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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]

Background: While there is accumulated evidence showing the rapid rise of the burden caused by noncommunicable diseases (NCDs) in Vietnam, information on the extent to which households in the country suffer financial catastrophe or impoverishment caused by the diseases is still largely lacking. This paper aims to examine the self-reported prevalence of major chronic diseases among a population in rural Vietnam and to analyse the household financial burden associated with these diseases. Methods: A cross-sectional survey of 800 randomly selected households was carried out in Vo Nhai District, Thai Nguyen Province, in 2010. Face-to-face interviews were conducted with key informants of selected households on diagnosed chronic NCDs, health care utilization and health expenditure of all household members. The World Health Organization's definitions of catastrophic expenditure and impoverishment were used. Both descriptive and analytical statistics were applied. Results: The prevalence of chronic NCDs in households and individuals was 29.3 and 33.4%, respectively. The catastrophic health expenditure and impoverishment rates among the households who have at least one member with a chronic disease were 14.6 and 7.6%, respectively. These rates were significantly higher than the corresponding figures among the households whose members were free from the diseases (4.2 and 2.3%, respectively). The odds of experiencing catastrophic health expenditure and impoverishment among the household with NCD patients were 3.2 and 2.3 times greater than that of other households. Conclusion: Findings from this study indicate that the epidemiological and household financial burdens caused by chronic diseases in Vietnam are now substantial and need immediate mitigation measures. [ABSTRACT FROM AUTHOR]

Background: While there is accumulated evidence showing the rapid rise of the burden caused by non-communicable diseases (NCDs) in Vietnam, information on the extent to which households in the country suffer financial catastrophe or impoverishment caused by the diseases is still largely lacking. This paper aims to examine the self-reported prevalence of major chronic diseases among a population in rural Vietnam and to analyse the household financial burden associated with these diseases. Methods: A cross-sectional survey of 800 randomly selected households was carried out in Vo Nhai District, Thai Nguyen Province, in 2010. Face-to-face interviews were conducted with key informants of selected households on diagnosed chronic NCDs, health care utilization and health expenditure of all household members. The World Health Organization's definitions of catastrophic expenditure and impoverishment were used. Both descriptive and analytical statistics were applied. Results: The prevalence of chronic NCDs in households and individuals was 29.3 and 33.4%, respectively. The catastrophic health expenditure and impoverishment rates among the households who have at least one member with a chronic disease were 14.6 and 7.6%, respectively. These rates were significantly higher than the corresponding figures among the households whose members were free from the diseases (4.2 and 2.3%, respectively). The odds of experiencing catastrophic health expenditure and impoverishment among the household with NCD patients were 3.2 and 2.3 times greater than that of other households. Conclusion: Findings from this study indicate that the epidemiological and household financial burdens caused by chronic diseases in Vietnam are now substantial and need immediate mitigation measures. [ABSTRACT FROM AUTHOR]

Background: Since the publication of the reports by the Commission on Social Determinants of Health (CSDH), many research papers have documented inequities, explaining causal pathways in order to inform policy and programmatic decision-making. At the international level, the sustainable development goals (SDGs) reflect an attempt to bring together these themes and the complexities involved in defining a comprehensive development framework. However, to date, much less has been done to address the monitoring challenges, that is, how data generation, analysis and use are to become routine tasks. Objective: To test proposed indicators of social determinants of health (SDH), gender, equity, and human rights with respect to their relevance in tracking progress in universal health coverage and population health (level and distribution). Design: In an attempt to explore these monitoring challenges, indicators covering a wide range of social determinants were tested in four country case studies (Bangladesh, Brazil, South Africa, and Vietnam) for their technical feasibility, reliability, and validity, and their communicability and usefulness to policy-makers. Twelve thematic domains with 20 core indicators covering different aspects of equity, human rights, gender, and SDH were tested through a review of data sources, descriptive analyses, key informant interviews, and focus group discussions. To test the communicability and usefulness of the domains, domain narratives that explained the causal pathways were presented to policy-makers, managers, the media, and civil society leaders. Results: For most countries, monitoring is possible, as some data were available for most of the core indicators. However, a qualitative assessment showed that technical feasibility, reliability, and validity varied across indicators and countries. Producing understandable and useful information proved challenging, and particularly so in translating indicator definitions and data into meaningful lay and managerial narratives, and effectively communicating links to health and ways in which the information could improve decision-making. Conclusions: This exercise revealed that for monitoring to produce reliable data collection, analysis, and discourse, it will need to be adapted to each national context and institutionalised into national systems. This will require that capacities and resources for this and subsequent communication of results are increased across countries for both national and international monitoring, including the successful implementation of the SDGs. [ABSTRACT FROM AUTHOR]

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This paper presents a qualitative study conducted in 2009 of provider and patient perceptions of primary level reproductive health services provided by commune health stations (CHSs), and the implications for Viet Nam's 2011–2020 National Strategy for Reproductive Health Care. In the three provinces of Thai Nguyen, Thua Thien Hue, and Vinh Long, we interviewed the heads of CHSs, held focus group discussions with midwives and women patients, and observed facilities. Half the 30 CHSs visited were in poor physical condition; the rest were newly renovated. However, the model of service delivery was largely unchanged from ten years before. Many appeared to fall short in meeting patient expectations in terms of modern medical equipment and technology, range of drug supplies, and levels of staff expertise. As a result, many women were turning to private doctors and public hospitals, at least in urban areas, or seeking medication from pharmacies. To make CHS clinics sustainable, promotion of access to reproductive health services should be undertaken concurrently with quality improvement. A responsive payment scheme must also be developed to generate revenues. Efforts should be made to reduce the unnecessary use of more costly services from private clinics and higher level public facilities. Cet article présente une étude qualitative réalisée en 2009 sur les perceptions chez les prestataires et les patients des services de santé génésique de niveau primaire assurés par les centres de santé communaux (CSC) et leurs conséquences pour la Stratégie nationale de soins de santé génésique 2011–2020 du Viet Nam. Dans les trois provinces de Thai Nguyen, Thua Thien Hue et Vinh Long, nous avons interrogé les chefs des CSC, organisé des discussions par groupe d'intérêt avec des sages–femmes et des patientes, et observé les installations. La moitié des 30 CSC visités étaient en mauvais état ; les autres venaient d'être rénovés. Néanmoins, lemodèle de prestation de services n'avait presque pas changé depuis dix ans. Beaucoup de CSC ne semblaient pas répondre aux attentes des patientes du point de vue de la modernité de l'équipement médical et de la technologie, du choix de médicaments disponibles et du niveau de compétence du personnel. Beaucoup de femmes s'adressaient donc à des médecins privés et des hôpitaux publics, au moins dans les zones urbaines, ou demandaient des médicaments dans les pharmacies. Pour que les CSC deviennent viables, la promotion de l'accès aux services de santé génésique doit être entreprise conjointement avec l'amélioration de la qualité. Un plan de paiement réactif doit aussi être mis au point pour créer des recettes. Il faut s'efforcer de réduire le recours inutile aux services coûteux de médecins et de centres privés ou d'installations publiques de niveau supérieur. En este artículo se presenta un estudio cualitativo realizado en 2009 de las percepciones del personal de salud y pacientes en cuanto a los servicios de salud reproductiva proporcionados en el primer nivel de atención por estaciones de salud comunitarias (CHS por sus siglas en inglés) y las implicaciones para la Estrategia Nacional de Servicios de Salud Reproductiva en Vietnam, del 2011 al 2020. En las tres provincias de Thai Nguyen, Thua Thien Hue y Vinh Long, entrevistamos la dirección de las CHS, realizamos discusiones en grupos focales con parteras profesionales y mujeres pacientes y observamos las unidades de salud. La mitad de las 30 CHS visitadas se encontraban en malas condiciones físicas; el resto había sido renovado recientemente. Sin embargo, hubo muy pocos cambios en el modelo de prestación de servicios creado diez años atrás. En muchas de las CHS hubo considerable insatisfacción por parte de las pacientes en cuanto al equipo médico moderno y la tecnología, la variedad de medicamentos y los niveles de conocimientos y experiencia del personal. Por consiguiente, muchas mujeres estaban acudiendo a médicos particulares y hospitales públicos, por lo menos en las zonas urbanas, o buscando medicamentos en las farmacias. Para lograr la sostenibilidad de las CHS, se debe promover el acceso a los servicios de salud reproductiva a la vez que se mejora la calidad. Además, se debe elaborar un esquema de pago receptivo para generar ingresos y se deben realizar esfuerzos por reducir el uso innecesario de servicios costosos proporcionados por médicos y clínicas particulares y unidades públicas de nivel superior. [ABSTRACT FROM AUTHOR]

Vietnam has experienced a rapid increase in cancer incidence with many cancers (70%) being diagnosed at a late stage. The majority of physical and psychosocial care is provided by caregivers with minimal professional input. Due to limited resources in hospitals and social and cultural norms regarding caregiving in Vietnam, caregivers provide a range of supportive functions for family members diagnosed with cancer. This study sought to provide empirical evidence on the self-identified unmet needs of caregivers of inpatients in national oncology hospitals in Vietnam. Focus groups and in-depth interviews were conducted with caregivers (n = 20) and health care providers (n = 22) in national oncology hospitals in Hanoi and Ho Chi Minh City. Data was collaboratively analysed using thematic analysis. Findings were validated through key stakeholder group discussions with both caregivers and healthcare providers across multiple regions in Vietnam. Analysis demonstrated that the burden of informal care is high with many caregivers managing patient's severe and complex health needs with minimal support. Caregivers highlighted four main areas of critical need: (i) challenges in providing long term care, particularly in hospital and in-patient settings, such as accessing comfortable facilities, accommodation and finance; (ii) information needs about cancer, treatment, and nutrition; (iii) support for the emotional impact of cancer; and (iv) training about how to provide care to their family members during treatment and recovery phases. Caregivers provide invaluable support in supporting people with a cancer diagnosis, particularly given wider systemic challenges in delivering cancer services in Vietnam. Increasing visibility and formal support is likely to have both a positive impact upon the health and wellbeing of caregivers, as well as for cancer patients under their care. Given its absence, it is critical that comprehensive psychosocial care is developed for caregivers in Vietnam. [ABSTRACT FROM AUTHOR]

Background: Legislative initiatives have been implemented to fight against Intimate Partner Violence (IPV) and offer protection to its survivors in Vietnam. However, this type of violence is relatively common in the country, where broader structural inequalities, like poverty and the system of male dominance, increase women's vulnerability to IPV. Objective: This study aimed to explore the strategies that Vietnamese IPV survivors take to cope with the abuse from their partners and maximize their safety and wellbeing. Methods: Qualitative in-depth interviews were conducted with eight women survivors of IPV who lived in one of the Peace House Shelter in Hanoi. Participants were recruited through the shelter. Data were collected using semi-structured interviews and analyzed using qualitative content framed by the theoretical concept of the patriarchal bargain. Results: The IPV survivors in our study took two main strategies to cope with IPV: keeping silent and/or leaving the abuser. Leaving was a challenging strategy because it required support from others, something that was difficult to find due to the social stigma associated with divorce and the normalization of violence in intimate relationships. This was specially the case for participants coming from rural areas who did not count on a social network in the city where the shelter is located. The women strategized within a complex set of structural constrains like poverty, cultures of honor, social stigma, and traditional gender roles. As active agents, they decided whether challenging the patriarchal system would optimize their life options. Motherhood also played a crucial role in women's decisions regarding IPV. Conclusion: A strategy of conformity like silence can be a tactic for women to cope with a system of male dominance while navigating complex structural inequalities. To better address IPV in Vietnam, interventions should be sensitive to the structural gender inequalities within family and societal contexts. [ABSTRACT FROM AUTHOR]

Hazardous alcohol use is detrimental to persons with HIV (PWH), impacting medication adherence and liver function, yet globally resources to target alcohol use behavior in this population are limited. Few studies have identified the costs of integrating alcohol reduction interventions into HIV care. To estimate the costs of implementing and delivering two evidence-based behavioral counseling interventions targeting hazardous alcohol use among persons with HIV and to estimate the costs of scale-up in ART clinics in Thai Nguyen, Vietnam. We undertook a micro-costing approach to determine the costs of delivering two adapted evidence-based interventions to reduce alcohol use: an intensive combined cognitive behavioral therapy and motivational enhancement therapy-informed intervention (CoI) and an abbreviated brief alcohol intervention (BI). A total of 294 participants with hazardous alcohol use were identified through a brief screening tool and received the CoI (n = 147) and the BI (n = 147) over 3 months. We estimated costs using time and motion studies, budget analysis, staff interviews, and participant questionnaires. Data were collected from 2016 to 2018 in VND and converted to USD. The total cost of implementation and administration of the intervention to 147 participants receiving the CoI was $13,900 ($95 per participant) and to 147 participants receiving the BI was $5700 ($39 per participant). Implementation and startup costs including training accounted for 27% of costs for the CoI and 28% for the BI. Counselor costs accounted for a large proportion of both the CoI (41%) and the BI (30%). Implementing and delivering alcohol reduction interventions to people with HIV in Vietnam with appropriate fidelity is costly. These costs may be reduced, particularly counselor labor costs, by using an evidence-based brief intervention format. Future research should explore the budgetary impact of brief and combined interventions to reduce hazardous alcohol use, particularly among vulnerable populations. [ABSTRACT FROM AUTHOR]

Introduction: Under current HIV transmission mechanisms operating in Vietnam, women are seen as victims of their male partners. Having multiple sexual partners is one of the well-known risk factors for HIV infection. However, little is known about women's risky sexual behaviour and their vulnerability to HIV in Vietnam. This study aims to explore association between early sexual initiation and the number of lifetime sexual partners in Vietnamese women. Although the Vietnamese culture is socially conservative in this area, identifying women's risky sexual behaviour is important for the protection of women at risk of HIV and other sexually transmitted diseases. Design: A total of 8,791 women, who reported having had sexual intercourse, were included in this analysis of data from the 2011 Multiple Indicator Cluster Survey in Vietnam. Data were collected using two-stage strata sampling, first at the national level and second across six geographical regions (n = 8,791). Multivariable logistic regressions describe association between early initiation of a sexual activity and lifetime multiple sexual partners. Results: Early sexual intercourse was significantly associated with having lifetime multiple sexual partners. Women who were aged 19 or younger at first sexual intercourse were over five times more likely to have multiple sexual partners, compared with women whose first sexual intercourse was after marriage; aged 10-14 years (OR = 5.9; 95% CI = 1.9-18.8) at first intercourse; and aged 15-19 years (OR = 5.4; 95% CI =4.0-7.2) at first intercourse. There was significant association with having multiple sexual partners for women of lower household wealth and urban residence, but the association with educational attainment was not strong. Conclusions: The study results call for health and education policies to encourage the postponement of early sexual activity in young Vietnamese women as protection against risky sexual behaviour later in life. [ABSTRACT FROM AUTHOR]

Background: Despite significant achievements in health indicators during previous decades, Vietnam lags behind other developing countries in reducing common early childhood illnesses, such as diarrhea and respiratory infections. To date, there has been little research into factors that contribute to the prevalence and treatment of childhood morbidity in Vietnam. Objective: This study examines the determinants of diarrhea and 'illness with a cough' and treatments for each of the conditions among young children in Vietnam, and describes trends over time. Design: Data from the Vietnam Multiple Indicator Cluster Surveys in 2000, 2006, and 2011 were used. Multivariable logistic regressions were undertaken to investigate factors associated with these childhood illnesses and proper treatment patterns. Results: Between 2000 and 2011, the prevalence of diarrhea among children under the age of five declined from 11 to 7%, while having illness with a cough increased to 40% in 2011 after falling from 69 to 28% between 2000 and 2006. During the same period, the prevalence of oral rehydration therapy (ORT) for treating diarrhea increased from 13 to 46%, whereas the rate of seeking formal treatment for illnesses with a cough fell from 24 to 7%. Multivariable models indicated that children who were older than 2 years (odds ration [OR]: 0.44, 95% confidence interval [CI]: 0.37-0.53,p < 0.001), male (OR: 1.21,95% CI: 0.64-2.37, p <0.05), living in rural areas (OR: 1.28,95% CI: 1.00-1.64,p <0.05), or of Kinh ethnicity (OR: 0.70,95% CI: 0.56-0.87,p <0.01) were more likely to suffer from diarrhea. Ethnic differences and higher household wealth were factors significantly associated with having illness with a cough. In particular, the effect of level of wealth on illness with a cough varied in each wave. Mothers with higher levels of education had higher odds of seeking ORT compared with mothers with the lowest level of education. Seeking formal treatment for children who have illness with a cough was associated with being in a household in the richest wealth quintile (OR: 0.56, 95% CI: 0.34-0.91, p <0.05). Conclusions: This study demonstrates the importance of identifying different risk factors for these two illnesses and also factors associated with healthcare-seeking behaviors in order to reduce the burden of childhood morbidity in Vietnam. Policies aimed at tackling childhood morbidities should include comprehensive strategies that impact on socioeconomic and environmental factors. [ABSTRACT FROM AUTHOR]

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

Background: In Vietnam, initiatives have been started aimed at increasing the practice of handwashing with soap (HWWS) among primary schoolchildren. However, compliance remains low. Objective: This study aims to investigate responses to a teacher-centred participatory HWWS intervention in a multi-ethnic population of primary schoolchildren in northern rural Vietnam. Design: This study was implemented in two phases: a formative research project over 5 months (July November 2008) and an action research project with a school-based HWWS intervention study in two rural communes during 5 months (May, September-December 2010). Based upon knowledge from the formative research in 2008, schoolteachers from four selected schools in the study communes actively participated in designing and implementing a HWWS intervention. Qualitative data was collected during the intervention to evaluate the responses and reaction to the intervention of teachers, children and parents. This included semi-structured interviews with children (15), and their parents (15), focus group discussions (FGDs) with schoolchildren (32) and school staff (20) and observations during 15 HWWS involving children. Results: Observations and interview data from children demonstrated that children were visibly excited and pleased with HWWS sessions where teachers applied active teaching methods including rewards, games and HWWS demonstrations. All children, schoolteachers and parents also viewed the HWWS intervention as positive and feasible, irrespective of ethnicity, gender of schoolchildren and background of schoolteachers. However, some important barriers were indicated for sustaining and transferring the HWWS practice to the home setting including limited emphasis on hygiene in the standard curriculum of schools, low priority and lack of time given to practical teaching methods and lack of guidance and reminding HWWS on a regular basis at home, in particular by highland parents, who spend most of their time working away from home in the fields. Access to soap and water at the household level did not seem a barrier for the uptake of HWWS but continuous access to these might be a challenge at schools. Conclusions: This study demonstrated that it is feasible to engage teachers and implement active teaching methods for behaviour change of HWWS in a group of multi-ethnic primary schoolchildren without the need for major investments in water and hygiene infrastructures. However, in those areas there was limited transfer of practice from school promotion to home. Continuous access to soaps at schools needs to be invested. [ABSTRACT FROM AUTHOR]

Background: Natural disasters have severe impacts on the health and well-being of affected households. However, we find evidence that official damage cost assessments for floods and other natural disasters in Vietnam, where households have little or no insurance, clearly underestimate the total economic damage costs of these events as they do not include the welfare loss from mortality, morbidity and reduced well-being experienced by the households affected by the floods. This should send a message to the local communities and national authorities that higher investments in flood alleviation, reduction and adaptive measures can be justified since the social benefits of these measures in terms of avoided damage costs are higher than previously thought. Methods: We pioneer the use of the contingent valuation (CV) approach of willingness-to-contribute (WTC) labour to a flood prevention program, as a measure of the welfare loss experienced by household due to a flooding event. In a face-to-face household survey of 706 households in the Quang Nam province in Central Vietnam, we applied this approach together with reported direct physical damage in order to shed light of the welfare loss experienced by the households. We asked about households' WTC labour and multiplied their WTC person-days of labour by an estimate for their opportunity cost of time in order to estimate the welfare loss to households from the 2007 floods. Results: The results showed that this contingent valuation (CV) approach of asking about willingness-to-pay in-kind avoided the main problems associated with applying CV in developing countries. Conclusion: Thus, the CV approach of WTC labour instead of money is promising in terms of capturing the total welfare loss of natural disasters to households, and promising in terms of further application in other developing countries and for other types of natural disasters. [ABSTRACT FROM AUTHOR]

Background: Over the past two decades, health insurance in Vietnam has expanded nationwide. Concurrently, Vietnam's private health sector has developed rapidly and become an increasingly integral part of the health system. To date, however, little is understood regarding the potential for expanding public-private partnerships to improve health care access and outcomes in Vietnam. Objective: To explore possibilities for public-private collaboration in the provision of ambulatory care at the primary level in the Mekong region, Vietnam. Design: We employed a mixed methods research approach. Qualitative methods included focus group discussions with health officials and in-depth interviews with managers of private health facilities. Quantitative methods encompassed facility assessments, and exit surveys of clients at the same private facilities. Results: Discussions with health officials indicated generally favorable attitudes towards partnerships with private providers. Concerns were also voiced, regarding the over- and irrational use of antibiotics, and in terms of limited capacity for regulation, monitoring, and quality assurance. Private facility managers expressed a willingness to collaborate in the provision of ambulatory care, and private providers facilites were relatively well staffed and equipped. The client surveys indicated that 80% of clients first sought treatment at a private facility, even though most lived closer to a public provider. This choice was motivated mainly by perceptions of quality of care. Clients who reported seeking care at both a public and private facility were more satisfied with the latter. Conclusions: Public-private collaboration in the provision of ambulatory care at the primary level in Vietnam has substantial potential for improving access to quality services. We recommend that such collaboration be explored by Vietnamese policy-makers. If implemented, we strongly urge attention to effectively managing such partnerships, establishing a quality assurance system, and strengthening regulatory mechanisms. [ABSTRACT FROM AUTHOR]

Background: Vietnam is one of the most disaster-prone countries in the world. The country suffers from many kinds of natural disasters, of which the most common and serious one is flooding. Long and heavy rainfall during the last days of October and the first week of November 2008 resulted in a devastating flood unseen for over three decades in the capital city of Hanoi. It caused a substantial health impact on residents in and around the city and compromised the capacity of local health services. Objective: The aim of this study is to ascertain the vulnerability and health impacts of the devastating flood in Hanoi by identifying the differences in mortality, injuries, and morbidity patterns (dengue, pink eye, dermatitis, psychological problems, and hypertension) between flood affected and non-affected households. Design: A cross-sectional study was carried out involving 871 households in four selected communes (two heavily flood affected and two comparatively less affected) from two severely flooded districts of Hanoi. Participants were interviewed and information collected on the social, economic, and health impacts of the devastation within 1 month after the flood. Results: The self-reported number of deaths and injuries reported in this study within 1 month after the heavy rainfall were a bit higher in severely affected communes as compared to that of the less affected communes of our study. The findings showed higher incidences of dengue fever, pink eye, dermatitis, and psychological problems in communes severely affected by flood as compared to that of the controlled communes. Conclusions: For people in flood prone areas (at risk for flooding), flood prevention and mitigation strategies need to be seriously thought through and acted upon, as these people are exposed to greater health problems such as psychological issues and communicable diseases such as pink eye or dermatitis. [ABSTRACT FROM AUTHOR]

Neonatal mortality is a major health problem in low and middle income countries and the rate of improvement of newborn survival is slow. This article is a review of the PhD thesis by Mats Målqvist, titled 'Who can save the unseen -- Studies on neonatal mortality in Quang Ninh province, Vietnam', from Uppsala University. The thesis aims to investigate structural barriers to newborn health improvements and determinants of neonatal death. The findings reveal a severe under-reporting of neonatal deaths in the official health statistics in Quang Ninh province in northern Vietnam. The neonatal mortality rate (NMR) found was four times higher than what was reported to the Ministry of Health. This underestimation of the problem inhibits adequate interventions and efforts to improve the survival of newborns and highlights the invisibility of this vulnerable group. The findings of the thesis also point at an inequity in survival chances based on ethnicity of the mother. Newborns of ethnic minority mothers were at a twofold risk of dying within the first 4 weeks of life compared to their peers belonging to the hegemonic group of Kinh (OR 2.08, 95% CI: 1.393.10). This increased risk was independent of maternal education and household economic status. Neonatal mortality was also associated with home deliveries, non-attendance to antenatal care and distance to the health care facilities. However, ethnic minority mothers still had an increased risk of experiencing a neonatal death even if they attended antenatal care, delivered at, or lived close to a health facility. This example of ethnic inequity highlights the importance to target those most in need. [ABSTRACT FROM AUTHOR]

Background: Vietnam is one of the most disaster-prone countries in the world. The country suffers from many kinds of natural disasters, of which the most common and serious one is flooding. Long and heavy rainfall during the last days of October and the first week of November 2008 resulted in a devastating flood unseen for over three decades in the capital city of Hanoi. It caused a substantial health impact on residents in and around the city and compromised the capacity of local health services. Objective: The aim of this study is to ascertain the vulnerability and health impacts of the devastating flood in Hanoi by identifying the differences in mortality, injuries, and morbidity patterns (dengue, pink eye, dermatitis, psychological problems, and hypertension) between flood affected and non-affected households. Design: A cross-sectional study was carried out involving 871 households in four selected communes (two heavily flood affected and two comparatively less affected) from two severely flooded districts of Hanoi. Participants were interviewed and information collected on the social, economic, and health impacts of the devastation within 1 month after the flood. Results: The self-reported number of deaths and injuries reported in this study within 1 month after the heavy rainfall were a bit higher in severely affected communes as compared to that of the less affected communes of our study. The findings showed higher incidences of dengue fever, pink eye, dermatitis, and psychological problems in communes severely affected by flood as compared to that of the controlled communes. Conclusions: For people in flood prone areas (at risk for flooding), flood prevention and mitigation strategies need to be seriously thought through and acted upon, as these people are exposed to greater health problems such as psychological issues and communicable diseases such as pink eye or dermatitis. [ABSTRACT FROM AUTHOR]

Childhood obesity may soon be an equally important health threat as undernutrition and infectious diseases. Accurate information about prevalence and risk factors of obesity in children is important for the design of prevention. The aim of this study was to estimate prevalence of overweight and obesity for preschool children in two Vietnamese areas, one urban and one rural, and to identify risk factors. A cross-sectional study was conducted in urban Dong Da and rural Ba Vi districts, Hanoi, Vietnam. Totally, 2,677 children, 1,364 urban and 1,313 rural, were weighed and measured. Caregivers were interviewed. Background information about children and families was obtained from regular household surveys. The prevalence of overweight and obesity combined were 21.1% (95% CI 18.9–23.3) in the urban area and 7.6% (95% CI 6.2–9.2) in the rural. Multiple logistic regression revealed that at the individual level, in both sites, the risk increased with increased child age. The identified urban risk factors were being a boy, consuming large amounts of food, eating fast, and indoor activity less than 2 hours per day. The rural risk factors were frequent consumption of fatty food. At the family level, significant association was found in rural areas with frequent watching of food advertisements on television. Overweight and obesity are emerging problems in Vietnam, particularly in the urban context. Prevention programs should focus on education about healthy eating habits at early preschool age and need to be tailored separately for urban and rural areas since the risk factors differ. Non-healthy food advertisement needs to be restricted. [ABSTRACT FROM AUTHOR]