Showing papers by "Hanoi School Of Public Health published in 2016"

A century of trends in adult human height

Abstract: Being taller is associated with enhanced longevity, and higher education and earnings. We reanalysed 1472 population-based studies, with measurement of height on more than 18.6 million participants to estimate mean height for people born between 1896 and 1996 in 200 countries. The largest gain in adult height over the past century has occurred in South Korean women and Iranian men, who became 20.2 cm (95% credible interval 17.5–22.7) and 16.5 cm (13.3–19.7) taller, respectively. In contrast, there was little change in adult height in some sub-Saharan African countries and in South Asia over the century of analysis. The tallest people over these 100 years are men born in the Netherlands in the last quarter of 20th century, whose average heights surpassed 182.5 cm, and the shortest were women born in Guatemala in 1896 (140.3 cm; 135.8–144.8). The height differential between the tallest and shortest populations was 19-20 cm a century ago, and has remained the same for women and increased for men a century later despite substantial changes in the ranking of countries.

Socioeconomic inequalities in catastrophic health expenditure and impoverishment associated with non-communicable diseases in urban Hanoi, Vietnam

Abstract: The catastrophic health expenditure and impoverishment indices offer guidance for developing appropriate health policies and intervention programs to decrease financial inequity. This study assesses socioeconomic inequalities in catastrophic health expenditure and impoverishment in relation to self-reported non-communicable diseases (NCD) in urban Hanoi, Vietnam. A cross-sectional survey was conducted from February to March 2013 in Hanoi, the capital city of Vietnam. We estimated catastrophic health expenditure and impoverishment using information from 492 slum household and 528 non-slum households. We calculated concentration indexes to assess socioeconomic inequalities in catastrophic health expenditure and impoverishment. Factors associated with catastrophic health expenditure and impoverishment were modelled using logistic regression analysis. The poor households in both slum and non-slum areas were at higher risk of experiencing catastrophic health expenditure, while only the poor households in slum areas were at higher risk of impoverishment because of healthcare spending. Households with at least one member reporting an NCD were significantly more likely to face catastrophic health expenditure (odds ratio [OR] = 2.4; 95 % confidence interval [CI], 1.8–4.0) and impoverishment (OR = 2.3; 95 % CI, 1.1–6.3) compared to households without NCDs. In addition, households in slum areas, with people age 60 years and above, and belonging to the poorest socioeconomic group were significantly associated with increased catastrophic health expenditure, while only households that lived in slum areas, and belonging to the poor or poorest socioeconomic groups were significantly associated with increased impoverishment because of healthcare spending. Financial interventions to prevent catastrophic health expenditure and impoverishment should target poor households, especially those with family members suffering from NCDs, with older members and those located in slum areas in Hanoi Vietnam. Potential interventions derived from this study include targeting and monitoring of health insurance enrolment, and developing a specialized NCD service package for Vietnam’s social health insurance program.

Accumulation and potential health risks of cadmium, lead and arsenic in vegetables grown near mining sites in Northern Vietnam.

Abstract: The effect of environmental pollution on the safety of vegetable crops is a serious global public health issue. This study was conducted to assess heavy metal concentrations in soil, irrigation water, and 21 local vegetable species collected from four sites near mining activities and one control site in Northern Vietnam. Soils from vegetable fields in the mining areas were contaminated with cadmium (Cd), lead (Pb), and arsenic (As), while irrigation water was contaminated with Pb. Average concentrations of Pb and As in fresh vegetable samples collected at the four mining sites exceeded maximum levels (MLs) set by international food standards for Pb (70.6 % of vegetable samples) and As (44.1 % of vegetable samples), while average Cd concentrations in vegetables at all sites were below the MLs of 0.2. The average total target hazard quotient (TTHQ) across all vegetable species sampled was higher than the safety threshold of 1.0, indicating a health risk. Based on the weight of evidence, we find that cultivation of vegetables in the studied mining sites is an important risk contributor for local residents’ health.

Trends in socioeconomic inequalities in child malnutrition in Vietnam: findings from the Multiple Indicator Cluster Surveys, 2000-2011.

Abstract: Background : Child malnutrition is not only a major contributor to child mortality and morbidity, but it can also determine socioeconomic status in adult life. The rate of under-five child malnutrition in Vietnam has significantly decreased, but associated inequality issues still need attention. Objective : This study aims to explore trends, contributing factors, and changes in inequalities for under-five child malnutrition in Vietnam between 2000 and 2011. Design : Data were drawn from the Viet Nam Multiple Indicator Cluster Survey for the years 2000 and 2011. The dependent variables used for the study were stunting, underweight, and wasting of under-five children. The concentration index was calculated to see the magnitude of child malnutrition, and the inequality was decomposed to understand the contributions of determinants to child malnutrition. The total differential decomposition was used to identify and explore factors contributing to changes in child malnutrition inequalities. Results : Inequality in child malnutrition increased between 2000 and 2011, even though the overall rate declined. Most of the inequality in malnutrition was due to ethnicity and socioeconomic status. The total differential decomposition showed that the biggest and second biggest contributors to the changes in underweight inequalities were age and socioeconomic status, respectively. Socioeconomic status was the largest contributor to inequalities in stunting. Conclusions : Although the overall level of child malnutrition was improved in Vietnam, there were significant differences in under-five child malnutrition that favored those who were more advantaged in socioeconomic terms. The impact of socioeconomic inequalities in child malnutrition has increased over time. Multifaceted approaches, connecting several relevant ministries and sectors, may be necessary to reduce inequalities in childhood malnutrition. Keywords: trend; malnutrition; inequality; decomposition; Vietnam (Published: 29 February 2016) Citation: Glob Health Action 2016, 9 : 29263 - http://dx.doi.org/10.3402/gha.v9.29263 This paper is part of the Special Issue: Millennium Development Goals in Vietnam: the Progress and Social Determinants . More papers from this issue can be found at www.globalhealthaction.net

Father's involvement and its effect on early breastfeeding practices in Viet Nam.

Abstract: Fathers have an important but often neglected role in the promotion of healthy breastfeeding practices in developing countries. A community-based education intervention was designed to mobilize fathers' support for early breastfeeding. This study aimed to evaluate an education intervention targeting fathers to increase the proportion of early breastfeeding initiation and to reduce prelacteal feeding. Quasi-experimental study design was used to compare intervention and control areas located in two non-adjacent rural districts that shared similar demographic and health service characteristics in northern Viet Nam. Fathers and expectant fathers with pregnant wives from 7 to 30 weeks gestational age were recruited. Fathers in the intervention area received breastfeeding education materials, counselling services at a commune health centre and household visits. They were also invited to participate in a breastfeeding promotion social event. After intervention, early breastfeeding initiation rate was 81.2% in the intervention area and 39.6% in the control area (P < 0.001). Babies in the intervention area were more likely to be breastfed within the first hour after birth [odds ratio (OR) 7.64, 95% confidence interval (CI) 4.81-12.12] and not to receive any prelacteal feeding (OR 4.43, 95% CI 2.88-6.82) compared with those in the control area. Fathers may positively influence the breastfeeding practices of mothers, and as a resource for early childcare, they can be mobilized in programmes aimed at improving the early initiation of breastfeeding.

Schools of public health in low and middle-income countries: an imperative investment for improving the health of populations?

Abstract: Public health has multicultural origins. By the close of the nineteenth century, Schools of Public Health (SPHs) began to emerge in western countries in response to major contemporary public health challenges. The Flexner Report (1910) emphasized the centrality of preventive medicine, sanitation, and public health measures in health professional education. The Alma Ata Declaration on Primary Health Care (PHC) in 1978 was a critical milestone, especially for low and middle-income countries (LMICs), conceptualizing a close working relationship between PHC and public health measures. The Commission on Social Determinants of Health (2005–2008) strengthened the case for SPHs in LMICs as key stakeholders in efforts to reduce global health inequities. This scoping review groups text into public health challenges faced by LMICs and the role of SPHs in addressing these challenges. The challenges faced by LMICs include rapid urbanization, environmental degradation, unfair terms of global trade, limited capacity for equitable growth, mass displacements associated with conflicts and natural disasters, and universal health coverage. Poor governance and externally imposed donor policies and agendas, further strain the fragile health systems of LMICs faced with epidemiological transition. Moreover barriers to education and research imposed by limited resources, political and economic instability, and unbalanced partnerships additionally aggravate the crisis. To address these contextual challenges effectively, SPHs are offering broad based health professional education, conducting multidisciplinary population based research and fostering collaborative partnerships. SPHs are also looked upon as the key drivers to achieve sustainable development goals (SDGs). SPHs in LMICs can contribute to overcoming several public health challenges being faced by LMICs, including achieving SDGs. Most importantly they can develop cadres of competent and well-motivated public health professionals: educators, practitioners and researchers who ask questions that address fundamental health determinants, seek solutions as agents of change within their mandates, provide specific services and serve as advocates for multilevel partnerships. Funding support, human resources, and agency are unfortunately often limited or curtailed in LMICs, and this requires constructive collaboration between LMICs and counterpart institutions from high income countries.

How the alcohol industry relies on harmful use of alcohol and works to protect its profits.

Abstract: The alcohol industry have attempted to position themselves as collaborators in alcohol policy making as a way of influencing policies away from a focus on the drivers of the harmful use of alcohol (marketing, over availability and affordability) Their framings of alcohol consumption and harms allow them to argue for ineffective measures, largely targeting heavier consumers, and against population wide measures as the latter will affect moderate drinkers The goal of their public relations organisations is to 'promote responsible drinking' However, analysis of data collected in the International Alcohol Control study and used to estimate how much heavier drinking occasions contribute to the alcohol market in five different countries shows the alcohol industry's reliance on the harmful use of alcohol In higher income countries heavier drinking occasions make up approximately 50% of sales and in middle income countries it is closer to two-thirds It is this reliance on the harmful use of alcohol which underpins the conflicting interests between the transnational alcohol corporations and public health and which militates against their involvement in the alcohol policy arena [Caswell S, Callinan S, Chaiyasong S, Cuong PV, Kazantseva E, Bayandorj T, Huckle T, Parker K, Railton R, Wall M How the alcohol industry relies on harmful use of alcohol and works to protect its profits Drug Alcohol Rev 2016;35:661-664]

Household trends in access to improved water sources and sanitation facilities in Vietnam and associated factors: findings from the Multiple Indicator Cluster Surveys, 2000–2011

Abstract: Background : Despite progress made by the Millennium Development Goal (MDG) number 7.C, Vietnam still faces challenges with regard to the provision of access to safe drinking water and basic sanitation. Objective : This paper describes household trends in access to improved water sources and sanitation facilities separately, and analyses factors associated with access to improved water sources and sanitation facilities in combination. Design : Secondary data from the Vietnam Multiple Indicator Cluster Survey in 2000, 2006, and 2011 were analyzed. Descriptive statistics and tests of significance describe trends over time in access to water and sanitation by location, demographic and socio-economic factors. Binary logistic regressions (2000, 2006, and 2011) describe associations between access to water and sanitation, and geographic, demographic, and socio-economic factors. Results : There have been some outstanding developments in access to improved water sources and sanitation facilities from 2000 to 2011. In 2011, the proportion of households with access to improved water sources and sanitation facilities reached 90% and 77%, respectively, meeting the 2015 MDG targets for safe drinking water and basic sanitation set at 88% and 75%, respectively. However, despite these achievements, in 2011, only 74% of households overall had access to combined improved drinking water and sanitation facilities. There were also stark differences between regions. In 2011, only 47% of households had access to both improved water and sanitation facilities in the Mekong River Delta compared with 94% in the Red River Delta. In 2011, households in urban compared to rural areas were more than twice as likely (odds ratio [OR]: 2.2; 95% confidence interval [CI]: 1.9–2.5) to have access to improved water and sanitation facilities in combination, and households in the highest compared with the lowest wealth quintile were over 40 times more likely (OR: 42.3; 95% CI: 29.8–60.0). Conclusions : More efforts are required to increase household access to both improved water and sanitation facilities in the Mekong River Delta, South East and Central Highlands regions of Vietnam. There is also a need to address socio-economic factors associated with inadequate access to improved sanitation facilities. Keywords: MICS; Vietnam; improved water sources; sanitation facilities (Published: 29 February 2016) Citation: Glob Health Action 2016, 9 : 29434 - http://dx.doi.org/10.3402/gha.v9.29434 This paper is part of the Special Issue: Millennium Development Goals in Vietnam: the Progress and Social Determinants . More papers from this issue can be found at www.globalhealthaction.net

Intestinal parasite infections and associated risk factors in communities exposed to wastewater in urban and peri-urban transition zones in Hanoi, Vietnam

Abstract: Infections with intestinal parasites (helminths and intestinal protozoa) are endemic in Southeast Asia and inappropriate management and reuse of wastewater might exacerbate the risk of human infections. In rapidly growing urban settings, little is known about the extent of intestinal parasite infections. We assessed the point-prevalence and risk factors of intestinal parasite infections in population groups differently exposed to wastewater in urban and peri-urban transition zones in Hanoi, the capital of Vietnam. A cross-sectional survey was carried out between April and June 2014 in people aged ≥ 18 years at risk of wastewater exposure from To Lich River: workers maintaining wastewater treatment facilities; urban farmers reusing wastewater; and urban dwellers at risk of flooding events. For comparison, two peri-urban population groups living in close proximity to the Red River were chosen: farmers using river water for irrigation purposes; and people living in the same communities. A single stool sample was subjected to Kato-Katz and formalin-ether concentration methods for the diagnosis of helminth and intestinal protozoa infections. A questionnaire was administered to determine risk factors and self-reported signs and symptoms. A total of 681 individuals had complete data records. Highest point-prevalence rates of intestinal parasite infections were observed for peri-urban farmers (30 %). Hookworm and Trichuris trichiura were the predominant helminth species (25 % and 5 %, respectively). Peri-urban farmers were at higher odds of infection with intestinal parasites than any other groups (adjusted odds ratio 5.8, 95 % confidence interval 2.5 to 13.7). Lack of access to improved sanitation and not receiving deworming within the past 12 months were associated with higher infection risk, while higher educational attainment and socioeconomic status were negatively associated with intestinal parasite infections. Our results suggest that exposure to wastewater was not directly associated with infection with helminths and intestinal protozoa in different population groups in Hanoi. These findings might be explained by a high level of awareness of health risks and access to safe sanitary infrastructure in urban areas. The high prevalence rates observed in peri-urban farmers call for specific interventions targeting this population group.

mHealth information for migrants: an e-health intervention for internal migrants in Vietnam

Abstract: Socio-economic development in Vietnam has resulted in increased internal migration particularly among young women seeking employment opportunities in cities. Vietnamese female migrants who enter new environments often encounter the loss or neglect of their right to access sexual and reproductive health services. To address this, a mobile health (mHealth) intervention model was implemented over 12 months (2013–2014) in a factory in the Long Bien industrial zone of Hanoi, Vietnam. The intervention provided sexual and reproductive health services for female migrants through text messaging, information booklets accompanied maps, and free counseling via a hotline. To evaluate the impact of the intervention, pre- and post-intervention data were collected to measure changes in women’s knowledge and practices related to sexual and reproductive health. Qualitative data in the form of personal interviews were also collected. The sample size for the baseline survey was 411 women, and for the post-intervention survey it was 482 women (the intervention involved an open cohort). The majority of women were unmarried and under the age of 25. Results indicate that there was high uptake of the intervention services and that most women found the services important and useful. In addition, there was evidence that the intervention (1) increased women’s knowledge of sexual and reproductive health (e.g., proper use of condoms, identification of high-risk behaviors such as having unprotected sex), and (2) fostered improved practices related to sexual and reproductive health (e.g., increased gynecological check-ups and use of condoms). The study demonstrated the feasibility of implementing a multi-faceted intervention for migrant women working in an industrial zone in Hanoi, Vietnam as well as its successful uptake and some early positive effects. This can be used to inform future design and implementation of mHealth/eHealth intervention models for migrant and other vulnerable/hard to reach population.

Trends and determinants for early initiation of and exclusive breastfeeding under six months in Vietnam: results from the Multiple Indicator Cluster Surveys, 2000-2011.

Abstract: BackgroundThere is strong evidence that breastfeeding (BF) significantly benefits mothers and infants in various ways. Yet the proportion of breastfed babies in Vietnam is low and continues to decline. This study fills an important evidence gap in BF practices in Vietnam.ObjectiveThis paper examines the trend of early initiation of BF and exclusive BF from 2000 to 2011 in Vietnam and explores the determinants at individual and contextual levels.DesignData from three waves of the Multiple Indicator Cluster Survey were combined to estimate crude and adjusted trends over time for two outcomes – early initiation of BF and exclusive BF. Three-level logistic regressions were fitted to examine the impacts of both individual and contextual characteristics on early initiation of BF and exclusive BF in the 2011 data.ResultsBoth types of BF showed a decreasing trend over time after controlling for individual-level characteristics but this trend was more evident for early initiation of BF. Apart from child's age, ind...

Tobacco Control Policies in Vietnam: Review on MPOWER Implementation Progress and Challenges.

Abstract: In Vietnam, the WHO Framework Convention on Tobacco Control (WHO FCTC) took effect in March 2005 while MPOWER has been implemented since 2008. This paper describes the progress and challenges of implementation of the MPOWER package in Vietnam. We can report that, in term of monitoring, Vietnam is very active in the Global Tobacco Surveillance System, completing two rounds of the Global Adult Tobacco Survey (GATS) and three rounds of the Global Youth Tobacco Survey (GYTS). To protect people from tobacco smoke, Vietnam has issued and enforced a law requiring comprehensive smoking bans at workplaces and public places since 2013. Tobacco advertising and promotion are also prohibited with the exception of points of sale displays of tobacco products. Violations come in the form of promotion girls, corporate social responsibility activities from tobacco manufacturers and packages displayed by retail vendors. Vietnam is one of the 77 countries that require pictorial health warnings to be printed on cigarette packages to warn about the danger of tobacco and the warnings have been implemented effectively. Cigarette tax is 70% of factory price which is equal to less than 45% of retail price and much lower than the recommendation of WHO. However, Vietnam is one of the very few countries that require manufacturers and importers to make "compulsory contributions" at 1-2% of the factory price of cigarettes sold in Vietnam for the establishment of a Tobacco Control Fund (TCF). The TCF is being operated well. In 2015, 67 units of 63 provinces/cities, 22 ministries and political-social organizations and 6 hospitals received funding from TCF to implement a wide range of tobacco control activities. Cessation services have been starting with a a toll-free quit-line but need to be further strengthened. In conclusion, Vietnam has constantly put efforts into the tobacco control field with high commitment from the government, scientists and activists. Though several remarkable achievements have been gained, many challenges remain. To overcome those challenges, implementation strategies that take into account the contextual factors and social determinants of tobacco use in Vietnam are needed.

The mCME Project: A Randomized Controlled Trial of an SMS-Based Continuing Medical Education Intervention for Improving Medical Knowledge among Vietnamese Community Based Physicians' Assistants.

Abstract: Background Community health workers (CHWs) provide critical services to underserved populations in low and middle-income countries, but maintaining CHW’s clinical knowledge through formal continuing medical education (CME) activities is challenging and rarely occurs. We tested whether a Short Message Service (SMS)-based mobile CME (mCME) intervention could improve medical knowledge among a cadre of Vietnamese CHWs (Community Based Physician’s Assistants–CBPAs) who are the leading providers of primary medical care for rural underserved populations. Methods The mCME Project was a three arm randomized controlled trial. Group 1 served as controls while Groups 2 and 3 experienced two models of the mCME intervention. Group 2 (passive model) participants received a daily SMS bullet point, and were required to reply to the text to acknowledge receipt; Group 3 (interactive model) participants received an SMS in multiple choice question format addressing the same thematic area as Group 2, entering an answer (A, B, C or D) in their response. The server provided feedback immediately informing the participant whether the answer was correct. Effectiveness was based on standardized examination scores measured at baseline and endline (six months later). Secondary outcomes included job satisfaction and self-efficacy. Results 638 CBPAs were enrolled, randomized, and tested at baseline, with 592 returning at endline (93.7%). Baseline scores were similar across all three groups. Over the next six months, participation of Groups 2 and 3 remained high; they responded to >75% of messages. Group 3 participants answered 43% of the daily SMS questions correctly, but their performance did not improve over time. At endline, the CBPAs reported high satisfaction with the mCME intervention, and deemed the SMS messages highly relevant. However, endline exam scores did not increase over baseline, and did not differ between the three groups. Job satisfaction and self-efficacy scores also did not improve. Average times spent on self-study per week did not increase, and the kinds of knowledge resources used by the CBPAs did not differ between the three groups; textbooks, while widely available, were seldom used. Conclusions The SMS-based mCME intervention, while feasible and acceptable, did not result in increased medical knowledge. We hypothesize that this was because the intervention failed to stimulate lateral learning. For an intervention of this kind to be effective, it will be essential to find more effective ways to couple SMS as a stimulus to promote increased self-study behaviors. Trial Registration ClinicalTrials.gov NCT02381743

Process evaluation of a knowledge translation intervention using facilitation of local stakeholder groups to improve neonatal survival in the Quang Ninh province, Vietnam

Abstract: Annually, 28 million neonatal deaths occur worldwide, despite the fact that three-quarters of them could be prevented if available evidence-based interventions were used Facilitation of community groups has been recognized as a promising method to translate knowledge into practice In northern Vietnam, the Neonatal Health – Knowledge Into Practice trial evaluated facilitation of community groups (2008–2011) and succeeded in reducing the neonatal mortality rate (adjusted odds ratio, 051; 95 % confidence interval 030–089) The aim of this paper is to report on the process (implementation and mechanism of impact) of this intervention Process data were excerpted from diary information from meetings with facilitators and intervention groups, and from supervisor records of monthly meetings with facilitators Data were analyzed using descriptive statistics An evaluation including attributes and skills of facilitators (eg, group management, communication, and commitment) was performed at the end of the intervention using a six-item instrument Odds ratios were analyzed, adjusted for cluster randomization using general linear mixed models To ensure eight active facilitators over 3 years, 11 Women’s Union representatives were recruited and trained Of the 44 intervention groups, composed of health staff and commune stakeholders, 43 completed their activities until the end of the study In total, 95 % (n = 1508) of the intended monthly meetings with an intervention group and a facilitator were conducted The overall attendance of intervention group members was 86 % The groups identified 32 unique problems and implemented 39 unique actions The identified problems targeted health issues concerning both women and neonates Actions implemented were mainly communication activities Communes supported by a group with a facilitator who was rated high on attributes and skills (n = 27) had lower odds of neonatal mortality (odds ratio, 037; 95 % confidence interval, 019–073) than control communes (n = 46) This evaluation identified several factors that might have influenced the outcomes of the trial: continuity of intervention groups’ work, adequate attributes and skills of facilitators, and targeting problems along a continuum of care Such factors are important to consider in scaling-up efforts ISRCTN ISRCTN44599712

Poly-victimisation and health risk behaviours, symptoms of mental health problems and suicidal thoughts and plans among adolescents in Vietnam.

Abstract: Limited evidence is available about poly-victimisation (exposure to multiple forms of victimisation) and mental health among adolescents in low and lower-middle-income countries. The aim of this study was to examine the associations between lifetime exposure to poly-victimisation, health risk behaviours, symptoms of common mental health problems and suicidal ideas in the previous year among high school students in Vietnam. Participants were high school students in rural and urban districts of Hanoi, Vietnam. The data source was an anonymously-completed structured self-report survey. Lifetime exposure to poly-victimisation was assessed using the juvenile victimisation questionnaire revised 2 (JVQ R-2); mental health symptoms by the depression, anxiety and stress scale-21 (DASS-21); involvement in health risk behaviours and previous year suicidal thoughts and plans by questions adapted from the 2013 youth risk behaviour survey. Data were collected between October, 2013 and January, 2014 and were analysed using generalised structural equation modelling. In total 1616/1745 (92.6 %) eligible students provided complete data. Prior year suicidal thoughts were reported by 21.4 % (95 % CI 18.5–24.5 %) of the female respondents and 7.9 % (95 % CI 6.2–9.8 %) of the male respondents. Prior year suicidal plans were reported by 7.8 % (95 % CI 5.9–9.8 %) of the girls and 4.0 % (95 % CI 2.7–5.3 %) of the boys. Poly-victimisation was associated with increased likelihood of involvement in health risk behaviours and symptoms of common mental health problems among both sexes, which increased adolescents’ risk of having suicidal ideas in the previous year. Compared to non-victims or victims of fewer forms, poly-victims were also more likely to report suicidal thoughts and plans among both girls and boys (p < 0.05). Overall, the results revealed that poly-victimisation was associated with increased involvement in health risk behaviours, poorer mental health and increased risks of suicidal ideas among Vietnamese adolescents. Suicidal ideas were prevalent among the students. Interventions to assist victims of violence and prevention of violence, especially poly-victimisation, among adolescents in Vietnam is therefore important.

Use of modern contraceptives among married women in Vietnam: a multilevel analysis using the Multiple Indicator Cluster Survey (2011) and the Vietnam Population and Housing Census (2009)

Abstract: Background : The prevalence of modern contraceptive use is an important indicator that reflects accessibility to reproductive health services. Satisfying unmet needs for family planning alone could reduce the number of maternal deaths by almost a third. This study uses multiple data sources to examine multilevel factors associated with the use of modern contraceptives among married women in Vietnam aged 15–49 years. Design : Data from different national surveys (Vietnam Population and Housing Census, Vietnam Living Standard Survey, and Multiple Indicator Cluster Survey) were linked to create a dataset including individual and contextual (provincial) variables ( N= 8,341). Multilevel modeling was undertaken to examine the impact of both individual and provincial characteristics on modern contraceptive use. Odds ratios (ORs) and 95% confidence intervals (CIs) are reported. Results : Individual factors significantly associated with the use of modern contraceptives were age 30–34 years (reference 15–19 years) (OR=1.63); high socioeconomic status (SES) (OR=0.8); having two living children (OR=2.4); and having a son (OR=1.4). The provincial poverty rate mediated the association between the individual’s SES and the likelihood of using modern contraceptives. Conclusions : The proportion of women in Vietnam using modern contraceptive methods has remained relatively high in recent years with significant variation across Vietnam’s 63 provinces. Women of lower SES are more likely to use modern contraceptive methods, especially in the poorer provinces. Achieving access to universal reproductive health is one of the Millennium Development Goals. Vietnam must continue to make progress in this area. Keywords: contraception; family planning; reproductive health; maternal health; differentials; multilevel modeling; MDG (Published: 29 February 2016) Citation: Glob Health Action 2016, 9 : 29574 - http://dx.doi.org/10.3402/gha.v9.29574 This paper is part of the Special Issue: Millennium Development Goals in Vietnam: the Progress and Social Determinants . More papers from this issue can be found at www.globalhealthaction.net

Evaluation of Two Techniques for Viral Load Monitoring Using Dried Blood Spot in Routine Practice in Vietnam (French National Agency for AIDS and Hepatitis Research 12338).

Abstract: Background. Although it is the best method to detect early therapeutic failure, viral load (VL) monitoring is still not widely available in many resource-limited settings because of difficulties in specimen transfer, personnel shortage, and insufficient laboratory infrastructures. Dried blood spot (DBS) use, which was introduced in the latest World Health Organization recommendations, can overcome these difficulties. This evaluation aimed at validating VL measurement in DBS, in a laboratory without previous DBS experience and in routine testing conditions. Methods. Human immunodeficiency virus (HIV)-infected adults were observed in a HIV care site in Hanoi, and each patient provided 2 DBS cards with whole blood spots and 2 plasma samples. Viral load was measured in DBS and in plasma using the COBAS Ampliprep/TaqMan and the Abbott RealTime assays. To correctly identify those with VL ≥ 1000 copies/mL, sensitivity and specificity were estimated. Results. A total of 198 patients were enrolled. With the Roche technique, 51 plasma VL were ≥1000 copies/mL; among these, 28 presented a VL in DBS that was also ≥1000 copies/mL (sensitivity, 54.9; 95% confidence interval [CI], 40.3–68.9). On the other hand, all plasma VL < 1000 copies/mL were also <1000 copies/mL in DBS (specificity, 100; 95% CI, 97.5–100). With the Abbott technique, 45 plasma VL were ≥1000 copies/mL; among these, 42 VL in DBS were also ≥1000 copies/mL (sensitivity, 93.3%; 95% CI, 81.7–98.6); specificity was 94.8 (95% CI, 90.0–97.7). Conclusions. The Abbott RealTime polymerase chain reaction assay provided adequate VL results in DBS, thus allowing DBS use for VL monitoring.

Secular trends in HIV knowledge and attitudes among Vietnamese women based on the Multiple Indicator Cluster Surveys, 2000, 2006, and 2011: what do we know and what should we do to protect them?

Abstract: Background : In Vietnam, women are at risk of HIV infection due to many factors. However, there is limited evidence about what women know and how they behave to protect themselves from HIV. Objective : The objective of this study was to investigate the trends in comprehensive HIV/AIDS knowledge, attitude, and associated factors among Vietnamese women from 2000 to 2011. Design : Data from three waves of the Vietnam Multiple Indicator Cluster Surveys (years 2000, 2006, and 2011) were used. Logistic regression methods examined factors associated with each of two dependent variables, HIV/AIDS knowledge and attitude toward HIV/AIDS. Results : Although there was an increasing trend in basic HIV/AIDS knowledge and positive attitude toward the disease, in Vietnamese women in the general population over the survey years, the prevalence of women with basic HIV/AIDS knowledge and positive attitude toward HIV/AIDS was low. Multivariable models indicated that women who had higher levels of education, lived in urban areas, had higher economic status, and knew about places of HIV-related services were more likely to have good HIV/AIDS knowledge (e.g. in 2011, AOR’s=3.01; 1.27; 1.88; 2.03, respectively). Women with higher educational attainment, knew about HIV services, and had better HIV knowledge were more likely to report positive attitude toward HIV/AIDS (e.g. in 2011, AOR’s=2.50; 1.72; 2.23, respectively). Conclusions : This study recommends that public health programs for the control of HIV, such as behavioral change communication campaigns or social policies for women, should focus not only in improving the quality of existing HIV/AIDS counseling and testing services but also on expanding coverage to increase accessibility to these services for women in rural areas. In addition, efforts to raise the level of knowledge about HIV/AIDS and improve attitude toward the disease should be undertaken simultaneously. The results of this study can help inform HIV control policies and practices in other developing countries. Keywords: HIV/AIDS knowledge; HIV/AIDS attitude; MICS; Vietnamese women; Vietnam (Published: 29 February 2016) Citation: Glob Health Action 2016, 9 : 29247 - http://dx.doi.org/10.3402/gha.v9.29247 This paper is part of the Special Issue: Millennium Development Goals in Vietnam: the Progress and Social Determinants . More papers from this issue can be found at www.globalhealthaction.net

Attitude towards working in rural area and self-assessment of competencies in last year medical students: A survey of five countries in Asia.

Abstract: Five countries in Asia including Bangladesh, China, India, Thailand and Vietnam formed a network called Asia-Pacific Network for Health Professional Education Reforms (ANHER). This network collectively conducted a survey at the national level and at the institutional level (for medical, nursing and public health education). We also undertook an assessment of final year graduates from these schools on their attitudes, competencies and willingness to work in rural areas. Pretested anonymous questionnaire comprised of four sections including demographic data, attitudes towards working in rural area, where to work after graduation and perception about competency of respondents was used. Descriptive and analytical statistics were used for data analyses. About 60 % of students from Bangladesh and Thailand had positive attitude towards working in rural area, 50 % in both China and India and only 33 % in Vietnam. Students’ positive attitudes towards their school in terms of preparing or inspiring them to work in rural areas were low across all five countries. Upon graduation and in the next five years, majority of students wanted to work in public sectors. Interestingly confidence about overall competency was quite low. Positive attitude towards working in rural areas varied significantly across five countries in Asia. Medical schools should improve the preparation and inspiration towards working in rural areas for their students. Medical schools should put more effort in improving students’ attitude towards working in rural areas.

Culturally adaptive storytelling method to improve hypertension control in Vietnam - “We talk about our hypertension”: study protocol for a feasibility cluster-randomized controlled trial

Abstract: Vietnam is experiencing an epidemiologic transition with an increased prevalence of non-communicable diseases. At present, the major risk factors for cardiovascular disease (CVD) are either on the rise or at alarming levels in Vietnam; inasmuch, the burden of CVD will continue to increase in this country unless effective prevention and control measures are put in place. A national survey in 2008 found that the prevalence of hypertension (HTN) was approximately 25 % among Vietnamese adults and it increased with advancing age. Therefore, novel, large-scale, and sustainable interventions for public health education to promote engagement in the process of detecting and treating HTN in Vietnam are urgently needed. A feasibility randomized trial will be conducted in Hung Yen province, Vietnam to evaluate the feasibility and acceptability of a novel community-based intervention using the “storytelling” method to enhance the control of HTN in adults residing in four rural communities. The intervention will center on stories about living with HTN, with patients speaking in their own words. The stories will be obtained from particularly eloquent patients, or “video stars,” identified during Story Development Groups. The study will involve two phases: (i) developing a HTN intervention using the storytelling method, which is designed to empower patients to facilitate changes in their lifestyle practices, and (ii) conducting a feasibility cluster-randomized trial to investigate the feasibility, acceptability, and potential efficacy of the intervention compared with usual care in HTN control among rural residents. The trial will be conducted at four communes, and within each commune, 25 individuals 50 years or older with HTN will be enrolled in the trial resulting in a total sample size of 100 patients. This feasibility trial will provide the necessary groundwork for a subsequent large-scale, fully powered, cluster-randomized controlled trial to test the efficacy of our novel community-based intervention. Results from the full-scale trial will provide health policy makers with practical evidence on how to combat a key risk factor for CVD using a feasible, sustainable, and cost-effective intervention that could be used as a national program for controlling HTN in Vietnam and other developing countries. ClinicalTrials.gov. Registration number: https://clinicaltrials.gov/ct2/show/NCT02483780 (registration date June 22, 2015).

Victimisation, poly-victimisation and health-related quality of life among high school students in Vietnam: a cross-sectional survey.

Abstract: In high and upper-middle income countries poly-victimisation (exposure to multiple forms of victimisation) is associated with worse health-related quality of life (HRQoL) among adolescents. There is a lack of empirical evidence about these associations from low- and lower-middle income countries. The aims of this study were to examine the associations between exposure to 1) individual forms of victimisation and 2) poly-victimisation and the HRQoL of adolescents in Vietnam. A cross-sectional, anonymously-completed survey of high school students in Hanoi, Vietnam. Lifetime exposure to eight individual forms of victimisation and poly-victimisation were assessed using the Juvenile Victimisation Questionnaire Revised-2 (JVQ R2). Health-related quality of life was assessed using the Duke Health Profile Adolescent Version (DHP-A). Bi-variate analyses and multiple linear regressions were conducted to assess the associations between individual forms of victimisation, poly-victimisation and HRQoL among girls and boys. In total 1616/1745 students (92.6 %) completed the questionnaire. Adolescent girls had significantly worse HRQoL than boys in all domains, except disability. Different forms of victimisation were associated with different HRQoL domains among girls and boys. Cyber victimisation was the most detrimental to girls’ HRQoL while for boys maltreatment was the most detrimental. Experiences of poly-victimisation were associated with worse HRQoL in physical, mental, social and general health, lower levels of self-esteem and increased levels of anxiety, depression and pain domains among both sexes. Among Vietnamese adolescents, experiences of individual forms of victimisation were associated with poorer HRQoL in specific domains; the most detrimental forms of victimisation varied for girls and boys. However, it was experiences of poly-victimisation that had the most detrimental impacts on the HRQoL of both sexes. Recognition of violence, including poly-victimisation, is still low in Vietnam. These data indicate that community education, prevention and early intervention programs to reduce violent victimisation and assist adolescents who have experienced it, with attention to gender differences, are needed in Vietnam.

Vietnamese mother's conceptions of childhood overweight: findings from a qualitative study.

Abstract: Background : Childhood overweight and obesity is a new and emerging problem in Vietnam. The so far observed prevalence increases have pointed to the need for public health intervention strategies with parents as crucial resources for change. Objective : The aim of this study was to understand mothers’ conceptions of childhood overweight. Design : Four focus group discussions were conducted with a total of 33 mothers of preschool children, 4–6 years old, living in urban and rural districts of Hanoi, Vietnam. The discussions were audio taped and transcribed verbatim. The obtained data were analyzed using the principles of phenomenography. Results : Four main categories with 13 subcategories emerged in the process of analysis. The first category, called ‘Concept of overweight’, contained mothers’ views on childhood overweight. A major concern was the negative aspects of overweight such as impaired social interaction and health problems. The second category, ‘Identification of overweight’, described the ways mothers use to recognize overweight in children: own experience, growth chart, and public or health care system’s information. The third category, ‘Causes of overweight’, showed mothers’ understanding of factors possibly contributing to overweight development: unhealthy food and lifestyle, genetic susceptibility, parent’s lack of knowledge, and limited time to take care of children as well as economic improvement. The fourth category, ‘Management of overweight’, described the ways mothers use to manage a child’s weight problem: control of their food intake, increasing their physical activity, and encouraging their child self-control. However, they find such strategies difficult to implement and their intentions are sometimes challenged by the child’s grandparents. Conclusions : The study gives an understanding of the mothers’ conceptions of four important and practically useful aspects of overweight in children. The findings highlight the roles of media and the health care system in enhancing a social awareness of the problem and the need for prevention. Growth charts need to be used more regularly and consciously in child health care for early detection of children at risk and as a tool for information to parents. When designing intervention programs, the entire extended families, especially grandparents and their roles, need to be considered. Keywords: childhood overweight; mothers’ conceptions; preschool children; qualitative study; Vietnam (Published: 23 March 2016) Citation: Glob Health Action 2016, 9 : 30215 - http://dx.doi.org/10.3402/gha.v9.30215

Prevalence of resistance to second-line tuberculosis drug among multidrug-resistant tuberculosis patients in Viet Nam, 2011.

Abstract: INTRODUCTION: Extensively drug-resistant TB (XDR-TB) represents an emerging public health problem worldwide. According to the World Health Organization, an estimated of 9.7% of patients with MDR-TB globally, are defined as XDR-TB. The objective of this study was to determine the prevalence of drug resistance to second line TB drugs among MDR TB patients detected in the fourth national TB drug resistance survey in Viet Nam. METHODS : Eighty clusters of TB patients were selected using a probability-proportion-to-size approach. Drug susceptibility testing (DST) was performed for the four major first line TB drugs to identify MDR TB patients. DST of second-line drugs (ofloxacin, amikacin, kanamycin, capreomycin) was performed on isolates from MDR- TB cases to identified pre-XDR and XDR patients. RESULTS : A total of 1629 smear-positive TB patients were eligible for culture and DST. Of those, DST results for first line drugs were available for 1312 patients of which 91 (6.9%) had MDR-TB. Second line drug susceptibility testing results were available for 84 of these patients. Of those, 15 patients (17.9%) had ofloxacin resistance and 6.0% were resistant to kanamycin and capreomycin. Five MDR-TB patients met the criteria of extensively drug-resistance (XDR) patients (6.0%). CONCLUSIONS: This survey provides the first estimates of the proportion of XDR-TB among MDR-TB patients in Viet Nam and provides important information for local policy regarding the conduct of second line DST. Local policies and programmes are geared towards prevention and early diagnosis and treatment with effective regimens is very important.

Multiple vulnerabilities and maternal healthcare in Vietnam: findings from the Multiple Indicator Cluster Surveys, 2000, 2006, and 2011

Abstract: BACKGROUND: Knowledge of the aggregate effects of multiple socioeconomic vulnerabilities is important for shedding light on the determinants of growing health inequalities and inequities in materna ...

Cost and impoverishment 1 year after hospitalisation due to injuries: a cohort study in Thái Bình, Vietnam.

Abstract: Background Evidence on the economic impact on individuals and their families following an injury in Vietnam is limited. This study examines the costs and the risk of impoverishment due to hospitalised injuries at 12 months following hospital discharge and associated factors. Method Employing a prospective cohort design, 892 people hospitalised for injury were recruited from Thai Binh General Hospital in Vietnam in 2010 and followed up for 12 months. All out-of-pocket costs incurred and income lost by injured persons and their caregivers associated with care and treatment of their injuries were reported. To examine associated factors, we used generalised estimating equation models for costs and modified Poisson regression for the risk of impoverishment. Results The mean total costs by 12 months postdischarge were US$804, nearly 1.2 times the annual average income. Injuries that incurred highest costs were falls (US$950) and road traffic injuries (RTIs) (US$794). At 12-month follow-up, 181 persons (26.9%) became impoverished, with those injured in RTIs and falls at highest risk (26.1% and 35.4%, respectively). Factors associated with higher costs were also those associated with higher risk of impoverishment. These include those injured in RTIs or falls; having higher severity level; principal injured region as upper extremities, lower extremities or head; physical nature of injuries as fracture or concussion injuries; and longer hospitalisation. Conclusions Injuries impose significant economic burden on injured persons and their families during and beyond hospitalisation. In addition to prevention, there is a need to reform health financing system to protect injured persons from significant out-of-pocket expense for healthcare services.

Validation of a Brief CES-D Scale for Measuring Depression and Its Associated Predictors among Adolescents in Chi Linh, Hai Duong, Vietnam

Abstract: Objectives: The aims of this paper were to confirm the validity and reliability of a brief CES-D measure for depression and identify the associated factors with the depression among adolescents and youth in Chi Linh, Hai Duong province, Vietnam. Methods: We used data from a prospective-longitudinal study of adolescents and youth (aged 13-17 at baseline) and their parent (N = 1402 mother/father-child dyads). Adolescents’ depression was assessed in 2009 and 2013. Parents’ connectedness was measured in 2013. Confirmatory factor Analysis (CFA) was used to certify the elementary factors produced by PCA using Comparative Fit Index (CFI), Tucker Lewis Index (TLI) and RMSEA. Multivariate linear regression was used to predict the factors associated with depression. Results: The results demonstrate that the depression items correspond as CFI (0.89), TLI (0.87) and RMSEA (0.084) are acceptable fit indices. The mean score of depression among adolescents and youth was 30.9 (Min = 16 and Max = 70; SD = 8.3). Age (β = -0.01; CI 95% = -0.1; -0.03), parent and youth can talk freely (β = -0.042; CI 95% = -0.08; -0.001) and good health status (β = -0.07; CI 95% = -0.1; -0.03) were found to be significantly associated with depression. Conclusions: Depression scale should be widely applied for screening the depression symptoms of adolescents and youth population. The necessary strategies should be implemented to improve the adolescent and young population’s depression status.