Background: Human papillomavirus (HPV) is a significant public health concern due to its role in cervical cancer. Awareness and uptake of the HPV vaccine are suboptimal in many parts of India, especially in urban slum areas. Anganwadi workers, as a part of the Integrated Child Development Services (ICDS), can play an important role in community education. Objectives: To assess and compare the awareness of the HPV vaccine among school-going girls in slum and non-slum areas of Nellore Municipal Corporation and to evaluate the role of Anganwadi workers in vaccine-related awareness dissemination. Methods: A cross-sectional study was conducted across 10 schools (5 from slum and 5 from non-slum areas) in Nellore. Anganwadi workers were trained and involved in sensitization sessions. Awareness levels were assessed using a pre-tested questionnaire among girls aged 11–16 years. Results: Out of 250 participants (125 from each area), awareness about HPV infection and vaccination was significantly lower in slum areas (22.5%) compared to non-slum areas (48.8%). After sensitization, a notable increase in awareness was observed in both groups (slum: 22.4% to 56.4%, non-slum: 48.8% to 72.0%). Conclusion: Anganwadi workers significantly improved HPV vaccine awareness among school children. Special focus on slum schools is necessary for equitable health promotion.
Cervical cancer ranks among the foremost causes of cancer-related fatalities in women across India, constituting roughly 17% of all cancer deaths in females aged 30 to 69 years. The primary etiological factor for cervical cancer is the human papillomavirus (HPV), a sexually transmitted pathogen, with types 16 and 18 accounting for nearly 70% of global cases. Although effective HPV vaccines that offer protection against these high-risk variants have been introduced, their adoption in India remains significantly low. The burden of cervical cancer is particularly pronounced in urban slum populations, attributed to lack of awareness, lower literacy levels and limited access to healthcare services.
Adolescence represents a pivotal opportunity for the administration of HPV vaccinations, ideally prior to the initiation of sexual activity. The Government of India has commenced HPV vaccination initiatives in select states through school-based programs and is progressively broadening its national efforts. Nevertheless, the knowledge and acceptance of the vaccine among adolescents and their guardians persist as obstacles to effective implementation. Anganwadi workers, operating under the Integrated Child Development Services (ICDS), are instrumental in promoting health and nutrition at the community level. They are ideally situated to provide education on preventive health measures, particularly for mothers and children. Their involvement in school health programs could enhance HPV-related health communication, especially within disadvantaged communities. There exists a scarcity of literature regarding the role of Anganwadi workers as facilitators in advancing vaccine awareness in educational environments. Consequently, this study seeks to assess the level of awareness regarding the HPV vaccine among adolescent girls in both slum and non-slum areas within the Nellore Municipal Corporation and to evaluate the effectiveness of a structured awareness campaign conducted by trained Anganwadi workers.
Study Design: Community-based cross-sectional study.
Study Area: Schools under Nellore Municipal Corporation, Andhra Pradesh.
Study Population: Adolescent girls aged 11–16 years attending government and private schools located in slum and non-slum regions.
Sample Size: Total of 250 students – 125 each from slum and non-slum schools (5 schools each group, 50 students per school).
Sampling Technique: Stratified random sampling based on school location.
Data Collection Tool: Pre-tested questionnaire covering demographic data, knowledge about HPV, vaccine awareness.
Intervention: Trained Anganwadi workers conducted awareness sessions in schools using posters, pamphlets.
Ethical Considerations: Institutional Ethics Committee approval and informed consent were obtained.
The study included 250 adolescent girls with an average age of 13.8 years. Most were in the 8th or 9th grade, with 72% attending government schools.
Pre awareness session levels were as follows:
Slum areas: 28% had heard of HPV, 52.4% heard about the vaccine, 19.6% were aware that the vaccine prevents cancer.
non-slum areas: 31.5% had heard of HPV, 44% heard about the HPV vaccine, 24.5% were aware that it prevents cancer.
Figure 1: Pre-Awareness session in Slum and Non-Slum Schools
Post awareness session levels increased significantly:
Slum areas: 44.8% had heard of HPV, 56.4% heard about HPV vaccine, 38.0% were aware that it prevents cancer.
non-slum areas: 67.2% had heard of HPV, 72.0% heard about the vaccine, 54.4% were aware that it prevents cancer.
Figure 2: Post Awareness session in Slum and Non-Slum Schools
The research indicates a notable difference in awareness of the HPV vaccine between students from slum and non-slum schools, reflecting the outcomes of earlier studies conducted in urban and peri-urban areas. While almost half of the students in non-slum institutions had some level of awareness regarding the HPV vaccine before the intervention, fewer than 25% of students in slum schools were informed about it. These findings highlight systemic disparities in health education and access to information among marginalized groups. Data collected after the awareness revealed a significant rise of more than a twofold increased awareness in both groups. This emphasizes the HPV vaccine awareness sessions in public can play a crucial role of in promoting adolescent and women health as well. Previous studies corroborate the effectiveness of community health workers in bridging gaps in health knowledge and facilitating behavioural changes in underserved populations. It is crucial to recognize that increased knowledge does not necessarily lead to higher vaccine uptake. Ongoing reinforcement through school health initiatives, interactions between parents and teachers, and collaboration with primary health centres is vital for maintaining progress. Although the study demonstrated significant short-term improvements, future investigations should concentrate on assessing the long-term retention of knowledge and actual vaccine uptake. Furthermore, involving parents and addressing vaccine hesitancy through targeted counselling will be essential for achieving broader public health objectives. Considering India's plans for a nationwide HPV vaccination, community-driven approaches can promote inclusivity and equity.
There is a stark gap in HPV vaccine awareness between slum and non-slum school children in Nellore. Public, when properly trained and empowered, can bridge this gap effectively.
Efforts should be made to institutionalize such awareness programs within school health services, especially targeting vulnerable populations in urban slums.