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Background: Nearly one-in-two Vietnamese men smoke cigarettes placing them among the highest tobacco consumers in the world. Despite the need for smoking cessation to curb the burden of tobacco-related diseases in Vietnam, this rate remains at less than 30%. Therefore, this study examines individual-, social- and policy factors associated with smoking cessation among adult male smokers in Vietnam. Methods: We established a longitudinal International Tobacco Control study of male smokers in Hanoi, Vietnam, in September 2018. This paper analyses 1525 men who participated in baseline and one-year follow-up. We applied a weighted multivariable logistic regression to examine the association between smoking cessation and individual-, social- and policy predictors. Results: At follow-up, 14.8% of participants had quit smoking for at least 30 consecutive days during the last year. Among the persistent smokers, 56.6% expressed intention to quit smoking. Factors associated with smoking cessation included a lower number of cigarettes smoked per day (aOR = 0.96, 95% CI: 0.94, 0.99) and having several attempts to quit smoking (aOR = 2.16, 95% CI 1.13, 4.12). Intention to quit smoking was associated with multiple quit attempts, a chronic condition diagnosis, more tobacco-related knowledge, greater self-efficacy, and more worries about their future health. The perceived impact of smoke-free policy and health warning labels were positively associated with intention to quit at any stage. Conclusions: Interventions aimed at increasing smoking cessation should focus on all aspects of individual, social, and policy factors. Persistent smokers are more motivated to quit if they have made multiple quit attempts, more self-efficacy of quitting and worried about their future health, indicating that increasing smokers’ beliefs and knowledge may be important for behavioural change. Health warning labels and tobacco taxation policies should be maintained and promoted as they are perceived to be particularly useful for persistent smokers’ intention to quit. [ABSTRACT FROM AUTHOR]

Aim: To estimate the prevalence of non-communicable disease risk factors and investigate the pathways from behavioral risk factors to metabolic risk factors among population aged 30–69 years old. Subject and methods: Data of this study were from the Vietnam STEPS 2015 survey that used the standardized World Health Organization STEPwise approach across all 63 provinces/cities of Vietnam. A total of 2579 participants aged 30–69 years who completed all three rounds of the STEPS survey were analyzed. Structural equation modeling was applied to develop path models from behavioral risk factors to metabolic risk factors. The metabolic risk factors included waist circumference, body mass index, blood pressure, total cholesterol, and blood glucose. Results: The prevalence of participants having two or more behavioral risk factors was 58.6% among males and 8.7% among females, while the figure for metabolic factors was 7.7% and 7.9% respectively. For females, the protective effect of physical activity was demonstrated for waist circumference, body mass index, total cholesterol, and blood glucose, whereas alcohol consumption did not have any impact on metabolic risk factors. In contrast, alcohol consumption showed a dose–response association with systolic blood pressure among males. Smoking status was associated with a smaller waist for both males and females, and lower body mass index for males. Conclusion: The pathways from behavioral risk factors to metabolic risk factors were different between females and males. Findings from this study should be used to develop the policy and prevention strategies appropriately for males and females to improve the helath of the population. [ABSTRACT FROM AUTHOR]

School violence and injury are major public health problems worldwide. The data of this study were from the Viet Nam Global School-based Student Health Survey (GSHS) - a nationally representative survey conducted in 2019, with a sample size of 7690 students aged 13-17 years old. We found the prevalence of violence and non-fatal injury to be 14.5% and 21.4%, respectively. Factors related to higher odds of violence and non-fatal injuries in both sexes included smoking cigarettes, drinking alcohol, having mental health problems (loneliness, worrying and suicidal thinking), and truancy. In contrast, parental monitoring was associated with lower odds of violence, and parental respect was a protective factor of both violence and non-fatal injuries. Students who experienced violence had a higher likelihood of having non-fatal injuries in both sexes. Future policies should consider individual factors and parent-child bonding, to mitigate the burden of violence and injury among in-school adolescents in Viet Nam. [ABSTRACT FROM AUTHOR]

This study was conducted to report the prevalence of financial hardship and identify associated factors among ethnic minority populations in Vietnam. In 2019, we conducted a cross-sectional study of 5,033 ethnic minority participants from 12 provinces located in four socioeconomic regions in Vietnam. Financial hardship was measured by asking the study respondents if they had to borrow money, sell household assets, or stop using health care services due to health care service fees. Among the health service users, 24.0% (95% CI: 22.3–25.8%) faced a health-related financial hardship. Participants with secondary education were more likely to experience financial hardship than illiterate participants. In contrast, those who were able to speak the Vietnamese language, had a religious affiliation, or had health insurance were likely to have lower financial hardship. Continuing to expand health insurance coverage and develop essential packages covered by health insurance is vital to reducing financial hardship. [ABSTRACT FROM AUTHOR]

Background: Perception of harm plays an important role in predicting intention to quit-an integral part of the cessation process. Perception on harm from bamboo waterpipe tobacco was unknown, even the predominant of this type of tobacco use. This study investigated the effects of perceived harm from cigarette and bamboo waterpipe tobacco on intention to quit among adult male Vietnamese tobacco users.Methods: From the nationally-representative 2015 Global Adult Tobacco Survey, we included 1,351 adult males (≥ 18 years old) who used cigarettes, bamboo waterpipes, or both. Demographic characteristics, tobacco use behaviors, perceived harm from tobacco use, and regulation/policy exposure were measured. Effects of perceived harm from cigarette and bamboo waterpipe tobacco on intention to quit were assessed by logistic regression.Results: Intention to quit prevalence was 59.0%, 55.0%, and 58.4% for cigarette, waterpipe, and dual users, respectively. Tobacco users who perceived that "using cigarettes and/or waterpipe could cause severe illness" and "waterpipe use is less harmful than cigarette smoking", had tobacco use bans at home, or were exposed to anti-smoking campaigns or encouragement to quit information were more likely to intend to quit. When analyzed by tobacco users, intention to quit was more likely for those users who perceived their tobacco product as more harmful than the other product type, although statistical significance was only observed for cigarette users.Conclusions: Misperceptions regarding harm from tobacco use could negatively affect intention to quit. Dissemination of accurate information on the risks from all forms of tobacco use and enforcement of tobacco control policies are important for encouraging intention to quit. [ABSTRACT FROM AUTHOR]

Background: Early detection of autism spectrum disorders (ASDs) is essential given the under-reported cases in low- and middle-income countries. This first national representative survey was conducted to explore the prevalence of ASDs amongst 18 and 30 months in seven provinces in Vietnam. Design and methods: During 2017-2018, a national cross-sectional and population-based survey for autism spectrum disorder (ASD) amongst 40,243 children aged 18 to 30 months was conducted in 7 provinces representing the socio-economic regions of Vietnam. M-CHAT was used to screen children and then confirmed by diagnostic assessment using DSM-IV criteria. Results: The prevalence of ASDs amongst children aged 18 and 30 months in Vietnam was high (0.758% or 1 in 132 children). Urban setting, male gender, and hereditable genes were associated with ASD prevalence. Conclusions: ASDs amongst children aged 18 and 30 months in Vietnam tend to be increasing and are similar to this rate in other middle-income countries but lower than that in Western countries. This under-recognized public health problem amongst children should be addressed by early detection and intervention for families with affected children. [ABSTRACT FROM AUTHOR]

BACKGROUND: Smoking leads to many smoking-attributable diseases. The promotion of quitting tobacco smoking is urgent as it has significant and immediate health benefits and improves the impacts of other tobacco control strategies. Intention to quit smoking is considered the first step before quitting smoking. METHODOLOGY: This paper used data from Vietnam provincial GATS 2020 on 80,166 participants who were 15-year-old or older. Data were collected from 34 provinces and cities throughout Vietnam and managed using REDCap. RESULTS: Among those who were current smokers, 50.3% (95% CI: 49.1%-51.4%) had the intention to quit smoking. Some predictive factors found to be positively associated with the intention to quit smoking were age (from 45-64), education level, received information about harmful effects or encouragement to quit smoking from media channels (from 6 channels), hearing about the Tobacco Control Law and noticing health warnings on the cigarette package. There was no significant difference in intention to quit smoking between current smokers from urban and rural areas or among different age groups to start smoking. CONCLUSIONS: Interventions or health promotion programs on smoking cessation should be focused on current smokers who have low education levels as they have a higher smoking rate and are less motivated to stop smoking. Received information about harmful effects or encouragement to quit smoking from media channels is also associated with stopping smoking in the future. The importance of health warning pictures on tobacco packages should be maintained and promoted as it has a specific effect on one's intention to stop smoking. [ABSTRACT FROM AUTHOR]

The network of primary healthcare facilities in Vietnam is countrywide but its capacity is still inadequate. Data from Vietnam Health Facility survey (2015) was used to assess the availability and readiness of three services: maternal and childcare, NCDs, and preventive services by measuring availability of inputs, including basic amenities, equipment, and essential drugs. Among 246 selected CHSs, were the availability rate of medical doctors were 85.4%. The maternal and childcare and some preventive services were highly available while services for NCDs were unpopular. 48% of CHSs had care management and observation for diabetes patients, and 43.1% can provide community-based screening. Drugs were not available in selected CHSs, especially those for NCDs, and mental health. No difference of service readiness was found between rural and urban CHSs. Specific attention should go to communal capacities to respond to new health challenges as NCDs or mental health and remained low availability of drugs. [ABSTRACT FROM AUTHOR]

Most countries have implemented restrictions on mobility to prevent the spread of Coronavirus disease-19 (COVID-19), entailing considerable societal costs but, at least initially, based on limited evidence of effectiveness. We asked whether mobility restrictions were associated with changes in the occurrence of COVID-19 in 34 OECD countries plus Singapore and Taiwan. Our data sources were the Google Global Mobility Data Source, which reports different types of mobility, and COVID-19 cases retrieved from the dataset curated by Our World in Data. Beginning at each country's 100th case, and incorporating a 14-day lag to account for the delay between exposure and illness, we examined the association between changes in mobility (with January 3 to February 6, 2020 as baseline) and the ratio of the number of newly confirmed cases on a given day to the total number of cases over the past 14 days from the index day (the potentially infective 'pool' in that population), per million population, using LOESS regression and logit regression. In two-thirds of examined countries, reductions of up to 40% in commuting mobility (to workplaces, transit stations, retailers, and recreation) were associated with decreased cases, especially early in the pandemic. Once both mobility and incidence had been brought down, further restrictions provided little additional benefit. These findings point to the importance of acting early and decisively in a pandemic. [ABSTRACT FROM AUTHOR]

This study aimed to describe mental health service utilization and examine associated factors among students in Vietnam. Data were collected at eight universities in Hanoi, Vietnam, in 2018 using an administered questionnaire. The total number of participants was 9,120 (95.1% response rate). Among students participating in our survey, 12.5% (95% CI: 10.9–14.1) with depression and/or anxiety symptoms used mental health service in the last 12 months. In the multivariable regression models, significant factors associated with mental health service utilization were marital status, types of housemate, mental health problems, physical activity, smoking status, and alcohol drinking. Our study made recommendations to stakeholders for improving mental health services utilization among students in Vietnam. These findings had important implications for future research on factors associated with mental health service utilization among university students. [ABSTRACT FROM AUTHOR]

Research on coping strategies and social support among Vietnamese cancer caregivers remains limited. In this study, we aim to examine the relationships between types of coping strategies utilized and social support among cancer caregivers. This was a cross-sectional study conducted in three main cancer hospitals in the Northern, Central and Southern regions of Vietnam. The 28-item Brief COPE Inventory (BCI) Scale and the Multidimensional Scale of Perceived Social Support (MSPSS) were utilized. Descriptive statistics and multivariate linear regression were performed. Active coping, acceptance and positive reframing were the most used coping strategies among participants, while substance use was the least commonly used. Level of social support was positively correlated with the utilization of coping mechanisms. Receiving high social support and utilizing positive coping strategies enables caregivers to mitigate their caregiving burden, control the situation and enhance their own quality of life. [ABSTRACT FROM AUTHOR]

This study investigates the prevalence of tobacco and alcohol uses and associated factors among 12 ethnic minorities in Vietnam in 2019. A cross-sectional survey was conducted among 5172 people aged ≥15 years. The prevalence of smoking and drinking was 19.7% and 29.9%, respectively, and significantly higher among men than women. These numbers were heterogeneous across ethnic minorities. Smoking prevalence was high among Ba Na (25.9%), Cham An Giang (22.3%), Khmer (23.5%), La Hu (26.3%), Ta Oi (30.7%), and Bru Van Kieu (29.6%) ethnicities whereas that of Gie Trieng and Mnong ethnicities was low (3.7% and 9.5%, respectively). Drinking prevalence ranged from 1.4% in Cham An Giang ethnicity to 68.6% in Ba Na ethnicity. A wide ethnic disparity on tobacco and alcohol use could be explained by the ethnic variation of lifestyles, social norms, and cultural features. Our findings suggest the need to develop ethnic-specific interventions to mitigate the smoking and drinking prevalence. [ABSTRACT FROM AUTHOR]

Background: This study aims to explore associations of individual- and provincial-level socioeconomic status (SES) and the combined interaction among these SES with individual physical activity (PA).Method: This analyze used data of 3068 Vietnamese people aged 18-65 years from the national representative STEPS survey in 2015 (STEPS2015). The survey collected PA-related data using the Global PA Questionnaire Version 2 and those on provicial-level characteristics from two surveys in 2014, namely the Intercensal Population and Housing Survey (IPHS) and The Vietnam Household Living Standard Survey (VLSS2014). Multilevel linear analyze was performed with individual and provincial characteristics as independent variables and the metabolic equivalent (MET) score - the indicator of individual PA - as the dependent variable.Results: Male and female participants with insufficient PA accounted for 20.2 and 35.7%, respectively. Both individual- and provicial-level SES were inversely associated with the individual PA level. As the provincial-level monthly income increased by 1 million Vietnam Dongs, the total PA score of individuals residing in that province reduced by 1900 METS. A buffering effect was reported between provincial and individual SES, as the provincial average income increased, the differences in PA scores between different SES groups decreased.Conclusion: Our data suggest that Vietnamese individuals in low SES groups tended to be more physically active than those in high SES groups because their PA was largely related to work. [ABSTRACT FROM AUTHOR]

Objectives To understand, describe and analyse the experiences of women with breast cancer in Vietnam when accessing and using breast cancer services. Design Descriptive qualitative study. Women were interviewed about their experiences from the first time they became aware of symptoms or changes to their body through treatment and post-treatment. This study is the first descriptive study on breast cancer in Vietnam from the perspective of women with a breast cancer diagnosis. Participants Women (n=13) who had completed or were still receiving treatment for breast cancer, purposively recruited from the north and south of Vietnam. Results An analysis of the experiences of women with breast cancer in Vietnam revealed a lack of awareness and knowledge about breast cancer and symptoms. Family and social support were described as key factors influencing whether a woman accesses and uses breast cancer services. Cost of treatment and out-of- pocket expenditures limited access to services and resulted in significant financial challenges for women and their families. Conclusions Vietnam has made huge strides in improving cancer care, and is tackling a complex and expanding public health challenge, however, there are a number of areas requiring strengthening and future research. While Vietnam has successfully expanded social health insurance coverage, changes that increase the percentage of costs covered for specific treatments, such as chemotherapy or radiotherapy, could benefit women and their families. [ABSTRACT FROM AUTHOR]

Background: Vietnam has been successful in increasing access to maternal, neonatal, and child health (MNCH) services during last decades; however, little is known about whether the primary MNCH service utilization has been properly utilized under the recent rapid urbanization. We aimed to examine current MNCH service utilization patterns at a district level.Methods: The study was conducted qualitatively in a rural district named Quốc Oai. Women who gave a birth within a year and medical staff at various levels participated through 43 individual in-depth interviews and 3 focus group interviews.Results: Primary MNCH services were underutilized due to a failure to meet increased quality needs. Most of the mothers preferred private clinics for antenatal care and the district hospital for delivery due to the better service quality of these facilities compared to that of the commune health stations (CHSs). Mothers had few sociocultural barriers to acquiring service information or utilizing services based on their improved standard of living. A financial burden for some services, including caesarian section, still existed for uninsured mothers, while their insured counterparts had relatively few difficulties.Conclusions: For the improved macro-efficiency of MNCH systems, the government needs to rearrange human resources and/or merge some CHSs to achieve economies of scale and align with service volume distribution across the different levels. [ABSTRACT FROM AUTHOR]

Given the rapid spread of the COVID-19 pandemic and the huge negative impacts it is causing, researching on COVID-19-related issues is very important for designing proactive and comprehensive public health interventions to fight against the pandemic. We describe the characteristics of COVID-19 patients detected in the two phases of the epidemic in Vietnam. Data used in this paper were mainly obtained from the official database of the Ministry of Health of Vietnam. Descriptive statistics were carried out using Stata 16 software. As of 18 May 2020, the cumulative number of COVID-19 cases detected in Vietnam was 324, 16 cases from 4 cities and provinces in the first phase (during 20 days, 0.8 cases detected per day) and 308 cases from 35 cities, provinces in the second phase (during 76 days, 4.1 cases detected per day). Vietnam has mobilized its entire political system to fight the COVID-19 and achieved some initial successes. We found both similarities and differences between the two phases of the COVID-19 epidemic in Vietnam. We demonstrated that the situation of the COVID-19 epidemic in Vietnam is getting more complicated and unpredictable. [ABSTRACT FROM AUTHOR]

Given the rapid spread of the COVID-19 pandemic and the huge negative impacts it is causing, researching on COVID-19-related issues is very important for designing proactive and comprehensive public health interventions to fight against the pandemic. We describe the characteristics of COVID-19 patients detected in the two phases of the epidemic in Vietnam. Data used in this paper were mainly obtained from the official database of the Ministry of Health of Vietnam. Descriptive statistics were carried out using Stata 16 software. As of 18 May 2020, the cumulative number of COVID-19 cases detected in Vietnam was 324, 16 cases from 4 cities and provinces in the first phase (during 20 days, 0.8 cases detected per day) and 308 cases from 35 cities, provinces in the second phase (during 76 days, 4.1 cases detected per day). Vietnam has mobilized its entire political system to fight the COVID-19 and achieved some initial successes. We found both similarities and differences between the two phases of the COVID-19 epidemic in Vietnam. We demonstrated that the situation of the COVID-19 epidemic in Vietnam is getting more complicated and unpredictable. [ABSTRACT FROM AUTHOR]

This study aims to describe the prevalence of raised blood pressure and the situation of management for raised blood pressure among the adult population in Vietnam. It also aims to examine the association between diversified socioeconomic and behavioral factors of raised blood pressure and awareness of raised blood pressure. Data were obtained from the STEPS survey conducted in Vietnam in 2015. Survey sample was nationally representative with a total of 3,856 people aged 18–69 years old. The study outcomes included raised blood pressure and awareness of and control of raised blood pressure. Multiple logistic regression was used to examine the association of socioeconomic and behavior risk factors with the outcome variables. The overall prevalence of raised blood pressure in Vietnam in 2015 was 18.9% (95% CI: 17.4%–20.6%). The prevalence of raised blood pressure was higher among men. Significantly correlated factors with raised blood pressure were age, sex, body mass index, and diabetes status. Levels of awareness of raised blood pressure were higher among the older age group and overweight people and lower among ethnic minority groups. Raised blood pressure in Vietnam is a serious problem due to its magnitude and the unacceptably high unawareness rate in the population. Public health actions dealing with the problems of raised blood pressure are urgent, while taking into account its relationship with sex and socioeconomic status. It is clear that the interventions should address all people in society, with a focus on disadvantaged groups which are the rural and ethnic minority peoples. [ABSTRACT FROM AUTHOR]

City governments are well-positioned to effectively address urban health challenges in the context of rapid urbanization in Asia. They require good quality and timely evidence to inform their planning decisions. In this article, we report our analyses of degree of data-informed urban health planning from three Asian cities: Dhaka, Hanoi and Pokhara. Our theoretical framework stems from conceptualizations of evidence-informed policymaking, health planning and policy analysis, and includes: (1) key actors, (2) approaches to developing and implementing urban health plans, (3) characteristics of the data itself. We collected qualitative data between August 2017 and October 2018 using: in-depth interviews with key actors, document review and observations of planning events. Framework approach guided the data analysis. Health is one of competing priorities with multiple plans being produced within each city, using combinations of top-down, bottom-up and fragmented planning approaches. Mostly data from government information systems are used, which were perceived as good quality though often omits the urban poor and migrants. Key common influences on data use include constrained resources and limitations of current planning approaches, alongside data duplication and limited co-ordination within Dhaka's pluralistic system, limited opportunities for data use in Hanoi and inadequate and incomplete data in Pokhara. City governments have the potential to act as a hub for multi-sectoral planning. Our results highlight the tensions this brings, with health receiving less attention than other sector priorities. A key emerging issue is that data on the most marginalized urban poor and migrants are largely unavailable. Feasible improvements to evidence-informed urban health planning include increasing availability and quality of data particularly on the urban poor, aligning different planning processes, introducing clearer mechanisms for data use, working within the current systemic opportunities and enhancing participation of local communities in urban health planning. [ABSTRACT FROM AUTHOR]

Introduction: The objectives of this study are to estimate the prevalence of multimorbidity (MM) among adults in the Central Highland Region (a poor region) of Vietnam in 2017 and to identify the sociodemographic correlates of these conditions. Methods: We used data from a cross-sectional study conducted in 2018 on health status among people in four provinces in the Central Highlands Region (Tay Nguyen) of Vietnam. A sample of 1680 adults (aged 15 years and older) were randomly selected for this study. Respondents were asked whether they had been told by a health worker that they had cancer, heart and circulatory conditions, chronic joint problems, chronic pulmonary diseases, chronic kidney problems, chronic digestive problems, psychological illness, diabetes, and/or other chronic conditions. Results: The prevalence of MM among the study participants was 16.4% (95% confidence interval (CI): 14.6%-18.2%). By looking at the 95% CIs, the differences in MM prevalence between the groups classified by gender, age, education, and occupation were not statistically significant. Only the difference in MM prevalence between farmers and government staff was statistically significant. Multivariate logistic analyses show education and occupations were shown to be significant correlates of MM. Conclusion: MMs were quite common among the adult populations in the study area, especially among people with lower socioeconomic status. Given the evidence, actions to reduce levels of MM in the setting are clearly urgent. The interventions should address all people in society, with focus on disadvantaged groups, like those with lower education and farmers. [ABSTRACT FROM AUTHOR]

Background: Overcrowding of high-level health facilities is a major concern in a Vietnamese health system. This may increase an economic burden to the households since health insurance is still insufficient in providing financial risk protection. This paper sought to examine the association between the use of high-level health facilities and household-level expenditure status such as out-of-pocket (OOP), and catastrophic expenditure on health, as well as a moderating effect of health insurances in rural and urban districts of Vietnam.Methods: Data utilized a health system community survey collected between 2015 and 2017 in two districts of Vietnam (one from rural area in northern part, and the other one from urban area in sourthern part). The world Health Organization's definition of catastrophic expenditure was used. Multivariate tobit and logistic regression were employed for catastrophic expenditure and OOP respectively. Interaction term between health insurance status and visit frequency in high-level facilities was included to investigate the moderating effect of health insurance.Results: Health insurance status was associated with neither OOP health expenditure nor catastrophic expenditure occurrence, whereas visit frequency of high-level health facilities was strongly associated with both outcomes in both districts(e.g., for catastrophic expenditure, ORs are 1.77 and 1.30 in northern and southern district respecitvely. P values are < 0.001). Significant interaction between health insurance status and use of high-level facilities on catastrophic expenditure occurrence was found in Quoc Oai district (OR = 0.68, p < 0.05).Conclusions: The present study demonstrated negative financial impact of utilizing high-level facility on household financial status and weak role of health insurance in decreasing this impact. Multi-faceted approach is called for to mitigate the patient's financial burden. [ABSTRACT FROM AUTHOR]

Background. Providing messages on risk factors for noncommunicable diseases (NCDs) plays an important role in preventing disease. Objectives. This study investigated how often adults living in a rural area in northern Vietnam heard about risks factor for NCD and where they obtained that information. Methods. A cross-sectional survey was conducted using a multistage stratified cluster sampling to recruit 2970 participants. Data analyses were adjusted for all variables in a two-level multilevel Poisson regression model. Results. Overall, 77% of respondents had heard about NCDs, while 38.3 to 50% had been exposed to messages on risk factors of NCDs in the last month. Television, radio, and friends/neighbors were the most common sources of information. Most people exposed information no more than one or two sources. Factors associated with exposure to messages about risk were occupation, age group, education, and economic status. Conclusion. Intervention programs should focus on providing information primarily through television, considering influencing factors as well ensuring that messages reach target audiences. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to validate measures of professional self-efficacy for detecting and responding to child abuse and neglect presentations, and then evaluate a clinical training programme for health professionals in a tertiary-level hospital in Vietnam.Design/methodology/approach A prospective, cohort design was used and professional self-efficacy was measured immediately prior to, and shortly after, training 116 nurses and doctors in emergency settings. Longer-term follow-up was measured six months later.Findings Linear mixed modelling showed that there was a statistically significant improvement in efficacy expectations for both suspected and known cases of child abuse and neglect between the pre- and post-test measures at zero and six weeks. These improvements did not persist to the six-month follow-up.Research limitations/implications The training succeeded in improving detection and clinical response to child abuse and neglect presentations but not faith in the provision of ongoing support for children and families.Practical implications Practice change in emergency settings in Vietnam can be achieved using a sustainable theoretically driven training programme.Social implications Building the capacity of health professionals to respond to cases of child abuse and neglect relies on the strength of the community and support services within which the hospital is located.Originality/value Measures of self-efficacy expectations and outcome expectations for responding to child abuse and neglect presentations in emergency settings in Vietnam are now validated. [ABSTRACT FROM AUTHOR]

Recurrent pregnancy loss (RPL) is a physical and mental burden for women. In Vietnam, exploring the cause of miscarriages is still a challenge to clinical physicians. We aimed to investigate the etiology of RPL in the National Hospital of Obstetrics and Gynecology in Vietnam from 2012 to 2014. The cross-sectional study included 301 pregnant women with a history of RPL. The patients were examined and offered medical testing to determine the cause(s). Based on the testing, we determined causation for (11.29%) patients who had positive scores on an antiphospholipid antibody test and who were subsequently successfully treated for their problem. [ABSTRACT FROM AUTHOR]

Purpose. This paper aims to analyze the household financial burden and poverty impacts of cancer treatment in Vietnam. Methods. Under the “ASEAN CosTs in ONcology” study design, three major specialized cancer hospitals were employed to assemble the Vietnamese data. Factors of socioeconomic, direct, and indirect costs of healthcare were collected prospectively through both individual interviews and hospital financial records. Results. The rates of catastrophic expenditure based on the cut-off points of 20%, 30%, 40%, and 50% of household’s income were 82.6%, 73.7%, 64.7%, and 56.9%, respectively. 37.4% of the households with patient were impoverished by the treatment costs for cancer. The statistically significant correlates of the impoverishment problem were higher among older patients (40–60 years: 1.77, 95% CI 1.14–2.73; above 60 years: 1.75, 95% CI 1.03–2.98); poorer patients (less than 100% national income: 29, 95% CI 18.6–45.24; less than 200% national income: 2.89, 95% CI 1.69–4.93); patients who underwent surgery alone (receiving nonsurgery treatment: 2.46, 95% CI 1.32–4.59; receiving multiple treatments: 2.4, 95% CI 1.38–4.17). Conclusions. Lots of households were pushed into poverty due to their expenditure on cancer care; more actions are urgently needed to improve financial protection to the vulnerable groups. [ABSTRACT FROM AUTHOR]

Background: Despite male smokers being dominant in Vietnam, scarce evidence on trends in socioeconomics inequalities among the hardcore male smokers is available in the country. In this study, we aimed at assessing the trends in socioeconomics inequalities among the hardcore smokers in adult male population in Vietnam over a five-year period from 2010 to 2015. Methods: We used data from two rounds of the Vietnam Global Adult Tobacco Survey (GATS) conducted in 2010 and 2015. We included only men aged 25 years and above in the analysis. We measured socioeconomic inequalities among hardcore smokers by calculating the concentration index. We conducted multiple logistic regression analysis to identify factors associated with hardcore smoking among men aged 25 years and above. Results: The results of this study showed that the prevalence of male hardcore smokers aged 25 years and above in Vietnam was 9.5% in 2010 which increased to 13.1% in 2015. The prevalence of male hardcore smokers declined in the richest group from the 2010 level whereas it increased in the middle, poor and poorest groups. All values of weighted concentration indices indicated that the prevalence of male hardcore smokers occurred more among the poor men in Vietnam in both 2010 and 2015. The socioeconomic inequalities in hardcore smokers increased during 2010 and 2015. Residence in urban areas was significantly associated with higher adult male hardcore smoking in our study. Belonging to the age groups between 40 and 59 years, attaining primary and lower education, being self-employed, belonging to the poorest household group, smoking being allowed at home and no rule for smoking at home were associated with higher risk of being hardcore smoker among adult males in Vietnam. Conclusions: We found increased trends in socioeconomic inequalities in hardcore smoking among the study population. Our study results indicate that existing smoking secession and tobacco control policy and interventions need to be modified or new policies and interventions should be introduced with the perspective of addressing socioeconomic inequalities to have the desired impact. We recommend implementing specific targeted interventions for vulnerable population groups for better results. [ABSTRACT FROM AUTHOR]

Background: Cervical cancer is currently the leading cause of cancer mortality among women in South Vietnam and the second leading cause of cancer mortality in North Vietnam. Human papillomavirus (HPV) vaccination has the potential to substantially decrease this burden. The World Health Organization (WHO) recommends that a cost-effectiveness analysis of HPV vaccination is conducted before nationwide introduction.Methods: The Papillomavirus Rapid Interface for Modeling and Economics (PRIME) model was used to evaluate the cost-effectiveness of HPV vaccine introduction. A costing study based on expert panel discussions, interviews and hospital case note reviews was conducted to explore the cost of cervical cancer care.Results: The cost of cervical cancer treatment ranged from US$368 - 11400 depending on the type of hospital and treatment involved. Under Gavi-negotiated prices of US$4.55, HPV vaccination is likely to be very cost-effective with an incremental cost per disability-adjusted life year (DALY) averted in the range US$780 - 1120. However, under list prices for Cervarix and Gardasil in Vietnam, the incremental cost per DALY averted for HPV vaccination can exceed US$8000.Conclusion: HPV vaccine introduction appears to be economically attractive only if Vietnam is able to procure the vaccine at Gavi prices. This highlights the importance of initiating a nationwide vaccination programme while such prices are still available. [ABSTRACT FROM AUTHOR]

Background: 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. Methods: 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. Results: 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. Conclusion: 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. [ABSTRACT FROM AUTHOR]

Objective: This study aims to characterize household trends in access to improved water sources and sanitaton in Chi Linh Town, Hai Duong Province, Vietnam, and to identify factors affecting those trends. Method: Data were extracted from the Chi Linh Health and Demographic Surveillance System (CHILILAB HDSS) database from 2004-2014, which included household access to improved water sources, household access to improved sanitation, and household demographic data. Descriptive statistical analysis and multinominal logistic regression were used. The results showed that over a 10-year period (2004-2014), the proportion of households with access to improved water and improved sanitation increased by 3.7% and 28.3%, respectively. As such, the 2015 Millennium Development Goal targets for safe drinking water and basic sanitation were met. However, 13.5% of households still had unimproved water and sanitation. People who are retired, work in trade or services, or other occupations were 1.49, 1.97, and 1.34 times more likely to have access to improved water and sanitation facilities than farming households, respectively (p < 0.001). Households living in urban areas were 1.84 times more likely than those living in rural areas to have access to improved water sources and improved sanitation facilities (OR =1.84; 95% CI = 1.73-1.96). Non-poor households were 2.12 times more likely to have access to improved water sources and improved sanitation facilities compared to the poor group (OR = 2.12; 95% CI = 2.00-2.25). More efforts are required to increase household access to both improved water and sanitation in Chi Linh Town, focusing on the 13.5% of households currently without access. Similar to situations observed elsewhere in Vietnam and other low- and middle- income countries, there is a need to address socio-economic factors that are associated with inadequate access to improved water sources and sanitation facilities. [ABSTRACT FROM AUTHOR]

Introduction: Achieving a fair and equitable distribution of health in the population while progressing toward universal health coverage (UHC) is a key focus of health policy in Vietnam. This paper describes health barriers experienced by women (and children by inference) in Vietnam, and measures how UHC, with reference to maternal health services and child mortality rates, is affected by selected social determinants of health (SDH), termed 'barriers'. Methods: Our study uses a cross-sectional design with data from the 2011 Vietnam Multiple Indicator Cluster Survey. The study sample includes 11,663 women, aged 15-49 years. Weighted frequency statistics are cross-tabulated with socioeconomic characteristics of the population to describe the extent and distribution of health barriers experienced by disadvantaged women and children in Vietnam. A subset of women who had a live birth in the preceding two years (n_1,383) was studied to assess the impact of barriers to UHC and health. Six multiple logistic regressions were run using three dependent variables in the previous two years: 1) antenatal care, 2) skilled birth attendants, and 3) child death in the previous 15 years. Independent predictor variables were: 1) low education (incomplete secondary education), 2) lack of access to one of four basic amenities. In a second set of regressions, a constructed composite barrier index replaced these variables. Odds ratios (ORs) and 95% confidence intervals (95% CI) were used to report regression results. Results: In Vietnam, about 54% of women aged 15-49 years in 2011, had low education or lacked access to one of four basic amenities. About 38% of poor rural women from ethnic minorities experienced both barriers, compared with less than 1% of rich urban women from the ethnic majority. Incomplete secondary education or lack of one of four basic amenities was a factor significantly associated with lower access to skilled birth attendants (OR_0.28, 95% CI: 0.14-0.55; OR-0.19, 95% CI: 0.05-0.80) and a higher risk of having had a child death in the previous two years (OR-1.71, 95% CI: 1.28_2.30; OR-1.59, 95% CI: 1.20-2.10). Conclusions: Our study shows the need for accelerating education and infrastructure investments for ethnic minority communities living in rural areas so as to be able to contribute to equity-oriented progress toward UHC. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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 socioeconomic 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. [ABSTRACT FROM AUTHOR]

Background: Since the beginning of 2014, there have been nearly 6,000 confirmed measles cases in northern Vietnam. Of these, more than 86% had neither been immunized nor was their vaccination status confirmed. Objective: To establish the likelihood that children under five in Vietnam had 'timely immunization completion' (2000-2011) and identify factors that account for variations in timely immunization completion. Design: Secondary data from the Multiple Indicator Cluster Survey (MICS), which sampled women aged 15-49 from the 1999 Vietnamese Population and Housing Census frame, were analyzed. Multilevel analysis using Poisson regression was undertaken. Results: Proportions of children under five who had timely immunization completion were low, especially for HBV dose 2 and HBV dose 3, which decreased between 2000 and 2011. Among seven vaccines used in the National Expanded Program of Immunization (EPI) in 2000, 2006, and 2011, measles dose 1 had the highest timely immunization completion at 65.3%, 66.7%, and 73.6%, respectively, and hepatitis B dose 1 had the lowest at 17.5%, 19.3%, and 45.5%, respectively. Timely immunization completion was less common among children whose mothers had relatively less household wealth, were from ethnic minorities, lived in rural areas, and had less education. At the community level, the child's region of residence was the main predictor of timely immunization completion, and the availability of hospital delivery and community prenatal care in the local community were also determinants. Conclusion: The EPI should include 'timely immunization completion' as a quality indicator. There should also be greater focus and targeting in rural areas, and among women who have relatively low education, belong to minority groups, and have less household wealth. Further research on this topic using multilevel analysis is needed to better understand how these factors interact. [ABSTRACT FROM AUTHOR]

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 maternal healthcare. Objective: This paper describes patterns of inequity in maternal healthcare utilization and analyzes associations between inequity and multiple socioeconomic vulnerabilities among women in Vietnam. Design: This is a repeated cross-sectional study using data from the Vietnam Multiple Indicator Cluster Surveys 2000, 2006, and 2011. Two maternal healthcare indicators were selected: (1) skilled antenatal care and (2) skilled delivery care. Four types of socioeconomic vulnerabilities -- low education, ethnic minority, poverty, and rural location -- were assessed both as separate explanatory variables and as composite indicators (combinations of three and four vulnerabilities). Pairwise comparisons and adjusted odds ratios were used to assess socioeconomic inequities in maternal healthcare. Results: In all three surveys, there were increases across the survey years in both the proportions of women who received antenatal care by skilled staff (68.6% in 2000, 90.8% in 2006, and 93.7% in 2011) and the proportions of women who gave birth with assistance from skilled staff (69.9% in 2000, 87.7% in 2006, and 92.9% in 2011). The receipt of antenatal care by skilled staff and birth assistance from skilled health personnel were less common among vulnerable women, especially those with multiple vulnerabilities. Conclusions: Even thoughVietnam has improved its coverage of maternal healthcare on average, policies should target maternal healthcare utilization among women with multiple socioeconomic vulnerabilities. Both multisectoral social policies and health policies are needed to tackle multiple vulnerabilities more effectively by identifying those who are poor, less educated, live in rural areas, and belong to ethnic minority groups. [ABSTRACT FROM AUTHOR]

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 socioeconomic 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. [ABSTRACT FROM AUTHOR]

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 maternal healthcare. Objective: This paper describes patterns of inequity in maternal healthcare utilization and analyzes associations between inequity and multiple socioeconomic vulnerabilities among women in Vietnam. Design: This is a repeated cross-sectional study using data from the Vietnam Multiple Indicator Cluster Surveys 2000, 2006, and 2011. Two maternal healthcare indicators were selected: (1) skilled antenatal care and (2) skilled delivery care. Four types of socioeconomic vulnerabilities - low education, ethnic minority, poverty, and rural location - were assessed both as separate explanatory variables and as composite indicators (combinations of three and four vulnerabilities). Pairwise comparisons and adjusted odds ratios were used to assess socioeconomic inequities in maternal healthcare. Results: In all three surveys, there were increases across the survey years in both the proportions of women who received antenatal care by skilled staff (68.6% in 2000, 90.8% in 2006, and 93.7% in 2011) and the proportions of women who gave birth with assistance from skilled staff (69.9% in 2000, 87.7% in 2006, and 92.9% in 2011). The receipt of antenatal care by skilled staff and birth assistance from skilled health personnel were less common among vulnerable women, especially those with multiple vulnerabilities. Conclusions: Even though Vietnam has improved its coverage of maternal healthcare on average, policies should target maternal healthcare utilization among women with multiple socioeconomic vulnerabilities. Both multisectoral social policies and health policies are needed to tackle multiple vulnerabilities more effectively by identifying those who are poor, less educated, live in rural areas, and belong to ethnic minority groups. [ABSTRACT FROM AUTHOR]

Background: Since the beginning of 2014, there have been nearly 6,000 confirmed measles cases in northern Vietnam. Of these, more than 86% had neither been immunized nor was their vaccination status confirmed. Objective: To establish the likelihood that children under five in Vietnam had 'timely immunization completion' (2000-2011) and identify factors that account for variations in timely immunization completion. Design: Secondary data from the Multiple Indicator Cluster Survey (MICS), which sampled women aged 15-49 from the 1999 Vietnamese Population and Housing Census frame, were analyzed. Multilevel analysis using Poisson regression was undertaken. Results: Proportions of children under five who had timely immunization completion were low, especially for HBV dose 2 and HBV dose 3, which decreased between 2000 and 2011. Among seven vaccines used in the National Expanded Program of Immunization (EPI) in 2000, 2006, and 2011, measles dose 1 had the highest timely immunization completion at 65.3%, 66.7%, and 73.6%, respectively, and hepatitis B dose 1 had the lowest at 17.5%, 19.3%, and 45.5%, respectively. Timely immunization completion was less common among children whose mothers had relatively less household wealth, were from ethnic minorities, lived in rural areas, and had less education. At the community level, the child's region of residence was the main predictor of timely immunization completion, and the availability of hospital delivery and community prenatal care in the local community were also determinants. Conclusion: The EPI should include 'timely immunization completion' as a quality indicator. There should also be greater focus and targeting in rural areas, and among women who have relatively low education, belong to minority groups, and have less household wealth. Further research on this topic using multilevel analysis is needed to better understand how these factors interact. [ABSTRACT FROM AUTHOR]

Introduction: Achieving a fair and equitable distribution of health in the population while progressing toward universal health coverage (UHC) is a key focus of health policy in Vietnam. This paper describes health barriers experienced by women (and children by inference) in Vietnam, and measures how UHC, with reference to maternal health services and child mortality rates, is affected by selected social determinants of health (SDH), termed 'barriers'. Methods: Our study uses a cross-sectional design with data from the 2011 Vietnam Multiple Indicator Cluster Survey. The study sample includes 11,663 women, aged 15-49 years. Weighted frequency statistics are crosstabulated with socioeconomic characteristics of the population to describe the extent and distribution of health barriers experienced by disadvantaged women and children in Vietnam. A subset of women who had a live birth in the preceding two years (n = 1,383) was studied to assess the impact of barriers to UHC and health. Six multiple logistic regressions were run using three dependent variables in the previous two years: 1) antenatal care, 2) skilled birth attendants, and 3) child death in the previous 15 years. Independent predictor variables were: 1) low education (incomplete secondary education), 2) lack of access to one of four basic amenities. In a second set of regressions, a constructed composite barrier index replaced these variables. Odds ratios (ORs) and 95% confidence intervals (95% CI) were used to report regression results. Results: In Vietnam, about 54% of women aged 15-49 years in 2011, had low education or lacked access to one of four basic amenities. About 38% of poor rural women from ethnic minorities experienced both barriers, compared with less than 1% of rich urban women from the ethnic majority. Incomplete secondary education or lack of one of four basic amenities was a factor significantly associated with lower access to skilled birth attendants (OR =0.28, 95% CI: 0.14-0.55; OR =0.19, 95% CI: 0.05-0.80) and a higher risk of having had a child death in the previous two years (OR = 1.71, 95% CI: 1.28-2.30; OR = 1.59, 95% CI: 1.20-2.10). Conclusions: Our study shows the need for accelerating education and infrastructure investments for ethnic minority communities living in rural areas so as to be able to contribute to equity-oriented progress toward UHC. [ABSTRACT FROM AUTHOR]

Vietnam's health system continues to make great progress in improving its capacities and performance. However, despite the many significant achievements that have been made, this paper summaries 11 health system research papers from different perspectives with the aim of providing scientific evidence for policy actions in Vietnam. Health system research is ultimately concerned with improving the health of people and communities, by enhancing the efficiency and effectiveness of the health system as an integral part of the overall process of socioeconomic development, with full involvement of all actors. We hope the findings from this cluster of papers provide some insights into issues of importance for the continued advancement and strengthening of the health system in Vietnam and can be considered a valid and reliable resource to inform planning, management and policy-making decisions. [ABSTRACT FROM AUTHOR]

There is a shortage of medical doctors in primary health care (PHC) settings in Vietnam. Evidence about the knowledge medical students have about PHC and their career decision-making is important for making policy in human resources for health. The objective of this study was to analyse knowledge and attitudes about PHC among medical students in their final year and their choice to work in PHC after graduation. A cross-sectional study was conducted among 400 final year general medical students from Hanoi Medical University. Self-administered interviews were conducted. Key variables were knowledge, awareness of the importance of PHC and PHC career choices. Descriptive and analytic statistics were performed. Students had essential knowledge of the concept and elements of PHC and were well aware of its importance. However, only one-third to one half of them valued PHC with regard to their professional development or management opportunities. Less than 1% of students would work at commune or district health facilities after graduation. This study evidences challenges related to increasing the number of medical doctors working in PHC settings. Immediate and effective interventions are needed to make PHC settings more attractive and to encourage medical graduates to start and continue a career in PHC. [ABSTRACT FROM AUTHOR]

Expanding effective coverage in Vietnam will require better use of available resources and placing higher priority on primary care. The way providers are currently paid does not give priority to primary care and does not reflect the costs of delivering services. This paper aims to estimate the unit costs of primary care visits at commune health stations (CHS) in selected areas in Vietnam. Seventy-six CHS from two provinces in northern Vietnam were studied. Costs were calculated from the perspective of the CHS using the top-down costing using the step-down cost accounting technique in order to estimate the full cost of delivering services. On average, the cost of one outpatient visit in mountainous, rural and urban CHSs was VND 49,521 (US$2.40), VND 41,375 (US$2.01) and VND 39,794 (US$1.93), respectively. Personnel costs accounted for the highest share of total costs followed by medicines. The share of operating costs was minimal. On average, CHSs recover 18.9% of their total cost for an outpatient visit from social insurance payments or fees that can be charged patients. The results provide valuable information for policy-makers as they revise the provider payment methods to better reflect the costs of services and give greater priority to primary care. [ABSTRACT FROM AUTHOR]

Disability is shown to be both a cause and a consequence of poverty. However, relatively little research has investigated the economic cost of living with a disability. This study reports the results of a study on the extra cost of living with disability in Vietnam in 2011. The study was carried out in eight cities/provinces in Vietnam, including Hanoi and Ho Chi Minh cities (two major metropolitan in Vietnam) and six provinces from each of the six socio-economic regions in Vietnam. Costs are estimated using the standard of living approach whereby the difference in incomes between people with disability and those without disability for a given standard of living serves as a proxy for the cost of living with disability. The extra cost of living with disability in Vietnam accounted for about 8.8-9.5% of annual household income, or valued about US$200- 218. Communication difficulty was shown to result in highest additional cost of living with disability and self-care difficulty was shown to lead to the lowest levels of extra of living cost. The extra cost of living with disability increased as people had more severe impairment. Interventions to promote the economic security of livelihood for people with disabilities are needed. [ABSTRACT FROM AUTHOR]

Background: The Association of Southeast Asian Nations (ASEAN) is characterized by much diversity in terms of geography, society, economic development, and health outcomes. The health systems as well as healthcare structure and provisions vary considerably. Consequently, the progress toward Universal Health Coverage (UHC) in these countries also varies. This paper aims to describe the progress toward UHC in the ASEAN countries and discuss how regional integration could influence UHC. Design: Data reported in this paper were obtained from published literature, reports, and gray literature available in the ASEAN countries. We used both online and manual search methods to gather the information and 'snowball' further data. Results: We found that, in general, ASEAN countries have made good progress toward UHC, partly due to relatively sustained political commitments to endorse UHC in these countries. However, all the countries in ASEAN are facing several common barriers to achieving UHC, namely 1) financial constraints, including low levels of overall and government spending on health; 2) supply side constraints, including inadequate numbers and densities of health workers; and 3) the ongoing epidemiological transition at different stages characterized by increasing burdens of non-communicable diseases, persisting infectious diseases, and reemergence of potentially pandemic infectious diseases. The ASEAN Economic Community's (AEC) goal of regional economic integration and a single market by 2015 presents both opportunities and challenges for UHC. Healthcare services have become more available but health and healthcare inequities will likely worsen as better-off citizens of member states might receive more benefits from the liberalization of trade policy in health, either via regional outmigration of health workers or intra-country health worker movement toward private hospitals, which tend to be located in urban areas. For ASEAN countries, UHC should be explicitly considered to mitigate deleterious effects of economic integration. Political commitments to safeguard health budgets and increase health spending will be necessary given liberalization's risks to health equity as well as migration and population aging which will increase demand on health systems. There is potential to organize select health services regionally to improve further efficiency. Conclusions: We believe that ASEAN has significant potential to become a force for better health in the region. We hope that all ASEAN citizens can enjoy higher health and safety standards, comprehensive social protection, and improved health status. We believe economic and other integration efforts can further these aspirations. [ABSTRACT FROM AUTHOR]

Background: A health system that provides equitable health care is a principal goal in many countries. Measuring horizontal inequity (HI) in health care utilization is important to develop appropriate and equitable public policies, especially policies related to non-communicable diseases (NCDs). Design: A cross-sectional survey of 1,211 randomly selected households in slum and non-slum areas was carried out in four urban districts of Hanoi city in 2013. This study utilized data from 3,736 individuals aged 15 years and older. Respondents were asked about health care use during the previous 12 months; information included sex, age, and self-reported NCDs. We assessed the extent of inequity in utilization of public health care services. Concentration indexes for health care utilization and health care needs were constructed via probit regression of individual utilization of public health care services, controlling for age, sex, and NCDs. In addition, concentration indexes were decomposed to identify factors contributing to inequalities in health care utilization. Results: The proportion of healthcare utilization in the slum and non-slum areas was 21.4 and 26.9%, respectively. HI in health care utilization in favor of the rich was observed in the slum areas, whereas horizontal equity was achieved among the non-slum areas. In the slum areas, we identified some key factors that affect the utilization of public health care services. Conclusion: Our results suggest that to achieve horizontal equity in utilization of public health care services, policy should target preventive interventions for NCDs, focusing more on the poor in slum areas. [ABSTRACT FROM AUTHOR]

Background: The World Health Organization emphasized that climate change is a significant and emerging threat to public health, especially in lower income populations and tropical/subtropical countries. However, people in Asia and Africa were the least likely to perceive global warming as a threat. In Vietnam, little research has been conducted concerning the perceptions of effects of climate change on human health. Objective: The aim of this study was to explore the perceptions on climate change and its impact on human health among people in Hanoi. Design: We applied a combined quantitative and qualitative approach to study perceptions on climate change among people in Hanoi. A total of 1,444 people were recruited, including 754 people living in non-slum areas and 690 people living in slum areas of Hanoi. A structured questionnaire was used to collect quantitative data on their perceptions. In a parallel qualitative study, two focus group discussions and 12 in-depth interviews (IDs) were carried out involving 24 people from both slum and non-slum areas. Results: The majority of the respondents in the study had heard about climate change and its impact on human health (79.3 and 70.1% in non-slum and slum areas, respectively). About one third of the respondents reported that members of their family had experienced illness in the recent summer and winter compared to the same seasons 5 years ago. The most common symptoms reported during hot weather were headaches, fatigue, and dizziness; hypertension and other cardiovascular diseases were also reported. During cold weather, people reported experiencing cough, fever, and influenza, as well as pneumonia and emerging infectious diseases such as dengue and Japanese encephalitis. Conclusions: The observed high level of awareness on the links between climate change and human health may help to increase the success of the National Prevention Program on Climate Change. Moreover, understanding the concerns of the people may help policy makers to develop and implement effective and sustainable adaptation measures for Hanoi City as well as for Vietnam as a whole. [ABSTRACT FROM AUTHOR]

Background: As a tropical depression in the East Sea, Vietnam is greatly affected by climate change and natural disasters. Knowledge of the current capacity of the primary healthcare system in Vietnam to respond to health issues associated with storms and floods is very important for policy making in the country. However, there has been little scientific research in this area. Objective: This research was to assess primary healthcare system capacities in a rural district in central Vietnam to respond to such health issues. Design: This was a cross-sectional descriptive study using quantitative and qualitative approaches. Quantitative methods used self-administered questionnaires. Qualitative methods (in-depth interviews and focus groups discussions) were used to broaden understanding of the quantitative material and to get additional information on actions taken. Results: 1) Service delivery: Medical emergency services, especially surgical operations and referral systems, were not always available during the storm and flood seasons. 2) Governance: District emergency plans focus largely on disaster response rather than prevention. The plans did not clearly define the role of primary healthcare and had no clear information on the coordination mechanism among different sectors and organizations. 3) Financing: The budget for prevention and control of flood and storm activities was limited and had no specific items for healthcare activities. Only a little additional funding was available, but the procedures to get this funding were usually time-consuming. 4) Human resources: Medical rescue teams were established, but there were no epidemiologists or environmental health specialists to take care of epidemiological issues. Training on prevention and control of climate change and disaster-related health issues did not meet actual needs. 5) Information and research: Data that can be used for planning and management (including population and epidemiological data) were largely lacking. The district lacked a disease early-warning system. 6) Medical products and technology: Emergency treatment protocols were not available in every studied health facility. Conclusions: The primary care system capacity in rural Vietnam is inadequate for responding to storm and flood-related health problems in terms of preventive and treatment healthcare. Developing clear facility preparedness plans, which detail standard operating procedures during floods and identify specific job descriptions, would strengthen responses to future floods. Health facilities should have contingency funds available for emergency response in the event of storms and floods. Health facilities should ensure that standard protocols exist in order to improve responses in the event of floods. Introduction of a computerized health information system would accelerate information and data processing. National and local policies need to be strengthened and developed in a way that transfers into action in local rural communities. [ABSTRACT FROM AUTHOR]