Alcohol use and HIV risk behaviors among rural adolescents in Khanh Hoa Province Viet Nam

Research suggests that youth are consuming more alcohol and at younger ages than in the past. Data also indicate that alcohol consumption is associated with participation in other risk behaviors including aggression and sexual behaviors. As part of a randomized control effectiveness trial for an HIV prevention program, 480 Vietnamese youth (15-20 years old) living in eight rural communes in Khanh Hoa Province were administered a paper and pencil baseline evaluation. The evaluation included items for actual and intended alcohol use, perceptions of peers' alcohol consumption, and attitudinal questions regarding alcohol. The tool included questions on engagement and intention to engage in sexual behaviors. In addition, 96 randomly selected youth participated in qualitative interviews on similar topics. Among the 480 surveyed youth, 29.2% had consumed alcohol. Among those youth, 17.6% reported intoxication in the past 6 months. While young men were significantly more likely to drink than young women (P < 0.00), those young women who did drink were as likely to report intoxication. Alcohol use was significantly associated with engagement in sexual behaviors (P < 0.00) and intention to engage in sexual behaviors (P < 0.02). The qualitative data provided information on the social contexts of drinking behaviors and more in-depth findings regarding associated risk behaviors. With limited information about alcohol consumption among Vietnamese youth, these findings suggest that there is a need for more extensive research on alcohol use and associated risk behaviors among this population, and for targeted alcohol prevention and harm-reduction programs.     

Common perinatal mental disorders in northern Viet Nam: community prevalence and health care use

Objective

To establish the prevalence of common perinatal mental disorders their determinants, and their association with preventive health care use among women in one rural and one urban province in northern Viet Nam.

Methods

We conducted a cross-sectional survey of cohorts of pregnant women and mothers of infants recruited systematically in 10 randomly-selected communes. The women participated in psychiatrist-administered structured clinical interviews and separate structured interviews to assess sociodemographic factors, reproductive health, the intimate partner relationship, family violence and the use of preventive and psychiatric health care. Associations between these variables and perinatal mental disorders were explored through univariate analyses and multivariable logistic regression.

Findings

Among women eligible for the study (392), 364 (93%) were recruited. Of these, 29.9% (95% confidence interval, CI: 25.20–34.70) were diagnosed with a common perinatal mental disorder (CPMD). The frequency of such disorders during pregnancy and in the postpartum period was the same. Their prevalence was higher among women in rural provinces (odds ratio, OR: 2.17; 95% CI: 1.19–3.93); exposed to intimate partner violence (OR: 2.11; 95% CI: 1.12–3.96); fearful of other family members (OR: 3.36; 95% CI: 1.05–10.71) or exposed to coincidental life adversity (OR: 4.40; 95% CI: 2.44–7.93). Fewer women with a CPMD used iron supplements than women without a CPMD, but the results were not statistically significant (P = 0.05). None of the women studied had ever received mental health care.

Conclusion

Perinatal depression and anxiety are prevalent in women in northern Viet Nam. These conditions are predominantly determined by social factors, including rural residence, poverty and exposure to family violence. At present the needs of women with common perinatal mental disorders are unrecognized and not attended to and their participation in essential antenatal preventive care appears to be compromised.     

厦门市碘盐浓度调整后妊娠期妇女碘营养状况

目的掌握GB 26878-2011《食用盐碘含量》标准执行后,厦门市妊娠期妇女碘营养状况,为卫生策略的制定提供依据。方法选择厦门市翔安区新店镇为调查点,调查妊娠期妇女食用新标准碘盐前后家中的碘盐覆盖率、合格碘盐食用率、尿碘、尿比重水平。结果基线调查及新标准实施后第1到第5次评估,妊娠期妇女家庭碘盐覆盖率均达到100%,盐碘中位数分别为27.8、25.7、24.3、23.7、24.3和25.8 mg/kg,5次评估的碘盐含量均比基线调查明显减少（均P〈0.01）;基线调查及5次评估测得尿碘中位数分别为103.8、128.5、138.9、100.2、97.1和96.2μg/L,第2次自评尿碘含量比基线调查高（P〈0.05）,第1、第3、第4、第5次评估的尿碘水平与基线调查尿碘水平差异无统计学意义（均P〉0.05）;基线调查及5次评估测得尿比重均数分别为1.0123、1.0153、1.0180、1.0143、1.0141和1.0132。第1、2、3次评估的尿比重水平均高于基线调查尿比重水平（均P〈0.05）,但第4、第5次评估的尿比重水平与基线调查间差异均无统计学意义（均P〉0.05）。结论新标准实施后,妊娠期妇女家中食盐含碘量显著减少,新标准实施前后妊娠期妇女均处于碘营养不足状态,需加强该人群碘营养,保障下一代健康。     

碘缺乏病区食用碘盐和碘油碘盐并用学生碘营养状况

目的：观察新确定碘缺乏病区食用碘盐和碘油碘盐并用的两组学生防治前后甲肿率和尿碘水平；补碘后甲肿学生的甲状腺体积回缩情况。方法：在观察前和观察1年后检测学生甲状腺体积和尿碘，甲状腺体积用日本Aloks SSD 500型B超仪测量，尿碘含量用酸消化砷－铈接触法测定。结果：碘盐防 且学生甲肿率由8．8％下降到7．3％，尿碘水平由77．1μg/L 上升到138．0μg/L；碘油碘盐防治组学生甲肿率由9．7％下降到3％，尿碘水平由86．3μg/L上升到283．2μg/L。结论：原“非碘缺乏病区”学生也存在碘营养不足；补碘防治1年碘油碘盐并用组学生甲肿率、尿碘水平均达到消除碘缺乏病的指标，而食用碘盐组学生甲肿率未达标。     

新国标碘盐浓度下贵州省儿童、孕妇碘营养状况调查

目的 了解和掌握新国标碘盐浓度(GB26878-2011)实施后贵州省儿童、孕妇碘营养状况及其碘缺乏病病情动态,完善长效防控机制,为制定碘缺乏病防制策略提供依据。 方法 采取人口比例概率抽样方法(PPS),在全省抽取30个县(市、区),每个县(市、区)随机抽取1所小学,每所小学抽取8～10岁儿童50名(男女各半、各年龄组均匀分布),B超检查甲状腺容积,检测尿碘及其家中食盐碘含量;在抽中小学所在乡(镇、街道办事处)随机采集20名孕妇即时尿样1份,检测尿碘含量。 结果 共检查8～10岁儿童1 536名,甲状腺肿大13人,甲状腺肿大率为0.85%;检测儿童尿样1 538份,尿碘中位数为218.3μg/L;检测居民户食用盐样1 538份,盐碘中位数为26.6mg/kg,碘盐覆盖率为99.6%,合格碘盐食用率92.1%,非碘盐率为0.4%。检测孕妇尿样594份,尿碘中位数为175.6μg/L。 结论 我省实行的新国标碘盐浓度基本满足儿童、孕妇碘营养需求,人群碘营养水平总体适宜、平稳。     

Identifying factors for job motivation of rural health workers in North Viet Nam

BACKGROUND: In Viet Nam, most of the public health staff (84%) currently works in rural areas, where 80% of the people live. To provide good quality health care services, it is important to develop strategies influencing staff motivation for better performance. METHOD: An exploratory qualitative research was carried out among health workers in two provinces in North Viet Nam so as to identify entry points for developing strategies that improve staff performance in rural areas. The study aimed to determine the major motivating factors and it is the first in Viet Nam that looks at health workers' job perception and motivation. Apart from health workers, managers at national and at provincial level were interviewed as well as some community representatives. RESULTS: The study showed that motivation is influenced by both financial and non-financial incentives. The main motivating factors for health workers were appreciation by managers, colleagues and the community, a stable job and income and training. The main discouraging factors were related to low salaries and difficult working conditions. CONCLUSION: Activities associated with appreciation such as performance management are currently not optimally implemented, as health workers perceive supervision as control, selection for training as unclear and unequal, and performance appraisal as not useful. The kind of non-financial incentives identified should be taken into consideration when developing HRM strategies. Areas for further studies are identified.     

The use of a computerized database to monitor vaccine safety in Viet Nam

Health information systems to monitor vaccine safety are used in industrialized countries to detect adverse medical events related to vaccinations or to prove the safety of vaccines. There are no such information systems in the developing world, but they are urgently needed. A large linked database for the monitoring of vaccine-related adverse events has been established in Khanh Hoa province, Viet Nam. Data collected during the first 2 years of surveillance, a period which included a mass measles vaccination campaign, were used to evaluate the system. For this purpose the discharge diagnoses of individuals admitted to polyclinics and hospitals were coded according to the International Classification of Diseases (ICD)-10 guidelines and linked in a dynamic population database with vaccination histories. A case-series analysis was applied to the cohort of children vaccinated during the mass measles vaccination campaign. The study recorded 107,022 immunizations in a catchment area with a population of 357,458 and confirmed vaccine coverage of 87% or higher for completed routine childhood vaccinations. The measles vaccination campaign immunized at least 86% of the targeted children aged 9 months to 10 years. No medical event was detected significantly more frequently during the 14 days after measles vaccination than before it. The experience in Viet Nam confirmed the safety of a measles vaccination campaign and shows that it is feasible to establish health information systems such as a large linked database which can provide reliable data in a developing country for a modest increase in use of resources.     

Assessing iodine status and monitoring progress of iodized salt programs

Despite remarkable progress in the control of the iodine deficiency disorders (IDD), they remain a significant global public health problem. Assessing the severity of IDD and monitoring the progress of salt iodization programs are cornerstones of a control strategy. Because thyroid size decreases only gradually in response to iodized salt, the goiter rate in children may be a poor IDD monitoring indicator for several years after the introduction of salt iodization. During this period, the goiter rate reflects chronic iodine deficiency, and will be inconsistent with measurements of urinary iodine. Thyroglobulin is a promising new biochemical indicator for monitoring thyroid function after the introduction of iodized salt. Recent development of a dried blood spot thyroglobulin assay makes sample collection practical even in remote areas. Interpretation of thyroid volume data from ultrasound surveys requires valid references from iodine-sufficient populations, but defining normal values for thyroid size in children has been difficult. New international reference criteria for thyroid volume were published recently and can be used for goiter screening in the context of IDD monitoring. Ensuring sustainability is one of the great remaining challenges in the global fight to eliminate IDD. A recent cohort study demonstrated the vulnerability of children in IDD-affected areas to even short-term lapses in iodized salt programs.     

Healthcare use for diarrhoea and dysentery in actual and hypothetical cases, Nha Trang, Viet Nam

To better understand healthcare use for diarrhoea and dysentery in Nha Trang, Viet Nam, qualitative interviews with community residents and dysentery case studies were conducted. Findings were supplemented by a quantitative survey which asked respondents which healthcare provider their household members would use for diarrhoea or dysentery. A clear pattern of healthcare-seeking behaviours among 433 respondents emerged. More than half of the respondents self-treated initially. Medication for initial treatment was purchased from a pharmacy or with medication stored at home. Traditional home treatments were also widely used. If no improvement occurred or the symptoms were perceived to be severe, individuals would visit a healthcare facility. Private medical practitioners are playing a steadily increasing role in the Vietnamese healthcare system. Less than a quarter of diarrhoea patients initially used government healthcare providers at commune health centres, polyclinics, and hospitals, which are the only sources of data for routine public-health statistics. Given these healthcare-use patterns, reported rates could significantly underestimate the real disease burden of dysentery and diarrhoea.     

Development of pandemic influenza vaccine production capacity in Viet Nam

The Institute of Vaccines and Medical Biologicals (IVAC), a state-owned vaccine manufacturer, initiated research into avian influenza vaccines in the early 1990 s in response to the threat of a highly pathogenic avian influenza pandemic. Successful results from laboratory studies on A(H5N1) influenza virus attracted seed funds and led to participation in the WHO technology transfer project to enhance influenza vaccine production in developing countries. IVAC's goal is to produce 500,000 doses of inactivated monovalent whole-virion influenza vaccine per year by 2012, and progressively increase capacity to more than 1 million doses to protect essential populations in Viet Nam in the event of an influenza pandemic. The WHO seed grants, supplemented by other international partner support, enabled IVAC to build in a very short time an influenza vaccine manufacturing plant under Good Manufacturing Practice and relevant biosafety standards, a waste treatment system and a dedicated chicken farm for high-quality eggs. Much of the equipment and instrumentation required for vaccine production has been installed and tested for functional operation. Staff have been trained on site and at specialized courses which provided comprehensive manuals on egg-based manufacturing processes and biosafety. Following process validation, clinical trials will start in 2011 and the first domestic influenza vaccine doses are expected in 2012.     

Cross-sectional study of sexual behaviour and knowledge about HIV among urban, rural, and minority residents in Viet Nam

OBJECTIVE: A cross-sectional survey was conducted in three districts of Quang Ninh province, Viet Nam, to find out what proportion of the people who lived there engaged in behaviour that put them at risk of becoming infected with HIV, and to measure their knowledge about HIV infection and AIDS. METHODS: The survey was conducted in a rural district, Yen Hung; a mountainous district inhabited primarily by ethnic minority groups, Binh Lieu; and an urban district, Ha Long. Participants aged 15-45 years were randomly selected from the general population to be interviewed. FINDINGS: A total of 630 people from 707 households were interviewed; 8% were not home despite repeated visits and 3% refused to participate. The prevalence of premarital intercourse ranged from 9% to 16% among married men and 4% to 7% among married women. Among single men the proportion who had ever had intercourse ranged from 6% to 16%. Fewer than 3% reported having ever had sex with a sex worker. The median number of extramarital sex partners was 1. Knowledge about HIV/AIDS was high in the urban and rural areas but low in the mountainous area. Being male and being 20-29 years old were associated with having multiple sex partners. CONCLUSION: The low prevalence of individuals reporting that they had had intercourse with sex workers and partners other than their spouse may explain the low rates of HIV infection among the heterosexual population; these rates are in contrast to the high rates of HIV infection found among injecting drug users. The association between having extramarital partners and being a younger man suggests that the tendency to have more sexual partners may increase in the future. If this happens, the potential for HIV to be spread through heterosexual sex will increase.     

Plague foci in Viet Nam: zoological and parasitological aspects.

Reported are the results of studies over the period 1989-94 on host-flea complexes in small mammals and their flea ectoparasites in and around a number of human settlements in Viet Nam in which human cases of plague had been found. Collections were also made in savanna and tropical forest areas within a 10-km radius of the settlements. The greatest numbers of small mammals, for the most part Rattus spp., and of the flea ectoparasite Xenopsylla cheopis were found in inhabited areas. X. cheopis was not found on any feral or sylvan mammal further than 0.6 km from settlements. A possible link between wild and commensal mammals may be provided by the flea Lentistivalius klossi, a specific parasite of squirrels and tree-shrews but also found in very small numbers on commensal rats. No zoonotic foci of plague were found in the immediate vicinity of the villages studied and it is most likely that plague persists in a commensal rat-X. cheopis cycle in and around human settlements in Viet Nam.     

Incidence of postpartum infection after vaginal delivery in Viet Nam

This study assessed the incidence of postpartum infection which is rarely clinically evaluated and is probably underestimated in developing countries. This prospective study identified infection after vaginal delivery by clinical and laboratory examinations prior to discharge from hospital and again at six weeks postpartum in Ho Chi Minh City, Viet Nam. Textbook definitions, physicians' diagnoses, symptomatic and verbal autopsy definitions were used for classifying infection. Logistic regression was used for determining associations of postpartum infection with socioeconomic and reproductive characteristics. In total, 978 consecutive, eligible consenting women were followed up at 42+/-7 (range 2-45) days postpartum (not associated with incidence). Ninety-eight percent took 'prophylactic' antibiotics. The most conservative estimate of the incidence of postpartum infection was 1.7%. The incidence of serious infection was 0.5%, but increased to 4.6% when verbal autopsy and symptomatic definitions were used. Postpartum infection, particularly serious infection, is greatly underestimated. Just preventing or treating infection could have a substantial impact on reducing maternal mortality in developing countries.     

出入境越南籍船舶的卫生现状及检疫措施

[目的] 了解来自越南的船舶卫生状况，探讨对来自越南的船舶的检疫措施。[方法] 对1997～2002年来自越南的越南籍船舶的卫生检疫情况进行总结和分析。[结果] 1997～2002年共检疫513艘次船舶，其中卫生状况良好的占船舶总数的19．1％；一般的占25．3％；差的占55．6％；虫患阳性率为30．8％；鼠患阳性率为24．6％。鼠虫患情况与船舶卫生状况和船上不同位置有关。[结论] 越南籍船舶的卫生状况较差，鼠虫患程度较为严重，检验检疫机关应加强来自越南的船舶的检疫监管工作。     

Multiple types of child maltreatment and adolescent mental health in Viet Nam

Objective

To examine the prevalence of multiple types of maltreatment (MTM), potentially confounding factors and associations with depression, anxiety and self-esteem among adolescents in Viet Nam.

Methods

In 2006 we conducted a cross-sectional survey of 2591 students (aged 12–18 years; 52.1% female) from randomly-selected classes in eight secondary schools in urban (Hanoi) and rural (Hai Duong) areas of northern Viet Nam (response rate, 94.7%). Sequential multiple regression analyses were performed to estimate the relative influence of individual, family and social characteristics and of eight types of maltreatment, including physical, emotional and sexual abuse and physical or emotional neglect, on adolescent mental health.

Findings

Females reported more neglect and emotional abuse, whereas males reported more physical abuse, but no statistically significant difference was found between genders in the prevalence of sexual abuse. Adolescents were classified as having nil (32.6%), one (25.9%), two (20.7%), three (14.5%) or all four (6.3%) maltreatment types. Linear bivariate associations between MTM and depression, anxiety and low self-esteem were observed. After controlling for demographic and family factors, MTM showed significant independent effects. The proportions of the variance explained by the models ranged from 21% to 28%.

Conclusion

The combined influence of adverse individual and family background factors and of child maltreatment upon mental health in adolescents in Viet Nam is consistent with research in non-Asian countries. Emotional abuse was strongly associated with each health indicator. In Asian communities where child abuse is often construed as severe physical violence, it is important to emphasize the equally pernicious effects of emotional maltreatment.