Social Determinants of Human Papillomavirus Vaccine Uptake Among Adolescent Girls in Low-Middle-Income Countries: A Systematic Review & Meta-Analysis
Cervical cancer remains the fourth most common cancer among women globally, despite being preventable with the human papillomavirus (HPV) vaccine. However, HPV vaccine uptake remains a challenge in low- and middle-income countries (LMICs), where cervical cancer elimination faces significant delays. The present study aims to identify the social determinants impacting HPV vaccine uptake in LMICs. This systematic review and meta-analysis included studies published between 2010 and 2025, identified through PubMed, Google Scholar, and ScienceDirect. Eligible studies reported HPV vaccine uptake (initiation, completion, or both) among adolescent girls aged 9 to 19 and examined at least 1 individual- or household-level social determinant. Data were thematically synthesized, and a meta-analysis was conducted using the random-effects model, with results expressed as odds ratios (ORs), with 95% confidence intervals (CIs). Eight studies, conducted in Ethiopia, Tanzania, and Uganda, were included. Key determinants assessed included age, religion, residence, parental education, occupation, wealth index, marital status, and household factors. Meta-analyses revealed wealth index (OR = 1.34; 95% CI: 1.05-1.70;
P
= .02) and parental marital status (OR = 0.86; 95% CI: 0.78-0.95;
P
< .01) as significant predictors of HPV vaccine uptake among adolescent girls in LMICs. Other factors, such as age, residence, parental education, etc., showed inconsistent effects or no significant association, with high heterogeneity across studies limiting the generalizability of some findings. This review highlights the complex, context-specific individual and household factors influencing HPV vaccine uptake among adolescent girls in LMICs. While wealth index and parental marital status showed consistent associations, other factors varied across studies. Community-based, culturally sensitive, tailored interventions are critical to improve the vaccine uptake. Continued research with standardized mixed-methods is vital to address multilevel factors and ensure equitable HPV vaccine uptake in LMICs.
