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FACTORS INFLUENCING THE UPTAKE OF HUMAN PAPILLOMA

VIRUS VACCINE AMONG ADOLESCENT GIRLS AT THE SELECTED


SECONDARY SCHOOLS IN KIBAHA DISTRICT

RESEARCH PROPOSAL

By

NEHEMIA NGAILO

SUPERVISOR’S:

MAJOR SUPERVISOR: DR. LAWRENCIA DOMINICK MUSHI

&

CO- SUPERVISOR: DR.MACKFALLEN GILIAD ANASEL

NOVEMBER, 2022

1
LIST OF ABBREVIATIONS AND ACRONYMS

ASIR Age Standardized incidence rate

CDC Centers of Disease Control and Prevention

DMO District Medical Officer

FIG Full Immunized Girls

HPV Human Papilloma virus

SSA Sub-Saharan Africa

UK United Kingdom

WHO World Health Organization

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TABLE OF CONTENTS

LIST OF ABBREVIATIONS AND ACRONYMS...................................................i


LIST OF TABLE.......................................................................................................iv
LIST OF FIGURES....................................................................................................v

CHAPTER ONE.........................................................................................................1
THE PROBLE AND ITS BACKGROUND.............................................................1
1.0 Introduction.............................................................................................................1
1.1 Background of the study.........................................................................................1
1.2Statement of the Problem.........................................................................................6
1.3Research Question...................................................................................................8
1.4 Objectives...............................................................................................................8
1.4.1 General Objective................................................................................................8
1.4.2 Specific Objective................................................................................................8
1.5 Problem Justification..............................................................................................9
1.6 Significance of the Study........................................................................................9
1.7 Scope of the Study..................................................................................................9
1.7 Limitation of the Study.........................................................................................10
1.8 Organization of the Study.....................................................................................10

CHAPTER TWO......................................................................................................11
LITERATURE REVIEW........................................................................................11
2.0 Introduction...........................................................................................................11
2.1 Definition of Key Terms.......................................................................................11
2.2Theoretical Literature Review...............................................................................12
2.2.1 Protection Motivation Theory............................................................................12
2.2.2. ProspectTheory.................................................................................................12
2.3 Empirical Literature Review.................................................................................12
2.4 Conceptual Framework.........................................................................................14
2.4.1Conceptual framework........................................................................................15

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CHAPTER THREE..................................................................................................16
RESEARCH METHODOLOGY............................................................................16
3.0 Introduction...........................................................................................................16
3.1 Research Approaches............................................................................................16
3.2 Study Design.........................................................................................................16
3.3 Study Area............................................................................................................16
3.4 Study Population...................................................................................................17
3.5 Sample Size and Sampling Techniques................................................................18
3.5.1 Sample Size.......................................................................................................18
3.5.2 Sampling Techniques.........................................................................................19
3.6 Data Collection Source, Methods and Procedures...............................................19
3.6.1 Data Source........................................................................................................19
3.6.2 Data Collection Methods and Tools..................................................................19
3.6.2.1.Interviews.......................................................................................................19
3.6.2.2. Focused Group Discussion............................................................................20
3.6.2.3 Questionnaires................................................................................................20
3.7. Data Analysis Procedures....................................................................................21
3.8 Ethical Considerations..........................................................................................21
3.9 Proposal Timeframe and Budget..........................................................................22
3.9.1. Time Schedule..................................................................................................22
3.9.2 Proposed Budget................................................................................................22
REFERENCES.........................................................................................................23

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LIST OF TABLE
Table 3.1: Sample size categories...............................................................................18
Table 3.2 Time Schedule............................................................................................22
Table 3.3 Proposed Budget.........................................................................................22

iv
LIST OF FIGURES
Figure 1: Conceptual framework................................................................................15
Figure 2: Map of KibahaShowing Distribution of Study Area...................................17

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CHAPTER ONE

THE PROBLEM AND ITS BACKGROUND

1.0 Introduction

This chapter consisted the background of the of the study, statement of the

problem, research objectives, research questions, problem

justification ,significance of the study, scope of the study, limitations of the

study and organization of the study.

1.1 Background of the study

Human Papilloma virus (HPV) is one of the viruses which cause many cancers to
women that are transmitted through sexually intercourse (CDC, 2015). The level of
human papilloma virus is as high as 83% of HPV infections among girls whose age
ranked between 13–19 years after up to eight years of follow-up post-vaccination.
Therefore, due to HPV vaccine that is offered as primary protection or measures
against high-risk of cervical cancer the influence the uptake of vaccines to
adolescents girls as it is estimated that HPV reduces the deaths from cervical cancers
if level of vaccine uptake reaches 80% as indicated in immunization program for
adolescents so as to inform HPV vaccination policy and implementation program.

In case of introduction of immunization program, many countries across global has


tried to implement the school based immunization program, the program increased
the adolescents vaccination rate and HPV uptake level to adolescent girls who
becomes a vulnerable group. As the results, HPV leads to death of one woman after
every two minutes because of cervical cancer thus; it affects about 570,000 women
with an estimated 311,000 deaths across the globe, greater than 85% of the deaths
occurring in less developed countries. Therefore, the annual incidence rate of 85%,
and a crude mortality rate of more than87%, it is the fourth leading cause of death
among women of childbearing age, responsible for cervical cancer, vulval cancer,
anal cancer and or pharyngeal cancer (Runge et al., 2019).

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Globally, the uptake of HPV is reported in the country like UK in which HPV
vaccination programme was introduced in 2008 for adolescent girls, 6 with the
primary aim of preventing cervical cancer among adolescent girls. Initially, the
bivalent HPV vaccine was used in the UK’s routine vaccination programme, but in
2012, this was replaced with the quadrivalent vaccine. Also, in England the uptake of
the HPV vaccine between 12- to 13-year-old girls from September 2012 to August
2013 was 86.1% for all three doses. Some countries, such as Australia and 44.5%
had received three doses. Indeed the HPV vaccines are administered in a health care
setting in the US and are funded predominantly through private health insurance,
only being provided free of charge to those who are Medicaid eligible, uninsured or
underinsured (Carol et al , 2014) .

Furthermore, in sub-Sahara Africa (SSA) cervical cancer incidence rate is high


compared to other regions in the world, for example in Malawi is more than 70 per
100000 women’s, Mozambique incidence is 65 per 100000 women’s and Comoros
incidence is 61 per 100000 women’s (Ngcobo et al., 2019).

Also, the recent study in Kenya by Kolek (2022) indicated that papilloma virus in
Kenya that becomes a problem among female especially adolescents as it cause
cervical cancer but the parent’s knowledge and attitudes about the vaccine is nearly
negative perception on the effectiveness of the HPV as primary prevention thus,
impact on uptake that affects successful immunization. Although, the government
influences parents to encourage their adolescent’s girls to attend free vaccine services
all over the country through donor agencies support in delivery of human papilloma
virus vaccine for adolescents girls in school as a primary protection of cervical
cancers.

Meanwhile, Tanzania decided to introduce the vaccine into the national


immunization program as the strategies and the primary prevention to address high
cervical cancer burden to the adolescents girls of about 9–14-year old so as to
ensure protection to the greatest number of girls .These girls would be vaccinated
when sufficient HPV vaccine supplies became available; In this case; in 2017
Tanzania became the seventh African countries to accept HPV into its routine
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vaccine program. This program was introduced in the health policy as strategic
planning towards the protection of the adolescent’s girls from HPV infections. As the
results, the government introduced training health care workers, teachers, community
and religious leaders, and mass media on the importance of HPV vaccination to
adolescents and pre – adolescents as vulnerable group for human papilloma virus
(Bruni, et al (2019).

In addition to that, Uganda is among East African countries that use HPV vaccine as
coping mechanism and as a primary prevention against cervical cancers because
HPV covered almost 90% of cervical cancers cases. Therefore, different programs
was introduced to have a significant impact on public health but the challenges that
exist is about delivery of the vaccine to adolescents aged 9 to 15 years which is
recommended by WHO. In so doing, the government launched a vaccine program
against HPV to about 140,000 pre-adolescents and this vaccine is given out free of
charge but uptake has remained low in many parts of the but at least the average
estimated at 17% as of the population. As the results, the uptake of HPV vaccines for
adolescents of 9–15 years old is indicated in immunization and vaccination policy
and implementation program (Julieth et al, 2020).

According to WHO (2020) the uptake of HPV vaccine is low and its coverage is
below targeted number after relapsing of the targeted time. Thus, Tanzania as a
nation had a target of reaching 85% coverage of all young girls attaining age 14 by
2024. By the year 2022 the progress of HPV vaccination coverage targeted was 75%,
which has not been attained. Importantly, HPV is issued to young women for the
purpose of preventing cervical cancer which is caused by Human Papilloma Virus.

In the implementation of HPV delivery strategies, there is a need for effective,


affordable, sustainable, and compatible of the uptake of HPV in health systems to
achieve the highest possible coverage. The vaccine is an irreplaceable part of
prevention of cervical cancer especially in women of child-bearing age (WHO,
2017).

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The studies conducted by Ngcobo et al. (2019); Anyie et al. (2019) indicated that
HPV vaccines have efficacy against multiple types of cancers caused by HPV. It is
estimated that HPV prevent anal cancer by 80%, cervical cancer by 70%, vaginal
cancer by 60%, vulval cancer by 40% (De Vuyst et al, 2009) and HPV-positive or
pharyngeal cancer by more than 90% (Takes et al, 2015; Anjum &Zohaib, 2020).
The groups affected by cervical cancer, who are also the primary beneficiaries of
HPV vaccines, are women and young girls, with secondary schools being used
strategically to reach the maximum number of them.

Nevertheless, the decline in the incidence rate of cervical cancer worldwide since the
introduction of the HPV vaccine is strong evidence of its importance in the combat
against cervical cancer. Zhang et al (2021) gives estimation that, from 1990 to 2019
the annual global Age Standardized Incidence Rate (ASIR) of cervical cancer has
decreased at a rate of 0.38% per year. Similarly, the multiple studies which was
conducted about the uptake of human papilloma virus have been reported a dramatic
decline in cervical cancer incidences in developed countries. They have furthermore
associated such decline with a robust implementation of screening and vaccination
programs (Ferlay et al, 2010; Huh et al, 2015).

The level of uptake of HPV vaccine is lower in Tanzania due to high rate and trend
of incidence of cervical cancer in sub-Sahara Africa seems to differ from one nation
to another. As the results of low level of the uptake of the vaccine The uptake of
particularly Tanzania has a lower uptake of the vaccine despite of taking free
vaccine services as a benefits in protecting adolescent’s girls whose their age is
about 9- 25 years old against cervical cancer . For example, Tanzania the second
dose has a low coverage of around 49% (Alex et al, 2021). The secondary school
children strategically targeted for the vaccine have only been reached by 28% in
Mkuranga, 56% in Kisarawe and only 18% in Bagamoyo, Pwani (media seminar
report, 2020).

Likewise, in Tanzania health care is the key component of human capital, and plays a
fundamental role in determining household’s ability to access better labor
opportunities and escape poverty. In so doing, ministry of health has put effort in
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improving health of the citizens especially young babies and young girls by
introducing different vaccination programs such as oral polio vaccine to young
babies of 6,10 and 14 weeks, rotavirus vaccine to babies of 6 and 10 weeks,
pneumococcal conjugate vaccine to young babies of 6,10 and 14 weeks, measles and
rubella vaccine to babies with 9,18 month and Human papilloma virus vaccine to
young girls of 9 and years and above (National Immunization Schedule, 2018).
Therefore, in the case of human papilloma virus can cause infections to women and a
little cases of infections to men, one of the big problem is cervical cancer which is
estimated about 85% percentage of infections in Tanzania and cause death estimated
about 90% percentage of death caused by cervical cancer to women’s, cervical
cancer affect women’s between 35 to 44 ages but it can developed in women’s less
than 20 ages (Bray et al, 2018).

A study conducted by Bruni et al (2018) indicated that, the low HPV uptake resulted
the detrimental consequences of cervical cancers that have experienced from
individual level in Tanzania all the way to a national level especially the adolescent
girls are highly affected form cervical cancers including death as the worst fate after
a prolonged period of illness. For instance, Tanzania loses approximately 6690
women to cervical cancer each year, with more than 9700 new cases. At the same
time, the burden of disease carried by the patient’s family causes significant
economic loss. As the result, most of the treatment options for cervical cancer are
expensive and are only available in zonal and national hospitals as the results; the
long distance from district hospital affects provision of vaccine services to vulnerable
group of adolescents and pre adolescents. Moreover, the emotional stress borne by
the family in case of death and prolonged illness is a huge burden and may affect the
quality of life of the grieving family members.

Also, WHO (2019) reported that government of Tanzania adopted and incorporated
HPV vaccine into its routine vaccination programs in 2014. It was initially delivered
through outreach programs to schools as well as in health facility stations. Health
education campaigns have also been undertaken through various media and to great
success as observed in Anyie et al (2019). The cost of attaining one Fully Immunized

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Girl (FIG) is estimated by WHO (2020) to be 4.50 USD which is equivalent to
10,500 Tsh. The government of Tanzania in collaboration with various stakeholders
such as GAVI and have ensured such finances are funded in each fiscal year. Apart
from the efforts made by the government and other health some parts in Tanzania
still report low uptake of vaccination in the intended groups. These parts include
Kibaha district, which has an estimated vaccination rate of 14% (media seminar
report, 2020). It is unclear what factors hinders uptake of the vaccination program in
this part or how to mitigate the problem for sustainable success.

Therefore, the delivery of HPV vaccination at secondary schools provides an ideal


route to reaching the adolescents girls. However, while there have been plans to
expand the national routine immunization schedule to include HPV vaccine, several
factors including global supply constraints and sociocultural barriers including the
mistrust of western medicine remain challenges. Therefore the government of
Tanzania through the ministry of health introduces HPV vaccination into its national
routine immunization schedule as primary preventions towards human papilloma
virus to adolescent’s girls. Thus, this study will seek to explore factors affecting the
uptake of HPV in Tanzania, a case of Kibaha district.

1.2 Statement of the Problem

Cervical cancer is the fourth most prevalent cancer worldwide and it causes death to
women’s. It is estimated that 311,000 worldwide deaths were caused by cervical
cancer in 2018 and the most who are affected much are women in middle age (WHO,
2017). According to health policies formulated by WHO against HPV pre –
adolescents and adolescents girls the Ministry of health in Tanzania has priotized
vaccine as it is recommended in WHO policies to eliminate HVP infections by 2030.
The policies focus on strategies of conducting the vaccination campaigns in Sub –
Sahara Africa that can help to reduce cervical cancer to new generations. The
strategies based on increasing the level of uptakes of the vaccines among adolescent
girls and how the vaccine program is effective, the global alliance for vaccine and
immunization was supported the provision of HPV vaccine in Sub -Saharan Africa
(Kolek, 2022) In most cases, the strategies used by health care stakeholders as
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preventive measures is to use vaccination to control HPV and screening for cervical
cancer, to detect it at early stages where it can be treated successfully. Nonetheless,
sub-Saharan African countries that had been delayed in HPV vaccine introduction
were still having low HPV vaccine uptake and associated factors among adolescent
school girls and HPV vaccine uptake was 17.61% whereas, in contrast, the
prevalence of cervical cancer was high. In Ethiopia, about 7,445 new cervical cancer
cases are diagnosed and about 5,338 women die of it annually.

Also, the HPV vaccination was adopted by the WHO and all member states, to
protect the women early enough before vaginal exposure to HPV, thus using
secondary schools as the meeting point for all the girls in the catchment area served
by the school. Despite the noble ideology and the government’s efforts, the uptake of
the strategic intervention in Kibaha District remains lower than anticipated.
According to Media Seminar Report (2020), the coverage of the vaccination for the
past two years have an average of 14%, leaving the targeted group exposed to the
fatal disease. Different factors may be speculated for association with success and
failure of assimilating the service by the target population, but no study has been
done in Tanzania to systematically explore the problem and make tailored
recommendations for its correction and mitigation.

The rates of HPV vaccination remain low compared to other routinely recommended
vaccines for the same age group of adolescent girls who are affected form cervical
cancer as the results, only six out of 10 girls ages 13-17 years old received at least
one dose of the HPV series, and only four out of 10 were fully protected with all
three doses. Therefore ,the rates for boys of the same age were even lower with only
42% starting and 22% completing the series .On other hand, the majority of girls
(85% of 11- to 12-year-olds and 95% of 13- to 18-year-olds) saw providers with high
intention to recommend HPV vaccines, only 30% initiated the series (Ndikom &
Oboh ,2017)

There is a need for interventions with greater focus on HPV and especially for the
link between HPV and cervical cancer. The interventions have to focus on
educational intervention that is delivered by the government and other health
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stakeholders through the ministry of health as a feasible and effective way to increase
adolescents’ girls towards a level of uptakes of HPV as a primary prevention
regardless of adolescents’ age differences. Also, the school-based interventions must
reach all adolescents girls regardless of socioeconomic status, ethnicity or cultural
background and the follow-up is needed in so as to determine whether the school-
based educational interventions are effective in implementation of health policy.
Consequently, in implementation of HPV delivery strategies, there is a need for
effective, affordable, sustainable, and compatible of the uptake of HPV in health
systems to achieve the highest possible coverage (Shepherd & Harris, 2011).

The latter however, falls under secondary prevention, implying that the incumbent
has already fallen victim of the disease. So this leaves only vaccination as the safest
and most strategic preventive intervention. Therefore, this study seeks to explore the
problem and find out the factors pertaining to both success and failure of complete
vaccination of adolescent girls in Kibaha district, thus filling the gap in knowledge
streamline.

1.3 Research Question

What are the determinants of low uptake of HPV vaccine among adolescent girls of
secondary schools in Kibaha District?

1.4 Objectives

1.4.1 General Objective

To explore factors influencing low uptake of HPV vaccine among adolescent girls of
secondary school in Tanzania, a case of Kibaha district.

1.4.2 Specific Objective

i. To determine the level of HPV vaccine uptake among adolescent girls at


secondary school in Kibaha district.
ii. To determine factors affecting the uptake of HPV vaccine among adolescent
girls at secondary schools in Kibaha district.

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iii. To determine mechanisms that can be used to improve the uptake of HPV
vaccine among adolescent girls at secondary schools in Kibaha.

1.5 Problem Justification

At the moment, vaccine uptake among the intended groups is low in Kibaha District.
This is evidenced by the low numbers of girls who have completed all the vaccine
schedules and are thus completely immunized. However, the reasons for such low
turn up of the intended population to get vaccinated are not well understood. So this
study will explore these reasons and offer a sustainable way forward.

The information generated by this study will benefit Kibaha District community
members by increasing HPV vaccine coverage after implementation of the study’s
recommendations. This will in turn decrease the incidence rate of cervical cancer as
well as the other cancer types prevented by HPV vaccination. Ultimately, the
findings of this study may be in other locales with similar demography and sharing
the same problem as Kibaha District. After finding out the factors, this study will
make appropriate recommendations to competent authorities, implementation of
which will surely solve the problem. Moreover, the solutions may be adopted further
in other areas with the problem that share socio-economic characteristics similar to
Kibaha District.

1.6 Significance of the Study

This study will generate knowledge about factors influencing the uptake of human
papilloma virus vaccine among adolescent girls at secondary schools in Tanzania
context, a case Kibaha district. Also, this study is justified by several sexual
transmitted diseases including the spread of papilloma virus. Importantly, this study
will give insights to adolescents ‘girls, teachers and health care professionals on the
uptake of HPV vaccination and immunization. Thus, this study expects to add value
to the existing knowledge by bringing to views on human papilloma virus, cervical
cancers, strategies towards eliminating HPV in Tanzania, a case of Kibaha district
council.

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1.7 Scope of the Study

The findings of this study confined itself to a total of 120 respondents in Kibaha
district council; these respondents will be consulted through questionnaires FGD and
interview methods. All these respondents the respondents will be consulted through
FGD and interview will be the DMO, medical health officers, girl’s adolescents and
parents in the selected secondary schools in Kibaha district council. In this study the
major issue discussed will be the assessment factors affecting the uptake of human
papilloma virus vaccine among adolescent girls at secondary schools in Tanzania in
Kibaha district council.

1.7 Limitation of the Study

Best and Khan (2006) define limitation of the study as a condition beyond the
researchers control that may place limits on the study and application to other
situations. The key limitation of this study will be accessing related literature. There
was limited literature on the factors influencing the uptake of human papilloma virus
vaccine among adolescent girls at secondary schools in Tanzania in Kibaha district
council and thus the researcher was forced to link two diverse bodies of literature.

1.8 Organization of the Study

This study will be organized into three chapters. Chapter one will deal with the
background of the study, statement of the problem, objectives of the study and its
scope which inform the study and its context, thus, it is providing justification of the
study, chapter two will be on literature review or literature related to this study. The
major focus will on identification of the knowledge gap or development of new
knowledge from the literature review and current study. Chapter three is concerned
with the research methodology, data collection techniques and tools for data analysis
and data analysis techniques.

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CHAPTER TWO

LITERATURE REVIEW
2.0 Introduction

In this study, different literatures were reviewed to explore cervical cancer in order to
understand its etiology and make tailored recommendations with the aim of reducing
its incidences. Among the studies are those which suggested HPV vaccination as the
most strategic preventive measure for the problem. This review dissects the literature
to better understand what is known and reveal the gap to be filled.

To obtain relevant articles, a systematic literature search was made using multiple
search engines. Some of such engines include Google scholar, research gate and
some of websites such as WHO, elsevier and Tanzania health portal. Key search
terms used included “HPV vaccine”, “cervical cancer”, “incidence of cervical
cancer”, “adolescent at secondary schools”, “associated factors” .In this study
English language is the only language used and restricted to articles published not
more than 10 years old .

2.1 Definition of Key Terms

1. Human Papillomavirus (HPV) is a name given to a group of more than 200


sexually transmitted viruses spread through skin-to-skin contact during sexual
activity. HPV causes cervical cancer and the HPV vaccine is used to prevent it
(Burd, 2003)

2. Vaccine is the biological preparation that improves immunity to a particular


disease, it stimulates the body's immune system can quickly recognize and destroy
any of these microorganisms that it later encounters (Wilson et al, 2016).

3. Adolescent refers to young persons aged 10 to 19 years as adolescents. In this


study, the adolescent schoolgirls aged between 14 and 16 years old were included,
this is because this study also tried to determine HPV vaccination coverage and for
this to be possible it needed to include this age range (WHO, 2009).

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4.Uptake is refers to the number of adolescent schoolgirls aged 14 – 16 years who
received two or three doses of the HPV vaccine (Longman Dictionary of
Contemporary English 2011:1935)

2.2 Theoretical Literature Review

2.2.1 Protection Motivation Theory

Protection motivation theory assumes that, the intention to protect depends upon four
factors such as perceived susceptibility, perceived severity, response efficacy and
perceived self-efficacy (Heriet et al, 2015). Therefore, these are more useful in
uptake human papilloma vaccine among adolescent as a primary protection from
infections. As the result, any vaccination is a subjective norms in influence mothers'
intentions to vaccinate their daughters as a strategies to protect the children from the
infection .In case, of human papilloma virus (HPV), protection motivation theory
implies that, health stakeholders often make more efforts to motivate people to
influences pre- adolescent adolescents who are vulnerable against human papilloma
virus that leads to cervical cancer to the infected women. Thus, the parents' intentions
to have their daughter vaccinated are only solutions to the problem.

2.2.2. Prospect Theory

Prospect theory predict that, gains and losses are valued differently, which in turn
can alter decision-making in order to highlight the benefits of complying with a
recommended behaviour or avoidance of negative consequences. Not only that, but
also portray the negative consequences of noncompliance (Bowyer, 2014). This
theory has implication with the human papilloma virus because parents' perception
on HPV vaccination uptake as well and their intentions as a primary preventive
measures in HPV infections among adolescent girls.

2.3 Empirical Literature Review

Okwi and Nuwematsiko (2020) did research on the reason for the low uptake is
the lack of information, education, and communication materials on HPV
vaccine in health facilities, schools, and other communal places. As the results,
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the adolescents who received adequate information about HPV vaccine are more
likely to accept the vaccine, and the adolescents' vaccination decisions are
shaped by confidence in the vaccination programme and healthcare providers.

Dillner et al (2010) conducted research on the strategies towards protection of the


vulnerable group and observed that protection against anogenital wart among
vaccinated individuals ranges from 80-100%, while the protection against
premalignant lesions ranges from 60-80%. This is in line with the theoretical view
that once inoculation is successful, immunity is mounted against the pathogen,
resulting in the individual being protected against the disease caused by the
pathogen.

Priscilla et al (2017) soundness of the intervention, acceptance of the HPV


vaccination has been troublesome around the world. Thus, the factors have been
associated with low coverage. For instance in Brazil, the population’s knowledge
about HPV and its repercussions on health, had a direct impact on coverage of the
vaccine. Not only that, but also there were integrated approach among adolescents,
parents and health professionals, which had a positive influence on the coverage.

Julieth et al (2018) Conducted research on pre-and-post the deliverance of the human


papilloma virus vaccine expecting a high contribution to the success of vaccine.
Also, the study shows that, the vaccine uptake level and its associated factors are
very limited because of some barriers and factors affecting the utilization of the HPV
vaccine which might be used as basic information for further interventions. Thus,
this study assessed the uptake of HPV vaccination and its associated factors among
adolescent school girls.

Chu (2020) did research in Kenya on the preference of people in receiving


information on HPV vaccination in small groups, and that health care providers can
play strategic roles in promoting HPV vaccination. This is done through interactive
educational forum intervention delivered by co-ethnic health professionals for East
African countries to reduce barriers regarding adolescent HPV vaccination and
promote uptake of vaccinate their children. Thus, study aimed to evaluate the impact

xviii
of this interactive educational forum on HPV-related knowledge, perceived ability to
engage with their healthcare providers about HPV vaccines, barriers to vaccination,
and intentions to vaccinate their adolescent children.

Brockmsan et al (2020) examined the challenges to vaccine uptake for adolescents in


Africa, particularly the HPV vaccine, include cost of the vaccine for those not
eligible in national roll-out efforts, and lack of awareness and knowledge among
adolescents, caregivers and educators. Also, the Interventions focus on creating HPV
vaccine and cervical cancer prevention messaging for adolescents, caregivers and
educators will increase the uptake of HPV vaccinations, HPV testing and cervical
cancer screening for high-risk adolescent girls and young women. As the results, The
HPV vaccine is a critical and effective primary prevention measure against HPV-
related cancers, particularly for young women in low-resource settings with limited
screening resources and high HIV and HPV prevalence.

Kwan et, al (2016) examined that, the most relevant factors affecting HPV negative
perception as well as lack knowledge on the safety of the vaccine, accessibility to the
vaccines and parents’ instruction on the matter. The matter remains whether the
vaccination teams are aware of these barriers and if they have measures in place to
address them prior to the vaccination exercise.

Sousa et al (2018) developed a tool to measure knowledge of the adolescent girls,


their parents and community members in general on HPV vaccine, while
simultaneously measuring the acceptability of the vaccine.

2.4 Conceptual Framework

A Conceptual framework is a visual illustrate that represent expected relationship


between cause and effect in the research (Saunders, 2002). It indicates the
relationship between independent variables that influence dependent variables.

In this study we have dependent variable and independent variables where by


dependent variable in our study is HPV vaccine which could be influenced by

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independent variables which are knowledge, ideology and accessibility as stipulated
in the figure below:-

2.4.1Conceptual Framework

Independent Independent
variables variables

Knowledge
HPV vaccine
uptake

Ideology

Accessibility

Figure 1: Conceptual framework


Source: Researcher’s Design

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CHAPTER THREE

RESEARCH METHODOLOGY
3.0 Introduction

This chapter provides research methodologies and research designs such as, area of
study, target population, sample size and sampling techniques, source of data
collection and data collection tools or instruments.

3.1 Research Approaches

Morgan D (2013) research approach helps to structure collection, analysis and


interpretation of data. The researcher will use mixed methods both qualitative and
quantitative methods in data collection and analysis. The researcher is opted for
mixed methods because the methods will help in integrating knowledge from both
qualitative and quantitative data as well as overcoming each method’s weaknesses
and limitations.

3.2 Study Design

Kothari, (2013) stated that, research design is the method used in collection and

analysis of data in a manner that aims to combine relevance to the research

objectives with economy in the procedures. In this study descriptive design will used

to examine the factors affecting Human papilloma virus among adolescent’s girls in

Kibaha district. In this case, the researcher will collect raw data from the field and

analyzed them by using both quantitative and qualitative approaches.

3.3 Study Area

The proposed study area is Kibaha town. This is a township found in Pwani region in
Tanzania one of nine district of Pwani region, Kibaha covers an area of 1,502km 2. A
metropolitan mixture of population is found here, spanning from unemployed to
employed and self-employed. Similarly in all the demographic characteristics,
diversity may be observed. In case of demography, the total population of Kibaha

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according to census of 2012 the total population of 128,488 (Population and Housing
Census General Report, 2012). Kibaha town district consist of 14 wards which are
kibaha, Kongowe, MailiMoja, Mbwawa, Misugusugu, Mwendapole, Pangani,
PichaYaNdege, Sofu, Tangini, Visiga And Viziwaziwa Kibaha (District Profile,
20212). Therefore, Kibaha district was chosen because the estimation of vaccination
rate of 14% was shown in the district profile report (media seminar report, 2020). It
is unclear what factors hinders uptake of the vaccination program among adolescents
girls in the district.

Figure 2: Map of Kibaha Showing Distribution of Study Area


Source: Maphil web, (2013)

3.4 Study Population

The study population will include adolescent girls in Kibaha district secondary
schools, teachers, health officers, parents and district medical officers. These groups
of people will be targeted to provide the information about factors affecting the
uptake of HPV among adolescent’s girls in Kibaha district.

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3.5 Sample Size and Sampling Techniques

3.5.1 Sample Size

The population of the study will be 5549 which will include adolescent girls in
secondary school, DMO, health officers and parents of adolescent girls in secondary
schools. By using the equation developed by Robert slovin to calculate the sample
size.

The Solving formula is given by;

n=

Where: n = Sample size


N = Population size (number of department employees)
e = level of precision
Therefore
e =10% or 0.1,

= = 99.981~ 100

Therefore the sample size will be 100 which will be categorized as folows.-

Table 3.1: Sample size categories


Sample size category Sample size Percentage Data collection tool
Adolescent students 80 80% Questionnaire
District medical officer 1 1% Interview guide
District health officer 1 1% Interview guide
Ward health officers 5 5% Questionnaire
Parents 13 13% Interview guide
Total 100 100%
Source: Researcher (2022)

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3.5.2 Sampling Techniques

Prathapan (2014) asserts that the major reason for sampling is to reduce the
expenses in terms of time, money and effort.

The sampling techniques will be divided into the qualitative sample and quantitative
sample. For the qualitative sample, a purposive sampling technique will be used to
get the key informants. The researcher will select District Immunization and
Vaccination Officer to examine the information about vaccination and
immunization , also, nurses will be consulted on the of issue the vaccine at the
selected vaccination centers. For the quantitative sample, a multistage sampling
technique will be used in which schools will be selected by using simple random
sampling, and then a systematic sampling will be used to get individual participants
within the schools selected.

3.6 Data Collection Source, Methods and Procedures

3.6.1 Data Source

The nature of this study influences the use of primary data source by collecting
information from adolescent girls at secondary schools, parents of those adolescent
girls at secondary schools and health officers and then secondary data source by
reading other articles and vaccinations district reports.

3.6.2 Data Collection Methods and Tools

This study will involve three data collection methods which are FGD, interviews and
questionnaires for primary data and documentary review for secondary data the use
of different methods aimed to complement the strengths of each data collection tool
to overcome weaknesses of one another. These methods will help in increasing
validity and reliability of study results.

3.6.2.1. Interviews

Kothari (2013) the term interview is a method which involves oral questions through
face to face interactions between interviewee and interviewer. The researcher
xxiv
becomes the interviewer in which he/she asked questions to respondents. The
interview method of collecting data involves presentations of oral verbal and reply in
terms of oral verbal responses. This method will be used through personal interview
and if possible through telephones interview but the researcher will use personal
interviews.

3.6.2.2. Focused Group Discussion

The focused group discussion involves discussion with the respondents to obtain
ideas from them about the phenomenon under investigation (Punziano &
Paoli ,2019) The focused group discussion involves the people who share the same
and common interest in the issue that need different opinions, beliefs , attitudes ,
perception as well as experiences. Therefore, in this study, the researcher will form
FGD with DMO, medical officers, nurses, parents and adolescent girls in the area of
the study to examine factor affecting the uptake of human papilloma virus among
adolescent girls in secondary schools in Tanzania case of Kibaha district council.

3.6.2.3 Questionnaires

Kumar (2019) defines questionnaires as set of stimuli to which literate people are
exposed in order to observe their verbal behavior, under these stimuli within method
there are questions the researcher seeks from respondent in order to gain knowledge
about certain matters.

The researcher used open-ended questions due to the fact that it helps to get more
reliable and valid data about factor affecting the uptake of human papilloma virus
among adolescent girls in secondary schools in Tanzania case of Kibaha district
council. Also, the method will be useful because the questions will be answered even
if the researcher is absent and it is less time consuming. The questionnaires will
comprise of both open-ended and closed ended items. The open –ended items enable
the respondents to look critically on the problem and thus give diverged views and
responses. Closed-ended items will be expected to elicit specific information from
the respondents. Questionnaires will be distributed to the respondents living at the
places close to the area of study so as to provide information about factors affecting
xxv
the uptake of human papilloma virus among adolescent girls in secondary schools in
Tanzania case of Kibaha district council.

3.7. Data Analysis Procedures

The process of data collection was not an end in itself. Likewise, data analysis
procedures maintain the culminating activities of quantitative and qualitative
inquiries are analysis, interpretation and presentation of findings. This indicates that
the researcher does not end with the collection of data but the collected data should
be analyzed by using the statistical package for data analysis. Kothari (2004) asserts
that, analysis procedures may help researcher to summarize information collected
from the field.

Therefore in the process data collected will be categorized, computed and arranged
into the evidence for answering the research questions. For quantitative data the
study will have frequency and percentages through the use of tables and bar graphs
applied which are in simple descriptive analysis for the aim of having wheel
organized presentation of the results based on the research objectives.

3.8 Ethical Considerations

The study will observe the respondent rights, respondent should be willingly to
participate in order to provide information but also the issue of respondent privacy
and confidentiality will be observed.

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3.9 Proposal Timeframe and Budget

3.9.1. Time Schedule

Table 3.2 Time Schedule


PERIOD ACTIVITY
July 2022 Preparing and formulating research topic
August 2022 Writing Concept Note
August 2022 Developing and writing concept note on the research topic
September,2022 Submission of the concept note to the research supervisors
September , 2022 Making corrections of comments from the supervisors
October 2022 Defense for research proposal
November , 2022 Data collection
Decembers 2022 Submission of dissertation report to supervisors
January 2023 Making correction son dissertation report from supervisors
February 2023 Submission of final report draft to supervisors
March 2023 Defending dissertation report

Source: Researcher (2022)

3.9.2 Proposed Budget

Table 3.3 Proposed Budget


Activities Costs Total
Transport go and return 600,0000/=

Interment Access and Communication 500,0000 1,100,000/=


Research proposal Preparation and
Production 1,500,000/=
Typing &printing 500,000/=
Meals and accommodation 200,000 2,200,000/=
Binding
Grand Total 2,200,000/= 3,300,000/=
Source: Researcher (2022)

xxvii
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