Knowledge and Awareness of Human Papillomavirus (HPV), Cervical Cancer and HPV Vaccine among Women in Two Distinct Nepali Communities

"...[K]nowledge and awareness of HPV, cervical cancer and HPV vaccine remains very low in the Nepali women. Acceptance of a freely available HPV vaccine for children was high indicating potentially high uptake rates in these communities provided adequate information sharing about cervical cancer and HPV is present."

This study assessed human papillomavirus (HPV), cervical cancer, and HPV vaccine knowledge and awareness among women in two sub-populations in Nepal: Khokana, a traditional Newari village in the Lalitpur District about eight kilometers south of Kathmandu, and Sanphebagar, a village development committee within Achham District in rural far-western Nepal. Study participants were recruited during health camps conducted by Nepal Fertility Care Center, a Nepali non-governmental organisation (NGO). Staff administered a Nepali language survey instrument that included questions on socio-demographics, reproductive health, and knowledge on HPV, cervical cancer, and the HPV vaccine.

Of the 749 participants, 387 (51.7%) were from Khokana, and 362 (48.3%) were from Sanphebagar. Overall, 53.3% (n=372) of women were aware of cervical cancer, with a significant difference between Khokana and Sanphebagar (63.3% vs 43.0%; p=0.001). Factors associated with cervical cancer awareness included knowledge of HPV (Khokana: Odds Ratio (OR)=24.5; (95% Confidence Interval (CI): 3.1-190.2, Sanphebagar: OR=14.8; 95% CI: 3.7-58.4)) and sexually transmitted infections (Khokana: OR=6.18; 95% CI: 3.1-12.4; Sanphebagar: OR=17.0; 95% CI: 7.3-39.7) among other risk factors. "Approximately, a quarter of the women in our study learned about cervical cancer from an institutional source (government clinic/NGO clinic/school) and of these women, 21% of them were aware of HPV and 60% of them had knowledge of the HPV vaccine. Both of these numbers were higher than our study's overall averages of 14.3% and 7.5%, respectfully. This suggests that the Nepali medical staff were serving dual roles as both health care providers and reproductive health educators. Variables such as 'Have you ever had an abortion' and 'Do you currently use contraception' require that women make use of health care services and were significantly associated with our study's knowledge and awareness outcomes."

Overall, only 15.4% (n=107) of women had heard of HPV, and less than 10% (n=71) of women knew that cervical cancer was caused by HPV. Of 107 reporting knowledge of HPV, 34% (n=36) indicated that they had heard of or had knowledge of the HPV vaccine. Awareness of HPV was significantly associated with the knowledge of the HPV vaccine in both groups of women. If freely available, 77.5% (n=572) of the women reported willingness to have their children vaccinated against HPV, while 15.7% (n=116) indicated they would need to ask their husband or family before vaccinating their children. "Women who were aware of HPV and cervical cancer in Sanphebagar were over 10 times more likely to discuss the HPV vaccine with their family members and husbands before purchasing the vaccine. These results strongly indicate that HPV awareness greatly influences HPV vaccine acceptance in rural areas."

One conclusion: "It is possible that women who seek care for ailments specifically related to reproductive issues are learning about cervical cancer and HPV during their clinical visits. If women are using clinical visits to learn about reproductive health, then access to health care is important to educate Nepali women about HPV, cervical cancer and HPV vaccine."