Health professionals' willingness to pay and associated factors for human papilloma virus vaccination to prevent cervical cancer at College of Medicine and Health Sciences University of Gondar, Northwest Ethiopia

Acceptance and affordability of malaria vaccines: issues relating to hesitancy and willingness to pay amongst Nigerian parents of under-five children

BACKGROUND

With the recent approval of the malaria vaccine by the World Health Organization, it is expected that global acceptance and subsequent uptake of the intervention can help to reduce the burden of the disease in Africa. This study adopted a proactive approach in assessing parents' acceptance of the malaria vaccine, alongside their willingness to pay for the novel public health intervention.

METHODS

A national cross-sectional survey was undertaken in Nigeria using a questionnaire as the data collection instrument. The study tool was administered to parents of child-bearing age. Descriptive and inferential statistical analyses were performed using the Statistical Package for Social Sciences (SPSS) software version 25.

RESULTS

A total of 1413 valid responses were received with male (49.5%) and female (50.5%) participants represented by similar proportions. Close to two-thirds (62.5%) of the participants were between the ages of 31 and 40 years, and 47.4% of the participants were educated up to national diploma level. More than two-thirds (69.6%) of the participants indicated that they were worried about side effects that may be associated with the malaria vaccine. A strong majority (90%) of the participants indicated that the vaccine should be administered at no cost to citizens, while 46.7% of the respondents were willing to pay for the malaria vaccination. Levels of education attained by the respondents influenced their willingness to pay for malaria vaccination. This variable also underpinned participants'  reasons for non-acceptance of the vaccine. Those who attained only primary and secondary levels of education were significantly more likely to reject the malaria vaccine because they were against vaccines in general (AOR = 6.63; 95% CI = 1.33 - 39.25; p = 0.021).

CONCLUSION

This study provides critical novel insights which could influence vaccination efforts aimed at reducing the burden of malaria in Nigeria, as well as similar settings.

Human Papillomavirus Vaccination for Boys: Insights into Knowledge, Acceptance, and Willingness to Pay among Parents in Yogyakarta, Indonesia

OBJECTIVE

This study aimed to measure knowledge, acceptance, and willingness to pay (WTP) towards Human Papillomavirus (HPV) vaccination for boys among parents in Yogyakarta Province, Indonesia.

METHODS

The cross-sectional, descriptive study was conducted from September to November 2023 through electronic self-reported questionnaires survey. The parents of boys aged 11 to 15 years of age and had never had an HPV vaccination for their son before were recruited as survey respondents. The study respondents were recruited through school-based approach involving 12 elementary schools and 15 junior high schools that distributed in 3 districts of Yogyakarta Province. The survey examined demographic details, knowledge about HPV and its vaccine, understanding of HPV-related issues, willingness to receive the HPV vaccination, and readiness to pay for the vaccine.

RESULT

A total of 410 parents that coincidentally all were women participated in this study. The average knowledge score was 6.58 (43.9%), indicating that overall knowledge about HPV was moderate among the respondents. In contrast, a total of 346 parents (84.4%) expressed their willingness to vaccinate their son. The bivalent vaccine had mean of an out-of-pocket WTP of IDR 172,279 (USD 11.11) and the quadrivalent vaccine of IDR 223,144 (USD 14.39), with a median WTP of IDR 100,000 (USD 6.4) for both vaccines. These WTP values were about 20% of the market price. There was significant difference of WTP mean between group of respondents' characteristics for variables such as marital status, education, and income. There was also significant relationship between knowledge, acceptance, and WTP toward HPV vaccine.

CONCLUSION

Despite the high acceptance towards HPV vaccination, knowledge and WTP were still considered low. Such strategies are required to increase awareness regarding impact of HPV toward men's and women's health. In addition, at current situation voluntary HPV vaccination for boys was not favourable program.

Health Professionals' Preferences for Next-Generation Sequencing in the Diagnosis of Suspected Genetic Disorders in the Paediatric Population

Background/Objectives: Next-generation sequencing (NGS) can explain how genetics influence morbidity and mortality in children. However, it is unclear whether health providers will perceive and use such treatments. We conducted a discrete choice experiment (DCE) to understand Italian health professionals' preferences for NGS to improve the diagnosis of paediatric genetic diseases. Methods: The DCE was administered online to 125 health professionals in Italy. We documented attributes influencing professionals' decisions of NGS, including higher diagnostic yield, shorter counselling periods, cost, turnaround time, and the identification of fewer variants of unknown significance. Results: Results show that factors such as higher diagnostic yield, shorter counselling periods, lower costs, and faster turnaround times positively influenced the adoption of NGS tests. Willingness to pay (WTP) estimates varied from EUR 387 (95% CI, 271.8-502.9) for 7% increase in the diagnostic yield to EUR 469 (95% CI, 287.2-744.9) for a decrease of one week in the turnaround time. Responders would reduce diagnostic yield by 7% to decrease the turnaround time by one week in both the preference and the willingness to trade (WTT) spaces. Respondents prioritised diagnostic yield (RI = 50.36%; 95% CI 40.2-67.2%) compared to other attributes. Conclusions: therefore, health professionals value NGS for allowing earlier, more accurate genetic diagnoses.

Acceptance and willingness to pay for DTaP-HBV-IPV-Hib hexavalent vaccine among parents: A cross-sectional survey in China

DTaP-HBV-IPV-Hib hexavalent vaccine has been used in high-income countries for many years to prevent diphtheria, tetanus, pertussis, hepatitis B, poliomyelitis, and invasive Haemophilus influenzae type b disease. Currently, no hexavalent vaccines have been approved for use in China. Evidence of parental acceptance and interest in hexavalent vaccines can help policy makers and manufacturers make decisions about entering the vaccine market and the immunization program in China. We measured parental acceptance and willingness-to-pay (WTP) for a hexavalent vaccine to provide such evidence. We conducted a cross-sectional survey of children's caregivers in 16 vaccination clinics in seven cities in China and obtained information on socio-demographics, knowledge of disease, confidence in vaccines, previous vaccination experience, and acceptance of and WTP for hexavalent vaccine. Multivariate logistic regression was used to determine factors influencing acceptance, and multivariate tobit regression was used to identify factors impacting WTP. Between April 28 and June 30, 2023, a total of 581 parents of children aged 0-6 years participated in the survey; 435 (74.87%, 95% CI:71.3%-78.4%) parents indicated acceptance of hexavalent vaccine. Residence location, parents' education level, experience paying for vaccination, and disease knowledge scores were key factors affecting parents' choices for vaccination. Mean (SD) and median (IQR) willingness to pay for full 4-dose course vaccination were 2266.66 (1177.1) CNY and 2400 (1600-2800) CNY. Children's age (p < .001), parents' education level (p = .024), and perceived price barriers (p < .001) were significantly associated with WTP. Parents have high acceptance and willingness to pay for hexavalent vaccine. The less money parents have to pay out of pocket, the more willing they can be to accept the vaccine. Therefore, acceptance may increase even further if the vaccine is covered by medical insurance, provided free of charge by the government, or if its price is reduced. Our results provide reference for optimizing and adjusting immunization strategies in China.

Determinants of stillbirth among mothers who gave birth at Bishoftu General Hospital, Ethiopia: using a Bayesian logistic regression model

Introduction

Stillbirth remains a major public health problem in developing countries due to low health coverage and services. Approximately two million stillbirths occur every year; in particular, stillbirths are highly prevalent in low- and middle-income countries such as Ethiopia. However, there is scarce information available in Ethiopia regarding the determinants of stillbirth.

Methods

A facility-based, unmatched case-control study was conducted at Bishoftu General Hospital from April 1 to April 30, 2023. A systematic random sampling technique was used to select samples of the study subjects. The collected data were entered into Epi-info version 7.2. A Bayesian logistic regression model was used in this study, with a 95% Credible interval to determine the association between independent variables and stillbirth. All analyses were performed using STATA version 17 software.

Results

A total of 403 (81 cases and 322 controls) participants were included in the study. The average age of participants was 26 years (SD: ±5.03). According to the adjusted model, mothers who attained a middle school [adjusted odds ratio [AOR] = 0.23; 95% credible interval [CrI]: 0.11, 0.43], diploma and above (AOR = 0.25; 95% CrI: 0.12, 0.46), rural residence (AOR = 2.55; 95% CrI: 1.11, 4.99), married women (AOR = 0.46; 95% CrI: 0.20, 0.93), ANC visits more than 4 (AOR = 0.35; 95% CrI: 0.17, 0.63), history of prior stillbirth (AOR = 8.71; 95% CI: 3.22, 17.69), previous history of abortion (AOR = 3.29; 95% CI: 1.13, 7.666), duration of labor more than 24 h (AOR = 3.71; 95% CI: 1.28, 7.83); normal birth weight (AOR = 0.39; 95% CI: 0.15, 0.57) were significantly associated with stillbirth.

Conclusions

This study revealed that maternal education, rural residence, marital status, history of prior stillbirth, ANC visit, previous history of abortion, duration of labor, and birth weight were identified as determinants of stillbirth. Pregnant mothers should be identified early and given appropriate care, including comprehensive prenatal care and other maternal services.

Parental willingness to vaccinate their daughters against human papilloma virus and its associated factors in Woldia town, Northeast Ethiopia

Background

The cells of the cervical epithelial wall are the source of the malignant tumor caused by the human papilloma virus (HPV) known as cervical cancer. In 2018, Ethiopia implemented the HPV vaccine specifically targeting girls aged 9-14 years. This vaccination initiative serves as an effective preventive measure against cervical cancer, provided that parents express a positive inclination to have their daughters vaccinated as part of the program.

Objective

The aim of the study was to assess parental willingness to vaccinate their daughters against human papillomavirus and its associated factors in Woldia town, Northeast Ethiopia.

Methods

A community-based cross-sectional study was conducted among 414 parents of daughters aged 9-14 years between 10 and 25 January 2023. Respondents were selected by a systematic sampling method and a face-to-face interview was conducted to collect data. Data were entered into Epi Data version 4.6 and exported to SPSS version 25 for analysis. Multivariable analyses were used to examine the association between dependent and independent variables. The adjusted odds ratio (AOR), 95% confidence interval (CI), and p-value <0.05 were used to determine statistical significance.

Results

A total of 410 study participants with a response rate of 99% were included in the study, and approximately 72.9% (95% CI: 68.3-77.2) of them were willing to vaccinate their daughters. This study found that parents with a family history of cervical cancer screening (AOR = 3.27, 95%; CI = 1.38-7.74), secondary and above educational status (AOR = 2.72, 95% CI = 1.29-5.73), good knowledge of the human papilloma virus vaccination (AOR = 3.00, 95% CI = 1.70-5.28), and favorable attitude toward the human papilloma virus vaccine (AOR = 4.40, 95% CI = 2.45-7.88) were significantly associated with parental willingness to vaccinate their daughters against human papilloma virus.

Recommendation

In this study, most parents were willing to vaccinate their daughters against human papilloma virus. The significant determinants of parental willingness to their daughter's human papilloma virus vaccination were family history of cervical cancer screening, level of education, and knowledge and attitude toward the human papilloma virus vaccine. Therefore, health information regarding the human papillomavirus vaccination with an emphasis on raising community awareness should be designed.

Parents' willingness to vaccinate their daughters with human papillomavirus vaccine and associated factors in Debretabor town, Northwest Ethiopia: A community-based cross-sectional study

The Human Papilloma Virus (HPV) is the primary causative agent of cervical cancer. Vaccination against the HPV infection is an effective prevention measure for HPV-related diseases. This study aimed to assess parents' willingness to vaccinate their daughters with Human Papillomavirus vaccine and associated factors in Debre Tabor town. A community-based cross-sectional study was conducted among parents of daughters in Debre Tabor town, and a cluster sampling technique was used to select 738 study participants. A structured and interviewer-administered questionnaire was used to collect the data. Data were entered into EPI data version 4.6 and exported to SPSS version 26 for analysis. Multivariable logistic regression was done and a p-value of ≤ 0.05 was used to declare the level of significance. In this study, parents' willingness for HPV vaccination was found to be 79.10% (95% CI: 76.00, 82.00). Parents having media exposure, had good knowledge of HPV infection, and HPV vaccine, positive attitude, and positive perceived behavioral control toward the HPV vaccine had statistically significant association with willingness for the HPV vaccination of their daughters. Parents' willingness to HPV vaccination for their daughters was higher compared with a previous study done in the setting. Parental knowledge and their beliefs on HPV vaccination, and media exposure play an important role in the HPV vaccination of adolescents. Strengthening community-based education and effective promotion through multimedia on HPV infection and its prevention, addressing parental safety concerns and promoting their positive beliefs about the vaccine are important to increase parents' willingness.

Willingness to Pay for HPV Vaccine among Women Living with HIV in Nigeria

BACKGROUND

Human papillomavirus (HPV) is responsible for most cervical cancer cases globally, with women living with HIV having a higher risk of persistent HPV infection and HPV-associated disease. The HPV vaccine is a promising tool to reduce cervical cancer rates, but its uptake among women living with HIV in Nigeria is unknown.

METHODS

A facility-based, cross-sectional survey was conducted with 1371 women living with HIV to assess their knowledge of HPV, cervical cancer, and the HPV vaccine as well as their willingness to pay for the vaccine at the HIV treatment clinic at the Nigerian Institute of Medical Research, Lagos. To identify factors associated with the willingness to pay for the HPV vaccine, multivariable logistic regression models were developed.

RESULTS

This study found that 79.1% of participants had not heard of the vaccine, and only 29.0% knew its efficacy in preventing cervical cancer. In addition, 68.3% of participants were unwilling to pay for the vaccine, and the average amount they were willing to pay was low. Knowledge of HPV, the HPV vaccine, and cervical cancer and income were factors associated with the willingness to pay for the vaccine. Health workers were the primary source of information.

CONCLUSIONS

This study highlights the lack of knowledge and low willingness to pay for the HPV vaccine among women living with HIV in Nigeria and emphasizes the importance of improving education and awareness. Factors associated with the willingness to pay, such as income and knowledge, were identified. Practical strategies, such as community outreach and school-based education programs, could be developed to increase vaccine uptake. Further research is needed to explore additional factors influencing the willingness to pay.

Willingness to pay for cancer prevention, screening, diagnosis, and treatment: a systematic review

INTRODUCTION

Willingness to pay (WTP) studies examine the maximum amount of money an individual is willing to pay for a specified health intervention, and can be used to inform coverage and reimbursement decisions. Our objectives were to assess how people value cancer-related interventions, identify differences in the methodologies used, and review the trends in studies' publication.

AREAS COVERED

We extracted PubMed and EconLit articles published in 1997-2020 that reported WTP for cancer-related interventions, characterized the methodological differences and summarized each intervention's mean and median WTP values. We reviewed 1,331 abstracts and identified 103 relevant WTP studies, of which 37 (36%) focused on treatment followed by screening (26), prevention (21), diagnosis (7) and other interventions (12). The methods used to determine WTP values were primarily discrete-choice questions (n = 54, 52%), bidding games (15), payment cards (12) and open-ended questions (12). We found a wide variation in WTP reported values ranged from below $100 to over $20,000.

EXPERT OPINION

The WTP literature on oncology interventions has grown rapidly. There is considerable heterogeneity with respect to the type of interventions and diseases assessed, the respondents' characteristics, and the study methodologies. This points to the need to establish international guidelines for best practices in this field.

Women's Preference for Cervical Cancer Screening Methods in Iran: A Contingent Valuation Survey

Background: Cervical cancer is the fifth most deadly cancer in women in Iran. The present study aimed to investigate the monetary value of cervical cancer screening benefits from a social perspective. Methods: A cross-sectional study was conducted among 480 women aged 30 to 59 years in Mazandaran province, Iran, from 2020-21. The willingness to pay (WTP) for screening tests- Pap smear and simultaneous tests- was investigated using a researcher-made questionnaire based on the contingent valuation method (CVM) in 2 separate sample groups. The first group received basic information regarding cervical cancer (Scenario 1), while the second received complementary information in addition to basic knowledge (Scenario 2). Multivariate regression was applied to examine factors affecting WTP and the difference between the mean WTP in 2 scenarios was analyzed by a t-test. Results: The mean WTP of Pap smear and simultaneous tests was estimated at US$135.08 and US$160.19, respectively. There were significant and negative relationships between age and household size with the WTP of the Pap smear test. The number of people with income, household expenses, a chronic illness, and suggested base price indicated significant and positive effects on WTP of the Pap smear test. The number of people with income and household expenses showed significant and positive relationships with the WTP of simultaneous tests. There was no significant difference between the mean WTP of each group and the demand for screening tests was not elastic. Conclusion: The mean WTP of screening tests is notable when compared to their cost, demonstrating the need of concentrating on screening programs.

Acceptance and Willingness to Pay for Vaccine Against Human Papilloma Virus (HPV) Among Parents of Boys in Central Vietnam

Human papilloma virus (HPV) vaccine for adolescents was recommended as an effective prevention strategy of HPV-related cancers. In Vietnam, HPV vaccination has not been introduced to male adolescent. This study was conducted to examine the acceptance of having boys vaccinated against HPV and its underlying reasoning, and to identify their parent's willingness to pay (WTP) for HPV vaccination in central Vietnam. 785 parents of boys were directly interviewed based on a structured questionnaire. Parent's acceptability of HPV vaccine for their sons was identified by one question with response on 3-point scale (agree, don't know, and disagree). Multivariate logistic regression model was used to determine contributing factors to participant's acceptance. Bidding game method was applied to elicit WTP values for HPV vaccination with initial bid of 161.2 USD. The results showed that 49.2% of parents agreed to have their sons vaccinated against HPV. Factors that influenced parent's acceptance including son's age older than 12 years (OR = 1.5; 95% CI: 1.08-1.98); being eldest son (OR = 1.6; 95% CI: 1.13-2.19), being mother (OR = 1.4; 95% CI: 1.01-1.91), parents with high educational level (OR = 1.7; 95% CI: 1.11-2.47) and their knowledge of HPV and HPV vaccine (OR = 1.8; 95% CI: 1.23-2.65). Average WTP value for full doses of HPV vaccine was 137.5 USD, ranging between 9 USD and 188.3 USD. Parents' knowledge of HPV and HPV vaccine was the only factor affecting WTP value (Rho: 0.11; p-value: 0.030). The findings suggest a strategy be introduced for HPV vaccination to male adolescents in Vietnam.

Willingness to pay for and acceptance of cervical cancer prevention methods: A systematic review and meta-analysis

Background: The Willingness to pay (WTP) for and acceptance of cervical cancer prevention (CCP) methods have an important role in the control of this type of cancer. Therefore, the aim of this study was to estimate the WTP and acceptance of CCP methods with the contingent valuation method (CVM). Methods: In this systematic review and meta-analysis study, the required information was collected by searching relevant keywords in PubMed, Scopus, Embase, Web of Knowledge, and their Persian equivalent in the Scientific Information Database (SID) and Elmnet databases during January 1, 2000 to June 30, 2020. All studies that reported the WTP and CCP methods with the CVM in English or Persian were included. The reporting quality of studies was assessed by strengthening the Reporting of Observational Studies in Epidemiology (STROBE). Comprehensive meta-analysis (CMA: 2) software was used to conduct the meta-analysis. The content analysis method was used for qualitative data analysis. Results: Finally, 28 articles (with 49610 people) were included in the study. Most of the participants were women (35.7%). The HPV vaccine was the most common method of prevention (75%). The overall acceptance rate was 64% and the overall positive WTP rate was 66%. The average WTP was US$30.44, which accounts for about 0.84% of GDP per capita. The most significant effective factors included income, age, education, high-risk sexual behaviors, and awareness of cervical cancer, belief in the risk of cervical cancer, and belief about the effectiveness of prevention methods. The cost was the most important reason for the unwillingness to pay and accept. Conclusion: Results show that the WTP and acceptance rate of CCP methods are relatively high. It is recommended to reduce the cost of prevention methods, especially the HPV vaccine, and to increase awareness and improve the attitude of people. Also, it is recommended to consider other methods of estimation of WTP and other cancers in future studies.

Parents willingness to vaccinate their daughter against human papilloma virus and its associated factors in Bench-Sheko zone, southwest Ethiopia

Background

In Ethiopia, the human papillomavirus vaccine has been introduced since 2018. Since the vaccination program targets girls age 9-13, the success of vaccination depends on the parental decision and their willingness to vaccinate their daughters. Therefore, a study on parental willingness to vaccinate their daughter and factors associated is needed.

Objective

To assess parent's willingness to vaccinate their daughter against the human papillomavirus and its associated factors in Bench-Sheko Zone, southwest Ethiopia.

Methods

A community-based cross-sectional study was conducted among 502 participants in Bench-Sheko Zone, southwest Ethiopia. The participants were selected using a systematic random sampling method. Frequency tables, mean and standard deviation were used to summarize the data. A binary logistic regression using bivariate and multivariable logistic regression analysis was used to identify factors associated with parental willingness to vaccinate their daughter. The level of significance was declared at P-value < 0.05.

Results

Of the 502 participants interviewed, 399 (79.5%), 95% CI (76%, 83%) of parents were willing to vaccinate their daughter. The study found that primary education and above (AOR = 2.9, 95% CI [1.79, 4.95]), having good knowledge (AOR = 2.1, 95% CI [1.15, 4.10]) and positive attitude (AOR = 2, 95% CI [1.30, 3.41]) were significantly associated with parental willingness to vaccinate their daughter.

Conclusion

This study found that there was a high parental willingness to vaccinate their daughter against the human papillomavirus in the study area. Primary education and above, having good knowledge and positive attitude were factors associated with parental willingness to vaccinate their daughter. Therefore, providing health information's regarding human papillomavirus vaccination with emphasis to raise community awareness should be designed especially less educated parents need to be targeted.

Willingness to Pay for Childhood Malaria Vaccine Among Caregivers of Under-Five Children in Northwest Ethiopia

BACKGROUND

Malaria, a protozoan disease caused by the genus Plasmodium, is responsible for serious illnesses and death across the world. RTS, S/AS01 (Mosquirix™) is a recombinant protein-based malaria vaccine valuable for the prevention and control of the disease. However, studies done so far on the willingness to pay (WTP) malaria vaccine have been inadequate to inform policy-makers.

METHODS

A community-based cross-sectional study was conducted to assess the WTP for childhood malaria vaccine and associated factors among caregivers of under-five children from February to April 2019 in West Dembia district. A multistage stratified systematic sampling technique was used, and the contingent valuation method was used to estimate caregivers' willingness to pay for the vaccine. AOR with 95% CI and less than 0.05 p-values were used to declare factors associated with WTP.

RESULTS

Overall, 60.6% (95% CI: 56.60, 64.40%) of caregivers of under-five children were WTP for the childhood malaria vaccine at a price of US$ 23.11 per full doses. Urban residence (AOR=1.78, 95% CI: 1.04, 3.04), educational status (AOR=3.27; 95% CI: 1.07, 9.94) and vaccination experience for children (AOR= 2.12; 95% CI: 1.29, 3.48) were positively associated with the WTP. WTP for the vaccine was higher among rich households (AOR=3.15; 95% CI: 1.90, 5.22), caregivers who had the previous history of malaria attack (AOR=2.62; 95% CI: 1.68, 4.08), households with fewer members (AOR=1.59; 95% CI: 1.06, 2.40), and families more knowledgeable about malaria prevention and control (AOR=3.56; 95% CI: 1.83, 6.93) compared with their counterparts.

CONCLUSION

The majority of the participants were WTP for the childhood malaria vaccine. A significant rise in willingness to purchase was observed at price below the profile price. Thus, it is of great value to policy-makers to understand the price sensitivity before setting the price of the vaccine.