Knowledge of cervical cancer and uptake of HPV vaccine among in-school adolescent girls in Kwara State, Nigeria.

backgroundCervical cancer ranks as the second most common malignancy among Nigerian women, contributing heavily to preventable mortality, particularly in low-resource settings. HPV infection is the primary cause, and vaccination provides an effective prevention strategy. However, coverage in Nigeria remains critically low. Understanding knowledge and barriers among adolescent girls is imperative for designing interventions. This study explored these determinants among in-school girls in Kwara State.

methodsThis cross-sectional study surveyed 628 adolescent girls aged 9-14 years across rural, semi urban and urban LGAs in Kwara State. Multistage sampling included, random LGA selection, random school selection (7 public, 5 private per LGA), and systematic student sampling. Data were collected via comprehensive interviewer-administered questionnaires covering demographics, cervical cancer/HPV knowledge, barriers, and vaccine uptake. Analysis used STATA v18 with descriptive statistics and logistic regression with robust standard errors to identify predictors.

resultsMean age was 12.4 years (SD:1.7); 68.0% were in junior high school and 53.3% attended public schools. Overall knowledge levels were notably low: only 3.2% had good knowledge, 36.8% fair, and 60.0% poor. None of the participants had received the HPV vaccine. Major barriers included lack of awareness (82.2%), cost (76.0%), fear of side effects (71.2%), limited facility access (71.7%), and unawareness of vaccination sites (70.5%). Encouragingly, willingness to receive the vaccine was expressed by 71.2%. Fully adjusted logistic regression revealed that Muslim respondents had higher intention versus Christians (aOR = 1.61, 95%CI:1.12-2.33, p = 0.01). Location, age, school type, education level, and risk perception were not found to be significant predictors.

conclusionThis study exposes a critical disconnect between high willingness to vaccinate and profound knowledge deficits alongside substantial structural barriers. The complete absence of prior vaccinations underscores missed healthcare opportunities. To bridge this gap, targeted school-based health education leveraging teachers and healthcare workers is urgently needed to dispel myths about side effects and disseminate accurate information. Simultaneously, policy-driven strategies such as subsidizing vaccine costs, integrating vaccination into routine school health programs, and deploying mobile outreach to remote communities are essential to overcome financial and geographical obstacles. Translating favorable intentions into tangible uptake is critical for reducing Nigeria's future cervical cancer burden. CLINICAL TRIAL NUMBER: Not applicable.