Prevalence and Predictors of Parental Willingness to Vaccinate Daughters against Human Papillomavirus in Sub-Saharan Africa: A Systematic Review and Meta-Analysis

Daniel Asmelash^1*WONDAYA FENTA ZEWDIA²Gossa Fetene Abebe³Desalegn Girma³Abdu Hayder Mohammed⁴Abyot Asres⁴

• ¹Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan-Aman, Ethiopia
• ²Department of Statistics, College of Science, Bahir Dar University, Bahirdar, Amhara Region, Ethiopia
• ³Department of Midwifery, College of Medicine and Health Science, Mizan-Tepi University, Mizan-Aman, Ethiopia
• ⁴School of Public Health, College of Medicine and Health Science, Mizan-Tepi University, Mizan-Aman, Ethiopia

Background: Human papillomavirus (HPV) infection is a major health burden, especially in developing countries. Primary prevention through HPV vaccination has demonstrated excellent efficacy in preventing cervical cancer incidence. Parental willingness on behalf of their daughters plays a crucial part in deciding whether they should get an HPV vaccine or not, which determines the vaccine coverage. The purpose of this study was to determine the pooled prevalence and predictors of willingness to vaccinate their daughters against the HPV vaccine in Sub-Saharan Africa (SSA).Methods: A literature search of studies was conducted using multiple databases including the Web of Science, Cochrane Library, PubMed, Google Scholar, Gray Literature, Embase, and African Online Journal. The search included studies that were published between 2014 and 2024. The inclusion criteria included studies that examined parental willingness to vaccinate their daughters with HPV vaccine in SSA. Data were extracted using Excel and analyzed using Stata™ Version 11, and methodological quality was assessed using the Newcastle-Ottawa Scale modified for cross-sectional studies. The meta-analyses were performed using the random effects model. The protocol was registered with PROSPERO (CRD42024584292).Results: A total of 20 cross-sectional studies with 9,182 participants were included in the meta-analysis. The pooled prevalence of willingness to vaccinate daughters with the HPV vaccine was 73% (95% CI: 65-81%). Younger parents (AOR = 1.61, 95% CI: 1.08–2.39), educational status (AOR = 2.27, 95% CI: 1.66–3.12), higher income (AOR = 3.13, 95% CI: 1.96–5.02), good knowledge (AOR = 2.28, 95% CI: 1.59–3.27) and a positive attitude (AOR = 4.83, 95% CI: 2.51–9.30) toward HPV vaccine were significantly associated with parental willingness to vaccinate their daughters.Conclusion: The findings showed a significant proportion of parents remained unwilling to vaccinate their daughters against HPV in SSA. The study also found that parental willingness was significantly higher among parents with good knowledge about HPV and its vaccine, positive attitudes toward vaccination, younger age, higher educational status, and higher income levels. These findings underscore the critical role of parental willingness in shaping policies and initiatives aimed at increasing HPV vaccination rates and reduce the incidence of cervical cancer.