Human Papillomavirus Vaccination Uptake and Associated Factors among Adolescent Girls in Selected Local Government Areas of Rivers State, Nigeria

Abstract

Background: Human papillomavirus (HPV) is a common sexually transmitted infection and a cause of cervical cancer. Vaccination is effective, yet coverage remains low in many low- and middle-income countries. Nigeria struggles with scale-up, particularly in Rivers State. Aim: This study assessed HPV vaccination uptake and completion, and associated sociodemographic, knowledge-related and systemic factors among adolescent girls in selected local government areas (LGAs) of Rivers State. Methods: A community-based cross-sectional study was conducted from 1 October 2025 to 31 March 2026 among 435 adolescent girls aged 9–14 years, selected through multistage sampling from one urban (Obio/Akpor) and two rural (Degema and Gokana) LGAs. Data were collected using a validated questionnaire and analysed using SPSS v27.0 and Stata v17.0. Associations were assessed using the Rao–Scott chi-square test. Variables with p < 0.20 were entered into survey-weighted multivariable logistic regression; p < 0.05 was considered statistically significant. Results: Of the 435 girls, 41.2% were aged 11–12 years (mean age 11.6 ± 1.7 years), 67.1% had secondary education, and the caregivers were mostly mothers (69.9%; mean age 38.4 ± 6.2 years). HPV vaccination uptake was 23.7%, with only 5.4% completing the two-dose schedule. Knowledge was poor in 58.8%, fair in 5.7%, and good in 35.5%; awareness was lowest for vaccination age (28.3%) and the HPV–cervical cancer link (31.2%). Uptake rose progressively across knowledge categories (13.3%, 28.0%, 40.2%). Independent predictors were good knowledge (AOR = 4.85, 95% CI: 2.94–8.01), exposure to vaccine information (AOR = 2.94, 95% CI: 1.81–4.78), caregiver tertiary education (AOR = 3.51, 95% CI: 1.55–7.95), household income above ₦100,000 (AOR = 2.81, 95% CI: 1.37–5.77), and age of 13–14 years (AOR = 1.89, 95% CI: 1.13–3.16); all p ≤ 0.016. Fair knowledge was not significant (AOR = 2.18, 95% CI: 0.89–5.34). Vaccination was mainly attributed to healthcare worker recommendation (46.3%) and school programmes (31.5%). Reasons for non-vaccination were insufficient information (34.2%), fear of side effects (22.1%), parental refusal (18.4%), distance (8.7%), cost (2.3%), and religious/cultural beliefs (1.1%). Conclusion: HPV vaccination uptake and completion remain low, and knowledge is predominantly poor. Uptake increased progressively with knowledge level and was independently associated with knowledge, exposure to vaccine information, caregiver education, household income and older adolescent age. Parental refusal and religious/cultural beliefs were also reported as reasons for non-vaccination. Targeted interventions are needed to improve acceptance and completion.