Showing papers by "Hanoi School Of Public Health published in 2013"

Determinants of antiretroviral treatment adherence among HIV/AIDS patients: a multisite study

Abstract: Introduction: Adherence to antiretroviral treatment (ART) is vital in achieving virological treatment success. This study assessed the prevalence of optimal ART adherence and its determinants among HIV/AIDS patients in Vietnam. Method: A cross-sectional survey was conducted with 1,016 HIV/AIDS patients at seven hospitals and health centers providing antiretroviral treatment services in three provinces, including Hanoi, Hai Phong, and Ho Chi Minh City. Self-reported medication adherence was measured using a 30-day visual analog scale (VAS) and 7-day missed-doses questions. Results: The mean adherence VAS-score was 94.5 out of 100 (SD=8.2), ranging from 40 to 100%. The rate of suboptimal adherence was 25.9%. The rate of missed-doses was 25.2%. In multivariate analysis, increased perceived self-efficacy, use of mobile phone alarms, and reminders from family members were associated with optimal adherence; higher CD4 level, single status, and unstable employment were associated with suboptimal adherence. Conclusion: High rate of suboptimal adherence observed in this study highlights the importance of adherence support interventions during ART. The use of mobile phone reminders, involvement of relatives, and HIV self-management training programs have the potential to improve ART adherence in Vietnam. Keywords: HIV/AIDS; adherence; antiretroviral treatment; drug users; adherence aid; Vietnam (Published: 15 March 2013) Citation: Glob Health Action 2013, 6 : 19570 - http://dx.doi.org/10.3402/gha.v6i0.19570

Effect of Facilitation of Local Maternal-and-Newborn Stakeholder Groups on Neonatal Mortality: Cluster-Randomized Controlled Trial.

Abstract: BACKGROUND: Facilitation of local women's groups may reportedly reduce neonatal mortality. It is not known whether facilitation of groups composed of local health care staff and politicians can imp ...

Maternal health care utilization in Viet Nam: increasing ethnic inequity

Abstract: ObjectiveTo investigate changes that took place between 2006 and 2010 in the inequity gap for antenatal care attendance and delivery at health facilities among women in Viet Nam.MethodsDemographic, ...

Factors associated with suboptimal adherence to antiretroviral therapy in Viet Nam: a cross-sectional study using audio computer-assisted self-interview (ACASI).

Abstract: Background: Optimal adherence to antiretroviral therapy (ART) is necessary for people living with HIV/AIDS (PLHIV). There have been relatively few systematic analyses of factors that promote or inhibit adherence to antiretroviral therapy among PLHIV in Asia. This study assessed ART adherence and examined factors associated with suboptimal adherence in northern Viet Nam. Methods: Data from 615 PLHIV on ART in two urban and three rural outpatient clinics were collected by medical record extraction and from patient interviews using audio computer-assisted self-interview (ACASI). Results: The prevalence of suboptimal adherence was estimated to be 24.9% via a visual analogue scale (VAS) of past-month dose-missing and 29.1% using a modified Adult AIDS Clinical Trial Group scale for on-time dose-taking in the past 4 days. Factors significantly associated with the more conservative VAS score were: depression (p < 0.001), side-effect experiences (p < 0.001), heavy alcohol use (p = 0.001), chance health locus of control (p = 0.003), low perceived quality of information from care providers (p = 0.04) and low social connectedness (p = 0.03). Illicit drug use alone was not significantly associated with suboptimal adherence, but interacted with heavy alcohol use to reduce adherence (p < 0.001). Conclusions: This is the largest survey of ART adherence yet reported from Asia and the first in a developing country to use the ACASI method in this context. The evidence strongly indicates that ART services in Viet Nam should include screening and treatment for depression, linkage with alcohol and/or drug dependence treatment, and counselling to address the belief that chance or luck determines health outcomes.

Factors associated with suboptimal adherence to antiretroviral therapy in Viet Nam: A cross-sectional study using audio computer-assisted self-interview (ACASI)

Abstract: Background: Optimal adherence to antiretroviral therapy (ART) is necessary for people living with HIV/AIDS (PLHIV). There have been relatively few systematic analyses of factors that promote or inhibit adherence to antiretroviral therapy among PLHIV in Asia. This study assessed ART adherence and examined factors associated with suboptimal adherence in northern Viet Nam. Methods: Data from 615 PLHIV on ART in two urban and three rural outpatient clinics were collected by medical record extraction and from patient interviews using audio computer-assisted self-interview (ACASI). Results: The prevalence of suboptimal adherence was estimated to be 24.9% via a visual analogue scale (VAS) of past-month dose-missing and 29.1% using a modified Adult AIDS Clinical Trial Group scale for on-time dose-taking in the past 4 days. Factors significantly associated with the more conservative VAS score were: depression (p < 0.001), side-effect experiences (p < 0.001), heavy alcohol use (p = 0.001), chance health locus of control (p = 0.003), low perceived quality of information from care providers (p = 0.04) and low social connectedness (p = 0.03). Illicit drug use alone was not significantly associated with suboptimal adherence, but interacted with heavy alcohol use to reduce adherence (p < 0.001). Conclusions: This is the largest survey of ART adherence yet reported from Asia and the first in a developing country to use the ACASI method in this context. The evidence strongly indicates that ART services in Viet Nam should include screening and treatment for depression, linkage with alcohol and/or drug dependence treatment, and counselling to address the belief that chance or luck determines health outcomes.

Outcomes of Antiretroviral Therapy in Vietnam: Results from a National Evaluation

Abstract: Objectives: Vietnam has significantly scaled up its national antiretroviral therapy (ART) program since 2005. With the aim of improving Vietnam’s national ART program, we conducted an outcome evaluation of the first five years of the program in this concentrated HIV epidemic where the majority of persons enrolled in HIV care and treatment services are people who inject drugs (PWID). The results of this evaluation may have relevance for other national ART programs with significant PWID populations. Design: Retrospective cohort analysis of patients at 30 clinics randomly selected with probability proportional to size among 120 clinics with at least 50 patients on ART. Methods: Charts of patients whose ART initiation was at least 6 months prior to the study date were abstracted. Depending on clinic size, either all charts or a random sample of 300 charts were selected. Analyses were limited to treatment-nao ¨ve patients. Multiple imputations were used for missing data. Results: Of 7,587 patient charts sampled, 6,875 were those of treatment-nao ¨ve patients (74.4% male, 95% confidence interval [CI]: 72.4–76.5, median age 30, interquartile range [IQR]: 26–34, 62.0% reported a history of intravenous drug use, CI: 58.6–65.3). Median baseline CD4 cell count was 78 cells/mm 3 (IQR: 30–162) and 30.4% (CI: 25.8–35.1) of patients were at WHO stage IV. The majority of patients started d4T/3TC/NVP (74.3%) or d4T/3TC/EFV (18.6%). Retention rates after 6, 12, 24, and 36 months were 88.4% (CI: 86.8–89.9), 84.0% (CI: 81.8–86.0), 78.8% (CI: 75.7–81.6), and 74.6% (CI: 69.6–79.0). Median CD4 cell count gains after 6, 12, 24, and 36 months were 94 (IQR: 45–153), 142 (IQR: 78–217), 213 (IQR: 120–329), and 254 (IQR: 135–391) cells/mm 3 . Patients who were PWID showed significantly poorer retention. Conclusions: The study showed good retention and immunological response to ART among a predominantly PWID group of patients despite advanced HIV infections at baseline.

The economic burden of road traffic injuries: evidence from a provincial general hospital in Vietnam

Abstract: Objective To examine the costs of road traffic injuries (RTIs) in Vietnam and factors associated with increased costs. Method RTI data were collected in a prospective cohort study on the impact of injuries in Vietnam. Participants were persons admitted to the Thai Binh General Hospital because of RTI. All costs incurred by participants and their family members during hospitalisation were collected, including direct medical costs, direct non-medical costs and indirect costs. Generalised linear models were employed to examine predictors of increased costs including demographic and injury context characteristics. Results Each RTI hospitalisation costs the patient and family on average US$363 or 6 months of average salary. Income, injury severity, principal region of injury and length of hospital stay were statistically significant predictors of increased costs; age, gender, occupation and road user group were not. After controlling for injury characteristics and income, participants with principal injuries to the lower extremities had a cost 1.28 (95% CI 1.07 to 1.54) times higher than those with principal injuries to the face. Analyses of motorcycle-related RTIs with principal injury to the head also showed increased costs among those without a helmet (1.41 times higher, 95% CI 1.17 to 1.71). Conclusions RTIs can cause a substantial economic burden to the patient and family. During hospitalisation on average, an RTI would cost approximately 6 months of salary. In addition to interventions to decrease the risk of RTIs, those reducing the severity, such as wearing a motorcycle helmet, should be enforced to minimise the economic and health consequences of injury.

Ethnic minority health in Vietnam: a review exposing horizontal inequity

Abstract: Background: Equity in health is a pressing concern and reaching disadvantaged populations is necessary to close the inequity gap. To date, the discourse has predominately focussed on reaching the poor. At the same time and in addition to wealth, other structural determinants that influence health outcomes exist, one of which is ethnicity. Inequities based on group belongings are recognised as ‘horizontal’, as opposed to the more commonly used notion of ‘vertical’ inequity based on individual characteristics. Objective: The aim of the present review is to highlight ethnicity as a source of horizontal inequity in health and to expose mechanisms that cause and maintain this inequity in Vietnam. Design: Through a systematic search of available academic and grey literature, 49 publications were selected for review. Information was extracted on: a) quantitative measures of health inequities based on ethnicity and b) qualitative descriptions explaining potential reasons for ethnicity-based health inequities. Results: Five main areas were identified: health-care-seeking and utilization, maternal and child health, nutrition, infectious diseases, and oral health and hygiene. Evidence suggests the presence of severe health inequity in health along ethnic lines in all these areas. Research evidence also offers explanations derived from both external and internal group dynamics to this inequity. It is reported that government policies and programs appear to be lacking in culturally adaptation and sensitivity, and examples of bad attitudes and discrimination from health staff toward minority persons were identified. In addition, traditions and patriarchal structures within ethnic minority groups were seen to contribute to the maintenance of harmful health behaviors within these groups. Conclusion: Better understandings of the scope and pathways of horizontal inequities are required to address ethnic inequities in health. Awareness of ethnicity as a determinant of health, not only as a covariate of poverty or living area, needs to be improved, and research needs to be designed with this in mind. Keywords: ethnic minorities; Vietnam; inequity; policy; maternal health; child health; HIV; nutrition (Published: 4 March 2013) Citation: Glob Health Action 2013, 6 : 19803 - http://dx.doi.org/10.3402/gha.v6i0.19803

Factors associated with health risk behavior among school children in urban Vietnam

Abstract: Background: Health risk behavior among young people is a public health problem in Vietnam. In addition, road traffic injuries are the leading cause of death for those aged 15-29 years. The consequences can be devastating for adolescents and their families, and can create a significant economic burden on society. Objective: The aim of this study was to identify protective and risk factors that may influence three health risk behaviors among school children: suicidal thinking (ST), drinking alcohol (DA), and underage motorbike driving (MD). Methods: A cross-sectional survey of 972 adolescents (aged 12-15 years) was conducted in two secondary schools in Hanoi, Vietnam. The schools were purposely selected, one each from the inner city and a suburban area, from which classes (grade 6 to 8) were randomly selected. All students attending classes on survey days took part in the survey. The anonymous, self-completed questionnaire included measures of risk behavior, school connectedness, parental bonding, and other factors. Multivariable regression models were used to examine associations between the independent variables and the three health risk behaviors controlling for confounding factors. Results: Young people in the inner city school reported a higher prevalence of all three risk behaviors than those in the suburban area (ST: 16.1% [95% confidence interval, or CI, 12.9-19.3] versus 4.6% [95% CI 2.7-6.5], p<0.001; DA: 20.3% [95% CI 16.8-23.8] versus 8.3% [95% CI 5.8-10.8], p<0.001, and MD: 10.1% [95% CI 7.4-12.8] versus 5.7% [95% CI 3.6-7.8], p<0.01). School connectedness and mother and father care appeared to be significant protective factors. For males, bullying in school was associated with suicidal thoughts, whereas for both males and females, school connectedness may be protective against suicidal ideation. Conclusion: This study supports findings from other nations regarding suicidal thoughts and alcohol use, and appears to be one of the first to examine risk and protective factors for MD. Health promotion within schools should be introduced to improve students’ feelings of connectedness in combination with communication and education campaigns focusing on parental care and engaging teachers for the promotion of safer, supportive school environments. Keywords: risk behavior; risk factor; protective factor; school children; Vietnam (Published: 18 January 2013) Citation: Glob Health Action 2013, 6 : 18876 - http://dx.doi.org/10.3402/gha.v6i0.18876 This paper is part of the Cluster Public health in Vietnam: here's the data, where's the action? - more papers from this cluster can be found here .

Social capital and mental health among mothers in Vietnam who have children with disabilities.

Abstract: Background: Having a child with a disability is a heavy burden for mothers, especially in developing countries, where there is little available financial or other government support. Having a child with a disability is also linked to mental health problems and poor quality of life. Communities rich in social capital and individuals who have high levels of personal social capital generally enjoy day-to-day and long-term health and social benefits but this has not been investigated in Vietnam among mothers of children with disabilities. This study aims to investigate these mothers’ distress in terms of their social capital. Methods: A cross-sectional study based on an interviewer-assisted survey included 172 mothers of children with moderate/severe disabilities in two provinces of Vietnam (one in the North and one in central Vietnam), using a newly translated and modified version of the Australian community participation questionnaire, several measures of personal social cohesion, and Kessler’s 10-item measure of general psychological distress. Hierarchical linear regression modelling was used to explore the relationships among socio-demographic factors, multiple components of structural and cognitive social capita, and mothers’ distress controlling for a wide range of socio-demographic characteristics, the nature of the child’s disability, and mothers’ personality (extroversion). Results: Mothers in this study were highly and multiply disadvantaged, and they had very high levels of distress and low levels of community participation. Furthermore, most forms of participation were associated with greater, not less, distress. Socio-demographic characteristics, child’s disability, and mothers’ personality did little to explain variance in mothers’ distress, but types and amounts of participation were important predictors. The final regression model explained 29% of variance in distress, with major contributions made by living in a mountainous area, having a ‘reserved’ personality, and frequency and types of participation. Conclusion: Vietnamese mothers whose children have disabilities are extremely marginalised and distressed. They have only modest social capital, but the little they have tends to be related to better mental health. Being from the mountains; being ‘reserved’; spending time with friends, neighbours, and in educational activities; and trusting others are related to better mental health among these women. However, several types of participation are associated with worse mental health. Such activities should be avoided in any interventions designed to increase social capital as a mental health promotion strategy. Keywords: distress; social capital; mothers; children with disabilities; community participation; personal social cohesion; women’s health; mental health (Published: 11 February 2013) Citation: Glob Health Action 2013, 6 : 18886 - http://dx.doi.org/10.3402/gha.v6i0.18886 This paper is part of the thematic cluster Improving health and living conditions for elderly populations - more papers from this cluster can be found here .

Catastrophic household costs due to injury in Vietnam

Abstract: Objective Little is known about the costs of injury and their impact on injured persons and their families in Vietnam. This study aimed to examine the cost of injury in hospitalised patients and to identify the most costly injuries and those more likely to result in catastrophic household expenditure. Method A prospective cohort study was conducted, recruiting individuals admitted to Thai Binh General Hospital due to injury in Vietnam from January to August 2010. During the hospitalisation period, data on expenditure including direct medical, direct non-medical and indirect costs were collected. Demographic and injury characteristics were also obtained. The associations between the risk of catastrophic expenditure and injury cause, severity and principal injured region were examined by modified Poisson regression approach. Payment of more than 40% of the household non-subsistence spending was considered a catastrophic expenditure. Results Of 918 patients approached, 892 (97%) were recruited. Total costs for all participants during the hospitalisation period were US$ 325,812. Patients admitted for road injury accounted for the largest number of injuries ( n = 477, 53%), and the largest percentage of the total costs (US$ 175,044, 57%). This was followed by individuals hospitalised due to falls, representing 29% of the sample ( n = 261) and 31% of the total costs (US$ 103,128). In terms of cost per hospital stay, burn injuries were the most costly (US$ 427), followed by falls (US$ 395) and road crashes (US$ 367). Of all sample, 26% experienced catastrophic expenditure due to their injuries. Factors significantly associated with increased risk of catastrophic expenditure were having more severe or higher MAIS injuries (RR = 2.02, 95% CI: 1.14–3.57), principal injured region to lower extremities (RR = 3.34, 95% CI: 1.41–7.91) or head (RR = 3.21, 95% CI: 1.37–7.52), longer hospital stay (RR = 1.09, 95% CI: 1.07–1.10), older age, lower income and not having insurance (RR = 1.63, 95% CI: 1.21–2.21). Conclusion A high proportion of households experienced catastrophic expenditure following injury, highlighting the important need for programmes to prevent injuries, road traffic and fall-related injuries in particular. Furthermore, expansion of health insurance coverage may help individuals cope with the financial consequences of injury.

Financial burden of health care for HIV/AIDS patients in Vietnam.

Abstract: Objective To assess the out-of-pocket (OOP) payments for health-care services of HIV/AIDS patients, and identify associated factors in Vietnam. Methods Cross-sectional multisite survey of 1016 HIV/AIDS patients attending 7 hospitals and health centres in Ha Noi, Hai Phong and Ho Chi Minh City in 2012. Results HIV/AIDS patients used inpatient and outpatient care on average 5.1 times (95% CI = 4.7–5.4) besides ART services. Inpatient care cost US$ 461 on average and outpatient care US$ 50. Mean annual health-care expenditure for HIV/AIDS patients was US$ 188 (95% CI = 148–229). 35.1% of households (95% CI = 32.2–38.1) experienced catastrophic health expenditure; 73.3% (95% CI = 70.6–76.1) of households would be affected if ART were not subsidised. Being a patient at a provincial clinic, male sex, unstable employment, being in the poorest income quintile, a CD4 count of <200 cells/mL and not yet receiving ART increased the likelihood of catastrophic medical expense. Conclusions HIV/AIDS patients in Vietnam frequently use medical services and incur OOP payments for health care. Scaling up free-of-charge ART services, earlier access to and initiation of ART, and decentralisation and integration of HIV/AIDS-related services could reduce their financial burden. Objectif Evaluer les paiements directs de la poche pour les services de soins de sante des patients VIH/SIDA et identifier les facteurs associes au Vietnam. Methodes Etude transversale multi-site chez 1016 patients VIH/SIDA frequentant 7 hopitaux et centres de sante de Hanoi, Hai Phong et Ho Chi Minh City en 2012. Resultats Les patients VIH/SIDA utilisaient les soins hospitaliers et ambulatoires en moyenne 5,1 fois (IC95% = 4,7–5,4) en plus de services ART. Les soins hospitaliers coutaient en moyenne 461 USD et les soins ambulatoires 50 USD. La moyenne annuelle des depenses de soins de sante pour les patients VIH/SIDA etait de 188 USD (IC95% = 148–229). 35,1% des menages (IC95% = 32,2 a 38,1) experimentaient des depenses de sante catastrophiques; 73,3% (IC95% = 70,6 a 76,1) des menages seraient affectes si l’ART n’etait pas subventionnee. Etre un patient dans une clinique provinciale, le sexe masculin, l'emploi instable, etre dans le quintile le plus pauvre, un taux de CD4 < 200 cellules/ml et ne pas etre encore sous ART augmentaient la probabilite de frais medicaux catastrophiques. Conclusions Les patients VIH/SIDA au Vietnam utilisent frequemment les services medicaux et engagent des paiements directs de la poche pour les soins de sante. L'extension des services ART gratuits, l'acces rapide et l'initiation a l’ART et la decentralisation et l'integration des services lies au VIH/SIDA pourraient reduire leur charge financiere. Objetivo Evaluar los pagos de bolsillo para servicios sanitarios en pacientes con VIH/SIDA, e identificar los factores asociados en Vietnam. Metodos Estudio croseccional y multicentrico de 1016 pacientes con VIH/SIDA, atendidos en 7 hospitales y centros sanitarios en Ha Noi, Hai Phong, y la ciudad de Ho Chi Minh en el 2012. Resultados Los pacientes con VIH/SIDA utilizaron cuidados hospitalarios y externos una media de 5.1 veces (IC 95% = 4.7–5.4) ademas de los servicios de TAR. Los cuidados hospitalarios costaron en promedio US$ 461 y los cuidados externos US$ 50. El promedio de gastos sanitarios anuales para pacientes con VIH/SIDA era de US$ 188 (IC 95% = 148–229). Un 35.1% de los hogares (IC 95% = 32.2–38.1) experimentaban gastos sanitarios catastroficos; un 73.3% (IC 95% = 70.6–76.1) de los hogares estarian afectados si el TAR no estuviese subsidiado. Ser un paciente en una clinica de provincia, ser hombre, con un empleo inestable, estar en el quintil de ingresos mas pobre, un conteo de CD4 < 200 celulas/mL, y no estar aun recibiendo TAR aumentaban la probabilidad de los gastos medicos catastroficos. Conclusiones Los pacientes con VIH/SIDA en Vietnam utilizan de forma frecuente los servicios medicos e incurren en gastos de bolsillo para cuidados sanitarios. El llevar a escala los servicios gratuitos de TAR, un acceso mas temprano al inicio del TAR, descentralizacion e integracion de los servicios relacionados con VIH/SIDA podrian reducir su carga financiera.

Prevalence of cervical infection with HPV type 16 and 18 in Vietnam: implications for vaccine campaign.

Abstract: Background The Expanded Program on Immunization currently considers offering Human Papilomavirus vaccine on a routine basis in Vietnam. However, as the current available vaccine can prevent only two types HPV 16 and 18, before implementing a large-scale vaccine campaign we need information about the prevalence of infection with only HPV 16 and 18 in Viet Nam. This study was done in 5 large cities in Vietnam to estimate the prevalence of HPV 16 and/or 18 infections and to explore the distribution of other high risk types of HPV among married women in these provinces.

Road traffic injury among young people in Vietnam: evidence from two rounds of national adolescent health surveys, 2004–2009

Abstract: Background: Based on previous data, road traffic injury (RTI) was a leading cause of non-fatal injury in all-age groups in Vietnam, and among the top causes of injury in children and adolescents Specific analysis on RTIs in young people, however, has yet to be fully investigated Using the results of two surveys in 2004 and 2009, the present study aims to describe the current situation of non-fatal, unintentional RTIs among Vietnamese youths In addition, it explores RTI-related risk and protective factors Methods: This study utilized the nationally representative Survey Assessment of Vietnamese Youth 2009 (SAVY2) of 10,044 youths aged 14 to 25 from all 63 provinces in Vietnam The indicators were compared with data from SAVY1 in 2004 of 7,584 youths Bivariate and multivariable statistical techniques were applied Results: Overall, 75% of youths used a motorcycle in SAVY2 compared with 542% in SAVY1 Of the SAVY2 sample, the proportion that had experienced an RTI was 106% vs 141% in SAVY1 While the proportion of RTIs for both sexes decreased, the decline was greater for males (119% vs 178% in SAVY1) than in females (92% vs 104%) The proportion of rural youths aged 22-25 who experienced an RTI increased slightly in the 5 years between the two study intervals The percentage of youths reporting frequent helmet use increased significantly from 262% in SAVY1 to 736% in SAVY2 Factors related to the likelihood of ever having experienced an RTI included: older age, male, ever being drunk, and ever riding motorcycles after drinking Conclusion: While improvements in RTIs appear to have occurred between 2004 and 2009, more attention should be paid, particularly, in maintenance and supervision of law enforcement to helmet use and drunk driving Keywords: road traffic injury; adolescent; risk and protective factors; Vietnam (Published: 17 January 2013) Citation: Glob Health Action 2013, 6 : 18757 - http://dxdoiorg/103402/ghav6i018757 This paper is part of the Cluster Public health in Vietnam: here's the data, where's the action? - more papers from this cluster can be found here

Measuring compliance with Viet Nam's mandatory motorcycle helmet legislation

Abstract: The objective of this roadside observational study was to monitor helmet wearing among motorcycle riders and passengers in three provinces (Yen Bai, Da Nang and Binh Duong) in the Socialist Republic of Viet Nam, before and after a mandatory helmet law took effect on 15 December 2007. A total of 665,428 motorcycle riders and passengers were observed between November 2007 and February 2011 at 45 randomly selected sites covering the entire road network. Across all locations and time periods, correct helmet wearing averaged 40.1% before the law and 92.5% after; however, there were significant differences between time points and locations. The Viet Nam Government's decision to require all motorcycle riders and passengers to wear helmets has been thoroughly implemented nation wide and the results show that high wearing has been sustained. Further study is required on how high helmet wearing has and will translate into a reduction in motorcycle head injuries; however, Viet Nam's motorcycle helmet legislation should be seen as an important policy example for other low- and middle-income countries with a high utilization of motorcycles for personal transport.

The Chi Linh Health and Demographic Surveillance System (CHILILAB HDSS)

Abstract: The Chi Linh Health and Demographic Surveillance System (CHILILAB HDSS) is the only health and demographic surveillance system (HDSS) in an urbanizing area of the Chi Linh district of Hai Duong, a northern province of Vietnam. It is one of the few field laboratories in the world that links operational research and health interventions with field training. The CHILILAB HDSS provides longitudinal data on demographic and health indicators for the community of Chi Linh. In 2012, when the CHILILAB HDSS included 57,561 people from 17 993 households in 3 towns and 4 communes, it used structured questionnaires to collect information on population changes (birth, death, migration, marriage, and pregnancy) in the community. As of December 2012, 5 rounds of a baseline survey and 17 periodic update surveys or re-enumeration surveys had been conducted. In addition, several specialized public-health research projects, focused particularly on adolescent health, have been implemented by the CHILILAB HDSS. The information that the CHILILAB HDSS has gathered provides a picture of the health status of the population and socio-economic situation in Chi Linh district. The contact person for data sharing is the director of the CHILILAB (E-mail: thb@hsph.edu.vn).

HIV-related stigma: Impact on healthcare workers in Vietnam

Abstract: Stigma has been identified as a major barrier to HIV response. While much is known about stigma directed towards people living with HIV (PLHIV), less is known about stigma experienced by health workers who treat PLHIV. This study aims to explore the perceptions and experiences of health workers regarding how stigma influences their work with HIV-positive patients. The study employed a qualitative design involving individual semi-structured in-depth interviews with 14 health workers, purposively selected from hospitals and detention centres for people who use drugs and sex workers in Hanoi, Vietnam. Findings showed that the stigma experienced by health workers may be organised around several themes: (1) lack of social prestige associated with HIV work; (2) fear of infection expressed by family members; (3) feelings of being devalued within the healthcare field; and (4) work-related stress and burnout, especially for staff working in detention centres for drug users and female sex workers. Efforts are needed to improve the public image of HIV work, scale up stigma reduction, enhance stress management and create a safe and supportive working environment for health workers.

Female sex workers who use amphetamine-type stimulants (ATS) in three cities of Vietnam: Use and sexual risks related to HIV/AIDS

Abstract: Early evidence shows that amphetamine-type stimulant (ATS) use has been rapidly increasing in Vietnam. Female sex workers (FSWs) who use ATSs have increased sexual risks for HIV infection. This paper presents qualitative data from a mixed-method study conducted from 2010 to 2011 that aimed to explore the use of ATS among FSWs in three major cities and to identify HIV-related sexual risks among this group. A total of 37 in-depth interviews were conducted, and thematic analysis was performed using NVIVO 8.0 software. Study participants reported that they perceive ATS to be more ‘stylish’, ‘higher class’ and much less ‘addictive’ than heroin. The study highlights multiple sexual risks among this group, including having prolonged sex; sex with multiple simultaneous partners or clients; lack of negotiation for safe sex; increased likelihood of group sex in the context of drug pooling and extended drug and sexual network; as well as unprotected sex. There is an urgent need to promote contextually appropriate in...

New strategy toward dioxin risk reduction for local residents surrounding severe dioxin hotspots in Vietnam.

Abstract: Background: A public health intervention program with active involvement of local related stakeholders was piloted in the Bien Hoa dioxin hotspot (2007-2009), and then expanded to the Da Nang dioxin hotspot in Vietnam (2009-2011). It aimed to reduce the risk of dioxin exposure through foods for local residents. This article presents the results of the intervention in Da Nang. Methodology: To assess the results of this intervention program, pre- and post-intervention knowledge, attitude, and practice (KAP) surveys were implemented in 400 households, randomly selected from four wards surrounding the Da Nang Airbase in 2009 and 2011, respectively. Results: After the intervention, the knowledge on the existence of dioxin in food, dioxin exposure pathways, potential high-risk foods, and preventive measures significantly increased (P<0.05). Ninety-eight percentage were willing to follow advice on preventing dioxin exposure. Practices to reduce the risk of dioxin exposure also significantly improved (P<0.05). After intervention, 60.4% of households undertook exposure preventive measures, significantly higher than that of the pre-intervention survey (39.6%; χ 2 =40.15, P<0.05). Conclusions: This is seen as an effective intervention strategy toward reducing the risk of human exposure to dioxin at dioxin hotspots. While greater efforts are needed for remediating dioxin-polluted areas inside airbases, there is also evidence to suggest that, during the past four decades, pollution has expanded to the surrounding areas. For this reason, this model should be quickly expanded to the remaining dioxin hotspots in Vietnam to further reduce the exposure risk in these areas. Keywords: dioxin hotspots; intervention program; dioxin exposure through foods; risk communication; dioxin risk reduction; Vietnam (Published: 20 June 2013) Citation: Glob Health Action 2013, 6 : 21105 - http://dx.doi.org/10.3402/gha.v6i0.21105

Drinking & driving in Viet Nam: prevalence, knowledge, attitudes, and practices in two provinces.

Abstract: Objective Viet Nam is experiencing a shift in its burden of disease profile with injuries becoming more prominent. A history of high alcohol involvement in road traffic crashes despite stringent laws led to increased enforcement by police, enhanced public education messaging and targeted social marketing campaigns in Ha Nam and Ninh Binh provinces in Viet Nam. This study aims to illustrate the changes in prevalence (November 2010 to December 2011) and knowledge, attitudes and practices (KAP) around alcohol use and drink-driving for the year 2011. Methods Breath Alcohol Concentration (BrAC) was collected through police enforcement checkpoints in the two provinces. The proportion of drivers with BrAC above the legal limit was plotted over time for both provinces. The trend in prevalence of drink-driving over time was further assessed using Poisson regression models. Prevailing KAPs were determined through surveying randomly selected road users over the age of 17 years at gas stations at quarterly intervals. Cross tabulations of key variables as well Chi-Square statistic were used to assess associations. Results A total of 8,404 drivers were tested for BrAC levels of which less than 0.25% were female. Of 1,639 drivers displaying BrAC levels in excess of the legal limit, 87.3% were car drivers, 7.9% motorcyclists and 86% were between the ages of 25 and 44 years. KAP surveys captured 1,661 drivers over the study period. The prevalence of self-reported drink-driving increased 6 percentage points among respondents aged 27–36. Between 44% (January 2011) and 49% (December 2011) of respondents indicated awareness of a drinking and driving Blood Alcohol Concentration (BAC) or BrAC limit and only 25% of all study participants recalled being penalized for a traffic violation – none of which were for drink-driving. Conclusion While there has been some reduction in drink-driving prevalence, inadequate or incorrect knowledge on drink-driving legislation appears to be an impediment to greater gains. Increased attention needs to be paid to enforcement activities and social marketing campaigns need to be part of a multi-faceted programme that also works on improving existing legislation, takes into consideration gender issues, and enhances visible enforcement of the laws.

Lessons learned from stakeholders in a facilitation intervention targeting neonatal health in Quang Ninh province, Vietnam

Abstract: In northern Vietnam the Neonatal health - Knowledge Into Practice (NeoKIP, Current Controlled Trials ISRCTN44599712) trial has evaluated facilitation as a knowledge translation intervention to improve neonatal survival. The results demonstrated that intervention sites, each having an assigned group including local stakeholders supported by a facilitator, lowered the neonatal mortality rate by 50% during the last intervention year compared with control sites. This process evaluation was conducted to identify and describe mechanisms of the NeoKIP intervention based on experiences of facilitators and intervention group members. Four focus group discussions (FGDs) were conducted with all facilitators at different occasions and 12 FGDs with 6 intervention groups at 2 occasions. Fifteen FGDs were audio recorded, transcribed verbatim, translated into English, and analysed using thematic analysis. Four themes and 17 sub-themes emerged from the 3 FGDs with facilitators, and 5 themes and 18 sub-themes were identified from the 12 FGDs with the intervention groups mirroring the process of, and the barriers to, the intervention. Facilitators and intervention group members concurred that having groups representing various organisations was beneficial. Facilitators were considered important in assembling the groups. The facilitators functioned best if coming from the same geographical area as the groups and if they were able to come to terms with the chair of the groups. However, the facilitators’ lack of health knowledge was regarded as a deficit for assisting the groups’ assignments. FGD participants experienced the NeoKIP intervention to have impact on the knowledge and behaviour of both intervention group members and the general public, however, they found that the intervention was a slow and time-consuming process. Perceived facilitation barriers were lack of money, inadequate support, and the function of the intervention groups. This qualitative process evaluation contributes to explain the improved neonatal survival and why this occurred after a latent period in the NeoKIP project. The used knowledge translation intervention, where facilitators supported multi-stakeholder coalitions with the mandate to impact upon attitudes and behaviour in the communes, has low costs and potential for being scaled-up within existing healthcare systems.

Multilevel Determinants of Colleges/Universities Enrolment in Vietnam: Evidences from the 15% Sample Data of Population Census 2009

Abstract: In an increasingly knowledge-based globalized world, higher education, advanced training and skill development are critical priorities for Vietnam. This paper aims to estimate the participation in higher education and its regional distribution in Vietnam, and to identify its determinants at the individual and contextual levels. Data used were from Vietnam Population and Housing Census 2009 linked with Vietnam living standard survey 2009. The participation rate overall in the colleges/universities among 19–22 year olds in Vietnam was 16.3%, but this rate varied significantly across the provinces. Household socioeconomic status, gender, ethnic group, migrant status, and urban/rural residence were significant individual level predictors of participation while indicator of fertility stabilization, income distribution, and average education level were significant predictors at the contextual (provincial) level. The results show that individual, social and regional inequalities are important impediments to higher education participation among the Vietnam youth. The government needs to pay more attention to promoting higher education and training in order to position Vietnam in the global economy.

Prevalence and factors associated with road traffic crash among bus drivers in Hanoi, Vietnam

Abstract: Bus provides a main mode of public transport in Vietnam, but the risk of road traffic crash for bus drivers is unknown. This retrospective study estimated the crash prevalence among bus drivers in Hanoi, Vietnam, and identified driver characteristics affecting their crashes. Information on bus crashes for the period 2006-2009 was collected by interviewing drivers from five bus companies in Hanoi using a structured questionnaire. Logistic regression analysis was performed to determine pertinent risk factors affecting the crash prevalence for bus drivers. Of the total 365 participants recruited, 73 drivers reported 76 crashes, giving an overall crash prevalence of 20%. Among the crashed group, three drivers (4%) were involved in two crashes during the past 3 years. Crashes mainly occurred on streets or local roads (81%). Migrant worker (adjusted odds ratio (OR) 4.26, 95% confidence interval (CI) 2.20-8.25) and insufficient income perceived (OR 2.60, 95% CI 1.37-4.93) were identified to be significantly associated with the crash risk. Further prospective and qualitative studies are needed to provide detailed crash characteristics as well as behaviour and perception of bus drivers, so that an effective intervention can be developed to improve road safety and to prevent traffic injury of these drivers.

Factors associated with health risk behavior among school children in urban Vietnam

Abstract: Background Health risk behavior among young people is a public health problem in Vietnam. In addition, road traffic injuries are the leading cause of death for those aged 15–29 years. The consequences can be devastating for adolescents and their families, and can create a significant economic burden on society. Objective: The aim of this study was to identify protective and risk factors that may influence three health risk behaviors among school children: suicidal thinking (ST), drinking alcohol (DA), and underage motorbike driving (MD). Methods A cross-sectional survey of 972 adolescents (aged 12–15 years) was conducted in two secondary schools in Hanoi, Vietnam. The schools were purposely selected, one each from the inner city and a suburban area, from which classes (grade 6 to 8) were randomly selected. All students attending classes on survey days took part in the survey. The anonymous, self-completed questionnaire included measures of risk behavior, school connectedness, parental bonding, and other factors. Multivariable regression models were used to examine associations between the independent variables and the three health risk behaviors controlling for confounding factors. Results Young people in the inner city school reported a higher prevalence of all three risk behaviors than those in the suburban area (ST: 16.1% [95% confidence interval, or CI, 12.9–19.3] versus 4.6% [95% CI 2.7–6.5], p<0.001; DA: 20.3% [95% CI 16.8–23.8] versus 8.3% [95% CI 5.8–10.8], p<0.001, and MD: 10.1% [95% CI 7.4–12.8] versus 5.7% [95% CI 3.6–7.8], p<0.01). School connectedness and mother and father care appeared to be significant protective factors. For males, bullying in school was associated with suicidal thoughts, whereas for both males and females, school connectedness may be protective against suicidal ideation. Conclusion This study supports findings from other nations regarding suicidal thoughts and alcohol use, and appears to be one of the first to examine risk and protective factors forMD. Health promotion within schools should be introduced to improve students’ feelings of connectedness in combination with communication and education campaigns focusing on parental care and engaging teachers for the promotion of safer, supportive school environments.

Returns on investments of HIV prevention in Vietnam

Abstract: This study aimed to estimate the cost-effectiveness and returns on investments of HIV prevention programs implemented during 2006-2010 and to identify the optimal allocation of resources across combinations of programs for an effective HIV prevention response to inform the prioritization of funding and health resources in Vietnam. The spending-outcome relationships and an epidemiological model were used to compare observed conditions with counterfactual scenarios of reduced or no programs to calculate the cost-effectiveness and estimate healthcare costs saved and thus the return on investment. Model simulations of epidemic projections over many combinations of possible resource allocations were used to identify optimal allocations for reducing new infections over the next HIV budget period.