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The coverage survey also asked parents and guardians about the reasons they agreed to have girls
vaccinated. Three reasons stood out, with between 77 and 84 percent of all adults citing at least one of
these:
• Protection against cervical cancer.
• Disease or infection prevention.
• Vaccines are good for health, or families wanted the girl to be healthy.
Reasons that girls were not vaccinated were mostly programmatic: girls were absent from school on
days of vaccination, or were not aware of the vaccinations, or age was not correctly determined. In
contrast to concerns during planning stages of the project, a concern that parents might worry that
vaccination would encourage early sexual activity was not cited by any of the survey respondents as a
reason for refusing vaccination.
Overall, the survey found that vertical school-based delivery—selecting by grade—achieved high
coverage. Delivery with CDP, also in schools, performed well, but selecting by age was difficult to
implement, resulting in lower coverage among eligible girls. Future vaccine delivery strategies could
overcome these obstacles by selecting girls by grade in school and offering active follow-up sessions to
include those absent or out of school.
HPV Vaccine Acceptability
Dr. Anne Katahoire
Associate Professor and Director, Child Health and Development Centre
Makerere University, Uganda
Dr. Anne Katahoire and colleagues carried out an assessment of the acceptability of HPV vaccination
among stakeholders. The study was both qualitative, using focus group discussions and interviews, and
quantitative, assessing acceptability by means of a survey, as described above by Dr. LaMontagne.
Dr. Katahoire reported that acceptability was explored among girls, parents, health workers, teachers,
and community and district leaders. A particular group’s willingness to create a positive and supportive
environment for HPV vaccinations was used to assess acceptability.
Analyses of the focus group discussions and interviews with various stakeholders revealed that vaccine
acceptability was generally high in both districts. Several key influencers of acceptability were identified:
• Positive attitudes toward vaccinations in the communities, which created a supportive
environment for the introduction of the HPV vaccine.
• Endorsement of the vaccinations by district and community leaders and health workers.
• Lack of adverse effects following initial vaccinations.
Report of an African Regional Meeting on Cervical Cancer: September 2010 22