title: Reasons for receiving or not receiving HPV vaccination in primary schoolgirls in Tanzania: a case control study.
abstract: BACKGROUND
  There are few data on factors influencing human papillomavirus (HPV) vaccination uptake in sub-Saharan Africa. We examined the characteristics of receivers and non-receivers of HPV vaccination in Tanzania and identified reasons for not receiving the vaccine.
  
  
  METHODS
  We conducted a case control study of HPV vaccine receivers and non-receivers within a phase IV cluster-randomised trial of HPV vaccination in 134 primary schools in Tanzania. Girls who failed to receive vaccine (pupil cases) and their parents/guardians (adult cases) and girls who received dose 1 (pupil controls) of the quadrivalent vaccine (Gardasil™) and their parents/guardians (adult controls) were enrolled from 39 schools in a 1∶1 ratio and interviewed about cervical cancer, HPV vaccine knowledge and reasons why they might have received or not received the vaccine. Conditional logistic regression was used to determine factors independently associated with not receiving HPV vaccine.
  
  
  RESULTS
  We interviewed 159 pupil/adult cases and 245 pupil/adult controls. Adult-factors independently associated with a daughter being a case were older age, owning fewer household items, not attending a school meeting about HPV vaccine, and not knowing anyone with cancer. Pupil-factors for being a case included having a non-positive opinion about the school de-worming programme, poor knowledge about the location of the cervix, and not knowing that a vaccine could prevent cervical cancer. Reasons for actively refusing vaccination included concerns about side effects and infertility. Most adult and pupil cases reported that they would accept the HPV vaccine if it were offered again (97% and 93% respectively).
  
  
  CONCLUSIONS
  Sensitisation messages, especially targeted at older and poorer parents, knowledge retention and parent meetings are critical for vaccine acceptance in Tanzania. Vaccine side effects and fertility concerns should be addressed prior to a national vaccination program. Parents and pupils who initially decline vaccination should be given an opportunity to reconsider their decision.
authors.affiliation: London School of Hygiene and Tropical Medicine, London, United Kingdom. Deborah.Watson-Jones@lshtm.ac.uk
authors.forename: Deborah
authors.initials: D
authors.lastname: Watson-Jones
authors.forename: Keith
authors.initials: K
authors.lastname: Tomlin
authors.forename: Pieter
authors.initials: P
authors.lastname: Remes
authors.forename: Kathy
authors.initials: K
authors.lastname: Baisley
authors.forename: Riziki
authors.initials: R
authors.lastname: Ponsiano
authors.forename: Selephina
authors.initials: S
authors.lastname: Soteli
authors.forename: Silvia
authors.initials: S
authors.lastname: de Sanjosé
authors.forename: John
authors.initials: J
authors.lastname: Changalucha
authors.forename: Saidi
authors.initials: S
authors.lastname: Kapiga
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Hayes
mesh_terms: D000328:Adult; D052685:Alphapapillomavirus / Q000276:immunology; D016022:Case-Control Studies; D002648:Child; D005260:Female; D000068857:Human Papillomavirus Recombinant Vaccine Quadrivalent, Types 6, 11, 16, 18; D006801:Humans; D008297:Male; D053918:Papillomavirus Vaccines / Q000008:administration & dosage*; D010290:Parents; D010342:Patient Acceptance of Health Care; D013636:Tanzania
chemical_list: D000068857:Human Papillomavirus Recombinant Vaccine Quadrivalent, Types 6, 11, 16, 18; D053918:Papillomavirus Vaccines