Once she’s born, she belongs to the government … it can protect her” (IDI Butimba). BMN 673 We found that teachers, parents, pupils and health workers interviewed in our qualitative sub-study had limited or no knowledge about cervical cancer, HPV, and the HPV vaccine. Generally, most welcomed a vaccine to prevent cervical cancer and most parents said they would agree to have their daughter

vaccinated although some adopted a “wait and see” approach. Most had a strong belief that vaccines prevent diseases. Our findings are similar to formative research results by PATH in Uganda, Peru, Vietnam and India prior to HPV vaccination [29] and [30], and recent studies on vaccine acceptability in Ghana, Botswana, Kenya, and South Africa [31], [32], [33] and [34]. In a study amongst 147 Kenyan women seeking health services there was little knowledge about either cervical cancer or the HPV vaccine [31]. Findings were similar in South African antenatal attenders [34]. In Botswana, awareness PF-02341066 mw of cervical cancer was higher amongst many adults (mostly female) but again, few had heard of HPV vaccine [32]. In a Ghanaian study among 264 women, ages 18–65, where most had received higher education after secondary school, 87% of study participants

had heard about cervical cancer and 40% about the HPV vaccine [33]. Despite variability in cancer and vaccine awareness, in all of these sub-Saharan studies, the majority of the women were willing to vaccinate their child. Anti-fertility rumours, raised as a potential issue for the vaccine in our study and the study in Uganda, are widespread in Africa in relation to vaccines and health-related products and reflect underlying suspicions about public health interventions [35] and [36]. People may object to imported, foreign drugs and new medical interventions; knowing that the HPV vaccine has already been administered in Africa and

is approved by the Tanzanian government was thought to be persuasive by many respondents. from Issues of power and control over health emerged in the discussions about opt-out consent. Health workers saw public health actions as mandatory and considered that individual parent consent was not a necessary part of national immunisation policy, although provision of information to parents and communities was important. This was also stressed by other respondents. In Mwanza, parents wanted to be involved in the decision-making process but the consensus was that opt-out consent was acceptable, and there was considerable support for a girl’s right to be vaccinated, even if parents refused their consent. Uganda’s pilot HPV vaccination program also used a similar opt-out approach [20]. No parents in our study reported concerns that the vaccine might stimulate sexual activity, a concern that has sometimes emerged in high-income countries [37] and [38].