Determinants of human papillomavirus (HPV) vaccine hesitancy in sub- Saharan Africa: A systematic review

Abstract

Background: Vaccine hesitancy is a major public health issue that has negatively impacted vaccine uptake in sub-Saharan Africa (SSA). The reasons why individuals hesitate or refuse to vaccinate are variable and factors contributing to vaccine hesitancy are not well outlined. This review, therefore, aims to identify and describe the determinants of HPV vaccine hesitancy in SSA. Methods: A systematic search was conducted across four electronic databases (PubMed, Scopus, CINAHL and Web of Science) from 2007 until October 2021 and updated in January 2022. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, 13 studies were eligible and were included in the analysis. Data extraction and synthesis were guided by the Health Belief Model. Quality assessment was performed using the NIH and CASP quality assessment tools. Results: The most frequently reported factors influencing HPV vaccine hesitancy included concerns about side effects and infertility; limited knowledge of HPV vaccine, HPV infection, and cervical cancer; lack of awareness of vaccination opportunities; mistrust of health workers, health authorities, and new vaccines; influence by caregivers, peers, community members or respected members of the society and religious and cultural factors. Other factors included accessibility issues (roads in poor condition, transport costs), adolescent absenteeism on vaccination day and dropping out of school. Conclusion: To reduce hesitancy and improve HPV vaccination coverage, vaccination programs need to develop and implement inclusive and context-specific strategies to enhance vaccine confidence, alleviate concerns, engage, and provide appropriate information to stakeholders involved in HPV vaccination, and dispel rumours and misinformation. The capacity of teachers and healthcare providers must be reinforced to equip them with knowledge about HPV vaccines, improve their interpersonal communication skills so that they can be better advocates for the vaccine within their communities