003cdiv class=\"mathdisplay\" id=\"FileID_Equb\" name=\"EquationSource\"\u003e$$\\:n=\\frac{{1.96}^{2}\\times\\:0.22\\times\\:0.78}{{0.05}^{2}}$$\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Equc\" class=\"Equation\"\u003e\n \u003cdiv class=\"mathdisplay\" id=\"FileID_Equc\" name=\"EquationSource\"\u003e$$\\:\\text{n}=264\\:\\text{r}\\text{e}\\text{s}\\text{p}\\text{o}\\text{n}\\text{d}\\text{e}\\text{n}\\text{t}\\text{s}\\:$$\u003c/div\u003e\n\u003c/div\u003e\n\u003cp\u003eA 10% nonresponse rate was factored. Therefore, the final sample size was\u003c/p\u003e\n\u003cdiv id=\"Equd\" class=\"Equation\"\u003e\n \u003cdiv class=\"mathdisplay\" id=\"FileID_Equd\" name=\"EquationSource\"\u003e$$\\:\\text{n}=\\frac{264}{0.9\\:}$$\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Eque\" class=\"Equation\"\u003e\n \u003cdiv class=\"mathdisplay\" id=\"FileID_Eque\" name=\"EquationSource\"\u003e$$\\:\\text{n}=293\\:\\text{r}\\text{e}\\text{s}\\text{p}\\text{o}\\text{n}\\text{d}\\text{e}\\text{n}\\text{t}\\text{s}$$\u003c/div\u003e\n\u003c/div\u003e\n\u003ch3\u003eSampling procedure\u003c/h3\u003e\n\u003cp\u003eSimple random sampling technique was used to select four schools out of the 13 schools present in Sheema Municipality, Sheema District. Since Sheema Municipality has three divisions, at least one secondary school was randomly selected from each of the three divisions (Kabwohe, Sheema Central and Kagango Divisions). Probability Proportionate to size (PPS) sampling method was used to determine the number of adolescent girls who were included in the study from each school (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1: Number of participants sampled from each school\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cimg 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\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003cdiv align=\"char\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n\u003c/div\u003e\n\u003ch3\u003eData collection tools\u003c/h3\u003e\n\u003cp\u003eThe researcher used a structured questionnaire that was divided into four main sections. The first section assessed the social demographic characteristics of the respondents, such as place of residence, age, living status of the parents, religion and the nature of the schools. The second section assessed health-related factors such as the availability of vaccines, accessibility of vaccines, awareness of HPV vaccines, attitudes of health workers, perceived side effects of HPV vaccines, perceived risk of acquiring HPV and attitudes towards the vaccine. The third section assessed caretaker/parent-related factors such as education level, occupation, marital status and income level.\u003c/p\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003eData collection procedure\u003c/h2\u003e\n \u003cp\u003ePermission was sought from the Municipal Education Officer, which allowed the Principal Investigator (PI) to approach head teachers in each of the selected schools. At every school, permission to carry out the study was granted from the head teacher. Consent was sought from the head teachers since most of the study participants were younger than 18 years.\u003c/p\u003e\n \u003cp\u003eThe principal investigator and the research assistants moved to the schools, introduced themselves to the teachers, the students, their reasons for approaching them and then proceeded to collect the data. Upon entering the respective classes, the research team obtained informed consent from the teachers and the students. The researcher team then interviewed the participants who met the study inclusion criteria. The completed questionnaires were checked for completeness, after which the participants exited the study.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eStudy variables\u003c/h3\u003e\n\u003cp\u003eThe dependent variable was the uptake of the HPV vaccine. This was categorized as fully vaccinated or not fully vaccinated. Girls who received two doses of the HPV vaccine were considered fully vaccinated, which was in line with the recommendation of the Ministry of Health and those who received one or no dose at all were considered not fully vaccinated. This was confirmed by clearly describing the cards and showing the girl samples on the cards.\u003c/p\u003e\n\u003ch3\u003eQuality assurance\u003c/h3\u003e\n\u003cp\u003eThe principal investigator hired research assistants who were trained prior to data collection. The questionnaire was pretested among secondary school girls in Kibingo Girls Secondary School who were not included in the study. The questionnaire was tested to determine whether it generated the intended data. Errors noted in the pre-test exercise, including the interview protocol, were corrected before actual data collection. The principal investigator constantly supervised the research assistants during data collection. The questionnaires were checked for completeness immediately after the interview.\u003c/p\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n \u003ch2\u003eData analysis\u003c/h2\u003e\n \u003cp\u003eQuantitative data were entered into a computer in Microsoft Excel and then exported to Stata version 14 for statistical analysis. Continuous variables such as age were entered as continuous data, whereas categorical variables such as place of residence and caretakers\u0026rsquo; education level were coded. Frequency distributions for categorical variables were used to describe the demographic and socioeconomic characteristics of the adolescent girls. For continuous variables, standard deviations and means were used. Cross-tabulations using Pearson\u0026rsquo;s chi-square test was used to determine the distribution of the participants. Bivariate and multivariate logistic regression models were used to determine the factors associated with the uptake of the HPV vaccine. Crude and adjusted odds ratios with 95% confidence intervals are reported. The significance level for all the analyses was set at P\u0026thinsp;\u0026le;\u0026thinsp;0.05.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eSocio-demographic characteristics of the respondents\u003c/h2\u003e \u003cp\u003eA total of 293 adolescent girls aged 13\u0026ndash;17 years participated in the study. Most of the respondents were Anglicans (143, 48.8%), 289 (98.6%) had living parents, and 155 (52.9%) were residing in urban areas. Majority of the girls had parents who were married 258 (88.1%), 104 (35.5%) had secondary education level and 127 (43.3%) were businessmen/women (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSocio-demographic characteristics of the respondents\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\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 \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\u003eFrequency (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eReligion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAnglicans\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e143\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e48.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCatholics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e113\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e38.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMoslems\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSDAs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePlace of residence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e138\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e47.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e155\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e52.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eParental living status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDied\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLiving\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e289\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e98.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eMarital status of the parent/caretaker\u003c/p\u003e \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\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e258\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e88.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCohabiting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSeparated\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\u003e5.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eEducation level of the parent/caretaker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo education\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\u003e3.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e27.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e104\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e35.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTertiary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e34.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eOccupation of the parent/caretaker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFarmer\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\u003e10.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBusinessman/woman\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e127\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e43.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCivil servant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e126\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e43.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSelf employed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eHealth-related characteristics of the participants\u003c/h2\u003e \u003cp\u003eMajority of the participants had ever received the HPV vaccine 251 (85.7%), most of them 226 (90.0%) had received from outreaches, and 108 (43%) travelled for 1\u0026ndash;3 kilometres. Majority of the respondents rated distance as moderate at 114 (45.4%) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eHealth-related characteristics of the participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\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 \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\u003eFrequency (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage (%)\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\u003eEver received HPV vaccine\u003c/p\u003e \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\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e251\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e85.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eWhere HPV vaccine was obtained from\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGovernment health facility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOutreach\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e226\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e90.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrivate health facility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eDistance to the health facility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLess than 1Km\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e41.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u0026ndash;3 KM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e108\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e43.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAbove 3 KM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eRating of the distance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNear\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\u003e42.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e114\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e45.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eSource of information\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTeachers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e108\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e43.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHealth worker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e119\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e47.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRadio/Television\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\u003e2.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\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\u003e7.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eTime rating\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eShort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e37.45\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e36.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLong\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eUptake of the HPV vaccine\u003c/h2\u003e \u003cp\u003eIn this study, 196 (66.89%) of the girls received a complete dose of the HPV vaccine (95% CI: 61.0\u0026ndash;72.0) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eBivariate analysis of social demographic factors associated with the uptake of the HPV vaccine among adolescent girls aged 13\u0026ndash;17 years in Sheema Municipality, Sheema District.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eCompared with those living in rural areas, girls living in urban areas were 64% less likely to complete HPV vaccination (cOR\u0026thinsp;=\u0026thinsp;0.36, 95% CI: [0.21\u0026ndash;0.61], p\u0026thinsp;=\u0026thinsp;0.001). Girls whose parents/caretaker had secondary education were 4.49 times more likely (cOR: 4.49, 95% CI: 1.17\u0026ndash;17.1, p\u0026thinsp;=\u0026thinsp;0.028), and those whose parents/caretaker had tertiary education were 4.05 times more likely (cOR: 4.05, 95% CI: 1.06\u0026ndash;15.4, p\u0026thinsp;=\u0026thinsp;0.041) to complete HPV vaccination (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBivariate analysis of socio-demographic factors associated with the uptake of the HPV vaccine among adolescent girls aged 13\u0026ndash;17 years in Sheema Municipality, Sheema District.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" 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=\"left\" 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\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eHPV vaccination status\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ecOR (95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIncomplete n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCompleted n (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReligion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSDAs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4 (4.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5 (2.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eRef\u003c/em\u003e\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\u003eAnglicans\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e37 (38.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e106 (54.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.29 (0.58\u0026ndash;8.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.234\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCatholics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e38 (39.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e75 (38.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.57 (0.40\u0026ndash;6.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.514\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMoslems\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18 (39.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10 (5.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.44 (0.96\u0026ndash;2.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.297\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePlace of residence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e30 (30.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e108 (55.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eRef\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e67 (69.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e88 (44.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.36 (0.21\u0026ndash;0.61)\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 \u003cp\u003e\u003cb\u003eParental living status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDied\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (1.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eRef\u003c/em\u003e\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\u003eLiving\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e96 (99.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e193 (98.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.67 (0.68\u0026ndash;6.52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.730\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital status of parent/caretaker\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDivorced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4 (4.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (1.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eRef\u003c/em\u003e\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\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e87 (89.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e171 (87.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.62 (0.57\u0026ndash;11.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.214\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCohabiting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3 (3.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8 (4.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.55 (0.48\u0026ndash;26.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.214\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSeparated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3 (3.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14 (7.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.22 (0.88\u0026ndash;43.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.066\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducation level of parent/caretaker\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6 (6.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4 (2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eRef\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e38 (39.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e41 (20.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.61 (0.42\u0026ndash;6.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.481\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26 (26.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e78 (39.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.49 (1.17\u0026ndash;17.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.028*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTertiary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27 (27.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e78 (37.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.05 (1.06\u0026ndash;15.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.041*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOccupation of parent/caretaker\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFarmer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12 (12.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19 (9.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eRef\u003c/em\u003e\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\u003eBusiness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e48 (49.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e79 (40.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.03 (0.46\u0026ndash;2.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.925\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCivil servant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e36 (49.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e90 (45.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.57 (0.69\u0026ndash;3.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.275\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf employed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8 (4.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.05 (0.55\u0026ndash;45.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.149\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRef-Reference Category\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eBivariate analysis of the health service-related factors associated with the uptake of the HPV vaccine among adolescent girls aged 13\u0026ndash;17 years in Sheema Municipality, Sheema District.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eGirls who perceived themselves at risk of HPV were 1.84 times more likely to complete the HPV vaccination compared to those who did not perceive any risk (cOR\u0026thinsp;=\u0026thinsp;1.84, 95% CI: [1.12\u0026ndash;3.02], p\u0026thinsp;=\u0026thinsp;0.015). Compared with those who did not with perceived side effects of HPV vaccine, girls with perceived side effects of the HPV vaccine were 56% less likely to complete the HPV vaccination (cOR\u0026thinsp;=\u0026thinsp;0.44, 95% CI: [0.23\u0026ndash;0.84], p\u0026thinsp;=\u0026thinsp;0.013). Compared with those who did not receive such education, girls who received health education about the HPV vaccine were 1.98 times more likely to complete the vaccination (cOR\u0026thinsp;=\u0026thinsp;1.98, 95% CI: [1.17\u0026ndash;3.34], p\u0026thinsp;=\u0026thinsp;0.010) (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBivariate analysis of the health service-related factors associated with the uptake of the HPV vaccine among adolescent girls aged 13\u0026ndash;17 years in Sheema Municipality, Sheema District.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" 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=\"left\" 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\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eVaccination status\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ecOR (95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIncomplete n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCompleted n (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhere HPV vaccine was obtained from\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGovernment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3 (5.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13 (6.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eRef\u003c/em\u003e\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\u003eOutreach\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e51 (92.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e175 (89.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.79 (0.22\u0026ndash;2.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.721\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrivate Clinic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8 (4.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.84 (0.16\u0026ndash;20.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.621\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDistance to the health facility\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLess than 1Km\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26 (47.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e79 (40.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.46 (0.16\u0026ndash;1.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.144\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u0026ndash;3 KM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24 (43.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e84 (42.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.53 (0.18\u0026ndash;1.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.234\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbove 3 KM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5 (9.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33 (16.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eRef\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRating of the distance\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7 (12.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23 (11.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eRef\u003c/em\u003e\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\u003eNear\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24 (43.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e83 (42.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.14 (0.43\u0026ndash;2.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.787\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24 (43.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e90 (45.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.05 (0.40\u0026ndash;2.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.917\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTime rating\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLong\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15 (27.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50 (25.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eRef\u003c/em\u003e\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\u003eShort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15 (27.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e79 (40.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.80 (0.38\u0026ndash;1.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.562\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25 (45.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e67 (34.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.58 (0.71\u0026ndash;3.51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.262\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePerceived risk of HPV\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e48 (49.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e68 (34.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eRef\u003c/em\u003e\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\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e49 (50.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e128 (65.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.84 (1.12\u0026ndash;3.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.015*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePerceived side effects of HPV vaccine\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e74 (76.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e172 (87.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eRef\u003c/em\u003e\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\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e23 (23.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24 (12.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.44 (0.23\u0026ndash;0.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.013*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eReceived health education of HPV vaccine\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e38 (39.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e48 (24.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eRef\u003c/em\u003e\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\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e59 (60.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e148 (75.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.98 (1.17\u0026ndash;3.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.010*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRef-Reference Category\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eMultivariate analysis of the factors associated with the uptake of the HPV vaccine among adolescent girls aged 13\u0026ndash;17 years in Sheema Municipality, Sheema District.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eParticipants who perceived themselves at risk of HPV were 1.73 times more likely to complete the HPV vaccination compared to those who did not perceive any risk (aOR\u0026thinsp;=\u0026thinsp;1.73, 95% CI: [1.00\u0026ndash;2.99], p\u0026thinsp;=\u0026thinsp;0.048). Compared with those who did not receive health education, those who received health education about the HPV vaccine were 2.17 times more likely to complete the vaccination (aOR\u0026thinsp;=\u0026thinsp;2.17, 95% CI: [1.23\u0026ndash;3.83], p\u0026thinsp;=\u0026thinsp;0.007). Participants whose parents/caretakers had higher education levels were significantly more likely to complete the HPV vaccination than those whose parents/caretakers had no education. Specifically, girls whose parents/caretakers had secondary education were 6.61 times more likely (aOR: 6.61, 95% CI: 1.57\u0026ndash;27.8, p\u0026thinsp;=\u0026thinsp;0.010), and those whose parents/caretakers had tertiary education were 5.56 times more likely (aOR: 5.56, 95% CI: 1.33\u0026ndash;23.1, p\u0026thinsp;=\u0026thinsp;0.019) to complete the vaccination. Participants living in urban areas were 63% less likely to complete the vaccination compared to those living in rural areas (aOR\u0026thinsp;=\u0026thinsp;0.37, 95% CI: [0.21\u0026ndash;0.65], p\u0026thinsp;=\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariate analysis of the factors associated with the uptake of the HPV vaccine among adolescent girls aged 13\u0026ndash;17 years in Sheema Municipality, Sheema District.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" 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=\"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=\"char\" char=\".\" 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\u003eCompleted n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ecOR (95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP Value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eaOR (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\u003ePerceived risk of HPV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e68 (34.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eRef\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eRef\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e128 (65.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.84 (1.12\u0026ndash;3.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.015*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.73 (1.00-2.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.048*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePerceived side effects of HPV vaccine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e172 (87.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eRef\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eRef\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24 (12.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.44 (0.23\u0026ndash;0.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.013*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.56 (0.27\u0026ndash;1.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.118\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReceived health education of HPV vaccine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e48 (24.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eRef\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eRef\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e148 (75.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.98 (1.17\u0026ndash;3.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.010*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.17 (1.23\u0026ndash;3.83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.007*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducation level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4 (2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eRef\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eRef\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e41 (20.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.61 (0.42\u0026ndash;6.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.481\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.60 (0.61\u0026ndash;10.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.193\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e78 (39.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.49 (1.17\u0026ndash;17.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.028*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.61 (1.57\u0026ndash;27.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.010*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTertiary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e78 (37.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.05 (1.06\u0026ndash;15.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.041*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.56 (1.33\u0026ndash;23.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.019*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePlace of residence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e108 (55.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eRef\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eRef\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e88 (44.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.36 (0.21\u0026ndash;0.61)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.001*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.37 (0.21\u0026ndash;0.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRef-Reference Category\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study, 66.8% of the girls aged 13--17 years had completed the recommended two doses of the HPV vaccine. This was, however, higher than what was reported in studies carried out among adolescents in Lira Uganda (17.4%)\u0026nbsp;(15), Mbale district in Eastern Uganda\u0026nbsp;(22)(14%)\u0026nbsp;,\u0026nbsp;Ugandan girls aged 10--14 years\u0026nbsp;(21),\u0026nbsp;Denmark (62%), Japan (48.2%),\u0026nbsp;Germany (39.5%)\u0026nbsp;(23)\u0026nbsp;and the United States\u0026nbsp;(14%)\u0026nbsp;in the United States\u0026nbsp;(24).\u003c/p\u003e\n\u003cp\u003eOn the other hand, other studies have reported markedly higher HPV completion rates than those reported in this study. For example, the uptake of the HPV vaccine was 91% in Scotland, the highest ever reported in the world (25), followed by Taiwan (90%) (26) and Prince Edward Island in Canada (85%) (27).\u003c/p\u003e\n\u003cp\u003eIn this study, the education level of parents/caregivers was significantly associated with the uptake of the HPV vaccine. Compared with those whose parents had illiterate parents, girls whose parents had secondary and tertiary education levels were more likely to receive the two recommended doses of the HPV vaccine. This finding is in agreement with that of a study conducted in Hong Kong,\u0026nbsp;where girls whose mothers had a tertiary education were twice\u0026nbsp;as\u0026nbsp;likely to be vaccinated against HPV than those\u0026nbsp;whose mothers were\u0026nbsp;less educated\u0026nbsp;(28). Similar findings were\u0026nbsp;reported in Germany\u0026nbsp;(19)\u0026nbsp;and California\u0026nbsp;(29).\u0026nbsp;Ogilvie et al., explained that educated parents were more likely to conduct an information search over the internet\u0026nbsp;than\u0026nbsp;less educated parents\u0026nbsp;were\u0026nbsp;(30).\u0026nbsp;In contrast to the findings of this study,\u0026nbsp;a\u0026nbsp;population-based evaluation of a publicly funded, school-based HPV vaccine program\u0026nbsp;in British Columbia, Canada and Norway\u0026nbsp;revealed\u0026nbsp;that parents with higher education\u0026nbsp;levels\u0026nbsp;were less likely to vaccinate their children against HPV\u0026nbsp;(31).\u003c/p\u003e\n\u003cp\u003eCompared with those in rural areas, girls residing in urban areas were less likely to complete the recommended two doses of the HPV vaccine. A study carried out in Canada revealed a statistically significant relationship between the area of residence and the uptake of the HPV vaccine (32). In contrast, a systematic review and meta-analysis carried out in East Africa revealed that females from urban residences were more likely to receive\u0026nbsp;the HPV vaccine than rural residents\u0026nbsp;were\u0026nbsp;(33).\u0026nbsp;A\u0026nbsp;multilevel\u0026nbsp;study carried out in Uganda\u0026nbsp;revealed\u0026nbsp;no relationship between place of residence and HPV vaccine uptake\u0026nbsp;(21).\u003c/p\u003e\n\u003cp\u003eParticipants who received health education about the HPV vaccine were more likely to complete the HPV vaccination than those who did not receive health education. These findings suggest that health education plays a critical role in improving vaccine uptake by increasing awareness, addressing misconceptions, and enhancing the perceived importance of vaccination. When individuals are informed about the benefits, risks, and importance of the HPV vaccine, they are more likely to trust the vaccination process and complete the required doses. A systematic review and meta-analysis conducted in East Africa reported similar results, showing that having good knowledge about the HPV vaccine positively influenced its uptake (33).\u0026nbsp;This finding was also supported by a study of systematic reviews and meta-analyses among teenagers, which highlighted the positive impact of knowledge on HPV vaccine uptake (34)\u0026nbsp;in Italy\u0026nbsp;(35), China\u0026nbsp;(36)\u0026nbsp;and Ethiopia\u0026nbsp;(37).\u0026nbsp;This may be because knowledge plays a crucial role in\u0026nbsp;the adoption of\u0026nbsp;important prevention strategies. Understanding HPV infection and the HPV vaccine helps individuals make informed, evidence-based decisions about getting vaccinated.\u003c/p\u003e\n\u003cp\u003eParticipants who perceived themselves at risk of HPV were more likely to complete the HPV vaccination than those who did not perceive any risk. A similar study in Ethiopia revealed that participants who perceived themselves at risk of acquiring HPV were nearly five times more likely to receive the vaccine than those who did not perceive any risk. (38). Similarly, a study conducted in the USA revealed that sexually active college women were less likely to receive the HPV vaccine (39). This could be attributed to a low-risk perception, as indicated in the current study, where those who felt at higher risk were more likely to receive the vaccine.\u003c/p\u003e"},{"header":"Conclusions and recommendations","content":"\u003cp\u003eThe uptake of the HPV vaccine among adolescent girls in this study was greater than that reported in several previous studies but still fell short of the highest reported rates worldwide. Girls with more educated parents, those who received health education, and those who perceived themselves at risk of HPV were more likely to complete the recommended two doses. However, urban residency was associated with lower rates of vaccine completion.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEfforts should focus on increasing awareness through health education and integrating HPV vaccination education into school health programs to ensure that students and their parents receive adequate information. Awareness campaigns should be conducted to emphasize the risks of HPV infection and the protective benefits of vaccination. Finally, it is worth investigating the factors contributing to lower vaccine uptake in urban settings and developing strategies to improve access and acceptance.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations of the study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDespite the great effort made, the study may still be subject to social desirability bias and recall bias. Since the HPV vaccine is administered through a school-based program, the findings may not be generalizable to out-of-school adolescents. Additionally, the cross-sectional study design limits the ability to establish cause‒and‒effect relationships.\u003c/p\u003e"},{"header":"Abbreviations ","content":"\u003cp\u003eaOR \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Adjusted Odds Ratio\u003c/p\u003e\n\u003cp\u003eCDC \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Centre for Disease Control\u003c/p\u003e\n\u003cp\u003eCI \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Confidence Interval\u003c/p\u003e\n\u003cp\u003ecOR \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Crude Odds Ratio\u003c/p\u003e\n\u003cp\u003eHPV \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Human Papilloma Virus\u003c/p\u003e\n\u003cp\u003eMOH \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Ministry of Health\u003c/p\u003e\n\u003cp\u003eSTI \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Sexually Transmitted Infections\u003c/p\u003e\n\u003cp\u003eWHO \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;World Health Organization\u003c/p\u003e\n\u003cp\u003ePPS \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Probability Proportionate Sampling\u003c/p\u003e\n\u003cp\u003eREC \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Research Ethics Committee\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical clearance to conduct the study was obtained from the Faculty Research Committee (FRC) and Mbarara University Research Ethics Committee (REC). Permission to conduct the study in the proposed study area was obtained from the Town Clerk and Municipal Education Officer of Sheema Municipality. Administrative clearance was obtained from the head teachers of different schools. We also obtained consent from the students under the guidance of their class teachers.\u003c/p\u003e\n\u003cp\u003eDuring data collection, written informed consent was obtained from each respondent. The head teachers and teachers signed informed consent forms on behalf of those students younger than 18 years. For any reason, participants were allowed to drop out of the study at any time if they wished to. The researcher ensured the confidentiality of the data collected. Random codes were used in the questionnaires.\u0026nbsp;The study was performed in accordance with\u0026nbsp;the\u0026nbsp;Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent form publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe dataset analysed during the current study is available upon request from the author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo potential financial or nonfinancial\u0026nbsp;interests\u0026nbsp;were reported by the author(s).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was not supported by any specific grant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCC, FK and EM conceptualized and designed the study, reviewed the relevant literature and wrote the manuscript. CC, BT and RM designed the questionnaire and conducted the data collection and analysis. EM reviewed the study and manuscript and guided the study. All the authors contributed to the final version of the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eWHO. World Health Orgaization, Human papillomavirus and cancer, https://www.who.int/news-room/fact-sheets/detail/human-papilloma-virus-and-cancer. 2024.\u003c/li\u003e\n \u003cli\u003eCDC. Centers for Disease Control and Prevention. Human papillomavirus (HPV) is the most common sexually transmitted infection (STI) in the United States: HPV vaccines can prevent some of the health effects HPV causes [Internet] Atlanta (GA): Centers for Disease Control and Prevention; 2021. [cited 2021 Sep 10]. Available from: https://www.cdc.gov/std/hpv/stdfact-hpv.htm . . 2021.\u003c/li\u003e\n \u003cli\u003eWHO. 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Factors influencing completion of multi-dose vaccine schedules in adolescents: a systematic review. BMC public health. 2016;16(1):1-17.\u003c/li\u003e\n \u003cli\u003eAlberts CJ, van der Loeff MFS, Hazeveld Y, de Melker HE, van der Wal MF, Nielen A, et al. A longitudinal study on determinants of HPV vaccination uptake in parents/guardians from different ethnic backgrounds in Amsterdam, the Netherlands. BMC public health. 2017;17(1):1-12.\u003c/li\u003e\n \u003cli\u003eKumar VM, Whynes DK. Explaining variation in the uptake of HPV vaccination in England. BMC public health. 2011;11(1):1-7.\u003c/li\u003e\n \u003cli\u003eSch\u0026uuml;lein S, Taylor KJ, K\u0026ouml;nig J, Claus M, Blettner M, Klug SJ. Factors influencing uptake of HPV vaccination among girls in Germany. BMC public health. 2016;16(1):1-8.\u003c/li\u003e\n \u003cli\u003eNPHC. National Population and Housing Census 2024, https://www.ubos.org/wp-content/uploads/publications/National-Population-and-Housing-Census-2024-Preliminary-Report.pdf. 2024.\u003c/li\u003e\n \u003cli\u003eIsabirye A, Mbonye M, Asiimwe JB, Kwagala B. Factors associated with HPV vaccination uptake in Uganda: a multi-level analysis. BMC Women\u0026apos;s Health. 2020;20(1):1-11.\u003c/li\u003e\n \u003cli\u003eNabirye J, Okwi LA, Nuwematsiko R, Kiwanuka G, Muneza F, Kamya C, et al. Health system factors influencing uptake of Human Papilloma Virus (HPV) vaccine among adolescent girls 9-15 years in Mbale District, Uganda. BMC public health. 2020;20(1):171.\u003c/li\u003e\n \u003cli\u003ePoethko-M\u0026uuml;ller C, Buttmann-Schweiger N. HPV vaccination coverage in German girls: results of the KiGGS study: first follow-up (KiGGS Wave 1). Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz. 2014;57(7):869-77.\u003c/li\u003e\n \u003cli\u003eLaz TH, Rahman M, Berenson AB. An update on human papillomavirus vaccine uptake among 11\u0026ndash;17 year old girls in the United States: National Health Interview Survey, 2010. Vaccine. 2012;30(24):3534-40.\u003c/li\u003e\n \u003cli\u003ePotts A, Sinka K, Love J, Gordon R, McLean S, Malcolm W, et al. High uptake of HPV immunisation in Scotland\u0026ndash;perspectives on maximising uptake. Eurosurveillance. 2013;18(39):20593.\u003c/li\u003e\n \u003cli\u003eLee C-C, Chen T-S, Wu T-Z, Huang L-M. A human papillomavirus public vaccination program in Taiwan: the Kinmen County experience. Journal of the Formosan Medical Association. 2012;111(12):682-5.\u003c/li\u003e\n \u003cli\u003eMcClure CA, MacSwain M-A, Morrison H, Sanford CJ. Human papillomavirus vaccine uptake in boys and girls in a school-based vaccine delivery program in Prince Edward Island, Canada. Vaccine. 2015;33(15):1786-90.\u003c/li\u003e\n \u003cli\u003eLi SL, Lau YL, Lam TH, Yip PSF, Fan SYS, Ip P. HPV vaccination in Hong Kong: uptake and reasons for non-vaccination amongst Chinese adolescent girls. Vaccine. 2013;31(49):5785-8.\u003c/li\u003e\n \u003cli\u003eChao C, Velicer C, Slezak JM, Jacobsen SJ, editors. Correlates for completion of 3-dose regimen of HPV vaccine in female members of a managed care organization. Mayo Clinic Proceedings; 2009: Elsevier.\u003c/li\u003e\n \u003cli\u003eOgilvie G, Anderson M, Marra F, McNeil S, Pielak K, Dawar M, et al. A population-based evaluation of a publicly funded, school-based HPV vaccine program in British Columbia, Canada: parental factors associated with HPV vaccine receipt. PLoS Med. 2010;7(5):e1000270.\u003c/li\u003e\n \u003cli\u003eHansen BT, Campbell S, Burger E, Nyg\u0026aring;rd M. Correlates of HPV vaccine uptake in school-based routine vaccination of preadolescent girls in Norway: A register-based study of 90,000 girls and their parents. Preventive medicine. 2015;77:4-10.\u003c/li\u003e\n \u003cli\u003eOgilvie GS, Remple VP, Marra F, McNeil SA, Naus M, Pielak KL, et al. Parental intention to have daughters receive the human papillomavirus vaccine. Cmaj. 2007;177(12):1506-12.\u003c/li\u003e\n \u003cli\u003eAgimas MC, Adugna DG, Derseh NM, Kassaw A, Kassie YT, Abate HK, et al. Uptake of human papilloma virus vaccine and its determinants among females in East Africa: a systematic review and meta-analysis. BMC Public Health. 2024;24(1):842.\u003c/li\u003e\n \u003cli\u003eKessels SJ, Marshall HS, Watson M, Braunack-Mayer AJ, Reuzel R, Tooher RL. Factors associated with HPV vaccine uptake in teenage girls: a systematic review. Vaccine. 2012;30(24):3546-56.\u003c/li\u003e\n \u003cli\u003eCocchio S, Bertoncello C, Baldovin T, Fonzo M, Bennici SE, Buja A, et al. Awareness of HPV and drivers of HPV vaccine uptake among university students: a quantitative, cross‐sectional study. Health \u0026amp; social care in the community. 2020;28(5):1514-24.\u003c/li\u003e\n \u003cli\u003eYou D, Han L, Li L, Hu J, D. Zimet G, Alias H, et al. Human papillomavirus (HPV) vaccine uptake and the willingness to receive the HPV vaccination among female college students in China: a multicenter study. Vaccines. 2020;8(1):31.\u003c/li\u003e\n \u003cli\u003eAddisu D, Gebeyehu NA, Belachew YY. Knowledge, attitude, and uptake of human papillomavirus vaccine among adolescent schoolgirls in Ethiopia: a systematic review and meta-analysis. BMC Women\u0026apos;s Health. 2023;23(1):279.\u003c/li\u003e\n \u003cli\u003eHailu G, Wirtu D, Tesfaye T, Getachew M. Human papillomavirus vaccine uptake and associated factors among adolescent girls in high schools of Nekemte city, Western Ethiopia, 2020. BMC Women\u0026apos;s Health. 2023;23(1):560.\u003c/li\u003e\n \u003cli\u003eBarnard M, George P, Perryman ML, Wolff LA. Human papillomavirus (HPV) vaccine knowledge, attitudes, and uptake in college students: Implications from the Precaution Adoption Process Model. PloS one. 2017;12(8):e0182266.\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":"Human papilloma virus, adolescent girls, uptake","lastPublishedDoi":"10.21203/rs.3.rs-5910968/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5910968/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHuman papilloma virus (HPV) is the most common sexually transmitted infection (STI). Globally, HPV affects millions of women in their late teens and early 20s. The use of the HPV vaccine is the only way to avert this trend. However, the uptake of HPV vaccination is reportedly low in Uganda. This study therefore assessed the magnitude and factors associated with the uptake of the HPV vaccine among adolescent girls aged 13–17 years in secondary schools in Sheema Municipality, Sheema District.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA cross-sectional study was conducted among 293 adolescent girls aged 13–17 years in secondary schools in the Sheema Municipality. A pretested questionnaire was used for data collection. A proportional sampling technique was used to determine the number of adolescent girls selected from each school. Simple random sampling was used to enrol the respondents in the study. The data were entered into Microsoft Excel and analysed using Stata version 14. Multivariate logistic regression was used to determine the factors associated with HPV vaccination uptake. Variables with p \u0026lt; 0.05 were considered significant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMore than half (66%) of the participants had received the recommended two doses of the HPV vaccine. The factors associated with the uptake of the HPV vaccine included perceived risk of HPV (aOR = 1.73, 95% CI: [1.00–2.99], p = 0.048), receiving health education (aOR = 2.17, 95% CI: [1.23–3.83], p = 0.007), having parents/caretakers with secondary education (aOR:6.61, 95% CI: 1.57–27.8, p = 0.010), receiving tertiary education (aOR:5.56, 95% CI: 1.33–23.1, p = 0.019) and living in urban areas (aOR = 0.37, 95% CI: [0.21–0.65], p = 0.001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study revealed relatively high HPV vaccine uptake among adolescent girls, although it was still below the highest global rates. Completion of the HPV vaccine was more likely among those with educated parents, received health education, and those with perceived risk of HPV, whereas urban residency was linked to lower uptake. To improve vaccination rates, efforts should focus on increasing awareness through school-based health programs, conducting awareness campaigns on HPV risks and vaccine benefits, and addressing barriers to vaccine access in urban areas.\u003c/p\u003e","manuscriptTitle":"Magnitude and factors associated with the uptake of the HPV vaccine among adolescent girls aged 13-17 years in Sheema Municipality, Sheema District. 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