Cervical cancer develops in the anatomical part of the female reproductive system that separates the vagina from the uterus. Almost all cases are due to chronic infection with the human papillomavirus (HPV), making it a preventable and curable cancer [1]. It is the (4th) most common cancer in women, with approximately (604,000) new cases. It is also the (2^nd) most common female cancer in less developed regions, which accounts for (85%) of new cases. In (2020), cervical cancer caused (320,000) deaths worldwide [2]. Almost all, or 90% of these deaths, occurred in developing countries, particularly in sub-Saharan Africa, where it is steadily and markedly increasing [3] [4].

In Senegal, in (2020), cervical cancer occupies the (1st) place, with (10%) of all cancers and all sexes combined. It is also the leading female cancer with (26.8%) of cancer cases [4]. The survival rate at (1) year is (32%) and (1%) at (5) years [5]. The World Health Organization (WHO) has approved the use of bivalent vaccines against HPV (16) and (18) or quadrivalent vaccines against types (6), (11), (16) and (18). Vaccination of girls aged between (11) and (13) years against HPV should be the central element of national prevention strategies [6]. After a pilot phase (2014-2016) in the health districts of Dakar West and Mékhé, the quadrivalent HPV vaccine (Gardasil®) has been introduced in the Expanded Program on Immunization (EPI) since November (2018) at a rate of (2) doses spaced (6) months apart for girls aged (9) to (10) years. During the pilot phase, complete vaccination coverage in Dakar West was (90.5%) in (2015) and (96%) in (2016) [7]. These very satisfactory results contrast with those of the scale-up. Indeed, in (2020), for a target of (90%), national HPV vaccination coverage was (32%) for the (1^st) dose and (13%) for the (2^nd). The majority, (67) out of (79) districts, had not reached the (90%) target [8]. In (2020), according to administrative data, HPV vaccination coverage in the Koumpentoum health district was (45%) for the (1^st) dose and (35%) for the (2^nd) [8].

Caroline D et al. in their systematic review conducted in sub-Saharan Africa with a majority of articles from South Africa, Uganda and Kenya, found that the causes of non-vaccination against HPV were lack of information of mothers or guardians and fear of infertility associated with the disease [9].

What are the factors associated with HPV vaccination coverage in the Koumpentoum health district? The objective of this research was to determine HPV vaccination coverage in the Koumpentoum health district among girls aged between (11) and (13) years and to identify associated factors in order to make recommendations for improvement.

Factors statistically and significantly associated with coverage of the first dose of the HPV vaccine were instruction of mothers or guardians (OR = 5.62 (3.16 - 9.99); p < 0.001), schooling of the young girls (OR = 4.1 (2.23 - 7.53); p < 0.001),

information on cervical cancer (OR = 18.97 (5.68 - 63.24); p < 0.001), knowledge of risks factors (OR = 8.04 (4.41 - 14.63); p < 0.001), information on HPV vaccine (ORa = 10.26 (1.69 - 62.23); p = 0.011), knowledge on vaccine target (OR = 17.11 (8.51 - 34.41); p < 0.001), knowledge of schedule vaccine (ORa = 3.67 (1.2 - 22.51); p = 0.022), knowledge of prevention methods (OR = 26.86 (12.22 - 59.05); p < 0.001), and to be favorable in EPI in general (ORa = 18.71 (1.51 - 28.23]; p = 0.02).

In our sample, there was no association between the place of residence of mothers or guardians and HPV vaccination of young girls, contrary to the results of North American [15] and Chinese [16] [17] [18] authors. Indeed, the latter found that overall HPV vaccination coverage was higher in developed countries and urban areas than in developing countries and suburban and rural areas. However, Faye et al. in Kaffrine found the opposite with higher HPV vaccination coverage in rural areas [19]. This lack of difference in our sample can be explained by the fact that the department of Koumpentoum is essentially rural and does not have any large cities [10].

The age of the mothers or guardians was not associated with the vaccination of the young girl in accordance with the results found in national series such as Faye et al. [19] and Ndiaye et al. [20]. However, one might expect greater receptivity on the part of young mothers or guardians and greater mobility and attendance at health facilities due to cultural realities.

We did not find an association between mothers or guardian’s marital status and girl’s vaccination, as in the series by Ndiaye et al. [20]. However, the education of mothers or guardians was associated with vaccination of young girls, as in the series of Ndiaye et al. (OR = 1.97; (1.81 - 2.25); p = 0.01) [20] but in contrast to that of Faye et al. [19]. The dissemination of key messages in local languages (Fulani, Mandingo, Serer and Wolof) by community prevention and promotion actors (community relays and aunts), health providers and Niani FM radio improved access to health information.

There was no relations between the practice of an IGA and the vaccination of young girls, contrary to the series of Ndiaye et al. [20] (ORa = 1.21 (1.13 - 1.85); p < 0.001), and Alene T. et al. [21] (ORa = 3.44 (1.97 - 6.01); p < 0.05), where the income of the head of the household was predictive of the vaccination of young girls. Indeed, even if HPV vaccination is free, there may be direct and indirect costs associated with mothers or guardians and young girls travelling to service points. These costs can be a barrier to vaccination, hence the need to strengthen advanced and mobile strategies.

Young girls whose mothers or guardians were informed about cervical cancer (OR = 18.97 (5.68 - 63.24); p < 0.001), knew its risk factors (OR = 8.04 (4.41 - 14.63); p < 0.001) and knew how to prevent it (OR = 26.86 (12.22 - 59.05); p < 0.001) were more likely to be vaccinated. Similar associations between vaccination of young girls and knowledge of cervical cancer and the possibility of cure were found by Alene T. et al. in Gondar, Ethiopia (ORa = 5.42 (2.69 - 11.52); p < 0.05) [21], Ndiaye et al. in Dakar [18] (ORa = 3.05 (2.75 - 4.53); p < 0.001) [20] and by Thiam in Kédougou (ORa = 2.98 (1.19, 7.47); p = 0.025) [22].

Knowledge of HPV vaccination (ORa = 10.26 (1.69 - 69.23); p = 0.011), knowledge of the target to be vaccinated (OR = 17.11 (8.51 - 34.51); p < 0.001) and knowledge of the HPV vaccination schedule (ORa = 3.67 (1.2 - 11.51); p = 0.022) were predictive of better vaccination of young girls. This association between good knowledge of HPV vaccination and vaccine uptake was also found in the series by Rabiu A. et al. in Nigeria (OR = 6.11 (1.37 - 27.34); p = 0.018) [23], Faye et al. in Kaffrine (OR = 10.92 (2.93 - 40.64); p < 0.001) [19] and Thiam in Kédougou (ORa = 2.98 [1.19 - 7.47]; p = 0.025) [22].

The main reasons for non-vaccination were lack of information in (71.43%) of cases and fear of side effects in (10.32%). This indicates the need to increase awareness among mothers or guardians, by diversifying communication channels, about cervical cancer, its causes, means of prevention of the disease, HPV vaccination and its safety.

Young girls whose mothers or guardians were supportive of the EPI were more likely to be vaccinated against HPV (ORa = 18.71 (1.51 - 22.23); p = 0.02). This indicates the importance of comprehensive interpersonal communication about cervical cancer and its prevention and the fact that the HPV vaccine has become a component of the EPI.

Mothers or guardians who have school education was more likely to vaccine their daughters (OR = 5.62 (3.16 - 9.99); p < 0.001) according to Ndiaye et al. [20] (ORa = 1.97; (1.81 - 2.25); p < 0.001). This link may be related to better understanding and adherence to health policies and a higher standard of living for educated mothers or guardians.

Also, young schooled girls were more likely to be vaccinated (OR = 4.1 (2.23 - 7.53); p < 0.001). This finding was also found during the pilot phase in 2016 by Sy K. et al. in West Dakar [7]. Indeed, the target young girls aged between (9) and (14) are mainly in primary and secondary school. Consequently, awareness, involvement and collaboration with the national education sector are imperative in order to reach this school target and the vaccination coverage objective of (90%).

The information provided to mothers or guardians is crucial to achieving the vaccination coverage target. Factors associated with low HPV vaccination coverage in the Koumpentoum health district are related to mothers’ or guardians’ lack of knowledge, which is a consequence of insufficient and inadequate communication. HPV vaccination coverage could be significantly improved through an acceleration plan focusing on interpersonal communication and involving national education sector.

We would like to thank the health providers and community health workers in the Koumpentoum health district and the families who participated in the survey.

The authors declare no conflicts of interest regarding the publication of this paper.

Diop, E.H.C.A., Ndiaye, A.A. and Bop, M.C. (2022) Associated Factors with Vaccination among Girls Aged between (11) and (13) against Papillomaviruses in Koumpentoum Health District (Senegal). World Journal of Vaccines, 12, 20-31. https://doi.org/10.4236/wjv.2022.122003