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Background The One Health concept promotes the enhancement of human, animal and ecosystem health through multi-sectorial governance support and policies to combat health security threats. In Vietnam, antimicrobial resistance (AMR) in animal and human health settings poses a significant threat, but one that could be minimised by adopting a One Health approach to AMR surveillance. To advance understanding of the willingness and abilities of the human and animal health sectors to undertake investigations of AMR with a One Health approach, we explored the perceptions and experiences of those tasked with investigating AMR in Vietnam, and the benefits a multi-sectorial approach offers. Methods This study used qualitative methodology to provide key informants’ perspectives from the animal and human health sectors. Two scenarios of food-borne AMR bacteria found within the pork value chain were used as case studies to investigate challenges and opportunities for improving collaboration across different stakeholders and to understand benefits offered by a One Health approach surveillance system. Fifteen semi-structured interviews with 11 participants from the animal and six from the human health sectors at the central level in Hanoi and the provincial level in Thai Nguyen were conducted. Results Eight themes emerged from the transcripts of the interviews. From the participants perspectives on the benefits of a One Health approach: (1) Communication and multi-sectorial collaboration; (2) Building comprehensive knowledge; (3) Improving likelihood of success. Five themes emerged from participants views of the challenges to investigate AMR: (4) Diagnostic capacity; (5) Availability and access to antibiotics (6) Tracing ability within the Vietnamese food chain; (7) Personal benefits and (8) Managing the system. Conclusion The findings of this study suggest that there is potential to strengthen multi-sectorial collaboration between the animal and human health sectors by building upon existing informal networks. Based on these results, we recommend an inclusive approach to multi-sectorial communication supported by government network activities to facilitate partnerships and create cross-disciplinary awareness and participation. The themes relating to diagnostic capacity show that both sectors are facing challenges to undertake investigations in AMR. Our results indicate that the need to strengthen the animal health sector is more pronounced.

Since facing outbreaks of severe acute respiratory syndrome and avian influenza A in 2003, Vietnam has increasingly applied a One Health approach to address emerging infectious diseases of animal origin. Here, we reflect on the challenges and opportunities of One Health in the context of zoonoses, food safety, and antimicrobial resistance, drawing on a stocktake of One Health training, policy, and research in Vietnam. We also report on the results of a virtual consultation workshop held on July 2021 with representatives from 32 institutions in Vietnam to explore future One Health directions. As Vietnam approaches nearly two decades of disease preparedness and response, we hope our experiences can provide practical insights to support countries in developing coordination mechanisms and moving the One Health agenda forward toward better public health outcomes.

This paper examines the impact of financial constraints on the development of Vietnamese firms driven by Total Factor Productivity (TFP) growth at the firm level. The effects of financial constraints by FCIf index on TFP growth of 97,860 firms are estimated by applying Dynamic Panel Data model over the period 2012-2017. The results show that there was a negative correlation between FCIf and labor productivity growth and TFP growth in all industries. While FCIf index is increased by 0.1, TFP growth of firms is reduced by 3.71%. The results also show that there was an inverse relationship between FCIf index, and the size of value added and assets of firms. Firms operating in manufacturing, wholesale and retail trade, and private firms face the biggest financial constraints.

This work proposed a novel procedure of Water Quality Index (WQI) development that could be used for practical applications on a local or regional scale, based on available monitoring data. Principal component analysis (PCA) was applied to the monthly data of 11 water quality parameters (pH, conductivity (EC), total suspended solid (TSS), dissolved oxygen (DO), five -day biological oxygen demand (BOD), chemical oxygen demand (COD), ammonia (N-NH4), nitrate (N-NO3), phosphate (P-PO4), total coliform, and total dissolved iron monitored at 11 sites at Huong river in the years 2014–2016. From the PCA, the three extracted principal components explained 67% of the total variance of original variables. From the set of communality values, the weight (wi) for each parameter was determined. Linear sub-index functions were established based on the permissible limits from the National Technical Regulations on Surface Water Quality set up by the Vietnam Environment Agency (VEA) to derive the sub-index (qi) for each parameter. The multiplicative formula that is the product of the sub-indices (qi) raised to the respective weights (wi), was used for calculation of the final WQI values. The proposed index (WQI) was then applied to the river with quarterly data of the 11 parameters monitored at ten sites in the years 2017–2020. The WQI representatively reflected the actual status of the river overall water quality, of which 97.8% of the WQI values belonged to grades of EXCELLENT and GOOD, and 2.2% of grade MODERATE. Comparison between the river water quality evaluations resulting from the developed WQI with the WQI adopted by National Sanitation Foundation (NSF-WQI) and the index issued by Vietnam Environment Agency (VN-WQI) indicated that the proposed WQI was more suitable for river quality assessment.

Japanese encephalitis (JE) is the major cause of viral encephalitis (VE) in most Asian-Pacific countries. In Vietnam, there is no nationwide surveillance system for JE due to lack of medical facilities and diagnoses. Culex tritaeniorhynchus, Culex vishnui, and Culex quinquefasciatus have been identified as the major JE vectors in Vietnam. The main objective of this study was to forecast a risk map of Culex mosquitoes in Hanoi, which is one of the most densely populated cities in Vietnam. A total of 10,775 female adult Culex mosquitoes were collected from 513 trapping locations. We collected temperature and precipitation information during the study period and its preceding month. In addition, the other predictor variables (e.g., normalized difference vegetation index [NDVI], land use/land cover and human population density), were collected for our analysis. The final model selected for estimating the Culex mosquito abundance included centered rainfall, quadratic term rainfall, rice cover ratio, forest cover ratio, and human population density variables. The estimated spatial distribution of Culex mosquito abundance ranged from 0 to more than 150 mosquitoes per 900m2. Our model estimated that 87% of the Hanoi area had an abundance of mosquitoes from 0 to 50, whereas approximately 1.2% of the area showed more than 100 mosquitoes, which was mostly in the rural/peri-urban districts. Our findings provide better insight into understanding the spatial distribution of Culex mosquitoes and its associated environmental risk factors. Such information can assist local clinicians and public health policymakers to identify potential areas of risk for JE virus. Risk maps can be an efficient way of raising public awareness about the virus and further preventive measures need to be considered in order to prevent outbreaks and onwards transmission of JE virus., Author summary Our study was to estimate the spatial distribution of Culex mosquitoes in Hanoi, which is one of the most densely populated cities in Vietnam. Our findings may provide better insight into understanding the spatial distribution of Culex mosquitoes and its associated environmental risk factors. Such information can assist local clinicians and public health policymakers to identify the potential areas of risk for JE virus.

Sustainably intensifying agriculture to secure food for people, while minimizing the human, animal, and environmental health impacts is an unprecedented global food security challenge. Action research is needed to understand and mitigate impacts, with Ecosystem approaches to health (Ecohealth) emerging as a promising framework to support such efforts. Yet, few have critically examined the application of Ecohealth principles in an agricultural context, particularly in Southeast Asia where agricultural intensification is rapidly expanding. In this paper, we evaluate the strengths, challenges, and opportunities of agriculture-related Ecohealth projects in low-resource settings of Vietnam, Thailand, Indonesia, and China, drawing on a case study of the Field Building Leadership Initiative (FBLI). To do this, we used a developmental evaluation framework involving several iterative cycles of document reviews, interviews, focus groups, and outcome harvesting with researchers, partners, and community members involved in FBLI. Results highlight the importance of transdisciplinarity, participation, and knowledge-to-action principles in co-generating knowledge and co-developing practical solutions. Implementing such principles presents challenges in terms of coordinating regional collaborations, managing high workloads, meaningfully engaging communities, and ensuring ongoing monitoring and evaluation. To address these challenges, there is a need to strengthen capacity in integrated approaches to health, improve institutionalization of Ecohealth, foster community engagement, and systematically monitor and evaluate efforts. Ecohealth holds significant promise in improving food security, but only when considerable time is spent developing and implementing projects with communities.

Mosquito-borne diseases (MBDs) are causing high morbidity and mortality for humans. Urban livestock keeping is still common in cities around the world. The animals may serve as reservoirs for zoonotic MBDs, which increase the risks for humans. Here we assess the knowledge and practices related to MBDs in households with livestock and without livestock and explore the perceptions of the health care sector about MBDs and livestock keeping in Hanoi city of Vietnam in a cross-sectional study. A quantitative survey was conducted including 513 households with and without livestock-keeping in six districts and complemented with qualitative surveys with four health staff from Hanoi Center of Disease Control and three district health centers. The quantitative survey indicated that the participants possessed basic knowledge on MBDs with an average score of 18.3 out of 35, of which non-livestock-keeping households had a better knowledge than households keeping livestock (p

Pork and pork products are important staple food in the diet of Vietnamese consumers. The safety of pork, including biological contamination, is a concern to several public authorities and value chain actors. This cross-sectional study aimed to identify Salmonella and total bacterial count (TBC) contamination of cut pork sold in different outlets, and determine the potential factors leading to contamination. A total of 671 pork samples were collected from different retail channels in three provinces in Northern Vietnam. Hygiene conditions and practices at pork vending premises were also observed and recorded. Data analysis used descriptive statistics and regression analysis. Overall, Salmonella prevalence in retailed pork was 58.1%. Salmonella contamination in pork from traditional retail, modern retail and food services were 60.5%, 50.9% and 80.5%, respectively. Eighty percent and 68% of fresh pork in canteen and street food was contaminated with Salmonella. Only a small proportion of a subset of the pork samples (6.2%) tested met the Vietnamese standard requirement for TBC contamination. Average concentration of TBC in fresh pork in traditional retail, modern retail and food services were 6.51 (SD: 0.64), 6.38 (0.65), and 6.96 (0.85) LogCFU/g, respectively. Transport time, use of the same tools for pork and other types of meat, storage temperature, and environment hygiene are important factors that might affect microbial contamination. The findings underline the high level of microbial contamination, which requires practical interventions to improve food safety hygiene practices and behavior of pork retailers.

Background Dengue is a mosquito-borne flavivirus present in many metropolitan cities of tropical countries. Methods During and after the dengue season (September 2018 to January 2019), we conducted a case-control study in order to determine the risk factors for dengue fever in Hanoi city, Vietnam. 98 dengue patients and 99 patients with other acute infections, such as Hepatitis B virus infection, were recruited at Department of Infectious Disease of Bach Mai national hospital in Hanoi. Patients were interviewed using a structured questionnaire covering demographic, housing, environmental factors and knowledge, attitude, and practice on dengue prevention and control. Univariate analysis and multivariable logistic regression were used to determine the risk factors of dengue status. Results The mean score of knowledge items and practice items was only 7.9 out of total 19 points and 3.9 out of total 17 points, respectively. While the mean score of attitude items was 4.8 out of total 6 points. Multivariable logistic regression indicated that older patients had lesser risk of getting dengue infection as compared to younger adults aged 16–30, and patients living in peri-urban districts were less likely to suffer of dengue fever than patients living in central urban districts (OR = 0.31; 95% CI 0.13–0.75). This study could not find any association with occupation, water storage habit, knowledge, attitude, or practice on dengue prevention. Conclusions All patients had a relatively low level of knowledge and practice on dengue prevention and control. However, the attitude of the participants was good. We found that age group and living district were the risk factors correlated with the dengue status. Communication programs on raising dengue awareness should be repeated all year round and target particular groups of adolescents, younger adults, landlords and migrants from other provinces to improve their knowledge and encourage them to implement preventive measures against dengue fever.

Background Hepatitis E virus (HEV) is a zoonotic disease and has been reported around the world. The main objective of this study was to evaluate the sero-prevalence and phylogenetic analysis of HEV in Vietnam. Pig blood and fecal pooled samples were collected to assess the prevalence of HEV. We assessed the true prevalence (TP) of HEV from apparent prevalence (AP) by taking into account the sensitivity and specificity of diagnostic tests using a Bayesian approach. For phylogenetic analysis, the data compared with worldwide HEV reference strains including all eight genotypes (G1-G8) which were identified in previous study. Results A total of 475 sera and 250 fecal pooled samples were collected at slaughterhouses and pig farms from five provinces, in Viet Nam. Overall, the sero-AP of HEV was 58.53% (95% confidence interval: 53.95–62.70) while the sero-TP was slightly higher (65.43, 95% credible interval: 47.19–84.70). In terms of pooled samples, overall, the RNA-AP was 6.80% (95% confidence interval: 4.01–10.66). One strain in Hanoi, two strains in Dak Lak, seven strains in An Giang, four strains in Son La and two strains in Nghe An were isolated. The phylogenetic tree demonstrated that 19 Vietnamese strains were clustered into HEV 3 and 4. Conclusions This study provided evidence that HEV is circulating in domestic pigs in Vietnam. From a public health perspective, it is very important to raise public awareness for high-risk groups (e.g. slaughterhouse workers, pig traders, farmers and market sellers) who have more opportunities to come in contact with pig and contaminated meats.

Background: Contact with livestock wastewater on farms and in communities can pose a risk to human and animal health. Methods: This cross-sectional study was conducted in 180 households and 24 pig farms (96 wastewater samples) to explore information about pig production, livestock waste management, antibiotic use, and to analyze antibiotic residues and microbial contamination, respectively. Results: Of the 120 households raising pigs, biogas systems were the most commonly used to treat animal waste (70%), followed by compositing (19%), and the remaining respondents discharged waste directly into drains or ponds (11%). The majority of respondents (78%) used antibiotics to treat and prevent disease in pigs, but 32% of them did not know of any disadvantages of antibiotic abuse. ELISA assays were performed on half of the wastewater samples (n = 48), demonstrating that residues of flouroquinolones and sulfonamides were present in 6.3% (3/48) and 22.9% (11/48) of tested samples, respectively. The average residual level of sulfamethazine was 27.8 ug/l. Further, E. coli concentrations exceeding regulatory levels in Vietnam were found in nearly all samples. Salmonella spp. was also found in 57.3% of samples, though prevalence rates varied across the different sites. Finally, G. lamblia was found in 8.4% of samples, and C. parvum was found in 5.2% of samples. Conclusions: This study suggests that livestock wastewater carried potential harmful pathogens and antibiotic residues that could come into contact with humans in the community. Thus, appropriate operation and application of livestock wastewater treatment (such as biogas or composting) and management should be a continued focused.

Background Newly emergent and virulent strains of H7N9 avian influenza virus are rapidly spreading in China and threaten to invade Vietnam. We sought to introduce aerosol sampling for avian influenza viruses in Vietnam.Methods During October 2017, National Institute for Occupational Safety and Health 2-stage aerosol samplers were assembled on a tripod and run for 4 hours. Concomitantly, up to 20 oropharyngeal (OP) swab samples were collected from chickens and ducks distanced at 0.2-1.5 m from each sampler.Results The 3 weeks of sampling yielded 30 aerosol samples that were 90% positive for influenza A, by quantitative reverse-transcription polymerase chain reaction, and 116 OP swab sample pools (5 samples per pool) that were 47% positive. Egg cultures yielded 1 influenza A virus (not H5 or H7) from aerosol and 25 influenza A viruses from OP swab sample pools (5 were H5 positive). The association between positive sample types (over time and position) was strong, with 91.7% of positive OP pooled swab samples confirmed by positive aerosol samples and 81% of influenza A positive aerosol samples confirmed by positive OP swab samples.Conclusions We posit that aerosol sampling might be used for early warning screening of poultry markets for novel influenza virus detection, such as H7N9. Markets with positive aerosol samples might be followed up with more focused individual bird or cage swabbing, and back-tracing could be performed later to locate specific farms harboring novel virus. Culling birds in such farms could reduce highly pathogenic avian influenza virus spread among poultry and humans.We found strong agreement between influenza A-positive aerosol and bird swab samples. We propose that aerosol sampling might be used in concert with direct swab sample surveillance in screening poultry markets for novel influenza viruses, such as H7N9.

Context Ecohealth is a transdisciplinary research approach that considers socio-economic, cultural, and environmental factors. Ecohealth program assessment is sometimes unable to capture the process of change, especially when the evidence is not well documented. As such, there is a need to better understand how ecohealth approaches are understood, integrated, and adapted in practice to support the sustainability of the approach. Objective To evaluate the use of an ecohealth approach to a community-based intervention to improve environmental sanitation and draw lessons learned for similar public health initiatives. Design An iterative evaluation approach involving 27 in-depth interviews and 9 focus group discussions was used to gather feedback on the intervention activities and outcomes from all participants. Setting and participants The study site was Hoang Tay commune, Kim Bang district, Ha Nam province. The participants included 12 farmers, 4 local policy makers, and 7 researchers from Hanoi University of Public Health. Results The farmers provided specific shortcomings of the biogas procedure steps, while the local authorities identified new and more effective ways to promote sanitation guidelines. Outcomes, as behavior changes, in 3 participant groups were captured. Conclusion Participation in ecohealth interventions should be collegial to give opportunities for all related stakeholders to build capacity, support, and achieve the transdisciplinary principle. This also helps ensure that the community-based solutions are incorporated in public health interventions. Participatory monitoring and evaluation should support the understanding of the implementation process to capture intervention outcomes.

CONTEXT The use of biogas systems to treat livestock waste is a common practice in Vietnam. However, farmers' knowledge and practices of the safe and appropriate use of household biogas units (HBUs) are still limited and could negatively impact human, animal, and environmental health. OBJECTIVE To assess the effectiveness of an intervention to improve knowledge and practices of biogas operation among farmers in 2 communes of Ha Nam Province, Vietnam. DESIGN A community-based intervention approach. SETTING This study was conducted from 2015 to 2016 in 2 communes of Ha Nam Province, Vietnam. PARTICIPANTS Only farmers with HBUs (N = 399) participated in this research. Farmers were assigned to either an intervention group or a control group at a ratio of 1:2. INTERVENTION Two intervention steps were implemented over a 6-month period as follows: (i) the core farmer group trained in 6 steps of HBU safe handling practice; and (ii) the core farmer group conducted peer-to-peer communication with its neighbors in the commune using the provided material. MAIN OUTCOME MEASURE(S) Farmers' knowledge and practices in biogas operation were assessed by a structured questionnaire. The questionnaire was administered before (baseline) and after the intervention (follow-up) to both the control and intervention groups. RESULTS There was a significant difference in the knowledge and practices of biogas operation between the 2 groups, in which farmers in the intervention group demonstrated better understanding of the related topic than the control group (P < .05, t test). A linear regression model indicated that baseline and follow-up scores in both knowledge and practices of the intervention group were higher than those of the control group. After the intervention, the mean difference score in knowledge and practices between the intervention and control groups was 5.0 and 2.0 points, respectively (P < .01). CONCLUSION A community-based intervention approach could be applied to improve knowledge and practices among farmers in using biogas systems. However, further studies should be conducted to assess the sustainability and effectiveness of this model.

In Vietnam, pigs and poultry are predominantly produced by small-scale farmers, creating challenges for zoonotic disease management. The objective of this study was to characterize practices related to livestock and manure management and to measure association with 3 self-reported health symptoms (coughing, fever, and diarrhea/nausea/vomiting) in a region currently undergoing health transitions. We analyzed cross-sectional survey data collected from a subset (N = 5520) of the Chi Linh Health and Demographic Surveillance System cohort in Chi Linh district, Vietnam. Bivariate analyses indicated that female gender was a significant risk factor for all 3 health symptoms, whereas age (≥60 years), suburban living, low education level, and household wealth were risk factors for 2 symptoms. Overall, we found no indication that biogas production or exposure to livestock and manure adversely affected human health. Efforts to control zoonotic disease transmission should prioritize utilization of veterinarians, enhanced farm biosecurity, and improvements to commune drinking water/wastewater infrastructure.

Background Bacillary dysentery (BD) is an acute bacterial infection of the intestine caused by Shigella spp., with clinical symptoms ranging from fever to bloody diarrhoea to abdominal cramps to tenesmus. In Vietnam, enteric bacterial pathogens are an important cause of diarrhoea and most cases in children under 5 years of age are due to Shigella strains. The serogroups S. flexneri and S. sonnei are considered to be the most common. The main objective of this study was to, for the first time, assess the seasonal patterns and geographic distribution of BD in Vietnam, and to determine the climate risk factors associated with the incidence of BD in Kon Tum Province, where the highest rate of bacillary dysentery was observed from 1999 to 2013. Methods The seasonal patterns and geographic distribution of BD was assessed in Vietnam using a seasonal-trend decomposition procedure based on loess. In addition, negative binomial regression models were used to determine the climate risk factors associated with the incidence of BD in Kon Tum Province, from 1999 to 2013. Results Overall, incidence rates of BD have slightly decreased over time (except for an extremely high incidence in 2012 in the north of Vietnam). The central regions (north/south central coast and central highlands) had relatively high incidence rates, whereas the northwest/east and Red River Delta regions had low incidence rates. Overall, seasonal plots showed a high peak in the mid-rainy reason and a second smaller peak in the early or late rainy season. The incidence rates significantly increased between May and October (“wet season”) across the country. In Kon Tum Province, temperature, humidity, and precipitation were found to be positively associated with the incidence of BD. Conclusions Our findings provide insights into the seasonal patterns and geographic distribution of BD in Vietnam and its associated climate risk factors in Kon Tum Province. This study may help clinicians and the general public to better understand the timings of outbreaks and therefore equip them with the knowledge to plan better interventions (such as improving water, sanitation, and hygiene conditions) during peak seasons. This can, in turn, prevent or reduce outbreaks and onwards transmission during an outbreak. Electronic supplementary material The online version of this article (doi:10.1186/s40249-017-0325-z) contains supplementary material, which is available to authorized users.

Dengue is a growing problem in Hanoi, with cyclical epidemics of increasing frequency and magnitude. In June 2019, we conducted a cross-sectional survey using mixed methods to investigate how inhabitants of Hanoi perceive and respond to the risk of mosquito-borne diseases (MBD). A total of 117 participants recruited using a stratified random sampling method were interviewed in three districts of Hanoi. Knowledge and practices (KP) regarding MBDs were assessed using a pre-tested questionnaire. Inferential statistics were used to identify factors associated with KP scores and describe the relationship between variables. Additionally, a “risk-mapping” exercise was conducted in a subsample through semi-structured interviews and analyzed qualitatively and quantitatively using the System Effects platform. Factors significantly associated with knowledge scores were education and family history of MBDs. While knowledge and practice scores were found to be positively correlated in the statistical analysis, this was not corroborated by our observations on the field. The results also revealed gaps in knowledge about MBDs and vectors and highlighted a general feeling of powerlessness which prevented the adoption of protective behaviors. Therefore, educational interventions which provide concrete tools to empower communities should have a positive impact on improving vector control.

BackgroundLeptospirosis is an important zoonotic disease with a global distribution, affecting a wide range of mammalian animals and humans. Japanese encephalitis (JE) virus is the major vector-borne zoonotic disease in the Asia-Pacific region. The main objective of this study was to evaluate the seroprevalence of serovar-specific Leptospira and JE in swine from 10 provinces in Vietnam.MethodsSamples were initially collected for swine influenza surveillance from March to April 2017 at large-scale farms (with at least 50 sows and/or 250 fattening pigs) with pigs that tested positive for influenza in the previous surveillance period (2015-16).FindingsA total of 2,000 sera samples were analyzed from 10 provinces. Overall, the seroprevalence of leptospirosis was 21.05% (95% CI: 19.28-22.90) using a cut-off titer of ≥ 1:100. The apparent prevalence of JE was 73.45% (95% CI: 71.46-75.37) while the true prevalence was slightly higher (74.46%, 95% credible interval: 73.73-86.41). We found a relatively high presence of leptospirosis and JE in pigs kept on large farms. Prevalence was comparable with other studies suggesting opportunistic testing of samples collected for other surveillance purposes can be a valuable tool to better understand and prevent the potential transmission of these zoonotic diseases from pigs to people in Vietnam.ConclusionOur study provides evidence to veterinarians and animal health professionals for evidence-based practice such as diagnosis, vaccination and zoonotic control. Further investigation into the possible role of different domestic animals, wildlife species or environmental factors is needed to identify the potential risk factors and transmission routes in Vietnam.

Interventions designed to reduce the burden of foodborne illness often require value chain actors to alter undesired and risky behaviours. This desired behavioural change may be supported by 'nudge theory', a sub-field of behavioural economics, which describes how individuals can be encouraged, or 'nudged', to act in ways which produce net societal benefits without restricting freedom of choice. This research aimed to investigate the use of nudges in the pork value chain in Vietnam. Key informant interviews (n = 12) were initially utilised to document the type of nudges being used within existing food safety interventions, followed by a questionnaire-based survey (n = 132) to describe the behavioural elements of pork value chain actors which could be amenable to nudging. Finally, a workshop was conducted to measure the response of stakeholders (n = 30) to various nudge elements which could be used to support future food safety interventions. Key informant interviews demonstrated that the use of behavioural nudges were a common aspect of food safety interventions in the pork value chain in Hanoi and Hung Yen Province. Survey participants reported that when considering food safety, veterinarians and actors' peers were highly trusted, and reputation was thought to be an effective incentive to illicit behavioural change. During the workshop, stakeholders appeared aware of the major slaughter and retail contamination points and cited lack of access to improved infrastructure as the limiting factor in their ability to improve hygiene. Value chain actors reported positive responses to the concept of using posters containing photographic images as nudges and stipulated that media should reflect the local context and contain language framed to suit the target audience. We suggest that the findings of this study are used to create site specific nudges for the Vietnamese pork industry targeting key value chain actors, such slaughterhouse workers and traditional retailers, which should be tested in the field to investigate their effectiveness.

Aquaculture systems are highly complex, dynamic and interconnected systems influenced by environmental, biological, cultural, socio-economic and human behavioural factors. Intensification of aquaculture production is likely to drive indiscriminate use of antibiotics to treat or prevent disease and increase productivity, often to compensate for management and husbandry deficiencies. Surveillance or monitoring of antibiotic usage (ABU) and antibiotic resistance (ABR) is often lacking or absent. Consequently, there are knowledge gaps for the risk of ABR emergence and human exposure to ABR in these systems and the wider environment. The aim of this study was to use a systems-thinking approach to map two aquaculture systems in Vietnam – striped catfish and white-leg shrimp – to identify hotspots for emergence and selection of resistance, and human exposure to antibiotics and antibiotic-resistant bacteria. System mapping was conducted by stakeholders at an interdisciplinary workshop in Hanoi, Vietnam during January 2018, and the maps generated were refined until consensus. Thereafter, literature was reviewed to complement and cross-reference information and to validate the final maps. The maps and component interactions with the environment revealed the grow-out phase, where juveniles are cultured to harvest size, to be a key hotspot for emergence of ABR in both systems due to direct and indirect ABU, exposure to water contaminated with antibiotics and antibiotic-resistant bacteria, and duration of this stage. The pathways for human exposure to antibiotics and ABR were characterised as: occupational (on-farm and at different handling points along the value chain), through consumption (bacterial contamination and residues) and by environmental routes. By using systems thinking and mapping by stakeholders to identify hotspots we demonstrate the applicability of an integrated, interdisciplinary approach to characterising ABU in aquaculture. This work provides a foundation to quantify risks at different points, understand interactions between components, and identify stakeholders who can lead and implement change., Graphical abstract Unlabelled Image, Highlights • The contribution of aquaculture to antibiotic resistance is not well understood. • Systems mapping was used for two aquaculture systems in Vietnam. • Hotspots were identified for the emergence/selection of antibiotic resistance. • Human exposure points to antibiotics and antibiotic-resistant bacteria were mapped. • Findings inform risk quantification and identification of stakeholders to effect change.

To quantify salmonellosis risk in humans through consumption of boiled pork in urban Hung Yen Province, Vietnam, using a quantitative microbial risk assessment. We collected 302 samples along the pork value chain in Hung Yen between April 2014 and February 2015. We developed a model in @Risk, based on microbiological, market, and household surveys on cooking, cross-contamination and consumption, and conducted sensitivity analysis. Salmonella prevalence of pen floor swabs, slaughterhouse carcasses and cut pork were 33.3, 41.7 and 44.4%, respectively. The annual incidence rate of salmonellosis in humans was estimated to be 17.7% (90% CI 0.89–45.96). Parameters with the greatest influence risk were household pork handling practice followed by prevalence in pork sold in the central market. Wide confidence interval in the incidence estimate was mainly due to the variability in the degree of reduction in bacteria concentration by cooking, and pork consumption pattern. The risk of salmonellosis in humans due to boiled pork consumption appears to be high. Control measures may include improving the safety of retailed pork and improving household hygiene.

This study assesses the risk of exposure to hazardous chemical residues in pork meat, liver, and kidney collected at wet markets in Nghe An and Hung Yen provinces and discusses health impact implication. 514 pig feed, kidney, liver, and pork samples were pooled and qualitatively and quantitatively analyzed for tetracyclines, fluoroquinolones, sulphonamide, chloramphenicol, β-agonists, and heavy metals. We compare the results with current regulations on chemical residues and discuss health implications. Legal antibiotics were found in feed. Tetracycline and fluoroquinolones were not present in pork, but 11% samples were positive with sulfamethazine above maximum residue limits (MRL); 11% of packaged feed and 4% of pork pooled samples were positive for chloramphenicol, a banned substance; two feed, two liver, and one pork samples were positive for β-agonists but did not exceed current MRL; 28% of pooled samples had lead, but all were below MRL; and all samples were negative for cadmium and arsenic. Thus, the health risks due to chemical hazards in pork in Hung Yen and Nghe An seemed not as serious as what were recently communicated to the public on the mass media. There is potential exposure to sulphonamide, chloramphenicol, and β-agonists from pork. Risk communication needs to focus on banned chemicals, while informing the public about the minimal risks associated with heavy metals.

In Vietnam, Japanese encephalitis virus accounts for 12-71% of viral encephalitis (VE) cases followed by enteroviruses and dengue virus among identified pathogens. This study is the first attempt to evaluate the seasonality of VE and associated environmental risk factors in two provinces from 2004 to 2013 using a seasonal trend-decomposition procedure based on loess regression and negative binomial regression models. We found seasonality with a peak of VE in August and June in Son La and Thai Binh, respectively. In Son La, the model showed that for every 1°C increase in average monthly temperature, there was a 4.0% increase in monthly VE incidence. There was a gradual decline in incidence rates as the relative humidity rose to its mean value (80%) and a dramatic rise in incidence rate as the relative humidity rose past 80%. Another model found that a 100 mm rise in precipitation in the preceding and same months corresponded to an increase in VE incidence of 23% and 21%, respectively. In Thai Binh, our model showed that a 1°C increase in temperature corresponded with a 9% increase in VE incidence. Another model found that VE incidence increased as monthly precipitation rose to its mean value of 130 mm but declined gradually as precipitation levels rose beyond that. The last model showed that a monthly increase in duration of sunshine of 1 hour corresponded to a 0.6% increase in VE incidence. The findings may assist clinicians by improving the evidence for diagnosis.

The use of wastewater in agriculture and aquaculture has a long tradition throughout Asia. For example, in Hanoi, it creates important livelihood opportunities for >500,000 farmers in peri-urban communities. Discharge of domestic effluents pollute the water streams with potential pathogenic organisms posing a public health threat to farmers and consumers of wastewater-fed foodstuff. We determined the effectiveness of Hanoi's wastewater conveyance system, placing particular emphasis on the quality of wastewater used in agriculture and aquaculture. Between April and June 2014, a total of 216 water samples were obtained from 24 sampling points and the concentrations of total coliforms (TC), Escherichia coli, Salmonella spp. and helminth eggs determined. Despite applied wastewater treatment, agricultural field irrigation water was heavily contaminated with TC (1.3×10(7)colony forming unit (CFU)/100mL), E. coli (1.1×10(6)CFU/100mL) and Salmonella spp. (108 most probable number (MPN)/100mL). These values are 110-fold above Vietnamese discharge limits for restricted agriculture and 260-fold above the World Health Organization (WHO)'s tolerable safety limits for unrestricted agriculture. Mean helminth egg concentrations were below WHO tolerable levels in all study systems (

In resource-constrained settings, the recovery of nutrients and the production of energy from liquid and solid waste are important. We determined the range and magnitude of potential community health impacts of six solid and liquid waste recovery and reuse business models in Hanoi, Vietnam. We employed a health impact assessment (HIA) approach using secondary data obtained from various sources supplemented with primary data collection. For determining the direction (positive or negative) and magnitude of potential health impacts in the population, a semiquantitative impact assessment was pursued. From a public health perspective, wastewater reuse for inland fish farming, coupled with on-site water treatment has considerable potential for individual and community-level health benefits. One of the business models investigated (i.e. dry fuel manufacturing with agro-waste) resulted in net negative health impacts. In Hanoi, the reuse of liquid and solid waste—as a mean to recover water and nutrients and to produce energy—has considerable potential for health benefits if appropriately managed and tailored to local contexts. Our HIA methodology provides an evidence-based decision-support tool for identification and promotion of business models for implementation in Hanoi.

Pork is the most commonly consumed meat in Vietnam, and Salmonella enterica is a common contaminant. This study aimed to assess potential S. enterica cross-contamination between raw and cooked pork in Vietnamese households. Different scenarios for cross-contamination were constructed based on a household survey of pork handling practices (416 households). Overall, 71% of people used the same knife and cutting board for both raw and cooked pork, however, all washed their hands and utensils between handling raw and cooked pork. The different scenarios were experimentally tested. First, S. enterica was inoculated on raw pork and surfaces (hands, knives and cutting boards), next, water used for washing and pork were sampled to identify the presence and concentration of S. enterica during different scenarios of food preparation. Bootstrapping techniques were applied to simulate transfer rates of S. enterica cross-contamination. No cross-contamination to cooked pork was observed in the scenario of using the same hands with new cutting boards and knives. The probability of re-contamination in the scenarios involving re-using the cutting board after washing was significantly higher compared to the scenarios which used a new cutting board. Stochastic simulation found a high risk of cross-contamination from raw to cooked pork when the same hands, knives and cutting boards were used for handling raw and cooked pork (78%), when the same cutting board but a different knife was used, cross-contamination was still high (67%). Cross-contamination between was not seen when different cutting boards and knives were used for cutting raw and cooked pork. This study provided an insight into cross-contamination of S. enterica, given common food handling practices in Vietnamese households and can be used for risk assessment of pork consumption.

BACKGROUND: The Sustainable Development Goals include commitments to end poverty, and promote education for all, gender equality, the availability of water and decent work for all. An important constraint is the fact that each day, many millions of women and children, and much less frequently men, carry their household's water home from off-plot sources. The burden of fetching water exacerbates gender inequality by keeping women out of education and paid employment. Despite speculation about the potential health impacts of fetching water, there is very little empirical evidence. We report the first large study of the health impacts of carrying water on women and children. METHODS: A cross-sectional survey was conducted in South Africa, Ghana and Vietnam during 2012. It investigated water carrying methods and health status. Because areas of self-reported pain were correlated we undertook factor analysis of sites of reported pain, to interpret patterns of pain reporting. Regression analysis using Generalised Estimating Equations (GEE) investigated water carrying as a risk factor for general health and self-reported pain. RESULTS: People who previously carried water had increased relative risk of reporting pain in the hands (risk ratio RR 3.62, 95% confidence interval CI 1.34 to 9.75) and upper back (RR 2.27, 95% CI 1.17 to 4.40), as did people who currently carry water (RR hand pain 3.11, 95% CI 1.34 to 7.23; RR upper back pain 2.16, 95% CI 1.25 to 3.73). The factor analysis results indicate that factor 1, 'axial compression', which is correlated with pain in the head and upper back, chest/ribs, hands, feet and abdomen/stomach, is associated with currently (0.30, 95% CI 0.17 to 0.43) or previously (0.21, 95% CI 0.01 to 0.42) carrying water. Factor 2, 'soft tissue strain', which is correlated with pain in the neck, shoulders/arms, lower back and hips/pelvis or legs, is marginally negatively associated with currently (-0.18, 95% CI -0.32 to -0.04) carrying water. The factor 'axial compression' was more strongly associated with carrying water containers on the head. CONCLUSIONS: Participants who reported a history of current or past water carrying more frequently reported pain in locations most likely to be associated with sustained spinal axial compression in the cervical region. Given the fact that cervical spinal conditions are globally one of the more common causes of disability, our findings suggest that water carrying, especially by head loading is a major contributing factor in musculoskeletal disease burden in low income countries. Our findings support the proposed indicator for monitoring SDG6.1: "Percentage of population using safely managed drinking water services at home."

Lithocarpus vuquangensis Ngoc & Hung is described from Vu Quang National Park, North Central Vietnam. The morphological comparison and phylogenetic analysis based on rbcL, matK and ITS provided evidence that the new species was not assignable to any of the previously known taxa in Vietnam and its surrounding countries. The description, photographs, preliminary conservation status and DNA barcode sequences are also provided for the new species.

This article characterizes the health risk perceptions toward excreta and wastewater management practices among waste management stakeholders in Vietnam and explores the implications of such perceptions on hygiene behaviors and preventative actions. Key informant interviews (n = 19, 12 women and 7 men) were conducted with farmers, community leaders, researchers, and government representatives in Hanoi and Ha Nam Province. Interviews were audio-recorded with permission, transcribed, and analyzed using a constant comparative method and qualitative thematic analysis. Researchers and government representatives perceived that the lack of knowledge of safe waste management practices among farmers was responsible for the use of &ldquo, outdated&rdquo, and often &ldquo, unsafe&rdquo, waste management practices. However, many farmers were aware of the health risks and safe hygienic practices but felt that safety measures were impractical and viewed susceptibility to diseases as low risk. Farmers also identified unfavorable climate and working conditions, limited financial capacity, and limited farm space as barriers to adopting safe management practices. At the broader level, inadequate communication between ministries often led to the creation of inconsistent waste management regulations. These barriers create constraints on efforts to improve sustainable waste management practices. Promoting collaboration between sectors, encouraging farmer-to-farmer knowledge sharing, and designing and implementing risk communication strategies that account for risk perceptions of stakeholders are recommended.