Caregiver factors associated with HPV vaccination uptake in a pastoralist community in Kenya

Abstract

Abstract Introduction: Cervical cancer remains the leading cause of cancer death among women in Kenya, and HPV vaccination coverage is lowest in mobile pastoralist populations. This study examined the level of, and factors associated with, HPV vaccination uptake among caregivers of adolescent girls aged 15–18 years. Methods: A concurrent mixed-methods study among 204 caregivers selected by multi-stage sampling across the three wards of the sub-county. Knowledge was measured with a 15-item composite score, and perceptions and attitudes with an 18-item scale. Proportions are reported with Wilson 95% confidence intervals (CI), and binary logistic regression exhibited complete separation; adjusted prevalence ratios (aPR) were estimated using modified Poisson regression with robust variance. Two focus group discussions and ten key informant interviews were analysed thematically using the Braun and Clarke framework. Results: Uptake of at least one dose of HPV was 38.7% (95% CI: 32.3–45.6), and completion of the two-dose schedule was 11.3% (95% CI: 7.6–16.3); only 29.1% (95% CI: 20.3–39.9) of those who initiated completed the schedule. Ward differences were not statistically significant (P=0.121). Knowledge was poor in 65.2% (95% CI: 58.4–71.4) of caregivers, and attitudes were poor in 82.8% (95% CI: 77.1–87.4). Among the 125 caregivers of unvaccinated girls, 61.6% expressed no intention to vaccinate; the most frequently reported reasons were fear of infertility (62.6%) and doubts about vaccine safety (59.3%). In the adjusted model, good knowledge (aPR: 2.32, 95% CI: 1.40–3.84) and fair knowledge (aPR: 1.74, 95% CI: 1.12–2.70) relative to poor knowledge, and good attitudes (aPR: 1.72, 95% CI: 1.16–2.56) relative to poor attitudes, remained independently associated with uptake. Occupation remained an independent association, with livestock-dependent caregivers less likely (aPR: 0.41, 95% CI: 0.20–0.81) and petty traders more likely (aPR: 1.81, 95% CI: 1.12–2.92) to have vaccinated daughters than housewives. Qualitative accounts converged on fertility anxiety, moral framing of adolescent sexuality, paternal veto over girls’ health decisions, weak initial mobilisation and the exclusion of out-of-school and mobile girls from school-based delivery. Conclusion: HPV vaccination uptake in this pastoralist setting is far below national and global targets and is associated most strongly with caregiver knowledge and attitudes, with an additional independent contribution from livelihood. Interventions should prioritise community-embedded communication delivered through trusted local voices, deliberate engagement of male household heads, and outreach adapted to mobility, alongside consolidation of Kenya’s November 2025 transition to a single-dose schedule.