ANNEXTURE 1

INSTITUTION BASED (IBR) RESEARCH PROPOSAL

TEMPLATE
Principal Researcher/Investigator
Name: Dr Onyinye Chime

Institution: Enugu State University of Science and Technology College of Medicine

Department: Community Medicine

Telephone No.:+2349157381203

E-mail Address: onyinye.chime@esut.edu.ng

Co-Researcher(s) (if any)
1. Name: Prof. Sussan Arinze-Onyia
2. Name: Dr Chinonyelu Orji
3. Name: Dr Hope Nwoga
4. Name: Dr Chikezie Obasi
5. Name: Dr Obinna Nduagubam
Project Title:
The Impact of Health Education on the Knowledge, Perception and Uptake of Hum
Virus Vaccine Among Female Urban and Rural Secondary School Students In Enugu

Executive Summary:

This is a research project proposal that is seeking to assess the “Impact of Educational
Knowledge, Perception, and Uptake of Human Papilloma Virus Vaccine Among Fema
Rural Secondary School Students in Enugu State, Nigeria”. The rationale behind this p
cancer of the cervix has remained the major cause of morbidity and mortality amon
Nigeria. Since 2008, the National Cancer Prevention Program (NCPP) as well a
recommendations on the prevention of cervical cancer has been in the forefront in ce
prevention through efforts aimed at supporting the health sector in scaling up HPV
screening and early treatment of cervical cancer. Despite all these, cervical cancer rem
health problem and continues to cut short the lives of our women in Nigeria.

The specific objectives of this research project are: 1. To assess the knowledge of

1
among urban and rural female secondary school students in Enugu State. 2.To
perception of urban and rural female secondary school students in Enugu State t
vaccine. 3. To determine the uptake of the HPV vaccine among urban and rural fema
school students in Enugu State. 4. To determine the factors that influence HPV va
among urban and rural female secondary school students in Enugu State. 5. To ascerta
of HPV health education on urban and rural female secondary school students in Enug
research project will be a cross sectional, interventional study design, utilizing a
interventional approach.

This project will be utilizing a quantitative methodology and will be conducted in fo

schools in Enugu state. Young school girls in junior secondary schools 1-3 and aged
years of age will be included in this study. School girls who are ill during the period o
will be excluded. Baseline data will be collected from the school girls on their
perception and uptake of HPV vaccine after which a health educational campaign will b
Post intervention data will also be collected. Analysis will be done with IBM SPSS
Statistical significance with be claimed at P=0.05. This research project is expec
background knowledge, perception, and uptake of HPV vaccination as well as show
an effective peer health education on the above mentioned variables.

The project result is also expected to strengthen the existing cervical cancer prevent
and improve the uptake of Human Papilloma Virus vaccine. The budget estimates was
in mind the cost of hiring needed equpment and other human and material resources ne
out the research project prudently. Finally the combination of the research team
possible for a thorough research project execution.

Keywords: HPV vaccine, Cervical cancer, health education, knowledge, Perception, Up

Introduction

Human Papilloma Virus (HPV) infection is the most prevalent sexually transmit
worldwide. (Loke A.Y. et al, 2017). The infections are most prevalent in young adul
because sexual risk behaviours are greatest in this age group. Studies have documented
active young women, in particular, carry the highest risk of infection with rates as h
71%. (Perez G.K. et al, 2016). It is estimated that approximately 75% of sexually ac
women will acquire HPV infection in their lifetime. (Mavundza E. J. et al, 2021
practice receptive anal intercourse, (Gerend M. A. et al, 2016; Nadarzynski T. et al, 20
who have sex with men (MSM) are also at high risk of HPV infection and its associa
(Gerend M. A. et al, 2016; Nadarzynski T. et al, 2014; Pan H. et al, 2022). There are m
documented HPV types that are classified into low-risk and high-risk types. (Mavund
2021; Lubeya M. K. et al, 2022; Kutz J. M. et al, 2023). Some of the more prevalent h
types include HPV 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58 and 59, whereas some of
low-risk HPV types include HPV 6, 11, 40, 42, 43, 44, 54, 61 and 72. (Mavundz
2021). Although most HPV infections are asymptomatic and transient, persistent in
high-risk HPV types may result in cancers, including cervical, anal, vulvar, vagina
oropharyngeal cancers (Lu P. J. et al, 2015; Niccolai L. M. et al, 2015) and genital wa
L. M. et al, 2015).

Cervical cancer is the most common cancer associated with HPV infection and the
common cancer in women globally. (Kutz J. M. et al, 2023). In 2020, it was estima
were about 604, 127 cases of cervical cancer and 341, 831 cervical cancer related death
E. J. Et al, 2021) Globally about 7.5% of cancer-related deaths among women was
cervical cancer. (Vu M. et al, 2018). Low and Middle-Income Countries (LMICs), espe
Saharan Africa (SSA), carry the largest burden of this disease. (Ngcobo N. J. et al
Saharan Africa, accounts for 20% of cases and 25% of deaths from cervical cance
(Mwenda V. et al, 2023) with women of low socioeconomic status bearing the gre
(Okolie E. A. et al, 2023). The burden is mainly caused by the lack of preventive ser
vaccination or cytological screening (i. e. Pap smears) programmes. (Schmeler K. M
Hsiao A. et al, 2023). Cervical cancer most predominantly affects young, uneducated f
in less developed countries where access to information about the disease, screening,
is inadequate. (WHO, 2020). In sub-Saharan Africa (SSA), cervical cancer is the se
cause of female cancers which accounts for 22.5% of all cancer cases. Moreover, a
females were diagnosed annually with the disease. (Makuza J. D. et al, 2015). HPV inf
responsible for an estimated 90%, 60% and 70% of anal, penile and oropharyngeal ca
respectively. (Schmeler K. M. et al, 2016; Patty N. J. S. et al, 2017)

Vaccination is one of the most effective public health interventions for controlling an
life-threatening diseases and infections. (Singh S. et al, 2018). There is an estimation
save approximately 2–3 million lives globally every year. (Dlamini S. K. et al, 2018)
has been regarded as one of the greatest public health achievements of the 20th century
al, 2017; Gidengil C. et al, 2019). HPV vaccination is an important tool to prevent and
infection and its complications, (Lu P. J. et al, 2015) however, HPV vaccines are m
when administered before sexual debut and first exposure to HPV. (Gallagher K. E. et a
first HPV vaccine was licensed about 19 years ago, in 2006. (WHO, 2022; Kutz
2023). Currently, there are about six licensed HPV vaccines that are used across the
include Cervarix, Cecolin and Walrinvax (the bivalent vaccines); Gardasil and C
quadrivalent vaccines); and Gardasil-9 (the nonavalent vaccine). (Okolie E. A. et al,
2022). Evidence has shown that all six vaccines are safe, effective and highly imm
preventing HPV infection and its consequences. (Okolie E. A. et al, 2023). All vaccine
for use in women and men, except for Cecolin and Walrinvax, which are licensed
only. (WHO, 2022). HPV vaccination is currently recommended for adolescent men
aged 9–14 years in a one or two-dose series. For young men and women above
immunocompromised individuals, including those living with HIV, a three-do
recommended. (WHO, 2022). The introduction of HPV vaccination has been
significant breakthrough in the prevention of cervical cancer and other HPV-related dis
H. et al, 2017).

Many countries globally have introduced HPV vaccines in their national immunisation
to prevent cervical cancer since the licensing of the first vaccine in 2006. (Cooper S
Waller J. et al, 2020). As of 2019, HPV vaccination programmes have been introduced
80% and 41% of high-income countries and LMICs, respectively. (Okolie E. A. et al, 2
et al, 2021). As of December 2019, Nigeria was not there were only 17 countr
introduced HPV vaccination in their national immunisation programmes in Africa
Dacosta E. et al, 2020) and they include Libya, Lesotho, Rwanda, Uganda, Zambia, M
Africa, Botswana, Mauritius and Seychelles. (Kutz J. M. et al, 2023; Abdullahi L. H
Chido-Amajuoyi O. G. et al, 2019). As at the end of 2022, 172 of the 194 WHO M
were considered to have partially or fully introduced national HPV vaccination program
2022). Despite carrying the severe burden of HPV infection and its associated disea
LMICs have introduced HPV vaccination programmes. Out of the 172 countri
introduced HPV vaccination programmes worldwide, only 47 (24%) targeted bo
women. (WHO, 2022).

The global awareness of the Human Papilloma Virus (HPV) and the uptake of its va
adolescents have been low especially among developing countries (Bonanni P. et a
instance, in Nigeria several studies have reported low level of knowledge of the virus a
among parents and even their children. (Morhason-Bello I. O. et al, 2015; Rabiu K. A
However, the reverse has been the case among developed countries where knowledge
the vaccine has been reported to be high. (Borena W. et al, 2016). Another study from
reported that only about 18.5% of secondary school students have knowledge of HPV
about 18.5% uptake. Religious approval and perception of whether vaccination redu
significantly associated with vaccine uptake. (Olufunto T. et al, 2023).

Despite the availability of HPV vaccine for about 19 years, proven efficacy and
recommendation, as well as its implementation by many developed countries, HPV va
remains low in LMICs, compared with other childhood and adolescent vaccines. (Ort
2019). It was estimated that only 4% of men and 15% of women were fully vaccinated
2019. (Grandal M. et al, 2021). Numerous factors that constitute barriers to HPV vac
been identified, including lack of healthcare provider recommendations, concerns
concerns about side effects and a general lack of awareness and knowledge about HPV
(Bradt H. M. et al, 2016). The healthcare workers’ recommendation for vaccination wa
the strongest predictor of vaccine uptake. (Kataria I. et al, 2022; Kong W. Y. et al, 2
have shown that individuals who receive a recommendation for the HPV vaccination ar
to initiate vaccination. (Kong W. Y. et al, Chido-Amajuoyi O. G. et al, 2024). This fur
that knowledge and understanding of HPV vaccination can improve uptake.

Vaccine hesitancy is defined as a delay in acceptance or a refusal of vaccination

availability of vaccination services. (Kateeb E. et al, 2021; El-Elimat T. et al, 2021). It
by factors such as complacency (the person does not see a need and value for
confidence (individual’s confidence in the vaccine) and convenience (access to vaccine
S. et al, 2021; Jafflin K. et al, 2022). Vaccine hesitancy is considered an imp
contributing to low levels of vaccination coverage in many settings. (Ames H. et al, 2
A. et al, 2019). Rejection to vaccinations is not a new phenomenon; it dates back
smallpox vaccination. (Dube E. et al, 2021). In 2019, the WHO identified vaccine hes
of the top 10 threats to global health. (Barello S. et al, 2020; Cooper S. et al, 2021).

For a vaccination programme to be successful, a high level of acceptability and u

relevant population is required. (Cooper S. et al, 2021; Waller J. et al, 2020). There is,
urgent need for the evaluation of the factors associated with HPV vaccination uptak
HPV vaccination target mainly young adolescents, parents/caregivers make the decision
these adolescents. (Anyaka C. U. et al, 2024). Their decision-making also affects th
HPV vaccination programmes. (Anyaka C. U. et al, 2024; Aragaw G. M. et al, 2023).

Problem Statement/Justification

HPV has about 200 serotypes comprising of both oncogenic and non-oncogenic strai
risk HPVs are also called oncogenic HPVs. Oncogenic HPVs (such as HPV 16
responsible for almost 100%, 90%, 70%, 50%, 40%, and 13–72% of cervical, anal, va
vulvar, and oropharyngeal cancers, respectively. (Husain N. et al, 2017; Lee L. Y.
Every year, about 510,000 women are newly diagnosed with invasive cervical cancer w
women die as a result of the disease. Furthermore, approximately 80% of newly repo
cancer cases are from the developing world. (WHO, 2017). There are various routes of
of HPV. The virus can be transmitted through sexual contact (e.g. anal sex, penetrative
and oral sex), skin-to-skin contact, and through child delivery (from mother to child).
risk of HPV infection is as high as 80% (Rodriguez A. C. et al, 2018)

Unfortunately, in Nigeria, HPV vaccination is yet to be introduced into the nat

immunization programs despite the very high prevalence rate of HPV-associated disea
populace. (Lekoane K. M. B. et al, 2019). Generally, young people are known to
vulnerable population group when it comes to the risk of contracting HPV infections. (
D. et al, 2015). This assertion was made based on the rising rate of risky sexual behav
unprotected oral, vaginal and anal sexual intercourse) among the population, coupl
HPV vaccination coverage among them. (Lekoane K. M. B. et al, 2019).

It is estimated that about three out of four people have HPV at some point in their liv
age of 50 years, at least 80 percent of women will have acquired the HPV infection.
CDC, 2020). Persistent infection with high-risk HPV subtypes 16 and 18 have been e
be responsible for about 70% of all cervical cancer cases worldwide. (Bruni L. et al, 2
papillomavirus infection is most prevalent in the younger population. (Izekor S. et al,
23.7% of women and 73% of men in the general population in Nigeria carry a HPV gen
and within the first three years of sexual debut, 50% of women have evidence of an H
(Bruni L. et al, 2019). It is the second most common cancer in women living in le
regions of the world. (WHO, 2019). The development of cervical cancer is a multi-stag
occurs over many years and begins when a woman gets infected with an oncogenic typ
In Nigeria, cervical cancer ranks as the second most common cancer in women aged 1
with about 14,943 new cases diagnosed annually. (Bruni L. et al, 2019). It is the se
cause of cancer mortality in the country. (WHO, 2020). These statistics are indicative o
burden of disease in a country where the population at risk for cervical cancer (fem
years and above) is estimated to be 53.1 million. (Bruni L. et al, 2019).

Cervical cancer can be prevented through the use of specific interventions such as hea
(on delayed sexual debut, practice of safe sex, benefits of HPV vaccination) and
vaccination against HPV. It can be completely cured when diagnosed early after the use
methods such as Papanicolaou (Pap) smear test. Unfortunately, the uptake of both HPV
and cervical screening services are still rudimentary in Nigeria. (Ferlay J. et al, 201
despite the strides made in HPV vaccination and education, over half a million wome
develop cervical cancer each year and over 85% of these cases occur in developing cou
the lack of effective screening and prevention programmes. (Ferlay J. et al, 2018)
A study conducted among senior secondary school students in six states in Nigeria rep
knowledge of HPV vaccine was very low among the students. The majority (74.0%
average knowledge about the HPV vaccine. (Fagbule O. F. et al, 2020). In another stu
of HPV vaccine was 18.5% and 79.9% were willing to vaccinate. The major bar
vaccination were lack of adequate information about the vaccine and fear of the side
vaccine. (Akpor O. A. et al, 2023). All these show that both knowledge and up
vaccination was poor in Nigeria.

Justification
HPV vaccine was launched in Nigeria in 2009, yet almost two decades after, the knowl
as the causative agent of cervical and HPV vaccination as a preventive measure ag
cancer including the uptake of vaccination by the target population of young p
abysmally low. Many studies carried out among female students in secondary
universities in Nigeria have corroborated this fact. (Oluwole E. O. et al, 2019; Ojimah C
Bisi-Onyemaechi A. I. et al, 2018; Ndikom C. M. et al, 2017). In a similar way,
caregivers of young people have demonstrated poor knowledge of cervical cancer pr
screening for their children in Nigeria. (Ifedioha C. O. et al, 2018; Azuogu B. N. et a
deficiency of such knowledge may adversely affect the acceptability and uptake of
since it is these parents and caregivers that will encourage their children to get vaccinat

In Nigeria, few and limited studies have assessed the knowledge of secondary schoo
HPV vaccines. Therefore, it will be of huge public health benefit if the knowledge of
people in Nigeria on HPV vaccine is known, as such information will go a long way i
Nigerian government and other relevant stakeholders on how to develop, promote, an
public health policies/ programs that will mitigate the community spread of the virus
and also encourage their uptake of HPV vaccine.

Also, most of the studies we reviewed concentrated on knowledge and uptake of HPV
this study will go beyond that to also study the perception of these students concernin
and the factors that determine uptake thereby giving a comprehensive information on
secondary students. From our search no similar studies with the same objectives as ou
conducted among secondary school students in Enugu state. The outcomes of this stud
inform all relevant stakeholders in the Enugu state and Nigerian public health secto
effectively formulate, promote, and implement school health education policies/program
mitigating the spread of HPV infection among adolescents in Nigeria.

Conducting this kind of study amongst secondary school students is highly just
roughly 1 in 10 adolescents in Nigeria are sexually active. (Chimah U. C. et al, 2016; O
et al, 2017). Secondly, the knowledge of HPV vaccine among these adolescents
collective level of preparedness towards the prevention of HPV transmission; and
outcomes of this study will help to inform all relevant stakeholders in the Nigerian
sector on how to effectively formulate, promote, and implement school heal
policies/programs targeted at mitigating the spread of HPV infection among adolescent

Secondary school students are a special population at risk of contacting HPV w

subsequent development of cervical cancer. This is so because most of them are ad
may be exploring sexually. Therefore, this study will promote the knowledge of HPV
perception and uptake among secondary school students and add to the body of evid
reducing the burden of cervical cancer in Nigeria, Sub Saharan Africa and the world g
findings of this study will also help to promote acceptability and uptake of HPV v
Africa, by developing interventions tailored to address identified factors.

This study will also compare knowledge of HPV vaccine, perception towards HPV, up
and factors that affect uptake of the vaccine among urban and rural secondary schoo
determine whether there are disparities based on place of residence. This will also
interventions to specific needs of these adolescents based on their place of residence.

Research Questions
1. What is the level of knowledge of HPV vaccine among urban and rural fema
 school students in Enugu State.
2. How do urban and rural female secondary school students in Enugu State per
vaccine.
3. What is the uptake of the HPV vaccine among urban and rural female seco
students in Enugu State.
4. What factors determine HPV vaccine uptake among urban and rural fema
school students in Enugu State.
5. What are the effects of HPV health education on urban and rural female seco
students in Enugu State.
Objective(s) of the study
General Objective: To evaluate the impact of health education on knowledge, pe
uptake of HPV vaccine among urban and rural female secondary school students in Enu

Specific Objectives
1. To assess the knowledge of HPV vaccine among urban and rural female seco
students in Enugu State.
2. To ascertain the perception of urban and rural female secondary school stude
State towards HPV vaccine.
3. To determine the uptake of the HPV vaccine among urban and rural female seco
students in Enugu State.
4. To determine the factors that influence HPV vaccine uptake among urban and
secondary school students in Enugu State.
5. To ascertain the effects of HPV health education on urban and rural female seco
students in Enugu State.
Literature Review

Across the global, African, and Nigerian contexts, including specifically within Enugu
education has consistently demonstrated its effectiveness in improving knowledge a
regarding HPV infection and the benefits of HPV vaccination among adolescents.
(Yordanos Sisay Asgedom et al., 2024)
This increase in knowledge often leads to a higher degree of w
intention among both adolescents and their parents to receive the HPV vaccine.
(Iova et al., 2024; Yordanos Sisay Asgedom
Furthermore, interventions that combine
components with other supportive strategies, such as vaccination reminders, peer supp
or logistical facilitation, tend to have a more substantial positive impact on the actual
vaccine uptake. (Iova et al., 2024)

However, the effectiveness of health education interventions on HPV vaccine uptake i

and can vary considerably depending on several factors, including the specific type o
implemented, the methods used for delivery, the characteristics of the population being
the broader contextual factors at play, such as cultural norms and the existin
infrastructure. (Iova et al., 2024) Studies examining the impact of health education on
uptake have employed a range of research designs, including rigorous cluster randomiz
trials (Grandahl et al., 2016) , quasi-experimental designs that involve assessing part
before and after the intervention (Kim et al., 2024) , and smaller-scale pilot interve
designed to test the feasibility and initial impact of specific approaches. (Kim et al., 2
evidence indicating the positive influence of health education, HPV vaccine uptak
remained below optimal levels in many African countries. (Yordanos Sisay Asgedom e
Specifically within Enugu State, prior to the recent national and state-level vaccinatio
female secondary school students and teachers exhibited low baseline knowledge ab
the HPV vaccine. However, there was a generally high level of acceptance of the va
those individuals who were aware of its existence and purpose. (Enebe et al., 2021) E
recent governmental and collaborative campaigns conducted in Enugu State ha
significant increases in HPV vaccination coverage among the target age group. (VO
specific role and effectiveness of the health education strategies that were integrated
recent campaigns warrant further and more detailed investigation to understand wha
most to this positive shift in uptake.

Methodology (Should include description of study area/site/subjects, data collection and da

Study Area
The study area is Enugu State, one of the five states in the Southeast geopolitical zon
Enugu State has 17 local government areas (LGAs); 3 urban and 14 rural LGAs. En
314 public secondary schools and 210 private secondary schools. (MoE Enugu State
school census report. The student-teacher ratio is 15:1 for secondary schools in the st
student-classroom ratio is 144:1.
Study Design
This will be a quasi-experimental interventional study with a pre-test/post-test control
aimed at comparing determinants and evaluating the impact of an educational interven
vaccine uptake among female secondary school students in urban and rural areas in
The state is bordered to the north by Benue and Kogi, to the East and South-east by Eb
the South by Abia State and to the West by Anambra State. It covers an area of 13,
kilometer. The state capital is Enugu and the State has a projected population of 7,690
The people are primarily civil servants, traders and students. The primary religion is C
diverse denominations. The spoken languages are Igbo and English Languages.

Study Population
The study population will consist of female students enrolled in selected public seconda
urban and rural areas of Enugu State. Both junior and senior secondary school stu
included.

Inclusion Criteria
 Female students aged 9–14years.

Exclusion Criteria
 Students who became sick during the period of the study .

 Sample Size Determination

The required sample size for this interventional study was calculated using the
comparing two independent proportions:

n = (Zα/2 + Zβ)2 [p1(1 - p1) + p2(1 - p2)]/ (p1 - p2)2

Where:

 n: sample size per group

 Zα/2 =1.96, for 95% confidence
 Zβ=0.84, for 80% power
  p1, assumed uptake rate in the control group
 p2, expected uptake rate in the intervention group

From recent literature:

 Baseline HPV vaccine uptake among Nigerian female adolescents = 18%

 Expected uptake after health education = 35%

So:

 p1 = 0.18 (Umeh et al 2021)

 p2 = 0.35

n = (1.96 + 0.84)2 . [0.18 (1 – 0.18) + 0.35 (1 – 0.35)]

(0.35 – 0,18)2

n = (2.8)2 . (0.1476 + 0.2275)

(0.17)2

n = 7.841 . 0.3751 = n = 2.94 = 102 per group

0.0289 0.0289

Minimum sample size = 102 respondents

To account for potential non-response, a 10% adjustment was applied

nadjusted = 102/ 0.90 = 114

Final sample size = 114 students per group. This will be increased to 150 per group pe
more robust study.

300 total participants will be the minimum sample size for this proj

a total of 300 female secondary school students, comprising 150 students in

intervention and control groups. Will be recruited for this study.

Sampling Technique
A multi-stage sampling technique will be employed:
Stage 1 will involve selection of two LGAs (one urban and one rural) from Enugu
simple random sampling.
From each selected LGA, two public secondary schools (one for intervention and the
will be randomly selected in the second stage (making a total of four schools).
Proportionate sampling will be used to allocate sample size to the schools based on
load.
Cluster sampling will be used to select 2 classes from each form.(JSS1 – JSS3). Partic
enrolled until the required sample size is attained.
Intervention
The intervention will consist of a structured health education program focused on:
 HPV infection and its link to cervical cancer.

 Benefits, safety, and efficacy of the HPV vaccine.

 National and global recommendations for HPV vaccination.
This educational session will be delivered by the researchers (doctors) through intera
and presentations using infographics and video clips. This will last for 45-60 minutes
group will receive standard health talks unrelated to HPV.

Study Instrument
A pre-tested, semi-structured, self-administered questionnaire will be used to co
baseline, immediate and post-intervention (after 12 weeks). The questionnaire will
sections: Section A on Socio-demographic characteristics, section B on Knowledge of
vaccine, section C on Perception on HPV vaccine and section D on HPV Vaccin
willingness to be vaccinated.
Pre-Testing of Instrument:
The questionnaire will be pre-tested among 23 (10%) of our sample size in a second
Enugu State not selected for the study. This is to remove ambiguities and ensure
reliability of the tool using the Cronbach’s alpha tool.
Data Collection Procedure

 Baseline data will be collected from both intervention and control group
intervention: This will be done by projecting and reading out the questionn
board.
 The educational intervention will then be delivered only to the intervention gro
control group receives standard health education unrelated to HPV.
 Twelve weeks post-intervention, the same questionnaire will be re-adminis
groups to assess changes in knowledge, perception, and vaccine uptake.
 Vaccine uptake will be verified using school health records or vaccination
available. Additionally, HPV vaccines will be made available from State Prima
Development Agency for willing students. This will also be used to determin
vaccine uptake.
Data Analysis
Data will be analyzed using SPSS version 26. Descriptive statistics (means, freq
percentages) will be used to summarize data. Chi-square test will be used for bivariate
difference in pre- and post-intervention knowledge, perception, and vaccine up
evaluated. Multivariable logistic regression will be conducted to determine predic
vaccine uptake, with statistical significance set at p < 0.05.

Ethical Considerations
Ethical approval will be obtained from the Health Research Ethics Committee of
University Teaching Hospital (ESUTH). Permission will also be obtained Post Pri
Management Board. Parental consent and student assent will be required for
Anonymity, privacy, and confidentiality of participants will be strictly maintained. Par
be informed of their right to withdraw from the study at any time without any conseque

Results (Expected Outputs/Results)

1. This study will reveal the comparative level of knowledge of the HPV va
students in urban and rural areas in Enugu State

2. The research will provide a view of how students perceive the HPV vacci
common fears, beliefs, and trust in healthcare systems.

3. We will be able to quantify the rate of HPV vaccine uptake among stud
settings.

4. We shall be able to identify key factors that influence vaccine uptake in ord
the design of more effective, context-sensitive interventions.

5. Finally, the research is expected to demonstrate the impact of health educat

on students’ knowledge, perceptions, and willingness to receive the vaccine.
Work Plan/Time Frame (Provide activity by activity in the form of a GANTT Chart)

Duration Quarter
S/N Activity Year
Month
(s) 1st 2nd 3rd 4th

1. √ C
2025
Pretesting of questionnaires 1 acti
exp
2. Restructuring of 2025 √
“
pretested 1
questionnaires
3. Pretesting of questionnaires 1 2025 √ “

4. Recruitment of respondents for

3 2025 √ “
the study

5. Data entry and cleaning 1 2026 √ “

6. Data analysis 1 2026 √ “

9. Report writing 2 2026 √ “

10 Result dissemination to
stakeholders and presentation 1 2026 √ “
at meetings/conferences

11. Journal publication 2 2026 √ “

Budget (Provide a budget break-down by activity/line item)

 DESCRIPTION OF ITEM
Unit Total TOTA
1.0 Equipment (List & Specify)
1.1 H i r i n g o f p r o j e c t o r s 40,000 160,000
and screens x4
1.2 M o b i l e S t a n d i n g Flex 30,000 30,000
1.3 Hiring and fueling of generators x 30,000 120,000
4
Sub-Total 310000
2.0 Supplies/Consumables
2 . 1 P r i n t i n g of 75000 225,000
q u e s t i o n n a i r e s f o r 250
p a r t i c i p a n t s
X4schools
2.2 Printing of Consent form for 12500 50,000
250 students per school
2.3 Printing of Assent form for 12500 50,000
250 students per school
Sub-Total 325000

3.0 Refreshments for students

and their teachers
3.1 Biscuits for 300 per school @N100 30000 120000
each X4 schools
Sub-Total 120,000
4.0 Training
4.1 Training of Research 5,000 50000
Assistants (training of 10
assistants)
4.2 Hiring of projector and screen 40000 40000
for training
Sub-Total 90,000

5.0 Data Collection and Analysis

5.1 Data Entrants (4) @N100 per 50,000 200000

questionnaire per school
5.2 Souvenir for 50000
25000
300 participants (pen) @N100 per pen
for 250 respondents X 4 schools
5.3 Data Analysis @N60000 per set 60000 180000
5.4 Ethical Clearance 50000 50000
Sub-Total 480000
5.0 Travels
5.1 Local transportation for d a t a 20000
 collection
Car-hires for first visit for urban 20000
Car hire for first visit for rural 40000 40000
Care hires for each visit for urban (Bus 40000 120000
hire) x3
Car hires for each visit for rural (bus 80000 240000
hire X 3)
Sub-Total 420,000
6.0 Others/Miscellaneous (Specify)
6.1 Publication fee 250,000 250,000 250000
TOTAL N1,995,0

th
Reference

Abdullahi, L. H., Hussey, G. D., Wiysonge, C. S., & Kagina, B. M. (2020). Lessons lea
the national introduction of human papillomavirus (HPV) vaccination programmes in 6
countries: Stakeholders’ perspectives. S Afr Med J, 110 (6), 525-31.
doi:10.7196/SAMJ.2020.v110i6.14332
Adeniyi, F. I., John-Akinola, Y. O., & Oluwasanu, M. M. (2023). Intention and Concer
HPV Vaccination among In-School Adolescents in Ibadan, Oyo State, Nigeria. Nigeria
Journal : Journal of the Nigeria Medical Association, 64(3), 352.
https://pmc.ncbi.nlm.nih.gov/articles/PMC11223017/
Akpor, O. A., Adeyiolu, A. T., Alade, M. I., Adebiyi, S., Adeola, R. S., & Adeyanju, B
Knowledge, attitude, and utilization of human papillomavirus vaccination among femal
undergraduates in Ekiti State, Nigeria. African Journal of Reproductive Health, 27 (6s)
10.29063/ajrh2023/v27i6s.10
Ames, H., Njang, D. M., Glenton, C., Fretheim, A., Kaufman, J., Hill, S., et al. (2017).
perceptions of communication about vaccination in two regions of Cameroon: A qualita
study. PLoS ONE, 12, e0183721. doi:10.1371/journal.pone.0183721
Amponsah-Dacosta, E., Kagina, B. M., & Olivier, J. (2020). Health systems constraints
facilitators of human papillomavirus immunization programmes in sub-Saharan Africa:
review. Health Policy Plan, 35, 701–17. doi:10.1093/heapol/czaa017
Anyaka, C. U., Alero, B. J., Olukoya, B., Envuladu, E. A., Musa, J., & Sagay, A. S. (20
Knowledge of HPV Infection, Cervical Cancer and the Acceptance of HPV Vaccination
Children in Jos, Nigeria. J West Afr Coll Surg, 14(2),146–53. doi:10.4103/jwas.jwas_3
Aragaw, G. M., Anteneh, T. A., Abiy, S. A., Bewota, M. A., & Aynalem, G. L. (2023).
willingness to vaccinate their daughters with human papillomavirus vaccine and associa
in Debretabor town, Northwest Ethiopia: A community-based cross-sectional study. Hu
Immunother, 19, 2176082. doi:10.1080/21645515.2023.2176082
Asgedom, Y. S., Kebede, T. M., Seifu, B. L., Mare, K. U., Asmare, Z. A., Asebe, H. A.
Shibeshi, A. H., Tebeje, T. M., Sabo, K. G., Fente, B. M., Lombebo, A. A., Koyira, M.
Kassie, G. A. (2024). Human papillomavirus vaccination uptake and determinant factor
adolescent schoolgirls in sub-Saharan Africa: A systematic review and meta-analysis. H
Vaccines & Immunotherapeutics, 20(1). https://doi.org/10.1080/21645515.2024.232629
El-Elimat, T., AbuAlSamen, M. M., Almomani, B. A., AI-Sawalha, N. A., & Alali, F. Q
Acceptance and attitudes toward COVID-19 vaccines: A cross-sectional study from Jor
ONE, 16, e0250555. doi:10.1371/journal.pone.0250555
Elikwu, C. J., Ajani, T. A., Shonekan, O., Nwadike, V., Tayo, B., Okangba, C. C., Idak
Onyekachi, O., Ene, B., Omeonu, A. C., Faluyi, B., Ajide, J. O., Braimoh, G.-F., Ezeh,
Ogunbowale, I. M., Omotayo, E. O., Ukpai, C., Etoh, F., Elikwu, C. J., … Etoh, F. (202
Evaluation of Awareness of Human Papillomavirus and Cervical Cancer among Female
Undergraduates of a Private Mission University in Southwestern Nigeria. Advances in
Microbiology, 12(11), 621–633. https://doi.org/10.4236/AIM.2022.1211043
Enebe, J. T., Enebe, N. O., Agunwa, C. C., Nduagubam, O. C., Okafor, I. I., Aniwada,
Aguwa, E. N. (2021). Awareness, acceptability and uptake of cervical cancer vaccinatio
among female secondary school teachers in Enugu, Nigeria: a cross-sectional study. Th
African Medical Journal, 39, 62. https://doi.org/10.11604/PAMJ.2021.39.62.28824
Evans School of Public Policy & Governance. (n.d.). Achieving 71% HPV Vaccination
Nigeria - Evans School of Public Policy & Governance. Retrieved April 13, 2025, from
https://evans.uw.edu/achieving-71-hpv-vaccination-coverage-in-nigeria/
Fagbule, O. F., Kanmodi, K. K., Aliemeke, E. O., Ogunniyi, K. E., Ogbeide, M., Victor
(2020). Knowledge of HPV and HPV vaccine among senior secondary school students
Implications on cancer prevention strategies, the CHANCE Study. Population Medicin
https://doi.org/10.18332/popmed/127237
Fagbule, O. F., Kanmodi, K. K., Aliemeke, E. O., Ogunniyi, K. E., Ogbeide, M., Victor
T. O., Adewuyi, H. O., Omoleke, S. A., & Kanmodi, P. A. (2020). Knowledge of HPV
vaccine among senior secondary school students in Nigeria: Implications on cancer pre
strategies, the CHANCE Study. Population Medicine, 2. https://doi.org/10.18332/POPM
Ferlay, J., Shin, H., Bray, F., Forman, D., Mathers, C., & Parkin, D. (2010). Estimates o
burden of cancer in 2008. Int J Cancer Prevention, 127, 2893-2917.
Gallagher, K. E., Howard, N., Kabakama, S., Mounier-Jack, S., Burchett, H. E. D., LaM
S., et al. (2017). Human papillomavirus (HPV) vaccine coverage achievements in low a
income countries 2007-2016. Papillomavirus Res, 4, 72–8. doi:10.1016/j.pvr.2017.09.0
Gerend, M. A., Madkins, K., Phillips, G., & Mustanski, B. (2016). Predictors
Papillomavirus Vaccination Among Young Men Who Have Sex With Men. Sex Tra
185–91. doi:10.1097/OLQ.0000000000000408
Gidengil, C., Chen, C., & Parker, A. M. (2019). Beliefs around childhood vaccines in th
States: A systematic review. Vaccine (Auckl), 37, 6793–802. doi:10.1016/j.vaccine.201
Grandahl, M., Rosenblad, A., Stenhammar, C., Tydén, T., Westerling, R., Larsson, M.,
M., Andrae, B., Dalianis, T., & Nevéus, T. (2016). School-based intervention for the pr
HPV among adolescents: A cluster randomised controlled study. BMJ Open, 6(1).
https://doi.org/10.1136/BMJOPEN-2015-009875
Grandahl, M., & Nevéus, T. (2021). Barriers towards HPV Vaccinations for Boys and Y
A Narrative Review. Viruses, 13, 1644. doi:10.3390/v13081644
Hsiao, A., Struckmann, V., & Stephani, V. (2023). Costs of delivering human papillom
vaccination using a one- or two-dose strategy in Tanzania. Vaccine (Auckl), 41, 372–
9. doi:10.1016/j.vaccine.2022.11.032
Husain, N., & Neyaz, A. (2017). Human papillomavirus associated head and neck squa
carcinoma: Controversies and new concepts. J Oral Biol Craniofac Res, 7(3),198-205.
doi:10.1016/j.jobcr.2017.08.003
Ifedioha, C. O., & Azuike, A. C. (2018). Knowledge and attitudes about cervical cance
prevention among female secondary school students in Nigeria. Trop Med Int Health, 2
723.
Ihudiebube-Splendor. (n.d.). Attitude and Perceived Barriers to Uptake of Human Papi
Vaccine among Female Students in a Nigerian Tertiary Institution. Retrieved April 13,
www.ijmrhs.com
Ijeoma V Ezeome, & Joseph Ezugworie. (2019). Male Acceptance of Human Papillom
Vaccine for Family Members in Enugu, South-East Nigeria. Journal of Vaccines & Vac
10:408. DOI: 10.35248/ 2157-7560.19.10.408
Iova, C. F., Daina, L. G., Daina, M. D., & Ghitea, T. C. (2024). The Effectiveness of In
Targeting Adolescents in HPV Vaccination—A Scoping Review. Medicina, 60(9), 155
https://doi.org/10.3390/MEDICINA60091550
Israel, C. E., Ogbu, N. N., Ingwu, J. A., Chinenye, A. J., & Chikeme, P. C. (2019). Kno
acceptance of human papilloma virus vaccine among secondary school students in quee
secondary school, Enugu, Nigeria. Nursing Practice Today, 6(1), 34–40.
https://doi.org/10.18502/NPT.V6I1.391
Izekor, S., Osifo, U., Orhue, P., Momoh, A., Airhomwanbo, K. (2014). Knowledge and
condom usage among undergraduate students in Edo State, Nigeria. International Journ
Community Research, 3(1), 12-18.
Jafflin, K., Deml, M. J., Schwendener, C. L., Kiener, L., Delfino, A., Gafner, R., et al. (
Parental and provider vaccine hesitancy and non-timely childhood vaccination in
Switzerland. Vaccine (Auckl),40,3193–202. doi:10.1016/j.vaccine.2022.04.044
Kataria, I., Siddiqui, M., Treiman, K., Foley, S., Anand, M., Biswas, S. et al. (2022). A
Perceptions, and Choices of Physicians Pertaining to Human Papillomavirus (HPV) Va
India: A Formative Research Study. 12. Vaccine: X, 12, 100228. doi: 10.1016/j.jvacx.2
Kateeb, E., Danadneh, M., Pokorná, A., Klugarova, J., Abdulqader, H., Klugar, M., et a
Predictors of Willingness to Receive COVID-19 Vaccine: Cross-Sectional Study of Pal
Dental Students. Vaccines (Basel), 26, 9(9), 954. doi:10.3390/vaccines9090954
Kim, Y., Lee, H., Park, J., Kim, Y.-C., Kim, D. H., & Lee, Y.-M. (2024). eHealth Com
Intervention to Promote Human Papillomavirus Vaccination Among Middle-School Gi
Development and Usability Study. JMIR Formative Research, 8(1), e59087.
https://doi.org/10.2196/59087
Kong, W. Y., Bustamante, G., Pallotto, I. K., Margolis, M. A., Carlson, R., McRee, A.
(2021). Disparities in Healthcare Providers’ Recommendation of HPV Vaccination for
Adolescents: A Systematic Review. Cancer Epidemiol Biomarkers Prev, 30(11),1981–
92. doi:10.1158/1055-9965.EPI-21-0733

Kutz, J., Rausche, P., Gheit, T., Puradiredja, D. I. & Fusco, D. (2023). Barriers and faci
HPV vaccination in sub-saharan Africa: a systematic review. BMC Public Health, 23,
974. doi:10.1186/s12889-023-15842-1
Lee, L. Y., & Garland, S. M. (2017). Human papillomavirus vaccination: the population
F1000Res. 6, 866. doi:10.12688/f1000research.10691.1
Lekoane, K. M. B., Kuupiel, D., Mashamba-Thompson, T/ P., & Ginindza, T. G. (2019
on the prevalence, incidence, mortality and trends of human papilloma virus-associated
sub-Saharan Africa: systematic scoping review. BMC Cancer, 19(1), 563. doi:10.1186/
5781-3
Loke, A. Y., Kwan, M. L., Wong, Y., & Wong, A. K. Y. (2017). The Uptake of Human
Papillomavirus Vaccination and Its Associated Factors Among Adolescents: A Systema
Review. J Prim Care Community Health, 8, 349–62. doi:10.1177/2150131917742299
Lu, P., Yankey, D., Jeyarajah, J., O’Halloran, A., Elam-Evans, L. D., Smith, P. J., et al.
HPV Vaccination Coverage of Male Adolescents in the United States. Pediatrics, 136,
49. doi:10.1542/peds.2015-1631
Lubeya MK ,Mwanahamuntu M ,Chibwesha C , Mukosha M, Wamunyima MM, & Ka
(2022) Implementation strategies to increase human papillomavirus vaccination uptake
adolescent girls in sub-Saharan Africa: A scoping review protocol. PLoS One, 17(8),
e0267617. doi:10.1371/journal.pone.0267617
Makuza, J. D., Nsanzimana, S., Muhimpundu, M. A., Pace, L. E., Ntaganira, J., & Ried
(2015). Prevalence and risk factors for cervical cancer and pre-cancerous lesions in Rw
Afr Med J, 22(1). doi: 10.11604/pamj.2015.22.26.7116.

Mavundza, E. J., Iwu-Jaja, C. J., Wiyeh, A. B., Gausi, B., Abdullahi, L. H., Halle-Ekan
al. (2021). A Systematic Review of Interventions to Improve HPV Vaccination Covera
(Basel), 9, 687. doi:10.3390/vaccines9070687
Ministry of Education Enugu State. 2013-2014 Annual School Census Report. 2014. A
https://www.esspin.org/reports/download/411-file-Enugu-ASC-Report2013_14.pdf. Ac
12/04/2025.
Morhason‐Bello, I. O., Wallis, S., Adedokun, B. O., & Adewole, I. F. (2015). Willingn
reproductive‐ aged women in a Nigerian community to accept human papillomavirus v
their children. Journal of Obstetrics and Gynecology research, 41(10),1621-9.
Mwenda, V., Jalang’o, R., Miano, C., Bor, J., Nyangasi, M., Mecca, L., et al. (2023). I
effectiveness, and budget implications of HPV vaccination in Kenya: A modelling stud
(Auckl), 41, 4228–38. doi:10.1016/j.vaccine.2023.05.019
Nadarzynski, T., Smith, H., Richardson, D., Jones, C. J., & Llewellyn, C. D. (2014). Hu
papillomavirus and vaccine-related perceptions among men who have sex with men: a s
review. Sex Transm Infect, 90(7), 515–23. doi:10.1136/sextrans-2013-051357
Ndikom, C. M., & Oboh, P. I. (2017). Perception, acceptance and uptake of human pap
vaccine among female adolescents in selected secondary schools in Ibadan, Nigeria. Af
Res, 20, 237-244.
Ngcobo, N. J., Burnett, R. J., Cooper, S., & Wiysonge, C. S. (2019). Human papillomav
vaccination acceptance and hesitancy in South Africa: Research and policy agenda. S A
J 2019, 109(1),13-15. doi:10.7196/SAMJ.2018.v109i1.13723
Niccolai, L. M., & Hansen, C. E. (2015). Practice- and Community-Based Intervention
Human Papillomavirus Vaccine Coverage: A Systematic Review. JAMA Pediatr, 169,
doi:10.1001/jamapediatrics.2015.0310
Odimegwu, C., & Somefun, O. D. (2017). Ethnicity, gender and risky sexual behaviour
Nigeria youth: an alternative explanation. Reprod Health. 2017,14(1), 16. doi:10.1186/
0284-7
Ohareri, B., Adefolaju, A. O., & Onyeneho, C. A. (2020). Knowledge, attitudes and per
Nigerian parents towards human papilloma virus (HPV) vaccines. European Journal of
4(January). https://doi.org/10.18332/EJM/114886
Ojeleye, O. A., & Adejumo, P. O. (2019). Knowledge and acceptance of HPV vaccinat
Lagos students. African Journal of Midwifery and Women’s Health, 13(2), 1–8.
https://doi.org/10.12968/AJMW.2018.0003
Ojimah, C., & Maduka, O. (2017). Awareness and uptake of human papillomavirus vac
female undergraduate students: Implications for cervical cancer prevention in South-So
Port Harcourt Med J. 11, 134-140. 1
Okagbue, H. I., Erekosima, G., Sampson, S., Atuhaire, B., Samuel, O., Chimezie, B., D
Jimoh, A., Ogbu, G., Ayuba, J., & Shinshima, I. (2025). Predictors of willingness of HP
uptake across Eight States in Nigeria. BMC Public Health, 25(1). https://doi.org/10.118
025-22000-2
Okolie, E. A., & Nwadike, B. I. (2023). Spotlight on Human Papillomavirus Vaccinatio
Is Nigeria Making Any Progress? JCO Glob Oncol, 9, e2300088. doi:10.1200/GO.23.0
Olufunto, T. E. (2023). Knowledge, attitude, and uptake of Human Papilloma Virus (H
among parents of adolescents attending outpatient clinic at the University of Benin Tea
Hospital, Nigeria. African Journal of Reproductive Health, 27 (3), 108-117. DOI:
10.29063/ajrh2023/v27i3.12
Oluwole, E. O., Idowu, O. M., Adejimi, A. A., Balogun, M. R., & Osanyin, G.E. (2019
Knowledge, attitude and uptake of human papillomavirus vaccination among female un
in Lagos State, Nigeria. J Family Med Prim Care, 8(11), 3627- 3633.
Ortiz, R. R., Smith, A., & Coyne-Beasley, T. (2019). A systematic literature review to e
potential for social media to impact HPV vaccine uptake and awareness, knowledge, an
about HPV and HPV vaccination. Hum Vaccin Immunother, 15, 1465-
75. doi:10.1080/21645515.2019.1581543
Pan, H., He, W., Lin, B., & Zhong, X. (2022). Factors influencing HPV vaccination wi
among men who have sex with men in China: a structural equation modeling analysis. H
Immunother, 18(1), 2038504. doi:10.1080/21645515.2022.2038504

Patty, N. J. S., van Dijk, H. M., Wallenburg, I., Bal, R., Helmerhorst, T. J. M., & van E
(2017). To vaccinate or not to vaccinate? Perspectives on HPV vaccination among girls
parents in the Netherlands: a Q-methodological study. BMC Public Health, 17(1),
872. doi:10.1186/s12889-017-4879-2
Perez, G. K., Cruess, D. G., & Strauss, N. M. (2016). A brief information-motivation-b
skills intervention to promote human papillomavirus vaccination among college-aged
women. Psychol Res Behav Manag, 9,285–96. doi:10.2147/PRBM.S112504
Perlman, S., Wamai, R. G., Bain, P. A., Welty, T., Welty, E., & Ogembo, J. G. (2014).
and awareness of HPV vaccine and acceptability to vaccinate in sub-Saharan Africa: A
review. PLoS ONE, 9(3). https://doi.org/10.1371/JOURNAL.PONE.0090912
Rabiu, K. A., Alausa, T. G., Akinlusi, F. M., Davies, N. O., Shittu, K. A. & Akinola, O
Parental acceptance of human papillomavirus vaccination for adolescent girls in Lagos,
Journal of Family Medicine and Primary Care, 9(6), 2950-3000.
Ritchwood, T. D., Ford, H., DeCoster, J., Sutton, M., & Lochman, J. E. (2015). Risky S
Behavior and Substance Use among Adolescents: A Meta-analysis. Child Youth Serv R
88. doi:10.1016/j.childyouth.2015.03.005
Rodríguez, A. C., Schiffman, M., Herrero, R., Wacholder, S., Hildesheim, A., Castle, P
(2008). Rapid clearance of human papillomavirus and implications for clinical focus on
infections. J Natl Cancer Inst. 100(7), 513-517. doi:10.1093/jnci/djn044
Schmeler, K. M., & Sturgis, E. M. (2016). Expanding the benefits of HPV vaccination
men. Lancet, 387, 1798–9. doi:10.1016/S0140-6736(16)30314-2
Sendekie, A. K., Abate, B. B., Adamu, B. A., Tefera, A. M., Mekonnen, K. T., Ashagri
Tadesse, Y. B., Dagnaw, A. D., Melaku, M. S., & Bizuneh, G. K. (2025). Human papil
vaccination hesitancy among young girls in Ethiopia: factors and barriers to uptake. Fro
Public Health, 13, 1507832. https://doi.org/10.3389/FPUBH.2025.1507832/BIBTEX
Singh, S., Sahu, D., Agrawal, A., & Vashi, M. D. (2018). Ensuring childhood vaccinati
slums dwellers under the National Immunization Program in India - Challenges and
opportunities. Prev Med, 112:54–60. doi:10.1016/j.ypmed.2018.04.002
Talabi, O., Gilbert, H., Smith Fawzi, M. C., Anorlu, R., & Randall, T. (2023). Examinin
and facilitators of HPV vaccination in Nigeria, in the context of an innovative delivery
mixed-methods study. BMJ Public Health, 1, 3. https://doi.org/10.1136/bmjph-2023-00
Tamara May. (2025, February 24). HPV Awareness Day 2025: Vaccination progress a
challenges | Research Communities by Springer Nature.
https://communities.springernature.com/posts/hpv-awareness-day-2025-vaccination-pro
challenges
Umeh, I. B., Nduka, I., & Ezeanochie, M. (2021). Awareness and acceptability of huma
papillomavirus vaccine among female adolescents in Southern Nigeria. Journal of Publ
Africa, 12(1), 168–173. https://doi.org/10.4081/jphia.2021.168
VON. (n.d.). Enugu State vaccinates 220,000 girls against HPV – Voice of Nigeria. Re
15, 2025, from https://von.gov.ng/enugu-state-vaccinates-220000-girls-against-hpv/
Vu, M., Yu, J., Awolude, O. A., & Chuang, L. (2018). Cervical cancer worldwide. Cur
Cancer, 2018, 42(5), 457–10. doi: 10.1016/j.currproblcancer.2018.06.003.
Waller, J., Forster, A., Ryan, M., Richads, R., Bedford, H., & Marlow, L. (2020). Decis
about HPV vaccination in parents of boys and girls: A population-based survey in Engl
Wales. Vaccine (Auckl), 38(5),1040–7. doi:10.1016/j.vaccine.2019.11.046
Wirsiy, F. S., Nkfusai, C. N., Ako-Arrey, D. E., Dongmo, E. K., Manjong, F. T., & Cum
N. (2021). Acceptability of COVID-19 Vaccine in Africa. Int J MCH AIDS, 10(1),134–
8. doi:10.21106/ijma.482
World Health Organization. Fact sheet on human papillomavirus (HPV) and cervical ca
 Available from: https://www.who.int/news-room/factsheets/detail/human-papillomaviru
and-cervical-cancer. [cited April 3, 2025].
World Health Organization. Immunization, Vaccines and Biologicals: Research and de
Geneva, Switzerland: World Health Organization; 2017. http://www.who.int/vaccine_r
April 10, 2025].
World Health Organization. Nigeria's call to action - Time to Eliminate Cervical Cance
2020. Available from: Available from: https://www.afro.who.int/news/nigeriascall-acti
eliminate-cervical-cancernigeria. [cited April 2, 2025]
World Health Organization. Human papillomavirus vaccines: who position paper (2022
vaccins contre les papillomavirus humains: note de synthèse de l’Oms (mise à jour de
2022). In: Weekly Epidemiological Record= Relevé épidémiologique hebdomadaire. 97
Yordanos Sisay Asgedom, Tsegaye Melaku, Kusse Urmale Mare, & Gizachew Ambaw
(2024). Human papillomavirus vaccination uptake and determinant factors among ado
schoolgirls in sub-Saharan Africa: A systematic review and meta-analysis. 31;20(1):23
10.1080/21645515.2024.2326295.

Signature of Principal Researcher: Signature/Date of

Chairman ICR:

Signature/Date of Director of Academic Planning: Signature/Date of Head

of Institution: