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ORIGINAL ARTICLE
Open Access

Income Inequalities in Hepatitis B Vaccination and Willingness to Pay Among Women of Reproductive Age in Hanoi, Vietnam

Xuan Thi Thanh Le, Nguyen Thao Thi Nguyen, Huong Thi Le, Toan Thanh Thi Do, Thang Huu Nguyen, Huong Lan Thi Nguyen, Trang Ha Nguyen, Linh Gia Vu, Bach Xuan Tran, Carl A. Latkin, Cyrus S.H. Ho and Roger C.M. Ho
Global Health: Science and Practice September 2021, 9(3):523-531; https://doi.org/10.9745/GHSP-D-20-00480
Xuan Thi Thanh Le
aSchool for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.
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Nguyen Thao Thi Nguyen
bDuke University School of Medicine, Duke University, Durham, NC, USA.
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Huong Thi Le
aSchool for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.
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Toan Thanh Thi Do
aSchool for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.
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Thang Huu Nguyen
aSchool for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.
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Huong Lan Thi Nguyen
cInstitute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam.
dFaculty of Nursing, Duy Tan University, Da Nang, Vietnam.
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  • For correspondence: nguyentlanhuong5@duytan.edu.vn
Trang Ha Nguyen
cInstitute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam.
dFaculty of Nursing, Duy Tan University, Da Nang, Vietnam.
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Linh Gia Vu
eCenter of Excellence in Evidence-based Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam.
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Bach Xuan Tran
aSchool for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.
fJohns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Carl A. Latkin
fJohns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Cyrus S.H. Ho
gDepartment of Psychological Medicine, National University Hospital, Singapore, Singapore.
hDepartment of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
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Roger C.M. Ho
hDepartment of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
iInstitute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore, Singapore.
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Figures & Tables

Figures

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  • FIGURE 1
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    FIGURE 1

    Bidding Process Used During Interviews With Women of Reproductive Age to Determine Willingness to Pay for One Dose of Hepatitis B Vaccine, Hanoi, Vietnam

  • FIGURE 2
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    FIGURE 2

    (a) Lorenz Curve Showing History of Hepatitis B Vaccination Among Women of Reproductive Age, Hanoi, Vietnam, by Monthly Household Income; (b) Lorenz Curve Showing Willingness to Pay for One Dose of Hepatitis B Vaccine Among Women of Reproductive Age, Hanoi, Vietnam, by Monthly Household Income

    Abbreviations: HBV, hepatitis B virus; WTP, willingness to pay.

  • FIGURE 3
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    FIGURE 3

    Cumulative Percentage of Women Willing to Pay Various Amounts for Hepatitis B Vaccine, Hanoi, Vietnam, by Household Income Quintile

Tables

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    TABLE 1.

    Sociodemographic Characteristics of Participants in Study of Effects of Household Income on Willingness to Pay for Hepatitis B Vaccine, Hanoi, Vietnam, (n=695)

    Income Quintiles
    Q1Q2Q3Q4Q5TotalP Value  
    Total, n (%)124 (17.8)211 (30.4)131 (18.9)120 (17.3)109 (15.7)695 (100.0)
    Mean age, years26.826.228.127.627.127.0.06
    Mean household monthly income, US$187.0389.6611.6830.01612.8663.2<.01a
    Married, n (%)120 (96.8)204 (97.1)130 (100.0)117 (98.3)108 (100.0)679 (98.3).12
    Living in rural area, n (%)107 (90.7)151 (72.6)42 (32.6)25 (21.4)14 (12.8)339 (49.8)<.01a
    Having any children, n (%)119 (96.0)192 (91.0)119 (90.8)110 (91.7)101 (92.7)641 (92.2).51
    Education, n (%)
     ≤ Secondary48 (38.7)29 (13.7)10 (7.6)5 (4.2)2 (1.8)94 (13.5)<.01a
     High51 (41.1)85 (40.3)40 (30.5)20 (16.7)19 (17.4)215 (30.9)
     Vocational training13 (10.5)52 (24.6)27 (20.6)31 (25.8)16 (14.7)139 (20.0)
     University12 (9.7)45 (21.3)54 (41.2)64 (53.3)72 (66.1)247 (35.5)
    • ↵a Significant at P<.05.

    • View popup
    TABLE 2.

    Hepatitis B Vaccination Awareness, Uptake, and Willingness to Pay Among Participants in Study of Effects of Household Income on Willingness to Pay for the Vaccine, Hanoi, Vietnam, (n=695)

    CharacteristicsIncome Quintiles
    Q1Q2Q3Q4Q5TotalP Value  
    History of Hepatitis B virus infection, n (%)8 (6.5)7 (3.3)2 (2.3)2 (1.7)2 (1.8)22 (3.2).19
    Awareness of Hepatitis B vaccine, n (%)107 (86.3)202 (95.7)121 (92.4)116 (96.7)107 (98.2)653 (94.0)<.01a
    Source of general vaccination information, n (%)
     School6 (4.8)11 (5.2)6 (4.6)5 (4.2)8 (7.3)36 (5.2).84
     Television30 (24.2)70 (33.2)57 (43.5)57 (47.5)43 (39.5)257 (37.0)<.01a
     Radio or loudspeaker45 (36.3)81 (38.4)23 (17.6)27 (22.5)17 (15.6)193 (27.8)<.01a
     Newspapers/magazines16 (12.9)36 (17.1)41 (31.3)38 (31.7)28 (25.7)159 (22.9)<.01a
     Internet35 (28.2)95 (45.0)82 (62.6)81 (67.5)83 (76.2)376 (54.1)<.01a
     Health workers79 (63.7)129 (61.1)78 (59.5)51 (42.5)51 (46.8)388 (55.8)<.01a
     Friends and relatives6 (4.8)18 (8.5)32 (24.4)23 (19.2)30 (27.5)109 (15.7)<.01a
     Other8 (6.5)13 (6.2)2 (1.5)5 (4.2)2 (1.8)30 (4.3).13
    History of Hepatitis B vaccination, n (%)23 (18.6)71 (33.7)58 (44.3)53 (44.2)44 (40.4)249 (35.8)<.01a
    Willingness to pay for Hepatitis B vaccine, n (%)78 (62.9)123 (58.6)81 (61.8)80 (67.2)70 (64.2)432 (62.3).61
    Maximum amount willing to pay for Hepatitis B vaccine
     Mean, US$8.09.89.911.013.210.3.09
     Median, US$5.36.48.58.58.58.5.09
    • ↵a Significant at P<.05.

    • View popup
    TABLE 3.

    Characteristics of Participants Who Were and Were Not Willing to Pay for Hepatitis B Vaccines and Reasons for Not Willing to Pay

    CharacteristicsNot Willing to PayWilling to PayP Value 
    Total, n (%)261 (37.7)432 (62.3)
    Age, mean (SD), years27.2 (6.8)27.0 (5.0).92
    Household monthly income, mean (SD), US$642.8 (550.9)676.2 (548.6).36
    Married, n (%)258 (98.9)419 (97.9).35
    Living in rural area, n (%)122 (48.8)215 (50.1).74
    Having any children, n (%)242 (92.7)399 (92.4).86
    Education, n (%)
     ≤ Secondary45 (17.2)49 (11.3).03
     High72 (27.6)143 (33.1)
     Vocational training43 (16.5)94 (21.8)
     University101 (38.7)146 (33.8)
    History of hepatitis B vaccine, n (%)10 (3.9)12 (2.8).44
    Awareness of hepatitis B vaccine, n (%)239 (91.6)413 (95.6).03
    Source of general vaccination information, n (%)
     School20 (7.7)16 (3.7).02
     Television86 (33.0)171 (39.6).08
     Radio or loudspeaker61 (23.4)132 (30.6).04
     Newspapers/magazines57 (21.8)102 (23.6).59
     Internet125 (47.9)251 (58.1)<.01
     Health workers134 (51.3)253 (58.6).06
     Friends and relatives31 (11.9)78 (18.1).03
     Other9 (3.5)20 (4.6).45
    History of hepatitis B vaccination, n (%)91 (34.9)158 (36.6).65
    Reasons for not being willing to pay
     Not necessary118 (45.2)
     Unaffordable7 (2.7)
     No risk of hepatitis B virus infection48 (18.4)
     Already injected43 (16.5)
     Others45 (17.2)
    • Abbreviation: SD, standard deviation.

    • View popup
    TABLE 4.

    Factors Associated With Willingness to Pay for HBV Vaccine and Maximum Amount

    CharacteristicPrevious HBV vaccinationWTP for HBV vaccineAmount of WTP for one dose of HBV vaccine
    OR95%CIOR95%CICoef.95%CI
    Education
     ≤ Secondaryrefrefref
     High0.990.52, 1.881.550.89, 2.696.44a1.95, 10.93
     Vocational training1.300.66, 2.581.510.81, 2.816.62a1.64, 11.61
     University2.29a1.16, 4.510.890.49, 1.623.17-1.65, 7.99
    Household monthly income quintiles
     Q1refrefref
     Q21.730.97, 3.100.58a0.35, 0.98–1.14-5.24, 2.96
     Q31.870.96, 3.650.730.40, 1.320.36-4.36, 5.08
     Q41.560.78, 3.111.080.57, 2.051.87-3.05, 6.80
     Q51.280.62, 2.630.890.46, 1.703.93-1.19, 9.05
    Marital status
     Having spouse/partnerrefrefref
     Other4.04a1.06, 15.54.690.92, 23.8912.29a1.76, 22.83
    Living area
     Urban arearef
     Rural area0.700.46, 1.08
    Source of general vaccination information
     School (Yes vs. No-ref)0.33a0.16, 0.69-5.00-11.03, 1.03
     Magazine/Newspaper (Yes vs. No-ref)1.49a1.01, 2.20
     Listening to radio or loudspeaker (Yes vs. No-ref)1.460.99, 2.163.07a0.03, 6.11
     Internet (Yes vs. No-ref)1.57a1.09, 2.28
     Medical staff (Yes vs. No-ref)1.43a1.01, 2.01
     Friends and relatives (Yes vs. No-ref)1.550.96, 2.523.21-0.52, 6.94
    Ever heard about HBV vaccine
     Norefref
     Yes4.54a1.33, 15.491.650.79, 3.44
    • Abbreviations: Coeff, coefficient; CI, confidence interval; HBV, hepatitis B virus, OR, odds ratio; WTP, willingness to pay.

    • ↵aP<.05.

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Global Health: Science and Practice
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Income Inequalities in Hepatitis B Vaccination and Willingness to Pay Among Women of Reproductive Age in Hanoi, Vietnam
Xuan Thi Thanh Le, Nguyen Thao Thi Nguyen, Huong Thi Le, Toan Thanh Thi Do, Thang Huu Nguyen, Huong Lan Thi Nguyen, Trang Ha Nguyen, Linh Gia Vu, Bach Xuan Tran, Carl A. Latkin, Cyrus S.H. Ho, Roger C.M. Ho
Global Health: Science and Practice Sep 2021, 9 (3) 523-531; DOI: 10.9745/GHSP-D-20-00480

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Income Inequalities in Hepatitis B Vaccination and Willingness to Pay Among Women of Reproductive Age in Hanoi, Vietnam
Xuan Thi Thanh Le, Nguyen Thao Thi Nguyen, Huong Thi Le, Toan Thanh Thi Do, Thang Huu Nguyen, Huong Lan Thi Nguyen, Trang Ha Nguyen, Linh Gia Vu, Bach Xuan Tran, Carl A. Latkin, Cyrus S.H. Ho, Roger C.M. Ho
Global Health: Science and Practice Sep 2021, 9 (3) 523-531; DOI: 10.9745/GHSP-D-20-00480
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