Factors associated with uptake of Human Papilloma Virus Vaccine among school girls aged 9-14 years in Lira City northern Uganda: A cross-sectional study

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Since 2008, HPV vaccination has been routinely recommended for pre-adolescents and adolescent girls in Uganda as the primary preventive measure for cervical cancer. However, in Uganda, most especially Lira district there is limited literature on HPV vaccination uptake and associated factors among girls aged 9-14years. This study assessed the uptake of HPV vaccine and associated factors among in-school girls aged 9–14 years in Lira City northern Uganda. Methods A cross-sectional study was conducted among 245 primary school girls aged 9–14 years in Lira City, west northern Uganda. Multistage sampling technique was used to sample eligible participants and data was collected using interviewer administered questionnaire. Data was analysed using SPSS version 23.0. Results HPV vaccination uptake was at 19.6% among the school girls aged 9–14 years in Lira City west northern Uganda. The mean age of the girls was 12.11 (± 1.651) years. Individual factors that were found significantly associated with HPV vaccination included; age of 12–14 years [cOR 5.40, 95% CI (2.04–14.24), P = 0.001], Ever had about the vaccine [cOR: 2.05, 95% CI (0.26–3.50), P = 0.021], taught about cervical cancer at school [cOR: 11.54, 95% CI (4.91–33.89), P = 0.021]. Health system related factors that were found to be associated with HPV uptake; Availability of the vaccines at Health Facilities [cOR: 7.88, 95% CI (2.92–10.32), P = 0.002], Received health workers recommendation [cOR: 3.2, 95% CI (0.93–7.82), P = 0.000]. Conclusion Findings indicate that HPV vaccine uptake was very low. The ministry of health should strategize more on increasing awareness on HPV vaccination to young girls and their care takers in Lira City especially through collaborating with different schools though not neglecting the out of school girls. Human Papilloma Virus Vaccine Uptake Adolescent school girls Lira City Figures Figure 1 Study Background Genital human papillomavirus (HPV) infection is the most common sexually transmitted infection worldwide, estimated at 75% and 80% among men and women of all ages respectively ( 1 ). HPV is considered to be one of the most important risk factors in the development of cervical cancer with persistent infection of high-risk HPV oncogenic types 16 and 18 ( 2 ). Globally, Cervical cancer is the fourth most common cancer among women, with an estimated 604,000 new cases and 342,000 related deaths in 2020 ( 3 ). Low- and Middle-income countries disproportionately carry a high burden 90% of the new cases and related deaths due to cervical cancer (3). In Uganda, cervical cancer is the number one cause of death among women with cancer-related deaths estimated at 40.5 per 100,000 ( 4 ). Global HPV immunization coverage as of 2018 was estimated at 12.2% ( 5 ). Despite improvements in HPV in the past 15 years. In sub-Saharan Africa HPV vaccine completion is estimated at 20% compared to developed countries such as Australia and New Zealand with 77% completion of HPV vaccine dosage ( 6 ). To achieve the 90-70-90 World Health Organization (WHO) targets by 2030 ( 7 ). WHO suggested countries on the path of cervical cancer elimination to have 90% of the girls vaccinated before 15 years, 70% of women screened by age of 35 years and again by 45 years of age, and 90% of women identified with cancer receive treatment ( 7 ). HPV vaccination has been routinely recommended for pre-adolescents and adolescent girls in Uganda ( 8 ). The introduction of HPV vaccines represents a step forward in the primary prevention of cervical cancer and other HPV-related malignancies. Currently, there are two types of HPV vaccine: bivalent, which mainly protects against HPV genotypes 16 and 18, and Quadrivalent, which protects against genotypes 6, 11, 16, and 18 ( 9 , 10 ). The vaccines have been shown to provide cross-protection against other oncogenic HPV genotypes as well ( 11 , 12 ). Uganda Ministry of Health Uganda (MoH) has continued to address challenges associated with HPV vaccination delivery strategy since 2015, through multiple vaccination centers such as schools, health facilities, and outreach posts currently providing routine immunization services ( 13 ). Studies show that school attendance is positively associated with HPV vaccination status due to the less effort required to reach out to girls in the implementation of the HPV vaccine delivery strategy (14). Despite the concerted efforts, findings show that the uptake of HPV vaccine among girls aged 10–14 years is as low as 22% across Uganda ( 15 ). In addition, there is limited literature especially in the Lira district on HPV vaccination uptake more so after the horrible effects of the COVID-19 pandemic. Therefore, this study investigated the uptake of HPV vaccine and associated factors among in-school girls aged 9–14 years in Lira City, West, northern Uganda to assist in re-designing appropriate strategies meant to enhance the HPV vaccination uptake in Lira City and Uganda as a whole. Materials And Methods 2.1 Study Design And Setting This was a cross-sectional study employing quantitative methods of data collection and analysis. This study was conducted among six schools in Lira City West, northern Uganda. Lira City is the main, administrative, and commercial centre of the Lira District. It is located approximately 100 kilometres (62 miles), southeast of Gulu City the largest city in northern Uganda, and approximately 337 kilometres (209 miles), by road, north of Kampala the capital city of Uganda. 2.2 Study Population This study was conducted among 245 girls aged 9–14 years in selected primary schools located in Lira City West, Northern Uganda. All girls aged 9-14years who were available at the time of data collection studying in selected schools whose parents had consented and they also assented were included in the study. Girls who were ill, those whose parents had not consented, and girls who did not assent to participate in the study were excluded. This study focused on girls aged 9–14 years because they are the target age group for the HPV vaccine and are also less likely sexually exposed (15) . 2.3 Sample Size Determination The sample size was determined using the Leslie Kish formula (1965) n = z 2 pq/d 2 with the assumptions, the confidence interval was taken at 95%., the level of uptake of HPV vaccine taken (p) was 0.1761 (17), the level of those not vaccinated given by (q) was 0.8239, The z-score (z) was 1.96, a margin of error (d) was 0.05. Therefore, the calculated sample size was 245 participants plus 10% of the non-response. 2.4 Data Collection Method And Tools We used researcher-administered questionnaires to collect data. The questionnaire was developed by the research team, piloted, reviewed, and adjusted accordingly to fit our study objectives before the actual data collection process. The questionnaire collected information on the following: demographic characteristics of participants (age, class, tribe, religion, birth order, staying with parents, family type), uptake of the vaccine (having received the HPV vaccine, if yes, how many times, if no, then why), individual characteristics (having had about the vaccine and cervical cancer, HPV knowledge), socio-economic factors(home area, number of members in the family, family head, access to media, being taught about HPV and cervical cancer at school, receiving vaccine from school, absence from school), Health system factors(estimated distance to facility, health worker recommendation, having seen posters at the facility about the HPV vaccine and cervical cancer, having visited the facility to get HPV vaccine, availability of the vaccine, availability of the health workers at the facility, exposure to outreach clinics). The outcome variable for this study was the self-reported receipt of the vaccine regardless of the number of doses. 2.5 Data Collection Procedure The study used a multistage sampling method which involved dividing the accessible population into three sub-counties in which the different primary schools are located. Two schools were randomly selected from each sub-county resulting in a total of six schools from where the study participants were accessed. The sample per school was chosen using proportion to size. The desirable number of participants picked from each school was determined using the formula below; This study also employed a convenience random sampling technique given the availability of the study participants who meet the inclusion criteria. The first participant was selected randomly then subsequent participants were selected depending on their availability until the desired sample size of 245 was achieved. Administration of the questionnaire with selected participants lasted between 25 and 40 minutes. 2.6 Data Management and Analysis . While in the field every questionnaire was checked for completeness to ensure no missing data at the end of each interview process. A data entry screen with checks was created in SPSS version 23.0 to ensure no missing and out of range values are entered within the data set. Data were entered and analysed using SPSS version 23.0. Continuous variables were summarised and presented as frequencies and percentages in appropriate tables and pie-chart, categorical variables were analysed using descriptive statistics, cross-tabulation, and logistic regression at a 95% level of confidence. The model fitness was checked using the Hosmer-Lemeshow test at p < 0.05 and the backward conditional logistic regression method was used to determine variables that were independently associated with the outcome variable. Results In this study, 260 prospective participants were approached 247 participants accepted to participate in this study giving us a response rate of 95%. Two participants were dropped from this study to bring the actual sample size used in this study to 245. 3.1 Demographic characteristics of in-school girls aged 9–14 years in Lira City West northern Uganda. A total of 245 girls aged 9–14 years were recruited in this study and all girls who were approached accepted to partake in this study giving us a response rate of 100%. The mean age of the girls was 12.11 (± 1.651) years. Almost all of the participants, 219(89.6%) belonged to the Langi tribe, 222(90.6%) belonged between first and third birth order, 214(87.3%) stayed with their parents at home, and of these 181(73.9%) belonged to nuclear families. Three-quarters of the girls 190(77.6%) were Catholics and protestants by religion, and 176(71.8%) came from homes located in the town area. All most all of the girls 200(81.6%) came from male-headed families. The majority of the participants 149(60.8%) came from families that had 6–10 members and had access to media at home ( Table 1 ). Table 1 ; Socio-demographic characteristics of school girls aged 9–14 years in Lira city northern Uganda (n = 245) VARIABLE FREQUENCY (n = 245) PERCENTAGES (%) Age (years) 9–11 81 33.1 12–14 164 66.9 Religion Catholic 97 39.6 Anglican 93 38.0 Others 55 22.4 Tribe Langi 219 89.4 Others 26 10.6 Birth Order 1–3 222 90.6 Others 23 9.4 Stay with parents Yes 214 87.3 No 31 12.7 Family Type Nuclear Family 181 73.9 Extended Family 64 26.1 Home Area Town 176 71.8 Village 69 28.2 Family Head Father 200 81.6 Others 45 18.4 Media Access at Home Television 132 53.9 Others 113 46.1 3.2 Uptake of HPV vaccine among school girls aged 9–14 years in Lira City West northern Uganda. Out of the 245 study participants interviewed 48(19.6%) had ever received the HPV vaccine and of these 3.7% reported to have received one dose, 9.8% had received two doses and 5.3% had received three doses of the vaccine. However, of those who had never received the HPV vaccine 62(43.1%) reported having no idea about the HPV vaccine as the reason to why they were not vaccinated. (Fig. 1 ) Figure 1 level of uptake of HPV vaccine among adolescent school girls 3.3 Bi-variate analysis of Individual and socio-economic factors associated with uptake of HPV vaccine among in-school girls aged 9–14 years in Lira City West northern Uganda. In binary logistic regression, the factors that were found statistically associated with uptake of HPV vaccine at p value < 0.05 were; age of participants 12–14 years (p < 0.001), Ever heard about the HPV vaccine (p < 0.001), Ever heard about cervical cancer (p < 0.002), being taught about cervical and HPV at school (p = 0.020) and in-school vaccination (p = 0.003). Factors that were not statistically associated with uptake of HPV vaccine were home area, media access, school absence and health seeking behaviors as shown in (Table 2 ). Table 2 Individual factors associated with HPV vaccine uptake among in-school girls Characteristics Ever received HPV vaccine n(%) cOR 95% CI P-value YES NO Lower Upper Age < 0.001* 9–11 5(2.0) 76(31.0) Ref 12–14 43(17.6) 121(49.4) 5.40 2.04 14.24 Ever had about the HPV vaccine < 0.001* No 1(0.4) 170(69.7) Ref Yes 47(19.3) 26(10.7) 2.05 0.26 3.50 Ever heard about cervical cancer 0.002* No 27(11.0) 11(4.5) Ref Yes 21(8.6) 186(75.9) 0.046 0.020 0.106 Health seeking behavior 0.600 Traditional/herbal 7(2.9) 35(14.3) Ref Biomedical 41(16.7) 162(66.1) 1.265 0.524 3.054 Taught about cervical cancer at school 0.021* No 12(4.9) 181(73.9) Ref Yes 36(14.7) 16(6.5) 11.54 4.91 33.82 Ever received a vaccine at school 0.053 No 4(1.6) 82(33.6) Ref Yes 44(18.0) 114(46.7) 7.91 2.73 22.88 *p-value < 0.05 Statistically Significant, Cor-crude Odd Ratio 3.4 Health system factors associated with uptake of HPV vaccine among in-school girls aged 9–14 years in Lira City West northern Uganda. In binary logistic regression, the factors that were found statistically associated with uptake of HPV vaccine at P-value < 0.05 were; distance to the health facility (p = 0.036), availability of HPV vaccine at the hospital (p = 0.002), health workers recommendation (p ≤ 0.001 ( Table 3 ). Table 3 Bivariate analysis of Health System factors associated with HPV vaccine uptake among in-school girls aged 9–14 years in Lira City northern Uganda Variable Ever received HPV vaccine n (%) cOR 95% CI P-value YES NO Lower Upper Distance to the health Centre 0.036* Near 36(14.7) 107(43.7) Ref Far 12(4.9) 90(36.7) 0.43 0.209 0.911 Health worker recommendation 0.001* No 10(4.1) 178(72.7) Ref Yes 38(15.5) 19(7.8) 3.2 0.93 7.82 Seen posters about cervical cancer 0.320 No 26(10.6) 166(67.8) Ref Yes 22(9.0) 31(12.7) 4.53 2.284 8.990 Availability of the vaccines 0.002* No 3(8.3) 7(19.4) Ref Yes 23(63.9) 3(8.3) 7.88 2.92 10.32 Exposure to outreach clinics 0.421 No 28(11.4) 185(75.5) Ref Yes 20(8.2) 12(4.9) 11.01 4.857 24.968 *p-value < 0.05 Statistically Significant, Cor-crude Odds Ratio Discussion Our study found low 19.6% uptake of the HPV vaccine among school girls aged 9–14 years in Lira City northern Uganda. Our findings conform with the results of previous similar studies conducted in Lira District northern Uganda where uptake of the HPV vaccine was low at 17.61% ( 17 ). Similarly, our findings agree with the national HPV vaccine coverage among adolescent girls where uptake of the HPV vaccine is estimated at 22% ( 18 ). The low uptake in this study may be due to the fewer efforts in HPV vaccine delivery to improve vaccination among these girls most probably due to the effects of the COVID-19 pandemic that disrupted the health system. Our study further found that school girls aged 12 years and above were almost five times more likely to uptake the HPV vaccine compared to their counterparts. Our findings agree with results from previous similar studies conducted in Mbale District, eastern Uganda where girls with increased age of 11 years and above were two times more likely to uptake the HPV vaccine compared to their counterparts ( 19 ) This similarity could be attributed to the knowledge acquisition as girls grow older. Another possible reason could be procrastination due to the age gap allowance provided by the Ugandan ministry of health of 9–14 years ( 20 ) whereby the girls or their parents might think of getting the vaccine later in life. Furthermore, our study found that school girls who ever heard about the HPV vaccine were two times more likely to uptake HPV compared to their counterparts who never heard about the HPV vaccine. These findings concur with the results of a similar previous study conducted in Mbale District; eastern Uganda where adolescent girls who received adequate information on the HPV vaccine were six times more likely to utilize the HPV vaccine ( 19 ). This could be explained in a way that those who had heard about the vaccine and had knowledge about the HPV vaccine could have acknowledged its benefits which provoked them to go for the vaccine. Therefore, the ministry of health and related stakeholders should put more effort into programs that create awareness of the HPV vaccine to optimize its uptake among girls aged 9–14 years in Lira City. Our study also found that school girls aged 9–14 years in Lira City, who received a recommendation for HPV vaccination by health workers were three times more likely to uptake the HPV vaccine compared to their counterparts. These findings are similar to results from a previous study carried out in Mulago Hospital, Central Uganda where health worker recommendation was one of the factors associated with the timely completion of the HPV vaccination among girls aged 9–14 years ( 21 ). This highlights the importance of health workers' efforts in improving the uptake of the HPV vaccine, whereby with more recommendations from them, more girls would get vaccinated. Distance to the health Centre was significantly associated with vaccine uptake. This indicates that those who had received the vaccine could probably be living near health Centers and could easily access the vaccine. Similar findings from a study conducted in Kenya reported distance to the hospital as a statistically significant risk factor for non-completion of the doses for the vaccine ( 23 ). This implies that vaccine delivery strategies should be revised to ensure that the vaccines can easily be accessed by all people in their places of residence. Study Limitations And Strengths This study had some limitations that must be considered in the interpretation and application of the results. This was an in-school study conducted in only six schools in Lira City West, Northern Uganda, so the findings of this study may not be representative the perspective of non- school going adolescent girls. The study only employed quantitative approach hence missed out on the qualitative data which always complements the quantitative data. However, results of this study can be used as an inference for future research studies. Self-reported bias. This was minimized through asking neutral worded questions. Conclusion The uptake of HPV vaccine among school girls aged 9–14 years in Lira City, West was very low at 19.6%. Factors significantly associated with HPV vaccination included; age of 12 years and above, having heard about the vaccine, being taught about cervical and HPV at school, in-school vaccination, availability of HPV vaccine at the hospital, health workers recommendation. With this information, health policy planners can play a more active role in making recommendations for HPV vaccination by providing more appropriate target programs and policies in promoting HPV vaccination in the target age group of 9–14 years. Recommendations The results of the study can be used to design future strategies to increase uptake of HPV vaccine in Lira City such as through use of posters in health Centers, communities and schools typed in different languages to improve awareness about the HPV vaccine and cervical cancer. The ministry of health should offer ample orientation and training to all health workers about disseminating information on HPV vaccination to all eligible girls and their care takers while addressing their concerns about the vaccine appropriately such that these girls can receive the vaccine alongside other services or leave with information about it after visiting the health Centre. There is also need to empower the teachers with the information about HPV and cervical cancer such that they can easily pass it on to girls in school and also be champions in their communities to ease dissemination of information. Declarations Ethical Considerations and consent, assent to participate The research protocol was reviewed and approved by the Gulu University Research and Ethics Committee (GUREC-2022-281). Administrative clearance was also obtained from the office of the District Health Officer, Lira District, and participating school administrations. Written informed consent was obtained from the parents/guardians of the participants/adolescent school girls. Written informed assent was also sought from the participants. The study was performed in accordance with Declaration of Helsinki. Consent for publication Not applicable Data Availability The data sets used and/or analyzed during the study are available from the corresponding author on reasonable request. Conflicts of Interest The authors declare that they have no competing interests. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Authors Contribution Renniter Mirembe Nakayita/ participated in topic development, protocol development, data collection, data analysis, and manuscript writing. Deo Benyumiza / participated in protocol writing, data collection, data analysis, manuscript writing and reviewing. Catherine Nekesa/ participated in protocol development, data collection, data analysis, and manuscript writing. Aisha Nalubuuka/ participated in protocol development, data collection, data analysis, and manuscript writing. Julius Kyeswa / participated in protocol development, data collection, data analysis, and manuscript writing. Ivan Misuk / participated in topic development, protocol development, data collection, and manuscript writing. Tom Murungi / participated in protocol development, data collection, data analysis, and manuscript writing. Samson Udho / participated in data analysis, and manuscript writing, and manuscript review. Edward Kumakech / participated in data analysis, and manuscript writing, and manuscript review. Acknowledgments Special gratitude goes out to the different schools in Lira City west for their participation in this research study. 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Role of Religious Leaders in Promoting Contraceptive Use in Nigeria: Evidence From the Nigerian Urban Reproductive Health Initiative. 2018; Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 08 Jul, 2023 Read the published version in BMC Women's Health → Version 1 posted Editorial decision: Major revision 20 Mar, 2023 Reviews received at journal 15 Mar, 2023 Reviewers agreed at journal 14 Mar, 2023 Reviewers invited by journal 14 Mar, 2023 Editor assigned by journal 30 Jan, 2023 Editor invited by journal 27 Jan, 2023 Submission checks completed at journal 27 Jan, 2023 First submitted to journal 24 Jan, 2023 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 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-2511777","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":171105990,"identity":"c4471f93-e7ad-4f62-9092-4a87e1238df1","order_by":0,"name":"Renniter Mirembe Nakayita","email":"","orcid":"","institution":"Lira University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Renniter","middleName":"Mirembe","lastName":"Nakayita","suffix":""},{"id":171105991,"identity":"0c43e0a7-b613-4ddf-b459-a58ec699c839","order_by":1,"name":"Deo 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University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Catherine","middleName":"","lastName":"Nekesa","suffix":""},{"id":171105993,"identity":"72fe75f0-637d-47d2-852c-2a8f3b53fd60","order_by":3,"name":"Ivan Misuk","email":"","orcid":"","institution":"Lira University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Ivan","middleName":"","lastName":"Misuk","suffix":""},{"id":171105994,"identity":"dc623a2e-d49b-4972-8156-d376620f5f89","order_by":4,"name":"Julius Kyeswa","email":"","orcid":"","institution":"Lira University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Julius","middleName":"","lastName":"Kyeswa","suffix":""},{"id":171105995,"identity":"c8962ccb-1aa6-45da-84fa-e81e23aea0ee","order_by":5,"name":"Aisha Nalubuuka","email":"","orcid":"","institution":"Lira University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Aisha","middleName":"","lastName":"Nalubuuka","suffix":""},{"id":171105996,"identity":"a02e3446-6b7d-445e-aaba-4f5ee70d839d","order_by":6,"name":"Tom Murungi","email":"","orcid":"","institution":"Lira University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Tom","middleName":"","lastName":"Murungi","suffix":""},{"id":171105998,"identity":"ae1a7e10-43ba-4d85-99f9-32aefd52c25b","order_by":7,"name":"Samson Udho","email":"","orcid":"","institution":"Lira University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Samson","middleName":"","lastName":"Udho","suffix":""},{"id":171105999,"identity":"df17a006-0b17-496e-b5d0-31239298018e","order_by":8,"name":"Kumakech Edward","email":"","orcid":"","institution":"Lira University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Kumakech","middleName":"","lastName":"Edward","suffix":""}],"badges":[],"createdAt":"2023-01-24 20:59:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2511777/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2511777/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12905-023-02511-z","type":"published","date":"2023-07-08T21:33:30+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":32285741,"identity":"eb312146-5fa7-4b88-8287-046ae66c7acc","added_by":"auto","created_at":"2023-01-31 18:34:29","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":17519,"visible":true,"origin":"","legend":"\u003cp\u003elevel of uptake of HPV vaccine among adolescent school girls\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-2511777/v1/3a1ac203974adfd27c27ef92.png"},{"id":44735231,"identity":"3d075141-de95-459b-bb0f-aed7d5642358","added_by":"auto","created_at":"2023-10-16 22:24:21","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":662641,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2511777/v1/e2377124-a8f8-4513-b943-5404b696fbb1.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Factors associated with uptake of Human Papilloma Virus Vaccine among school girls aged 9-14 years in Lira City northern Uganda: A cross-sectional study","fulltext":[{"header":"Study Background","content":"\u003cp\u003eGenital human papillomavirus (HPV) infection is the most common sexually transmitted infection worldwide, estimated at 75% and 80% among men and women of all ages respectively (\u003cb\u003e1\u003c/b\u003e). HPV is considered to be one of the most important risk factors in the development of cervical cancer with persistent infection of high-risk HPV oncogenic types 16 and 18 (\u003cb\u003e2\u003c/b\u003e). Globally, Cervical cancer is the fourth most common cancer among women, with an estimated 604,000 new cases and 342,000 related deaths in 2020 (\u003cb\u003e3\u003c/b\u003e). Low- and Middle-income countries disproportionately carry a high burden 90% of the new cases and related deaths due to cervical cancer (3). In Uganda, cervical cancer is the number one cause of death among women with cancer-related deaths estimated at 40.5 per 100,000 (\u003cb\u003e4\u003c/b\u003e).\u003c/p\u003e \u003cp\u003eGlobal HPV immunization coverage as of 2018 was estimated at 12.2% (\u003cb\u003e5\u003c/b\u003e). Despite improvements in HPV in the past 15 years. In sub-Saharan Africa HPV vaccine completion is estimated at 20% compared to developed countries such as Australia and New Zealand with 77% completion of HPV vaccine dosage (\u003cb\u003e6\u003c/b\u003e). To achieve the 90-70-90 World Health Organization (WHO) targets by 2030 (\u003cb\u003e7\u003c/b\u003e). WHO suggested countries on the path of cervical cancer elimination to have 90% of the girls vaccinated before 15 years, 70% of women screened by age of 35 years and again by 45 years of age, and 90% of women identified with cancer receive treatment (\u003cb\u003e7\u003c/b\u003e).\u003c/p\u003e \u003cp\u003eHPV vaccination has been routinely recommended for pre-adolescents and adolescent girls in Uganda (\u003cb\u003e8\u003c/b\u003e). The introduction of HPV vaccines represents a step forward in the primary prevention of cervical cancer and other HPV-related malignancies. Currently, there are two types of HPV vaccine: bivalent, which mainly protects against HPV genotypes 16 and 18, and Quadrivalent, which protects against genotypes 6, 11, 16, and 18 (\u003cb\u003e9\u003c/b\u003e,\u003cb\u003e10\u003c/b\u003e). The vaccines have been shown to provide cross-protection against other oncogenic HPV genotypes as well (\u003cb\u003e11\u003c/b\u003e,\u003cb\u003e12\u003c/b\u003e). Uganda Ministry of Health Uganda (MoH) has continued to address challenges associated with HPV vaccination delivery strategy since 2015, through multiple vaccination centers such as schools, health facilities, and outreach posts currently providing routine immunization services (\u003cb\u003e13\u003c/b\u003e). Studies show that school attendance is positively associated with HPV vaccination status due to the less effort required to reach out to girls in the implementation of the HPV vaccine delivery strategy (14).\u003c/p\u003e \u003cp\u003eDespite the concerted efforts, findings show that the uptake of HPV vaccine among girls aged 10\u0026ndash;14 years is as low as 22% across Uganda (\u003cb\u003e15\u003c/b\u003e). In addition, there is limited literature especially in the Lira district on HPV vaccination uptake more so after the horrible effects of the COVID-19 pandemic. Therefore, this study investigated the uptake of HPV vaccine and associated factors among in-school girls aged 9\u0026ndash;14 years in Lira City, West, northern Uganda to assist in re-designing appropriate strategies meant to enhance the HPV vaccination uptake in Lira City and Uganda as a whole.\u003c/p\u003e"},{"header":"Materials And Methods","content":"\u003ch3\u003e2.1 Study Design And Setting\u003c/h3\u003e\n\u003cp\u003eThis was a cross-sectional study employing quantitative methods of data collection and analysis. This study was conducted among six schools in Lira City West, northern Uganda. Lira City is the main, administrative, and commercial centre of the Lira District. It is located approximately 100 kilometres (62 miles), southeast of Gulu City the largest city in northern Uganda, and approximately 337 kilometres (209 miles), by road, north of Kampala the capital city of Uganda.\u003c/p\u003e\n\u003ch3\u003e2.2 Study Population\u003c/h3\u003e\n\u003cp\u003eThis study was conducted among 245 girls aged 9\u0026ndash;14 years in selected primary schools located in Lira City West, Northern Uganda. All girls aged 9-14years who were available at the time of data collection studying in selected schools whose parents had consented and they also assented were included in the study. Girls who were ill, those whose parents had not consented, and girls who did not assent to participate in the study were excluded. This study focused on girls aged 9\u0026ndash;14 years because they are the target age group for the HPV vaccine and are also less likely sexually exposed \u003cstrong\u003e(15)\u003c/strong\u003e.\u003c/p\u003e\n\u003ch3\u003e2.3 Sample Size Determination\u003c/h3\u003e\n\u003cp\u003eThe sample size was determined using the Leslie Kish formula (1965) n\u0026thinsp;=\u0026thinsp;z\u003csup\u003e2\u003c/sup\u003epq/d\u003csup\u003e2\u003c/sup\u003e with the assumptions, the confidence interval was taken at 95%., the level of uptake of HPV vaccine taken (p) was 0.1761 (17), the level of those not vaccinated given by (q) was 0.8239, The z-score (z) was 1.96, a margin of error (d) was 0.05. Therefore, the calculated sample size was 245 participants plus 10% of the non-response.\u003c/p\u003e\n\u003ch3\u003e2.4 Data Collection Method And Tools\u003c/h3\u003e\n\u003cp\u003eWe used researcher-administered questionnaires to collect data. The questionnaire was developed by the research team, piloted, reviewed, and adjusted accordingly to fit our study objectives before the actual data collection process. The questionnaire collected information on the following: demographic characteristics of participants (age, class, tribe, religion, birth order, staying with parents, family type), uptake of the vaccine (having received the HPV vaccine, if yes, how many times, if no, then why), individual characteristics (having had about the vaccine and cervical cancer, HPV knowledge), socio-economic factors(home area, number of members in the family, family head, access to media, being taught about HPV and cervical cancer at school, receiving vaccine from school, absence from school), Health system factors(estimated distance to facility, health worker recommendation, having seen posters at the facility about the HPV vaccine and cervical cancer, having visited the facility to get HPV vaccine, availability of the vaccine, availability of the health workers at the facility, exposure to outreach clinics). The outcome variable for this study was the self-reported receipt of the vaccine regardless of the number of doses.\u003c/p\u003e\n\u003ch3\u003e2.5 Data Collection Procedure\u003c/h3\u003e\n\u003cp\u003eThe study used a multistage sampling method which involved dividing the accessible population into three sub-counties in which the different primary schools are located. Two schools were randomly selected from each sub-county resulting in a total of six schools from where the study participants were accessed. The sample per school was chosen using proportion to size. The desirable number of participants picked from each school was determined using the formula below;\u003c/p\u003e\n\u003cp\u003e\u003cimg 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\"\u003e\u003c/p\u003e\n\u003cp\u003eThis study also employed a convenience random sampling technique given the availability of the study participants who meet the inclusion criteria. The first participant was selected randomly then subsequent participants were selected depending on their availability until the desired sample size of 245 was achieved. Administration of the questionnaire with selected participants lasted between 25 and 40 minutes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.6 Data Management and Analysis\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003eWhile in the field every questionnaire was checked for completeness to ensure no missing data at the end of each interview process. A data entry screen with checks was created in SPSS version 23.0 to ensure no missing and out of range values are entered within the data set. Data were entered and analysed using SPSS version 23.0. Continuous variables were summarised and presented as frequencies and percentages in appropriate tables and pie-chart, categorical variables were analysed using descriptive statistics, cross-tabulation, and logistic regression at a 95% level of confidence. The model fitness was checked using the Hosmer-Lemeshow test at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 and the backward conditional logistic regression method was used to determine variables that were independently associated with the outcome variable.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eIn this study, 260 prospective participants were approached 247 participants accepted to participate in this study giving us a response rate of 95%. Two participants were dropped from this study to bring the actual sample size used in this study to 245.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.1 Demographic characteristics of in-school girls aged 9\u0026ndash;14 years in Lira City West northern Uganda.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 245 girls aged 9\u0026ndash;14 years were recruited in this study and all girls who were approached accepted to partake in this study giving us a response rate of 100%. The mean age of the girls was 12.11 (\u0026plusmn;\u0026thinsp;1.651) years. Almost all of the participants, 219(89.6%) belonged to the Langi tribe, 222(90.6%) belonged between first and third birth order, 214(87.3%) stayed with their parents at home, and of these 181(73.9%) belonged to nuclear families. Three-quarters of the girls 190(77.6%) were Catholics and protestants by religion, and 176(71.8%) came from homes located in the town area. All most all of the girls 200(81.6%) came from male-headed families. The majority of the participants 149(60.8%) came from families that had 6\u0026ndash;10 members and had access to media at home \u003cstrong\u003e(\u003c/strong\u003eTable \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cstrong\u003e).\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\u0026nbsp;\u003ctable border=\"1\" id=\"Tab1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003e; Socio-demographic characteristics of school girls aged 9\u0026ndash;14 years in Lira city northern Uganda (n\u0026thinsp;=\u0026thinsp;245)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVARIABLE\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFREQUENCY (n\u0026thinsp;=\u0026thinsp;245)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePERCENTAGES (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9\u0026ndash;11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e33.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12\u0026ndash;14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e164\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e66.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eReligion\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\u0026nbsp;\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=\"char\"\u003e\n \u003cp\u003e97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e39.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAnglican\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e38.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e22.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTribe\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\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLangi\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e219\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e89.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eBirth Order\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\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u0026ndash;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e222\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e90.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eStay with parents\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\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e214\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e87.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eFamily Type\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\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNuclear Family\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e181\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e73.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eExtended Family\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e26.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHome Area\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\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e176\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e71.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVillage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e28.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eFamily Head\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\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFather\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e81.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e18.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMedia Access at Home\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\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTelevision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e132\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e53.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e113\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e46.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.2 Uptake of HPV vaccine among school girls aged 9\u0026ndash;14 years in Lira City West northern Uganda.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOut of the 245 study participants interviewed 48(19.6%) had ever received the HPV vaccine and of these 3.7% reported to have received one dose, 9.8% had received two doses and 5.3% had received three doses of the vaccine. However, of those who had never received the HPV vaccine 62(43.1%) reported having no idea about the HPV vaccine as the reason to why they were not vaccinated. \u003cstrong\u003e(Fig.\u0026nbsp;1\u003c/strong\u003e\u003cspan class=\"BoldItalic\" name=\"Emphasis\" type=\"BoldItalic\"\u003e)\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFigure 1 level of uptake of HPV vaccine among adolescent school girls\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.3 Bi-variate analysis of Individual and socio-economic factors associated with uptake of HPV vaccine among in-school girls aged 9\u0026ndash;14 years in Lira City West northern Uganda.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn binary logistic regression, the factors that were found statistically associated with uptake of HPV vaccine at p value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 were; age of participants 12\u0026ndash;14 years (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), Ever heard about the HPV vaccine (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), Ever heard about cervical cancer (p\u0026thinsp;\u0026lt;\u0026thinsp;0.002), being taught about cervical and HPV at school (p\u0026thinsp;=\u0026thinsp;0.020) and in-school vaccination (p\u0026thinsp;=\u0026thinsp;0.003). Factors that were not statistically associated with uptake of HPV vaccine were home area, media access, school absence and health seeking behaviors as shown in (Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u0026nbsp;\u003c/p\u003e\u0026nbsp;\u003ctable border=\"1\" id=\"Tab2\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eIndividual factors associated with HPV vaccine uptake among in-school girls\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eCharacteristics\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eEver received HPV vaccine n(%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003ecOR\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e95% CI\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eYES\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNO\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eLower\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eUpper\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\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\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9\u0026ndash;11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5(2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e76(31.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRef\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\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12\u0026ndash;14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e43(17.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e121(49.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eEver had about the HPV vaccine\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\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1(0.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e170(69.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRef\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\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e47(19.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e26(10.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eEver heard about cervical cancer\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\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.002*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e27(11.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11(4.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRef\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\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21(8.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e186(75.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.046\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.106\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHealth seeking behavior\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\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.600\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTraditional/herbal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7(2.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e35(14.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRef\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\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBiomedical\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e41(16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e162(66.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.265\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.524\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.054\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTaught about cervical cancer at school\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\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.021*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12(4.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e181(73.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRef\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\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e36(14.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16(6.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e33.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eEver received a vaccine at school\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\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.053\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4(1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e82(33.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRef\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\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e44(18.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e114(46.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e22.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003ch3\u003e*p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 Statistically Significant, Cor-crude Odd Ratio\u003c/h3\u003e\n\u003cp\u003e\u003cstrong\u003e3.4 Health system factors associated with uptake of HPV vaccine among in-school girls aged 9\u0026ndash;14 years in Lira City West northern Uganda.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn binary logistic regression, the factors that were found statistically associated with uptake of HPV vaccine at P-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 were; distance to the health facility (p\u0026thinsp;=\u0026thinsp;0.036), availability of HPV vaccine at the hospital (p\u0026thinsp;=\u0026thinsp;0.002), health workers recommendation (p\u0026thinsp;\u0026le;\u0026thinsp;0.001 \u003cstrong\u003e(\u003c/strong\u003eTable \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e\u003cstrong\u003e).\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\u0026nbsp;\u003ctable border=\"1\" id=\"Tab3\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eBivariate analysis of Health System factors associated with HPV vaccine uptake among in-school girls aged 9\u0026ndash;14 years in Lira City northern Uganda\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eEver received HPV vaccine n (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003ecOR\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e95% CI\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eYES\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNO\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eLower\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eUpper\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eDistance to the health Centre\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\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.036*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNear\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e36(14.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e107(43.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRef\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\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFar\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12(4.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e90(36.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.209\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.911\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHealth worker recommendation\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\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10(4.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e178(72.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRef\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\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e38(15.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19(7.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSeen posters about cervical cancer\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\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.320\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e26(10.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e166(67.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRef\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\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e22(9.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e31(12.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.284\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.990\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAvailability of the vaccines\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\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.002*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3(8.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7(19.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRef\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\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e23(63.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3(8.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eExposure to outreach clinics\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\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.421\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e28(11.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e185(75.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRef\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\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20(8.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12(4.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.857\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e24.968\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003ch3\u003e*p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 Statistically Significant, Cor-crude Odds Ratio\u003c/h3\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur study found low 19.6% uptake of the HPV vaccine among school girls aged 9\u0026ndash;14 years in Lira City northern Uganda. Our findings conform with the results of previous similar studies conducted in Lira District northern Uganda where uptake of the HPV vaccine was low at 17.61% (\u003cstrong\u003e17\u003c/strong\u003e). Similarly, our findings agree with the national HPV vaccine coverage among adolescent girls where uptake of the HPV vaccine is estimated at 22% (\u003cstrong\u003e18\u003c/strong\u003e). The low uptake in this study may be due to the fewer efforts in HPV vaccine delivery to improve vaccination among these girls most probably due to the effects of the COVID-19 pandemic that disrupted the health system.\u003c/p\u003e\n\u003cp\u003eOur study further found that school girls aged 12 years and above were almost five times more likely to uptake the HPV vaccine compared to their counterparts. Our findings agree with results from previous similar studies conducted in Mbale District, eastern Uganda where girls with increased age of 11 years and above were two times more likely to uptake the HPV vaccine compared to their counterparts (\u003cstrong\u003e19\u003c/strong\u003e) This similarity could be attributed to the knowledge acquisition as girls grow older. Another possible reason could be procrastination due to the age gap allowance provided by the Ugandan ministry of health of 9\u0026ndash;14 years (\u003cstrong\u003e20\u003c/strong\u003e) whereby the girls or their parents might think of getting the vaccine later in life.\u003c/p\u003e\n\u003cp\u003eFurthermore, our study found that school girls who ever heard about the HPV vaccine were two times more likely to uptake HPV compared to their counterparts who never heard about the HPV vaccine. These findings concur with the results of a similar previous study conducted in Mbale District; eastern Uganda where adolescent girls who received adequate information on the HPV vaccine were six times more likely to utilize the HPV vaccine (\u003cstrong\u003e19\u003c/strong\u003e). This could be explained in a way that those who had heard about the vaccine and had knowledge about the HPV vaccine could have acknowledged its benefits which provoked them to go for the vaccine. Therefore, the ministry of health and related stakeholders should put more effort into programs that create awareness of the HPV vaccine to optimize its uptake among girls aged 9\u0026ndash;14 years in Lira City.\u003c/p\u003e\n\u003cp\u003eOur study also found that school girls aged 9\u0026ndash;14 years in Lira City, who received a recommendation for HPV vaccination by health workers were three times more likely to uptake the HPV vaccine compared to their counterparts. These findings are similar to results from a previous study carried out in Mulago Hospital, Central Uganda where health worker recommendation was one of the factors associated with the timely completion of the HPV vaccination among girls aged 9\u0026ndash;14 years (\u003cstrong\u003e21\u003c/strong\u003e). This highlights the importance of health workers\u0026apos; efforts in improving the uptake of the HPV vaccine, whereby with more recommendations from them, more girls would get vaccinated.\u003c/p\u003e\n\u003cp\u003eDistance to the health Centre was significantly associated with vaccine uptake. This indicates that those who had received the vaccine could probably be living near health Centers and could easily access the vaccine. Similar findings from a study conducted in Kenya reported distance to the hospital as a statistically significant risk factor for non-completion of the doses for the vaccine (\u003cstrong\u003e23\u003c/strong\u003e). This implies that vaccine delivery strategies should be revised to ensure that the vaccines can easily be accessed by all people in their places of residence.\u003c/p\u003e"},{"header":"Study Limitations And Strengths","content":"\u003cp\u003eThis study had some limitations that must be considered in the interpretation and application of the results. This was an in-school study conducted in only six schools in Lira City West, Northern Uganda, so the findings of this study may not be representative the perspective of non- school going adolescent girls.\u003c/p\u003e \u003cp\u003eThe study only employed quantitative approach hence missed out on the qualitative data which always complements the quantitative data. However, results of this study can be used as an inference for future research studies.\u003c/p\u003e \u003cp\u003eSelf-reported bias. This was minimized through asking neutral worded questions.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe uptake of HPV vaccine among school girls aged 9\u0026ndash;14 years in Lira City, West was very low at 19.6%. Factors significantly associated with HPV vaccination included; age of 12 years and above, having heard about the vaccine, being taught about cervical and HPV at school, in-school vaccination, availability of HPV vaccine at the hospital, health workers recommendation. With this information, health policy planners can play a more active role in making recommendations for HPV vaccination by providing more appropriate target programs and policies in promoting HPV vaccination in the target age group of 9\u0026ndash;14 years.\u003c/p\u003e"},{"header":"Recommendations","content":"\u003cp\u003eThe results of the study can be used to design future strategies to increase uptake of HPV vaccine in Lira City such as through use of posters in health Centers, communities and schools typed in different languages to improve awareness about the HPV vaccine and cervical cancer.\u003c/p\u003e \u003cp\u003eThe ministry of health should offer ample orientation and training to all health workers about disseminating information on HPV vaccination to all eligible girls and their care takers while addressing their concerns about the vaccine appropriately such that these girls can receive the vaccine alongside other services or leave with information about it after visiting the health Centre. There is also need to empower the teachers with the information about HPV and cervical cancer such that they can easily pass it on to girls in school and also be champions in their communities to ease dissemination of information.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical Considerations and consent, assent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research protocol was reviewed and approved by the Gulu University Research and Ethics Committee (GUREC-2022-281). Administrative clearance was also obtained from the office of the District Health Officer, Lira District, and participating school administrations. Written informed consent was obtained from the parents/guardians of the participants/adolescent school girls. Written informed assent was also sought from the participants. The study was performed in accordance with Declaration of Helsinki.\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\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data sets used and/or analyzed during the study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eConflicts of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors Contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRenniter Mirembe Nakayita/\u0026nbsp;\u003c/strong\u003eparticipated in\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003etopic development, protocol development, data collection, data analysis, and manuscript writing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeo Benyumiza\u003c/strong\u003e/ participated in protocol writing, data collection, data analysis, manuscript writing and reviewing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCatherine Nekesa/\u0026nbsp;\u003c/strong\u003eparticipated in protocol development, data collection, data analysis, and manuscript writing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAisha Nalubuuka/\u0026nbsp;\u003c/strong\u003eparticipated in protocol development, data collection, data analysis, and manuscript writing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eJulius Kyeswa\u003c/strong\u003e/ participated in protocol development, data collection, data analysis, and manuscript writing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIvan Misuk\u003c/strong\u003e/ participated in topic development, protocol development, data collection, and manuscript writing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTom Murungi\u003c/strong\u003e/ participated in protocol development, data collection, data analysis, and manuscript writing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSamson Udho\u003c/strong\u003e/ participated in data analysis, and manuscript writing, and manuscript review.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEdward Kumakech\u003c/strong\u003e/ participated in data analysis, and manuscript writing, and manuscript review.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSpecial gratitude goes out to the different schools in Lira City west for their participation in this research study. We also acknowledge the management and staff Lira University particularly faculty of nursing and midwifery for their tireless efforts in training and mentoring undergraduate students through topic development, proposal writing, data collection and manuscript writing we are really grateful.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eMayoral E, Mayoral-Andrade G, \u0026hellip; LMA of M, 2018 undefined. Diagnosis of Transient/Latent HPV Infections-A Point of View! Elsevier. \u003c/li\u003e\n\u003cli\u003eMedicines IBJ of B and, 2018 undefined. Human Papillomavirus\u0026mdash;The Cause of Human Cervical Cancer. scirp.org. \u003c/li\u003e\n\u003cli\u003eSung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021 May;71(3):209\u0026ndash;49. \u003c/li\u003e\n\u003cli\u003eNakisige C, Trawin J, Mitchell-Foster S, Payne BA, Rawat A, Mithani N, et al. Integrated cervical cancer screening in Mayuge District Uganda (ASPIRE Mayuge): A pragmatic sequential cluster randomized trial protocol. BMC Public Health. 2020 Jan;20(1):1\u0026ndash;13. \u003c/li\u003e\n\u003cli\u003eSpayne J, Hesketh T. Estimate of global human papillomavirus vaccination coverage: analysis of country-level indicators. BMJ Open [Internet]. 2021 Sep 1 [cited 2022 Oct 31];11(9):e052016. Available from: https://bmjopen.bmj.com/content/11/9/e052016\u003c/li\u003e\n\u003cli\u003eLubeya MK, Mwanahamuntu M, Chibwesha C, Mukosha M, Wamunyima MM, Kawonga M. Implementation strategies to increase human papillomavirus vaccination uptake for adolescent girls in sub-Saharan Africa: A scoping review protocol. PLoS One [Internet]. 2022 Aug 1 [cited 2022 Oct 31];17(8). Available from: https://pubmed.ncbi.nlm.nih.gov/36006961/\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. Global strategy to accelerate the elimination of cervical cancer as a public health problem and its associated goals and targets for the period 2020 \u0026ndash; 2030. United Nations General Assembly [Internet]. 2020 [cited 2022 Oct 31];2(1):1\u0026ndash;56. Available from: https://www.who.int/publications/i/item/9789240014107\u003c/li\u003e\n\u003cli\u003ePatrick L, Bakeera-Kitaka S, Rujumba J, Malande OO. Encouraging improvement in HPV vaccination coverage among adolescent girls in Kampala, Uganda. PLoS One [Internet]. 2022 Jun 1 [cited 2022 Oct 31];17(6):e0269655. Available from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0269655\u003c/li\u003e\n\u003cli\u003eJennings MC, Loharikar A. A Vaccine Against Cervical Cancer: Context for the Global Public Health Practitioner. Glob Health Sci Pract [Internet]. 2018 Dec 27 [cited 2022 Oct 31];6(4):629\u0026ndash;34. Available from: https://www.ghspjournal.org/content/6/4/629\u003c/li\u003e\n\u003cli\u003eHPV VACCINE INTO NATIONAL IMMUNIZATION P R O G R A M M E S Guide to. 2016 [cited 2022 Oct 31]; Available from: www.who.int/immunization/documents\u003c/li\u003e\n\u003cli\u003eCosta AP, Giraldo PC, Cobucci RN, Consolaro ML, Souza RP, Can\u0026aacute;rio LB, et al. Cross-Protective IgG and IgA Antibodies against Oncogenic and Non-Oncogenic HPV Genotypes. Asian Pac J Cancer Prev [Internet]. 2020 Sep 1 [cited 2022 Oct 31];21(9):2799. Available from: /pmc/articles/PMC7779425/\u003c/li\u003e\n\u003cli\u003eCovert C, Ding L, Brown D, Franco EL, Bernstein DI, Kahn JA. Evidence for cross-protection but not type-replacement over the 11 years after human papillomavirus vaccine introduction. https://doi.org/101080/2164551520181564438 [Internet]. 2019 Aug 3 [cited 2022 Oct 31];15(7\u0026ndash;8):1962\u0026ndash;9. Available from: https://www.tandfonline.com/doi/abs/10.1080/21645515.2018.1564438\u003c/li\u003e\n\u003cli\u003eSnidal S. Lessons learned from Uganda: Delivering HPV vaccines to hard-to-reach girls - Clinton Health Access Initiative. \u003c/li\u003e\n\u003cli\u003eIsabirye A, Mbonye M, Asiimwe JB, Kwagala B. Factors associated with HPV vaccination uptake in Uganda: A multi-level analysis. BMC Womens Health. 2020 Jul;20(1):1\u0026ndash;11. \u003c/li\u003e\n\u003cli\u003eIsabirye A, Mbonye M, Asiimwe JB, Kwagala B. Factors associated with HPV vaccination uptake in Uganda: A multi-level analysis. BMC Womens Health. 2020 Jul;20(1):1\u0026ndash;11. \u003c/li\u003e\n\u003cli\u003eKisaakye E, Namakula J, Kihembo C, Kisakye A, Nsubuga P, Babirye JN. Level and factors associated with uptake of human papillomavirus infection vaccine among female adolescents in Lira District, Uganda. Pan African Medical Journal. 2018;31. \u003c/li\u003e\n\u003cli\u003eKisaakye E, Namakula J, Kihembo C, Kisakye A, Nsubuga P, Babirye JN. Level and factors associated with uptake of human papillomavirus infection vaccine among female adolescents in Lira District, Uganda. Pan African Medical Journal. 2018;31. \u003c/li\u003e\n\u003cli\u003eIsabirye A, Mbonye M, Asiimwe JB, Kwagala B. Factors associated with HPV vaccination uptake in Uganda: A multi-level analysis. BMC Womens Health [Internet]. 2020 Jul 13 [cited 2022 Nov 1];20(1):1\u0026ndash;11. Available from: https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-020-01014-5\u003c/li\u003e\n\u003cli\u003eNabirye J, Okwi LA, Nuwematsiko R, Kiwanuka G, Muneza F, Kamya C, et al. Health system factors influencing uptake of Human Papilloma Virus (HPV) vaccine among adolescent girls 9-15 years in Mbale District, Uganda. BMC Public Health [Internet]. 2020 Feb 4 [cited 2022 Nov 1];20(1):1\u0026ndash;11. Available from: https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-020-8302-z\u003c/li\u003e\n\u003cli\u003eMOH. Strategic Plan for Cervical Cancer Prevention and Control in Uganda. 2010; \u003c/li\u003e\n\u003cli\u003ePatrick L. Factors associated with timely human papillomavirus vaccine completion among girls 9-14 years at Mulago Hospital. [Internet]. 2019 [cited 2022 Mar 8]. Available from: http://196.43.133.114/handle/10570/7416\u003c/li\u003e\n\u003cli\u003eNabirye J, Okwi LA, Nuwematsiko R, Kiwanuka G, Muneza F, Kamya C, et al. Health system factors influencing uptake of Human Papilloma Virus (HPV) vaccine among adolescent girls 9-15 years in Mbale District, Uganda. BMC Public Health. 2020 Feb 4;20(1):1\u0026ndash;11. \u003c/li\u003e\n\u003cli\u003eMabeya H, Menon S, Weyers S, Naanyu V, Mwaliko E, Kirop E, et al. Uptake of three doses of HPV vaccine by primary school girls in Eldoret, Kenya; a prospective cohort study in a malaria endemic setting. 2018; \u003c/li\u003e\n\u003cli\u003eAdedini SA, Babalola S, Ibeawuchi C, Omotoso O, Akiode A, Odeku M. Role of Religious Leaders in Promoting Contraceptive Use in Nigeria: Evidence From the Nigerian Urban Reproductive Health Initiative. 2018; \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Human Papilloma Virus Vaccine, Uptake, Adolescent school girls, Lira City","lastPublishedDoi":"10.21203/rs.3.rs-2511777/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2511777/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\n\u003cp\u003eCervical cancer is the principal burden of Human Papillomavirus (HPV) infections and a public health priority. Since 2008, HPV vaccination has been routinely recommended for pre-adolescents and adolescent girls in Uganda as the primary preventive measure for cervical cancer. However, in Uganda, most especially Lira district there is limited literature on HPV vaccination uptake and associated factors among girls aged 9-14years. This study assessed the uptake of HPV vaccine and associated factors among in-school girls aged 9–14 years in Lira City northern Uganda.\u003c/p\u003e\n\u003ch2\u003eMethods\u003c/h2\u003e\n\u003cp\u003eA cross-sectional study was conducted among 245 primary school girls aged 9–14 years in Lira City, west northern Uganda. Multistage sampling technique was used to sample eligible participants and data was collected using interviewer administered questionnaire. Data was analysed using SPSS version 23.0.\u003c/p\u003e\n\u003ch2\u003eResults\u003c/h2\u003e\n\u003cp\u003eHPV vaccination uptake was at 19.6% among the school girls aged 9–14 years in Lira City west northern Uganda. The mean age of the girls was 12.11 (± 1.651) years. Individual factors that were found significantly associated with HPV vaccination included; age of 12–14 years [cOR 5.40, 95% CI (2.04–14.24), P = 0.001], Ever had about the vaccine [cOR: 2.05, 95% CI (0.26–3.50), P = 0.021], taught about cervical cancer at school [cOR: 11.54, 95% CI (4.91–33.89), P = 0.021]. Health system related factors that were found to be associated with HPV uptake; Availability of the vaccines at Health Facilities [cOR: 7.88, 95% CI (2.92–10.32), P = 0.002], Received health workers recommendation [cOR: 3.2, 95% CI (0.93–7.82), P = 0.000].\u003c/p\u003e\n\u003ch2\u003eConclusion\u003c/h2\u003e\n\u003cp\u003eFindings indicate that HPV vaccine uptake was very low. The ministry of health should strategize more on increasing awareness on HPV vaccination to young girls and their care takers in Lira City especially through collaborating with different schools though not neglecting the out of school girls.\u003c/p\u003e","manuscriptTitle":"Factors associated with uptake of Human Papilloma Virus Vaccine among school girls aged 9-14 years in Lira City northern Uganda: A cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-01-31 18:34:24","doi":"10.21203/rs.3.rs-2511777/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2023-03-20T16:23:19+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2023-03-15T09:08:39+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"b81f17b0-3098-48a1-8c82-e465cb876a50","date":"2023-03-14T22:51:54+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2023-03-14T22:45:39+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2023-01-30T14:43:42+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2023-01-27T10:28:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2023-01-27T10:10:43+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Women's Health","date":"2023-01-24T20:49:45+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"deca605d-cf35-46ba-8bac-d89245fd79fb","owner":[],"postedDate":"January 31st, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2023-10-16T22:08:35+00:00","versionOfRecord":{"articleIdentity":"rs-2511777","link":"https://doi.org/10.1186/s12905-023-02511-z","journal":{"identity":"bmc-womens-health","isVorOnly":false,"title":"BMC Women's Health"},"publishedOn":"2023-07-08 21:33:30","publishedOnDateReadable":"July 8th, 2023"},"versionCreatedAt":"2023-01-31 18:34:24","video":"","vorDoi":"10.1186/s12905-023-02511-z","vorDoiUrl":"https://doi.org/10.1186/s12905-023-02511-z","workflowStages":[]},"version":"v1","identity":"rs-2511777","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2511777","identity":"rs-2511777","version":["v1"]},"buildId":"GqpaHPwrfC8PjnIFayRh5","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}