Human papillomavirus vaccine acceptability in Cameroon: a systematic review and meta-analysis

Background

Human papillomavirus (HPV) vaccination is a key strategy for cervical cancer elimination. In Cameroon, HPV vaccine was introduced into the expanded program on immunization in 2020. However, synthesized evidence on vaccine acceptability is needed to guide policy. This systematic review and meta-analysis aimed to estimate the pooled prevalence of HPV vaccine knowledge, willingness to vaccinate, recommendation practices, and actual uptake in Cameroon, and to identify determinants of vaccine hesitancy.

Methods

We searched PubMed, Scopus, Web of Science, Embase, Cochrane Library, and African Journals Online from studies to January 2025. Studies reporting willingness to vaccinate, knowledge, recommendation, and uptake of HPV vaccine were included. Pooled prevalence estimates and odds ratios were calculated using random-effects models. Heterogeneity was assessed using the I² statistic. The study was reported following PRISMA 2020 guidelines and registered in PROSPERO ID: CRD420261301213.

Results

Thirty-three studies were included. Among 4,993 participants, who were mainly healthcare workers (n = 1,739) and parents (n = 2,419), the pooled prevalence of willingness to vaccinate was 68.1% (95% confidence interval [CI]: 57.4–77.2; 12 studies; I² = 98%). The pooled prevalence of HPV vaccine knowledge was 41.3% (95% CI: 28.7–55.1; 33 studies; n = 8,175 participants; I² = 98%). Approximately two-thirds of participants (67.7%; 95% CI: 50.7–81.0; 8 studies; n = 1,617) reported recommending the vaccine, but actual uptake was 22.9% (95% CI: 6.9–54.5; 9 studies; n = 9,686). The vaccine coverage ranged from 1.6% to 90.6%. Willingness significantly declined from 74.2% before 2014 to 57.5% after 2021. Healthcare workers had the highest knowledge (74.5%) and willingness (77.8%) among included participant groups. Lack of HPV knowledge was associated with nearly three-fold higher hesitancy (odds ratio [OR]: 2.58; 95% CI: 2.06–3.22). High heterogeneity was observed for all pooled estimates, suggesting that they should be interpreted as average estimates rather than precise values.

Conclusions

Despite moderate willingness, HPV vaccine knowledge and uptake remain low in Cameroon, with marked disparities across regions and populations. Addressing knowledge gaps and strengthening context-specific vaccination strategies are needed to improve coverage.