Table of Contents  
Year : 2013  |  Volume : 23  |  Issue : 1  |  Page : 14-17

Human papilloma virus vaccine: Awareness and acceptability amongst female medical students and health workers in a University Teaching Hospital in Eastern Nigeria

Department of Obstetrics and Gynaecology, Imo State University Teaching Hospital, Orlu, Nigeria

Date of Acceptance30-Sep-2013
Date of Web Publication14-Feb-2014

Correspondence Address:
Chukwuemeka E Ojiyi
Departments of Obstetrics and Gynaecology, Imo State University Teaching Hospital, P.M.B. 08 Orlu
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1116-5898.127102

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Background: Cervical cancer is the leading cause of cancer deaths in women in the developing countries. Human papilloma virus (HPV) has been implicated as the causative agent. Cervical cancer can primarily be prevented by vaccinating girls and women against HPV infection. Acceptability is demonstrated by the willingness of health workers to use these strategies themselves and to recommend them to their daughters and others. Aim: The aim of this study is to determine the awareness and acceptability of HPV vaccine among female health workers and female medical students in Orlu, Imo State, South-eastern Nigeria. Materials and Methods: A questionnaire based cross-sectional survey using 150 female health workers including female clinical medical students selected randomly from the Imo State University Teaching Hospital, Orlu. Results: The awareness of HPV vaccine was high (74.0%). The majority (57.3%) got the information either from conferences or class lectures. Other sources of information were radio, television and journals 5 (28.0%), while 14.6% got the information from their colleagues. Most of the health workers (67.3%) would recommend the vaccine to their adolescent daughters and clients. Most (64.6%) of the respondents did not think that the vaccine would lead to promiscuity. A good number of the respondents think that the vaccine would reduce the incidence of cervical cancer. Conclusion: The awareness of HPV vaccine and among female health workers in Orlu is high. This is very encouraging these female health workers will help in the dissemination of information regarding the use of this vaccine in the primary prevention of cervical cancer.

Keywords: Acceptability, awareness, human papilloma virus vaccine, Orlu

How to cite this article:
Ojiyi CE, Dike EI, Okeudo C, Nzewuihe AC, Uzoma MJK. Human papilloma virus vaccine: Awareness and acceptability amongst female medical students and health workers in a University Teaching Hospital in Eastern Nigeria. Niger J Surg Sci 2013;23:14-7

How to cite this URL:
Ojiyi CE, Dike EI, Okeudo C, Nzewuihe AC, Uzoma MJK. Human papilloma virus vaccine: Awareness and acceptability amongst female medical students and health workers in a University Teaching Hospital in Eastern Nigeria. Niger J Surg Sci [serial online] 2013 [cited 2022 Aug 19];23:14-7. Available from:

  Introduction Top

Cervical cancer is a female genital malignancy that has claimed the lives of women world-wide, but more so in the developing countries. [1] it is estimated that about 80% or more of the world burden of cervical cancer is in the developing world. [2] The cancer is however, preventable [3] and has a long precancerous stage. [4],[5] During this interval, screening could be instituted and any precancerous lesion identified could be adequately treated to prevent progression to invasive cancer. [4] Human papilloma virus (HPV) has been implicated as the causative agent. [2],[6] The new prevention strategy for cervical cancer is directed at immunization against this HPV infection prior to first sexual exposure as a form of primary prevention or to screen for the effects of HPV infection of the cervix as a form of secondary prevention. [7] The Papanicolaou Smear, a non-invasive procedure, has been the screening tool employed for more than four decades. [8] It is no doubt the most widely used screening test for the disease. [9],[10] This screening tool has reduced cervical cancer incidence in the developed countries by over 70%. [2],[7] However, in the developing countries, the picture is different. In these countries, the resources are limited [8],[11] and thus, there is underutilization of the available screening centers. In these resource poor countries, the problem is further compounded by the fact that both women and the health care providers themselves often lack information about cervical cancer as a disease entity, its causative agent and how cost effective it is to prevent it. [2],[12]

In the recent past, the discovery of HPV vaccine has transformed the prospects for reducing the incidence of cervical cancer on a global scale. [13] HPV vaccination is hoped to represent an effective intervention in the developing world where cervical cancer screening is either not available, rudimentary or is ineffective. [2],[13],[14],[15] The vaccines have been found to have remarkable efficacy, achieving more than 98% protection in randomized trials against cervical intra-epithelial neoplasia grade two and three; and adenocarcinoma in situ. [2],[13],[16] Wide spread use of the vaccine alone has the potential to reduce cervical cancer deaths by 50% over several decades. [2],[17] The target group is adolescent girls and young women aged 9-25 years. [2],[17] Countries with the capacity to combine vaccination of adolescents with a screening program that target women who are already sexually active will likely have a better outcome. [7] The effectiveness of a vaccine delivery program will largely depend upon whether the health care providers recommend the vaccine. [18] This study is therefore aimed at assessing the awareness and acceptability of the HPV vaccine among female health workers who are supposed to be the promoters of this strategy of cervical cancer prevention.

Acceptability of the vaccine will be demonstrated by the health worker's willingness to recommend the vaccine to their adolescent daughters and other sexually unexposed young women.

  Materials and Methods Top

Study area

This study was carried out at the Imo State University Teaching Hospital, Orlu, in the South-eastern part of Nigeria. The area is inhabited mainly by the Igbos. The hospital provides both general and specialist services to the people of Imo State environs. The hospital has a total of 174 beds, out of which 20 are for gynecological inpatients while 38 are for obstetric patients.

Study design

A questionnaire based cross-sectional survey using 150 female workers selected systematically from the hospital.

Sampling method

A frame of each group of health workers was first obtained and a multistage sampling technique was employed to select the required sample size. In the first stage, proportionate stratified sampling method was used to distribute the estimated sampling size of 175 to the six groups of female health workers as follows; 40 questionnaires to the female medical students; 70 to the nurses; 20 to the laboratory scientists; 20 to the pharmacists; 10 to the dieticians and 15 to the physiotherapists. In the second stage, systematic sampling method was used to select every 4 th name in the prepared frame of each group of health workers. These selected health workers after selecting the first name on the list. In each group were searched for and questionnaires distributed to them accordingly.

Sample size determination

This was calculated using the formula:

n = Z 2 Pq/d 2

Where, n = Sample size, Z = Coefficient of Z statistics obtained from the standard normal distribution table, P = Prevalence rate (in %), q = 100 − p and E = Sample error tolerated (in %).

Using a utilization rate of 9.0% obtained from a previous study from Enugu, South-eastern Nigeria, [19] with a confidence limit of 95% (d = 5%) and Z of 1.96, the calculated minimum sample size was 126.

Data collection

The study took place between the 5 th of July and the 8 th of November, 2010. Data was obtained using self-structured and pre-tested questionnaires. Each questionnaire consisted of 23 questions organized to cover respondent's socio-demographic characteristics, awareness and acceptability of the HPV vaccine. The questionnaire was pre-tested among 15 health workers at the Federal Medical Centre, Owerri to ascertain their clarity. Difficult and ambiguous questions were modified. Ethical clearance was obtained from the hospital's Research and Ethics Committee. Each selected female health worker was counseled and a verbal consent subsequently obtained. The questionnaires were then administered to them.

Statistical analysis

This was a descriptive and inferential statistics using the Statistical Package for Social Sciences (SPSS) computer software version 13.0 for windows. Frequency tables were generated from relevant variables. Descriptive statistics such as means ± standard deviations were used to summarize quantitative with proportions. All the analyses were performed at the 5% level of significance.

  Results Top

Out of the 175 questionnaires administered, 14 could not be retrieved and 11 were badly filled. The 150 properly filled questionnaires were used for the study, giving a response rate of 85.7%. The mean age of the respondents was 30.6 ± 2.7 years with a range of 20-65 years. Majority of the respondents 91 (60.6%) were between 20 and 30 years. Almost half of the respondents, 74 (49.3%) were married while 76 (50.6%) were single. Thirty-one (20.6%) were medical students, 15 (10%) were laboratory scientists, 68 (45.3%) were nurses, 16 (10.6%) were pharmacists, 10 (6.6%) were dieticians and 10 (6.6%) were physiotherapists [Table 1].
Table 1: Sociodemographic characteristics of the respondents

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Majority of the respondents, 123 (82.0%) were aware that cervical cancer was preventable. Similarly, 136 (88.6%) knew that HPV was sexually transmitted. 77 said that the age of first coitus in our environment was 10-15 years while 51 (34.0%) felt it was between 15 and 20 years. Only 15 (10.0%) said that the age at first coitus was before 10 years while 7 (4.6%) felt it was after 20 years.

A good number of the respondents, 111 (74.0%) were aware of the HPV vaccine while 39 (26.0%) were not aware as shown in [Table 2]. Among those who were aware of the vaccine, 42 (28.0%) got the information from radio, television or journals, while 86% (57.3%) got the information from conferences or lectures. Only 22 (14.6%) got the information from colleagues. 57 (38.0%) said the vaccine should be given at age 8-14 years, while 54 (36.0%) felt it should be given at age 15-20 years. Many of the respondents, 101 (67.3%) will recommend it for their adolescent clients and daughters. Most (64.6%) of the respondents did not think that the vaccine would lead to promiscuity. A good number of the respondents, 93 (62.0%) think that the use of the vaccine will reduce the incidence of cervical cancer. 92 (61.3%) of the respondents would want the vaccine to be included in the national immunization schedule. [Table 3] shows the acceptability of the vaccine amongst the 111 who were aware of the vaccine.
Table 2: Awareness of human papilloma virus vaccine

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Table 3: Acceptability of human papilloma virus vaccine

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  Discussion Top

Vaccination against HPV is known and accepted as a complimentary and synergistic program to cervical screening in the race to combat cervical cancer. Both constitute the new standards for prevention of cervical cancer. [17] The high degree of awareness obtained in this study may not be unconnected to the high level of education of the respondents. It may also be due to the fact that our respondents were health workers and hence well-informed.

Almost 74.0% awareness of HPV vaccine obtained in this study is high but is lower than the 87.0% awareness obtained in 2009 at Pittsburgh. [20] The high awareness of the HPV vaccine among female workers in Orlu is a welcome development. Being health workers, they are in the vanguard of the current war aimed against reducing the incidence of cervical cancer in our environment. As the sayings go "you cannot give what you don't have" and "knowledge is power." It is also an encouraging finding that most of the respondents (81.3%) were willing to receive the vaccine if offered to them. These will encourage acceptability of the vaccine by the general populace. This high acceptability is comparable to the findings of other studies world-wide. [6],[8],[21],[22],[23] The fact that just about 28% of the respondents were aware of the vaccine through the mass media (radio, television, journals) is quite encouraging as these media constitute one of the easiest ways of information dissemination. The mass media should be encouraged to get more involved in the dissemination of such a lifesaving information.

Furthermore very gratifying is the fact that a good number of the respondents think that the vaccine will reduce the incidence of cervical cancer and therefore will recommend it to their wards.

This study also revealed that up to 14.6% of the respondents felt that vaccination of adolescents would lead to promiscuity. This negative view is one of the potential setbacks to the uptake of HPV vaccine as found in other studies. [21],[24]

  Conclusion Top

Based on the above study it can be concluded that the awareness and acceptability of HPV vaccine among female health workers in Orlu is high. This is a welcome development in that being health workers, they will be invaluable in the dissemination of information regarding the use of this useful tool in the fight against cervical cancer.

  References Top

1.Sankaranarayanan R. Overview of cervical cancer in the developing world. FIGO 26 th annual report on the results of treatment in gynecological cancer. Int J Gynaecol Obstet 2006;95 Suppl 1:S205-10.  Back to cited text no. 1
2.Okonofua F. HPV vaccine and prevention of cervical cancer in Africa. Afr J Reprod Health 2007;11:7-12.  Back to cited text no. 2
3.Ayinde OA, Omigbodun AO. Knowledge, attitude and practices related to prevention of cancer of the cervix among female health workers in Ibadan. J Obstet Gynaecol 2003;23:59-62.  Back to cited text no. 3
4.Snijders PJ, Steenbergen RD, Heideman DA, Meijer CJ. HPV-mediated cervical carcinogenesis: Concepts and clinical implications. J Pathol 2006;208:152-64.  Back to cited text no. 4
5.Moscicki AB, Schiffman M, Kjaer S, Villa LL. Chapter 5: Updating the natural history of HPV and anogenital cancer. Vaccine 2006;24 Suppl 3:S3/42-51.  Back to cited text no. 5
6.Duval B, Gilca V, Boulianne N, Pielak K, Halperin B, Simpson MA, et al. Cervical cancer prevention by vaccination: Nurses′ knowledge, attitudes and intentions. J Adv Nurs 2009;65:499-508.  Back to cited text no. 6
7.Castilaw D, Wittet S. Preventing cervical cancer: Unprecedented opportunities for improving women′s health. Outlook 2007;23:12-4. Available from: [Last accessed on 2009 Dec 12].  Back to cited text no. 7
8.Sauvageau C, Duval B, Gilca V, Lavoie F, Ouakki M. Human papilloma virus vaccine and cervical cancer screening acceptability among adults in Quebec, Canada. BMC Public Health 2007;7:304.  Back to cited text no. 8
9.Ayinde OA, Ogunbode OO, Adebabyo OJ. Determinants of cervical cancer and the utilization of screening among a Nigerian female population. Trop J Obstet Gynaecol 2005;22:21-4.  Back to cited text no. 9
10.Frazer IH. Human papilloma virus vaccine. Int J Obstet Gynaecol 2006;94:381-8.  Back to cited text no. 10
11.Parkin D, Whelan S, Ferley J. Cancer Incidence in Five Continents. Vol. VIII. Lyon: IARC Scientific Publication; 2002. No. 155.  Back to cited text no. 11
12.Bingham A, Bishop A, Coffey P, Winkler J, Bradley J, Dzuba I, et al. Factors affecting utilization of cervical cancer prevention services in low-resource settings. Salud Publica Mex 2003;45 Suppl 3:S408-16.  Back to cited text no. 12
13.Stanley M. Human papillomavirus vaccines versus cervical cancer screening. Clin Oncol (R Coll Radiol) 2008;20:388-94.  Back to cited text no. 13
14.Massad LS, Einsten M, Myers E, Wheeler CM, Wentzensen N, Solomon D. The impact of human papilloma virus vaccination on cervical cancer prevention efforts. Gynaecol Oncol 2009;2:22-4.  Back to cited text no. 14
15.Alliance for Cervical Cancer Prevention (ACCP). The Case for Investing on Cervical Cancer Prevention. Cervical Cancer Prevention in Depth No. 3. Seattle: ACCP; 2004.  Back to cited text no. 15
16.Harper DM, Franco EL, Wheeler CM, Moscicki AB, Romanowski B, Roteli-Martins CM, et al. Sustained efficacy up to 4.5 years of a bivalent L1 virus-like particle vaccine against human papillomavirus types 16 and 18: Follow-up from a randomised control trial. Lancet 2006;367:1247-55.  Back to cited text no. 16
17.Monsonego J. Prevention of cervical cancer (II): Prophylactic HPV vaccination, current knowledge, practical procedures and new issues. Presse Med 2007;36:640-66.  Back to cited text no. 17
18.Riedesel JM, Rosenthal SL, Zimet GD, Bernstein DI, Huang B, Lan D, et al. Attitudes about human papillomavirus vaccine among family physicians. J Pediatr Adolesc Gynecol 2005;18:391-8.  Back to cited text no. 18
19.Dim CC, Nwagha UI, Ezegwui HU, Dim NR. The need to incorporate routine cervical cancer counselling and screening in the management of women at the outpatient clinics in Nigeria. J Obstet Gynaecol 2009;29:754-6.  Back to cited text no. 19
20.Dim CC, Dim NR, Ezegwui HU, Ikeme AC. An unmet cancer screening need of HIV-positive women in southeastern Nigeria. Medscape J Med 2009;11:19.  Back to cited text no. 20
21.Brewer NT, Fazekas KI. Predictors of HPV vaccine acceptability: A theory-informed, systematic review. Prev Med 2007;45:107-14.  Back to cited text no. 21
22.Gerend MA, Lee SC, Shepherd JE. Predictors of human papillomavirus vaccination acceptability among underserved women. Sex Transm Dis 2007;34:468-71.  Back to cited text no. 22
23.Fazekas KI, Brewer NT, Smith JS. HPV vaccine acceptability in a rural Southern area. J Womens Health (Larchmt) 2008;17:539-48.  Back to cited text no. 23
24.Scarinci IC, Garcés-Palacio IC, Partridge EE. An examination of acceptability of HPV vaccination among African American women and Latina immigrants. J Womens Health (Larchmt) 2007;16:1224-33.  Back to cited text no. 24


  [Table 1], [Table 2], [Table 3]


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