International Journal of Public Health and Epidemiology Research

Vol. 5(1), PP. 083-090, February, 2019. © www.premierpublishers.org. ISSN: 1406-089X

Research Article

Parents’ Support to Female Children in the Uptake of the

Human Papilloma Virus (Hpv) Vaccine in the Tiko Health
District Cameroon
1Ngouakam Hermann*, 2Neba Erasmous Ndonwi, 3Nana Njamen Theophile, 4Njodzeka Marion
1,2,4Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, Buea, Cameroon
3Department of Gynaecology and Obstetrics, Faculty of Health Sciences, University of Buea, Buea, Cameroon

The incidence rate of Human papilloma virus (HPV) related cervical cancer in Cameroon is still
very high (19.4%). Cervical cancer mainly caused by HPV infections can successfully be
prevented by vaccination, which is available at a cost but not yet implemented in the national
vaccination program. Parents play a very important role in deciding whether to vaccinate their
children against HPV or not. The main objective of this study was to determine parents’
willingness to support female children (13-18 years) in the Tiko Health District (THD) towards
uptake of the vaccine against HPV 6, 11, 16 and 18. A cross-sectional study was done between
November 2017 and May 2018, among parents and their daughters in four health areas in the THD:
Holforth, Missellele, Mutengene, and Tiko town. A total of 840 participants (420 pairs, each made
up of parent and daughter) completed the questionnaires. Less than half (36.3%; 95%CI: 31.7 –
41.2) of the parents were willing to support the uptake of the vaccine against HPV 6, 11, 16 and 18
by their daughters. Also, our findings showed a statistically significant association between
parents’ that were willing to support the uptake of HPV vaccine and their daughters’ willingness
to take up the HPV vaccine (x2=8.69, p=0.003). A Bivariate analyses indicated that being older than
40 years (AOR=1.95; 95%CI: 1.20-3.13), more educated (AOR=13.6; 95%CI: 3.01-61.11), and girl’s
relationship with parent (AOR=0.43; 95%CI: 0.19-0.96) were predictors of parents’ willingness to
support their daughters in the uptake of the HPV vaccine. The proportion of parents in the Tiko
Health District that are willing to support their daughters in the uptake of the vaccine against HPV
6, 11, 16 and 18 was low (36.3%).

Keywords: Cervical cancer, parents’ support, willingness and vaccine uptake.

INTRODUCTION

Background In Cameroon 1,993 new cases of cervical cancer are

Cervical cancer is gradually becoming a rare disease in
many developed countries but this is not the case with
many countries in sub-Saharan Africa. Eighty-five percent
(85%) of the 270,000 deaths from cervical cancer in 2015
occurred in low- and middle-income countries (Ntekin,
2012). Cervical cancer incidence and mortality rates are
highest in sub-Saharan Africa (Kgaa, 2014). In developing
countries, cervical cancer is the second most commonly
diagnosed cancer in women after breast cancer with an
estimated 44,500 new cases in 2012 (84% of the new
cases worldwide).
diagnosed annually, with a crude incidence rate of 19.4%.
Cervical cancer ranks the second leading cause of female
cancer in Cameroon after breast cancer (25.6%) and the
second most common female cancer in women aged 15 to
44 years (WHO, 2013). About 1,120 women die from
cervical cancer annually in Cameroon making it the first of
female mortality from 15 to 44 years (Bruni et al., 2017).
*Corresponding Author: Ngouakam Hermann,
Department of Public Health and Hygiene, Faculty of
Health Sciences, University of Buea, Buea, Cameroon.
Email: tiingou4@yahoo.com; Tel: +237 670395424

Parents’ Support to Female Children in the Uptake of the Human Papilloma Virus (Hpv) Vaccine in the Tiko Health District Cameroon
Ngouakam et al. 084
Human papillomavirus (HPV) is the most common viral
infection of the reproductive tract and most sexually active
men and women will be infected at some point in their lives
and may be repeatedly infected (WHO, 2017). Seventy-
percent (70%) of cervical cancers worldwide are caused
by two HPV types (16 and 18).
Cervical cancer is preventable and curable in the very
early stages of the disease. A Study in Cameroon has
supported the view that cervical cancer prevention via
vaccination and with routine screening is crucial in
addressing the growing burden of cervical cancer in Low
and Middle-Income Countries especially given the cost of
access to treatment and lack of radiation treatment
infrastructure (Manga et al., 2017). The implementation of
a national screening policy, organizing HPV vaccination
and low cost screening programs, can help to reduce the
impact of cervical cancer in the population (Ndamba,
2016). Another study conducted in Mozambique prior to
the first round of the HPV vaccine demonstration
programme in that country anticipatesd high acceptability
of the HPV vaccine and high awareness about cervical
cancer, despite low HPV knowledge (Bardaji et al., 2018).
Three prophylactic HPV vaccines, directed against high-
risk HPV types, are currently available and marketed in
many countries worldwide for the prevention of HPV-
related disease: the quadrivalent vaccine licensed in 2006,
the bivalent vaccine in 2007 and the nanovalent vaccine in
2014 (Bruni et al., 2010). Since 2006, HPV vaccine has
become available in many countries either through
government vaccination programs or through the private
sector for individuals who can afford to pay. Effectively
targeting the most common cancer-causing HPV types (16
and 18), the vaccine has the potential to dramatically
reduce the future burden of cervical cancer (Friedman-
Rudoovsky et al., 2015). A study that assessed the
knowledge and awareness of cervical cancer, HPV and
HPV vaccine, and willingness and acceptability to
vaccinate in sub-Saharan African (SSA) countries
revealed high levels of willingness and acceptability of
HPV vaccine but low levels of knowledge and awareness
of cervical cancer, HPV or HPV vaccine (Perlman et al.,
2014).
WHO recommends introduction of HPV vaccine as part of
a national cervical cancer control strategy in countries
where it is feasible and cost-effective, and where the
vaccine can be delivered to adolescent girls effectively
(Friedman-Rudoovsky et al., 2015). The Cameroon Baptist
Convention Health Services, carried out an HPV
demonstration project in Cameroon that proved that with
adequate education of all stakeholders, HPV vaccination
is feasible (Wamai et al., 2012), Ogembo et al., 2014).
MATERIALS AND METHODS
This was a cross-sectional community-based study that
was conducted between November 2017 and May 2018
Parents’ Support to Female Children in the Uptake of the Human Papilloma Virus (Hpv) Vaccine in the Tiko Health District Cameroon
among parents and their daughters in the Tiko Health
District.
Parents or guardians who participated in the study gave
assent for their female children mostly secondary school
students at their puberty and not too aware of the risk
factors of common sexually transmitted infections. Parents
or guardians of these girls in the Tiko Health District either
work in the Cameroon Development Corporation (CDC)
plantations, farmers, civil servants or are involved in
business.
Were included in our study all parents or guardians of a
female child aged 13 to 18 years old who is vaccinated or
not against the Human Papillomavirus and their teenage
daughters aged 13-18 years old who has been vaccinated
or not against HPV.
The sample size of the study participants was determined
using the Lorenz formula for sample size calculation
(Vinogradov, 1997). Based on that, we estimated a
minimum sample size 384 participants and a nonresponse
rate of 10%. This made up a sample size of 422.
Considering the fact that participants for our study were
considered as pairs (each parent/guardian and his/her
daughters), we therefore had 422 pairs giving a total of 844
participants.
A multi-stage sampling method was used in the study.
THD was conveniently selected for the study. Participants
were neither forced nor compelled to participate in the
study.
➢ Stage one: Out of the eight Health Areas (HA) that
formed the THD, four were selected by Simple
Random Sampling (SRS). These were: Holforth,
Misellele, Mutengene and Tiko Town.
➢ Stage two: Selection of quarters in each HA: Half of
total number of quarters were selected except in
Misellele where all were selected. They were
respectively:
• Holforth: four out of seven quarters (Quarters 1, 2,
5, 7, and the C.D.C Camp),
• Mutengene: 10 out of 20 quarters (Quarters 3, 5,
6, 7, 10, 11, 12, 13, 15, and 18).
• Tiko town: 5 out of 10 streets (streets = quarters)
(streets 1, 2, 3, 6 and 7) and
• Misellele: 2 out of 2 quarters (Missellele C.D.C
camp and Missellele native).
➢ Stage three: Probability Proportionate to Size (PPS)
sampling technique was used to determine the
proportion of the sample size from each of the four
sampled health areas.
Number of study participants selected from each Health
area were according to the size of the targeted population
in the Health area.
a. Mutengene: Participants from ten out of twenty
quarters were randomly selected and included in the

study. These were: Quarters 3, 5, 6, 7, 10, 11, 12, 13,
15, and 18.
b. Holforth: Participants were randomly selected from the
C.D.C camp.
c. Tiko Town: Participants were randomly selected from
five streets (streets 1, 2, 3, 6 and 7).
d. Missellele: Participants were randomly selected from
the Missellele C.D.C camp and Missellele native.
All data were entered into the Epi info software version 7.1
and were later imported into the Statistical Package for the
Social Sciences (IBM-SPSS) Statistics 20 (IBM-SPSS
Corp., Chicago USA) for analysis through descriptive
statistics and bivariate analyses. The level of significance
was placed at p value < 0.05.
RESULTS
A total of 420 pairs of parents and their daughters
participated in this study as summarized in Table 1. The
mean age of parents was 40.8 ± 6.8 years with less than
half of them 208(49.52%) aged above 40 years, while that
of their daughters was 15.5 ±1.2 years with majority
345(81.1%) of them aged between 13 – 16 years.
Custodians of the female adolescents were their biological
mothers 339(80.71%). Regarding level of education,
126(30.0%), 172(40.95%) and 90(21.43%) of the parents
had completed primary, secondary and tertiary education
respectively while 32(7.62%) had no formal education.
Concerning the daughters, 393(93.57%) were in
secondary school while the remaining 27(6.43%) were in
primary school. Parents were either married or cohabiting
335 (79.76%). As concerns occupation, 300 (71.4%) of the
parents were employed either as civil servants, private
sector workers or entrepreneurs or business persons and
318(75.71%) of the parents had a monthly income less
than 100,000 FCFA.
Risky Sexual Behaviors of Daughters
The mean age at first sexual debut was 15.2 ± 1.6 years
and ranged from 12 – 18 years. About one-quarter
(24.32%) of the daughters had their first sexual intercourse
between the ages of 12 and 14 years. As concerns number
of sexual partners, 13.81% and 3.81% of the daughters
had one and more than one sexual partners respectively.
About one-quarter (25.68%) of the sexually active
daughters didn’t use condoms during sexual intercourse.
About ten percent (10.81%) of the sexually active
daughters had ever had a sexually transmissible infection
(Table 2).
Proportion of parents willing to Support the Uptake of
HPV Vaccine by their Daughters
The proportion of parents or guardians that were willing to
support the uptake of HPV vaccine by their daughters was
Parents’ Support to Female Children in the Uptake of the Human Papilloma Virus (Hpv) Vaccine in the Tiko Health District Cameroon
Int. J. Public Health Epidemiol. Res. 085
36.3% (95% CI: 31.7 – 41.2) (Figure 1). Meanwhile a
higher proportion (63.7%) of the parents or guardians were
not willing to support their daughters to take the HPV
vaccine (Figure 1).
Figure 1: The proportion of parents willing to support the
uptake of HPV vaccine by their daughters
Association Between parent’s Willingness to support
HPV vaccine and Child’s Willingness to take up the
Vaccine
In a Bivariate analysis, parents willingness to support HPV
vaccine was associated with their daughters’ willingness to
take up the HPV vaccine, which showed that there was a
statistically significant association between parents
willingness to support HPV vaccine and their daughters’
willingness to take up the vaccine (χ2 = 8.69, p = 0.003)
(Table 3).
About half (49.4%) of the daughters were willing to take
the HPV vaccine when their parents were also willing to
support its uptake. However, only 31.5% of the parents
were willing to support the uptake of the HPV vaccine
when their daughters were not willing to take the vaccine.
(Table 3).
Knowledge of Participants on Cervical cancer
The parents had a mean knowledge score of 9.59±2.04 on
22 while the daughters had 6.16±1.78 on 22. The
knowledge scores of the parents showed an insignificantly
very weak positive correlation (r = 0.04, p = 0.425) with that
of their daughters. The parents had a significantly higher
mean knowledge score compared to their daughters (t =
25.9, df = 822, p<0.001). The proportions of parents and
daughters with a good knowledge on cervical cancer were
48.3% (95%CI: 43.56 – 53.13) and 39.5% (95%CI: 34.93
– 44.30) respectively (Figure 2).
Ngouakam et al. 086
Figure 2: Proportion of parents and daughters with good
knowledge on cervical cancer
Socio-demographic and Behavioral Predictors of the
Willingness of Parents to Support the Uptake of the
HPV Vaccine
In a Bivariate analysis, parent’s age, parent’s educational
level, parent’s marital status, daughters’ relationship with
parent and Health area of residence were associated with
willingness of parents to support the uptake of HPV
vaccine by their daughters. After adjusting for
confounders, only parent’s age, parent’s educational level,
daughter’s relationship with parent, daughter’s number of
sexual partners and Health area of residence were
associated with willingness of parents to support the
uptake of HPV vaccine by the daughters (Table 4).
The odds of reporting being willing to support the uptake
of HPV vaccine were significantly lower among non-
biological daughters (AOR: 0.43; 95%CI: 0.19 – 0.96) and
daughters who had sexual partners (AOR: 0.46; 95%CI:
0.24 – 0.87).
However, the odds of reporting being willing to support the
uptake of HPV vaccine were significantly higher among
parents aged 40 years and above (AOR: 1.95; 95%CI:
1.20 – 3.17), educated parents (AOR: 5.30; 95%CI: 1.11 –
24.82) and residing in Mutengene Health Area (AOR: 2.08;
95%CI: 1.16 – 3.75) (Table 4).
DISCUSSION
Parents are the ones that decide whether or not to
vaccinate their children against HPV; the decision is
complex, and several factors are important. On an
individual level, the decision is based on attitudes, beliefs,
knowledge, socio-demographics, as well as cultural and
religious aspects. While at the national level, governmental
policies and access to adequate health services (such as
vaccination and screening programs) are significant
factors. Previous research findings have reported a
number of important correlates related to parents’
decisions to accept or refuse the HPV vaccine uptake for
their daughters that include parents’ general vaccination
Parents’ Support to Female Children in the Uptake of the Human Papilloma Virus (Hpv) Vaccine in the Tiko Health District Cameroon
attitudes, anticipated regret, adherence to other routinely
recommended vaccines, social norms, and positive media
influence (Krawczyk et al., 2015). This study aimed at
determining parents’ willingness to support female children
(13-18years) towards uptake of the HPV vaccine in the
Tiko health District of South West region of Cameroon. The
result of this study showed that of the 420 parents or
guardians that participated in the study, 36.3% (95%CI:
31.7 – 41.2) of the parents were willing to support the
uptake of HPV vaccine by their daughters. This low
proportion might be as a result of lack of knowledge about
the possible severe clinical outcomes of HPV infection
which can negatively influence preventive measures such
as vaccination. However, their willingness to support the
uptake of HPV vaccine was statistically significantly
associated with parent’s level of education, daughter’s
relationship with parent, and Health area of residence and
parents’ age. This may be so because parents with a better
education background may have more access to health
information (Ganczak et al., 2018). The result of this study
were in line with that of a study conducted in Italy on
knowledge of human papillomavirus infection and its
prevention among adolescents and parents that reported
that vaccination of students was significantly associated
with parents educational status (Pelucchi et al., 2018).
Also these results were in line with that of a study
conducted in the northern region of Cameroon on the
awareness, acceptability and uptake of Human Papilloma
Virus vaccine among Cameroonian School-attending
female adolescents that showed that 46.8% were willing to
accept the HPV vaccine (Akono et al., 2012). However, the
results of this study were different from that of a study
conducted in Poland (Europe) on factors that predict
parental willingness to have their children vaccinated
against HPV in a country with low HPV vaccination
coverage that reported that 85.1% of parents that took part
in the study expressed their willingness to vaccinate their
children against HPV (Ganczak et al., 2018) and across-
sectional study of HPV vaccine acceptability in Gaborone,
Botswana that reported 88% of parents were willing to
have their adolescent daughters receive HPV vaccine
(Diangi et al., 2011).
Our findings revealed a statistically significant association
between parents’ willingness to support HPV vaccine and
their daughters’ willingness to take up the HPV vaccine (χ 2
= 8.69, p = 0.003). Also a good quantity (49.4%) of the
daughters were willing to take the HPV vaccine when their
parents were also willing to support its uptake. Even
though parents’ willingness to support HPV vaccine was
significantly associated with the age of the parents as
parents of age 40 years and above were more willing
(AOR: 1.96; 95%CI: 1.20-3.17) to allow their daughters to
be vaccinated against the HPV vaccine. This could be so
because parents which were older in age may have had a
history of cervical cancer or may have been screened for
cervical cancer for at least one or two times. Also educated
parent were more willing to support their daughters to be
vaccinated than parents who reported never had any

formal education. This could be so because educated
parents perceived future risk of the getting the disease as
compared to parents that had no formal education.
Parents living with a female child that was a relative were
less willing (AOR: 0.43; 95%CI: 0.19 – 0.96) to support
them to get vaccinated than parents who were leaving with
their biological daughters. Parents living in the Mutengene
Health area were more willing to get theirs daughters
vaccinated than those in the other health areas. This was
so because most of them reported that they had been
given health education on cervical cancer and the
importance of vaccinating their young daughters at their
job site (Baptist Hospital Mutengene) as compared to the
other health areas which had few cases with good
knowledge on cervical cancer. This study is in line with a
study conducted in Germany among girls on the factors
influencing uptake of HPV vaccination which showed that
having a mother with high level of education (OR: 1.5, 95
% CI 1.0–2.3), was a significant predictor for vaccination
(Chulein et al., 2016). This study also reported that the
odds of reporting being willing to support the uptake of
HPV vaccine were significantly higher with parents’ level
of education as educated parents were more willing (AOR:
5.30; 95%CI: 1.11 – 24.82) to support HPV uptake than
parents with no formal education (Chulein et al., 2016).
However, the result of this study differs from a systematic
review conducted on the predictors of vaccine
acceptability that showed that Parents with lower levels of
education reported higher vaccine acceptability (Brewer
and Fazekas, 2007).
Knowledge on cervical cancer was measured using 22
item instrument. Parents had a mean knowledge score of
9.59±2.04 on 22 while their daughters had a mean
knowledge score of 6.16±1.78 on 22. Participants that had
a knowledge score above the mean were considered to
have “good knowledge” while those that had knowledge
score below the mean were considered to have “poor
knowledge”. The knowledge scores of the parents showed
an insignificantly very weak positive correlation (r = 0.04,
p = 0.425) with that of their daughters. Parents had a
significantly higher mean knowledge score compared to
their daughters (t = 25.9, df = 822, p<0.001). This is
because majority of the parents were females and some
have either been vaccinated or screened for cervical
cancer and so they have good knowledge on the subject
as compared to their daughters. It was also found that a
higher proportion of parents (38.2%) with poor knowledge
on cervical cancer were more willing to accept HPV
vaccine for their daughters as compared to parents with
good knowledge on cervical cancer (34.6%). Also a higher
proportion of the daughters (38.8) with poor knowledge on
cervical cancer were more willing to accept HPV vaccine
than those with good knowledge. With the high
acceptability of HPV vaccine despite poor knowledge
about cervical cancer and HPV represents an opportunity
for increased education and awareness strategies about
cervical cancer, HPV and HPV vaccine. This is important
Parents’ Support to Female Children in the Uptake of the Human Papilloma Virus (Hpv) Vaccine in the Tiko Health District Cameroon
Int. J. Public Health Epidemiol. Res. 087
to help both parents and their daughters to understand the
transmission of HPV, its characteristics and associated
and the benefits of HPV vaccine risks (Mingo et al., 2015).
Engaging parents and their daughters through improved
and increased education will elevate public trust, which is
a critical component of successful implementation of
widespread vaccine coverage. The result of this study
were similar to a systematic review on knowledge and
awareness of HPV vaccine and acceptability to vaccinate
in Sub-Saharan Africa, that revealed high levels of
willingness and acceptability of HPV vaccine but low levels
of knowledge and awareness of cervical cancer, HPV or
HPV vaccine (Palman et al., 2014). On the other hand, the
result of this study were different from that of a study
conducted in the northern region of Cameroon that
reported that women had weak knowledge about cervical
cancer (10.74%) (Georges et al., 2017).
CONCLUSIONS
The result of our study showed that the proportion of
parents in the Tiko Health District willing to support their
daughters in the uptake of the HPV vaccine was low
(36.3%).
Also, there was a statistically significant association
between parents’ willingness to support the uptake of HPV
vaccine and their daughters’ willingness to take up the
HPV vaccine.
There is no relationship between knowledge of parents’ on
cervical cancer and their willingness to support the uptake
of the HPV vaccine. Also, there is no relationship between
daughters’ knowledge on cervical cancer and their
willingness to take up the vaccine against HPV 6, 11, 16
and 18.
There are some significant factors which could predict
parents’ willingness to support their daughters in the
uptake of the HPV vaccine which include; parent’s age,
level of education, and girl’s relationship with parent.
Conflict of interests: The authors declare no potential
conflict of interests.
Funding: The work was funded solely by the main
researcher.
Ethics approval and consent to participate: The study
was approved by the Institutional Review Board of the
Faculty of Health Sciences of the University of Buea (Ref.
no: 2018/211/UB/SG/IRB/FHS. An administrative
authorization was obtained from the Regional Delegation
of Public Health, South West region and the District
Medical Officer of Tiko Health District. Written informed
consent was obtained from the participants selected for
the study.
Ngouakam et al. 088

ACKNOWLEDGEMENTS Georges K., N. k, A.H., T. S. R., Ma J., Charlette N. (2017).

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special thanks go to the chiefs, quarter heads and all Kgaa M. (2014). Global Burden of Cancer in Women. Int J
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Joyal-Desmarais K., Rosberger Z. (2015). Parents’
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Parents’ Support to Female Children in the Uptake of the Human Papilloma Virus (Hpv) Vaccine in the Tiko Health District Cameroon
 Int. J. Public Health Epidemiol. Res. 089

APPENDIX

TABLES

Table 1: Summary of Socio-demographic characteristics of the participants (N=420 pairs)

CHARACTERISTIC PARENTS CHARACTERISTIC DAUGHTERS
No (%) No (%)
Age (years) Mean (40.8 ± 6.8) Age (years) Mean (15.5±1.2)
21-40 212 (50.48) 13-16 345 (81.1)
40+ 208 (49.52) 17-18 75 (17.9)
Gender
Male 59 (14.05) /
Female 361 (85.95) Female 420 (100)
Relationship with child Relationship with caregiver
Parent 339 (80.71) Parent 339 (80.71)
Relative 81 (19.29) Relative 81 (19.29)
Level of education Level of education
No formal education 32 (7.62) No formal education 00
Primary education 126 (30.0) Primary education 27 (6.43)
Secondary education 172 (40.95) Secondary education 393 (93.57)
Tertiary education 90 (21.43) Tertiary education 00
Marital status Marital status
Single 37 (8.81) Single 420 (100)
Married/Cohabiting 335 (79.76) /
Divorced/Widow(er) 48 (11.43) /
Occupation Occupation
Unemployed 120 (28.6) Primary school pupil 27 (6.43)
Employed 300 (71.4) Secondary school student 393 (93.57)
Monthly income (FCFA)
< 100,000 318 (75.71) NA
≥ 100,000 102 (24.29)
Religion Religion
Christians 401 (95.5) Christians 397 (95.89)
Muslims 14 (3.3) Muslims 17 (4.11)
Others 5 (1.2) Others /
Health Area Health Area
Holforth 133 (31.7) Holforth 133 (31.7)
Missellele 22 (5.2) Missellele 22 (5.2)
Mutengene 189 (45.0) Mutengene 189 (45.0)
Tiko town 76 (18.1) Tiko town 76 (18.1)
NA = Not Applicable, SD = Standard Deviation

Table 2: Risky sexual behaviors predisposing daughters to cervical cancer

SEXUAL BEHAVIOUR FREQUENCY PERCENTAGE
What was your age at first sexual intercourse? (years) Mean±SD (15.2±1.6) Range (12 – 18)
12 – 14 18 24.32
15 – 18 56 75.68
How many sexual partners do you have?
0 346 82.38
1 58 13.81
>1 16 3.81
Do you use condom during sexual intercourse?
Yes 55 74.32
No 19 25.68
Have you had any history of STIs?
Yes 8 10.81
No 66 89.19
SD = Standard Deviation, STIs = Sexually Transmissible Infections

Parents’ Support to Female Children in the Uptake of the Human Papilloma Virus (Hpv) Vaccine in the Tiko Health District Cameroon
Ngouakam et al. 090

Table 3: Association between parent’s willingness to support and child’s willingness to take up the HPV vaccine
Categories Parent’s willingness support the uptake of HPV Chi-square p-value
vaccine value
Child’s willingness to take Willing Not willing
up the HPV vaccine No (%) No (%)
Willing 39 (49.4) 40 (50.6) 8.69 0.003
Not willing 94 (31.5) 204 (68.5)

Table 4: Sociodemographic and behavioral predictors of the willingness of parents to support the uptake of the
HPV vaccine
Variable Willingness of parents to support the uptake of HPV vaccine
UOR (95%CI) p-value AOR (95%CI) p-value
Parent’s age
21-40 years 1 1
40+ years 1.66 1.09 – 2.15 0.027 1.95 1.20 - 3.17 0.034
Parent’s level of education
No formal 1 1
Primary 3.78 1.24 – 11.5 0.004 6.60 1.50 – 29.72 0.014
Secondary 5.28 1.84 – 16.56 < 0.001 13.6 3.01 – 61.11 < 0.001
Tertiary 2.23 0.70 – 7.12 0.470 5.30 1.11 – 24.82 0.035
Parent’s marital status
Single 1 1
Married/Cohabiting 2.95 0.99 – 8.81 0.154 1.92 0.59 – 6.31 0.253
Divorced/Widow(er) 5.25 1.55 – 17.81 0.043 3.41 0.89 – 13.17 0.076
Girl’s relationship to
caregiver
Daughter 1 1
Relative 0.37 0.18 – 0.79 < 0.001 0.43 0.19 – 0.96 0.014
Girl’s level of education
Primary 1 1
Secondary 1.80 0.72 – 4.71 0.354 1.70 0.58 – 4.94 0.452
Girl’s age of sexual debut
12 -14 years 1 1
15 -18 years 1.05 0.56 – 1.94 0.245 1.45 0.66 - 2.17 0.854
Number of sexual
partner of the girl
0 1 1
1 0.65 0.36 – 1.15 0.054 0.46 0.24 – 0.87 0.041
>1 2.08 0.55 – 7.89 0.482 1.40 0.36 – 5.54 0.264
Health area
Holforth 1 1
Missellele 1.62 0.68 – 3.83 0.245 1.97 0.75 – 5.17 0.369
Mutengene 1.98 1.15 – 3.44 0.021 2.08 1.16 – 3.75 0.021
Tiko town 0.98 0.46 – 2.01 0.458 0.88 0.38 – 1.97 0.258
UOR = Unadjusted Odds Ratio, AOR = Adjusted Odds Ratio

Accepted 20 November 2018

Citation: Ngouakam H, Ndonwi NE, Theophile NN, Marion N (2019). Parents’ Support to Female Children in the Uptake
of the Human Papilloma Virus (Hpv) Vaccine in the Tiko Health District Cameroon. International Journal of Public Health
and Epidemiology Research, 5(1): 083-090.

Copyright: © 2019 Ngouakam et al. This is an open-access article distributed under the terms of the Creative Commons
Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original
author and source are cited.

Parents’ Support to Female Children in the Uptake of the Human Papilloma Virus (Hpv) Vaccine in the Tiko Health District Cameroon