BMC Public Health
http://www.biomedcentral.com/bmcpublichealth/content
(Accessed 1 August 2015)

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Research article
Household antimicrobial self-medication: a systematic review and meta-analysis of the burden, risk factors and outcomes in developing countries
Moses Ocan, Ekwaro Obuku, Freddie Bwanga, Dickens Akena, Sennono Richard, Jasper Ogwal-Okeng, Celestino Obua BMC Public Health 2015, 15:742 (1 August 2015)

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Research article
Socio-economic determinants of disease progression among HIV infected adults in Kenya
Nyawira Gitahi–Kamau, James Kiarie, Kenneth Mutai, Beatrice Gatumia, P. Gatongi, A. Lakati BMC Public Health 2015, 15:733 (31 July 2015)

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Research article
A cost-utility analysis of cervical cancer screening and human papillomavirus vaccination in the Philippines
Anna Melissa Guerrero1*, Anne Julienne Genuino1, Melanie Santillan2, Naiyana Praditsitthikorn3, Varit Chantarastapornchit3, Yot Teerawattananon3, Marissa Alejandria4 and Jean Anne Toral5
Author Affiliations
BMC Public Health 2015, 15:730 doi:10.1186/s12889-015-2046-1
Published: 30 July 2015
Abstract
Background
Cervical cancer is the second leading cause of cancer cases and deaths among Filipino women because of inadequate access to screening and treatment services. This study aims to evaluate the health and economic benefits of HPV vaccination and its combination with different screening strategies to find the most optimal preventive strategy in the Philippines.
Methods
A cost-utility analysis was conducted using an existing semi-Markov model to evaluate different screening (i.e., Pap smear, visual inspection with acetic acid) and vaccination strategies against HPV infection implemented alone or as part of a combination strategy at different coverage scenarios. The model was run using country-specific epidemiologic, cost and clinical parameters from a health system perspective. Sensitivity analysis was performed for vaccine efficacy, duration of protection and costs of vaccination, screening and treatment.
Results
Across all coverage scenarios, VIA has been shown to be a dominant and cost-saving screening strategy with incremental cost-effectiveness ratio (ICER) ranging from dominant to Php 61,059 (1443 USD) per QALY gained. VIA can reduce cervical cancer cases and deaths by 25 %. Pap smear screening was found to be not cost-effective due to its high cost in the Philippines. Adding HPV vaccination at a cost of 54 USD per vaccinated girl on top of VIA screening was found to be potentially cost-effective using a threshold of 1 GDP per capita (i.e., Php 120,000 or 2835 USD/ QALY) with the most favorable assumption of providing lifelong immunity against high-risk oncogenic HPV types 16/18. The highest incremental QALY gain was achieved with 80 % coverage of the combined strategy of VIA at 35 to 45 years old done every five years following vaccination at 11 years of age with an ICER of Php 33,126 (783 USD). This strategy may result in a two-thirds reduction in cervical cancer burden. HPV vaccination is not cost-effective when vaccine protection lasts for less than 20 years.
Conclusion
High VIA coverage targeting women aged 35–45 years old at five-year intervals is the most efficient and cost-saving strategy in reducing cervical cancer burden in the Philippines. Adding a vaccination program at high coverage among 11-year-old girls is potentially cost-effective in the Philippines assuming a life-long duration of vaccine efficacy.

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Research article
Factors influencing full immunization coverage among 12–23 months of age children in Ethiopia: evidence from the national demographic and health survey in 2011
Yihunie Lakew1, Alemayhu Bekele2 and Sibhatu Biadgilign3*
Author Affiliations
BMC Public Health 2015, 15:728 doi:10.1186/s12889-015-2078-6
Published: 30 July 2015
Abstract
Background
Immunization remains one of the most important public health interventions to reduce child morbidity and mortality. The 2011 national demographic and health survey (DHS) indicated low full immunization coverage among children aged 12–23 months in Ethiopia. Factors contributing to the low coverage of immunization have been poorly understood. The aim of this study was to identify factors associated with full immunization coverage among children aged 12–23 months in Ethiopia.
Methods
This study used the 2011 Ethiopian demographic and health survey data. The survey was cross sectional by design and used a multistage cluster sampling procedure. A total of 1,927 mothers with children of 12–23 months of age were extracted from the children’s dataset. Mothers’ self-reported data and observations of vaccination cards were used to determine vaccine coverage. An adjusted odds ratio (AOR) with 95 % confidence intervals (CI) was used to outline the independent predictors.
Results
The prevalence of fully immunized children was 24.3 %. Specific vaccination coverage for three doses of DPT, three doses of polio, measles and BCG were 36.5 %, 44.3 %, 55.7 % and 66.3 %, respectively. The multivariable analysis showed that sources of information from vaccination card [AOR 95 % CI; 7.7 (5.95-10.06)], received postnatal check-up within two months after birth [AOR 95 % CI; 1.8 (1.28-2.56)], women’s awareness of community conversation program [AOR 95 % CI; 1.9 (1.44-2.49)] and women in the rich wealth index [AOR 95 % CI; 1.4 (1.06-1.94)] were the predictors of full immunization coverage. Women from Afar [AOR 95 % CI; 0.07 (0.01-0.68)], Amhara [AOR 95 % CI; 0.33 (0.13-0.81)], Oromiya [AOR 95 % CI; 0.15 (0.06-0.37)], Somali [AOR 95 % CI; 0.15 (0.04-0.55)] and Southern Nation and Nationalities People administrative regions [AOR 95 % CI; 0.35 (0.14-0.87)] were less likely to fully vaccinate their children.
Conclusion
The overall full immunization coverage in Ethiopia was considerably low as compared to the national target set (66 %). Health service use and access to information on maternal and child health were found to predict full immunization coverage. Appropriate strategies should be devised to enhance health information and accessibility for full immunization coverage by addressing the variations among regions.