Low rate of human papillomavirus vaccination among schoolgirls in Lebanon: barriers to vaccination with a focus on mothers’ knowledge about available vaccines

Figures & data

Table 1 Demographic and socioeconomic characteristics of participating mothers and their awareness about genital warts, cervical cancer, and HPV vaccine

Parameters	Number of responders (%) (N=1,193)
Mother’s age, years (mean ± SD)	42.6 (±5.80)
Mother’s marital age, years (mean ± SD)	21.7 (±4.25)
Number of children
1	58 (4.9)
2	231 (19.4)
3	430 (36)
4	301 (25.2)
5	119 (10)
>5	54 (4.5)
Nationality
Lebanese	1,051 (88.1)
Palestinian	52 (4.4)
Syrian	77 (6.5)
Others	13 (1.1)
Educational level
Below elementary	90 (7.6)
Middle school	330 (27.7)
High school	404 (33.9)
University degree	337 (28.3)
Higher education	31 (2.6)
Religion
Muslim	1,142 (95.7)
Christian	48 (4)
Secularism	3 (0.3)
Working mother
Yes	279 (23.4)
No	912 (76.4)
Unknown	2 (0.2)
Work status
Health care worker	46 (3.9)
Non-health care worker	204 (17.9)
Unknown	29 (2.4)
Monthly family income (USD)
<450	139 (11.7)
450–1,000	289 (24.2)
1,000–2,000	253 (21.2)
>2,000	185 (15.5)
Unknown	327 (27.4)
Awareness about genital warts	310 (26)
Awareness about cervical cancer	858 (71.9)
Awareness about HPV vaccine	408 (34.2)

Abbreviations: HPV, human papillomavirus; SD, standard deviation; USD, US dollars.

Table 2 Comparison between mothers who were aware about HPV vaccine and those who were not in relation to their demographic features, socioeconomic status, and knowledge about cervical cancer

Parameters	Total responders	Number of mothers aware of the HPV vaccine	Number of mothers who were not aware of the HPV vaccine	Chi-square value	P-value
Mother’s age (years)	1,193	408 (34.2%)	785 (65.8%)
<40	352 (29.5%)	111 (31.5%)	241 (67.5%)	1.6	0.453
40–50	735 (61.6%)	260 (35.4%)	475 (64.6%)
>50	106 (8.9%)	37 (34.9%)	69 (65.1%)
Mother’s marital age (years)	1,193	408 (34.2%)	785 (65.8%)
≤18	298 (25%)	65 (21.8%)	233 (77.2%)	35.9	<0.0001
19–23	516 (43.3%)	177 (34.3%)	339 (65.7%)
24–28	304 (25.5%)	132 (43.4%)	172 (56.6%)
≥29	75 (6.3%)	34 (45.3%)	41 (54.7%)
Mother’s nationality	1,193	408 (34.2%)	785 (65.8%)
Lebanese	1,051 (88.1%)	388 (36.9%)	663 (63.1%)	31.6	<0.0001
Syrian	52 (4.4%)	3 (5.8%)	49 (94.2%)
Palestinian	77 (6.5%)	15 (19.5%)	62 (79.5%)
Other	13 (1.1%)	2 (15.4%)	11 (84.6%)
Mother’s educational level	1,192	408 (34.2%)	784 (65.8%)
Below elementary	90 (7.6%)	8 (8.9%)	82 (91.1%)	68.9	<0.0001
Middle school	330 (27.7%)	87 (26.4%)	243 (73.6%)
High school	404 (33.9%)	136 (33.7%)	268 (65.3%)
University	337 (28.3%)	158 (46.9%)	179 (53.1%)
Higher education	31 (2.6%)	19 (61.3%)	12 (38.7%)
Working mother	1,191	407 (34.2%)	784 (65.8%)
Yes	279 (23.4%)	147 (52.7%)	132 (47.3%)	55.5	<0.0001
No	912 (76.6%)	260 (28.5%)	652 (71.5%)
Mother’s work sector	250	133 (53.2%)	117 (46.8%)
Health care worker	46 (18.4%)	41 (89.1%)	5 (10.9%)	29.2	<0.0001
Non-health care worker	204 (81.6%)	92 (45.1%)	112 (54.9%)
Monthly family income	866	296 (34.2%)	570 (65.8%)
<450 USD	139 (16.1%)	24 (17.3%)	115 (82.7%)	57.3	<0.0001
450–1,000 USD	289 (33.4%)	77 (26.6%)	212 (72.4%)
1,000–2,000 USD	253 (29.2%)	96 (37.9%)	157 (62.1%)
>2,000 USD	185 (21.4%)	99 (53.5%)	86 (46.5%)
Knowledge about cervical cancer	1,192	408 (34.0%)	784 (66.0%)
Yes	858 (72%)	404 (47.1%)	454 (52.9%)	*	<0.0001
No	334 (28%)	4 (1.2%)	330 (98.8%)
Pediatrician offering HPV vaccine	1,193	408 (34.2%)	785 (65.8%)
Yes	264 (22.1%)	258 (97.7%)	6 (2.3%)	608.0	<0.0001
No	929 (77.9%)	150 (16.1%)	779 (83.9%)

Note:

* Fisher’s exact test was used.

Abbreviations: HPV, human papillomavirus; USD, US dollars.

Table 3 Comparison between mothers who vaccinated their girls and those who did not with respect to different aspects of the girls’ sexual life and the mothers’ knowledge about cervical cancer, HPV, and the vaccine

Parameters	Total responders, n (%)	Number of mothers with vaccinated girls, n (%)	Number of mothers with non-vaccinated girls, n (%)	Chi-square value	P-value
The girl received all childhood vaccines	1,193	30 (2.5)	1,163 (97.5)
Yes	1,029 (86.3)	28 (2.7)	1,001 (97.3)	*	0.417
Girls’ expected age of marriage, years	1,070	27 (2.5)	1,043 (97.5)
<20	42 (3.9)	0	42 (100)	8.2	0.042
20–25	939 (87.8)	21 (2.2)	918 (97.8)
26–30	87 (8.1)	6 (6.9)	81 (92.1)
>30	2 (0.2)	0	2 (100)
A girl might be sexually active before marriage	1,175	29 (2.5)	1,146 (97.5)
Yes	10 (0.9)	0	10 (100)	*	1.00
No	1,165 (99.1)	29 (2.5)	1,136 (97.5)
Belief that the future son in law would have a premarital sexual experience	1,140	27 (2.4)	1,113 (97.6)
Yes	208 (18.2)	5 (2.4)	203 (97.6)	4.7	0.095
No	932 (81.8)	22 (2.4)	910 (97.6)
Belief that marriage is always monogamous from both partners	1,168	30 (2.6)	1,138 (97.4)
Yes	875 (74.9)	23 (2.6)	852 (97.4)	0.2	0.913
No	293 (25.1)	7 (2.4)	286 (97.6)
Knowledge about HPV vaccine	1,193	30 (2.5)	1,163 (97.5)
Yes	408 (34.2)	30 (7.4)	378 (92.6)	*	<0.0001
No	785 (65.8)	0	785 (100.0)
Knowledge about cervical cancer	1,192	30 (2.6)	1,162 (97.4)
Yes	858 (72)	30 (3.5)	828 (96.5)	*	<0.0001
No	334 (28)	0	334 (100)
Knowledge about warts	1,193	30 (2.5)	1,163 (97.5)
Yes	310 (26)	17 (5.5)	293 (94.5)	15.1	<0.0001
No	883 (74)	13 (1.5)	870 (98.5)
Knowledge about the sexual transmission of HPV	1,193	30 (2.5)	1,163 (97.5)
Yes	310 (26)	17 (5.5)	293 (94.5)	15.0	<0.0001
No	883 (74)	13 (1.5)	870 (98.5)
Family history of cervical cancer	1,193	30 (2.5)	1,163 (97.5)
Yes	80 (6.7)	0	80 (100)	*	0.257
No	1,113 (93.3)	30 (2.7)	1,083 (97.3)
Source of information about cervical cancer	857	30 (3.5)	827 (96.5)
Obstetrician	569 (66.4)	18 (3.2)	551 (96.8)	34.0	<0.0001
Pediatrician	88 (10.3)	12 (13.6)	76 (86.4)
Social media and educational audio–visual programs	150 (17.5)	0	150 (100)
Family history	37 (4.3)	0	37 (100)
Other	13 (1.5)	0	13 (100)
Pediatrician offering HPV vaccine	1,193	30 (2.5)	1,163 (97.5)
Yes	264 (22.1)	28 (10.6)	236 (89.4)	*	<0.0001
No	929 (77.9)	2 (0.2)	927 (99.8)
Belief that the vaccine is not safea	1,163	NA	1,163 (100)
Yes	136 (11.7)	NA	136 (100)	–	–
No	1,027 (88.3)	NA	1,027 (100)
Belief that the vaccine is not effectivea	1,163	NA	1,163 (100)
Yes	34 (2.9)	NA	34 (100)	–	–
No	1,129 (97.1)	NA	1,129 (100)
Belief that the vaccine is unaffordablea	1,163	NA	1,163 (100)
Yes	168 (14.4)	NA	168 (100)	–	–
No	995 (85.6)	NA	995 (100)
Monthly family income (USD)	866	16 (1.8)	850 (98.2)
<450	139 (16.1)	1 (0.7)	138 (99.3)	1.2	0.757
450–1,000	289 (33.4)	6 (2.1)	283 (97.9)
1,000–2,000	253 (29.2)	5 (2)	248 (98)
>2,000	185 (21.4)	4 (2.2)	181 (97.8)

Notes:

* Fisher’s exact test was used;

a These questions were asked only to mothers of non-vaccinated girls.

Abbreviations: NA, not available; USD, US dollars.