Human papillomavirus and Vaccination: Knowledge, Beliefs, and Perception of Future registered Nurses

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Acquiring knowledge and necessary skills to teach the community about health-related behavior, screening, and early detection methods as well as preventive measures. Is the responsibility of nurses for a dominant role in cancer prevention [21, 22]. The majority of the respondents in this study knew of HPV is the sexual transmission, as the main cause of cervical cancer; this determination is consistent with results that are obtained by Ursa et al in his written report which was conducted among nurses in Tanzania 2011 [23, 24, 25]Appear obviously in our subject field the students received most of their data from the internet. In our country the issues of sexual health are not readily introduced in school curriculum due to our culture and religion barriers, This is similar to findings that were obtained by Goold et al 2006 who observed that the internet could be a pragmatic and approachable style to deliver sexual health education to young [26].A survey led by Pegasus Health independent Provider Association, among Practitioner Nurse, in Christchurch in New Zealand, showed that 94.2% of the respondents are well informed about HPV vaccination. Misconceptions have been found in our study, regarding this concept as 65.1% of respondents think that immunization with the HPV vaccine will get rid of the need for further cervical cancer screening [27].The HPV vaccine is considered also a relatively new ideal tool for primary prevention of cervical cancer. The vaccine provides protection in (90% –100%) against persistent infection and cervical disease and represents the future method of cancer prevention. Just 25.2%% of respondents in our study knew about the HPV vaccine, similar findings were reported by Nader Ghotbi et al, from the survey conducted in Prefectural University in Japan 2010 [12]. Conversely to Magda, s study of females at health Science College (Saudi) aware of the HPV vaccine [28]. Some other survey in Pakistan indicates that awareness about HPV vaccine was less than 10%. Opposite to all previous studies a recent study among Korean university female undergraduate students shows that nearly 83.8% were well informed about HPV vaccine as preventive measures against cervical cancer [29]. Also, Pegasus Health independ¬ent Provider Association study stated the majority of Practitioner Nurses they intend to recommend HPV vaccine to their pa¬tients and families if it is publicly funded and more than 70% would recommend vaccination even if they have to pay for it[27]. The HPV vaccine will be utilized in practice along with its increased understanding by the suppliers and the recipients. On the other hand, health professionals have an important role in the acceptance of HPV vaccination, because their knowledge and beliefs affect their recommendations to the general population. Nonetheless, the confident attitude of nurses and doctors toward HPV, cervical cancer, and HPV vaccine, may lead to a successful vaccine introduction if a national policy would be implemented [30]. Therefore, targeted educational efforts are needed to ensure that nurses are introduced in the prevention of human Papillomavirus related diseases, as well as their known influence on patients’ decisions to receive the vaccine [31]. Overall, most of our respondents were cited positive attitude to vaccination against HPV, Which did not contribute to risk behavior in a survey that was conducted in Turkey 2012 among the medical & nursing students, only (4.5%) of respondents reported that vaccination would lead to riskier sexual behaviors [32].ABSTRACT Introduction: Human papillomavirus (HPV) is the most common sexually transmitted infection and causes 529.000 cases of cervical cancer every year. Nowadays, there are vaccines available to prevent infection. Knowledge of HPV influences the attitude towards the vaccine and is, therefore, a factor of accepting the vaccine. Aim: To examine the knowledge of HPV and attitudes towards HPV-vaccine among Sudanese female university students. Method: Descriptive and cross-sectional study with a quantitative method using a questionnaire. Purposive sampling was used. The sample consisted of students from different universities in Khartoum, Sudan and out of the 246 students who filled in the questionnaire.Result: revealed that participants had relatively high levels of awareness. However, many revealed that participants had relatively high levels of awareness. However, many respondents had significant gaps in their knowledge of HPV and the HPV vaccine.These data suggest that further efforts to educate young adults on these topics are warranted.Conclusions: The present study is an initiative to find out the level of awareness about one of the currently most discussed topic of cervical cancer vaccine, among the future health care providers. The existing gap between the knowledge of the students can be overcome by various educational programs. In fact, all health workers need to be educated about how to help patients to understand the advantages and limitations of this cervical cancer prevention strategy.Keywords: human papillomavirus, knowledge, Attitude, HPV-vaccine, student nurse∗ Corresponding authorDr. Afaf AbdallaEmail: [email protected] papillomavirus (HPV) is a sexually transmitted infection (STI) which is the primary cause of cervical cancer. The most common type of cancer in the world, among women, with approximately 529.000 new cases and nearly 274.000 deaths reported each year (World Health Organization [WHO], 2011) [1]. In the Sudan, it ranks as the second most frequent cancer among women after breast cancer, account about 50% of all cancers in Sudanese women, so there is an urgent intervention for proper early detection of cancer in Sudan to get treatment more effective, less expensive, more affordable, and acceptable to patients [2, 3].We identified female in age between 20–24 years old affected with high prevalence seen, HPV has many types, but high risk seen in (types 16 and 18) they are responsible for about 70% of infections, and low risk (mainly types 6 and 11) in less than 10% of all infections [4, 5]. Women whose infections persist are at significant risk of developing precancerous is indicated for the women whose infection persist without treatment. It is seeing a peak prevalence of HPV infection in women under age 25 from several studies conducted in several international regions [6]. It is usually acquired within the first two years after starting sexual intercourse; HPVs are highly transmissible through sexual contact, as stated by WHO 2008 and ACOG Committee on Practice Bulletins-Gynecology (2009) [7].Oral contraceptives more contributing factor to Human Papillomavirus (HPV), this proven from studies find women using oral contraceptives for five years or longer slightly elevates the risk of getting cervical cancer, the risk increased by fourfold among women who had used OCs for longer than 5 years. Prevalence of oral contraceptive use among Sudanese women is 4.5% [8, 9]. Women should use a condom regularly with multiple partners to protect their self from contracting HPV infection. One study agrees with this, that the failure to use condoms by Danish husbands during risky sexual encounters highly correlated with the incidence of cervical cancer among their wives [10, 11, and 12]. A cross-sectional survey among the female college students at Asia Pacific University (APU) in Japan proved that there was deficit knowledge about safer sex practices, and a lack of motivation to periodic follow up to the health clinics to take consultation for preventive measures like Pap smear screening [12].Recently introduced, two HPV vaccines – the (Gardasil 17) and (Cervarix®) vaccine that protects against HPV6/11/16/18 and the HPV 16/18 respectively used to who acquire HPV infection as well a begin sexual intercourse to approval for primary prevention of cervical cancer [13,14]. The Human Papilloma Virus vaccine protects about 90% –100% against infection and cervical cancer. There is a need for screening for women who have not received the vaccine as well as for those who have been immunized, in spite of the successes of the vaccine. Many countries reported their acceptance of HPV vaccination to be given for adolescent [15, 13, 14]. It appears clearly attitude influence acceptability and beliefs of the HPV vaccination [16]. In general, most agencies feel have different views about when females take the vaccination, some define it around the age of 11 – 12 years. At 2006, WHO and UNFPA identified the time for global use of the vaccine in adolescent, between 9–10 years to 13 years of age (3 doses over 6 months). They are varied in opinion to deliver HPV vaccination, such as school-based, health-center based, and outreach in communities [10]. For promotion for women’s health and the health of their families, nurses should take responsibility for promoting HPV immunization and cervical screening within a broader health framework relevant to the local context [17].Australia, Canada, New Zealand, United Kingdom, and the United States are the first countries to introduce HPV vaccine in 2007 in response to global call, provided free by the government, and included in school-based vaccination program which was initiated for female adolescents aged 11-12 years to catch-up vaccination up to 26 years of age for females for the subsequent two years [18]. There is an urgent call for nurses to promote early education of HPV transmission routes and prevention methods to adolescents, by encouraging sexual health promotion among adolescents in society [19]. The transmission of information and acquisition of knowledge on the etiology and how the disease can be prevented among nurses and nursing students could reduce vulnerability to known risk factor [20].A recent study of nurses’ knowledge, attitudes, and practices towards cervical cancer and HPV infection prevention were done among 133 nurses working in a Srinagar University Hospital in Northeast Thailand, concluded that nurses possess a restrained level of knowledge about cervical cancer and HPV, with some major misunderstanding. Those educational efforts are required to ensure participation of nurse’s in the prevention of human Papillomavirus related diseases [11].MethodsThis was a cross-sectional descriptive survey involving final undergraduate nursing students. It was conducted in nursing colleges at all Universities located in Khartoum state and has final undergraduate students. The study population consisted of the final year undergraduate nursing students who are studying at eligible selected universities in Khartoum state. The minimal sample size was calculated, 246participants. The list of the students was obtained from each university. A systematic sampling method was used to select nurse students from the list of universities which included both public and individual universities.The instrument for this survey was a close-ended (multiple choice) self-administered A questionnaire designed to determine the knowledge, attitude, and acceptance of the participants to HPV vaccination.The study respondents were assured of confidentiality and the first part of the questionnaire provided socio-demographic information about the students. The second part assessed their knowledge of HPV infections, attitude to vaccines and their willingness to accept HPV vaccine. There was no health education on the subject for the participants before the completion of the questionnaire. The questionnaire was pre-tested in a similar population for validity and reliability using 20% of the calculated size.Data analysis was done using SPSS version 20 with both descriptive and Inferential Statistics. In particular, Chi-square statistics were employed to calculate the level of correlation between the variables and the nature of the independent variables in this subject area. P values less than 0.05 were considered significant. Participation in the study was voluntary and written informed consent was received from respondents prior to their participation. Ethical approval was obtained from the Health Research and Ethics Committee of the Universities.Conclusion:There were gaps in the knowledge of cervical cancer, HPV and HPV vaccination among nursing students in Sudan. Full acceptability of HPV vaccine was also high beside; several obstacles to vaccination were identified, such as the unavailability of a vaccine in Sudan. However, the majority were willing to be vaccinated if the vaccine is available. Capacity building, training, and involvement of nurses in cervical cancer prevention program as an important sound health policy. Training the nurses to be in charge of taking the cervical cytological specimen may be another helpful option.AcknowledgmentThe authors wish to appreciate the efforts of the entire staff of the Nursing Colleges of the participated universities all students responded to the study.Conflict of InterestThe authors declare that they have no conflict of interest.