EVALUATION OF KNOWLEDGE, ATTITUDES, AND PRACTICES PERTAINING TO HPV PREVENTION AMONG TERTIARY STUDENTS IN NIGERIA

CHAPTER ONE

INTRODUCTION

1.1 Background of the study

Human papillomaviruses (HPVs) are a heterogeneous collection of pathogens in the papillomavirus family, distinguished by their nonenveloped, double-stranded circular DNA configuration. HPVs, with more than 200 known kinds, have a notable propensity for infecting squamous epithelial tissues, including both cutaneous and mucosal surfaces (NIH, 2019; Li & Xu, 2017). HPV is the most common sexually transmitted virus globally, profoundly affecting persons' social life (Kombe et al., 2021). Although often linked to sexual activity, HPV may also be transmitted by non-sexual routes, such as skin-to-skin, skin-to-mucosa, or mucosa-to-mucosa contact (Sabeena et al., 2017). HPV varieties are classified into high-risk and low-risk categories according to their carcinogenic potential (Li & Xu, 2017). The high-risk genotypes account for about 99.7% of invasive cervical cancers globally (Athanasiou et al., 2020) and serve as the main risk factor for the later onset of virtually all cervical malignancies in women (Stanley, 2016). HPV is present in 99.7 percent of cervical cancer cases (Stanley, 2016). Moreover, HPV is the primary cause and a substantial contributor to carcinomas in the anogenital region in both genders, as well as head and neck squamous cell carcinomas (Stanley, 2016).

Vaccination for HPV is essential in avoiding cervical cancer and other health complications associated with HPV infection (Wang et al., 2020; Yousefi et al., 2022). The safety profile of these vaccinations is outstanding, with no significant adverse issues detected. The vaccine attains optimal efficacy when taken before a person engages in sexual activity, since its principal objective is to provide protection against HPV prior to exposure (WHO, 2014). Adolescents aged ten to fourteen generate a much higher volume of antibodies after HPV vaccination than females aged 18 to 53 years (Nicoli et al., 2022). Moreover, HPV vaccinations elicit a much more robust antibody response compared to the natural response triggered by HPV infection (Stanley, 2016). Recent research and reviews have revealed that providing adjuvant HPV vaccination after the treatment of HPV-related disorders is associated with a reduced risk of recurrence of cervical intraepithelial neoplasia (CIN) (Di Donato et al., 2021).

Suboptimal HPV vaccination rates are linked to various determinants, such as familial social dynamics, parental knowledge deficiencies, parental attitudes towards vaccines, safety concerns, lack of healthcare provider recommendations, limited access to preventive healthcare services, and vaccine hesitancy (Holman et al., 2018). Ndejjo et al. (2017) assert that parental understanding and attitudes about HPV vaccinations are crucial factors influencing the adoption of HPV vaccination in children. The effectiveness of vaccines is significantly influenced by the level of acceptance and adoption, which are mostly dependent on parental permission for vaccinating their eligible children.

HPV infection impacts millions worldwide, with young people, especially those in higher education, at increased risk owing to behavioural and societal determinants such as early sexual initiation and many sexual partners (World Health Organisation [WHO], 2020; Louie et al., 2009). Notwithstanding the significant incidence of HPV and its association with cervical and other malignancies, awareness and preventative measures, including HPV vaccination, continue to be disturbingly inadequate in most regions of Nigeria. Research indicates that insufficient understanding of HPV among adolescents greatly hinders the adoption of preventative strategies, especially vaccination (Olubodun et al., 2021; Okunade et al., 2021).

Studies reveal that awareness of HPV, its transmission, and its repercussions is inadequate among Nigerian adolescents, thereby obstructing the implementation of preventative measures (Obiri-Yeboah et al., 2016; Anorlu, 2008). Comprehension and perspectives about HPV preventive strategies, including vaccination, are shaped by several variables, such as cultural views, religious convictions, and the expected likelihood of HPV infection (Bello et al., 2021; Ikeako et al., 2020). In Nigeria, HPV vaccination programs are not ubiquitous nor systematically incorporated into public health efforts, resulting in poor vaccination rates among the youth. The WHO and other international health organisations have underscored the need of focussing awareness efforts on young people to guarantee their comprehension of the advantages of vaccination and safe behaviours (WHO, 2021). Considering the restricted availability of HPV vaccinations and the prevalence of misinformation, it is essential to evaluate tertiary students' understanding and perceptions of HPV, as they constitute a vital demographic for advancing public health measures (Fasinu et al., 2020).

The perspective on HPV preventive methods among university students in Nigeria is influenced by both individual views and social and environmental variables, such as peer influence and society norms (Makwe et al., 2012; Ezechi et al., 2021). Research indicates that young individuals with favourable views towards preventive health behaviours, including vaccination and frequent screening, are more inclined to engage in these activities (Ogundare et al., 2021; Akinyemi & Adekanle, 2019). In Nigeria, many students possess misunderstandings about HPV and vaccine, often seeing them as superfluous or even detrimental. This view is exacerbated by the absence of focused teaching initiatives at Nigerian colleges, where knowledge about HPV and its ramifications is scarce. The university environment may function as an optimal platform for health education among tertiary students, delivering precise information and rectifying misunderstandings about HPV, its associated dangers, and preventative strategies (Oluwole et al., 2020; Adejuyigbe et al., 2021).

The practices related to HPV prevention among tertiary students are affected by the availability and accessibility of preventive resources, including HPV vaccinations and screening services (Ngige et al., 2022; Oladepo et al., 2020). The Nigerian healthcare system encounters considerable obstacles in the distribution and accessibility of HPV vaccinations, especially for young individuals. Moreover, despite global initiatives to decrease HPV infection rates by vaccination, actual implementation in Nigeria is constrained by elevated costs, insufficient healthcare infrastructure, and cultural obstacles (Idowu et al., 2022; Bruni et al., 2019). Therefore, it is essential to assess the HPV preventive behaviours of tertiary students, who often lack sufficient information and tools for making educated health choices. Mitigating these obstacles by focused education and regulatory measures might improve preventative behaviours among this population, hence decreasing the incidence of HPV and related malignancies. This research will enhance comprehension of how knowledge, attitudes, and behaviours related to HPV prevention are formed among Nigerian tertiary students and provide insights for refining public health strategies about HPV in this demographic.

1.2 Statement of the Problem

Human Papillomavirus (HPV) is a widespread health concern worldwide, particularly in resource-limited environments such as Nigeria, where it substantially increases the prevalence of cervical cancer in women (Bruni et al., 2019; World Health Organisation [WHO], 2020; ICO/IARC, 2019). Despite the availability and proven efficacy of preventative strategies like the HPV vaccination, awareness and adoption are notably low in Nigeria, especially among young people who face increased infection risk owing to social and behavioural factors (Olubodun et al., 2021; Bello et al., 2021). Tertiary students, often within the age bracket most susceptible to HPV infection, provide a vital demographic for preventative initiatives. Many tertiary students, however, have insufficient understanding about HPV, its transmission, and preventative measures, which hinders their capacity to make educated health choices and implement preventive behaviours.

The perspectives of tertiary students regarding HPV and its prevention are shaped by various factors, such as cultural beliefs, peer influences, and religious views, which may result in misconceptions and reluctance towards vaccination (Makwe et al., 2012; Ezechi et al., 2021; Akinyemi & Adekanle, 2019). Negative attitudes and distrust in HPV vaccinations have resulted in Nigeria's low vaccination rates, leading to significant public health consequences as HPV infections continue to increase (Okunade et al., 2021; Oladepo et al., 2020). Misinformation about the safety and effectiveness of vaccinations continues to proliferate, exacerbated by insufficient health education initiatives aimed at young adults. Such attitudes adversely impact individual health and hinder the attainment of herd immunity, thereby increasing the HPV-associated risks for a broader community (Oluwole et al., 2020; Adejuyigbe et al., 2021).

A deficiency in HPV prevention practices intensifies the problem, as numerous tertiary students lack sufficient access to preventive resources, including HPV vaccines and screenings, owing to financial limitations and inadequate healthcare infrastructure (Idowu et al., 2022; Oladepo et al., 2020; Ngige et al., 2022). In the absence of effective measures, the population remains susceptible to HPV transmission and its enduring repercussions, which include several cancer types. This disparity underscores the need for improved policies that facilitate access to immunisation and education, especially within the Nigerian healthcare system. Comprehending the current knowledge, attitudes, and behaviours of tertiary students will allow healthcare officials to pinpoint particular obstacles and solve them via customised public health programs that render HPV prevention accessible and acceptable to this at-risk demographic. This work will help to overcoming the practical problems that impede HPV prevention, hence supporting initiatives aimed at fostering a healthy future for young people in Nigeria.

1.3 Objectives of the study

The primary objective of this study is to critically evaluate knowledge, attitudes, and practices pertaining to HPV prevention among tertiary students in Nigeria. Specific objectives of this study are to:

1. To assess the level of knowledge about Human Papillomavirus (HPV) and its associated health risks among tertiary students in Nigeria

2. To evaluate the attitudes of tertiary students in Nigeria toward HPV prevention measures, including vaccination and screening

3. To examine the preventive practices adopted by tertiary students in Nigeria to protect themselves from HPV infection

4. To identify the factors influencing knowledge, attitudes, and practices related to HPV prevention among tertiary students in Nigeria

1.4 Research Questions

The following research questions which are in line with the objectives of this study will be answered in this study:

1. 1. 1. What is the level of knowledge about Human Papillomavirus (HPV) and its associated health risks among tertiary students in Nigeria?

      2. What are the attitudes of tertiary students in Nigeria toward HPV prevention measures, including vaccination and screening?

      3. What are the preventive practices adopted by tertiary students in Nigeria to protect themselves from HPV infection?

      4. What are the factors influencing knowledge, attitudes, and practices related to HPV prevention among tertiary students in Nigeria?

1.5 Research Hypotheses

To determine the effectiveness of this study, the following research null hypotheses will be formulated to guide the study and it will be tested at 0.05% levels of significance.:

Ho: The knowledge about Human Papillomavirus (HPV) and its associated health risks among tertiary students in Nigeria is low

Ha: The knowledge about Human Papillomavirus (HPV) and its associated health risks among tertiary students in Nigeria is high

1.6 Significance of the study

This research is of great importance for public health policymakers, healthcare professionals, educational institutions, students, and researchers as it offers an in-depth understanding of the knowledge, attitudes, and practices concerning HPV prevention among tertiary students in Nigeria.

This study provides essential insights for public health policymakers regarding the existing awareness of HPV, preventive behaviours, and attitudes among young adults engaged in tertiary education. This information can be utilised by those in positions of authority to design focused interventions that tackle the particular informational deficiencies and attitudinal obstacles faced by young individuals, resulting in more impactful strategies for HPV prevention. Gaining insight into the perceptions of tertiary students regarding HPV and the preventive measures they adopt will aid policymakers in formulating comprehensive awareness initiatives that highlight HPV prevention and mitigate the risk of HPV-related diseases, including cervical cancer, which remains a pressing public health issue in Nigeria.

This study will significantly aid healthcare providers and health educators by identifying specific areas where educational initiatives could be enhanced to elevate HPV awareness and prevention strategies among young adults. Healthcare professionals will acquire a deeper understanding of the misconceptions and attitudes that students possess concerning HPV, vaccination, and screening practices. This knowledge will enable them to refine their communication and outreach strategies effectively. This may result in enhanced patient understanding and a more uniform participation in preventative healthcare services. Health educators in higher education settings, armed with this information, can collaborate with public health authorities to develop curriculum enhancements, workshops, and health initiatives that offer students thorough insights into HPV and associated health matters, promoting informed choices regarding vaccination and safe practices.

Higher education establishments in Nigeria are poised to benefit from the insights of this research, as it will elucidate the general understanding and behaviours related to HPV within their student populations. Institutions of higher learning have the opportunity to leverage this information to establish health education programs, foster collaborations with healthcare providers, and initiate peer-led initiatives aimed at enhancing HPV literacy among their student populations. This proactive strategy fosters an atmosphere in which learners are motivated to explore and participate in initiatives aimed at HPV prevention. Institutions have the capacity to cultivate collaborations with local health organisations to implement vaccination initiatives and routine screenings, thus enhancing the overall health and well-being of their students while establishing a benchmark for other institutions throughout Nigeria.

This study serves as a significant resource for students and researchers, offering insights that can guide future enquiries into the awareness and prevention of HPV within youth demographics. Individuals engaged in the fields of public health, health education, or epidemiology might discover that the findings of this study are relevant to their academic pursuits or research endeavours, potentially igniting a deeper intellectual curiosity regarding HPV prevention and public health initiatives. This study contributes to the existing body of work on HPV awareness and prevention in Nigeria, providing a basis for subsequent investigations to delve into further aspects of HPV prevention and enhance the current understanding of the topic. The findings of this study may provide a foundational reference for further exploration into the various factors influencing knowledge and prevention of HPV, including cultural beliefs, socio-economic status, and disparities in regional healthcare. Ultimately, this research seeks to enable various stakeholders to engage in informed and coordinated actions that will help decrease HPV prevalence and enhance public health among the youth in Nigeria.

1.7 Scope of the study

Broadly, this study focus is to critically evaluate knowledge, attitudes, and practices pertaining to HPV prevention among tertiary students in Nigeria. Empirically, the study will explore the level of knowledge about Human Papillomavirus (HPV) and its associated health risks among tertiary students in Nigeria, the attitudes of tertiary students in Nigeria toward HPV prevention measures, including vaccination and screening, the preventive practices adopted by tertiary students in Nigeria to protect themselves from HPV infection and the factors influencing knowledge, attitudes, and practices related to HPV prevention among tertiary students in Nigeria

Geographically, the study will be carried out at the University of Abuja, FCT.

1.8 Limitations of the study

During the examination, the researchers carefully examined the inherent limitations that are present in all human behaviours. One of the main challenges we faced was the lack of extensive scholarly research on the subject. A notable factor that contributed to the issue was the limited data available regarding evaluation of knowledge, attitudes, and practices pertaining to HPV prevention among tertiary students in Nigeria. Given the task at hand, it was quite demanding to find the required materials, books, or information and organise the data, requiring a significant investment of time and effort.

In addition, the study's findings may be constrained by the small number of participants and the limited scope of the research, which mainly revolves around University of Abuja, FCT. Therefore, the findings of the study have limited practical implications, highlighting the need for further research.

In addition, the individual experienced significant constraints due to financial constraints. As a student with limited financial resources, they had to carefully navigate these constraints throughout their study. The exorbitant transportation fees at the research site proved to be a significant hindrance in meeting the financial obligations tied to travel expenses.

Furthermore, the person had a packed schedule due to their scholarly obligations, including attending lectures and participating in a range of educational pursuits.

1.9 Definition of terms

Knowledge: Knowledge is an awareness of facts, a familiarity with individuals and situations, or a practical skill

Attitude: Attitude can be defined as the way in which a person views and evaluates something or someone, a predisposition or a tendency to respond positively or negatively toward a certain idea, object, person, or situation.

Prevention: Prevention is an action taken to decrease the chance of getting a disease or condition

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