An introduction to the health system in Vietnam

After independence, the Vietnamese government made an enormous effort to construct a comprehensive health care network from the central down to the grass roots levels, however, the health situation of the population has not improved as much as was expected. The most fundamental cause is poverty, as it is in other developing countries. Because of poverty, the means to achieve a safer environment such as sanitation, safe drinking, water and adequate nutrition, is often absent. Inefficient administration due to the sectionalism among different organizations makes the situation worse. With the introduction of a market policy in 1986, privatization has been introduced into the health sector in order to address some of the inadequacies inherent in the current system. Although privatization might reduce public health expenditures by reducing utilization pressure on public facilities, it deprives the most vulnerable inhabitants of health services. An erratum to this article is available at .     

四川口岸输入性疟疾疫情监测结果分析

目的分析输入性疟疾在四川口岸出入境人群中的流行特征及流行趋势,为制定防治对策和措施提供科学依据。方法收集2008-2013年期间,在四川国际旅行卫生保健中心进行传染病监测体检的出入境人员疟疾检出情况,对人群分布、时间分布、疫源地分布等进行描述性分析。结果共报告输入性疟疾病例32例,大部分为归国劳务男性青壮年,疫源地均为非洲国家。结论近年来四川口岸出入境人群中疟疾病例逐渐增多,需进一步加强防治知识宣传和行为干预工作,采取有力措施降低输入性疟疾带来的危害。     

2008-2012年舟山市流动人口疟疾监测分析

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中国突发公共卫生事件监测系统评价指标体系初探

目的 探索建立我国突发公共卫生事件监测系统评价指标体系,为开展突发公共卫生事件报告质量评价工作提供依据.方法 结合我国突发公共卫生事件监测系统的特点,通过文献综述初步设计指标框架,采用Delphi法对效度与信度进行评价,进而遴选出指标体系.结果 突发公共卫生事件监测系统评价指标分为3级:一级指标4项(包括组织体系、网络平台、监测报告和分析利用),二级指标16项,三级指标70项.在一级指标中,组织体系14项,占20.00%;网络平台21项,占30.00%;监测报告24项,占34.29%;分析利用11项,占15.71%.各指标重要性平均得分为4.29(3.77～4.94)分,平均变异系数为0.14(0.12～0.16).各指标α信度系数均数为0.84(0.81～0.89).不同指标适用的评估对象不同.结论 本指标体系一级指标符合监测系统的特征及目的;二级指标明确了管理控制的核心内容;三级指标可获得性、操作性强.本指标专家认同率高,效度与信度良好,对开展突发公共卫生事件监测系统评估工作具有参考意义.     

2001-2009年浙江省慈溪市疟疾监测分析

目的分析慈溪市2001-2009年疟疾流行特征,指导疟疾防治。方法用回顾性流行病学方法对慈溪市2001-2009年疟疾发病资料进行分析。结果 2001-2009年全市共检出135例疟疾病例,除1例为本地人口外出输入性感染,余均为外来人口输入性病例,外来流动人口疟疾平均年发病率2.17/10万;患者年龄主要为20～39岁,职业以民工为主;病原以间日疟为主,占99.26%。结论 9年来慈溪市在疟疾防治工作中取得了显著成绩,但由于流动人口带来的输入性病例时有发生,疟疾防治工作仍不可松懈。     

2004-2008年浙江省湖州市吴兴区疟疾监测动态分析

目的分析浙江省湖州市吴兴区2004-2008年疟疾监测动态,为及时修订防治措施提供依据。方法根据吴兴区2004-2008年疫情报表和个案调查表提供的资料,进行血检情况、病例特征分析。结果吴兴区2004-2008年对＂三热＂病人共血检6142例,发现疟疾病例26例,以输入性病例为主,4-11月各月均有病例发生,主要集中在7、8、10月,病例主要集中在织里镇、道场乡等流动人口聚集地,男女之比为2.25∶1,年龄分布在7～74岁之间。结论应重点针对流动人口开展＂三热＂病人血检、病例主动搜索及健康教育工作,并适时延长疟疾常规监测时间,提高疟疾病例发现率,巩固当前防制效果。     

Evaluation of a real-time PCR assay for malaria diagnosis in patients from Vietnam and in returned travellers

Real-time PCR diagnosis of malaria has advantages over traditional microscopic methods, especially when parasitaemia is low and when dealing with mixed infections. We have developed a new real-time PCR with specific genes in each Plasmodium species present only in one copy to identify the four pathogenic Plasmodium spp. for humans. The sensitivity was less than 25 parasites/microl. No cross-hybridisation was observed with human DNA or among the four Plasmodium spp. Using LightCycler PCR and conventional microscopy, we compared the diagnosis of malaria in patients from Vietnam and in returned European travellers with suspicion of malaria. In patients from Vietnam with suspicion of malaria, one mixed infection was observed by PCR only; the remaining data (54 of 55 patients) correlated with microscopy. In 79 patients without symptoms, low parasitaemia was detected in 7 samples by microscopy and in 16 samples by PCR. In returned travellers, PCR results were correlated with microscopy for all four species in 48 of 56 samples. The eight discrepant results were resolved in favour of real-time PCR diagnosis. This new real-time PCR is a rapid, accurate and efficient method for malaria diagnosis in returned travellers as well as for epidemiological studies or antimalarial efficiency trials in the field.     

Health system research in Vietnam: Generating policy-relevant knowledge

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.     

海南省新生儿破伤风监测系统的建立及运行效果分析

目的　掌握新生儿破伤风（ Ｎ Ｎ Ｔ） 实际发病水平及发病因素,以便为制定消除策略提供依据,海南省于１９９７ 年开展了 Ｎ Ｎ Ｔ 监测工作。方法　监测运用急性弛缓性麻痹（ Ａ Ｆ Ｐ） 监测方法,并与之同时运行。结果　全年共监测病例２１６ 例,远高于疫情报告７８ 例。监测结果表明：在家分娩、旧法接生是发病主因。病儿母亲８８ ．８９ ％ 无破伤风类毒素（ Ｔ Ｔ） 免疫史。三亚市、琼中县的监测资料表明,由于育龄妇女 Ｔ Ｔ 免疫率提高, Ｎ Ｎ Ｔ 发病率较１９９６ 年分别下降６１ ．２９ ％ 、８２ ．０５ ％ 。结论　提高育龄妇女 Ｔ Ｔ 接种率是实现消除 Ｎ Ｎ Ｔ 最经济简便的措施,将 Ｎ Ｎ Ｔ 监测工作纳入 Ａ Ｆ Ｐ监测系统同时运行是行之有效的。     

湖南省郴州市2003-2012年疟疾流行特征及监测效果研究

目的 了解郴州市疟疾流行特征及监测效果,为疟疾防治和消除提供科学依据.方法 运用描述性流行病学方法对郴州市2003-2012年疟疾流行病学及监测资料进行统计分析.结果 郴州市2003-2012年共报告疟疾病例41例,年平均发病率为0.09/10万,死亡1例,无暴发疫情;其中间日疟24例（58.54％）,恶性疟15例（36.58％）,三日疟2例（4.88％）;本地病例4例（9.76％）,输入性病例37例（90.24％）,93.33％（14/15）的恶性疟病例均由非洲输入;发热患者血检107 975人次,阳性率为3.43/万,疟疾病例实验室检测率和确诊率均为100％;传疟媒介主要以中华按蚊为主（86.04％）,蚊密度高峰出现在7-8月.结论 郴州市基本消除疟疾后,疟疾疫情控制在较低水平,病例以输入性为主,在今后的疟疾防治和消除工作中,应加强流动人口监测和发热患者血检.     

生育健康监测的电子化研究

目的：建立一套电子化的生育健康监测系统,使数据的采集、运转、汇总分析、信息反馈及管理等完全实现计算机化和网络化,进一步提高生育保健服务和科学管理水平,方法：采用先进的计算机技术和网络技术、在已有的国产保健监测、儿童保健监测和出生缺陷监测的基础上进行电子化研究,包括电子保健册、数据运转及信息反馈等系统的计算机程序设计和网络实现设计,结果：主要成果包括：（1）建立了电子数据采集系统;（2）建立了电子数据运转系统;（3）建立了电子信息反馈系统;（4）建立了相应的辅助系统。结论：这是国内首次建立的以人群为基础的生育健康电子监测系统,它具有许多优点和特点,解决了数据在采集,运转及反馈过程中的不准确性,不安全性和迟滞性等重大问题,目前,已在全国22个市（县）推广使用了这套电子监测系统,并收到很好效果。     

安徽省疟疾发病地理信息系统研究

目的建立疟疾发病地理信息系统模型，对疟疾发病情况进行空间分析。方法收集1950～2005年疟疾发病资料，使用EpiInfo3．3．2软件建立数据库并拟合地理信息系统模型。结果1970～1999年，疟疾发病率最高达到12156．42／10万，最低仅为1．32／10万，总体呈逐年下降趋势，平均下降速度为27．01％；2000～2005年，疫情出现回升，6年间疟疾发病率平均上升速度61．91％。结论安徽省疟疾历史上严重流行区在长江以北，重点在沿淮淮北地区；现阶段疟疾高发地区仍然徘徊在淮河流域及其以北地区，但发病范围可能有所扩大。     

地理信息系统在公共卫生领域的应用

地理信息系统（GIS）是一门综合性学科,具有海量空间数据管理分析、可视化结果展示等特点,已经广泛应用在不同的领域.近年来,GIS在流行病学研究、疾病监测、突发公共卫生事件应对、环境健康研究和卫生决策等方面发挥着重要作用,具有较好的应用前景.此文就GIS在公共卫生领域的应用研究进行综述.     

常熟市生育健康电子监测系统的推广应用

目的 推广应用生育健康电子监测系统,构建妇幼卫生信息网络。方法 以市妇幼保健院为中心建立与全市所有产科医院及乡镇卫生院相连接的星状数据传输系统,通过统一配置设备、培训人员、建章立制和定期检查等手段,使98.04％(300/306)的妇儿保健人员能正确操作电子监测系统;从婚检开始发放磁卡,把辖区内所有新婚妇女、孕产妇及0～6岁儿童均纳入监测范围。结果 经过1年多来的推广应用研究,妇幼保健管理模式发生了变革,实现了信息资源共享。全市所有妇幼保健对象得到了及时有效的卫生保健服务。2000年我市未发生孕产妇死亡,婴儿死亡率降至5.25 ％。(37/7 048)。医院经济收入有所增加。结论 推广该项目前景广阔,它将给广大妇女儿童带来全新、完善和高效的保健服务,同时也可使管理者获得相应的经济效益。     

Maternal social capital and child health in Vietnam

STUDY OBJECTIVE: To explore the association between maternal social capital and child physical and mental health in Vietnam. DESIGN: Cross sectional survey. Measures of maternal structural social capital comprised group membership, citizenship, and social support. Measures of cognitive social capital comprised trust, social harmony, sense of fairness, and belonging. Child health was measured by anthropometrics and mothers' reports of acute and chronic physical health problems and child mental health. PARTICIPANTS: 2907 mothers and their 1 year old or 8 year old children from five provinces in Vietnam. MAIN RESULTS: The study found low levels of group membership and citizenship and high levels of cognitive social capital and support, and generally higher levels of social capital among the mothers of 8 year old compared with 1 year old children. All but one association was in the hypothesised direction (that is, higher levels of social capital associated with reduced risk of child health problems). There were more statistically significant relations between maternal social capital and the health of 1 year olds compared with 8 year old children, and between measures of social support and cognitive social capital and child health, than with group membership and involvement in citizenship activities. CONCLUSION: This study is the first to explore the association between multiple dimensions of social capital and a range of different child health outcomes in the developing world. These results now need to be tested using longitudinal data.     

地理信息系统在疟疾控制研究中的应用

及时、准确地预测和预报疟疾疫情是控制疟疾流行的关键。地理信息系统在疟疾控制中的推广应用,为开展疟疾现场研究提供了有力的技术手段,并为决策者制定预防策略,赢取宝贵时间,以采取相应防治措施,减少社会和人民的经济损失。因此,近年来地理信息系统在疟疾控制与研究中发挥着日趋重要的作用。     

The use of a GIS-based malaria information system for malaria research and control in South Africa

The paper aims to outline the innovative development and application of a Geographical Information System based Malaria Information System for malaria research and control in South Africa. This system is a product of collaboration between the Malaria Control Programmes and the Malaria Research Programme of the Medical Research Council of South Africa. The ability of such a system to process data timeously into a usable format is discussed, as well as its relevance to malaria research, appropriate malaria control measures, tourism, and social and economic development.     

Integrating a project monitoring system into a public health network: Experiences from Alive & Thrive Vietnam

Little information is available about how to build a monitoring system to measure the output of preventive nutrition interventions, such as counselling on infant and young child feeding. This paper describes the Alive & Thrive Vietnam (A&T) project experience in nesting a large-scale project monitoring system into the existing public health information system (e.g. using the system and resources), and in using monitoring data to strengthen service delivery in 15 provinces with A&T franchises. From January 2012 to April 2014, the 780 A&T franchises provided 1,700,000 counselling contacts (~3/4 by commune franchises). In commune franchises in April 2014, 80% of mothers who were pregnant or with children under two years old had been to the counselling service at least one time, and 87% of clients had been to the service earlier. Monitoring data are used to track the progress of the project, make decisions, provide background for a costing study and advocate for the integration of nutrition counselling indicators into the health information system nationwide. With careful attention to the needs of stakeholders at multiple levels, clear data quality assurance measures and strategic feedback mechanisms, it is feasible to monitor the scale-up of nutrition programmes through the existing routine health information system.     

区域内慢性病病种质效分析在分级诊疗中的应用探索

目的 对2014年成都市不同级别医院不同病种的费用、治疗效果等方面进行综合评价,为分级诊疗下各级别医院的病种难易程度定位及病人就医流向提供数据支持。 方法 利用因子分析法构建不同级别医院不同病种的指标评价体系,得到相应得分及排序。 结果 在保证医疗质量与安全的前提下,各级别医院的优势病种显示出显著不同。 结论 不同级别医院应探索质效评价排名靠前的病种,明确医院定位,医保政策制定者应以病种分级管理为基础,制定差别化支付政策,从而引导病人理性就医。