Pattern and predictors of healthcare providers' recommendations for human papillomavirus vaccination in Ebonyi State, Nigeria

Introduction: Nigeria recently introduced the human papillomavirus (HPV) vaccine into its National Programme of Immunization (NPI). The uptake of this vaccine was fraught with several challenges, such as misinformation, vaccine hesitancy and belief barriers. Healthcare provider recommendations are known to improve the uptake of HPV vaccine. This study assessed the pattern and predictors of HPV vaccine recommendations among healthcare providers in Ebonyi State. Methods: This was a facility-based cross-sectional study conducted from July to August 2024 among healthcare providers in Ebonyi State. The respondents were selected using a multistage sampling technique. An interviewer-administered structured questionnaire programmed into Open Data Kit was used to collect data. Descriptive, bivariate, and multivariate analyses were done using IBM Statistical Product and Service Solutions (SPSS) version 26. The level of significance was set at 5%. Results: A total of 935 healthcare providers participated in the survey. The mean age of the respondents was 36.6±9.5 years. The prevalence of frequent recommendations of HPV vaccination was 37.3% (95% CI: 34.1 – 40.6). Among those who had never recommended the vaccine (33.7%), the most frequent reasons included lack of information (35.9%) and the perception that vaccine recommendation was not their duty (31.1%). The independent predictors of HPV vaccine recommendation by healthcare providers included age (aOR=0.50; 95% CI: 0.28 – 0.90), education [(West African Examination Council O’ level; aOR = 0.06; 95% CI: 0.01–0.22) and (Ordinary National Diploma/Higher National Diploma; aOR = 0.31; 95% CI: 0.14–0.71)], actual knowledge (aOR=12.38; 95% CI: 7.28 – 21.10), self-reported knowledge (aOR=2.94; 95% CI: 1.74 – 4.96) and attitude to HPV vaccination (aOR=15.62; 95% CI: 7.76 – 31.44). Conclusions: Only one third of the healthcare providers frequently recommended the HPV vaccine. Age, educational status, knowledge of HPV vaccination, and attitude of healthcare providers to HPV vaccination were associated with HPV vaccine recommendation by healthcare providers. Reorienting healthcare providers through regular training sessions on the national HPV vaccination guidelines, while designing targeted health education programmes to address identified knowledge gaps among healthcare providers, is recommended.