Determinants of human papillomavirus vaccination uptake in Nigeria: a mixed-methods systematic review

BACKGROUND: Human papillomavirus (HPV) vaccination coverage in Nigeria is hindered by multiple barriers, including limited awareness, socioeconomic constraints, cultural beliefs, systemic challenges, and policy gaps. As a result, the burden of cervical cancer and other HPV-associated malignancies continues to rise despite public health interventions. The current mixed-methods systematic review (SR) synthesizes evidence on the determinants of HPV vaccination uptake in Nigeria to inform context-specific strategies for improving coverage. METHODS: The methodological procedures of this SR adhered to the Joanna Briggs Institute’s (JBI) guideline for systematic reviews and reported using PRISMA. A comprehensive systematic search of nine electronic databases was undertaken to identify peer-reviewed articles published from January 2015 to August 2025. After deduplication and screening of the retrieved literature, the methodological quality of the included studies was evaluated using the Mixed-Methods Appraisal Tool. Relevant data were extracted from all included articles and synthesized using a convergent integrated approach. RESULTS: Among the 481 records identified, 16 studies involving 10,764 participants met the eligibility criteria. Most studies were conducted in southern Nigeria and focused on adolescents, students, parents, and caregivers. HPV vaccine acceptance ranged from 32.7% to 97.3%, yet actual uptake remained low at 1% to 15% in most studies. Limited knowledge and poor awareness were the most consistent determinants of low uptake. Other barriers included fear of side effects, misconceptions about infertility or sexual behavior, limited healthcare engagement, and lack of provider recommendation. Sociocultural influences such as parental approval, religious beliefs, and cultural norms also shaped vaccination decisions, while vaccine cost and limited availability further restricted uptake. CONCLUSION: A significant gap exists between HPV vaccine acceptance and actual uptake in Nigeria. Improving coverage requires coordinated strategies that strengthen public education, address vaccine affordability, enhance provider communication, and respond to sociocultural concerns influencing vaccination decisions.