Human Papillomavirus vaccination uptake and its determinants among female secondary school students in Hawassa City, Southern Ethiopia: institution-based cross-sectional study

Abstract

Human Papillomavirus (HPV) vaccination is a cornerstone of cervical cancer prevention, yet uptake among adolescent girls in Ethiopia remains suboptimal. Understanding the determinants of HPV vaccine practice is essential to guide targeted interventions. Therefore, we aimed to investigate the uptake of the HPV vaccine and the factors influencing it among female secondary school students in Hawassa City, Southern Ethiopia. An institution-based cross-sectional study was conducted in 2025 among 661 female secondary school students in Hawassa City, Ethiopia. Data were collected using a structured self-administered questionnaire, with HPV vaccine uptake as the primary outcome. Descriptive statistics summarized participants' characteristics and HPV vaccine uptake level. Multivariable logistic regression was performed to identify factors associated with HPV vaccine uptake. We reported adjusted odds ratios (AORs) and 95% confidence intervals (CIs). Statistical significance was set at p < 0.05. Among 661 female students, 401 (60.7%) had received at least one dose of the HPV vaccine. Of these, 201 (50.1%) had received two doses, 173 (43.1%) had received one dose, and 27 (6.7%) were unsure of the number of doses received. Vaccine uptake was higher among students living in urban areas (AOR = 2.74, 95% CI: 1.68-4.39), those with prior information about HPV and HPV vaccination (AOR = 4.05, 95% CI: 2.59-6.18), good knowledge of HPV (AOR = 4.04, 95% CI: 2.71-6.17), and a positive attitude toward HPV vaccination (AOR = 2.54, 95% CI: 1.68-4.99). Students with a neutral attitude toward HPV vaccination also showed higher uptake than those with a negative attitude (AOR = 1.75, 95% CI: 1.09-2.78). Maternal education remained a significant predictor (AOR = 3.25, 95% CI: 1.74-6.09), and attendance at government schools further increased the likelihood of vaccination (AOR = 1.36, 95% CI: 1.09-1.87). HPV vaccination coverage among female secondary school students in Hawassa City was suboptimal. Urban residence, prior information about HPV and HPV vaccination, good knowledge of HPV, positive and neutral attitudes toward HPV vaccination, higher maternal education, and attendance at government schools were significantly associated with HPV vaccine uptake. These findings support strengthening school-based education, engaging mothers, prioritizing rural outreach, and enhancing multisectoral collaboration to improve HPV vaccine coverage and support cervical cancer prevention in Ethiopia.