Human papillomavirus awareness and vaccination willingness among adults in Madagascar: a cross-sectional study

Disease awareness is key to utilising healthcare services, including vaccinations. Madagascar, with high human papillomavirus (HPV) prevalence (> 36%), marked cervical cancer rates, and low general routine vaccination coverage, faces major challenges in managing HPV-related diseases, mostly because of its fragile health system and the absence of HPV vaccination programmes. This study aimed to assess HPV awareness and vaccination willingness in Madagascar to inform strategies for implementing HPV vaccination programmes in the country. A cross-sectional survey among adults was conducted in the Boeny and Matsiatra Ambony regions. HPV awareness and willingness to be vaccinated against HPV were analysed using Poisson regression. Overall, the level of HPV awareness was low (4.6%; 95% CI: 3.8-5.6). Urban residency (aPR = 1.7; 95% CI: 1.1-2.6), higher education (aPR = 2.1; 95% CI: 1.1-4.0), and recent contact with healthcare services (aPR = 1.8; 95% CI: 1.2-2.6) were associated with greater HPV awareness. HPV vaccination willingness was generally high (67.0%; 95% CI: 65.0-69.0) but was significantly higher among participants aware of HPV (aPR = 1.4; 95% CI: 1.2-1.5). Most participants received ample information on general routine vaccinations, with healthcare workers (HCWs) reported as the most reliable source of information (48.6%). This study shows that improving knowledge about HPV could increase the success of HPV vaccination programmes in the country. In addition, the study highlights the importance of education in terms of health literacy, stressing that efforts to reach rural populations with lower levels of education are crucial.