Published in PLOS One on 2026-04-28, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Kibir Temesgen Assefa, Abebaw Gebeyehu Worku, Achenef Asmamaw Muche, Bisrat Misganaw Geremew, Mulat Adefris Woldetsadik, Kassahun Alemu
Source: PLOS One • DOI 10.1371/journal.pone.0348076
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Human papillomavirus (HPV) vaccination has emerged as the most effective method for preventing cervical cancer. Despite this, Ethiopia’s HPV vaccine non-uptake rate remains high, with significant geographic variation, and there is limited evidence on the geospatial determinants of these inequities. This study aimed to map the geographic inequities in HPV vaccine non-uptake and identify its determinants among adolescent girls in Ethiopia.
We conducted a secondary data analysis using the Ethiopian National Immunization Survey dataset. A stratified two-stage cluster sampling technique was used to select 467 enumeration areas (EAs) and a weighted sample of 5,341 adolescent girls. The geographic inequity of HPV vaccine non-uptake was analyzed using Moran’s I, Getis-Ord Gi statistics, and Kriging interpolation in ArcGIS 10.8. We employed geographically weighted regression analysis to identify geographic factors associated with inequity in HPV vaccine non-uptake.
Forty-six percent (46%, 95% CI: 44.7–47.8) of adolescent girls did not receive the HPV vaccine, and there were geographical variations in vaccine coverage. Higher proportions of HPV vaccine non-uptake were identified in eastern Amhara, eastern Oromia, central and northern Somali, central Afar, and the urban administrative units of Dire Dawa and Harari. Poor attitude and poor knowledge towards the HPV vaccine, not living with parents, and urban residence were predictors of geographic inequities in HPV vaccine non-uptake.
The proportion of HPV vaccine non-uptake varied across Ethiopia, with geographic inequities identified in the eastern and northeastern parts of Ethiopia. Poor attitudes and knowledge about the vaccine, not living with parents, and urban residence contributed to these inequities. These findings highlight the need for targeted educational campaigns in areas with high non-uptake to improve knowledge and attitudes, alongside tailored strategies for regions where urban residence and not living with parents influence uptake.
Introduction
Human papillomaviruses (HPVs) are a group of epitheliotropic viruses, many of which are carcinogenic and strongly associated with cervical, anal, oropharyngeal, and other anogenital cancers [1]. HPV-related cervical cancer is the most common cancer in women worldwide [2]. Globally, HPV infects 80% of sexually active individuals, with low- and middle-income countries accounting for more than 90% of cases [3]. In Ethiopia, 31.5 million women are at risk of contracting HPV, which causes 99% of cervical cancers, with over 7,445 new cases annually, and 70% of cases dying from the disease [4,5]. Over 90% of cervical cancers can be prevented with highly effective, safe, and free or low-cost HPV vaccines [6–9].
Despite the effectiveness and safety of HPV vaccines, the non-uptake rate remains high [10–13], and significant geographic inequities exist both between and within countries [14–16], ranging from 5.6% to 98.9% [17]. The 2023 WHO report estimated that globally, seven out of eight girls remain unvaccinated [17]. The Strategic Advisory Group of Experts Vaccine Hesitancy Determinants Matrix identified contextual, individual, and multi-level factors responsible for non-uptake and geographic inequities [18]. Socioeconomic status, including income, occupational status, educational level, residence, and geographical location, as well as vaccine access, contributed to HPV vaccine uptake [19–21]. Studies from Switzerland [22], the USA [23], China [24], Kenya [25], and Uganda [26] reported that local policies, community attitudes, socio-economic conditions, racial differences, culture, and healthcare access problems are significant factors for HPV vaccine non-uptake and coverage inequities.
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider public health desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Kibir Temesgen Assefa, Abebaw Gebeyehu Worku, Achenef Asmamaw Muche, Bisrat Misganaw Geremew, Mulat Adefris Woldetsadik, Kassahun Alemu. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
Explore connected evidence
- Evidence brief: Understanding factors influencing HPV vaccine uptake among caregivers in Kwara State, Nigeria: A qualitative study
- Evidence brief: Strengthened HPV vaccination among adolescents living with HIV, – Findings of a Pilot QI project in Kampala Metropolitan, Uganda
- Evidence brief: Spatial distribution of uptake of newly introduced vaccines and its associated factors among children aged 12–35 months in Ethiopia: Multi-scale Geographically Weighted Regression Analysis
