Barriers to vaccination in Latin America: A systematic literature review.

Thailand has one of the world's highest prevalence of cervical cancer, mainly caused by the human papillomavirus (HPV) HPV infections can successfully be prevented by vaccination, which is available at a cost but not yet implemented in the national vaccination program Parents play a critical role in deciding whether to vaccinate their child against HPV Thus, the aim was to examine the association between parents' knowledge, beliefs, and acceptance of the HPV vaccination for their daughters, considering their socio-demographics and religious beliefs A cross-sectional design was used among three schools in Thailand: Nakorn Phatom province (suburban) and Bangkok (urban) Parents of 9-12-year-old daughters completed the questionnaires, guided by the Health Belief Model In total, 359 parents completed the questionnaires; of those, 301 were included in the final analyses The ordinary least squares (OLS) regression analysis showed that background knowledge of HPV and the HPV vaccine was positively related to knowledge of HPV and cervical cancer For beliefs, knowledge was positively associated with susceptibility (ie, parents' perceived risk of an HPV infection/ related disease), severity, and benefit However, knowledge was not significantly related to barriers For acceptance, higher susceptibility and benefit were related to higher acceptance, and greater knowledge was associated with higher acceptance Thus, we found associations between parents' knowledge, beliefs, and acceptance of the HPV vaccination for their daughters, considering their socio-demographics and religious beliefs Parents, who reported religion as important, as opposed to those who did not, were more favorable toward the HPV vaccination Four out of ten mothers had never undergone a cervical cancer screening, but most had accepted previous childhood vaccinations for their daughters The overall acceptance of the vaccine was high, and we believe our results are promising for future implementation of the HPV vaccination in the national childhood vaccination program in Thailand

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Parents’ knowledge, beliefs, and acceptance of the HPV vaccination in relation to their socio-demographics and religious beliefs: A cross-sectional study in Thailand

Human papillomavirus vaccination uptake in low-and middle-income countries: a meta-analysis.

The concept of Vaccine Hesitancy has begun to appear in the scientific landscape, referring to the reluctance of a growing proportion of people to accept the vaccination offer. A variety of factors were identified as being associated with vaccine hesitancy but there was no universal algorithm and currently there aren't any established metrics to assess either the presence or impact of vaccine hesitancy. The aim of this study was to systematically review the published questionnaires evaluating parental vaccine hesitancy, to highlight the differences among these surveys and offer a general overview on this matter. This study offers a deeper perspective on the available questionnaires, helping future researches to identify the most suitable one according to their own aim and study setting.

Resources for assessing parents' vaccine hesitancy: a systematic review of the literature.

Infections with Human Papillomavirus (HPV) are the main cause of cervical cancer. Since 2014, the HPV vaccine was introduced in the Brazilian National Vaccination Calendar. The purpose of this study was to assess the knowledge of adolescent girls and their mothers/guardians about HPV and HPV vaccine, identify the factors associated with this knowledge, and evaluate immunization dropout rate. This was a cross-sectional study involving adolescent girls and their mothers/guardians. Participants underwent an interview that addressed sociodemographic data, sexual and gynecological history, and knowledge about HPV, HPV vaccine and cervical cancer. The third quartile of the total score was established as a cutoff for assessing knowledge. Adolescents who correctly answered more than four questions and mothers/guardians who obtained more than five correct responses were categorized into high knowledge. Poisson regression analysis was performed to identify variables associated with low knowledge. Vaccination records were used to assess immunization dropout rates. Any adolescent who did not complete the two-dose vaccination schedule was considered dropout. A total of 666 adolescent girls and 623 mothers/guardians were interviewed. Low knowledge was observed in 76.7% of adolescents and 79.8% of mothers/guardians. Most were unaware of the causal relationship between HPV and cervical cancer, signs and symptoms of HPV infection, and had limited knowledge about the HPV vaccine. Factors associated with low knowledge of adolescents were aged 12 years [IRR 1.2 (95% CI 1. 1-1.3)] or less [IRR 1.3 (95% CI (1. 2-1.4)]; household income lower than US$750 [IRR 1.7 (95% CI 1. 1-2.6)] and household income between US$751 and US$1500 [IRR 1.6 (95% CI 1.0–2.6)]. Among mothers/guardians, low knowledge was related to having completed elementary school or less [IRR 1.5 (95% CI 1. 2-2.0)]; and household income lower than US$750 [IRR 1.2 (95% CI 1.0–1.4)]. Knowledge of adolescents and mothers/guardians was not associated with vaccine uptake. HPV immunization dropout rate was considered high (32.3%). Knowledge about HPV and cervical cancer as well as vaccine uptake was low. Results highlight the need for educational interventions about HPV and cervical cancer. These actions may contribute to improve adherence to HPV vaccination.

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Knowledge about cervical cancer and HPV immunization dropout rate among Brazilian adolescent girls and their guardians

To evaluate the HPV vaccination coverage in Boa Vista, Roraima (Brazil) and to identify personal and socioeconomic factors related to non-compliance to HPV vaccination. A school-based, cross-sectional study was conducted by distributing a self-administered questionnaire to the parents or guardians of pre-adolescent girls. The questionnaire addressed compliance to, knowledge about and perception of HPV and the HPV vaccine. Between July and November 2015, 13 private and public schools were visited based on a random cluster sampling method. A total of 1337 questionnaires were distributed to all female students in the target age group, and 797 were completed and returned (the participation rate was 59.6 %). The vaccination coverage rate was 82.7 % and was higher among public school students than among private school students (84.1 % vs 56.3 %; p = 0.003). Most parents (60 %) incorrectly answered more than half of the questions related to HPV knowledge, and limited knowledge about HPV and the HPV vaccine correlated with lower compliance to vaccination (adjusted OR = 1.42; 95 % CI: 1.01 to 2.76). In the perception analysis, the belief that the HPV vaccine is important for the daughter was an important protective factor (adjusted OR = 0.62; 95 % CI: 0.23 to 0.93), and concern about adverse effects of the HPV vaccine was a risk factor for non-compliance (adjusted OR = 1.66; 95 % CI: 1.01 to 2.71). Family income, religion and education level of the parents or guardians did not correlate with compliance to vaccination. HPV vaccination coverage was high in Boa Vista, Brazil, but knowledge about the vaccine was deficient. This deficiency was associated with a distorted perception and was negatively associated with compliance to vaccination. Actions aimed at informing the public about the HPV vaccine, including its risks and benefits, are needed to attain higher vaccination coverage in Brazil.

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Factors related to non-compliance to HPV vaccination in Roraima—Brazil: a region with a high incidence of cervical cancer

Background: Neurological complications involving central and peripheral nervous system are well described but there is paucity of literature on involvement of autonomic nervous system. HIV patients on ART have a higher prevalence of symptoms due to dysautonomia in comparison to normal individuals.
Aims and objectives: To study the prevalence of cardiac autonomic dysfunction in PLHA (People living with HIV/ AIDS) with and without antiretroviral treatment.
Methodology: It is a cross sectional study. The subjects are broadly divided into 3 categories with 25 patients in each group. PLHA on ART, PLHA not on ART and healthy controls.
Observation and results: Three patients from ART group two from ART naive group had symptoms of syncope. There was a significant difference between the autonomic parameters in the control population as compared to that of PLHA, but no difference between those on ART and not on ART. The resting heart rate was significantly higher in PLHA compared to controls. On testing for sympathetic response, there was no notable difference between the median values of fall in systolic blood pressure between PLHA patients and control population. Respiratory sinus arrhythmia, expiration to inspiration ratio, in the controls was higher when compared to PLHA There is a significant difference in fall in systolic blood pressure between the HIV on ART and not on ART, however there was no significant difference in other autonomic parameters.
Conclusion: This study shows that deterioration of parasympathetic function is more common than sympathetic function decline in HIV infected subjects as compared to normal population.

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Ingrid Ferreira Buttenbender

Papers

Factors related to non-compliance to HPV vaccination in Roraima—Brazil: a region with a high incidence of cervical cancer

Knowledge, Perception and Seroprevalence of HIV/STIS among Young Adults in Brazilian Amazon Region: A Population-Based Study