Human Papillomavirus Vaccine Uptake and Its Associated Factors Among Adolescent Girls in Kaduna North LGA, Nigeria: A Mixed Study

Introduction: Cervical cancer remains a critical public health concern globally, particularly in low- and middle-income countries like Nigeria, where it is one of the leading causes of cancer-related mortality among women. The disease is primarily attributed to persistent infection with high-risk types of the human papillomavirus (HPV), notably HPV-16 and HPV-18. Despite the availability of highly effective prophylactic vaccines, uptake remains low in many sub-Saharan African countries, including Nigeria. In October 2023, Nigeria integrated the HPV vaccine into its national immunization program, marking a major policy shift aimed at reducing the incidence of cervical cancer. However, little is known about the actual level of vaccine uptake and the associated determinants in subnational contexts such as Kaduna North Local Government Area (LGA). This study was designed to assess HPV vaccine uptake and the factors influencing it among adolescent school girls in Kaduna North LGA. Methods: A cross-sectional descriptive study design was employed, targeting adolescent girls aged 10–19 years enrolled in public and private secondary schools within Kaduna North LGA. Using a multistage sampling approach, 418 respondents were systematically selected to ensure adequate representation. Data were collected through a structured, pre-tested electronic questionnaire administered via Microsoft Forms, which included both closed- and open-ended questions addressing demographic characteristics, awareness and knowledge of HPV and the vaccine, vaccination status, perceived barriers, and suggestions for improvement. Quantitative data were analyzed using SPSS version 25, employing descriptive statistics and chi-square tests for associations, while multivariable logistic regression was used to identify significant predictors of vaccine uptake (p < 0.05). Qualitative responses were analyzed using thematic content analysis to complement the quantitative findings. Results: The results revealed that while 65.1% of respondents reported having heard of HPV, only 42.3% had adequate knowledge of the virus and its vaccine. Alarmingly, only 7.5% of the respondents had received at least one dose of the HPV vaccine. Bivariate analysis showed statistically significant associations between vaccine uptake and several key factors: parental willingness to vaccinate (χ² = 46.8, p < 0.001), awareness of the vaccine's existence (χ² = 13.9, p = 0.001), cultural attitudes toward vaccination (χ² = 8.9, p = 0.003), and prior awareness of HPV-related health risks (χ² = 6.7, p = 0.01). Multivariate logistic regression confirmed these factors as independent predictors of uptake. The primary barriers to vaccination identified included misinformation, fear of adverse effects, parental disapproval, sociocultural misconceptions, and inadequate access to vaccination points—especially for girls in less-resourced schools. Qualitative data provided further insights into community perceptions, suggesting that mistrust of the health system, religious myths, and inadequate engagement with school authorities were major deterrents. Respondents emphasized the need for targeted health education, involvement of religious and traditional leaders, and integration of HPV vaccine education into school health programs. Several participants proposed peer-led advocacy and digital campaigns as innovative strategies to improve vaccine awareness and acceptability among adolescents. Conclusion: This study concludes that HPV vaccine uptake among adolescent school girls in Kaduna North LGA is significantly low despite the vaccine’s integration into Nigeria’s national routine immunization program. The findings underscore the role of parental influence, cultural attitudes, and information access in shaping adolescent health behavior. The study recommends a multi-pronged strategy including community-based sensitization, religious and parental engagement, school-based vaccination drives, and consistent communication through trusted channels. These measures are essential for improving coverage and contributing to Nigeria’s broader goal of cervical cancer prevention and eventual elimination.