Keywords:
Knowledge - Papillomavirus infections - Angola - Faculty - Students - Uterine cervical
neoplasms
Palavras-chave:
Conhecimento - Infecções por papilomavírus - Angola - Faculdade - Estudantes - Neoplasias
do colo do útero
INTRODUCTION
Cervical cancer is the first most common cancer among women in Angola, and the human
papillomavirus (HPV) is an important causative agent of the disease.[1] We now have vaccines available to prevent HPV infection. Angola does not have an
HPV vaccination policy or screening methods. There is a need to study the awareness
of HPV vaccination and take steps to improve the use of vaccination.
Cervical cancer accounts for 37% of cancers among women in Angola. A total of 2,949
new cases of cervical cancer were diagnosed in 2018.[2] It is considered the first leading cause of female cancer-related deaths in Angola.[2]
Human papillomavirus (HPV) infection is now a well-established cause of cervical cancer
and there is growing evidence that HPV is a relevant factor in other anogenital cancers
(anus, vulva, vagina, and penis) as well as head and neck cancers. HPV types 16 and
18 are responsible for about 70% of all cervical cancer cases worldwide. HPV vaccines
that prevent HPV 16 and 18 infections are now available and have the potential to
reduce the incidence of cervical cancer and other anogenital cancers.[3]
In a study conducted among Iranian women in 2013-16, the prevalence of HPV infection
was 29.3%.[6] In the same study, among HPV-positive individuals, the high and low-risk HPV subtypes
were found 67.2% and 52.0%, respectively.[6] A study was conducted in the rural Philippines, in 2020, among the community that
inferred that only 13.9% had undergone cervical cancer screening.[7] In a study conducted among Thai women, in 2020, 46% of participants had insufficient
knowledge about HPV infection and vaccination.[8]
Recent advances in technology have led to the introduction of the HPV vaccine to prevent
HPV infection, which will directly help reduce the incidence of cervical, anogenital
and genital warts.
Vaccination is also recommended for boys as it is also implicated in penile, rectal,
and oral cancer. Men also play a role in the transmission of HPV infection to women.[9]
As the HPV vaccine is a recent introduction and is targeted at the 9 to 26 age group,
awareness of this vaccine in the general population appears to be lower. 9-14 years
is the ideal age to administer this vaccine, as it provides maximum immunogenicity
of the vaccine at that age.[10]
In a study conducted in Mangalore with medical students, 78.35% of students were aware
of cervical cancer prevention; 82.47% knew that cervical cancer is caused by a virus;
74.22% were aware of the availability of the vaccine.[11] In a study carried out in Manipal with medical students, only 28.4% of male students
knew that there is a need for vaccination in men.[12] The HPV vaccine is a more recent addition to the universal immunization schedule.
Therefore, your awareness is lower compared to other vaccines.
Assessing knowledge about vaccination among university students helps us to understand
the level of awareness about it among future physicians. Knowledge about the symptoms
of cervical cancer can help with the early detection and treatment of cervical cancer.
After discovering the vaccination status, it will guide us to conduct proper awareness
programs and motivate students to get vaccinated.
This study was carried out with the following objectives:
-
Assess knowledge of the HPV virus as a causal factor for cervical cancer.
-
Assess knowledge about the availability of HPV vaccination.
-
Assess attitude towards vaccination.
-
Assess the vaccination status of university students surveyed.
MATERIAL AND METHODS
A cross-sectional study was conducted on students from different universities and
faculties of medicine, nursing, law, administration, psychology, engineering, and
science in Angola. The inclusion criteria were students willing to participate in
the study, attending the 2nd to the 4th degree of graduation, and aged between 18-26 years. Exclusion criteria were those
who were unwilling to participate in the study.
A sample of 106 students was chosen (2nd to 4th students) ([Table 1]).
Table 1
Number of participants
|
Medicine
|
Nursing
|
Law
|
Administration
|
Psychology
|
Engineering
|
Science
|
|
18
|
33
|
11
|
8
|
7
|
13
|
16
|
The questionnaire was prepared using the google forms platform, consisted of 10 questions,
of which 4 questions assessed knowledge, 4 questions assessed attitude, and 2 questions
assessed practice concerning HPV infection and HPV vaccination. Were of the multiple-choice
type, the participants were asked to choose an answer. The questions about attitude
and practice were yes or no questions.
Knowledge was assessed through questions about risk factors, causal agents, cervical
cancer screening methods. In the question about risk factors, 4 correct risk factors
were given and the inference was made about each risk factor chosen in percentage.
Likewise, the question: cancers most common among women in Angola; was rated 2 out
of 4 correct answers in the options.
Questions about knowledge of vaccine availability, if the vaccine is given in health
facilities; were used to assess knowledge about the HPV vaccine with a yes or no type
of answer. The question about the right age group for vaccination had 1 in 4 correct
answers in the options.
Attitude was assessed based on willingness to be vaccinated and to recommend the vaccine
to a female relative with a yes or no type of response. Percentages based on correct
answers were calculated and compared for each question separately for male and female
students.
Knowledge about cervical cancer
In a question about the most common cancers among women in Angola, 30 (29%) participants
chose breast cancer, 46 (45%) participants chose cervical cancer and 30 (21%) both
chose breast cancer and the cervical ([Table 2]).
Table 2
Question about the most common cancers among women in Angola
|
Breast cancer
|
30 (29%)
|
|
Cervical cancer
|
46 (45%)
|
|
Breast and cervical cancer
|
30 (21%)
|
*Knowledge about cervical cancer;,** about the HPV vaccine
More female students compared to male students were aware of this.
Knowledge about the HPV virus as a causative agent of cervical cancer was found in
12 (12%) men and 94 (88%) women ([Table 3]).
Table 3
Knowledge about the HPV virus as a causative agent of cervical cancer
|
Men
|
12 (12%)
|
|
Women
|
94 (88%)
|
Among male students, 8 (24%) of the students correctly identified risk factors for
cervical cancer such as early marriage, early childbirth, multiple sexual partners,
and infections, respectively.
Among female students, 39 (53%) of the students were able to correctly identify early
marriage, early childbirth, multiple sexual partners, and infections, respectively,
as risk factors for cervical cancer.
A question was asked about the method of screening for cervical cancer, where 3 (9%)
of men and 66 (91%) of women chose Pap smear as the correct screening method. When
asked whether cervical cancer can be treated if detected early, 30 (92%) men and 7
(96%) women responded positively.
Knowledge about the HPV vaccine
59 (82%) women compared to 14 (44%) men were aware of the availability in private
hospitals of the HPV vaccine for cervical cancer in 2 private hospitals. When asked
about the right age group for vaccination, 53 (72%) women compared to 7 (2%) men gave
the correct answer and this association was statistically significant. Only 7 (2%)
men knew that the HPV vaccine could be administered to boys, while 72 (99%) women
knew this fact. 33 (100%) male students and 73 (100%) female students agreed that
women who have already been vaccinated need cervical cancer screening.
Among the participants, sources of knowledge and information about the HPV vaccine
were found as teachings from faculties of medicine, nursing, friends, newspapers,
books, the internet, and television, respectively.
Practice concerning HPV vaccination
0 (0%) of male students was fully vaccinated, while 9 (13%) of female students were
fully vaccinated. In addition, it was found that 0 (0%) male students and 1 (0.73%)
female students took the partial course of vaccination.
Attitude towards HPV vaccination
Among participants, 73 (100%) female students compared to 32 (99%) male students were
willing to be vaccinated. Among participants, 32 (99%) men and 73 (100%) women were
ready to recommend the vaccine to a female relative.
DISCUSSION AND CONCLUSION
DISCUSSION AND CONCLUSION
Our study aimed to assess the knowledge and acceptability of the HPV vaccine among
university students. According to our study, 4 (12%) men and 72 (99%) women knew that
the HPV virus causes cervical cancer. To compare, in a study by Al-Darwish et al.
(2014)[9] in Saudi Arabia, among medical students, 45% of men and 53.2% of women were able
to identify HPV infection as the cause of cervical cancer. This shows that there is
a big difference in knowledge about the causal agent between the two studies with
more students knowing in the present study.
In the current study, 59 (82%) women and 14 (44%) men knew that the HPV vaccine is
available at 2 private hospitals in Luanda. A study conducted by Pandey et al. (2012)[7], in Manipal, among medical students showed that 65.7% of men and 83.1% of women
were aware of the availability of the HPV vaccine.
A higher percentage of male students were aware in the current study when compared.
In a study conducted by Borlu et al. (2016)[10], in Turkey, among undergraduate university students, 160 (62.5%) medical students
were aware of the availability of the HPV vaccine compared to 116 (66.5%) medical
students in our study.
The current study shows that 32 (99%) men and 73 (100%) women were willing to be vaccinated.
In addition, 32 (92%) men and 73 (100%) women were willing to recommend the vaccine
to a female relative. This indicates that there is a lack of awareness among men regarding
the recommended vaccination for men. This is also reflected in the fact that only
99% of men were willing to vaccinate for themselves, compared to 99% of men willing
to advise a female relative to vaccinate. In a study conducted by Fu et al. (2014)[12] among medical students in ChongQing, China, 57.2% of men and 78.5% of women were
willing to receive or advise HPV vaccination.
In the present study, none male students had received the partial course of vaccination,
with 0 of the men had received the full vaccination. 9 (13%) women received full vaccination
with 1 (0.73%) having received a partial course of vaccination. In a study conducted
by Berenson et al. (2017).[13] In the US, among 231 medical students, 81 (66.4%) female students and 16 (14.7%)
male students reported having started the vaccine. Among all participants in our study,
only 14 (9.3%) of the participants had received full vaccination compared to 75 (35.2%)
students with complete vaccination status, according to a study by Afonso et al. (2017)[14] in the US among 213 medical students. In the same study, partially vaccinated students
were 19 (8.9%), compared to 2 (1.33%) in this study.
Regarding risk factors for cervical cancer, 8 (24%) male students and 39 (53%) female
students were able to correctly identify early marriage, early childbirth, multiple
sexual partners, and infections such as risk factors for cervical cancer.
The Pap smear as a screening method for cervical cancer was known by 90.1% of participants
in a study by Maharajan et al. (2015)[15] in Malaysia among 305 medical students. In our study, 51 (69%) of the participants
demonstrated this knowledge. This knowledge seems comparable in both studies.
When asked about the need for screening for cervical cancer after vaccination, 106
(100%) of the students responded positively in the present study. In a study conducted
by Yam et al. (2017)[11], in Hong Kong, among 420 medical and non-medical students, 88 (86.3%) medical students
below the 3rd year and 141 (99.3%) medical students from the 3rd year onwards have this knowledge. These data appear to be similar to our study. More
studies can be carried out to advocate with the Ministry of Health for the implementation
of the vaccine in the national vaccination calendar.
The present study concludes that there is not a good knowledge of university students
about the HPV vaccine, meaning the availability of the vaccine, the right age group
for vaccination, and the recommended vaccination for men need to be improved. Vaccination
status is poor among men and women because it is not on the national vaccination calendar.
Angola does not have a vaccination policy against HPV or screening methods, we believe
that this is the reason for the results found. The government through the Ministry
of Health must incorporate the HPV vaccine in the vaccination calendar.
Bibliographical Record
João Wilson Rocha, Ana Morais Vasconcelos, Honolfo Elves Simões, Elizandra Soqui,
Nilton Helibrando Rosa. Knowledge of human papillomavirus vaccines among university
students in Angola. Brazilian Journal of Oncology 2022; 18: e-20220299.
DOI: 10.5935/2526-8732.20220299
