Cervical cancer is a major public health problem, particularly in low- and middle-income countries where screening programs are poorly accessible and mortality rates are high [1] . Globally, it is estimated that more than 600,000 new cases are diagnosed each year, with more than 85% of deaths occurring in developing countries, a high proportion of which are in sub-Saharan Africa [1] . The human papillomavirus (HPV) is the main etiological agent, and vaccination against this virus is an effective means of prevention [2] . In Cameroon, the HPV vaccine was integrated into the Expanded Program on Immunization (EPI) in 2021, targeting girls and boys aged 9 to 13 years [3] . However, the successful introduction and widespread use of this vaccination also depend on the commitment and competence of health personnel, particularly those in vaccination units [4] . Due to their key role in informing and guiding patients, healthcare workers can effectively contribute to raising awareness, providing information and motivating people to get vaccinated [4] . Their level of knowledge, attitudes towards the vaccine and professional practices directly influence community uptake and vaccination coverage [5] . This study therefore aimed to assess the level of knowledge, attitudes and practices of vaccination staff in the Ngog-Mapubi Health District in order to identify the levers and barriers to optimal implementation.

In rural areas, nursing assistants are the most represented compared to state-certified staff but have adequate references on vaccination [7] . In this study, of the 28 staff members examined, nursing assistants were the most represented with 47%, followed by state-certified nurses with 32%. Health care providers have an important role to play in overcoming prejudices about vaccines and their importance, because their recommendations are a factor in the acceptance of vaccines by people who need them [3] [4] . As for seniority, it is an indicator of performance in vaccination activities, the longer the staff is in the exercise of a task, the more efficient they become [8] . Finding a study that reinforces the arguments on the seniority of staff.

A generally variable level of knowledge among vaccination staff was observed. Although the majority are aware of the HPV vaccine and its importance, gaps remain regarding vaccination recommendations and target groups. This insufficient knowledge can hinder the identification, and referral, of individuals who require HPV vaccine. On the other hand, the messaging and engagement strategies may lack precision and fail to generate the intended outcomes. This finding may also reflect broader gaps in training, supervision, or access to updated program guidelines. Perfect knowledge of the target group regarding vaccination is a major indicator that reflects the quality of vaccination services. Good vaccination performance cannot be achieved if staff do not have a basic understanding of the target group [9] .

In the study population, 100% of vaccination personnel adopted the fixed strategy of vaccination, a result close to that of Ngomba et al. (2016), where 81.4% of health facility staff did not carry out any advanced strategy, the vaccination sessions were carried out using a fixed strategy, which also justifies the low vaccination coverage (22%) observed [10] .

It was also observed that 92% of the staff conduct awareness sessions only during discussion sessions at the Health center, thus, the lack of community outreach to raise awareness among the population could be a justification for the low HPV vaccination coverage of 1.6% throughout the central region of Cameroon and therefore in Ngog-Mapubi, which is a district of this region [11] [12] . This gap may indicate a potential disconnect between message delivery and audience needs or contexts.

Conversely, the perception among 91% of staff that current awareness strategies are not fully effective highlights critical gaps in communication efforts and suggests a need for strategic adjustments. It indicates that existing methods (mainly reliant on health facility settings) are not resonating with the intended audiences. The staff recognize the need of enhancing their existing efforts with complementary approach that will help to achieve more meaningful, lasting results.

This study reveals that despite generally positive attitude and good practices, there are some gaps in knowledge of the health facility staff regarding HPV vaccination. The strong perception among staff that their communication methods are ineffective reinforces the need for complementary approaches as community-based outreach, while the insufficient staff knowledge of target populations highlights the need of targeted training.

An experimental study should be conducted to evaluate the effect of an advanced strategy on HPV vaccination coverage.

Therefore, it is recommended to: