Assessment of Human Papillomavirus Vaccination Acceptability and Coverage Among Adolescent Girls in North East Nigeria

Nigeria's national HPV vaccination programme, introduced in phases from 2023, targets adolescent girls for the prevention of HPV-associated cervical cancer. Implementation in the North East geopolitical zone faces contextual challenges including low female secondary school enrolment, cultural reservations around vaccinating adolescent girls, and fragile health infrastructure. This study assesses HPV vaccine acceptability among parents and adolescent girls and evaluates early vaccination coverage in Adamawa, Gombe, and Taraba states, North East Nigeria. A mixed-methods design will survey 600 parent-girl dyads at secondary schools using structured questionnaires and conduct 24 focus group discussions with parents, religious leaders, and community health workers. Coverage data from the State Primary Health Care Development Agencies will be reviewed for the first two years of programme implementation (2023 to 2025). Acceptability determinants including religious concerns, vaccine safety perceptions, trust in health authorities, and school-based access barriers will be quantitatively modelled using structural equation modelling. Comparable studies from northern Nigerian states identify maternal education and male partner approval as key determinants of paediatric vaccine acceptance. Findings will produce a state-specific HPV acceptability profile and provide actionable recommendations for the NPHCDA and implementing partners to tailor demand generation strategies for the North East, strengthening the programme's reach in an under-vaccinated zone. Keywords: HPV vaccination, adolescent girls, acceptability, North East Nigeria, cervical cancer prevention