TY - JOUR
T1 - Human papillomavirus vaccination in rural Malawi
T2 - Identifying factors associated with vaccine uptake using a community-based household survey
AU - Moucheraud, Corrina
AU - Kalande, Pericles
AU - Chibaka, Symon
AU - Phiri, Khumbo
AU - Makwaya, Amos
AU - Duah, Maame
AU - Li, Mei
AU - Liu, Muxin
AU - Hoffman, Risa M.
AU - Phiri, Sam
N1 - Publisher Copyright:
© 2025 The Author(s). Published with license by Taylor & Francis Group, LLC.
PY - 2025
Y1 - 2025
N2 - Uptake of the human papillomavirus (HPV) vaccine is suboptimal globally. Effective interventions are needed to meet the global goal of vaccinating 90% of girls against HPV, and this requires a robust understanding of barriers to vaccine uptake. Using a household survey in three communities of Malawi with parents/guardians of girls aged 9–13 years, we collected and analyzed data about intervention-amenable factors hypothesized to be associated with girls’ HPV vaccination status. The 299 parent/guardian respondents provided information on 382 girls aged 9–13 years, of whom 39.0% (n = 149) had received ≥ 1 dose of the HPV vaccine. More than half of parents/guardians were concerned about the HPV vaccine’s safety. Greater HPV vaccine hesitancy was associated with having an unvaccinated daughter in adjusted multilevel models (aOR 0.69 [95% CI 0.50–0.93]). Higher odds of being vaccinated were found among daughters of respondents with greater knowledge about the HPV vaccine and who knew someone who had cervical cancer. Speaking with more people about cervical cancer/HPV vaccination, and perceiving that other parents are vaccinating their daughters against HPV, were strongly associated with daughters’ HPV vaccination status (aOR 2.03 [95% CI 1.59–2.62] and 3.68 [95% CI 1.97–7.18, respectively). Most parents/guardians had not experienced, or did not anticipate experiencing, challenges accessing HPV vaccination services, but those who did also had daughters with lower odds of vaccination. Interventions that leverage social networks and norms, increase confidence in the vaccine’s safety, and work to improve access to HPV vaccination services, may increase coverage of the HPV vaccine in Malawi.
AB - Uptake of the human papillomavirus (HPV) vaccine is suboptimal globally. Effective interventions are needed to meet the global goal of vaccinating 90% of girls against HPV, and this requires a robust understanding of barriers to vaccine uptake. Using a household survey in three communities of Malawi with parents/guardians of girls aged 9–13 years, we collected and analyzed data about intervention-amenable factors hypothesized to be associated with girls’ HPV vaccination status. The 299 parent/guardian respondents provided information on 382 girls aged 9–13 years, of whom 39.0% (n = 149) had received ≥ 1 dose of the HPV vaccine. More than half of parents/guardians were concerned about the HPV vaccine’s safety. Greater HPV vaccine hesitancy was associated with having an unvaccinated daughter in adjusted multilevel models (aOR 0.69 [95% CI 0.50–0.93]). Higher odds of being vaccinated were found among daughters of respondents with greater knowledge about the HPV vaccine and who knew someone who had cervical cancer. Speaking with more people about cervical cancer/HPV vaccination, and perceiving that other parents are vaccinating their daughters against HPV, were strongly associated with daughters’ HPV vaccination status (aOR 2.03 [95% CI 1.59–2.62] and 3.68 [95% CI 1.97–7.18, respectively). Most parents/guardians had not experienced, or did not anticipate experiencing, challenges accessing HPV vaccination services, but those who did also had daughters with lower odds of vaccination. Interventions that leverage social networks and norms, increase confidence in the vaccine’s safety, and work to improve access to HPV vaccination services, may increase coverage of the HPV vaccine in Malawi.
KW - HPV vaccination
KW - Malawi
KW - global health
KW - public health
KW - vaccine acceptability
KW - vaccine hesitancy
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U2 - 10.1080/21645515.2025.2485651
DO - 10.1080/21645515.2025.2485651
M3 - Article
C2 - 40177952
AN - SCOPUS:105002295741
SN - 2164-5515
VL - 21
JO - Human Vaccines and Immunotherapeutics
JF - Human Vaccines and Immunotherapeutics
IS - 1
M1 - 2485651
ER -