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Supplementary Material 1

Additional file 2: Consolidated criteria for reporting qualitative studies (COREQ): a 32-item checklist.

Additional file 1: Patient interview guide.

Additional file 1. Connected Woreda checklist and point allocations.

Tsigereda Alene,1 Asmamaw Atnafu,2 Zeleke Abebaw Mekonnen,3,4 Amare Minyihun2 1University of Gondar Specialized Comprehensive Hospital, University of Gondar, Gondar, Ethiopia; 2Department of Health System and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia; 3Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia; 4Health Systems Directorate, Federal Ministry of Health, Addis Ababa, EthiopiaCorrespondence: Amare MinyihunUniversity of Gondar, P.o. Box: 196, Gondar, EthiopiaEmail amarebdr@gmail.comBackground: Cervical cancer is one of the profound threats to women’s lives and the fourth most common cancer among women. Ethiopia launched the human papilloma vaccination for the first time, with the support of the Global Alliance for Vaccine and Immunization (GAVI) in 2018. Therefore, the aim of this study was to assess the acceptability of the human papillomavirus vaccine and associated factors among parents of daughters in Gondar town, Northwest Ethiopia.Methods: A community-based cross-sectional study with a total sample of 946 study participants was conducted in Gondar town from April to May 2019. The study participants were selected using a multistage sampling technique from parents having a daughter of 9− 17 years age. Data were collected using an interviewer-administered questionnaire. The data were entered into EpiData version 4.2 and exported to STATA version 14 for analysis. Variables having a p-value of < 0.2 and < 0.05 in the bivariable and multivariable logistic regression were considered as a statistically significant factor for the acceptance of HPV vaccination.Results: A total of 899 study participants with a response rate of 95% were included in the study. Among participants in this study, 81.3% with 95% CI (78.6, 83.7) accepted to vaccinate their daughters for HPV vaccination. The acceptance to vaccinate daughters for HPV vaccination was affected by being from the richest household [AOR= 3.44, 95% CI = (1.97, 6.01)], good knowledge about cervical cancer [AOR=5.49, 95% CI= (2.62, 11.52)], and positive attitude towards HPV vaccination [AOR=21.53, 95% CI= (11.60, 39.96)].Conclusion: The study revealed that the acceptance to human papillomavirus vaccination is high and was significantly associated with the level of knowledge about cervical cancer, the attitude towards HPV vaccination, and the wealth status of the households. Therefore, community education on cervical cancer and its prevention is crucial to increase awareness and acceptance as well.Keywords: cervical cancer, HPV, acceptance, Gondar town, daughters

Asmamaw Atnafu, Tsegaye Gebremedhin Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, EthiopiaCorrespondence: Asmamaw AtnafuDepartment of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, PO Box: 196, Gondar, EthiopiaEmail asme2002@gmail.comPurpose: Utilization of primary healthcare services in the rural communities of Ethiopia is very low. The Ethiopian government has introduced community-based health insurance (CBHI) to improve the health service utilization of the rural community. Thus, this study was conducted to examine the association between CBHI enrollment and child health service utilization in northwest Ethiopia.Patients and Methods: A cross-sectional case comparison study among CBHI enrolled and unenrolled households was conducted. A total of 226 sick children from 2008 surveyed households were included in the study. Bivariate-probit regression analysis was employed to account the endogenous nature of insurance enrollment and child health services utilization.Results: The results showed that the overall sick child healthcare visit in the CBHI enrolled group was about 0.44 (44%) point more compared to those unenrolled households. CBHI enrolled households in the poorest wealth group have a higher probability of visiting healthcare facilities for their sick children (coefficient: 0.13, SD: 0.07, 95% CI: − 0.01, 0.27), whereas CBHI enrolled households with older age household head have a lower probability of visiting healthcare facilities for their sick children (coefficient: − 0.16, SD: 0.08, 95% CI: − 0.32, 0.01).Conclusion: A promising positive effect on sick children’s health services utilization among CBHI enrolled was noticed. Moreover, households in the poorest wealth status and older age head affect the use of sick children’s healthcare services among those CBHI enrolled. Therefore, policy measures to expand benefit packages and supply-side interventions are essential to enhance the effects of CBHI on different health service utilization.Keywords: health insurance, child health services utilization, bivariate-probit regression, northwest Ethiopia