Secondhand Smoke and Socio-Demographic Associated Factors: Results From the Vietnam Population-Based Provincial Global Adult Tobacco Survey in 2022.

Background: Secondhand smoke (SHS) has detrimental effects on community health, including coronary heart diseases, stroke, lung cancer etc. This manuscript exploited data from the Vietnam Population-based Provincial Global Adult Tobacco Survey (PGATS) in 2022 to update the prevalence of adult exposure to SHS and associated socio-demographic factors. Methods: With the sample size of 71,981 adults aged 15+ throughout 30 provinces and cities in Vietnam, data was collected using the Global Adult Tobacco Survey (GATS) questionnaire. Bivariate analysis and multivariate logistic regression modelling were performed. Results: In the past 30 days, 44.4% (95% CI: 44.0%-44.9%) adults aged 15+ exposed to SHS at home while 23.1% (95% CI: 22.6%-23.6%) exposed to SHS at work. Female exposure to SHS in the past 30 days was higher at homes but lower at indoor workplaces. Participants aged 15-24 were likely to have higher odds of SHS exposure in the past 30 days to other age groups. Those living in the urban areas had 1.15 times higher odds (95% CI: 1.08-1.22) of exposure to SHS than those in the rural areas. Current smokers tended to have 2.2 times higher odds of exposure to SHS at the indoor workplaces compared to non-smokers (95% CI: 2.05-2.37). Conclusions: The prevalence of exposure to SHS at home was still relatively high amongst the adult population. While there was a significant reduction of SHS exposure at indoor workplaces, there was a higher prevalence of women being exposed to SHS at home. The Government of Vietnam should continue to strictly implement the smoke-free environment resolution at indoor workplaces and appropriate communication campaigns to protect people, especially women from SHS exposure at homes.

Effects of Heatwaves on Hospital Admissions for Cardiovascular and Respiratory Diseases, in Southern Vietnam, 2010-2018: Time Series Analysis.

This study investigated the associations between heatwaves and daily hospital admissions for cardiovascular and respiratory diseases in two provinces in Viet Nam known to be vulnerable to droughts during 2010-2018. This study applied a time series analysis with data extracted from the electronic database of provincial hospitals and meteorological stations from the corresponding province. To eliminate over-dispersion, this time series analysis used Quasi-Poisson regression. The models were controlled for the day of the week, holiday, time trend, and relative humidity. Heatwaves were defined as the maximum temperature exceeding P90th over the period from 2010 to 2018 during at least three consecutive days. Data from 31,191 hospital admissions for respiratory diseases and 29,056 hospitalizations for cardiovascular diseases were investigated in the two provinces. Associations between hospital admissions for respiratory diseases and heatwaves in Ninh Thuan were observed at lag 2, with excess risk (ER = 8.31%, 95% confidence interval: 0.64-16.55%). However, heatwaves were negatively associated with cardiovascular diseases in Ca Mau, which was determined amongst the elderly (age above 60), ER = -7.28%, 95%CI: -13.97--0.08%. Heatwaves can be a risk factor for hospital admission due to respiratory diseases in Vietnam. Further studies need to be conducted to assert the link between heat waves and cardiovascular diseases.

Deep learning models for forecasting dengue fever based on climate data in Vietnam.

BACKGROUND: Dengue fever (DF) represents a significant health burden in Vietnam, which is forecast to worsen under climate change. The development of an early-warning system for DF has been selected as a prioritised health adaptation measure to climate change in Vietnam. OBJECTIVE: This study aimed to develop an accurate DF prediction model in Vietnam using a wide range of meteorological factors as inputs to inform public health responses for outbreak prevention in the context of future climate change. METHODS: Convolutional neural network (CNN), Transformer, long short-term memory (LSTM), and attention-enhanced LSTM (LSTM-ATT) models were compared with traditional machine learning models on weather-based DF forecasting. Models were developed using lagged DF incidence and meteorological variables (measures of temperature, humidity, rainfall, evaporation, and sunshine hours) as inputs for 20 provinces throughout Vietnam. Data from 1997-2013 were used to train models, which were then evaluated using data from 2014-2016 by Root Mean Square Error (RMSE) and Mean Absolute Error (MAE). RESULTS AND DISCUSSION: LSTM-ATT displayed the highest performance, scoring average places of 1.60 for RMSE-based ranking and 1.95 for MAE-based ranking. Notably, it was able to forecast DF incidence better than LSTM in 13 or 14 out of 20 provinces for MAE or RMSE, respectively. Moreover, LSTM-ATT was able to accurately predict DF incidence and outbreak months up to 3 months ahead, though performance dropped slightly compared to short-term forecasts. To the best of our knowledge, this is the first time deep learning methods have been employed for the prediction of both long- and short-term DF incidence and outbreaks in Vietnam using unique, rich meteorological features. CONCLUSION: This study demonstrates the usefulness of deep learning models for meteorological factor-based DF forecasting. LSTM-ATT should be further explored for mitigation strategies against DF and other climate-sensitive diseases in the coming years.

Perceptions and Use of Electronic Cigarettes Among Young Adults in Vietnam 2020.

Electronic cigarette use among adolescents has increased in the past decade. Little is known about the perception and use of e-cigarettes in Vietnam, especially among young people. This study examines the perceptions and use of electronic cigarettes among young adults in Vietnam. The study uses data from a survey of adult tobacco consumption among adults at the provincial level in 2020, which was funded and managed by the Vietnam Tobacco Control Fund-Ministry of Health. Data were collected from 34 provinces and cities throughout Vietnam and managed using REDCap software. The survey engaged 80,166 participants, of which 9478 were young adults aged 15-24 were selected and reported in this paper. The results show that, at the time of the survey, 2.4% of young Vietnamese adults were smoking e-cigarettes. Many survey participants cited more than one reason for smoking e-cigarettes. These reasons included preferring the taste of e-cigarettes (64.0%), disliking the odour of other cigarettes (46.2%), following the example of family members (44.9%), and believing e-cigarettes threatened fewer health risks (39.1%). Almost half of the e-cigarette users wanted to quit (48%). E-cigarette use was associated with males living in urban areas who are aware of the Law on Prevention and Control of Tobacco Harms. The findings of this study provide evidential data that support public health policies aimed at reducing and ceasing e-cigarette use among young people.

Clustering Lifestyle Risk Behaviors among Vietnamese Adolescents and Roles of School: A Bayesian Multilevel Analysis of Global School-Based Student Health Survey 2019.

BACKGROUND: Adolescence is a vulnerable period for many lifestyle risk behaviors. In this study, we aimed to 1) examine a clustering pattern of lifestyle risk behaviors; 2) investigate roles of the school health promotion programs on this pattern among adolescents in Vietnam. METHODS: We analyzed data of 7,541 adolescents aged 13-17 years from the 2019 nationally representative Global School-based Student Health Survey, conducted in 20 provinces and cities in Vietnam. We applied the latent class analysis to identify groups of clustering and used Bayesian 2-level logistic regressions to evaluate the correlation of school health promotion programs on these clusters. We reassessed the school effect size by incorporating different informative priors to the Bayesian models. FINDINGS: The most frequent lifestyle risk behavior among Vietnamese adolescents was physical inactivity, followed by unhealthy diet, and sedentary behavior. Most of students had a cluster of at least two risk factors and nearly a half with at least three risk factors. Latent class analysis detected 23% males and 18% females being at higher risk of lifestyle behaviors. Consistent through different priors, high quality of health promotion programs associated with lower the odds of lifestyle risk behaviors (highest quality schools vs. lowest quality schools; males: Odds ratio (OR) = 0·67, 95% Highest Density Interval (HDI): 0·46 - 0·93; females: OR = 0·69, 95% HDI: 0·47 - 0·98). INTERPRETATION: Our findings demonstrated the clustering of specific lifestyle risk behaviors among Vietnamese in-school adolescents. School-based interventions separated for males and females might reduce multiple health risk behaviors in adolescence. FUNDING: The 2019 Global School-based Student Health Survey was conducted with financial support from the World Health Organization. The authors received no funding for the data analysis, data interpretation, manuscript writing, authorship, and/or publication of this article.

Knowledge, Attitudes, and Practices Regarding COVID-19 prevention among Vietnamese Healthcare Workers in 2020.

INTRODUCTION: Healthcare workers (HCWs) are at the frontline of COVID-19 control and prevention but also are high-risk groups for COVID-19 infection. The low level of knowledge and negative attitudes toward COVID-19 among HCWs can lead to inappropriate responding, wrong diagnoses, and poor practices for prevention. This research aims to examine the knowledge, attitudes, and practices regarding COVID-19 prevention and factors influencing the practices among HCWs in Daklak province, Vietnam. METHOD: A cross-sectional study was conducted among 963 HCWs working at district health centers and commune health stations through an online survey. RESULTS: Overall, HCWs have good knowledge (91.3%), a positive attitude (71.5%), and appropriate practice (83.1%) regarding COVID-19 prevention. There was 89.6% of HCWs facing difficulties in practicing preventive measures such as felt difficult to change their habits (56.4%), insufficient personal protective equipment (PPE) (40.0%), and inconvenience to practice preventive measures (14.4%). The factors associated with implementing good practices are age group, residence, and knowledge about COVID-19. RECOMMENDATION: The Daklak Department of Health should provide additional training programs and guidelines about COVID-19 prevention and PPE for HCWs. More studies on risk and protective factors, and assessment about KAP regarding COVID-19 prevention at the post of the pandemic are needed.

Reported handwashing practices of Vietnamese people during the COVID-19 pandemic and associated factors: a 2020 online survey.

COVID-19 pandemic currently affects nearly all countries and regions in the world. Washing hands, together with other preventive measures, to be considered one of the most important measures to prevent the disease. This study aimed to characterize reported handwashing practices of Vietnamese people during the COVID-19 pandemic and associated factors. Kobo Toolbox platform was used to design the online survey. There were 837 people participating in this survey. All independent variables were described by calculating frequencies and percentages. Univariate linear regression was used with a significant level of 0.05. Multiple linear regression was conducted to provide a theoretical model with collected predictors. Seventy-nine percent of the respondents used soap as the primary choice when washing their hands. Sixty percent of the participants washed their hands at all essential times, however, only 26.3% practiced washing their hands correctly, and only 28.4% washed their hands for at least 20 seconds. Although 92.1% washed hands after contacting with surfaces at public places (e.g., lifts, knob doors), only 66.3% practiced handwashing after removing masks. Females had better reported handwashing practices than male participants (OR = 1.88; 95% CI: 1.15-3.09). Better knowledge of handwashing contributed to improving reported handwashing practice (OR = 1.30; 95% CI: 1.20-1.41). Poorer handwashing practices were likely due, at least in part, to the COVID-19 pandemic information on the internet, social media, newspapers, and television. Although the number of people reported practicing their handwashing was rather high, only a quarter of them had corrected reported handwashing practices. Communication strategy on handwashing should emphasize on the minimum time required for handwashing as well as the six handwashing steps.

Knowledge, Attitudes, and Practices of the Vietnamese as Key Factors in Controlling COVID-19.

This study aimed to describe knowledge, attitudes, and practices (KAP) in controlling COVID-19 and some related factors among the Vietnamese population in 2020. A cross-sectional study was conducted involving 1999 participants aged 18-59 years old, through an online questionnaire. The results showed that 92.2% of the participants had a high knowledge level regarding COVID-19 prevention measures, 68.6% had a positive attitude toward COVID-19 prevention measures, and 75.8% practiced all six measures for preventing the spread of the virus. Age, sex, marital status, knowledge, and fear were significantly associated with the practices aimed at COVID-19 prevention. Married people and participants with high levels of knowledge were more likely to practice all preventive measures. In contrast, young people, men, and those who fear COVID-19 were less likely to practice all preventative measures. Good KAP among Vietnamese people could be an important factor in helping authorities gain initial success in containing the coronavirus and COVID-19. In addition to continuously raising and maintaining the community's awareness, attitude, and practices in disease prevention, the introduction and strict implementation of sanctions and regulations were also important in ensuring good practices were implemented and sustained over time. Groups with lower KAP levels should be provided with more information and support to promote appropriate disease prevention practices.

Access to Improved Water Sources and Sanitation in Minority Ethnic People in Vietnam and Some Sociodemographic Associations: A 2019 National Survey.

BACKGROUND: Achieving access to clean water and basic sanitation remains as major challenges in Vietnam, especially for vulnerable groups such as minority people, despite all the progress made by the Millennium Development Goal number 7.C. OBJECTIVES: The study aimed to describe the access to improved water sources and sanitation of the ethnic minority people in Vietnam based on a national survey and to identify associated factors. METHODS: A cross-sectional study was conducted in 2019 with a sample size of 1385 ethnic minority households in 12 provinces in Vietnam. Multivariate logistic regression modeling was performed to examine the probability of having access to improved water sources and sanitation and sociodemographic status at a significance level of P < .05. RESULTS: The access to improved water sources and sanitation was unequal among the ethnic minority people in Vietnam, with the lowest access rate in the northern midland and mountainous and Central Highland areas and the highest access rate in the Mekong Delta region. Some sociodemographic variables that were likely to increase the ethnic minority people's access to improved water sources and/or sanitation included older age, female household heads, household heads with high educational levels, religious households, and households in not poor status. CONCLUSION AND RECOMMENDATIONS: The study suggested more emphasis on religion for improving the ethnic minority's access to improved water sources and sanitation. Besides, persons of poor and near-poor status and with low educational levels should be of focus in future water and sanitation intervention programs.

Hygienic Practices and Structural Conditions of the Food Processing Premises Were the Main Drivers of Microbiological Quality of Edible Ice Products in Binh Phuoc Province, Vietnam 2019.

BACKGROUND: Ice is used in large quantities as refreshment in alcoholic and nonalcoholic beverages, especially in summer time. Contamination of edible ice products with pathogens is a public health concern in various countries, including Vietnam. This study aimed to assess the food safety conditions, the quality of edible ice products and related factors at manufacturing premises in Binh Phuoc Province, Vietnam in 2019. METHODS: A cross-sectional study was conducted in 2019 using both quantitative and qualitative methods. Food safety assessment was carried out in all 45 ice producing premises in the province and 79 ice samples were collected and analyzed microbiologically. In-depth interviews were conducted with 2 food safety management staff, 4 owners of premises, and 4 workers. RESULTS: Only 22.4% (18/79) and 37.8% (30/79) of the premises met requirement for food safety conditions and microbiological food safety requirements, respectively. Half of the ice samples, 51.9% (41/79), were contaminated, 49.4% (39/79) with Escherichia coli and 12.7% (10/79) with total coliforms. Streptococci, Pseudomonas aeruginosa were not detected. The major risks were material, odds ratio (OR) = 4.2 (95% confidence interval [CI]: 1.002-17.6), structural challenges in the facilities, OR = 4.3 (95% CI: 1.13-16.7), broken floors or difficulty in cleaning, OR = 5.4 (95% CI: 1.26-22.9), and poor staff hygiene practices, OR = 19.5 (95% CI: 4.2-91.1). Workers lacked knowledge and appropriate practices to prevent microbial contamination of ice products. CONCLUSIONS: The food safety conditions and the quality of ice cubes at manufacturing premises in Binh Phuoc Province were not acceptable. Hygiene deficiencies in ice producing and handling processes, inadequate knowledge of staff, inadequate food safety management practices, and hygiene conditions of the premises were important factors in producing contaminated ice products. We recommend more staff training and crediting the staff when performing adequate practices, paying attention to broken floors or difficulty in cleaning, structural deficiency, and ensuring regular monitoring of premises. This study adds a special interest to ensure food safety conditions at ice producing premises to prevent microbial contamination of the products.

Vietnam Climate Change and Health Vulnerability and Adaptation Assessment, 2018.

BACKGROUND: The Global Climate Risk Index 2020 ranked Vietnam as the sixth country in the world most affected by climate variability and extreme weather events over the period 1999-2018. Sea level rise and extreme weather events are projected to be more severe in coming decades, which, without additional action, will increase the number of people at risk of climate-sensitive diseases, challenging the health system. This article summaries the results of a health vulnerability and adaptation (V&A) assessment conducted in Vietnam as evidences for development of the National Climate Change Health Adaptation Plan to 2030. METHODS: The assessment followed the first 4 steps outlined in the World Health Organization's Guidelines in conducting "Vulnerability and Adaptation Assessments." A framework and list of indicators were developed for semi-quantitative assessment for the period 2013 to 2017. Three sets of indicators were selected to assess the level of (1) exposure to climate change and extreme weather events, (2) health sensitivity, and (3) adaptation capacity. The indicators were rated and analyzed using a scoring system from 1 to 5. RESULTS: The results showed that climate-sensitive diseases were common, including dengue fever, diarrheal, influenza, etc, with large burdens of disease that are projected to increase. From 2013 to 2017, the level of "exposure" to climate change-related hazards of the health sector was "high" to "very high," with an average score from 3.5 to 4.4 (out of 5.0). For "health sensitivity," the scores decreased from 3.8 in 2013 to 3.5 in 2017, making the overall rating as "high." For "adaptive capacity," the scores were from 4.0 to 4.1, which meant adaptive capacity was "very low." The overall V&A rating in 2013 was "very high risk" (score 4.1) and "high risk" with scores of 3.8 in 2014 and 3.7 in 2015 to 2017. CONCLUSIONS: Adaptation actions of the health sector are urgently needed to reduce the vulnerability to climate change in coming decades. Eight adaptation solutions, among recommendations of V&A assessment, were adopted in the National Health Climate Change Adaptation Plan.

Bioaccumulation of PCDD/Fs in foodstuffs near Bien Hoa and Da Nang airbases: assessment on sources and distribution.

In this survey, food items were collected from vicinities of Bien Hoa and Da Nang airbase and determined for polychloro-dibenzo-dioxins and polychloro-dibenzo-furans (PCDD/Fs) to assess their accumulation, distribution in the local food items, and risk of PCDD/F exposure through consumption of the local foods. Dioxin compounds were determined using isotope dilution method which is slightly modified from US-EPA method 1613B. The dioxin concentration was the highest in fish followed by eggs, chicken, meat (pork and beef), and vegetables. Particularly, in Bien Hoa airbase, the mean concentrations of dioxin on TEQ and lipid basis (except for vegetables) were 26 pg/g for fish, 13 pg/g for eggs, 20 pg/g for chicken, 4.5 pg/g for meat, and 0.34 pg/g fresh wt for vegetables. In Da Nang airbase, the mean levels of dioxin on TEQ and lipid basis were slightly lower, 12.9 pg/g for fish, 8.7 pg/g for eggs, 5.9 pg/g for chicken, 6.7 pg/g for meat, and 0.17 pg/g for vegetables. It has been interesting to observe that free-range chicken expose to higher level of dioxin than caged chicken. In some free-range chicken, the portion of 2,3,7,8-TCDD was relatively high and implying recent exposure to dioxin.

Water Supply, Sanitation, and Medical Waste Treatment and Disposal at Commune Health Centers in Vietnam.

Water hygiene, sanitation, and proper management of health care wastes at health care facilities are important in preventing infections and improving health and the environment. This article describes the access to safe water and sanitation facilities and the disposal of medical wastes at commune health centers (CHCs) in Vietnam. Data was extracted from the 2015 World Bank Vietnam District and Commune Health Facility Survey. Bivariate and multivariate logistic regression was applied to identify associations of CHCs' access to improved water and sanitation and their medical waste management. Overall, 72.76% CHCs had access to both improved water and sanitation facilities, and better access was found in the richest communes. Rural CHCs had higher prevalence of appropriate wastewater treatment. The majority of CHCs combusted medical solid wastes by specialized incinerations, contracted out with sanitation companies, or transported them to district health centers. However, the data was insufficient to give in-depth analysis and conclusion on water and sanitation conditions and the management of medical wastes at CHCs. More information should be collected for further analysis and conclusion.

Exposure to Tobacco Advertising, Promotion Among the Adult Population in Vietnam and Its Implications for Public Health.

INTRODUCTION: The Law on Tobacco Control and the Law on Advertisement prohibit the advertising of any tobacco product in Vietnam. Tobacco promotion and marketing are alsostrictly prohibited. However, the violation of tobacco adverting and promotion is still common in Vietnam. OBJECTIVES: This article aims at describing the exposure to tobacco advertising and promotion among the population aged 15+ years in Vietnam based on the data from the Global Adult Tobacco Survey 2015 from the view of the community, identifying any possible associations between the exposure to tobacco advertising and promotion and other individual factors, and discussing its possible public health implications. METHOD: A cross-sectional study with the nationwide scale. Secondary data from the Global Adult Tobacco Survey 2015 was explored and analyzed. Chi-square test and multivariate logistic regressions were applied in the data analysis. RESULTS: The most common type of adults' exposure to tobacco advertising and promotion was points of sale (8.6%); 9.8% adults exposure to one source of tobacco advertising and 4.0% of them exposed to one source of tobacco promotion. Around 13.3% of Vietnamese adults were exposed to tobacco advertisement, while 2.0% were exposed to tobacco promotion, 5.3% were exposed to both tobacco advertising and promotion, and 16.6% were exposed to tobacco advertising or promotion. Gender, educational level, age, occupation, marital status, socioeconomic status, location (urban, rural), and current smoking status were associated with the exposure to tobacco advertising, tobacco promotion, tobacco advertising and promotion, and tobacco advertising or promotion. CONCLUSION AND RECOMMENDATION: Although there are comprehensive bans on tobacco advertising and promotion in Vietnam, adults aged 15+ years still reported their exposure to tobacco advertising and promotion. There should be a strict enforcement of the ban on tobacco advertising and promotion in Vietnam.

Food safety in Vietnam: where we are at and what we can learn from international experiences.

Food-borne diseases are attracting a lot of attention in Vietnam as a result of repeated episodes of adulterated and unsafe food. In this paper, we provide some perspectives on food safety in Vietnam from the point of view of an international research institution working on food safety with partners in the country. We argue that one of the key issues of food safety in Vietnam is that certain food value chain stakeholders lack ethics, which leads to the production and trading of unsafe foods in order to make profits irrespective of adverse health effects on consumers. In turn, the shortfall in ethical behaviours around food can be attributed to a lack of incentives or motivating factors.Although food safety causes panic in the population, it is unclear how much contaminated food contributes to the burden of food-borne diseases and food poisonings in Vietnam. However, globally, the biggest health problem associated with food are infections from consuming food contaminated with viruses, bacteria or parasites. A major food safety challenge is the inappropriate way of communicating food risks to the public. Another key constraint is the inherent difficulty in managing food in wet markets and from smallholder production. On the other hand, local foods, and local food production and processing are an important cultural asset as well as being essential to food safety, and these aspects can be put at risk if food safety concerns motivate consumers to purchase more imported foods.In this paper, we also discuss good experiences in food safety management from other countries and draw lessons learnt for Vietnam on how to better deal with the current food safety situation.

Exposure assessment of chemical hazards in pork meat, liver, and kidney, and health impact implication in Hung Yen and Nghe An provinces, Vietnam.

OBJECTIVES: 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. METHODS: 514 pig feed, kidney, liver, and pork samples were pooled and qualitatively and quantitatively analyzed for tetracyclines, fluoroquinolones, sulphonamide, chloramphenicol, ß-agonists, and heavy metals. We compare the results with current regulations on chemical residues and discuss health implications. RESULTS: 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 ß-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. CONCLUSIONS: There is potential exposure to sulphonamide, chloramphenicol, and ß-agonists from pork. Risk communication needs to focus on banned chemicals, while informing the public about the minimal risks associated with heavy metals.

Violation of Bans on Tobacco Advertising and Promotion at Points of Sale in Viet Nam: Trend from 2009 - 2015.

Comprehensive bans on tobacco advertising and promotion were introduced through tobacco control legislation in Viet Nam, but it has been established that violations of the bans are very common. This study was conducted to explore the trend in violations of bans on tobacco advertising and promotion at points of sale in Viet Nam in the past six years and to explore any differences in the violation situations before and after the Law on Tobacco Control came into effect on 1st May 2013. Quantitative data were collected through observation of violations of the bans on tobacco advertising and promotion at points of sale in 10 provinces throughout Viet Nam in four survey rounds (2009, 2010, 2011, and 2015). Variation in violation prevalence over time was examined by chi-square test using a Bonferini method. Binary logistic regression was employed to identify the factors that may have influences on different types of violation. A level of significance of p<0.05 was used for all tests in this article. The most common form of violation was the display of more than one pack/one carton of a cigarette brand. Violation of bans on tobacco advertising increased while violations on promotion ban and on displaying tobacco decreased through time. Some factors associated with the tobacco advertising and promotion bans included surveyed years, types of points of sale, regions and areas where the points of sale were located. The enforcement of the bans did not improve even after the issuance and the enactment of the Law on Tobacco Control. This suggests that the monitoring and enforcement of bans on tobacco advertising and promotion at points of sale should be strengthened. Penalties should be strictly applied for violators as indicated in the current tobacco control legislation.

Household trends in access to improved water sources and sanitation facilities in Vietnam and associated factors: findings from the Multiple Indicator Cluster Surveys, 2000-2011.

BACKGROUND: Despite progress made by the Millennium Development Goal (MDG) number 7.C, Vietnam still faces challenges with regard to the provision of access to safe drinking water and basic sanitation. OBJECTIVE: This paper describes household trends in access to improved water sources and sanitation facilities separately, and analyses factors associated with access to improved water sources and sanitation facilities in combination. DESIGN: Secondary data from the Vietnam Multiple Indicator Cluster Survey in 2000, 2006, and 2011 were analyzed. Descriptive statistics and tests of significance describe trends over time in access to water and sanitation by location, demographic and socio-economic factors. Binary logistic regressions (2000, 2006, and 2011) describe associations between access to water and sanitation, and geographic, demographic, and socio-economic factors. RESULTS: There have been some outstanding developments in access to improved water sources and sanitation facilities from 2000 to 2011. In 2011, the proportion of households with access to improved water sources and sanitation facilities reached 90% and 77%, respectively, meeting the 2015 MDG targets for safe drinking water and basic sanitation set at 88% and 75%, respectively. However, despite these achievements, in 2011, only 74% of households overall had access to combined improved drinking water and sanitation facilities. There were also stark differences between regions. In 2011, only 47% of households had access to both improved water and sanitation facilities in the Mekong River Delta compared with 94% in the Red River Delta. In 2011, households in urban compared to rural areas were more than twice as likely (odds ratio [OR]: 2.2; 95% confidence interval [CI]: 1.9-2.5) to have access to improved water and sanitation facilities in combination, and households in the highest compared with the lowest wealth quintile were over 40 times more likely (OR: 42.3; 95% CI: 29.8-60.0). CONCLUSIONS: More efforts are required to increase household access to both improved water and sanitation facilities in the Mekong River Delta, South East and Central Highlands regions of Vietnam. There is also a need to address socio-economic factors associated with inadequate access to improved sanitation facilities.