HPV vaccine acceptability in Ghana, West Africa

Abstract

Objective

Cervical cancer is a leading cause of cancer-related mortality among women in Ghana. As of this writing no data are available concerning knowledge, attitudes and acceptability of human papillomavirus (HPV) vaccination by women in Ghana.

Methods

Between November and December 2009, a self-administered survey was used to elicit information from 264 Ghanaian women, ages 18–65.

Results

Overall, 40% had heard about HPV vaccine and 94% were willing to vaccinate themselves or their daughters. Ideal age for vaccination was 12.7 years. Most women (75%) thought the vaccine should be received regardless of one's number of sex partners. The most prevalent concerns were whether the vaccine would be administered safely using clean needles (82%), and possible future side effects (77%). Concerns about cost and vaccine encouraging earlier sex were reported by nearly half. Significant barriers to vaccine acceptance were women's lack of knowledge about the gravity of cervical cancer in Ghana and utility of Pap test in detecting it, low perceived risk for cervical cancer, low social support to vaccine use, and low self-efficacy to find a doctor or clinic to get vaccinated (p < 05). About 55% of the women did not know the vaccine only works among those who are not yet infected with HPV. Schools and television were the most preferred methods of educating the public and cervical cancer prevention ranked as the ideal message (80%). Most respondents believed the decision to vaccinate their daughter should be made by both parents (34%) or in conjunction with the daughter (37%), as opposed to the government (17%).

Conclusions

Educational programs addressing specific barriers identified in the current study have the potential to significantly improve HPV vaccine uptake in Ghana.

Introduction

Cervical cancer is the second most common cancer world wide, with approximately 493,000 new cases diagnosed each year [1]. Nearly 80% of 274,000 annual deaths occur in developing countries and this proportion is expected to increase to 90% by 2020 [1]. In Sub-Saharan Africa, cervical cancer is one of the most common female cancers [2], with age-specific rates ranging from 19.9 per 100,000 in Nigeria [2] to 41.7 per 100,000 in Ugandan [3]. In Ghana, annual age-standardized cervical cancer incidence rate is 29.3/100,000 [4] and crude HPV DNA prevalence is reported at 8.8% for women age ≤30 and 12.2% for those age >30 [5].

Although organized screening using the Papanicolaou (Pap) screening test has substantially lowered the number of cervical cancer deaths in the developed countries, many women in developing countries have yet to experience the benefits of this simple intervention. Recent data from Ghana suggest that only about 12% of women undergo cervical cancer screening using Pap testing [6]. While cost has been identified a reason for this low prevalence, the most common barriers proposed are women's inadequate knowledge about purpose of screening, lack of awareness about local screening initiatives and concerns about what others may think [6].

For women in Ghana and around the world, the recent introduction of the human papillomavirus (HPV) vaccine may now represent the most promising means to reduce the incidence and subsequent mortality of cervical cancer. Two vaccines are currently available, the bivalent Cervarix vaccine and the quadrivalent Gardasil vaccine. These vaccines are thought to have the potential to prevent 70% of cervical cancers worldwide [7]. While to the medical sector the HPV vaccine may represent a veritable panacea, the implementation of widespread vaccinations yields its own set of unique challenges. Recently researchers have begun to assess the socio-cultural factors that may act as the greatest barriers to successful introduction of the HPV vaccine in resource-poor communities in Africa. Two recent qualitative studies in South Africa [8], [9] and one quantitative report from Kenya [10] have now provided data on barriers to vaccine introduction and uptake in this continent. Although cost and limited resources are obvious candidates in impeding the delivery of the vaccine [11], [12], equally important are the less tangible variables including negative attitudes and beliefs that women may harbor concerning efficacy as well as short- and long-term safety of the vaccine [13]. Unlike other vaccines, HPV is fraught with unique moral dilemmas, as infection with HPV is a sexually transmitted disease, thus raising questions regarding vulnerable populations, ideal age at vaccination, and social repercussions.

Due to a paucity of data, the present study was undertaken to investigate the acceptability of the HPV vaccine in Ghana. Specifically, our aim was to identify barriers and key concerns Ghanaian women may harbor towards vaccine uptake. Such information is the first step towards implementation of a country-wide vaccination program in this resource-poor community. Gaps in knowledge and lack of data concerning acceptability of cervical cancer vaccines in Sub-Saharan Africa are well documented [14] and acquisition of such data has become a top public health priority in the battle against cervical cancer.