Berihun Agegn Mengistie

Knowledge and attitude of parents towards the human papillomavirus vaccine for their daughters and associated factors in Debre Tabor town, northwest Ethiopia: a community-based cross-sectional study

Objective This study aims to assess parents’ knowledge and attitude towards the human papillomavirus (HPV) vaccination of their daughters and the associated factors in Debre Tabor town, northwest Ethiopia. Design A community-based cross-sectional study. Setting Debre Tabor town, Northwest Ethiopia. Participants A total of 702 participants were included in the study, with a response rate of 98.2%. Three out of the six kebeles in the town were randomly selected, and participants within the selected kebeles were recruited through a cluster sampling technique. An interviewer-administered structured questionnaire was used to collect data from 15 December 2021 to 15 February 2022. Primary and secondary outcome measures Parents’ level of knowledge and attitude towards the HPV vaccination of their daughters, and the associated factors. Results In the study, parents’ knowledge and attitude towards HPV vaccination were found to be 46.4% (95% CI 42.7% to 50.1%) and 61.5% (95% CI 58.0% to 65.2%), respectively. Parents with a higher level of education (adjusted OR (AOR)=2.27; 95% CI 1.39 to 3.69), media exposure (AOR=3.36; 95% CI 1.21 to 9.33) and a good attitude towards the HPV vaccine (AOR=8.81; 95% CI 5.78 to 13.44) were significantly associated factors that affect parents’ level of knowledge. Positive subjective norms (AOR=1.53; 95% CI 1.01 to 2.31) and perceived behavioural control towards the HPV vaccine (AOR=3.48; 95% CI 2.37 to 5.10) had statistically significant associations with parents’ attitude. Conclusions In this study, more than half of parents had poor knowledge of the HPV and its vaccination, while the majority of the participants showed a favourable attitude to the vaccine. Educational attainment, media exposure and a positive attitude were significantly associated with parental knowledge, and parents’ attitude was positively influenced by subjective norms and perceived behavioural control. This suggests a need to increase the parents’ level of awareness through educational interventions, particularly via media and community engagement. To improve the acceptance and uptake of the HPV vaccination, it is important to address negative attitudes and common misconceptions among parents on the safety, efficacy and necessity of the vaccine for their daughters.

Prevalence and determinants of precancerous cervical lesions among women screened for cervical cancer in Africa: A systematic review and meta-analysis

Background Precancerous cervical lesions, or cervical intraepithelial neoplasia (CIN), represent a significant precursor to cervical cancer, posing a considerable threat to women’s health globally, particularly in developing countries. In Africa, the burden of premalignant cervical lesions is not well studied. Therefore, the main purpose of this systematic review and meta-analysis was to determine the overall prevalence of precancerous cervical lesions and identifying determinants among women who underwent cervical cancer screening in Africa. Methods This study followed the Preferred Reporting Item Review and Meta-analysis (PRISMA) guidelines. The protocol for this systematic review and meta-analysis was registered on the International Prospective Register of Systematic Reviews (PROSPERO) (ID: CRD42025645427). We carried out a systematic and comprehensive search on electronic databases such as PubMed and Hinari. In addition, Google Scholar and ScienceDirect were utilized to find relevant studies related to precancerous cervical lesions. Data from the included studies were extracted using an Excel spreadsheet and analyzed using STATA version 17. The methodological quality of the eligible studies was examined using the Joanna Briggs Institute (JBI) assessment tool. Publication bias was checked by using the funnel plot and Egger’s tests. A random-effects model using the Der Simonian Laird method was used to estimate the pooled prevalence of pre-cancerous cervical lesions in Africa. The I-squared and Cochrane Q statistics were used to assess the level of statistical heterogeneity among the included studies. Results A total of 112 eligible articles conducted in Africa, encompassing 212,984 study participants, were included in the quantitative meta-analysis. Thus, the pooled prevalence of pre-cancerous cervical lesions in Africa was 17.06% (95% confidence interval: 15.47%−18.68%). In this review, having no formal education (AOR = 4.07, 95% CI: 1.74, 9.53), being rural dweller(AOR = 2.38, 95% CI: 1.64, 3.46), history of STIs (AOR = 3.94, 95% CI: 2.97, 5.23), history of having multiple partners (AOR = 2.73, 95% CI: 2.28, 3.28), early initiation of coitus (AOR = 2.77, 95% CI: 2.11, 3.62), being HIV-seropositive women (AOR = 3.33, 95% CI: 2.32, 4.78), a CD4 count <200 cells/mm³ (AOR = 5.17, 95% CI: 1.70, 15.71), not being on ART (AOR = 2.58, 95% CI: 1.45, 4.58), smoking (AOR = 3.91, 95% CI: 1.43, 10.67) and prolonged use of oral contraceptive pills (AOR = 4.39, 95% CI: 2.77, 6.96) were significantly associated with precancerous cervical lesions. Conclusions In Africa, the overall prevalence of pre-cancerous cervical lesions is high (17%). The findings of this review highlight that health professionals, health administrators, and all other concerned bodies need to work in collaboration to expand comprehensive cervical cancer screening methods in healthcare facilities for early detection and treatment of cervical lesions. In addition, increasing community awareness and health education, expanding visual inspection of the cervix with acetic acid in rural areas, offering special attention to high-risk groups (HIV-positive women), encouraging adherence to antiretroviral therapy for HIV-positive women, overcoming risky sexual behaviors and practices, and advocating early detection and treatment of precancerous cervical lesions.

Uptake of cervical cancer screening and its determinants in Africa: Umbrella review

Background Cervical cancer is the fourth most prevalent type of cancer in women globally. Early detection and treatment of precancerous cervical lesions and human papillomavirus (HPV) infection are strongly advised to decrease the incidence of cervical cancer and death. Cervical cancer is a major public health concern in low- and middle-income nations, where screening and treatment options are constrained. Thus, the main objective of this umbrella review was to determine the pooled uptake of cervical cancer screening and its determinants in Africa. Methods This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The protocol for this umbrella review was registered on the International Prospective Register of Systematic Reviews (PROSPERO) with reference number CRD42024518297. We conduct a systematic and comprehensive search by using Google Scholar, PubMed, Scopus, Hinari, and Science Direct, from January 1, 2014, to September 20, 2024. The data were extracted using Microsoft Excel spreadsheet. The methodological quality of the included studies was examined using A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2). The statistical analysis was carried out using STATA version 17, which includes descriptive analysis, forest plots for prevalence, funnel plot, and an Egger test to examine publication bias. A random-effects model was used to determine the pooled effect estimate. Publication bias was checked by using the funnel plot and Egger’s tests. Results This umbrella review included 11 systematic reviews and meta-analysis studies across Africa with a total of 143,327 study participants. The overall prevalence of cervical cancer screening practice in Africa was 20.94% (95% CI: 15.84%–26.04%). Women’s level of knowledge (AOR: 3.22, 95% CI: 1.64–6.33), positive attitude toward CCS (AOR: 2.48, 95% CI: 2.18–2.81), perceived vulnerability to cervical cancer (AOR = 3.57, 95% CI: 2.75, 4.63), and history of STIs (AOR = 4.89, 95% CI: 3.14, 7.62) were significantly associated with cervical cancer screening practice. In conclusion, the combined estimate of cervical cancer screening use in Africa remains much lower (20.94%) than the World Health Organization (WHO) recommendations target (70%). It indicates that there is a large gap that requires being addressed in collaboration to reduce the burden of cervical cancer and its morbidity and mortality across the continent. Therefore, healthcare professionals, policymakers, and other stakeholders shall implement effective strategies such as empowering women, improving the knowledge and attitude towards cervical cancer screening, advocacy, and expanding screening programs to all eligible women to increase utilization of cervical cancer screening.