Human Ppapillomavirus (HPV) vaccine uptake and its determinants among women in Africa: An umbrella review

Berihun Agegn Mengistie^1*Amlaku Nigusie Yirsaw²Gebeyehu Lakew²Gebrehiwot Berie Mekonnen³Adamu Shibabaw⁴Alex Ayenew Chereka⁴Gemeda Wakgari Kitil⁵Wubet Tazeb Wondie⁶Alemken Eyayu Abuhay⁷Eyob Getachew²

• ¹Department of General Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Amhara Region, Ethiopia
• ²Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Amhara Region, Ethiopia
• ³Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Amhara, Ethiopia
• ⁴Department of Health Informatics, College of Health Sciences, Mattu University, Mattu, Ethiopia
• ⁵Departments of Midwifery, College of Health Sciences, Mettu University, Mettu, Ethiopia
• ⁶Department of Pediatrics and Child Health Nursing, College of Health Sciences and Referral Hospital, Ambo University, Ambo, Ethiopia, Ambo, Oromia Region, Ethiopia
• ⁷University of Gondar Comprehensive Specialized Hospital, Gondar, Amhara Region, Ethiopia

Background: Worldwide, cervical cancer is the fourth most prevalent disease among women. It is primarily caused by persistent infections with the human papillomavirus (HPV). The World Health Organization (WHO) strongly suggests the HPV vaccine for females 9 to 14 years old. Although HPV vaccination is the most effective primary prevention for cervical cancer, the accessibility and uptake of the HPV vaccine remain low in developing nations, particularly in Africa. Thus, this umbrella review aimed to determine the pooled prevalence of human papillomavirus vaccine uptake and its determinant factors in Africa. Methods: The protocol was registered on the International Prospective Register of Systematic Reviews (PROSPERO) with reference number CRD42024560032. The eligible systematic review and meta-analysis studies were retrieved using PubMed, Hinari, Scopus, and Google Scholar. The data were extracted using Microsoft Excel 2019 and analyzed using Stata software version 17. The methodological quality of the included studies was examined using the AMSTAR 2 assessment tool. Publication bias was checked by using the funnel plot and Egger’s test. A random-effects model (Der Simonian-Laird method) was used to estimate the pooled estimates of HPV vaccine uptake. The I-squared test was performed to assess statistical heterogeneity among the included papers. Results: This umbrella review included five systematic reviews and meta-analysis studies across Africa with a total of 707,005 study participants. The pooled prevalence of HPV uptake in Africa was 41.38% (95% CI: 34.70, 48.06). Women's knowledge of HPV vaccination (AOR: 3.22, 95% CI: 1.64–6.33) and attitude toward HPV immunization (AOR: 2.48, 95% CI: 2.18–2.81) were significantly associated with HPV vaccine uptake. Conclusions: The uptake of the HPV vaccine in Africa remains much lower (41.38%) than the WHO global HPV vaccination target (90%) by 2030. Therefore, advocate uptake of the HPV vaccine by promoting the women’s knowledge and attitude towards HPV vaccination programs through facility-based education and counseling, planned campaigns, community-based programs, and advocating HPV vaccination and cervical cancer prevention measures via various mass media.