JARAMOGI OGINGA ODINGA UNIVERSITY OF SCIENCE AND TECHNOLOGY.

KISUMU CAMPUS.

BACHELOR OF SCIENCE IN COMMUNITY HEALTH AND DEVELOPMENT

STUDENT NAME: ODIRA DIANA ALUOCH

REG. NO: H131/3105/2020

HCB 2312

TITTLE: UPTAKE OF HUMAN PAPILLOMA VIRUS VACCINE IN KUOYO HEALTH

CENTER, KISUMU EAST, KISUMU COUNTY

INSTRACTOR NAME: DR. WILLIAM AKOBI

DATE OF SUBMISSION: 8/9/2023

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DECLARATION

I declare to the best of my ability that this proposal is as a result of my own efforts and has never

been submitted for any academic award to this university and any other university or

institution.

NAME: Odira Diana Aluoch

Reg. No. H131/3105/2020

Signature………………………… Date………………………

Declaration by supervisor

This research project has been submitted with approval as Jaramogi Oginga Odinga University

of Science and Technology Supervisor. I can confirm this research report has not been presented

anywhere to the best of my knowledge and therefore has been submitted with my approval as the

University supervisor.

Name

Signature

……………………………………………………………..

Date

……………………………………………………………..

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DEDICATION

This research proposal is dedicated to God Almighty without whom I am nothing. I also dedicate

it to my parents for their endless prayers and support during this study

ACKNOWLEDGEMENT

I take this opportunity to first and foremost thank God Almighty who renewed my strength at

every single stage of doing this proposal. Special thanks go to my instructor Dr. William Akobi

for his endless assistance, encouragement and guidance throughout this journey. I also wish to

take this opportunity to thank my family for their prayers about my well-being, financial and

moral support. Not forgetting my classmates and JOOUST fraternity for the institutional role

played in my life.

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Contents
LIST OF TABLES...........................................................................................................................4
LIST OF FIGURES.........................................................................................................................5
ACRONYM AND ABBREVIATION.............................................................................................6
ABSTRACT....................................................................................................................................7
CHAPTER ONE..............................................................................................................................8
1.0 INTRODUCTION................................................................................................................8
1.1 Background of the study...................................................................................................8
1.2 Statement of problem........................................................................................................9
1.3 Aims and Objective.........................................................................................................10
1.4 Research Questions.........................................................................................................10
1.5 Significance of Study......................................................................................................11
1.6 Scope of the Project........................................................................................................12
CHAPTER TWO...........................................................................................................................13
2.0 LITERATURE REVIEW....................................................................................................13
2.1 Introduction.....................................................................................................................13
2.2 Factors influencing uptake of HPV Vaccine...................................................................13
2.3 Causes of cervical cancer and its prevention..................................................................14
2.4 Predisposing factors for cervical cancer.........................................................................15
2.5 Primary prevention of cervical cancer............................................................................16
2.6 Secondary prevention of cervical cancer........................................................................18
2.7 Treatment for cervical precancerous lesions/cervical cancer..........................................20
CHAPTER THREE.......................................................................................................................21
3.0 RESEARCH METHODOLOGY.......................................................................................21
3.1 Introduction.........................................................................................................................21
3.2 Research Design..............................................................................................................21
3.3 Study area selection........................................................................................................22
3.4 Target Population............................................................................................................22
3.5 Inclusion Criteria.............................................................................................................23
3.6 Exclusion Criteria...........................................................................................................23
3.7 Sampling procedure and sample size determination.......................................................23
3.8 Data Collection Tools/Instruments..................................................................................24
3.9 Questionnaire pilot run....................................................................................................24

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 3.10 Validity and Reliability...................................................................................................25
3.10.1 Validity.....................................................................................................................25
3.10.2 Reliability................................................................................................................26
3.11 Data Analysis..................................................................................................................26
3.12 Ethical Considerations....................................................................................................27
CHAPTER FOUR.........................................................................................................................29
4.0 RESULTS AND DISCUSSIONS.......................................................................................29
4.1 Introduction.........................................................................................................................29
4.2 Response rate..................................................................................................................29
4.3 Gender of respondents....................................................................................................29
4.4 Age of the respondents....................................................................................................30
4.5 The level of education.....................................................................................................31
4.6 Work experience..............................................................................................................31
4.7 Social position of the respondents in the community.....................................................32
4.8 Socio-behaviors leading to cervical cancer infection.....................................................32
4.9 The ease of access to information about cervical cancer and HPV vaccination.............33
4.10 Level of awareness of existence of a vaccine to protect against cervical cancer............33
4.11 The influence of economic status on chances of getting cervical cancer.......................34
4.12 Major reasons for increased chances of getting infected with cervical cancer...............35
4.13 Factors affecting the decision to take HPV vaccination.................................................35
CHAPTER FIVE...........................................................................................................................36
5.0 SUMMARY, RESEARCH FINDINGS, CONCLUSION AND RECOMMENDATIONS36
5.1 Introduction.........................................................................................................................36
5.2 Summary of findings.......................................................................................................36
5.3 Conclusion......................................................................................................................38
5.4 Recommendation............................................................................................................39
5.5 Areas for further studies..................................................................................................40
5.6 Adolescent autonomy......................................................................................................40
References......................................................................................................................................41
APPENDICES...............................................................................................................................50

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 LIST OF TABLES
Table 4.1……………………………………………………………………………30

Table 4.2…………………………………………………………………………….31

Table 4.3…………………………………………………………………………….32

Table 4.4…………………………………………………………………………….32

Table 4.5……………………………………………………………………………33

Table 4.6……………………………………………………………………………33

Table 4.7……………………………………………………………………………34

Table 4.8……………………………………………………………………………35

Table 4.9……………………………………………………………………………35

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 LIST OF FIGURES
Figure 4.1…………………………………………………………………………………..31

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 ACRONYM AND ABBREVIATION

HPV- Human papillomavirus Vaccine.

CDC- Centers for Disease Control and Prevention.

MOH- Ministry of Health.

STIs- Sexually Transmitted Infections

HIV- Human immunodeficiency Virus.

NOCDCS- National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular

Disease and Stroke.

AHS- Annual Health Survey.

PHC- Primary Health Care.

NGO- Non-Government Organization.

NPPC- National Programme for Palliative Care.

M&E- Monitoring and Evaluation.

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 ABSTRACT

Title: Uptake of Human Papillomavirus (HPV) Vaccine in Kuoyo Health Center, Kisumu East,

Kisumu County

Human Papillomavirus (HPV) is a common sexually transmitted infection that can lead to
various cancers, including cervical cancer. Vaccination against HPV is a vital preventive measure
to reduce the incidence of these cancers. This research project investigates the uptake of the HPV
vaccine at the Kuoyo Health Center in Kisumu East, Kenya.
The study adopts a descriptive research design with a mixed-methods approach, integrating
quantitative analysis of vaccination data with qualitative interviews with healthcare practitioners
and vaccine recipients. The key goals are to estimate the overall rate of HPV vaccine uptake,
identify variables influencing vaccine acceptance or hesitation, and evaluate the efficiency of
vaccination promotion measures in the local environment.
Preliminary findings reveal that while there is a notable demand for the HPV vaccine, several
barriers to uptake exist, including limited awareness, cost considerations, and concerns about
vaccine safety. The study also highlights successful interventions and best practices that have
positively influenced vaccine uptake.
Ultimately, the research aims to contribute to the development of targeted strategies for
increasing HPV vaccine coverage in Kisumu East, with the overarching goal of reducing the
burden of HPV-related diseases and improving public health outcomes. The findings will inform
policy recommendations and healthcare initiatives to enhance vaccination rates, particularly
among populations at risk (adolescent girls).
This research project underscores the significance of HPV vaccination as a crucial component of
preventive healthcare and underscores the need for tailored approaches to address local
challenges in vaccine acceptance and accessibility.
Keywords: HPV vaccine, Uptake, Kisumu East, Cervical Cancer, Vaccination, Healthcare, Public
Health, Prevention and control.

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 CHAPTER ONE

1.0 INTRODUCTION

1.1 Background of the study

Human Papillomavirus (HPV) infection is a worldwide public health problem due to its link to a

variety of malignancies, including cervical cancer, which is the fourth most frequent disease in

women globally. The Centers for Disease Control and Prevention predicts 43 million HPV

infections and 13 million new cases in 2018. The HPV vaccine has emerged as a critical tool in

the prevention of HPV-related diseases, giving protection against the most common HPV strains

that cause cancer.

Cervical cancer is a prominent source of morbidity and mortality among women, and Kisumu

East, an area in Kenya, shares this worldwide health problem. Recognizing the promise of HPV

vaccination to lessen the prevalence of cervical cancer, Kenya included it in its national

immunization program, with the objective of reaching adolescent girls before they become

sexually active.

The Kuoyo Health Center in Manyatta B, located in Kisumu East, is a critical healthcare

institution in the area, providing immunization treatments as well as other health interventions.

Monitoring HPV vaccine uptake in this unique healthcare context is critical because it can

provide useful insights into vaccination program success and reveal local issues that may limit

optimal vaccine coverage.

Key factors influencing HPV vaccine uptake in low- and middle-income countries like Kenya

include limited awareness about the vaccine, concerns about vaccine safety, cost-related barriers,

and cultural or religious beliefs. Tailored strategies are needed to address these barriers and

promote vaccine acceptance within the local context. As such, this research project aims to

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bridge the knowledge gap by conducting a comprehensive investigation into the uptake of the

HPV vaccine at the Kuoyo Health Center, Kisumu East. The study seeks to shed light on the

factors that facilitate or hinder vaccine acceptance, evaluate the impact of vaccination promotion

efforts, and generate evidence-based recommendations for improving HPV vaccine coverage.

1.2 Statement of problem

Despite the serious public health consequences of Human Papillomavirus (HPV) infection and

the availability of a preventive HPV vaccination, vaccine uptake in Kisumu East, Kenya,

particularly at the Kuoyo Health Center, remains a major problem. This research intends to

address the following major issues and questions:

Suboptimal HPV Vaccine Coverage: Kisumu East, like many other parts of the world, has a

high prevalence of HPV-related diseases, including cervical cancer. However, the current

adoption of the HPV vaccine among eligible populations, namely adolescent girls aged 9 to 16,

at the Kuoyo Health Center, is not extensively established.

Barriers to Vaccine Uptake: A variety of factors may impede individual and parental

acceptance of the HPV vaccine, including limited awareness of HPV and the HPV vaccine,

concerns about vaccine safety and efficacy, economic constraints, cultural or religious beliefs,

fear of pain, and a lack of time.

Effectiveness of Vaccination Promotion Strategies: To promote HPV vaccination, health

education programs and community involvement activities are routinely implemented. It is

crucial to analyze the efficiency of these techniques in the context of the Kuoyo Health Center

and establish if they effectively address the stated barriers to vaccination adoption.

Impact on Public Health: Inadequate HPV vaccine coverage has serious public health

consequences since it leaves a large section of the population vulnerable to HPV-related diseases.

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Involvement of Healthcare Providers: Healthcare providers play an important role in

recommending and giving immunizations. Understanding the dynamics of vaccine

administration requires investigating the extent to which healthcare providers at the Kuoyo

Health Center are actively involved in recommending and giving the HPV vaccine.

1.3 Aims and Objective

The primary objective of this research project is to comprehensively assess the uptake of the

Human Papillomavirus (HPV) vaccine at the Kuoyo Health Center in Kisumu East, Kenya, in

order to:

i. Determine the overall rate of HPV vaccine uptake among eligible populations attending

the Kuoyo Health Center.

ii. Identify and analyze the socio-demographic, economic, and healthcare-related factors

influencing HPV vaccine acceptance or hesitancy among the target population.

iii. Investigate the effectiveness of local HPV vaccination promotion strategies, including

awareness campaigns and educational initiatives, in increasing vaccine uptake.

1.4 Research Questions

i. How does the overall rate of HPV vaccine uptake vary among the eligible population and

what factors contribute to the observed pattern?

ii. What socio-demographic, economic and healthcare related factors significantly influence

the acceptance of HPV vaccine among the targeted population and how do these factors

interact in shaping vaccination decisions?

iii. How effective are the local HPV vaccination promotion strategies, such as awareness

campaigns and educational initiatives in increasing vaccine uptake among the target

population and what specific elements contribute to their success or limitations?

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 1.5 Significance of Study

This research project holds significant importance due to its potential to positively impact both

public health outcomes and healthcare practices in the Kisumu East region and beyond. The

following points underscore the significance of this study:

Improved Health Outcomes: Cervical cancer and other HPV-related diseases pose a substantial

health risk to individuals in Kisumu East.

Preventive Healthcare: The study focuses on HPV vaccination, a key preventive measure

against a range of cancers. By increasing vaccine coverage, the research has the potential to shift

the healthcare paradigm from treatment-focused to prevention-focused, saving lives and reducing

the burden on healthcare systems.

Informed Policy Decisions: Evidence-based research findings can inform policy decisions at

local, regional, and national levels.

Enhanced Healthcare Practices: Understanding the factors that influence vaccine acceptance

and the effectiveness of vaccination promotion strategies can benefit healthcare providers.

Community Engagement: By involving the community in the research process, this study

fosters community awareness and engagement regarding HPV vaccination. This can lead to

increased community support for vaccination initiatives and greater awareness of the importance

of preventive healthcare.

Empowering Women's Health: Cervical cancer disproportionately affects women. Increasing

HPV vaccine coverage is a significant step toward empowering women to take control of their

health and reduce the risk of this potentially deadly disease.

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 1.6 Scope of the Project

This research project primarily focuses on assessing the uptake of the Human Papillomavirus

(HPV) vaccine within the specific context of the Kuoyo Health Center, located in Kisumu East,

Kenya. The scope of the project encompasses the following key aspects:

Geographical Scope: The study is geographically limited to the Kisumu East region of Kenya,

with a specific focus on the Kuoyo Health Center as the primary research connected site.

Target Population: The research primarily targets individuals eligible for the HPV vaccine, with

a particular emphasis on adolescent girls and young women within Manyatta B.

Data Collection: Data collection methods include the analysis of vaccination records at the

Kuoyo Health Center to determine the actual rate of HPV vaccine uptake versus the targeted

number in a year.

Factors Affecting Uptake: The project investigates a range of factors influencing HPV vaccine

uptake, including but not limited to awareness, perceptions of vaccine safety, socio-economic

considerations, cultural and religious beliefs, and healthcare provider recommendations.

Effectiveness of Promotion Strategies: The study assesses the effectiveness of HPV

vaccination promotion strategies implemented within the Kuoyo Health Center's catchment area.

Recommendations and Implications: Based on the research findings, the project will generate

evidence-based recommendations aimed at enhancing HPV vaccine coverage in Kisumu East.

Public Health Impact: While focused on a specific geographic area, the research project

acknowledges the broader public health implications of increasing HPV vaccine coverage.

Duration: The project's timeline is determined by the data collection, analysis, and reporting

phases. It is conducted within a timeframe feasible for thorough data collection and rigorous

analysis while considering logistical and resource constraints.

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 CHAPTER TWO

2.0 LITERATURE REVIEW

2.1 Introduction

This chapter provides a critical evaluation of earlier work by other researchers that is pertinent to

this topic. The methods in which the documents will be involved with the study issue will be

examination, clarification, and comprehension of current connected research work. This chapter

essentially covers prior research that attempted to address issues concerning human

papillomavirus vaccination uptake in Kuoyo health facility, Kisumu east, Kisumu County. This

review comprises a broad variety of empirical international research literature from across the

world as well as a more concentrated assessment of empirical research from Kisumu, the study's

site, which is well described in depth in the later portion of this review.

2.2 Factors influencing uptake of HPV Vaccine

Awareness and Knowledge: Several studies have emphasized the role of awareness and

knowledge in influencing HPV vaccine acceptance (Gallagher et al., 2019; LaMontagne et al.,

2017). Individuals and caregivers who are informed about the vaccine's benefits and safety are

more likely to opt for vaccination.

Healthcare Provider Recommendations: Healthcare providers play a pivotal role in

recommending and administering vaccines (Brewer et al., 2017). Their strong recommendation

has been shown to positively impact vaccine acceptance rates, highlighting the importance of

provider-patient communication.

Socioeconomic Factors: Socioeconomic factors, such as income levels and access to healthcare,

have been found to influence vaccine uptake (Perkins et al., 2020). Cost barriers can deter

individuals from seeking vaccination services.

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Cultural and Religious Beliefs: Cultural and religious beliefs can impact vaccine decision-

making (Reiter et al., 2015). Understanding these beliefs is essential for developing culturally

sensitive vaccination strategies.

2.3 Causes of cervical cancer and its prevention

Cervical cancer is a condition characterized by uncontrolled cell proliferation and spread

(America, Cancer Treatment Center, 2012). Death can occur if the transmission isn't regulated

(CDC, 2007). Cervical cancer is the second most common malignancy in women (Ferlay, 2009).

This is not the case in many industrialized nations, where the prevalence is dropping as a result

of broad screening programs (Khan, 2005). If precancerous lesions are found early by screening

and treated appropriately, the illness can be almost eliminated (ACS, 2005). The high incidence

of cervical cancer in Kenya can be significantly decreased if the government implements

national cancer screening programs, launches tracking initiatives, and makes treatment money

available to all treatment institutions (Yamada et al, 2008). Many conferences have been held to

discuss the consequences of cervical cancer. An international conference was held at Oxford

University in 2009 to examine cervical cancer in Kenya and to develop measures for preventing

cervical cancer in Kenya and throughout Africa (MOM, 2008, MOPH, 2009). This symposium

brought together World Health Organization health experts, pharmaceutical representatives,

international oncologists, and other cancer agents. The conference's goal was to request

worldwide financial help to lower the frequency of cervical cancer in disadvantaged nations in

Africa, including Kenya (Kerr, 2009). Cervical cancer is caused by the human papillomavirus

(HPV), a sexually transmitted infection (McAlpine et al., 2010).

According to studies, human papillomavirus infection causes nearly 99.7% of all

occurrences of cervical cancer (American Cancer Society, 2012). Thirty-nine percent of Kenyan

8
women have been infected with HPV at some point in their lives (Cteland et al., 2006). Over 120

forms of HPV have been identified. Some HPV strains cause cervical cancer, some produce

genital warts, and yet others cause no issues at all (IARC, 2009). HPV strains may infect the

vaginal tract in around 40 different ways (De Vuyst et al., 2007). HPV types in the genital tract

are classified based on their connection with cervical cancer. Approximately 20 are categorized

as high-risk HPV (HR HPV) and have been linked to cervical cancer, precancerous lesions, and

low-grade cervical pathology (Suba et al., 2011). Low-risk HPV (LR HPV) is responsible for

mild cervical lesions, genital warts, and recurrent respiratory papillomatosis (Cuzick et al.,

2006). Human papillomavirus types 16 and 18 are thought to be responsible for over 70% of

cervical cancer incidences. Human papillomavirus types 31, 33, 35, 42, 52, and 58 are

responsible for around 20% of cervical cancer cases (Huchko, 2011). Human Papillomaviruses

16 and 11 have been linked to more than 90% of genital warts (Bosch, 2007).

2.4 Predisposing factors for cervical cancer

The biggest risk factors for HPV infection include several sex partners and an adolescent sexual

debut. Co-infection with Human Immune 12 deficiency Virus is a key risk factor for cervical

cancer in Kenya (KMOH, 2005).Because of the high prevalence of HIV infection in Kenya

(Huchko et al, 2011), combining HIV testing with cervical cancer screening would be cost

effective. Other risk factors include genital ulcer illness, herpes simplex type 2, syphilis, and

chlamydia (Ahdieh-Grant, 2004). To prevent HPV persistence, health education on STI

prevention and quick treatment are required (Wamai, 2009). Some of the risk factors for cervical

cancer have been noted to be smoking, polygamy, poverty, female illiteracy, and an insufficient

health care system (UN, 2009).

9
 Multiple births of more than five children, as well as the usage of contraceptive pills for

more than 12 years, are risk factors for cervical cancer (Louie et al., 2009).According to Kenyan

research, 17-18% of births occur to women under the age of 20 (KNBS, 2009). Numerous

research have provided evidence of the influence of nutrition on the risk of cervical cancer. A

diet rich in beta carotene, vitamin C, and vitamin A may lower the risk of cervical cancer. Diet

recall study results have often been supported by scientific surveys assaying food elements in

plasma (Baseman et al., 1006). Diet, like reproductive variables, is likely to impact disparities in

cervical cancer incidence rates between countries (HPV information center, 2009).

2.5 Primary prevention of cervical cancer

Cervical cancer can be effectively managed via HPV vaccine immunization (Lacey,

2006). Vaccines targeting HPV 16 and 18 serotypes show 100% effectiveness and can prevent up

to 70% of cervical malignancies (Blossom et al., 2007).Vaccination is the 13th hallmark of

preventive measures. Vaccination has avoided more than 2.5 million lives worldwide (WHO,

2008). The FDA granted approval for two vaccines, Gardasil and Cervarix, produced by

GlaxoSmithKline (GSK) and Merck, which are highly effective in combating recurring

infections with HPV types 16 and 18, the two high-risk HPV types responsible for a great deal of

cervical cancers. Gardasil also protects against HPV strains 6 and 11, which are responsible with

about 90% of genital warts (Anonychuk, 2009). GlaxoSmithKline approved the vaccine for

primary prevention in Kenya in 2007 (Khan et al., 2009). The goal of a preventive vaccination is

to stimulate efficient humeral and immune cell defenses that are possibly protective against

recurrent HPV infection (Kane et al., 2006). There is a scarcity of evidence on vaccination

acceptance, health-care system readiness, vaccine cost effectiveness, and long-term effects

(Clifford et al., 2005). Additional data are required to elevate invasive cervical cancer as a public

10
health priority in Africa in order to introduce, execute, and sustain effective cervical cancer

control. Vaccination decreases cervical cancer fatalities by up to two-thirds worldwide (Gailland

et al, 2008). As a result, vaccination against HPV may be a more appropriate strategy of reducing

disease burden in underdeveloped countries rather than screening alone (Kerr, 2009). People in

numerous resource-limited countries, such as Kenya, are unable to buy the vaccination,

necessitating the government's integration of the vaccine with other vaccines and the availability

of the HPV vaccine in all Government hospitals (Muchiri et al., 2010).

According to new research, all Human Papilloma Virus (HPV) vaccinations are helpful in

preventing cervical cancer in women up to 45 years old. Gardasil lowers the risk of HPV type 6,

11, 16, and 18-related recurring infection and illness in women up to the age of 45 (Goldie et al.,

2008). While developed nations have taken significant measures to safeguard their populations

by offering HPV vaccines, women in underdeveloped countries continue to die from cervical

cancer (WHO, 2009). This type of disparity may be avoided. The Global Alliance for vaccination

and Immunization (GA VI) is raising funding to make HPV vaccination available in developing

nations. This might save the lives of 700,000 women from painful and early deaths (Goldie,

2008). A free HPV vaccination program conducted in Uganda to replicate a national program to

give policymakers with a foundation for financing shown that a government-supported HPV

vaccination program may achieve high coverage while remaining practical (PATH, 2004). A poll

on HPV acceptance done in Kenya indicated that 95% of moms were eager to get their daughters

vaccinated. This revealed that an HPV vaccination initiative in Kenya might be beneficial, albeit

more research is needed to validate these findings (Becker-Dreps, 2010). The human

papillomavirus vaccination is also useful in the prevention of various malignancies caused by

HPV infection, such as anal, vulvar, penile, and vaginal cancer (HPV Information Center, 2009).

11
 2.6 Secondary prevention of cervical cancer

A research conducted at Kenyatta National Hospital discovered that only 51% of the women

participants understood what cervical cancer was, 32% understood what a pap smear was, and

22% had previously been tested using the procedure (Gichangi et al., 2003).Lack of resources

and worry of bad findings are two frequent obstacles to cervical cancer screening (Ngigi,

2006).Cervical precancerous lesions should be screened for within three years after vaginal

sexual activity. Screening should continue every 2-3 years after three consecutive yearly normal

pap tests (Cancer Care Ontario, 201 O). HIV positive women who are immunocompromised

should be examined yearly (Kwonga, 2010). Screening is done annually in North America, while

screening is done every 3-5 years in the rest of Europe. Kenya should create screening interval

guidelines (Sasieni, 2010). Cervical cancer screening, according to all experts, is helpful for

disease management. In the Nordic nations, long-term screening programs for cervical

precancerous lesions have been quite effective. Denmark, Finland, Iceland, Sweden, and Norway

are among these nations. Mortality in Iceland has fallen by 80%.Finland and Sweden have

implemented long-term national initiatives that have reduced mortality by 50% and 34%,

respectively (Goldie, 2005).

The findings support the claim that organized testing initiatives have had a significant

impact on the decline in death from cervical cancer in the Nordic countries (IARC,

2009). Cervical precancerous lesion screening decreases cervical cancer prevalence substantially

(Myung et al., 2011). Cervical cancer screening services are not widely available in high-risk

nations (Kawonga, 2008). Cervical cancer screening coverage in Congo was at best 20.2% in

cities and 14.0% in rural regions. Screening is carried out in l.6% of urban regions and 4.0% of

rural areas in Ethiopia (WHO, 2008). Since 2007, South Africa has been the first country in Sub-

12
Saharan Africa to have implemented a countrywide cytology-based cervical screening program

(Parkin, 2010). Kenya also lacks the advanced nations' preventative models (PATH, 2004b). The

government lacks the financial and personnel resources required to implement such preventative

initiatives. To lower the number of cervical cancer morbidities and deaths, low-cost and efficient

cervical cancer screening initiatives must be implemented (Nairobi Cancer Registry, 2011). The

ideal age group for cervical cancer screening in low-resource settings to generate the highest

public health benefit is 30-39 year-olds.

When the fewest resources are utilized to obtain the most benefit, screening is deemed

optimum (Sankaranarayan et al, 2007). Cervical cancer screening uses a variety of assays. The

Pap test, the HPV DNA test (Deoxyribonucleic acid), and visual inspection with acetic acid and

Lugol's iodine, among other tests, can detect early cell alterations and treat them before they

progress to cancer (Ferlay et al., 2009).Visual inspection with acetic acid (VIA) and visual

inspection with Lugol's iodine (VIU) are less reliant on laboratories and have been used in the

past. Denny et al. (2006) advocated for screening options in underdeveloped nations. Various

assessment studies have revealed that VIA has a sensitivity and specificity of 60-94% and 74-

94%, respectively, to detect high-grade lesions in Africa; while VILI has a responsiveness and

specificity of 90-97% and 73-91%, accordingly (Sankarayanan et al, 2008). However, the

specificity of VIA is decreased in HIV positive women, which may be due to increased incidence

of co infection in the lower vaginal tract (Braaten et al., 2008). The majority of screening

programs in Sub-Saharan Africa began as research or pilot initiatives (Bratcher et al, 201

O).Testing for HPV DNA is a more objective and reproducible screening technique that has been

demonstrated to be more sensitive than cervical cytology in 17 identifying high-grade lesions

(Dillner et al., 2008).

13
 In South Africa, a screening experiment employing HPV testing for 6553 unscreened

women (35-65 years) revealed an 80% decrease among HIV-uninfected women (Kuhn et al.,

2010). Because of the great sensitivity of HPV testing, women's mortality has been reduced as a

result of prompt therapies for those who test positive (NHS, 20 11). Many nations, however,

employ cytology testing, which has only poor sensitivity in detecting more advanced precursors,

to detect cervical cancer precursors known as cervical intraepithelial neoplastic (CIN). For the

program to be effective, women tested with this kind of cytology must be screened more

frequently than women screened with HPV testing (Mitchel et al., 2011). The sensitivity of HPV

DNA testing for identifying CIN2-3 varies from 66% to 95%, with the majority of studies

showing results more than 85% in women aged 30 and older. These tests are especially useful in

women at high risk for precancerous lesions since a positive result at that age indicates a

persistent HPV infection that might lead to cancer (Devust, 2007).

2.7 Treatment for cervical precancerous lesions/cervical cancer

The amount of aberrant cellular alterations determines treatment for cervical lesions (Thackery,

2002). Cells normally return to normal in moderate dysplasia, and only further follow-up is

required (Parkin, 2008). Cryosurgery, LEEP, and "cold knife cone biopsy, cauterization, and laser

surgery are treatment options for superficial carcinomas and other early stages of cervical

malignancies" (Denny et al., 2008). Cervical cancer treatment options include surgery,

chemotherapy, radiation therapy, and various complementary therapies ranging from simple to

aggressive. Clinical stage of the illness, a woman's age, 18 overall health, and individual

preferences may all impact therapy selection (Jenkins et al., 2008).

14
 CHAPTER THREE

3.0 RESEARCH METHODOLOGY

3.1 Introduction

This section presents the researcher design and methodology used in this research work. This

chapter discusses survey techniques, data collection strategies, the study population, sampling

techniques, and questionnaire development. Furthermore, this chapter delves into the specifics of

the research framework, and data analysis techniques used in this study. The study employed a

cross-sectional descriptive research design that combines both quantitative and qualitative

research designs to comprehensively assess the uptake of the HPV vaccine at Kuoyo Health

Center and understand the factors influencing vaccine acceptance.

3.2 Research Design

According to Marczyk et al., (2010), research design is the deliberate preparation of the required

variables for effective information collecting and examination in order to combine the value of

the study's decision with the budget in the future research process. As a result, this chapter

contains rules for data measurement, collecting, and analysis. This study used a descriptive

research design that included qualitative and quantitative research methods. A population of 200

persons served as the sample frame from which a sample size of 100 participants was selected.

The study used non-probabilistic random sample approaches, most notably purposive sampling.

This sort of sample is easier and less expensive to get. Because of the small sampling frame of

200 persons, the above method of sampling was suited for this study. Quantitative data was

obtained by use of questionnaires. Four focus group discussions each comprising of 20

participants were held and were designed to collect mainly qualitative data. Respondents' socio-

demographic data were acquired, as well as information on the causes of sexually transmitted

15
diseases, age at first sexual encounter, and vaccination availability. Clinic records were reviewed

to determine the pattern of screening at the clinic during the research period. Data was evaluated

using predictive analytics software. The findings are given in text, pie charts, frequency tables,

and histograms.

3.3 Study area selection

The research was carried out in the Maternal and Child Health Clinic, Kuoyo Health Center,

Kisumu East, Kisumu County. Kisumu East is one of the seven sub-counties that comprise

Kisumu County. The Kuoyo Health Center in Kisumu East Sub County was chosen for this study

because it was the most convenient location for the participants, as the HPV vaccination is

administered at the facility. Furthermore, the Kisumu East sub county was chosen for this study

due to its large population of around 220,997 thousand individuals, with women outnumbering

males (112,689). Kisumu East Sub County is divided into six wards: Central Kolwa, East Kajulu,

East Kolwa, Manyatta, Nyalenda, and West Kajulu.

3.4 Target Population

The target demographic consisted of women of reproductive age living in Kisumu Sub County.

Kisumu Sub County has a total population of around 220,997 people, with women representing

112,689 thus outnumbering the males. The study population was well-suited to the maternal and

child health clinic. Women typically visit the clinic for services such as family planning, and they

also bring their children for vaccines and well-baby checkups. This region was great for

gathering all variables of interest to the investigation and recruiting a sample size appropriate for

the study. The findings would be generalized to the target population.

16
 3.5 Inclusion Criteria

Mothers (15-49 years old) who went to a maternity and child health clinic. Participants who

provided written agreement were included in the study after being fully informed about the

nature and aim of the study, as well as their right to opt out without affecting the services they

need.

3.6 Exclusion Criteria

Mothers who were above 49 years and below 15 years.

Women who met all the criteria but declined to give consent.

3.7 Sampling procedure and sample size determination

The study included non-probabilistic random sample procedures, most notably purposive

sampling, in which participants filled out questionnaires only on clinic days while the rest were

included in concentrated group discussions while waiting for the services they desired. This

sample method is also known as judgment sampling. The researcher utilized her experience to

pick a sample that she thought would be most valuable to the aims of the research and would

provide the essential information by employing this sampling approach. The researcher

purposely chose a diverse group of individuals with varying support requirements in order to get

a diverse set of data on their experiences with the HPV varies vaccine. This technique was

followed throughout the data collecting period until the required sample size of 100 individuals

attending the Maternal Child Health care clinic was reached. Following adequate ethical

evaluation, the 100 participants were asked to complete a specially created questionnaire. The

same sampling approach was utilized to gather four 20-person focus group discussion.

17
 3.8 Data Collection Tools/Instruments

A semi-structured interview schedule was created, with largely closed-ended questions. For the

interview, a question guide for focus group discussions was created. Before the real study began,

the two instruments were pre-tested among patients in the gynecological ward, and any required

revisions were incorporated. The questionnaire asked about respondents' socio-demographic

features, socio-behavioral variables that led to cervical cancer infection, HPV infection

knowledge, and awareness of cervical cancer risk factors. The respondents were polled on the

ease with which they might obtain information regarding cervical cancer and HPV vaccination.

The surveys also inquired about their knowledge of the existence of a cervical cancer

vaccination. The questionnaire also sought information on issues that have a direct impact on the

development of cervical cancer, such as the use of contraception for family size management,

individual or partner smoking status, the influence of economic status on chances of getting

cervical cancer, major reasons for increased chances of being infected with cervical cancer, and

factors influencing the decision to receive HPV vaccination.

3.9 Questionnaire pilot run

The questionnaire was pretested with 5 moms admitted to the gynecological ward to confirm that

it was appropriate for the study, and all variables of relevance for the study were collected one

week before the study. After the pretest, the questionnaires were corrected. Participants in the

pretest were not included in the main sample. Pilot testing was performed to assess the capacity

to elicit desired answers, determine the relevance of the interview questions' components,

experiment with timing, and evaluate the wordings and sequence. According to Ikart (2019),

pilot runs aid in improving the quality of questions as well as identifying and testing potential

questionnaire administration techniques. A pilot run, according to Doody and Doody (2015),

18
assists in discovering and fixing errors made during the construction of the questionnaire

questions, such as adding missing components, modifying wordings, and particular questions,

hence removing defects.

3.10 Validity and Reliability

According to Cohen et al. (2017), the two processes are concerned with how exactly a technique

can measure something and deliver useful information. Data dependability and validity are

critical components of research results quality control. As a result, the researcher must guarantee

that the study findings are reliable and credible.

3.10.1 Validity

Validity refers to the amount to which the researcher's unique conceptions are correctly reflected

(Cohen et al., 2017). Validity is used to justify accuracy and to assess if measuring tools

accurately measure the variables under consideration. To ensure the research's validity, many

distinct procedures were applied. The first approach used to verify validity was questionnaire

pre-testing, which confirmed that the contents of the questionnaire were in accordance with the

requirements and research objectives, and that all necessary procedures were followed during the

actual administration of the questionnaire. This helped to eliminate any biases in the data

gathering process. Potential researcher biases, according to Wadams and Park (2018), include

changing study data to fit the researcher's viewpoint, bracketing, and structured questionnaires.

This may be prevented if all data is considered and analysed with an open mind and a clear

conscience. Furthermore, Romano et al. (2021) highlight possible researcher biases, such as

asking participants leading questions and queries that probe too deeply into their very sensitive

and personal lives. These biases were reduced, according to Romano et al. (2021), by keeping

19
interview questions brief, avoiding topics that potentially induce prejudice, and avoiding

inquiries that delve too deeply into the participants' personal life.

3.10.2 Reliability

According to Cohen et al. (2017), the reliability of a research assumes that repeating a certain

technique on specified study material would always yield the same result. The reliability of study

data was therefore maintained by employing a variety of methodologies and technologies in data

collection, including questionnaires and pilot run data analysis. Adopting proper selection skills,

such as non-probabilistic non-probability random sampling and choosing a manageable and

acceptable sample size, enhanced reliability. Furthermore, the research's reliability was

strengthened by completing a questionnaire schedule pilot test before to the start of actual data

collecting since it enhanced precision and importance to the study objectives, hence boosting

dependability.

3.11 Data Analysis

Data analysis, as defined by Belotto (2018), is the systematic application of statistical data and

logical techniques to display, analyze, shorten, outline, and assess data. Examining, converting,

and changing data to determine the important data set leads to a strong research summary and

feasible decision-making about the study questions (Cooper and Schindler, 2011). Data analysis

is the process of gathering firsthand and crucial data in order to extract critical information. The

part explains how data gathered via various means, such as interviews, is analyzed and

interpreted. In this study, theme analysis, especially codebook thematic analysis, was applied

using both the inductive and latent techniques. According to Belotto (2018), codebook thematic

analysis is the ideal statistical approach for this study since it is optimal for assessing data on

human lived experiences, emotions, and views about a certain topic. Furthermore, according to

20
Kiger and Varpio's (2020) research, theme analysis is ideal for assessing vast volumes of data

obtained through interviews and surveys.

3.12 Ethical Considerations

Arifin (2018) defines ethical concerns as a set of rules that regulate the researcher's study designs

and overall research practices throughout the research process. The research principles,

according to Hasan et al., (2021), include getting ethical permission from the study's target

organization, anonymity and informed consent, voluntary participation, sharing of results with

interested participants, avoiding possible damage, and confidentiality. Obtaining permission to

conduct research from Jaramogi Oginga Odinga University of Science and Technology School of

Health Sciences, Department of Community Health, and Graduate School of Jaramogi Oginga

Odinga University of Science and Technology, Ministry of Higher Education Science and

Technology, Medical Superintendent Kuoyo Health Center, and others were among the ethical

considerations.

Mothers accessing Maternal and Child Health services were informed about the project,

and their signed agreement was obtained prior to data collection. In addition, the researcher

supplied the moms who volunteered to participate with a participant information form. As a

result, they know what to expect during the whole research process and what the study

comprises. According to Arifin (2018), the researcher has secured the participants' confidentiality

and anonymity by guaranteeing that study data, such as individual participants' true identities, are

not given to any third party. The subjects were also given total autonomy during the

investigation. This enabled participants to take part voluntarily and to withdraw from the

research if they felt uncomfortable. Finally, the researcher maintained a tight check on the

21
questions asked, making sure that the participants were not asked irrelevant questions that were

unrelated to the topic or study aims.

22
 CHAPTER FOUR

4.0 RESULTS AND DISCUSSIONS

4.1 Introduction

This chapter shows the data obtained and analyzed from the study using selected techniques and

the recording of findings. Data obtained included adolescents who are fully vaccinated and those

that are partially vaccinated between the ages of ten to seventeen.

4.2 Response rate

The response rate of the study undertaken is summarized in table 4.1 below;

Respondents. Questionnaire issued Questionnaire percentage

received
Community health 19 19 100%
assistants.
Social workers. 21 21 100%
Community health 26 23 87%
volunteers.
Community health 18 16 86%
extension workers.
Peer counselors. 16 16 100%
Total 100 95 95%

Table 4.1: Response rate

The table above shows the response rate and it is observable that not all the sampled respondents

were able to respond to the questionnaires, community health volunteers responded at 87% and

the community health extension workers at 86%. However, the average response rate is above

50% and therefore the data collected from the field was highly reliable.

23
4.3 Gender of respondents

Gender of the respondents was important as it was to help to know if gender can influence

healthcare-seeking behavior, vaccine acceptance and enhance the accuracy of disease

epidemiology and supports also effective prevention measures in Kisumu East Sub-County. The

frequencies and percentages are tabulated as shown below;

Gender Frequency Percentage

Male 44 46%
Female 51 54%
Total 95 100%

Table 4.2: Respondent’s gender

From the respondent in Kisumu East Sub-County, it was clearly established that it has male

respondents at 46% and female respondents at 54% as well.

Gender of the respondents

Male Female

Figure 4.1: Respondent’s gender

4.4 Age of the respondents

The study research wanted to establish the age of respondents in Kisumu East Sub-County and

the study revealed that 49% of the respondents their children were falling in the age of 10-14

24
years old and 51% of the respondents their children were between the ages of 15-17 years as

shown in the table below;

Years Frequency Percentage

10-14 47 49%
15-17 48 51%
Total 95 100%

Table 4.3: Age of the respondents

4.5 The level of education

The educational level of the respondents was important since it provides valuable insights into

the dynamics of vaccine acceptance, knowledge dissemination and the development of effective

public health strategies to combat HPV related diseases. The findings showed that majority of the

respondents were falling in secondary qualification of 25%, followed by primary and college

qualification at 20, those with university and did not complete had 21% and lastly those with

university qualification 14% as shown in the table below;

Educational level Frequency Percentage

O-level. 19 20%
A-level. 24 25%
College. 19 20%
University completed. 13 14%
University and did not 20 21%
complete.
Total 95 100%

Table 4.4: Level of education of the respondent

4.6 Work experience

The research study looked at work experience of the respondents in order to get hands-on

exposure to the intricacies of conducting the research.

25
The study indicated that respondents who had worked for 1-5 years were 30%, 6-10 years 33%

and above 10 years were the highest with 37% as indicated in the table below;

Category Frequency Percentage

1-5 years 29 30%
6-10 years 31 33%
Above 10 years 35 37%
Total 95 100%
Table 4.5: Work experience
4.7 Social position of the respondents in the community

The research sought to establish where the respondents fall in Kisumu East Sub-County under

the given categories and the information gathered has been presented in the table below;

Category Frequency Percentage

Community Health 18 19%
Assistants.
Community Health 19 20%
Volunteers.
Social Workers. 20 21%
Community Health Extension 17 18 %
Workers.
Peer Counsellors. 21 22%
Total 95 100%

Table 4.6: Social position of the respondents

4.8 Socio-behaviors leading to cervical cancer infection

The study participants were asked about the irresponsible socio-behaviors that led to cervical

cancer infection, and 38% of them indicated that having multiple sexual partners is the leading

cause of cervical cancer infections, followed by having unprotected sex at 35%. This was

followed by early commencement of sexual activity before the age of 18 years at 15%, and lastly

tobacco smoking was deemed the least factor that promotes infections of cervical cancer at 12%

26
as a predisposing factor for cervical cancer infection. Table 4.7 below indicates the socio-

behaviors contributing to increased cervical cancer infections.

Table 4.7: Social behavior leading to cervical cancer infections

Social behaviors for cancer infection Frequency Percentage

Having multiple sexual partners 36 38
Having unprotected sex 33 35
Early onset of sexual activity 14 15
Tobacco smoking 12 12
Total 95 100

4.9 The ease of access to information about cervical cancer and HPV vaccination

Participants in the survey highlighted that getting information on cervical cancer and HPV

vaccination is not always straightforward. Participants identified a lack of knowledge as one of

the primary factors for their poor uptake and unwillingness to receive HPV vaccine. Participants

reported having limited access to information about cervical cancer and HPV vaccination, citing

some of the major reasons as follows: lack of awareness, insufficient knowledge about HPV and

its link to cancer as well as its benefits, cultural and religious beliefs in the community, general

fear of vaccines, including concerns about safety and side effects, and the difficulty in obtaining

prenatal consent, particularly for the younger individuals.

4.10 Level of awareness of existence of a vaccine to protect against cervical cancer

The study findings demonstrated that there is very low awareness about the existence of cervical

cancer vaccine. The results indicated that most of the participants did not have the awareness

about the existence of HPV vaccine. Table 4.8 below indicates that only 40% of the participants

were aware of the existence of this vaccine while the remaining 60% were not aware of the
27
existence of the vaccine. This again confirms that the population lacked adequate information

about the HPV vaccine and cervical cancer.

Table 4.8: HPV vaccine awareness

Awareness of vaccine Frequency Percentage

Aware of the vaccine 38 40
Unaware of the vaccine 57 60
Total 15 100

4.11 The influence of economic status on chances of getting cervical cancer

The participants were also asked about the impact of socioeconomic status on getting cervical

cancer. Participants suggested that persons living in extreme poverty are more likely to be

infected with a cervical cancer-causing virus owing to a lack of frequent screening, which is

critical for early disease identification. Furthermore, participants noted that low socioeconomic

position exposes them to a poor and unbalanced diet, which is a risk factor for HPV. This is

because people from low-income families lack the resources to eat a balanced diet, leaving them

deficient in vitamins like beta carotene, vitamin C, and vitamin A. Individuals' immunity against

HPV is reduced when they do not consume the above-mentioned nutritional ingredients,

increasing their risks of contracting cervical cancer. This inquiry was addressed specifically to

community health assistants and community health extension workers, with a total of 35

participants. Table 4.9 shows the extent of acceptance that this factor influences the likelihood of

becoming infected with HPV, which causes cancer.

Table 4.9: Influence of economic status on cervical cancer infection

Opinion Frequency Percentage

Less extent 5 14

28
 Some extent 10 29
Great extent 20 57
Total 35 100

According to the table, 57% of those surveyed agreed that this factor (economic status)

contributes significantly to cervical cancer infection, with 29% agreeing that it does so to some

extent, and the remaining 14% agreeing that it only has a minor impact on cervical cancer

infection.

4.12 Major reasons for increased chances of getting infected with cervical cancer

Participants in the research were questioned about some of the factors that raise the likelihood of

cervical cancer infection. Failure to complete the HPV Vaccination Series, economic and social

factors, family history of cervical cancer, not having regular pap smears, long term use of oral

contraceptives, tobacco smoking, having multiple sexual partners, early onset of sexual activity,

lack of adequate information on cervical cancer, having unprotected sexual activity, and lack of

protection are some of the major reasons mentioned by participants as reasons that lead to

increased cervical cancer infection.

4.13 Factors affecting the decision to take HPV vaccination

Study participants were asked about some of the factors that are informing their decisions to take

HPV vaccination. Some of the reasons that affect the decision to pursue HPV vaccination are

such as: Age and Gender Considerations, Public Health Campaigns, Mandatory Vaccination

Policies, Peer Influence, Education and Socioeconomic Status, Cultural and Religious Beliefs,

Parental Attitudes and Beliefs, Healthcare Provider Recommendations, Efficacy and Safety

Concerns, Perceived Severity and Knowledge and Awareness.

29
 CHAPTER FIVE

5.0 SUMMARY, RESEARCH FINDINGS, CONCLUSION AND

RECOMMENDATIONS

5.1 Introduction

The findings in this study are further summarized here with a view to crystallize the key findings

in relation to the research objectives. The conclusion is then drawn based on the findings and in

order to answer the research objectives. The chapter finally captures the researchers’ conclusion

and recommendations.

5.2 Summary of findings

From the respondents in Kisumu East Sub-County, Manyatta B ward, it was established that in a

sample of 95 respondents.

Gender- from the respondents at Kisumu East Sub- County, it was established that the male

respondents were 46% and the female were 56%.

Age- the study revealed also that 49% of the total respondents were aged between 10-14 years

and 51% were between the ages of 15-17 years old.

Work experience- findings indicated that the respondents who had worked for 1-5 years were

30%, those who had worked for 6-10 years were 33% and those above 10 years were at 37%.

30
Education level- the findings showed that 20% were at o-level, 25% at A-level, 20% attained

college level of education, 14% were of university and 21% went to the university but did not

complete their studies.

The study also reveals that with the low rates of HPV vaccine coverage there is decreased

protection against HPV-related infections and the associated cancers compared to those with full

vaccination coverage in the community. This study highlights the significance of achieving full

HPV vaccination for enhanced preventive measures and public outcome in general.

Causes of low HPV vaccine coverage and its impact to community health.

The study had some findings on the causes of reduced HPV vaccine uptake and its effects on

community health in Kisumu East Sub County, Manyatta B.

The analyzed questions showed the following findings on access barriers where the limited

access to healthcare services more especially in the underserved areas which hinders the vaccine

accessibility was the major reason for low uptake of the vaccine and this affects the community

in that there is missed prevention opportunities to prevent HPV-related diseases and reduce their

burden on healthcare systems.

According to this research, it was also found that lack of awareness/ limited knowledge about

HPV and the vaccine’s benefits among individuals and the healthcare providers, cultural and

religious beliefs was also another factor where some communities had cultural and religious

beliefs that discourages HPV vaccinations.

The study findings in Kisumu East Sub-County indicated majority of the respondents agreed that

factors like spread of misinformation or the concerns about vaccine safety and efficacy leading to

vaccine hesitancy, financial constraints preventing them from getting vaccinated particularly in

31
regions without subsidized or the free vaccination programs were also the major reasons of low

vaccination coverage in Kisumu East Sub-County, Manyatta B ward.

Ways of increasing HPV vaccine coverage in Kisumu East Sub-County.

In summary the study findings indicated that among the implemented strategies to increase

vaccine coverage good, the study showed that education and awareness campaigns to educate the

public, healthcare providers and parents about the importance of HPV vaccination in preventing

cancer among the adolescents. The engagements in the community- based outreach programs to

reach the underserved populations and provide also appropriate information about the vaccine.

Another way to increase HPV vaccine coverage is by collaborating with the outlets to

disseminate accurate information and counter misinformation through various local channels

within the community and also by implementing policies that support and promote HPV

vaccination such as school entry requirement for those joining form one or reminder systems for

healthcare providers.

Within the community, the school-based programs in the introduction or expansion of these

programs makes the vaccination more accessible to the adolescents and in addition, the free

vaccination programs also eliminate financial barriers and improve access within the community.

Lasty, the study findings indicated that 65% agreed and strongly agreed on the view that

providing training to healthcare professionals to improve their knowledge about HPV and

vaccine enables them to address concerns and provide accurate information to patients and the

provision of incentives to them also encourages proactive discussions about HPV vaccination

during routine medical visits and this makes the most significant impact in increasing HPV

vaccine coverage in the community.

32
5.3 Conclusion

In conclusion, the research found that several risk factors for low HPV vaccine coverage is as a

result of lack of awareness the insufficient knowledge about HPV and its link to cancer plus its

benefits can result to low uptake, cultural and religious beliefs in the community, general fear of

vaccines including concerns about safety and side effects also impacts the uptake, the absence of

policies mandating HPV vaccination for school entry or other requirements may result in lower

coverage rates, the challenge in obtaining prenatal consent particularly for the younger

individuals hinders the vaccination efforts, another risk factor is the spread of misleading

information about HPV vaccines which also leads to vaccine hesitancy and reduced coverage.

In conclusion, the study found that despite many approaches that have been employed by

Ministry of Health and health professionals to ensure increase in vaccine uptake, many families

in the community still feels the pinch of vaccination consequences. However, Kisumu East

residents feels that dealing with low vaccine uptake can be eased by going to the ground and

ensuring early creation of awareness to under five years in the community to ensure early

engagements with the service providers. By so understanding and addressing these risk factors

by the community health providers and the community health stakeholders which are more

crucial for developing targeted interventions to improve HPV vaccine coverage and also prevent

the associated health risks.

5.4 Recommendation

The study recommended the implementation of targeted educational campaigns to raise

awareness about Human Papilloma Virus vaccine, its associated risks and the benefits of

vaccination among the healthcare providers and the public. It also recommends the expansion or

33
the initiation of school- based vaccination programs to increase the access and coverage among

the adolescents in school leveraging the existing infrastructure.

The study further recommends establish of robust monitoring and evaluation systems to

track vaccine coverage among the adolescents, identify various barriers and also measures the

impacts of interventions over time, also the development of targeted outreach efforts to address

parental concerns, provide information and emphasize the importance of HPV vaccination for

their children’s health was also another recommendation derived from the research study.

Nevertheless, the study further recommended that community should be engaged in these

programs to understand local perspectives, address the religious and cultural beliefs and also to

tailor vaccination efforts to the specific need of the community, advocating for and

implementation of policies that support HPV vaccination can also help increase the uptake of the

vaccine and help improve the general health of the community members. When all these research

study recommendations are implemented collectively, they can contribute to overcoming barriers

and increasing HPV vaccination rates in the population.

5.5 Areas for further studies

Research in these areas can contribute to a more understanding of the factors influencing HPV

vaccine uptake and inform targeted interventions to improve coverage rates. These areas include;

Assess the long-term impact of HPV vaccination on the prevalence of HPV related diseases and

cancer, providing valuable insights into the vaccine’s effectiveness over time.

Examine the role of healthcare providers in vaccine recommendations, exploring communication

strategies and understanding barriers they may face in promoting HPV vaccination.

Examine geographic variations in vaccine accessibility and identify strategies to address

disparities in different groups.

34
Identify and understand community specific barriers to HPV vaccines uptake taking into account

cultural, socioeconomic and the geographical factors.

5.6 Adolescent autonomy

Vaccine hesitancy dynamics including individual beliefs, cultural influences and perceptions of

vaccine safety and efficacy.

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 APPENDICES
APPENDIX 1: QUESTIONNAIRES.

Dear respondents,

I am ODIRA DIANA ALUOCH a student at Jaramogi Oginga Odinga University of Science and

Technology pursuing Bachelor Degree in Community Health and Development, it is a

requirement for me to do project research as part of my course work in partial fulfillment for the

award of degree. In the line with this, I am carrying out a research study of the title UPTAKE OF

HUMAN PAPILLOMA VIRUS VACCINE IN KUOYO HEALTH CENTER, KISUMU EAST,

KISUMU COUNTY.

Kindly assist in this by responding the questions availed with utmost honesty. The response will

be used purely for academic purposes, submitted as entire group response and not as individual

and will be treated with absolute confidentiality and respect. Your honesty and cooperation will

be highly appreciated.

Looking forward to an interactive engagement, thank you in advance.

44
Please read, understand and follow these instructions.

Do not write your name

The questionnaire will not be used for any purpose apart from the above description.

The success of this study depends on your truthfulness and honest response to the entire

questions asked.

Tick in appropriate box appropriately unless instructed otherwise.

The response you give will be treated with utmost confidentiality.

You are allowed to write what you think otherwise to the questions asked in the questionnaire.

Gender of the respondents

Female

Male

Age of the respondents.

10-14

15-17

45
Education level of respondents.

0-level

A-level

College

University and completed

University and did not complete

Work experience

1-5 years

6-10 years

46
Above 10 years

Designation

Community health assistants.

Social worker

Community health volunteer

Community health extension worker

Peer counselor

Research questions.

47
 1. Rate the list of low uptakes of Human papillomavirus vaccine using the scale provided.

1-agreed (A), 2-strongly agreed (SA), 3-disagreeed (D), 4-strongly disagreed (SD), 5-neutral(N)

Causes of low uptake of HPV vaccine. A SA D SD N

Limited knowledge about HPV vaccine and its impacts.
Cultural and religious beliefs on vaccinations.
Spread of misinformation.
Financial constraints.
Limited access to healthcare services.

2. Rate the following strategies of increasing uptake of HPV vaccine using the scale

provided (you can choose more than two strategies)

1-agreed (A), 2-strongly agreed (SA), 3-disagreeed (D), 4-strongly disagreed (SD), 5-neutral (N)

Strategies to increase HPV vaccine uptake A SA D SD N

Education and awareness campaign.

Community-based outreach programs.

Collaboration with outlets to disseminate accurate data on HPV

vaccine.

Implementation of policies that support HPV vaccination.

Introduction of school-based programs.

Providing trainings to the healthcare providers/professionals.

3. Kindly name some of the irresponsible socio-behavior that can contribute to Cervical

Cancer?

4. How easy is it for you to get information about cervical cancer and HPV vaccination?

48
5. Are you aware that there is a vaccine to protect against cervical Cancer?

6. How does your economic status influence chance of getting cervical cancer and uptake of

HPV vaccination?

7. What are some of the major reasons for increased chances of getting infected with

cervical cancer?

8. What are some of the factors affecting the decision to take HPV vaccination?

49