Human papillomavirus vaccination in rural Malawi: Identifying factors associated with vaccine uptake using a community-based household survey

Uptake of the human papillomavirus (HPV) vaccine is suboptimal globally. Effective interventions are needed to meet the global goal of vaccinating 90% of girls against HPV, and this requires a robust understanding of barriers to vaccine uptake. Using a household survey in three communities of Malawi...

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Main Authors: Corrina Moucheraud, Pericles Kalande, Symon Chibaka, Khumbo Phiri, Amos Makwaya, Maame Duah, Mei Li, Muxin Liu, Risa M. Hoffman, Sam Phiri
Format: Article
Language:English
Published: Taylor & Francis Group 2025-12-01
Series:Human Vaccines & Immunotherapeutics
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Online Access:https://www.tandfonline.com/doi/10.1080/21645515.2025.2485651
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author Corrina Moucheraud
Pericles Kalande
Symon Chibaka
Khumbo Phiri
Amos Makwaya
Maame Duah
Mei Li
Muxin Liu
Risa M. Hoffman
Sam Phiri
author_facet Corrina Moucheraud
Pericles Kalande
Symon Chibaka
Khumbo Phiri
Amos Makwaya
Maame Duah
Mei Li
Muxin Liu
Risa M. Hoffman
Sam Phiri
author_sort Corrina Moucheraud
collection DOAJ
description Uptake of the human papillomavirus (HPV) vaccine is suboptimal globally. Effective interventions are needed to meet the global goal of vaccinating 90% of girls against HPV, and this requires a robust understanding of barriers to vaccine uptake. Using a household survey in three communities of Malawi with parents/guardians of girls aged 9–13 years, we collected and analyzed data about intervention-amenable factors hypothesized to be associated with girls’ HPV vaccination status. The 299 parent/guardian respondents provided information on 382 girls aged 9–13 years, of whom 39.0% (n = 149) had received ≥ 1 dose of the HPV vaccine. More than half of parents/guardians were concerned about the HPV vaccine’s safety. Greater HPV vaccine hesitancy was associated with having an unvaccinated daughter in adjusted multilevel models (aOR 0.69 [95% CI 0.50–0.93]). Higher odds of being vaccinated were found among daughters of respondents with greater knowledge about the HPV vaccine and who knew someone who had cervical cancer. Speaking with more people about cervical cancer/HPV vaccination, and perceiving that other parents are vaccinating their daughters against HPV, were strongly associated with daughters’ HPV vaccination status (aOR 2.03 [95% CI 1.59–2.62] and 3.68 [95% CI 1.97–7.18, respectively). Most parents/guardians had not experienced, or did not anticipate experiencing, challenges accessing HPV vaccination services, but those who did also had daughters with lower odds of vaccination. Interventions that leverage social networks and norms, increase confidence in the vaccine’s safety, and work to improve access to HPV vaccination services, may increase coverage of the HPV vaccine in Malawi.
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spelling doaj-art-57dc58eff915487bb9ecb535663a4f182025-08-20T01:55:57ZengTaylor & Francis GroupHuman Vaccines & Immunotherapeutics2164-55152164-554X2025-12-0121110.1080/21645515.2025.2485651Human papillomavirus vaccination in rural Malawi: Identifying factors associated with vaccine uptake using a community-based household surveyCorrina Moucheraud0Pericles Kalande1Symon Chibaka2Khumbo Phiri3Amos Makwaya4Maame Duah5Mei Li6Muxin Liu7Risa M. Hoffman8Sam Phiri9School of Global Public Health, New York University, New York, USAImplementation Science Department, Partners in Hope, Lilongwe, MalawiEnvironmental Education, Children in the Wilderness, Lilongwe, MalawiImplementation Science Department, Partners in Hope, Lilongwe, MalawiPartners in Hope, Lilongwe, MalawiSchool of Global Public Health, New York University, New York, USASchool of Global Public Health, New York University, New York, USASchool of Global Public Health, New York University, New York, USADavid Geffen School of Medicine, University of California Los Angeles, Los Angeles, USAPartners in Hope, Lilongwe, MalawiUptake of the human papillomavirus (HPV) vaccine is suboptimal globally. Effective interventions are needed to meet the global goal of vaccinating 90% of girls against HPV, and this requires a robust understanding of barriers to vaccine uptake. Using a household survey in three communities of Malawi with parents/guardians of girls aged 9–13 years, we collected and analyzed data about intervention-amenable factors hypothesized to be associated with girls’ HPV vaccination status. The 299 parent/guardian respondents provided information on 382 girls aged 9–13 years, of whom 39.0% (n = 149) had received ≥ 1 dose of the HPV vaccine. More than half of parents/guardians were concerned about the HPV vaccine’s safety. Greater HPV vaccine hesitancy was associated with having an unvaccinated daughter in adjusted multilevel models (aOR 0.69 [95% CI 0.50–0.93]). Higher odds of being vaccinated were found among daughters of respondents with greater knowledge about the HPV vaccine and who knew someone who had cervical cancer. Speaking with more people about cervical cancer/HPV vaccination, and perceiving that other parents are vaccinating their daughters against HPV, were strongly associated with daughters’ HPV vaccination status (aOR 2.03 [95% CI 1.59–2.62] and 3.68 [95% CI 1.97–7.18, respectively). Most parents/guardians had not experienced, or did not anticipate experiencing, challenges accessing HPV vaccination services, but those who did also had daughters with lower odds of vaccination. Interventions that leverage social networks and norms, increase confidence in the vaccine’s safety, and work to improve access to HPV vaccination services, may increase coverage of the HPV vaccine in Malawi.https://www.tandfonline.com/doi/10.1080/21645515.2025.2485651HPV vaccinationglobal healthvaccine acceptabilityvaccine hesitancypublic healthMalawi
spellingShingle Corrina Moucheraud
Pericles Kalande
Symon Chibaka
Khumbo Phiri
Amos Makwaya
Maame Duah
Mei Li
Muxin Liu
Risa M. Hoffman
Sam Phiri
Human papillomavirus vaccination in rural Malawi: Identifying factors associated with vaccine uptake using a community-based household survey
Human Vaccines & Immunotherapeutics
HPV vaccination
global health
vaccine acceptability
vaccine hesitancy
public health
Malawi
title Human papillomavirus vaccination in rural Malawi: Identifying factors associated with vaccine uptake using a community-based household survey
title_full Human papillomavirus vaccination in rural Malawi: Identifying factors associated with vaccine uptake using a community-based household survey
title_fullStr Human papillomavirus vaccination in rural Malawi: Identifying factors associated with vaccine uptake using a community-based household survey
title_full_unstemmed Human papillomavirus vaccination in rural Malawi: Identifying factors associated with vaccine uptake using a community-based household survey
title_short Human papillomavirus vaccination in rural Malawi: Identifying factors associated with vaccine uptake using a community-based household survey
title_sort human papillomavirus vaccination in rural malawi identifying factors associated with vaccine uptake using a community based household survey
topic HPV vaccination
global health
vaccine acceptability
vaccine hesitancy
public health
Malawi
url https://www.tandfonline.com/doi/10.1080/21645515.2025.2485651
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