Background
The Human papillomavirus (HPV) vaccine has been available for protection against HPV-associated cervical cancer and genital warts since 2006. Nonetheless, uptake has varied among countries and populations within countries. Studies have found that individuals’ knowledge and attitudes toward the vaccine are associated with immunization uptake. The purpose of the current review is to summarize and evaluate the evidence for educational interventions to increase HPV vaccination acceptance.

Educational interventions to increase HPV vaccination acceptance: A systematic review

Female human papillomavirus (HPV) vaccination: global uptake and the impact of attitudes.

Cervical cancer affects women in their reproductive ages. Screening is an important secondary prevention strategy. The long process of carcinogenic transformation from human papillomavirus (HPV) infection to invasive cancer provides ample opportunities to detect the disease at a stage when treatment is highly effective. Suitable screening tests are cytology, visual inspection after acetic acid application and HPV detection tests. Evidence of effectiveness of the tests to reduce cervical cancer mortality and the cost-effectiveness of screening programs have been demonstrated. Cervical intraepithelial neoplasia grade 2 and grade 3 are the high-grade cervical cancer precursors and need to be treated. Treatment is safe and effective with ablative or excisional techniques. The World Health Organization recommends screening women at least once in a lifetime between 30 and 49 years of age and ensuring effective treatment of the detected abnormalities. Combination of HPV vaccination and population-based screening will be instrumental in eliminating cervical cancer.

Secondary prevention of cervical cancer.

In 2010, the Cameroon Baptist Convention Health Services (CBCHS) received a donation of HPV vaccine (Gardasil®) to immunize girls of ages 9–13 years in the North West Region of Cameroon. We evaluated the effectiveness of the CBCHS campaign program in sensitizing parents/guardians to encourage HPV vaccine uptake, identified factors that influence parents’ decisions to vaccinate girls, and examined the uptake of cervical cancer screening among mothers. We conducted a cross-sectional survey in four healthcare facilities run by CBCHS, churches and other social settings. A total of 350 questionnaires were distributed and 317 were used for the analysis. There were high levels of awareness about cervical cancer, HPV and HPV vaccine. 75.5% understood HPV is sexually transmitted and 90.3% were aware of the use of vaccine as a preventive measure. Effectiveness of the vaccine (31.8%) and side effects/safety (18.4%) were the major barriers for parents to vaccinate their daughters. Bivariate analysis further revealed that the level of education (p = 0.0006), income level (p = 0.0044) and perceived risks (p = 0.0044) are additional factors influencing parents’ decisions to vaccinate girls. 35.3% of women had sought a cervical cancer screening, significantly higher than the general estimated rate of screening (<10%) in other parts of Cameroon and sub-Saharan Africa. These results support the viability of a community-tailored sensitization strategy to increase awareness among the targeted audience of parents/guardians, who are critical decision-makers for vaccine delivery to children.

Assessing the Effectiveness of a Community-Based Sensitization Strategy in Creating Awareness About HPV, Cervical Cancer and HPV Vaccine Among Parents in North West Cameroon

AIM: The human papillomavirus (HPV) vaccine is recommended for adolescent girls and young women; however the social structure in India will not permit vaccination of this age-group without parental approval. Our study aimed to explore the attitude of affluent urban Indian parents towards the HPV vaccine. METHODS: Well-to-do married couples with at least one daughter between 9-26 years of age were interviewed using a questionnaire in two parts. The first part was to assess their attitude to vaccination in general and their knowledge of cervical cancer; the second part was to assess their acceptance of the HPV vaccine. An educational fact sheet about cervical cancer and the HPV vaccine was administered in between the two parts. RESULTS: Of the 522 participants 27% of men and 24% of women agreed to vaccinate their daughters against a cancer initially. After going through the fact sheet 74% of both men and women were in favor of vaccination. CONCLUSIONS: The HPV vaccine seems to be well accepted among this subgroup of population if appropriately educated. (c) 2011 The Authors. Journal of Obstetrics and Gynaecology Research (c) 2011 Japan Society of Obstetrics and Gynecology.

Acceptability of human papillomavirus vaccine among the urban, affluent and educated parents of young girls residing in Kolkata, Eastern India.

Population prevalence of human papillomavirus (HPV) and cervical intraepithelial neoplasias (CIN) is an important indicator to judge the disease burden in the community, to monitor the performance of cervical cancer screening program and to assess the impact of HPV vaccination program. India being a country without any cervical cancer screening program has no published data on the population prevalence of CIN and only a few large community-based studies to report the high-risk HPV prevalence. The objective of our study was to study HPV and CIN prevalence in a previously unscreened population. We pooled together the results of three research studies originally designed to assess the performance of visual inspection after acetic acid application and Hybrid Capture 2 (HC 2). Nearly 60% of the screened women had colposcopy irrespective of their screening test results. The diagnosis and grading of cervical neoplasias were based on histology. The age standardized prevalence of HPV by HC 2 test was 6.0%. Age-adjusted prevalence of CIN1 and CIN2 was 2.3% and 0.5%, respectively. The age-adjusted prevalence of CIN3 was 0.4% and that of invasive cancer was 0.2%. The prevalence of high-risk HPV was relatively low in the population we studied, which is reflected in the low prevalence of high-grade CIN. The prevalence of CIN3 remained constant across age groups due to absence of screening.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/ijc.27793

Prevalence of high-risk human papillomavirus and cervical intraepithelial neoplasias in a previously unscreened population--a pooled analysis from three studies.

Context: Since the home is the primary source of exposure of children to second-hand smoke (SHS), measures to restrict smoking at home should be introduced to protect children from its adverse health consequences. Aims: Objectives of the study were to assess the level of awareness of rural Indian women on the health impacts of SHS on children and to look into the strategies they used to reduce children's exposure to SHS at home. Materials and Methods: A community-based cross-sectional study was conducted among 438 rural women using a survey questionnaire. Information on socio-demographic characteristics, knowledge on specific health effects of SHS on children, and attitude toward having a smoke-free home were collected. The perceived reasons that made it difficult to have smoke-free homes were also explored. Results: A total of 75.8% of women agreed that SHS was a serious health risk for children. Knowledge on health impacts of SHS on children identified asthma as the most common problem. Smoking by husbands (89.7%) was the major source of exposure to SHS at home. While 67.6% of women reported having taken measures to limit SHS exposure in their homes, only 12.8% of them had tried to introduce a complete ban on smoking at home. On a five-point evaluation scale, 73.3% of the women indicated a failure of their initiatives to have smoke-free homes. Conclusions: Women's initiatives to introduce restrictions on smoking at home had very limited success and did not produce an appreciable change in smoking behavior at home. Lack of empowerment of women in rural India probably rendered the interventional measures ineffective.

Toward smoke-free homes: A community-based study on initiatives of rural Indian women.

Aim Our aim was to improve our understanding of the contextual factors contributing to child drowning in rural West Bengal, India. Methods This 2017 study used interviews, focus groups and observations and the participants included community leaders, household heads, parents and children aged 7-17 years from three remote villages. They included adults and children who had been directly affected by the loss of family members or friends. Results We conducted 19 in-depth interviews, six focus groups and three informal observations in public locations where people were exposed to water. The area contained a high number of natural open areas of water, which increased the drowning risk. Participants reported that children frequently played unsupervised near potentially hazardous water, as their parents worked long hours and there was a lack of safe recreational spaces. Suggested approaches to reducing the drowning risk included parental education to improve child supervision and establishing village committees to effectively communicate the drowning risks to local government. Low-cost, community-based approaches to improving child water safety need to be developed. Conclusion Drowning was clearly a complex issue in rural West Bengal, with a significant impact on children and their families. Community-based approaches are clearly needed.

Srabani Mittal

Papers

Acceptability of human papillomavirus vaccine among the urban, affluent and educated parents of young girls residing in Kolkata, Eastern India.

Prevalence of high-risk human papillomavirus and cervical intraepithelial neoplasias in a previously unscreened population--a pooled analysis from three studies.

Toward smoke-free homes: A community-based study on initiatives of rural Indian women.

The impact and understanding of childhood drowning by a community in West Bengal, India, and the suggested preventive measures.