Geographic inequities in human papillomavirus vaccine non-uptake and its determinants among adolescent girls in Ethiopia: Evidence from the National Immunization Survey

Introduction: 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. Methods: 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. Results: 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. Conclusions: 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.