Knowledge, Attitudes and Practices Towards Human Papillomavirus (HPV) and HPV Vaccination among Students at Higher Institutions of Learning in Buea, South West Region of Cameroon: A Cross-Sectional Study

Knowledge, Attitudes and Practices Towards Human Papillomavirus (HPV) and HPV Vaccination among Students at Higher Institutions of Learning in Buea, South West Region of Cameroon: A Cross-Sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Knowledge, Attitudes and Practices Towards Human Papillomavirus (HPV) and HPV Vaccination among Students at Higher Institutions of Learning in Buea, South West Region of Cameroon: A Cross-Sectional Study Lucianni Ewang Sobe This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5833643/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Human papillomavirus (HPV) is the most common viral sexually transmitted infection (STI) of the reproductive tract, causing a range of diseases in men and women. HPV causes almost half a million cases of cervical cancer and 250,000 related deaths, 80% of which occur in developing countries. This study aimed to assess the knowledge, attitudes and practices towards HPV and HPV vaccination among students at higher institutions of learning in Buea. Methods A cross-sectional study design was used, where participants were selected from nine higher institutions of learning in Buea by means of random sampling. A self-administered structured questionnaire was used to collect information from 414 participants. A descriptive summary of the data was presented via frequency tables, percentages and graphs via Microsoft Excel. The descriptive statistics were mostly used to describe the outcome variables as percentages. The logistic regression model was used to test for associations between knowledge, attitudes and practices and the sociodemographic characteristics of the participants, and Pearson’s chi square test was used to examine the associations between the dependent variables and sex. A P-value < 0.05 was considered statistically significant. The data were analysed via Microsoft Excel 2013 and the statistical software R studio version 4.2.1. Results Among the respondents, 56% (231/414) were females and 44% (183/414) were males, of whom only 1% (4/414) had good knowledge of HPV and its vaccination, and 11.8% (49/414) and 87.2% (361/414) had moderate and poor knowledge, respectively. With respect to attitudes towards HPV and HPV vaccination, 37% (153/414) and 63% (261/414) demonstrated negative and positive attitudes, respectively, whereas 86.2% (357/417) and 13.8% (57/414) demonstrated adequate and inadequate practices, respectively. There was a statistically significant association between knowledge and sex ( P = 0.032, χ2 = 6.857) and between attitudes and sex ( P = 0.007, χ 2 = 6.857). However, there was not a statistically significant association between practice and sex ( P = 0.438, χ2 = 0.438). Conclusions Generally, this study revealed that students at higher institutions of learning in Buea do not have sufficient knowledge about HPV and HPV vaccination. However, this study highlights the need for more health campaigns to increase awareness of the disease in schools. Knowledge Attitude Practice Human Papilloma Virus Vaccination Students of Higher Institutions of Learning Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Background The human papillomavirus (HPV) is the most common viral sexually transmitted infection (STI) of the reproductive tract, causing a range of diseases in men and women [1]. At some points in the life of most people, they become infected with HPV [2]. This disease is now a global concern and a major public health problem [3,4]. Human papillomaviruses are nonenveloped double-stranded deoxyribonucleic acid (DNA) viruses that are particularly infective to humans. As a result, their morbidity and mortality are quite significant [5]. Most people infected with HPV do not know that they have the disease because it does not cause any symptoms or becomes undetectable for years without any treatment. However, some HPV infections do not go away; rather, they can remain in the body and introduce different complications [6]. HPV causes multiple epithelial lesions and cancers that can manifest as cutaneous and anogenital warts based on the subtype involved and may develop into carcinoma [7]. According to a WHO publication on HPV [8], this disease, which affects the skin or mucosal cells, can cause cancer of the cervix, other anogenital cancers, and cancer of the head and neck. The virus is usually contracted and spread, though not always, during sexual intercourse or skin-to-skin contact with an infected person even if condoms are used. Therefore, for both penetrative and nonpenetrative sexual contact (genital to genital, oral genital, anal-genital, oral-anal), transmission is still possible. Transmission is also possible through direct contact with cuts and abrasions when a healthy individual contacts an infected individual, and mother-to-child transmission can occur during birth, although it is rare [6,9]. Four out of five unvaccinated people at some point in their lives are infected with HPV [10]. HPVs that are sexually transmitted are classified into two groups: low- and high-risk groups. High-risk HPV types include 16, 18, 31, 33, 39, 45, 51, 52, 53, 58, 59, 66 and 68, of which HPV 16 and 18 are linked to all HPV-related cancers. They are responsible for converting normal cells into abnormal cells. High-risk HPV 16 is the main subtype responsible for approximately 50% of all cervical cancer cases [11]. Low-risk HPV: HPV 6 and HPV 11 are rarely associated with precancerous or cancer of the lower genital tract but cause approximately 90% of warts around the genitals [2,6]. The Australian government Department of Health [12] reported that high-risk HPV 16 and 18 are the causes of approximately 80% of cervical cancer cases in women and approximately 90% of HPV-related cancers in men, whereas low risk causes 95% of genital warts. HPV 6 and 11 cause approximately 90% of infections to wart around the genitals [2,6]. HPV has been implicated in other types of cancer, such as oropharyngeal and anal cancer. According to an article published online by Washington and Lee University [13], one in four college or university students in the United States of America is infected with sexually transmitted disease (STD). In the southwest region of Cameroon, Buea, compared with other towns in the region, is the center for educational studies and establishments; that is, it has many higher institutions of learning, and it is a host to one of Cameroon’s state universities. As such, students from different parts of the country come to Buea to study. This has led to an increase in drug and alcohol abuse, which is evident in the numerous drinking locations and nightclubs around the town. This influences the social and sexual lifestyles of some students, where some may even underestimate the risk of having unprotected sexual intercourse. Unfortunately, unprotected sexual intercourse is one of the routes of transmission for STIs such as HPV. Knowledge about HPV and its effects among students at higher education institutions may cause them to adhere to preventive measures against HPV infection. It may also influence students to tell their families and loved ones to vaccinate their children (girls) against the disease since it is a vaccine-preventable disease and why not their children in the near future, thereby increasing vaccine uptake. It may also encourage female students to perform regular checks and screenings for cervical cancer. To fight HPV and the diseases it causes, John Snow, Inc. (JSI), a global nonprofit public health organization dedicated to increasing health equity and improving the health of individuals and communities, supported the preparation, introduction, and routinization of the HPV vaccine in eight countries, including Cameroon. Plans for the routinization of the HPV vaccine were affected by the COVID-19 pandemic; as such, there was a shift in resources, focus and strategy for both HPV and COVID-19 vaccination, with a focus on COVID-19 campaigns and vaccination [14]. Coupled with the conspiracy behind the COVID-19 vaccine and the crisis in Cameroon, those in rural areas have limited access to sensitization campaigns and facilities where they can be tested for cervical cancer and receive the vaccine. Despite some of the challenges highlighted above, knowledge about HPV is important for reducing the prevalence of this disease both in men and in women. The National Committee for the fight against cancer in 2009 approved Gardasil to be used to vaccinate Cameroonian girls aged 9–26 years [15]. On October 29, 2014, the HPV vaccine was launched, and it did not cause many disagreements until it was announced to be used in the general population by the minister of public health [16]. Some of these disagreements were caused by anti-HPV vaccine campaigns that were conducted on social media platforms, highlighting adverse effects such as sterility, which allegedly occurred in Japan and other countries [17]. Social mobilization was a challenge for Cameroon, given its political situation and health care challenges, intensified by the pressure of the pandemic. Confidence and trust were the major challenges to build through communication across sectors [15]. On September 13, 2019, experts from the ministry of public health together with the association of science journalists and communicators of health promotion in Cameroon held a press conference; to dispel the doubts around the controversies surrounding the large-scale implementation of HPV vaccination in Cameroon [18], the HPV vaccination campaign was relaunched in September 2020. However, the Ministry of Public Health reported a low HPV vaccination rate, with only 5% of eligible girls who had received the vaccine [15]. It was therefore necessary to evaluate how successful this campaign was, especially among the adult population (18 years to 28 years of age), who were potentially at risk of HPV infection. This study was unique in the sense that it included the male sex, since they play a vital role in the epidemiology of HPV. This study will therefore generate data that may be exploited by policy makers in the ministry of public health to develop and carry out implementation programs concerning HPV effectively among students of higher institutions of learning and why not among students of the secondary and basic educational sector. These findings will help them formulate new strategies that will enable effective HPV screening and vaccine uptake. To achieve these goals, this study aimed to assess the level of knowledge of students at higher institutions of learning in Buea towards HPV and HPV vaccination, to determine the students’ attitudes towards HPV and HPV vaccination, and to determine the students’ practices towards HPV and HPV vaccination. The research hypothesis of this study is as follows: “There is no significant difference in the knowledge, attitudes and practices towards HPV and HPV vaccination among students at higher institutions of learning in Buea”. Methods This study was a cross-sectional study to assess the knowledge, attitudes and practices towards human papillomavirus (HPV) infection and HPV vaccination among students at higher institutions of learning in Buea. This study ran from March 2022 to August 2022, where recruitment of participants and data collection took place in June 2022. Seventeen higher institutions of learning in Buea were listed. Simple random sampling was used to select nine higher institutions of learning from the number listed. In those selected higher institutions of learning, convenience-sampling methods were used to select the study participants, where those who were available at the time of data collection and who were willing to take part in the research were recruited. Only participants who consented and signed the consent form were recruited. The participants had to fulfil the following criteria before they were recruited for the studies; the participant must be registered students in the selected higher institutions of learning in Buea, who consented to take part in the study, and the participants should be at most 27 years of age to be eligible to take part in this study. Students who were not in the selected higher institutions of learning in Buea and those who were older than 27 years of age were not eligible to participate in this study. A self-administered structured questionnaire was used to collect data from the study participants. This questionnaire was adopted from the questionnaire used by Yesaya [19], who carried out a similar study among students at the University of Eastern Finland. However, a few modifications were made to meet the objectives of this study. Questions that were specific to Finland were removed and replaced with those specific to Cameroon. In addition, more questions were added to the questionnaire, which were not present in that of Yesaya [19]. To determine the minimum sample size of the study, the formula proposed by Lwanga & Lemeshow [20] was used when dealing with a large population size greater than 10,000; N = Z 2 P (1-P)/W 2 . where N = minimum required sample size, Z = level of confidence (95%, Z = 1.96), P = expected prevalence or proportion in the population (50%, P = 0.5), and W = precision (5% precision, W = 0.05). The data were analysed via Microsoft Excel 2013 and the statistical software R studio version 4.2.1 [21]. A descriptive summary of the data was presented via frequency tables, percentages and graphs via Microsoft Excel. The logistic regression model was used to test for associations between knowledge, attitudes and practices and the sociodemographic characteristics of the participants, and Pearson’s chi square test was used to examine the associations between the dependent variables and sex. A P-value < 0.05 was considered statistically significant. Ethical approval for this study was obtained from the Faculty of Health Sciences Institutional Review Board (FHSIRB), and administrative clearance was obtained from the Regional Delegation of Public Health, southwest region of Cameroon. Results Sociodemographic characteristics of the study participants The respondents were of different ages, with a mean age of 21 years. The oldest respondent was 26 years of age, and the youngest respondent was 18 years. Among the 414 participants, 183 (44%) were males, and 231 (56%) were females. The respondents were from different religious backgrounds, of which the majority (153/414; 37.0%) were Roman Catholics. The lowest number of respondents did not practice any religion (16/414; 3.9%). The majority of the respondents were single (382/414, 92.3%), with the lowest number of respondents (17/414; 4.1%) cohabiting (Table 1 ). Table 1 Sociodemographic characteristics of the respondents. Sociodemographic characteristics of respondents N o of respondents (N = 414) Percentage (%) Gender Males 183 44 Females 231 56 Religious Background Protestant 113 27.3 Catholic 153 37.0 Muslim 20 4.8 Pentecostal 112 27.0 Not religious 16 3.9 Marital status Single Males 170 41.1 Females 212 51.2 Married Males 5 1.2 Females 10 2.4 Co-habiting Males 8 1.9 Females 9 2.2 Knowledge of HPV infection and HPV vaccination In terms of the overall score of the participants, 1.0% (4/414) had a good knowledge score, 11.8% (49/414) had a moderate knowledge score, and 87.2% (361/414) had a poor knowledge score. (Fig. 1 ). Knowledge of HPV infection and HPV vaccination according to higher institutions of learning of the respondents. In terms of knowledge according to higher institutions of learning of respondents, the majority of the respondents who had good knowledge (3/4; 75%) of HPV and HPV vaccination were from UB, the majority of the respondents who had moderate knowledge (35/49; 71.4%) of HPV infection and HPV vaccination were from UB, and the lowest number of respondents who had poor knowledge (72/361; 19.9%) of HPV were still from UB (Fig. 2 ). Knowledge of HPV infection and HPV vaccination according to respondents’ sociodemographic characteristics With respect to age, respondents who were between 18–20 years and 24–26 years of age had good knowledge (2/4; 50% each) of HPV infection and HPV vaccination. The respondents in the 18–20 years age group had moderate knowledge (31/49; 63.3%) of HPV infection and HPV vaccination, and the respondents in the 18–20 years age group had poor knowledge (165/361; 45.7%) of HPV infection and HPV vaccination. The majority of the male respondents had good knowledge (3/4; 75%) of HPV infection and HPV vaccination, the majority of the female respondents had moderate knowledge (35/49; 71.4%) of HPV infection and HPV vaccination, and the majority of the respondents with poor knowledge (195/361; 54%) of HPV infection and HPV vaccination were females. With respect to denomination, the majority of the respondents from the Roman Catholic and Muslim backgrounds had good knowledge (2/4; 50% each) of HPV infection and HPV vaccination, the respondents from the Pentecostal background had moderate knowledge (21/49; 42.9%) of HPV infection and HPV vaccination, and the majority of the respondents from the Roman Catholic background had poor knowledge (134/361; 37.1%) of HPV infection and HPV vaccination. The majority of the single respondents had good knowledge (4/4; 100%) of HPV infection and HPV vaccination, the respondents with moderate knowledge (47/49; 16.0%) of HPV infection and HPV vaccination were single, and the majority of the respondents who had poor knowledge (331/361; 91.7%) of HPV infection and HPV vaccination were single (Table 2 ). Table 2 Participants’ knowledge of HPV infection and HPV vaccination according to sociodemographic characteristics Knowledge score of respondents Variables Good N (%) (N = 4) Moderate N (%) (N = 49) Poor N (%) (N = 361) Age 18–20 2 (50) 31 (63.3) 165 (45.7) 21–23 0 (0) 8 (16.3) 127 (35.2) 24–26 2 (50) 10 (20.4) 69 (19.1) p -value 0.178 Sex Male 3 (75) 14 (28.6) 166 (46.0) Female 1 (25) 35 (71.4) 195 (54.0) p -value 0.032* Denomination Protestant 0 (0) 11 (22.4) 102 (28.3) Catholic 2 (50) 17 (34.7) 134 (37.1) Muslim 2 (50) 0 (0) 18 (5.0) Pentecostal 0 (0) 21 (42.9) 91 (25.2) Not religious 0 (0) 0 (0) 16 (4.4) p -value 0.000* Marital status Single 4 (100) 47 (96.0) 331 (91.7) Married 0 (0) 1 (2.0) 14 (3.9) Cohabiting 0 (0) 1 (2.0) 16 (4.4) p -value 0.839 Attitudes towards HPV infection and HPV vaccination With respect to the attitudes of the respondents, 63.0% (261/414) had a negative attitude, whereas 37.0% (153/414) of the respondents had a positive attitude toward the HPV and the HPV vaccine. (Fig. 3 ). Attitudes towards HPV infection and HPV vaccination according to higher institutions of learning of the respondents. The majority of the respondents who had a positive attitude (89/153; 58.2%) towards HPV infection and HPV vaccination were from UB and NASPW (22/153; 14.4%), and the majority of the respondents who had a negative attitude towards HPV were from UB (135/261; 51.7%) and NASPW (53/261; 20.3%) (Fig. 4 ). Attitudes towards HPV infection and HPV vaccination according to respondents’ sociodemographic characteristics The majority of the respondents who demonstrated a positive attitude (81/153; 52.9%) towards HPV infection and HPV vaccination were between the ages of 18–20 years, whereas the majority of the respondents who demonstrated a negative attitude (117/261; 44.8%) towards HPV infection and HPV vaccination were still between the ages of 18–20 years. The majority of the respondents who had a positive attitude (99/153; 64.7%) towards HPV infection and HPV vaccination were females, and many of the respondents who had a negative attitude towards HPV were still female (132/261; 50.6%). The majority of the respondents who had a Protestant religious background had a positive attitude (47/153; 30.7%) toward HPV infection and HPV vaccination, whereas the majority of the respondents who had a negative attitude (99/261; 37.9%) toward HPV infection and HPV vaccination were from the Roman Catholic background. Finally, the majority of the respondents who were single (141/153; 92.2%) had a positive attitude towards HPV infection and HPV vaccination. However, the majority of the respondents (241/261; 92.3%) who had a negative attitude towards HPV infection and HPV vaccination were single (Table 3 ). Table 3 Participants’ attitudes towards HPV infection and HPV vaccination according to sociodemographic characteristics. Attitude score Variables Positive N (%) (N = 153) Negative N (%) (N = 261) Age 18–20 81 (52.9) 117 (44.8) 21–23 51 (33.4) 84 (32.2) 24–26 21 (13.7) 60 (23.0) p -value 0.055 Sex Male 54(35.3) 129 (49.4) Female 99 (64.7) 132 (50.6) p -value 0.007* Denomination Protestant 47 (30.7) 66 (25.3) Catholic 54 (2.6) 99 (37.9) Muslim 5 (3.3) 15 (5.7) Pentecostal 42 (27.5) 70 (26.8) Not religious 5 (3.3) 11 (4.2) p -value 0.611 Marital status Single 141 (92.3) 241 (92.3) Married 6 (3.9) 9 (3.5) Cohabiting 6 (3.9) 11 (4.2) p -value 0.961 Practice towards HPV infection and HPV vaccination In terms of practice, 86.2% (357/414) of the respondents had an adequate practice score, whereas 13.8% (57/414) of the respondents had an inadequate practice score (Fig. 3 ). Practice towards HPV infection and HPV vaccination according to higher institutions of learning of the respondents. The majority of the respondents from UB (192/357; 53.8%) demonstrated adequate practices towards HPV infection and HPV vaccination. However, the majority of the respondents who demonstrated an inadequate practice (32/73; 56.0%) towards HPV infection and HPV vaccination were from UB (Fig. 4 ). Practice toward HPV infection and HPV vaccination according to respondents’ sociodemographic characteristics The majority of the respondents between the ages of 18–20 years (171/357; 47.9%) and 21–23 years (121/357; 33.9%) demonstrated adequate practices towards HPV infection and HPV vaccination, and the majority of the respondents between the ages of 18–20 years (27/57; 47.4%) and 24–26 years (16/57; 28.0%) demonstrated inadequate practices towards HPV infection and HPV vaccination. The majority of the female respondents (202/357; 56.6%) demonstrated adequate practices towards HPV infection and HPV vaccination. However, the majority of the respondents who demonstrated inadequate practices (29/57; 50.8%) towards HPV infection and HPV vaccination were females. The majority of the respondents, who were Roman Catholic, demonstrated adequate practices (137/357; 38.4%) towards HPV infection and HPV vaccination, whereas the majority of the respondents who demonstrated inadequate practices (19/57; 33.3%) towards HPV infection and HPV vaccination were from the Protestant religious background. The majority of the single (331/357; 92.7%) respondents demonstrated adequate practices towards HPV infection and HPV vaccination. However, most of the respondents who demonstrated inadequate practices (51/57; 89.5%) towards HPV infection and HPV vaccination were in the single category (Table 4 ). Table 4: Practices of participants towards HPV infection and HPV vaccination according to sociodemographic characteristics. Practice score Variables Adequate N (%) (N= 357) Inadequate N (%) (N=57) Age 18-20 171 (47.9) 27 (47.4) 21-23 121 (33.9) 14 (24.6) 24-26 65 (18.) 16 (28.0) p -value 0.206 Sex Male 155 (43.4) 28 (49.1) Female 202 (56.6) 29 (50.9) p -value 0.508 Denomination Protestant 94 (30.7) 19 (33.3) Catholic 137 (2.6) 16 (28.1) Muslim 15 (3.3) 5 (8.8) Pentecostal 98 (27.5) 14 (24.6) Not religious 13 (3.3) 3 (5.3) p -value 0.297 Marital status Single 331 (92.7) 51 (89.5) Married 14 (3.9) 1 (1.8) Cohabiting 12 (3.4) 5 (8.7) p -value 0.122 Discussion With respect to the data from this study, 44% (183/414) of the study participants were males, and 56% (231/414) were females. Among these 44% male participants, 41.1% (170/414) were single, whereas 1.2% (5/414) and 1.9% (8/414) were married and cohabiting, respectively. A total of 51.2% (212/414) of the female participants were single, whereas 2.4% (10/414) and 2.2% (9/414) were married and cohabiting, respectively. The majority of the participants were between the ages of 18 and 20 years (198/414), with the youngest being 18 years old and the oldest being 26 years old. This study revealed that the majority of the participants (275/414; 66%) had heard about HPV. The participants received information from school (32.2%; 181/414), and 2.9% (16/414) received it from the radio. This is probably because some of the participants had a biomedical background. These data contradict those of a study carried out in Turkey by Cinar et al . [22], where 83.2% of the study participants had not heard of HPV. This was because those with biomedical backgrounds were excluded from the study. Moreover, 57.5% of the participants were males and in a Muslim community, where issues concerning sexual lifestyles and activities are discouraged. A significant percentage of the participants agreed that both men and women were at risk of contracting HPV (244/414; 59%). This finding was in accordance with that carried out in Eastern Finland by Yesaya [19], although that in Finland was higher (85.3%) than that of this study. Data from this study revealed that 51% (210/414) of the participants believed that those infected with HPV presented with signs and symptoms of the disease, whereas 40% (167/414) did not know if those infected could present with signs and symptoms. With HPV being the most common STI with a global concern and a major public health problem [2,3], 56.5% (234/414) of the respondents in this study were not sure if HPV was common in Cameroon. The data of this study revealed that 63.5% (263/414) of the respondents knew that HPV was sexually transmitted, and 47.1% (195/414) believed that condoms provide protection against HPV. This finding was greater than that of Cinar et al . [22], who reported that 37.5% of the participants knew that HPV was sexually transmitted. Since HPV is sexually transmitted, it has almost the same risk factors as other STIs do. This explains why 41.4% (326/414) of the participants believed that unprotected sex was a risk factor for HPV infection, and a small proportion of participants believed that smoking (2.9%; 23/414) was a risk factor. HPV, like other STIs, can also be prevented. As such, a proportion of the study participants suggested that HPV could be prevented through vaccination (41.9%; 233/414) and having a single sex partner (16.4%; 91/414). All these are good preventive measures against HPV, but vaccination remains the best and absolute tool for fighting vaccine-preventable diseases. With respect to participants’ knowledge, 87.2% (361/414) of the study participants had poor knowledge about HPV infection and the HPV vaccine, 11.8% (49/414) had moderate knowledge, and 1% (4/414) had good knowledge about HPV infection and HPV vaccination. The majority of the respondents who were knowledgeable about HPV infection and HPV vaccination were female (8.7%; 36/414) rather than male (4.1%; 17/414), and there was a statistically significant association between knowledge and sex ( P = 0.032, χ 2 = 6.857). The results of this study are similar to those of Mahitha & Arunprasah [23], who reported that among university students in India, female respondents had better knowledge of HPV infection and HPV vaccination than male participants did. This result is also in line with a similar study carried out among university students in Hail, Saudi Arabia, by Alshammari & Knan [24], who reported poor knowledge among the participants. This may be because 63.0% (243) of the respondents were males, and 37.0% (143) of the participants were females. The results of this study contradict those of Dai et al . [25] among university students in China. Here, they recorded a moderate amount of knowledge among the participants in their studies. To determine the number of participants who had received the vaccine, this study assessed the vaccination status of female participants. Among the 231 female participants, 9% (9/231) reported that they had received the vaccine, whereas 91% (210/231) reported that they had not received the HPV vaccine. Among the 91% (210/231) of the participants who reported that they had not been vaccinated against HPV, 52.8% (111/210) reported that they had no idea about the existence of the vaccine, whereas the lowest number (0.5%; 1/210) of participants said that they were above the required age. These data are slightly lower than those of studies carried out in China among female college students, where 11.0% of the study participants were vaccinated [26]. In a similar study carried out by Kellogg et al . [27] among college students in the United States of America (USA), including males and females, 1/3 of the study participants were not vaccinated, 1/4 did not know their vaccination status, and 49.1% were vaccinated. This high vaccination percentage was probably because vaccination in the USA is open to all sexes. In another study by McLendon et al . [28] involving college students in the USA, 27.9% of the participants were not vaccinated, and 25.1% were not sure or did not know if they were vaccinated. This difference is quite significant because of the methodology of the different studies, where only the females were asked to respond, in addition to the fact that the male sex is not vaccinated against HPV in Cameroon. This is because implementation strategies are geared toward women in particular, with the aim of preventing cervical cancer. Given this low vaccination rate among females, it is very essential that HPV vaccination in Cameroonian women within the age group should be enhanced by scaling up vaccination campaigns and coverage in communities while hopefully including males in the near future. One of the risk factors for HPV infection is having multiple sex partners because it exposes the person to the virus. The smallest number of respondents in this study stated that they had more than one sex partner (37%; 155/414), whereas the majority (63%; 259/414) of respondents had not had more than one sex partner. This poses an enormous risk since most of the respondents were unvaccinated, aside from the fact that the majority of the participants were quite young. With this highly unvaccinated sexually active population, the incidence of HPV and other STIs may increase, thereby preventing prevention and control programs from being successful. However, although sexually active, the majority of the participants were afraid of contracting HPV (79%; 326/414), and 84% (349/414) were afraid of having diseases associated with HPV infection. Vaccination has been proven to be the most effective preventive measure for vaccine-preventable diseases. Vaccines are available to prevent some of the different subtypes of HPV arising from high-and low-risk HPV, respectively. To assess the participants’ thoughts on the safety of the HPV vaccine, 71% (295/414) stated that the HPV vaccine was safe, and 29% (119/414) stated that the vaccine was not safe. The participants who stated that the vaccine was not safe gave some reasons such as they had concerns about the side effects of the vaccine (42%; 58/119) and that they were worried about the efficacy of the vaccine (28.3%; 39/119). Adherence to any treatment put in place to combat a disease will eventually lead to the elimination of that disease. Therefore, adherence is driven by trust and confidence in what is given as a preventive tool to fight a disease. With respect to coronavirus disease 2019 (COVID-19), there has been a stigma toward vaccines, with the population having so much fear of vaccines, especially in regard to the side effects of vaccines. In a study carried out by Yam et al . [29], 33.1% of the respondents who were university students were concerned about the side effects of the HPV vaccine. The data of this study suggested that participants had a negative attitude (63%; 261/414) towards HPV infection and HPV vaccination, whereas 37% (153/414) had a positive attitude towards HPV infection and HPV vaccination. The results of this study are similar to those of Alshammari & Khan [24] among university students in Hail, Saudi Arabia. They also recorded a negative attitude towards HPV infection and HPV vaccination among the participants in their studies. In contrast to the data of this study, a positive attitude (90%) was recorded by Khatiwada et al . [30] when a similar study was carried out among university students in Indonesia. Widjaja [31] also reported a positive attitude (88.7%) in a study carried out among private university students in Malaysia. Compared with the male (13.0%; 54/414) respondents, the female (23.9%; 99/414) respondents demonstrated a positive attitude towards HPV infection and HPV vaccination. There was a statistically significant association between attitudes and gender ( P = 0.007, χ 2 = 7.247). The majority of the participants did not practice safe sex (70%; 294/414), whereas the lowest number of respondents (30%; 120/414) did practice safe sex. Among the 30% (120/414) who reported that they did not practice safe sex, 55.8% (67/120) practiced abstinence, 20% (24/120) preferred unprotected sexual intercourse, and 1.7% (2/120) had a single sex partner. Abstinence prevents an individual not only from contracting HPV but also from other STIs. Unprotected sexual intercourse is not a healthy habit to practice because it exposes an individual to a pool of different diseases. The peculiarity of this study was that it sought to know if the male participants were interested in being vaccinated if they were given the opportunity, 58% (107/183) accepted that they would be vaccinated, whereas 42% (76/183) refused that they would not be vaccinated. The data in this study are higher than those reported by Wang et al . [32], where 38.7% of the participants who were male from a study carried out with male university students in China had intentions to receive the HPV vaccine. Males’ lack of knowledge about the vaccine is likely because campaigns on infections caused by HPV are focused only on preventing cervical cancer, which does not affect men. Thus, health campaigns and resources are focused only on females, thereby excluding males. A greater percentage (329/414; 31.9%) of the participants suggested that sex education should be conveyed in schools. However, it should not be limited to schools only. Hospitals, through their health personnel, homes and churches, should also convey sex messages because they play a role in the lives of youths. An increase in awareness or knowledge about HPV will lead to improvements in attitudes and practices toward HPV infection and HPV vaccination. The analysis of the data in this study suggested that 86.2% (357/414) of the study participants demonstrated adequate practices, whereas 13.8% (57/414) demonstrated inadequate practices towards HPV infection and HPV vaccination. This may be because HPV, similar to other STIs, requires the same or similar practices for prevention. Additionally, the female (48.8%; 202/414) respondents demonstrated better practices towards HPV infection and HPV vaccination than the male (37.4%; 155/414) respondents did, and there was not statistically significant association between practice and sex ( P = 0.508, χ 2 = 0.438). Conclusions On the basis of the findings of this study, it is thus concluded that the students in higher institutions of learning in Buea do not have sufficient knowledge about HPV infection and HPV vaccination, with 1% (scoring between 15–20 points) having good knowledge, 11.8% (scoring between 10–14 points) having moderate knowledge, and 87.2% (scoring between 1–9 points) having poor knowledge, on a 20-point scale. Additionally, the students had a negative attitude towards HPV infection and HPV vaccination, with 63% (scoring ≤ 4 points) demonstrating a negative attitude and 37% (scoring > 4 points) demonstrating a positive attitude on a 7-point scale. Finally, the students demonstrated adequate practices towards HPV infection and HPV vaccination, with 13.8% (scoring ≤ 6 points) demonstrating inadequate practices and 86.2% (scoring > 6 points) demonstrating adequate practices on a scale of 12 points. However, this conclusion may not be specific to HPV alone, as the participants adopted adequate practice STDs in general. Limitations of the study A potential recall bias may have been experienced because some respondents were expected to recall past events. However, to minimize such bias, respondents were expected to respond to the question either by selecting a yes or a no. Despite all the limitations encountered by this study, it has benefit in the study of HPV infection and HPV vaccination in Cameroon in that its perception by a particular segment of the Cameroonian population has been identified and will therefore lead to improvements in the strategies put in place to combat this disease. Abbreviations CUIB: Catholic University Institute Bueas CHITECMA: Chartered Higher Institute of Technology COVID-19: Coronavirus Diseases 2019 CUIB: Catholic University Institute Buea DNA: Deoxyribonucleic Acid FHSERB: Faculty of Health Sciences Ethical Review Board HIBMAT: Higher Institute of Business Management and Technology HIMS: Higher Institute of Management Studies HPV: Human Papilloma Virus JSI: John Snow, Inc. LMU: Landmark University Institute NASPW: National Advance School of Public Works PAHO: Pan American Health Organization RHIBMS: Redemption Higher Institute of Biomedical and Management Science STDs: Sexually Transmitted Diseases STIs: Sexually Transmitted Infections UB: University of Buea USA: United States of America WHO: World Health Organization Declarations Ethics approval and consent to participate This study was conducted in full compliance with the ethical principles outlined in the Declaration of Helsinki. Ethical approval for the research was obtained from the Faculty of Health Sciences Institutional Review Board (FHSIRB)-University of Buea, South West region of Cameroon, reference number 2022/1834-05/UB/SG/IRB/FHS. All participants were informed about the purpose, procedures, potential risks, and benefits of the study. Written informed consent was obtained from each participant prior to their inclusion in the study. Confidentiality and privacy were strictly maintained throughout the study. Personal identifiers were anonymized, and data were stored securely to prevent unauthorized access. Participation was entirely voluntary, and participants were informed of their right to withdraw from the study at any time without repercussions. The study was designed to minimize potential risks to participants and to maximize the public health benefits of the findings, particularly regarding awareness and uptake of HPV vaccination. Results will be disseminated to relevant stakeholders, including participants and health authorities, to promote improved knowledge and practices regarding HPV and its vaccination. Consent for publication Not applicable Availability of data and materials Not applicable Clinical trial number Not applicable Competing interest Not applicable Funding This study was funded by the author Author contributions Not applicable Acknowledgements I wish to thank my supervisor and cosupervisor, Eyong Mathias Esum (PhD) and Kamena Jean Faustin (PhD), who supported me throughout this study with their guidance and knowledge so that I would be able to achieve my goals. References World Health Organization-Weekly epidemiological record. Human Papillomavirus Vaccines: WHO position paper (2022 update) . 2022; N o 50 , 645-672. The New Zealand HPV project. HPV key facts . 2007-2022. hpv.org.nz/about-hpv/hpv-strains. Accessed 03 April 2022. Naaji, A., & Chicin, G. Ethical challenges in Human Papillomavirus vaccination . Trivert ethics in science & technology.2021. Shu, N.E., Abiola, A.O., Akodu, B.A., Bassey, B.A., & Misago. N. Knowledge, attitudes and preventive practices for human papilloma virus infection among female sex workers in Lagos Metropolis. PanAfrican medical journal . 2020; 36 (278): 17912. Almansoori, L.S., Alkatheeri, M.S., Alhallami, A.A., Almarzooqi, M.Y., Al-Tatari, M., & Al-Tatari, H. Physians’ knowledge, attitude and practices toward HPV disease and vaccination in Al Ain city, UAE. International journal of contemporary research and review . 2019; 10 (06): 20741. New York University Langone health. (2022). Human Papillomavirus in adults. 2022. nyulangone.org/conditions/human-papillomavirus-in-adults/types. Accessed 03 April 2022. Luria, L., & Cardoza-Favarato, G. Human Papillomavirus . Treasure Island, Florida: Statpearls publishing. 2022. World Health Organization [WHO]: Human Papillomavirus [HPV]. 2022. who.int/teams/health-product-policy-and-standards/standards-and-specifications/vaccine-standardization/human-papillomavirus. Accessed 03 April 2022. Pan American Health Organization [PAHO]. HPV vaccine . 2022. https://www.paho.org/en/tag/human-papillomavirus-hpv-vaccine. Accessed 03 April, 2022. National foundation for infectious disease. HPV (Human Papillomavirus), (No. 23-7198530). Washington DC. 2022. https://www.nfid.org/infectious-diseases/hpv/. Accessed 14 June 2022. Shiffman, M., & Castle, P.E. Human Papillomavirus: Epidemiology and public health. Archives of pathology & laboratory medicine , 2003; 127 . Australian government; department of health. HPV (Human Papillomavirus). 2022. https://www.health.gov.au/health-topics/hpv-human-. Accessed 14 June 2022. Washington and Lee University. Sexually Transmitted Infections . 2020. my.wlu.edu. Accessed 16 March 2023. Ferguson, M. HPV vaccine introduction: learning and adapting in the time of COVID-19. Journal of stomatological investigation . 2022. jsi.com/hpv-vaccine-introduction-learning-and adapting-in-the-time-of-covid-19/. Accessed 25 August 2022. Elit, L., Ngalla, C., Afugchwi, G.M., tum, E., Fokom-Domgue, J., & Nouvet, E. Study protocol for assessing knowledge, attitudes and belief towards HPV vaccination of parents with children aged 9-14 years in rural communities of North West Cameroon: a qualitative study. British Medical Journal open . 2022; 12 : e062556. Amani, A., Nolna, S.K., Ndje, M.N., Ndongo, C.B., Ngounoue, M.D., Tiedeu, B.A., & Leke, R.G.F. Social media controversy affecting the introduction of HPV vaccination for young girls in Cameroon. Archives of women health and care . 2019; 2 (5): 1-2. Okuhara, T., Ishikawa, H., Okada, M., Kato, M., & Kiuchi, T. Newspaper coverage before and after the vaccination crisis began in Japan: a test mining analysis. BioMed Central 2019; 19 :770. Kindzeka, M.E. Cameroon: Millions of girls at risk for cervical cancer as parents reject HPV vaccination. Voice of America news . 2020. Yesaya, D.F. Knowledge, attitude and practice toward Human Papilloma Virus (HPV) and its vaccination among students at the University of Eastern Finland (unpublished Master’s thesis) . University of Eastern Finland. 2020. Lwanga, S.K., & Lemeshow, S. Sample size determination in health studies: A practical manual. World Health Organization. 1991. R Core Team. R: A language and environment for statistical computing. R foundation for statistical computing, Vienna, Austria. 2022. URL https://www.R-project.org/. Cinar, I.O., Ozkan, S., Aslan, G.K., & Alatas, E. Knowledge and behaviour of university students towards Human Papillomavirus and vaccination. Asian Pacific journal of oncology nursing . 2019; 6 :300-7. Mahitha, R., & Arunprasath, T.S. Knowledge and attitude towards Human Papilloma Virus and its vaccine among pharmacy students of tertiary teaching university hospitals in South India. Journal of evidence-based medicine and healthcare . 2016; 3 (86): 4688-4691. Alshammari, F., & Khan, K.U. (2022). Knowledge, attitudes and perceptions regarding Human Papillomavirus among university students in Hail, Saudi Arabia. Peer journal . 2022; 10 : e13140. Dai, Z., Si, M., Su, X., Wang, W., Zhang, X., Gu, X., Ma, L., Li, J., Zhang, S., Ren, Z., & Qao, Y. Willingness to Human Papillomavirus (HPV) vaccination and influencing factors among male and female university students in China. Journal of medical virology . 2021; 94 (6): 2776-2786. You, D., Han, L., Li, L., Hu, J., Zimet, G.D., Alias, H., Donae, M., Cai, L., Zeng, F., & Wong, L.P. 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 :31. Kellogg, C., Shu, J., Arroyo, A., Dinh, N.T., Wode, N., Sanchez, E., & Equils, O. A significant portion of college students are not aware of HPV disease and HPV vaccine recommendations. Human vaccines & immunotherapeutic . 2019; 15 (7-8): 1760-1766. McLendon, L., Puckett, P., Green, C., James, J., Head, K.J., Lee, H.Y., Pierce, J.Y., Beasley, M., & Daniel, C.L. Factors associated with HPV vaccination initiation among United States College students. Human vaccines & immunotherapeutic . 2020; 17 (4): 1033-1043. Yam, P.W.A., Lam, P.L., Chan, T.K., Chau, K.W., Hsu, M.L., Lim, Y.M., Lo, C.H., Sui, L., Tang, H.F., Tong, A.M.J.M., & Yeung, W.L A cross-sectional study on knowledge, attitude and practice related to Human Papillomavirus vaccination for cervical cancer prevention between medical and nonmedical students in Hong Kong. Asian pacific journal of cancer prevention . 2017; 18 (6):1689-1695. Khatiwada, M., Kartasasmita, C., Mediani, H.S., Delprat, C., Van Hal, G., & Dochez, C. Knowledge, attitude and acceptability of the Human Papillomavirus vaccine and vaccination among university students in Indonesia. Frontiers in public health 2021; 9:616456. Widjaja, V.N. Awareness, knowledge and attitudes of Human Papillomavirus (HPV) among private university students-Malaysia perspective. Asian pacific journal of cancer prevention . 2019; 20 (7): 2045-2050. Wang, S., Han, B., Wan, Y., Liu, J., Zhao, T., Liu., & Cui, F. (2020). Do male university students know enough about Human Papillomavirus (HPV) to make informed decision about vaccination? Medical science monitor . 2020; 26 : e924840. 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. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5833643","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":405594860,"identity":"8ebb3ef6-1fb3-4261-b78c-e9522f69a6b0","order_by":0,"name":"Lucianni Ewang 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18:36:42","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":14059,"visible":true,"origin":"","legend":"\u003cp\u003eRespondent knowledge scores for HPV infection and HPV vaccination.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5833643/v1/c3577e79f961561ed834df7c.png"},{"id":74692074,"identity":"f8926807-8d84-48d5-8485-b4bf28d38404","added_by":"auto","created_at":"2025-01-24 18:52:42","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":23591,"visible":true,"origin":"","legend":"\u003cp\u003eKnowledge score of respondents according to higher institutions of learning\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-5833643/v1/f83bbe1dbf63f10504c9651d.png"},{"id":74690803,"identity":"ab906c2b-5425-4a94-9f22-76dae24af8fd","added_by":"auto","created_at":"2025-01-24 18:36:42","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":11131,"visible":true,"origin":"","legend":"\u003cp\u003eRespondents’ attitudes towards HPV infection and HPV vaccination\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-5833643/v1/b4cbefa37c056dbfaea71e5f.png"},{"id":74690805,"identity":"de5859a7-829f-405c-baa9-47776f2c091a","added_by":"auto","created_at":"2025-01-24 18:36:42","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":24220,"visible":true,"origin":"","legend":"\u003cp\u003eAttitude scores of respondents according to higher institutions of learning.\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-5833643/v1/7f97d7aef05981fd56740b2a.png"},{"id":74691732,"identity":"a92bd0b9-f82c-44ee-bb07-6710288c50f5","added_by":"auto","created_at":"2025-01-24 18:44:43","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":11739,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 3: Respondents’ practice scores for HPV infection and HPV vaccination\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-5833643/v1/7766ef0687aa8c5739a028a9.png"},{"id":74692076,"identity":"53a4cb77-e6cd-45fd-b727-6669bb623699","added_by":"auto","created_at":"2025-01-24 18:52:43","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":25053,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 4: Practice scores of respondents according to higher institutions of learning\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-5833643/v1/9443605c4094ae75a82ab84a.png"},{"id":74692941,"identity":"b5e55a3c-e4bb-4409-ade6-c0a2c6d5f5be","added_by":"auto","created_at":"2025-01-24 19:08:49","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1500627,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5833643/v1/db378dd3-abcf-4dee-a011-1614ee810ced.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Knowledge, Attitudes and Practices Towards Human Papillomavirus (HPV) and HPV Vaccination among Students at Higher Institutions of Learning in Buea, South West Region of Cameroon: A Cross-Sectional Study","fulltext":[{"header":"Background","content":"\u003cp\u003eThe human papillomavirus (HPV) is the most common viral sexually transmitted infection (STI) of the reproductive tract, causing a range of diseases in men and women [1]. At some points in the life of most people, they become infected with HPV [2]. This disease is now a global concern and a major public health problem [3,4]. Human papillomaviruses are nonenveloped double-stranded deoxyribonucleic acid (DNA) viruses that are particularly infective to humans. As a result, their morbidity and mortality are quite significant [5]. Most people infected with HPV do not know that they have the disease because it does not cause any symptoms or becomes undetectable for years without any treatment. However, some HPV infections do not go away; rather, they can remain in the body and introduce different complications [6]. HPV causes multiple epithelial lesions and cancers that can manifest as cutaneous and anogenital warts based on the subtype involved and may develop into carcinoma [7].\u003c/p\u003e \u003cp\u003eAccording to a WHO publication on HPV [8], this disease, which affects the skin or mucosal cells, can cause cancer of the cervix, other anogenital cancers, and cancer of the head and neck. The virus is usually contracted and spread, though not always, during sexual intercourse or skin-to-skin contact with an infected person even if condoms are used. Therefore, for both penetrative and nonpenetrative sexual contact (genital to genital, oral genital, anal-genital, oral-anal), transmission is still possible. Transmission is also possible through direct contact with cuts and abrasions when a healthy individual contacts an infected individual, and mother-to-child transmission can occur during birth, although it is rare [6,9]. Four out of five unvaccinated people at some point in their lives are infected with HPV [10]. HPVs that are sexually transmitted are classified into two groups: low- and high-risk groups. High-risk HPV types include 16, 18, 31, 33, 39, 45, 51, 52, 53, 58, 59, 66 and 68, of which HPV 16 and 18 are linked to all HPV-related cancers. They are responsible for converting normal cells into abnormal cells. High-risk HPV 16 is the main subtype responsible for approximately 50% of all cervical cancer cases [11]. Low-risk HPV: HPV 6 and HPV 11 are rarely associated with precancerous or cancer of the lower genital tract but cause approximately 90% of warts around the genitals [2,6]. The Australian government Department of Health [12] reported that high-risk HPV 16 and 18 are the causes of approximately 80% of cervical cancer cases in women and approximately 90% of HPV-related cancers in men, whereas low risk causes 95% of genital warts. HPV 6 and 11 cause approximately 90% of infections to wart around the genitals [2,6]. HPV has been implicated in other types of cancer, such as oropharyngeal and anal cancer.\u003c/p\u003e \u003cp\u003eAccording to an article published online by Washington and Lee University [13], one in four college or university students in the United States of America is infected with sexually transmitted disease (STD). In the southwest region of Cameroon, Buea, compared with other towns in the region, is the center for educational studies and establishments; that is, it has many higher institutions of learning, and it is a host to one of Cameroon\u0026rsquo;s state universities. As such, students from different parts of the country come to Buea to study. This has led to an increase in drug and alcohol abuse, which is evident in the numerous drinking locations and nightclubs around the town. This influences the social and sexual lifestyles of some students, where some may even underestimate the risk of having unprotected sexual intercourse. Unfortunately, unprotected sexual intercourse is one of the routes of transmission for STIs such as HPV. Knowledge about HPV and its effects among students at higher education institutions may cause them to adhere to preventive measures against HPV infection. It may also influence students to tell their families and loved ones to vaccinate their children (girls) against the disease since it is a vaccine-preventable disease and why not their children in the near future, thereby increasing vaccine uptake. It may also encourage female students to perform regular checks and screenings for cervical cancer.\u003c/p\u003e \u003cp\u003eTo fight HPV and the diseases it causes, John Snow, Inc. (JSI), a global nonprofit public health organization dedicated to increasing health equity and improving the health of individuals and communities, supported the preparation, introduction, and routinization of the HPV vaccine in eight countries, including Cameroon. Plans for the routinization of the HPV vaccine were affected by the COVID-19 pandemic; as such, there was a shift in resources, focus and strategy for both HPV and COVID-19 vaccination, with a focus on COVID-19 campaigns and vaccination [14]. Coupled with the conspiracy behind the COVID-19 vaccine and the crisis in Cameroon, those in rural areas have limited access to sensitization campaigns and facilities where they can be tested for cervical cancer and receive the vaccine. Despite some of the challenges highlighted above, knowledge about HPV is important for reducing the prevalence of this disease both in men and in women.\u003c/p\u003e \u003cp\u003e The National Committee for the fight against cancer in 2009 approved Gardasil to be used to vaccinate Cameroonian girls aged 9\u0026ndash;26 years [15]. On October 29, 2014, the HPV vaccine was launched, and it did not cause many disagreements until it was announced to be used in the general population by the minister of public health [16]. Some of these disagreements were caused by anti-HPV vaccine campaigns that were conducted on social media platforms, highlighting adverse effects such as sterility, which allegedly occurred in Japan and other countries [17]. Social mobilization was a challenge for Cameroon, given its political situation and health care challenges, intensified by the pressure of the pandemic. Confidence and trust were the major challenges to build through communication across sectors [15]. On September 13, 2019, experts from the ministry of public health together with the association of science journalists and communicators of health promotion in Cameroon held a press conference; to dispel the doubts around the controversies surrounding the large-scale implementation of HPV vaccination in Cameroon [18], the HPV vaccination campaign was relaunched in September 2020. However, the Ministry of Public Health reported a low HPV vaccination rate, with only 5% of eligible girls who had received the vaccine [15].\u003c/p\u003e \u003cp\u003eIt was therefore necessary to evaluate how successful this campaign was, especially among the adult population (18 years to 28 years of age), who were potentially at risk of HPV infection. This study was unique in the sense that it included the male sex, since they play a vital role in the epidemiology of HPV. This study will therefore generate data that may be exploited by policy makers in the ministry of public health to develop and carry out implementation programs concerning HPV effectively among students of higher institutions of learning and why not among students of the secondary and basic educational sector. These findings will help them formulate new strategies that will enable effective HPV screening and vaccine uptake. To achieve these goals, this study aimed to assess the level of knowledge of students at higher institutions of learning in Buea towards HPV and HPV vaccination, to determine the students\u0026rsquo; attitudes towards HPV and HPV vaccination, and to determine the students\u0026rsquo; practices towards HPV and HPV vaccination. The research hypothesis of this study is as follows: \u0026ldquo;There is no significant difference in the knowledge, attitudes and practices towards HPV and HPV vaccination among students at higher institutions of learning in Buea\u0026rdquo;.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis study was a cross-sectional study to assess the knowledge, attitudes and practices towards human papillomavirus (HPV) infection and HPV vaccination among students at higher institutions of learning in Buea. This study ran from March 2022 to August 2022, where recruitment of participants and data collection took place in June 2022. Seventeen higher institutions of learning in Buea were listed. Simple random sampling was used to select nine higher institutions of learning from the number listed. In those selected higher institutions of learning, convenience-sampling methods were used to select the study participants, where those who were available at the time of data collection and who were willing to take part in the research were recruited. Only participants who consented and signed the consent form were recruited. The participants had to fulfil the following criteria before they were recruited for the studies; the participant must be registered students in the selected higher institutions of learning in Buea, who consented to take part in the study, and the participants should be at most 27 years of age to be eligible to take part in this study. Students who were not in the selected higher institutions of learning in Buea and those who were older than 27 years of age were not eligible to participate in this study. A self-administered structured questionnaire was used to collect data from the study participants. This questionnaire was adopted from the questionnaire used by Yesaya [19], who carried out a similar study among students at the University of Eastern Finland. However, a few modifications were made to meet the objectives of this study. Questions that were specific to Finland were removed and replaced with those specific to Cameroon. In addition, more questions were added to the questionnaire, which were not present in that of Yesaya [19]. To determine the minimum sample size of the study, the formula proposed by Lwanga \u0026amp; Lemeshow [20] was used when dealing with a large population size greater than 10,000; N\u0026thinsp;=\u0026thinsp;Z\u003csup\u003e2\u003c/sup\u003e P (1-P)/W\u003csup\u003e2\u003c/sup\u003e. where N\u0026thinsp;=\u0026thinsp;minimum required sample size, Z\u0026thinsp;=\u0026thinsp;level of confidence (95%, Z\u0026thinsp;=\u0026thinsp;1.96), P\u0026thinsp;=\u0026thinsp;expected prevalence or proportion in the population (50%, P\u0026thinsp;=\u0026thinsp;0.5), and W\u0026thinsp;=\u0026thinsp;precision (5% precision, W\u0026thinsp;=\u0026thinsp;0.05). The data were analysed via Microsoft Excel 2013 and the statistical software R studio version 4.2.1 [21]. A descriptive summary of the data was presented via frequency tables, percentages and graphs via Microsoft Excel. The logistic regression model was used to test for associations between knowledge, attitudes and practices and the sociodemographic characteristics of the participants, and Pearson\u0026rsquo;s chi square test was used to examine the associations between the dependent variables and sex. A P-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant. Ethical approval for this study was obtained from the Faculty of Health Sciences Institutional Review Board (FHSIRB), and administrative clearance was obtained from the Regional Delegation of Public Health, southwest region of Cameroon.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n \u003ch2\u003eSociodemographic characteristics of the study participants\u003c/h2\u003e\n \u003cp\u003eThe respondents were of different ages, with a mean age of 21 years. The oldest respondent was 26 years of age, and the youngest respondent was 18 years. Among the 414 participants, 183 (44%) were males, and 231 (56%) were females. The respondents were from different religious backgrounds, of which the majority (153/414; 37.0%) were Roman Catholics. The lowest number of respondents did not practice any religion (16/414; 3.9%). The majority of the respondents were single (382/414, 92.3%), with the lowest number of respondents (17/414; 4.1%) cohabiting (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eSociodemographic characteristics of the respondents.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\" style=\"width: 34.1387%;\"\u003e\n \u003cp\u003eSociodemographic characteristics of respondents\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" style=\"width: 7.5567%;\"\u003eN\u003csup\u003eo\u003c/sup\u003e of respondents (N\u0026thinsp;=\u0026thinsp;414)\u003cbr\u003e\u003c/th\u003e\n \u003cth align=\"left\" style=\"width: 6.9344%;\"\u003e\n \u003cp\u003ePercentage (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"4\" style=\"width: 57.9646%;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 43.3846%;\"\u003e\n \u003cp\u003eMales\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.5567%;\"\u003e\n \u003cp\u003e183\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.9344%;\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 43.3846%;\"\u003e\n \u003cp\u003eFemales\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.5567%;\"\u003e\n \u003cp\u003e231\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.9344%;\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\" style=\"width: 57.9646%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReligious Background\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 43.3846%;\"\u003e\n \u003cp\u003eProtestant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.5567%;\"\u003e\n \u003cp\u003e113\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.9344%;\"\u003e\n \u003cp\u003e27.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 43.3846%;\"\u003e\n \u003cp\u003eCatholic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.5567%;\"\u003e\n \u003cp\u003e153\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.9344%;\"\u003e\n \u003cp\u003e37.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 43.3846%;\"\u003e\n \u003cp\u003eMuslim\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.5567%;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.9344%;\"\u003e\n \u003cp\u003e4.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 43.3846%;\"\u003e\n \u003cp\u003ePentecostal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.5567%;\"\u003e\n \u003cp\u003e112\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.9344%;\"\u003e\n \u003cp\u003e27.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 43.3846%;\"\u003e\n \u003cp\u003eNot religious\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.5567%;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.9344%;\"\u003e\n \u003cp\u003e3.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 34.1387%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 17.1779%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.7975%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\" style=\"width: 34.1387%;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.2459%;\"\u003e\n \u003cp\u003eMales\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.5567%;\"\u003e\n \u003cp\u003e170\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.9344%;\"\u003e\n \u003cp\u003e41.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 9.2459%;\"\u003e\n \u003cp\u003eFemales\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.5567%;\"\u003e\n \u003cp\u003e212\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.9344%;\"\u003e\n \u003cp\u003e51.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\" style=\"width: 34.1387%;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.2459%;\"\u003e\n \u003cp\u003eMales\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.5567%;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.9344%;\"\u003e\n \u003cp\u003e1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 9.2459%;\"\u003e\n \u003cp\u003eFemales\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.5567%;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.9344%;\"\u003e\n \u003cp\u003e2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\" style=\"width: 34.1387%;\"\u003e\n \u003cp\u003eCo-habiting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.2459%;\"\u003e\n \u003cp\u003eMales\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.5567%;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.9344%;\"\u003e\n \u003cp\u003e1.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 9.2459%;\"\u003e\n \u003cp\u003eFemales\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.5567%;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.9344%;\"\u003e\n \u003cp\u003e2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003ch3\u003eKnowledge of HPV infection and HPV vaccination\u003c/h3\u003e\n\u003cp\u003eIn terms of the overall score of the participants, 1.0% (4/414) had a good knowledge score, 11.8% (49/414) had a moderate knowledge score, and 87.2% (361/414) had a poor knowledge score. (Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eKnowledge of HPV infection and HPV vaccination according to higher institutions of learning of the respondents.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn terms of knowledge according to higher institutions of learning of respondents, the majority of the respondents who had good knowledge (3/4; 75%) of HPV and HPV vaccination were from UB, the majority of the respondents who had moderate knowledge (35/49; 71.4%) of HPV infection and HPV vaccination were from UB, and the lowest number of respondents who had poor knowledge (72/361; 19.9%) of HPV were still from UB (Fig. \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eKnowledge of HPV infection and HPV vaccination according to respondents\u0026rsquo; sociodemographic characteristics\u003c/h3\u003e\n\u003cp\u003eWith respect to age, respondents who were between 18\u0026ndash;20 years and 24\u0026ndash;26 years of age had good knowledge (2/4; 50% each) of HPV infection and HPV vaccination. The respondents in the 18\u0026ndash;20 years age group had moderate knowledge (31/49; 63.3%) of HPV infection and HPV vaccination, and the respondents in the 18\u0026ndash;20 years age group had poor knowledge (165/361; 45.7%) of HPV infection and HPV vaccination. The majority of the male respondents had good knowledge (3/4; 75%) of HPV infection and HPV vaccination, the majority of the female respondents had moderate knowledge (35/49; 71.4%) of HPV infection and HPV vaccination, and the majority of the respondents with poor knowledge (195/361; 54%) of HPV infection and HPV vaccination were females.\u003c/p\u003e\n\u003cp\u003eWith respect to denomination, the majority of the respondents from the Roman Catholic and Muslim backgrounds had good knowledge (2/4; 50% each) of HPV infection and HPV vaccination, the respondents from the Pentecostal background had moderate knowledge (21/49; 42.9%) of HPV infection and HPV vaccination, and the majority of the respondents from the Roman Catholic background had poor knowledge (134/361; 37.1%) of HPV infection and HPV vaccination. The majority of the single respondents had good knowledge (4/4; 100%) of HPV infection and HPV vaccination, the respondents with moderate knowledge (47/49; 16.0%) of HPV infection and HPV vaccination were single, and the majority of the respondents who had poor knowledge (331/361; 91.7%) of HPV infection and HPV vaccination were single (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eParticipants\u0026rsquo; knowledge of HPV infection and HPV vaccination according to sociodemographic characteristics\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eKnowledge score of respondents\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGood\u003c/p\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;4)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;49)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePoor\u003c/p\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;361)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u0026ndash;20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31 (63.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e165 (45.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21\u0026ndash;23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 (16.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e127 (35.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24\u0026ndash;26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (20.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e69 (19.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003cstrong\u003e-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.178\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14 (28.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e166 (46.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35 (71.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e195 (54.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e \u003cstrong\u003e-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.032*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"5\"\u003e\n \u003cp\u003e\u003cstrong\u003eDenomination\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eProtestant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11 (22.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e102 (28.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCatholic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17 (34.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e134 (37.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMuslim\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18 (5.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePentecostal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21 (42.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e91 (25.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNot religious\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16 (4.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003cstrong\u003e-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e47 (96.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e331 (91.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14 (3.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCohabiting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16 (4.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003cstrong\u003e-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.839\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003ch3\u003eAttitudes towards HPV infection and HPV vaccination\u003c/h3\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eWith respect to the attitudes of the respondents, 63.0% (261/414) had a negative attitude, whereas 37.0% (153/414) of the respondents had a positive attitude toward the HPV and the HPV vaccine. (Fig. \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eAttitudes towards HPV infection and HPV vaccination according to higher institutions of learning of the respondents.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe majority of the respondents who had a positive attitude (89/153; 58.2%) towards HPV infection and HPV vaccination were from UB and NASPW (22/153; 14.4%), and the majority of the respondents who had a negative attitude towards HPV were from UB (135/261; 51.7%) and NASPW (53/261; 20.3%) (Fig. \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003eAttitudes towards HPV infection and HPV vaccination according to respondents\u0026rsquo; sociodemographic characteristics\u003c/h2\u003e\n \u003cp\u003eThe majority of the respondents who demonstrated a positive attitude (81/153; 52.9%) towards HPV infection and HPV vaccination were between the ages of 18\u0026ndash;20 years, whereas the majority of the respondents who demonstrated a negative attitude (117/261; 44.8%) towards HPV infection and HPV vaccination were still between the ages of 18\u0026ndash;20 years. The majority of the respondents who had a positive attitude (99/153; 64.7%) towards HPV infection and HPV vaccination were females, and many of the respondents who had a negative attitude towards HPV were still female (132/261; 50.6%).\u003c/p\u003e\n \u003cp\u003eThe majority of the respondents who had a Protestant religious background had a positive attitude (47/153; 30.7%) toward HPV infection and HPV vaccination, whereas the majority of the respondents who had a negative attitude (99/261; 37.9%) toward HPV infection and HPV vaccination were from the Roman Catholic background. Finally, the majority of the respondents who were single (141/153; 92.2%) had a positive attitude towards HPV infection and HPV vaccination. However, the majority of the respondents (241/261; 92.3%) who had a negative attitude towards HPV infection and HPV vaccination were single (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eParticipants\u0026rsquo; attitudes towards HPV infection and HPV vaccination according to sociodemographic characteristics.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eAttitude score\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePositive\u003c/p\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;153)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;261)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u0026ndash;20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e81 (52.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e117 (44.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21\u0026ndash;23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51 (33.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e84 (32.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24\u0026ndash;26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21 (13.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60 (23.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003cstrong\u003e-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.055\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e54(35.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e129 (49.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e99 (64.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e132 (50.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003cstrong\u003e-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.007*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"5\"\u003e\n \u003cp\u003e\u003cstrong\u003eDenomination\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eProtestant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e47 (30.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e66 (25.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCatholic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e54 (2.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e99 (37.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMuslim\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (3.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15 (5.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePentecostal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42 (27.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e70 (26.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNot religious\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (3.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11 (4.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003cstrong\u003e-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.611\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e141 (92.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e241 (92.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (3.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9 (3.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCohabiting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (3.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11 (4.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003cstrong\u003e-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.961\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003ch3\u003ePractice towards HPV infection and HPV vaccination\u003c/h3\u003e\n\u003cp\u003eIn terms of practice, 86.2% (357/414) of the respondents had an adequate practice score, whereas 13.8% (57/414) of the respondents had an inadequate practice score (Fig. \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePractice towards HPV infection and HPV vaccination according to higher institutions of learning of the respondents.\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eThe majority of the respondents from UB (192/357; 53.8%) demonstrated adequate practices towards HPV infection and HPV vaccination. However, the majority of the respondents who demonstrated an inadequate practice (32/73; 56.0%) towards HPV infection and HPV vaccination were from UB (Fig. \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003ePractice toward HPV infection and HPV vaccination according to respondents\u0026rsquo; sociodemographic characteristics\u003c/h3\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eThe majority of the respondents between the ages of 18\u0026ndash;20 years (171/357; 47.9%) and 21\u0026ndash;23 years (121/357; 33.9%) demonstrated adequate practices towards HPV infection and HPV vaccination, and the majority of the respondents between the ages of 18\u0026ndash;20 years (27/57; 47.4%) and 24\u0026ndash;26 years (16/57; 28.0%) demonstrated inadequate practices towards HPV infection and HPV vaccination. The majority of the female respondents (202/357; 56.6%) demonstrated adequate practices towards HPV infection and HPV vaccination. However, the majority of the respondents who demonstrated inadequate practices (29/57; 50.8%) towards HPV infection and HPV vaccination were females.\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eThe majority of the respondents, who were Roman Catholic, demonstrated adequate practices (137/357; 38.4%) towards HPV infection and HPV vaccination, whereas the majority of the respondents who demonstrated inadequate practices (19/57; 33.3%) towards HPV infection and HPV vaccination were from the Protestant religious background. The majority of the single (331/357; 92.7%) respondents demonstrated adequate practices towards HPV infection and HPV vaccination. However, most of the respondents who demonstrated inadequate practices (51/57; 89.5%) towards HPV infection and HPV vaccination were in the single category (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eTable 4: Practices of participants towards HPV infection and HPV vaccination according to sociodemographic characteristics.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 328px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 299px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePractice score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 328px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdequate\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eN (%)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N= 357)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInadequate\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eN (%)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N=57)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e18-20\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e171 (47.9)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e27 (47.4)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e21-23\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e121 (33.9)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e14 (24.6)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e24-26\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e65 (18.)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e16 (28.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 501px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.206\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e155 (43.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e28 (49.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e202 (56.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e29 (50.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 501px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.508\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDenomination\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eProtestant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e94 (30.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e19 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eCatholic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e137 (2.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e16 (28.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eMuslim\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e15 (3.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e5 (8.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003ePentecostal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e98 (27.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e14 (24.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eNot religious\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e13 (3.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e3 (5.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 501px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.297\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e331 (92.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e51 (89.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e14 (3.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e1 (1.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eCohabiting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e12 (3.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e5 (8.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 501px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.122\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Discussion","content":"\u003cp\u003eWith respect to the data from this study, 44% (183/414) of the study participants were males, and 56% (231/414) were females. Among these 44% male participants, 41.1% (170/414) were single, whereas 1.2% (5/414) and 1.9% (8/414) were married and cohabiting, respectively. A total of 51.2% (212/414) of the female participants were single, whereas 2.4% (10/414) and 2.2% (9/414) were married and cohabiting, respectively. The majority of the participants were between the ages of 18 and 20 years (198/414), with the youngest being 18 years old and the oldest being 26 years old.\u003c/p\u003e \u003cp\u003eThis study revealed that the majority of the participants (275/414; 66%) had heard about HPV. The participants received information from school (32.2%; 181/414), and 2.9% (16/414) received it from the radio. This is probably because some of the participants had a biomedical background. These data contradict those of a study carried out in Turkey by Cinar \u003cem\u003eet al\u003c/em\u003e. [22], where 83.2% of the study participants had not heard of HPV. This was because those with biomedical backgrounds were excluded from the study. Moreover, 57.5% of the participants were males and in a Muslim community, where issues concerning sexual lifestyles and activities are discouraged. A significant percentage of the participants agreed that both men and women were at risk of contracting HPV (244/414; 59%). This finding was in accordance with that carried out in Eastern Finland by Yesaya [19], although that in Finland was higher (85.3%) than that of this study. Data from this study revealed that 51% (210/414) of the participants believed that those infected with HPV presented with signs and symptoms of the disease, whereas 40% (167/414) did not know if those infected could present with signs and symptoms. With HPV being the most common STI with a global concern and a major public health problem [2,3], 56.5% (234/414) of the respondents in this study were not sure if HPV was common in Cameroon. The data of this study revealed that 63.5% (263/414) of the respondents knew that HPV was sexually transmitted, and 47.1% (195/414) believed that condoms provide protection against HPV. This finding was greater than that of Cinar \u003cem\u003eet al\u003c/em\u003e. [22], who reported that 37.5% of the participants knew that HPV was sexually transmitted. Since HPV is sexually transmitted, it has almost the same risk factors as other STIs do. This explains why 41.4% (326/414) of the participants believed that unprotected sex was a risk factor for HPV infection, and a small proportion of participants believed that smoking (2.9%; 23/414) was a risk factor. HPV, like other STIs, can also be prevented. As such, a proportion of the study participants suggested that HPV could be prevented through vaccination (41.9%; 233/414) and having a single sex partner (16.4%; 91/414). All these are good preventive measures against HPV, but vaccination remains the best and absolute tool for fighting vaccine-preventable diseases.\u003c/p\u003e \u003cp\u003eWith respect to participants\u0026rsquo; knowledge, 87.2% (361/414) of the study participants had poor knowledge about HPV infection and the HPV vaccine, 11.8% (49/414) had moderate knowledge, and 1% (4/414) had good knowledge about HPV infection and HPV vaccination. The majority of the respondents who were knowledgeable about HPV infection and HPV vaccination were female (8.7%; 36/414) rather than male (4.1%; 17/414), and there was a statistically significant association between knowledge and sex (\u003cem\u003eP\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.032, χ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;6.857). The results of this study are similar to those of Mahitha \u0026amp; Arunprasah [23], who reported that among university students in India, female respondents had better knowledge of HPV infection and HPV vaccination than male participants did. This result is also in line with a similar study carried out among university students in Hail, Saudi Arabia, by Alshammari \u0026amp; Knan [24], who reported poor knowledge among the participants. This may be because 63.0% (243) of the respondents were males, and 37.0% (143) of the participants were females. The results of this study contradict those of Dai \u003cem\u003eet al\u003c/em\u003e. [25] among university students in China. Here, they recorded a moderate amount of knowledge among the participants in their studies.\u003c/p\u003e \u003cp\u003eTo determine the number of participants who had received the vaccine, this study assessed the vaccination status of female participants. Among the 231 female participants, 9% (9/231) reported that they had received the vaccine, whereas 91% (210/231) reported that they had not received the HPV vaccine. Among the 91% (210/231) of the participants who reported that they had not been vaccinated against HPV, 52.8% (111/210) reported that they had no idea about the existence of the vaccine, whereas the lowest number (0.5%; 1/210) of participants said that they were above the required age. These data are slightly lower than those of studies carried out in China among female college students, where 11.0% of the study participants were vaccinated [26]. In a similar study carried out by Kellogg \u003cem\u003eet al\u003c/em\u003e. [27] among college students in the United States of America (USA), including males and females, 1/3 of the study participants were not vaccinated, 1/4 did not know their vaccination status, and 49.1% were vaccinated. This high vaccination percentage was probably because vaccination in the USA is open to all sexes. In another study by McLendon \u003cem\u003eet al\u003c/em\u003e. [28] involving college students in the USA, 27.9% of the participants were not vaccinated, and 25.1% were not sure or did not know if they were vaccinated. This difference is quite significant because of the methodology of the different studies, where only the females were asked to respond, in addition to the fact that the male sex is not vaccinated against HPV in Cameroon. This is because implementation strategies are geared toward women in particular, with the aim of preventing cervical cancer. Given this low vaccination rate among females, it is very essential that HPV vaccination in Cameroonian women within the age group should be enhanced by scaling up vaccination campaigns and coverage in communities while hopefully including males in the near future. One of the risk factors for HPV infection is having multiple sex partners because it exposes the person to the virus. The smallest number of respondents in this study stated that they had more than one sex partner (37%; 155/414), whereas the majority (63%; 259/414) of respondents had not had more than one sex partner. This poses an enormous risk since most of the respondents were unvaccinated, aside from the fact that the majority of the participants were quite young. With this highly unvaccinated sexually active population, the incidence of HPV and other STIs may increase, thereby preventing prevention and control programs from being successful. However, although sexually active, the majority of the participants were afraid of contracting HPV (79%; 326/414), and 84% (349/414) were afraid of having diseases associated with HPV infection. Vaccination has been proven to be the most effective preventive measure for vaccine-preventable diseases. Vaccines are available to prevent some of the different subtypes of HPV arising from high-and low-risk HPV, respectively. To assess the participants\u0026rsquo; thoughts on the safety of the HPV vaccine, 71% (295/414) stated that the HPV vaccine was safe, and 29% (119/414) stated that the vaccine was not safe. The participants who stated that the vaccine was not safe gave some reasons such as they had concerns about the side effects of the vaccine (42%; 58/119) and that they were worried about the efficacy of the vaccine (28.3%; 39/119). Adherence to any treatment put in place to combat a disease will eventually lead to the elimination of that disease. Therefore, adherence is driven by trust and confidence in what is given as a preventive tool to fight a disease. With respect to coronavirus disease 2019 (COVID-19), there has been a stigma toward vaccines, with the population having so much fear of vaccines, especially in regard to the side effects of vaccines. In a study carried out by Yam \u003cem\u003eet al\u003c/em\u003e. [29], 33.1% of the respondents who were university students were concerned about the side effects of the HPV vaccine.\u003c/p\u003e \u003cp\u003eThe data of this study suggested that participants had a negative attitude (63%; 261/414) towards HPV infection and HPV vaccination, whereas 37% (153/414) had a positive attitude towards HPV infection and HPV vaccination. The results of this study are similar to those of Alshammari \u0026amp; Khan [24] among university students in Hail, Saudi Arabia. They also recorded a negative attitude towards HPV infection and HPV vaccination among the participants in their studies. In contrast to the data of this study, a positive attitude (90%) was recorded by Khatiwada \u003cem\u003eet al\u003c/em\u003e. [30] when a similar study was carried out among university students in Indonesia. Widjaja [31] also reported a positive attitude (88.7%) in a study carried out among private university students in Malaysia. Compared with the male (13.0%; 54/414) respondents, the female (23.9%; 99/414) respondents demonstrated a positive attitude towards HPV infection and HPV vaccination. There was a statistically significant association between attitudes and gender (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.007, χ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;7.247).\u003c/p\u003e \u003cp\u003eThe majority of the participants did not practice safe sex (70%; 294/414), whereas the lowest number of respondents (30%; 120/414) did practice safe sex. Among the 30% (120/414) who reported that they did not practice safe sex, 55.8% (67/120) practiced abstinence, 20% (24/120) preferred unprotected sexual intercourse, and 1.7% (2/120) had a single sex partner. Abstinence prevents an individual not only from contracting HPV but also from other STIs. Unprotected sexual intercourse is not a healthy habit to practice because it exposes an individual to a pool of different diseases. The peculiarity of this study was that it sought to know if the male participants were interested in being vaccinated if they were given the opportunity, 58% (107/183) accepted that they would be vaccinated, whereas 42% (76/183) refused that they would not be vaccinated. The data in this study are higher than those reported by Wang \u003cem\u003eet al\u003c/em\u003e. [32], where 38.7% of the participants who were male from a study carried out with male university students in China had intentions to receive the HPV vaccine. Males\u0026rsquo; lack of knowledge about the vaccine is likely because campaigns on infections caused by HPV are focused only on preventing cervical cancer, which does not affect men. Thus, health campaigns and resources are focused only on females, thereby excluding males. A greater percentage (329/414; 31.9%) of the participants suggested that sex education should be conveyed in schools. However, it should not be limited to schools only. Hospitals, through their health personnel, homes and churches, should also convey sex messages because they play a role in the lives of youths. An increase in awareness or knowledge about HPV will lead to improvements in attitudes and practices toward HPV infection and HPV vaccination. The analysis of the data in this study suggested that 86.2% (357/414) of the study participants demonstrated adequate practices, whereas 13.8% (57/414) demonstrated inadequate practices towards HPV infection and HPV vaccination. This may be because HPV, similar to other STIs, requires the same or similar practices for prevention. Additionally, the female (48.8%; 202/414) respondents demonstrated better practices towards HPV infection and HPV vaccination than the male (37.4%; 155/414) respondents did, and there was not statistically significant association between practice and sex (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.508, χ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.438).\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eOn the basis of the findings of this study, it is thus concluded that the students in higher institutions of learning in Buea do not have sufficient knowledge about HPV infection and HPV vaccination, with 1% (scoring between 15\u0026ndash;20 points) having good knowledge, 11.8% (scoring between 10\u0026ndash;14 points) having moderate knowledge, and 87.2% (scoring between 1\u0026ndash;9 points) having poor knowledge, on a 20-point scale.\u003c/p\u003e \u003cp\u003eAdditionally, the students had a negative attitude towards HPV infection and HPV vaccination, with 63% (scoring\u0026thinsp;\u0026le;\u0026thinsp;4 points) demonstrating a negative attitude and 37% (scoring\u0026thinsp;\u0026gt;\u0026thinsp;4 points) demonstrating a positive attitude on a 7-point scale.\u003c/p\u003e \u003cp\u003eFinally, the students demonstrated adequate practices towards HPV infection and HPV vaccination, with 13.8% (scoring\u0026thinsp;\u0026le;\u0026thinsp;6 points) demonstrating inadequate practices and 86.2% (scoring\u0026thinsp;\u0026gt;\u0026thinsp;6 points) demonstrating adequate practices on a scale of 12 points. However, this conclusion may not be specific to HPV alone, as the participants adopted adequate practice STDs in general.\u003c/p\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eLimitations of the study\u003c/h2\u003e \u003cp\u003eA potential recall bias may have been experienced because some respondents were expected to recall past events. However, to minimize such bias, respondents were expected to respond to the question either by selecting a yes or a no. Despite all the limitations encountered by this study, it has benefit in the study of HPV infection and HPV vaccination in Cameroon in that its perception by a particular segment of the Cameroonian population has been identified and will therefore lead to improvements in the strategies put in place to combat this disease.\u003c/p\u003e \u003c/div\u003e"},{"header":"Abbreviations","content":"\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCUIB:\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 470px;\"\u003e\n \u003cp\u003eCatholic University Institute Bueas\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCHITECMA:\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 470px;\"\u003e\n \u003cp\u003eChartered Higher Institute of Technology\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCOVID-19:\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 470px;\"\u003e\n \u003cp\u003eCoronavirus Diseases 2019\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCUIB:\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 470px;\"\u003e\n \u003cp\u003eCatholic University Institute Buea\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDNA:\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 470px;\"\u003e\n \u003cp\u003eDeoxyribonucleic Acid\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFHSERB:\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 470px;\"\u003e\n \u003cp\u003eFaculty of Health Sciences Ethical Review Board\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHIBMAT:\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 470px;\"\u003e\n \u003cp\u003eHigher Institute of Business Management and Technology\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHIMS:\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 470px;\"\u003e\n \u003cp\u003eHigher Institute of Management Studies\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHPV:\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 470px;\"\u003e\n \u003cp\u003eHuman Papilloma Virus\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eJSI:\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 470px;\"\u003e\n \u003cp\u003eJohn Snow, Inc.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLMU:\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 470px;\"\u003e\n \u003cp\u003eLandmark University Institute\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNASPW:\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 470px;\"\u003e\n \u003cp\u003eNational Advance School of Public Works\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePAHO:\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 470px;\"\u003e\n \u003cp\u003ePan American Health Organization\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRHIBMS:\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 470px;\"\u003e\n \u003cp\u003eRedemption Higher Institute of Biomedical and Management Science\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSTDs:\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 470px;\"\u003e\n \u003cp\u003eSexually Transmitted Diseases\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSTIs:\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 470px;\"\u003e\n \u003cp\u003eSexually Transmitted Infections\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUB:\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 470px;\"\u003e\n \u003cp\u003eUniversity of Buea\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUSA:\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 470px;\"\u003e\n \u003cp\u003eUnited States of America\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWHO:\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 470px;\"\u003e\n \u003cp\u003eWorld Health Organization\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in full compliance with the ethical principles outlined in the Declaration of Helsinki. Ethical approval for the research was obtained from the Faculty of Health Sciences Institutional Review Board (FHSIRB)-University of Buea, South West region of Cameroon, reference number 2022/1834-05/UB/SG/IRB/FHS. All participants were informed about the purpose, procedures, potential risks, and benefits of the study. Written informed consent was obtained from each participant prior to their inclusion in the study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConfidentiality and privacy were strictly maintained throughout the study. Personal identifiers were anonymized, and data were stored securely to prevent unauthorized access. Participation was entirely voluntary, and participants were informed of their right to withdraw from the study at any time without repercussions.\u003c/p\u003e\n\u003cp\u003eThe study was designed to minimize potential risks to participants and to maximize the public health benefits of the findings, particularly regarding awareness and uptake of HPV vaccination. Results will be disseminated to relevant stakeholders, including participants and health authorities, to promote improved knowledge and practices regarding HPV and its vaccination.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was funded by the author\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eI wish to thank my supervisor and cosupervisor, Eyong Mathias Esum (PhD) and Kamena Jean Faustin (PhD), who supported me throughout this study with their guidance and knowledge so that I would be able to achieve my goals.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld Health Organization-Weekly epidemiological record. \u003cem\u003eHuman Papillomavirus Vaccines: WHO position paper (2022 update)\u003c/em\u003e. 2022; N\u003csup\u003eo\u003c/sup\u003e\u003cstrong\u003e50\u003c/strong\u003e, 645-672.\u003c/li\u003e\n\u003cli\u003eThe New Zealand HPV project. \u003cem\u003eHPV key facts\u003c/em\u003e. 2007-2022. hpv.org.nz/about-hpv/hpv-strains. 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Knowledge and behaviour of university students towards Human Papillomavirus and vaccination. \u003cem\u003eAsian Pacific journal of oncology nursing\u003c/em\u003e. 2019; \u003cstrong\u003e6\u003c/strong\u003e:300-7.\u003c/li\u003e\n\u003cli\u003eMahitha, R., \u0026amp; Arunprasath, T.S. Knowledge and attitude towards Human Papilloma Virus and its vaccine among pharmacy students of tertiary teaching university hospitals in South India. \u003cem\u003eJournal of evidence-based medicine and healthcare\u003c/em\u003e. 2016; \u003cstrong\u003e3\u003c/strong\u003e(86): 4688-4691.\u003c/li\u003e\n\u003cli\u003eAlshammari, F., \u0026amp; Khan, K.U. (2022). 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Human Papillomavirus (HPV) vaccine uptake and the willingness to receive the HPV vaccination among female college students in China: A multicenter study. \u003cem\u003eVaccines\u003c/em\u003e. 2020; \u003cstrong\u003e8\u003c/strong\u003e:31.\u003c/li\u003e\n\u003cli\u003eKellogg, C., Shu, J., Arroyo, A., Dinh, N.T., Wode, N., Sanchez, E., \u0026amp; Equils, O. A significant portion of college students are not aware of HPV disease and HPV vaccine recommendations. \u003cem\u003eHuman vaccines \u0026amp; immunotherapeutic\u003c/em\u003e. 2019;\u003cstrong\u003e15\u003c/strong\u003e (7-8): 1760-1766.\u003c/li\u003e\n\u003cli\u003eMcLendon, L., Puckett, P., Green, C., James, J., Head, K.J., Lee, H.Y., Pierce, J.Y., Beasley, M., \u0026amp; Daniel, C.L. 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Knowledge, attitude and acceptability of the Human Papillomavirus vaccine and vaccination among university students in Indonesia. \u003cem\u003eFrontiers in public health\u003c/em\u003e 2021; 9:616456.\u003c/li\u003e\n\u003cli\u003eWidjaja, V.N. Awareness, knowledge and attitudes of Human Papillomavirus (HPV) among private university students-Malaysia perspective. \u003cem\u003eAsian pacific journal of cancer prevention\u003c/em\u003e. 2019; \u003cstrong\u003e20\u003c/strong\u003e (7): 2045-2050.\u003c/li\u003e\n\u003cli\u003eWang, S., Han, B., Wan, Y., Liu, J., Zhao, T., Liu., \u0026amp; Cui, F. (2020). Do male university students know enough about Human Papillomavirus (HPV) to make informed decision about vaccination? \u003cem\u003eMedical science monitor\u003c/em\u003e. 2020; \u003cstrong\u003e26\u003c/strong\u003e: e924840.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Knowledge, Attitude, Practice, Human Papilloma Virus, Vaccination, Students of Higher Institutions of Learning","lastPublishedDoi":"10.21203/rs.3.rs-5833643/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5833643/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eHuman papillomavirus (HPV) is the most common viral sexually transmitted infection (STI) of the reproductive tract, causing a range of diseases in men and women. HPV causes almost half a million cases of cervical cancer and 250,000 related deaths, 80% of which occur in developing countries. This study aimed to assess the knowledge, attitudes and practices towards HPV and HPV vaccination among students at higher institutions of learning in Buea.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA cross-sectional study design was used, where participants were selected from nine higher institutions of learning in Buea by means of random sampling. A self-administered structured questionnaire was used to collect information from 414 participants. A descriptive summary of the data was presented via frequency tables, percentages and graphs via Microsoft Excel. The descriptive statistics were mostly used to describe the outcome variables as percentages. The logistic regression model was used to test for associations between knowledge, attitudes and practices and the sociodemographic characteristics of the participants, and Pearson\u0026rsquo;s chi square test was used to examine the associations between the dependent variables and sex. A P-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant. The data were analysed via Microsoft Excel 2013 and the statistical software R studio version 4.2.1.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAmong the respondents, 56% (231/414) were females and 44% (183/414) were males, of whom only 1% (4/414) had good knowledge of HPV and its vaccination, and 11.8% (49/414) and 87.2% (361/414) had moderate and poor knowledge, respectively. With respect to attitudes towards HPV and HPV vaccination, 37% (153/414) and 63% (261/414) demonstrated negative and positive attitudes, respectively, whereas 86.2% (357/417) and 13.8% (57/414) demonstrated adequate and inadequate practices, respectively. There was a statistically significant association between knowledge and sex (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.032, χ2\u0026thinsp;=\u0026thinsp;6.857) and between attitudes and sex (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.007, χ 2\u0026thinsp;=\u0026thinsp;6.857). However, there was not a statistically significant association between practice and sex (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.438, χ2\u0026thinsp;=\u0026thinsp;0.438).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eGenerally, this study revealed that students at higher institutions of learning in Buea do not have sufficient knowledge about HPV and HPV vaccination. However, this study highlights the need for more health campaigns to increase awareness of the disease in schools.\u003c/p\u003e","manuscriptTitle":"Knowledge, Attitudes and Practices Towards Human Papillomavirus (HPV) and HPV Vaccination among Students at Higher Institutions of Learning in Buea, South West Region of Cameroon: A Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-01-24 18:36:37","doi":"10.21203/rs.3.rs-5833643/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6097d78b-2164-4a4a-8108-7839a649e3b0","owner":[],"postedDate":"January 24th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-01-24T18:36:40+00:00","versionOfRecord":[],"versionCreatedAt":"2025-01-24 18:36:37","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5833643","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5833643","identity":"rs-5833643","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}