Showing papers by "Hanoi School Of Public Health published in 2014"

Fathers as Supporters for Improved Exclusive Breastfeeding in Viet Nam

Abstract: To determine the extent of exclusive breastfeeding practices among mothers of 4 and 6 month old infants whose fathers received breastfeeding education materials and counseling services. A quasi-experimental design was used. At the baseline, 251 and 241 couples were recruited into the intervention and control sites respectively. Fathers in the intervention area received breastfeeding education materials, counseling services at commune health centers and household visits. In the control site, where mothers routinely receive services on antenatal and postpartum care, fathers did not receive any intervention services on promoting breastfeeding. Primary indicators were exclusive breastfeeding at 4 and 6 months. At 6 months of age, based on 24-hour recall, 16.0 % (38/238) of mothers in the intervention group were exclusively breastfeeding their children, compared to 3.9 % (10/230) of those mothers in the control group (p < 0.001). Significant differences were found based on last-week recall (8.8 % in the intervention group vs. 1.3 % in the control group, p < 0.001) and since-birth recall (6.7 % in the intervention group vs. 0.9 % in the control group, p < 0.01). At 4 months of age, based on since birth recall, the breastfeeding proportion was significantly higher in the intervention group than in control group (20.6 % in the intervention group vs. 11.3 % in the control group, p < 0.01). An intervention targeting fathers might be effective in increasing exclusive breastfeeding practices at 4 and 6 months. To improve exclusive breastfeeding, health care staff working in maternal and child health units, should consider integrating fathers with services delivered to mothers and children.

Early Marriage and Intimate Partner Violence Among Adolescents and Young Adults in Viet Nam

Abstract: Research about the association between early marriage and intimate partner violence (IPV) in low-income countries has yielded conflicting evidence. The aim of this study was to describe the prevalence of and associations between early marriage, and IPV among adolescents and young adults in Viet Nam. Secondary analysis of data from the national Survey Assessment of Viet Namese Youth-Round II (SAVY-II) conducted in 2009-2010, which assessed a representative cohort of people aged 14 to 25 years recruited via a systematic household survey was undertaken. Prevalence was established using descriptive statistics. The association between early marriage and IPV was examined using multiple logistic regressions, adjusting for potential risk factors. Of 10,044 participants, 1,701 had ever married and were included in analyses. Early marriage (before age 18), and experiences of verbal, physical, or sexual IPV were more common among females than males. More young married men than women reported experiences of controlling behaviors by their partners. Early marriage, being illiterate, and exposure to sexual abuse were associated with experience of IPV among young females, but not among young males. Poverty and exposure to family violence was associated with IPV in both sexes. Addressing early marriage, low educational opportunities for girls, childhood sexual abuse, family violence, and poverty should be considered in strategies to reduce IPV in Viet Nam.

Assessing Health Risk due to Exposure to Arsenic in Drinking Water in Hanam Province, Vietnam

Abstract: We assessed health risks related to Arsenic (As) in contaminated drinking water in Hanam, applying the Australian Environmental Health Risk Assessment Framework, which promotes stakeholder involvement in risk assessments. As concentrations in 300 tube-well water samples, before and after filtration, were analyzed and the water consumption levels in 150 households were estimated. Skin cancer risk was characterized using Cancer Slope Factor index and lifetime average daily dose with a probabilistic approach. The results showed that arsenic concentrations in tube-well water ranged from 8–579 ppb (mean 301 ppb) before filtration and current sand filters used by the households did not meet the standard for As removal. Arsenic daily consumption of 40% of the adults exceeded the level of TDI (Tolerable Daily Intake) at 1 µg/kg/day. The average skin cancer risk in adults due to consuming filtered tube-well water for drinking purpose were 25.3 × 10−5 (using only well water) and 7.6 × 10−5 (using both well and rain water). The skin cancer risk would be 11.5 times higher if the water was not filtered. Improvement of filtration measures or the replacement of the current drinking water sources to minimize the health risks to the local population is urgently needed.

Effect of facilitation of local maternal-and-newborn stakeholder groups on neonatal mortality: a cluster randomised trial

Abstract: Background Facilitation of local women’s groups may reportedly reduce neonatal mortality. It is not known whether facilitation of groups composed by local healthcare staff and politicians can improve perinatal outcomes. We hypothesized that facilitation of local stakeholder groups would reduce neonatal mortality (primary outcome) and improve maternal, delivery and newborn care indicators (secondary outcomes) in Quang Ninh province, Vietnam. Trial registration: Current Controlled Trials ISRCTN44599712.

Direct and indirect costs of smoking in Vietnam

Abstract: Objective To estimate the direct and indirect costs of active smoking in Vietnam. Method A prevalence-based disease-specific cost of illness approach was utilised to calculate the costs related to five smoking-related diseases: lung cancer, cancers of the upper aerodigestive tract, chronic obstructive pulmonary disease, ischaemic heart disease and stroke. Data on healthcare came from an original survey, hospital records and official government statistics. Morbidity and mortality due to smoking combined with the average per capita income were used to calculate the indirect costs of smoking by applying the human capital approach. The smoking-attributable fraction was calculated using the adjusted relative risk values from phase II of the American Cancer Society Cancer Prevention Study (CPS-II). Costs were classified as personal, governmental and health insurance costs. Results The total economic cost of smoking in 2011 was estimated at 24 679.9 billion Vietnamese dong (VND), equivalent to US$1173.2 million or approximately 0.97% of the 2011 gross domestic product. The direct costs of inpatient and outpatient care reached 9896.2 billion VND (US$470.4 million) and 2567.2 billion VND (US$122.0 million), respectively. The government’s contribution to these costs was 4534.3 billion VND (US $215.5 million), which was equivalent to 5.76% of its 2011 healthcare budget. The indirect costs (productivity loss) due to morbidity and mortality were 2652.9 billion VND (US$126.1 million) and 9563.5 billion VND (US $454.6 million), respectively. These indirect costs represent about 49.5% of the total costs of smoking. Conclusions Tobacco consumption has large negative consequences on the Vietnamese economy.

Diarrhoeal diseases among adult population in an agricultural community Hanam province, Vietnam, with high wastewater and excreta re-use

Abstract: Background: Despite the potential health risks of wastewater and excreta use as fertiliser in agriculture, it is still widespread in Vietnam. However, the importance of diarrheal risk in adults’ associated with the combined exposures to both excreta and wastewater use in agriculture is largely unknown. This study was carried out to determine diarrhoeal incidence and associated risk factors among the adult population exposed to wastewater and excreta used in agriculture in Hanam province, Vietnam. Methods: An open cohort of 867 adults, aged 16–65 years, was followed weekly for 12 months to determine the incidence of diarrhoea. A nested case–control study was used to assess the risk factors of diarrhoeal episodes. Two hundred and thirty-two pairs of cases and controls were identified and exposure information related to wastewater, human and animal excreta, personal hygiene practices, and food and water consumption was collected. Results: The incidence rate of reported diarrhoea was 0.28 episodes per person-years at risk. The risk factors for diarrhoeal diseases included direct contact with the Nhue River water (odds ratio [OR] = 2.4, attributable fraction [AF] 27%), local pond water (OR = 2.3, AF 14%), composting of human excreta for a duration less than 3 months (OR = 2.4, AF 51%), handling human excreta in field work (OR = 5.4, AF 7%), handling animal excreta in field work (OR = 3.3, AF 36%), lack of protective measures while working (OR = 6.9, AF 78%), never or rarely washing hands with soap (OR =3.3, AF 51%), use of rainwater for drinking (OR= 5.4, AF 77%) and eating raw vegetables the day before (OR =2.4, AF 12%). Conclusions: Our study shows that professional exposure to wastewater and excreta during agricultural activities are significantly contributing to the risk of diarrhoea in adults. The highest attributable fractions were obtained for direct contact with Nhue River and local ponds, handling practices of human and animal excreta as fertilisers, lack of protective measures while working and poor personal hygiene practices, and unsafe food and water consumption were associated with the risk of diarrhoeal episodes in adults. Improve personal hygiene practices and use of relevant treated wastewater and excreta as the public health measures to reduce these exposures will be most effective and are urgently warranted.

Estimation of Vietnam National Burden of Disease 2008

Abstract: Burden of disease has been used to assess population health status. This article presents the first estimations of burden of disease in Vietnam in 2008 using disability-adjusted life years (DALYs). DALYs were calculated using the Global Burden of Disease (GBD) methods. Incidence, prevalence of diseases, and causes of death was extracted from Vietnam data. Disability weights were borrowed from GBD and Dutch research. In 2008, the total burden of disease in Vietnam was 12.3 million DALYs. Noncommunicable diseases dominated the total burden of diseases in Vietnam, accounting for 71% of the total burden, and cardiovascular disease was the leading cause group of premature death. While pneumonia was an important cause of burden in Vietnamese children, stroke and depression were the main causes of disease burden among adults. The study provides a snapshot of Vietnamese health status and offers guidance for health policymaking in Vietnam.

Enhancing the Benefits of Antiretroviral Therapy in Vietnam: Towards Ending AIDS

Abstract: Vietnam has a concentrated HIV epidemic, with the highest HIV prevalence being observed among people who inject drugs (PWID). Based on its experience scaling-up robust HIV interventions, Vietnam aims to further strengthen its response by harnessing the preventive benefits of antiretroviral therapy (ART). Mathematical modelling suggests that prioritizing key populations for earlier access to ART, combined with other prevention interventions, may have significant impact on the epidemic, cost-effectively reducing new HIV infections and deaths. Pilot studies are being conducted to assess feasibility and acceptability of expansion of HIV testing and counselling (HTC) and early ART among key populations and to demonstrate innovative service delivery models to address challenges in uptake of services across the care cascade. Earlier access of key populations to combination prevention interventions, combined with sustained political commitment and supportive environment for key populations, are essential for maximum impact of ART on the HIV epidemic in Vietnam.

Validation of public health competencies and impact variables for low- and middle-income countries

Abstract: Background The number of Master of Public Health (MPH) programmes in low- and middle-income countries (LMICs) is increasing, but questions have been raised regarding the relevance of their outcomes and impacts on context. Although processes for validating public health competencies have taken place in recent years in many high-income countries, validation in LMICs is needed. Furthermore, impact variables of MPH programmes in the workplace and in society have not been developed.

Outcome and impact of Master of Public Health programs across six countries: education for change

Abstract: The human resources for health crisis has highlighted the need for high-level public health education to add specific capacities to the workforce. Recently, it was questioned whether Master of Public Health (MPH) training prepared graduates with competencies relevant to low- and middle-income countries (LMICs). This study aims to examine the influence of the MPH programs geared towards LMICs offered in Vietnam, China, South Africa, Mexico, Sudan, and the Netherlands on graduates’ careers, application of acquired competencies, performance at the workplace, and their professional contribution to society. A self-administered questionnaire was sent to graduates from six MPH programs. Frequency distributions of the answers were calculated, and a bivariate analysis and logistic regression of certain variables was performed. The response rate was 37.5%. Graduates reported change in leadership (69%), in technical position (69%), acquiring new responsibilities (80%), and increased remuneration (63%); they asserted that MPH programs contributed significantly to this. Graduates’ attribution of their application of 7 key competencies ‘substantially to the MPH program’ ranged from 33% to 48%. Of the 26 impact variables, graduates attributed the effect they had on their workplace substantially to the MPH program; the highest rated variable ranged from 31% to 73% and the lowest ranged from 9% to 43%. Of the 10 impact variables on society, graduates attributed the effect they had on society substantially to the MPH program; for the highest rated variable (13% to 71%); for the lowest rated variable (4% to 42%). Candidates’ attribution of their application of acquired competencies as well as their impact at the workplace varied significantly according to institution of study and educational background. This study concludes that these MPH programs contribute to improving graduates’ careers and to building leadership in public health. The MPH programs contribute to graduates’ application of competencies. MPH programs contribute substantially towards impact variables on the workplace, such as development of research proposals and reporting on population health needs, and less substantially to their impact on society, such as contributing equitable access to quality services. Differences reported between MPH programs merit further study. The results can be used for curriculum reform.

Ecohealth as a field: looking forward.

Abstract: This forum paper proposes a reflection on the "field of ecohealth" and on how best to sustain a supportive environment that enables the evolution of diverse partnerships and forms of collaboration in the field. It is based on the results of a preconference workshop held in October 2012, in Kunming, China at the fourth biennial conference of the International Association for Ecology and Health. Attended by 105 persons from 38 countries, this workshop aimed to have a large-group and encompassing discussion about ecohealth as an emerging field, touching on subjects such as actors, processes, structures, standards, and resources. Notes taken were used to conduct a qualitative thematic analysis combined with a semantic network analysis. Commonalities highlighted by these discussions draw a portrait of a field in which human health, complex systems thinking, action, and ecosystem health are considered central issues. The need to reach outside of academia to government and the general public was identified as a shared goal. A disconnect between participants' main concerns and what they perceived as the main concerns of funding agencies emerged as a primary roadblock for the future.

Care practices and traditional beliefs related to neonatal jaundice in northern Vietnam: a population-based, cross-sectional descriptive study

Abstract: Background The National Hospital of Pediatrics in Vietnam performed >200 exchange transfusions annually (2006–08), often on infants presenting encephalopathic from lower-level hospitals. As factors delaying care-seeking are not known, we sought to study care practices and traditional beliefs relating to neonatal jaundice in northern Vietnam.

Identifying the impediments and enablers of ecohealth for a case study on health and environmental sanitation in Hà Nam, Vietnam

Abstract: Background: To date, research has shown an increasing use of the term “ecohealth” in literature, but few researchers have explicitly described how it has been used. We investigated a project on health and environmental sanitation (the conceptual framework of which included the pillars of ecohealth) to identify the impediments and enablers of ecohealth and investigate how it can move from concept to practice. Methods: A case study approach was used. The interview questions were centred on the nature of interactions and the sharing of information between stakeholders. Results: The analysis identified nine impediments and 15 enablers of ecohealth. Three themes relating to impediments, in particular—integration is not clear, don’t understand, and limited participation—related more directly to the challenges in applying the ecohealth pillars of transdisciplinarity and participation. The themes relating to enablers—awareness and understanding, capacity development, and interactions—facilitated usage of the research results. By extracting information on the environmental, social, economic, and health aspects of environmental sanitation, we found that the issue spanned multiple scales and sectors. Conclusion: The challenge of how to integrate these aspects should be considered at the design stage and throughout the research process. We recommend that ecohealth research teams include a self-investigation of their processes in order to facilitate a comparison of moving from concept to practice, which may offer insights into how to evaluate the process.

Policy processes underpinning universal health insurance in Vietnam

Abstract: Background : In almost 30 years since economic reforms or ‘renovation’ ( Doimoi ) were launched, Vietnam has achieved remarkably good health results, in many cases matching those in much higher income countries. This study explores the contribution made by Universal Health Insurance (UHI) policies, focusing on the past 15 years. We conducted a mixed method study to describe and assess the policy process relating to health insurance, from agenda setting through implementation and evaluation. Design : The qualitative research methods implemented in this study were 30 in-depth interviews, 4 focus group discussions, expert consultancy, and 420 secondary data review. The data were analyzed by NVivo 7.0. Results : Health insurance in Vietnam was introduced in 1992 and has been elaborated over a 20-year time frame. These processes relate to moving from a contingent to a gradually expanded target population, expanding the scope of the benefit package, and reducing the financial contribution from the insured. The target groups expanded to include 66.8% of the population by 2012. We characterized the policy process relating to UHI as incremental with a learning-by-doing approach, with an emphasis on increasing coverage rather than ensuring a basic service package and financial protection. There was limited involvement of civil society organizations and users in all policy processes. Intertwined political economy factors influenced the policy processes. Conclusions : Incremental policy processes, characterized by a learning-by-doing approach, is appropriate for countries attempting to introduce new health institutions, such as health insurance in Vietnam. Vietnam should continue to mobilize resources in sustainable and viable ways to support the target groups. The country should also adopt a multi-pronged approach to achieving universal access to health services, beyond health insurance. Keywords : universal health insurance; universal health coverage; policy process; Vietnam (Published: 26 September 2014) Citation : Glob Health Action 2014, 7 : 24928 - http://dx.doi.org/10.3402/gha.v7.24928

Scenario planning for community development in Vietnam: a new tool for integrated health approaches?

Abstract: Background : Like many countries in Southeast Asia, Vietnam’s rapid population and economic growth has met challenges in infrastructure development, especially sanitation in rural areas. Objective : As an entry point, we developed scenario planning as an action–research tool in a peri-urban community to identify first steps towards improving their complex sanitation problem and to, systemically, address emerging/re-emerging infectious diseases, as these are commonly linked to unsafe water and inadequate sanitation conditions. As an integrated approach, the process of constructing scenarios allowed us to work across sectors and stakeholders to incorporate this knowledge into a common vision. Design : We conducted focus group discussions to identify and rank driving forces, orally constructed scenarios for the most uncertain drivers, discussed scenario implications and options, and examined the overall process for usefulness and sustainability. During a one-month scoping phase and in between focus group meetings, we carried out household visits which helped us understand the context of data and gather feedback from participants outside of the formal data collection process. Recorded results from these activities were used to develop subsequent tools. Results and Conclusions : The research process gave us insights into how to adapt the scenario planning tool to identify alternative options. This involved choosing boundary partners, negotiating priorities, drawing out participant learning through self-assessment of our process (a prerequisite for changing mental models and thus achieving outcomes), and understanding how conveyed messages may reinforce the status quo. These insights showed the importance of examining research results beyond outputs and outcomes, namely through process. Keywords : integrated approaches; tools; scenarios; planning; sanitation; development; Vietnam (Published: 18 August 2014) Citation : Glob Health Action 2014, 7 : 24482 - http://dx.doi.org/10.3402/gha.v7.24482

Peer and community influences on the acceptance of premarital sex among Vietnamese adolescents.

Abstract: Aim Adolescents in Vietnam have a low level of sexual activity but this may increase with urbanisation and economic development. The aim of this analysis is to understand trends in correlates of permissive attitudes towards premarital sex among Vietnamese adolescents using an ecological framework. Methods Data from the Survey Assessment of Vietnamese Youth from 2003 (n = 7584) and 2009 (n = 10 044) were analysed using multivariable logistic regressions to examine associations between permissive attitudes towards premarital sex and demographic and contextual factors among adolescents aged 14 to 25. Results Correlates of having permissive attitudes towards premarital sex in both 2003 and 2009 included being male older age living in an urban area living in the North having ever used the Internet and perceiving that people in the community were having premarital sex. Variables that were significant in 2009 but not in 2003 included socio-economic status and belonging to an ethnic minority. Statistically significant changes in associations between 2003 and 2009 were observed for age socio-economic status and belonging to an ethnic minority. Conclusions The association of permissive attitudes with community norms and certain socio-demographic variables in conjunction with overarching economic development and urbanisation suggests that premarital sex will likely become increasingly common among Vietnamese adolescents. These trends should be further assessed as adolescent sexual activity becomes more common and adolescent friendly health services should be developed to provide appropriate and acceptable sexual and reproductive health care to young people.

The Context Assessment for Community Health tool - investigating why what works where in low- and middle-income settings

Abstract: Background The gap between what is known and what is practiced results in patients not benefitting from advances in healthcare and unnecessary costs for clients and health systems. The Promoting Action on Research Implementation in Health Services (PARIHS) framework posits (1) strong evidence, (2) context in terms of coping with change, and (3) facilitation as elements influencing successful implementation of new knowledge [1]. A strong context is considered key to warrant an environment receptive to change. Tools for systematic mapping of aspects of context influencing implementation have been developed for, and are being used in, high-income settings whereas there are no tools available for this purpose for lowand middle-income countries (LMICs).

Home-use icterometry in neonatal hyperbilirubinaemia: Cluster-randomised controlled trial in Vietnam.

Abstract: Aim To determine whether home-use icterometry improves parental recognition of neonatal jaundice, early care seeking and treatment to minimize risks of bilirubin encephalopathy. Methods Cluster-randomised controlled trial of community-level icterometry used at home by mothers in Chi Linh, Vietnam. Rural health-care workers identified and enrolled term newborns. Post-partum mothers received jaundice education and icterometry instructions and were cluster-randomised by commune. Cases received icterometers (icterometer group (IG)) and controls did not (control group (CG)). Subjects received mobile telephone calls from post-natal days 2–7 to determine maternal recognition by visual inspection and icterometer detection of jaundice (≥3.0 on five-point scale). Mothers without telephones, premature newborns ( 5 days were excluded. Results Three hundred fifty-two subjects were enrolled (183 IG and 169 CG), of whom 11 (3.4%) were lost to telephone follow-up. Jaundice was recognised and/or detected in 94 (27%) of all newborns. Icterometry helped 11 mothers (6%) detect neonatal jaundice that was not visually recognised by IG mothers. Detection by IG mothers was not statistically greater than CG mothers (P = 0.09). Follow-up care seeking was 8% in both groups (P = 0.2), and 11% of jaundiced newborns received treatment (9% IG vs. 16% CG, P = 0.3). Newborns who received care had bilirubin measurements that averaged 257 μmol/L IG vs. 322 μmol/L CG (P = 0.3). There were no deaths. Conclusions In this pilot study, home-use icterometry may help improve parental detection of jaundice in rural Vietnam. However, larger studies are necessary to determine the changes in recognition, care seeking and treatment.

Comparison of behaviors regarding live poultry exposure among rural residents in Vietnam and Thailand

Abstract: Introduction: Live poultry exposure and risk behaviors are more prevalent in rural communities, increasing the risk of influenza A/H5N1 infection. We examined the economic and socio-cultural influences on poultry-related practices by comparing the poultry-related practices among Vietnamese and Thai rural residents by family income and consumption preference. Methods: Stratified cluster sampling was performed to select households. Within each household, one adult was randomly selected for a face-to-face interview in five Vietnamese and five Thai rural districts. Using a standardized questionnaire to assess domestic poultry husbandry, live poultry purchase, and demographics, logistic regression enabled comparisons of behaviors related to live poultry exposure and examination of associated factors. Results: Among 994 Vietnamese and 907 Thai rural residents, live poultry exposure (prevalence of raising poultry, improper handling of sick or dead poultry, touching live poultry before buying, and slaughtering poultry at home) was more prevalent among Vietnamese than Thai respondents. After adjusting for other demographics, respondents with higher family incomes were less likely to rear backyard poultry in both Vietnam and Thailand, and with more likely to buy live poultry in Vietnam, but not in Thailand. Consumption preference for live poultry was associated with being more likely to rear backyard poultry in Vietnam and Thailand, and with being more likely to buy live poultry in Thailand, but not in Vietnam. Conclusion: The findings suggest important roles of economic imperatives and cultural preference for live poultry for consumption in supporting poultry rearing and live poultry purchase among rural residents.

Student-Centred Outcomes of an E-Learning Course on Public Health in Hanoi and New York

Abstract: Background We evaluated the satisfaction and improvement in learning outcomes of students taking a distance course in Public Health facilitated by the Institute for Preventive Medicine and Public Health at the Hanoi Medical University and the State University of New York at Albany. Methods A total of 36 students participated in pre- and post- course surveys online. We developed the Vietnamese E-Learning Student Outcomes Profile (VESOP) to evaluate the impact of distance learning methods on students’ learning outcomes. Factor analysis was applied to construct the measure items into five domains: Academic Skills, Intellectual Abilities, Interactions, Responsibility and Educational Engagement. Multivariate regression models, selected using stepwise approach, determined factors associated with changes in students’ learning outcomes. Student satisfaction with the course was assessed by determining their willingness to participate in and pay for future distance learning courses.