Knowledge of cervical cancer and acceptability of prevention strategies among HPV-Vaccinated and non-vaccinated adolescents in Uasin Gishu County, Kenya

Abstract

Background: Cervical cancer is a critical public health concern in sub-Saharan Africa. Contemporary approach seeks to actively include primary prevention in the global cervical cancer elimination challenge. Adolescents are key targets in this facet of care as they are in the age group for successful vaccination and can benefit from fostering early behavioral modification in avoidance of Human Papilloma Virus, HPV, infection. An HPV vaccination initiative in Uasin Gishu County, Kenya, immunized over 3000 girls aged 9-14 in 2013. Despite this, there is a dearth of information on the knowledge of cervical cancer amongst adolescents and their acceptance of cervical cancer prevention strategies. Objective: To compare the knowledge and source of information of cervical cancer and acceptability of prevention strategies among vaccinated and unvaccinated adolescents after an HPV vaccination initiative in Uasin Gishu County. Method: A cross sectional comparative study carried out in six randomly selected public schools that had participated in the vaccination initiative. By proportionate allocation, a total of 60 vaccinated and 120 unvaccinated adolescents were enrolled into the study. Ethical approval was obtained from the Institutional Research and Ethics Committee and written consent from the parents. Data collection was done using interviewer-administered questionnaires derived from factual statements based on information from print material used for community sensitization on cervical cancer. Results: The median age of the participants was 14.0 (IQR: 13.0-15.0). Of the vaccinated adolescents, 96.7% (58/60) had heard of cervical cancer as compared to 50.8% (61/120) of the unvaccinated adolescents (P<0.001). Most of the vaccinated adolescents (93.3%, 56/60) had heard of the HPV vaccine while only 5% (6/120) of the unvaccinated adolescents had heard of it (P>0.001). Both cohorts identified the school as the main source of information for cervical cancer. The two groups also showed similarity in their selection of cervical cancer prevention strategies acceptable to them like delaying sexual debut and frequency of using condoms for protection against sexually transmitted infections. Similar proportions of participants from both cohorts showed high acceptance of screening modalities for cervical cancer (85% vs 86.7%, p=0.940). Out of 120 unvaccinated participants, 63.7% expressed willingness to be vaccinated. Conclusions: Exposure to the HPV vaccine was associated with a higher knowledge of cervical cancer. The adolescents predominantly rely on the school for health information. Adolescents, both vaccinated and unvaccinated, show high acceptance of cervical cancer prevention strategies. Recommendations: Education on cervical cancer must be comprehensive and elaborate to ensure adolescents are sufficiently informed. Empowerment of the teachers by health care workers to ensure information dissemination. The high acceptance of cervical cancer prevention strategies should further encourage provision of these services such as rolling out the nationwide HPV vaccination.