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Background: Happiness is among the fundamental concepts in mental health that have an impact on different aspects of university students. In this study, we aimed to estimate the prevalence of happiness among university students in Vietnam and to identify the factors influencing happiness. Design and methods: A cross-sectional survey was conducted on undergraduate students in 8 universities and colleges in Hanoi, Vietnam. Happiness was measured using the Subjective Happiness Scale (SHS), and we used imputed Poisson regression to evaluate associations between happiness and associated factors. Results: Among 9120 participants students (95.1% response rate), the prevalence of "happier group" was 80.9% (95% CI: 80.1-81.7). In the multivariable regression models, factors associated with being "less happy" on SHS were the perceived financial burden, year in university, academic motivation profile, and self-reported depression and anxiety. Conclusions: University healthcare providers should pay attention to these associated factors while designing mental health care programs to promote happiness among university students.
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BACKGROUND: This study evaluated the impact of the tax increase in January 2019 on changes in intention to quit and the effect of cigarette prices on quit attempts and successful quitting among male cigarette smokers in Vietnam. METHODS: Data were derived from the ITC project in Vietnam, which included 1585 adult smokers at baseline (Wave 1, Aug-Oct 2018) followed up to waves 2 (Sep-Nov 2019) and 3 (Sep-Dec 2020). Generalized estimating equations regression was performed to estimate changes in the intention to quit. Multiple logistic regression analysis was used to evaluate the cigarette price of a cigarette pack in relation to quit attempts and successful quitting. RESULTS: The increase in cigarette tax in 2019 did not significantly increase the likelihood of the intention to quit. After the tax increase, 63.6% of participants who smoked made a quit attempt, and 27.6% successfully quit smoking in the follow-up waves. However, the price of a cigarette pack was not significantly associated with quit attempts and successful quitting. The study did not observe a significant impact of cigarette prices on quit attempts and successful quitting in all subgroups of household income. Factors associated with quit attempts included the number of cigarettes smoked and the intention to quit, while those associated with successful quitting included age, dual use of cigarettes and other tobacco products, and the intention to quit. CONCLUSION: Current cigarette prices were not associated with cessation behaviors even within the lowest household income group. Therefore, a sharp rise in cigarette tax is required to incentivize smokers to quit smoking.
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Comércio , Abandono do Hábito de Fumar , Impostos , Produtos do Tabaco , Humanos , Masculino , Vietnã , Abandono do Hábito de Fumar/economia , Abandono do Hábito de Fumar/estatística & dados numéricos , Abandono do Hábito de Fumar/psicologia , Adulto , Produtos do Tabaco/economia , Pessoa de Meia-Idade , Comércio/estatística & dados numéricos , Impostos/estatística & dados numéricos , Intenção , Fumantes/estatística & dados numéricos , Fumantes/psicologia , Adulto Jovem , Inquéritos e Questionários , AdolescenteRESUMO
OBJECTIVE: This study was conducted with the objective of exploring the usage of health-related quality of life (HRQOL) outcomes and willingness of health technology assessment (HTA) and public health stakeholders to use the EQ-5D-5L instrument in healthcare decision-making processes in Vietnam. METHOD: In this qualitative study, 11 interviews were held with key stakeholders involved in healthcare decision-making for HTA between June 2021 and June 2022. The interviewees included members of the Vietnamese pharmacoeconomic council and public-health professionals from a diverse array of regions of Vietnam. The data collection involved obtaining verbal consent, warm-up discussions and interviews conducted via Zoom, with subsequent verification by interviewees. The analysis employed a theoretical thematic approach, adopting a deductive methodology to identify and analyse underlying ideas and meanings within the empirical data. RESULTS: This study highlights the general importance and viability of HRQOL measures, and more particularly the EQ-5D-5L instrument, in healthcare decision-making in Vietnam. Challenges have been identified, including insufficient recognition, interpretation, standardisation and educational initiatives relating to HRQOL measurements. This study advocates for official training programmes on HRQOL measurements, guidelines for the application of the EQ-5D-5L and an open HRQOL database in Vietnam. Concerns regarding validity and outcome variation in HRQOL measurements underline the necessity for continuous psychometric properties assessments and regular updates to national HRQOL data in the Vietnamese context. CONCLUSION: HRQOL outcomes are important, and Vietnamese stakeholders express a readiness to employ the EQ-5D-5L in healthcare decision-making, especially HTA. Nevertheless, HRQOL measurements, including the EQ-5D-5L, are currently inadequately used in Vietnam, and further efforts are required to improve utilisation.
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Tomada de Decisões , Pesquisa Qualitativa , Qualidade de Vida , Avaliação da Tecnologia Biomédica , Humanos , Vietnã , Masculino , FemininoRESUMO
BACKGROUND: This study aimed to assess the cost-effectiveness of durvalumab as a treatment option for patients with inoperable stage III non-small cell lung cancer (NSCLC) from healthcare and partial societal perspectives in Vietnam. METHOD: A lifetime partitioned survival model was used to evaluate the costs and quality-adjusted life years (QALYs) associated with consolidation durvalumab in comparison with the standard of care alone. Local costs and utilities were incorporated into the model. In the base-case analysis, no discount was applied to the acquisition cost of durvalumab. Scenario-based, one-way and probabilistic-sensitivity analyses were conducted. RESULTS: The base-case analysis revealed that the intervention resulted in an increase of 1.38 life years or 1.08 QALYs for patients, but the intervention was not deemed cost-effective from either perspective in the base-case analysis. However, with a 70% reduction in the durvalumab acquisition cost, the intervention was observed to be cost-effective when evaluated from a healthcare perspective and when examining the undiscounted results from a partial societal standpoint. CONCLUSION: This study provides evidence regarding the cost-effectiveness of durvalumab for the treatment of inoperable stage III NSCLC in Vietnam for various scenarios. The intervention was not cost-effective at full acquisition cost, but it is important to acknowledge that cost-effectiveness arguments alone cannot solely guide decision-makers in Vietnam; other criteria, such as budget impact and ethical concerns, are crucial factors to consider in decision-making processes.
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Anticorpos Monoclonais , Antineoplásicos Imunológicos , Carcinoma Pulmonar de Células não Pequenas , Análise Custo-Benefício , Neoplasias Pulmonares , Anos de Vida Ajustados por Qualidade de Vida , Humanos , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Carcinoma Pulmonar de Células não Pequenas/economia , Carcinoma Pulmonar de Células não Pequenas/patologia , Vietnã , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/economia , Neoplasias Pulmonares/patologia , Anticorpos Monoclonais/economia , Anticorpos Monoclonais/uso terapêutico , Antineoplásicos Imunológicos/economia , Antineoplásicos Imunológicos/uso terapêutico , Estadiamento de Neoplasias , Masculino , Feminino , Pessoa de Meia-IdadeRESUMO
Low- and middle-income countries are increasingly faced with a triple burden of malnutrition: endemic underweight, micronutrient deficiencies and rising prevalence of overweight. This study aimed to address existing knowledge gaps and to identify priority policy options in Mongolia, the Philippines and Vietnam. A landscape analysis approach was adopted using methods set out in a UNICEF global toolkit. Quantitative and qualitative data were compiled from a range of global and national sources on childhood overweight and obesity, risk factors and policy responses. Key informant interviews and validation workshops were undertaken with key food and nutrition stakeholders from government and non-government organizations to identify priority policy options for the prevention of overweight and obesity among children. Overweight and obesity among children are increasing in all three countries. Associated risk factors are related to maternal nutrition, birthweight, breastfeeding, as well as diets and physical activity shaped by increasingly obesogenic environments. Key informants identified undefined policy approaches, poor community understanding and food and beverage industry influence as barriers to addressing overweight and obesity. Key policy priorities include restricting the marketing of unhealthy food and beverages, unhealthy food and beverage taxation, introduction of front-of-pack nutrition labels and improving school nutrition environments. Mongolia, the Philippines and Vietnam are all facing an increasing burden of childhood overweight and obesity. Despite differing national contexts, similar environmental factors are driving this rise. A suite of evidence-based policies can effectively be introduced to address obesogenic environments.
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Desnutrição , Obesidade Infantil , Criança , Humanos , Obesidade Infantil/epidemiologia , Obesidade Infantil/prevenção & controle , Sobrepeso/epidemiologia , Sobrepeso/prevenção & controle , Filipinas/epidemiologia , Vietnã/epidemiologia , Mongólia/epidemiologia , Política NutricionalRESUMO
BACKGROUND: The COVID-19 pandemic was a health emergency requiring rapid fiscal resource mobilisation to support national responses. The use of effective health financing mechanisms and policies, or lack thereof, affected the impact of the pandemic on the population, particularly vulnerable groups and individuals. We provide an overview and illustrative examples of health financing policies adopted in 15 countries during the pandemic, develop a framework for resilient health financing, and use this pandemic to argue a case to move towards universal health coverage (UHC). METHODS: In this case study, we examined the national health financing policy responses of 15 countries, which were purposefully selected countries to represent all WHO regions and have a range of income levels, UHC index scores, and health system typologies. We did a systematic literature review of peer-reviewed articles, policy documents, technical reports, and publicly available data on policy measures undertaken in response to the pandemic and complemented the data obtained with 61 in-depth interviews with health systems and health financing experts. We did a thematic analysis of our data and organised key themes into a conceptual framework for resilient health financing. FINDINGS: Resilient health financing for health emergencies is characterised by two main phases: (1) absorb and recover, where health systems are required to absorb the initial and subsequent shocks brought about by the pandemic and restabilise from them; and (2) sustain, where health systems need to expand and maintain fiscal space for health to move towards UHC while building on resilient health financing structures that can better prepare health systems for future health emergencies. We observed that five key financing policies were implemented across the countries-namely, use of extra-budgetary funds for a swift initial response, repurposing of existing funds, efficient fund disbursement mechanisms to ensure rapid channelisation to the intended personnel and general population, mobilisation of the private sector to mitigate the gaps in public settings, and expansion of service coverage to enhance the protection of vulnerable groups. Accountability and monitoring are needed at every stage to ensure efficient and accountable movement and use of funds, which can be achieved through strong governance and coordination, information technology, and community engagement. INTERPRETATION: Our findings suggest that health systems need to leverage the COVID-19 pandemic as a window of opportunity to make health financing policies robust and need to politically commit to public financing mechanisms that work to prepare for future emergencies and as a lever for UHC. FUNDING: Bill & Melinda Gates Foundation.
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COVID-19 , Pandemias , Humanos , Financiamento da Assistência à Saúde , Assistência de Saúde Universal , Emergências , COVID-19/epidemiologia , Política de SaúdeRESUMO
The study aimed to investigate differences in the prevalence of gynecological healthcare service utilization in 12 ethnic minority groups and associated socio-demographic correlates with gynecological healthcare service utilization in Vietnam. Based on the national survey on healthcare utilization among 6912 people in 12 ethnic minorities, 900 women aged 21-49 years were included in the final analysis. Prevalence of gynecological healthcare service utilization in 12 ethnic minority groups was measured, based on the question "Have you ever used any gynecological healthcare services?" Socio-demographic characteristics including region, ethnicity, age, marital status, literacy level, education level, languages spoken, occupation, religion, household economy status, using contraception, and distance to the nearest healthcare facility were examined. The association between gynecological healthcare service utilization and socio-demographic characteristics was assessed by using logistic regression. The results showed that the prevalence of gynecological healthcare service utilization was 62.0% (95% CI: 58.7-65.2%), which ranged from 36.5 (Mnong) to 87.7% (Bru Van Kieu). Bru Van Kieu women had significantly higher odds of gynecological healthcare service utilization (OR = 9.42, 95% CI = 3.71-23.91), compared to those in Khmer ethnicity. Besides, Ba Na, Cham Ninh Thuan, and Dao women also had significantly higher odds of gynecological healthcare service utilization (Ba Na: OR = 5.73, 95% CI = 2.15-15.26; Cham Ninh Thuan: OR = 4.24, 95% CI = 1.79-10.06; Dao: OR = 3.43, 95% CI = 1.49-7.90), compared to those in Khmer ethnicity. Getting married, being older, being not poor, and using contraception had significantly higher odds of using gynecological healthcare services. Health education specialists and healthcare workers should be aware of these issues so that they can provide appropriate gynecological healthcare services and ensure high coverage of routine gynecological exams in ethnic minority women in reproductive age.
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Minorias Étnicas e Raciais , Etnicidade , Humanos , Feminino , Grupos Minoritários , Vietnã/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde , Atenção à Saúde , Disparidades em Assistência à SaúdeRESUMO
PURPOSE: For many low- and middle-income countries (LMICs), breast cancer (BC) screening based on mammography is not a viable option. Clinical breast examination (CBE) may represent a pragmatic and cost-effective alternative. This paper examines the cost-effectiveness of CBE screening programme among a patient group for whom its cost-effectiveness is likely to be least evident (HER2-positive patients) and discuss the wider implications for BC screening in LMICs. METHODS: A Markov model was used to examine clinical and economic outcomes over a life-time horizon from the patient, public payer, and healthcare sector perspective. HER2-positive patients entered the model at either disease-free survival or metastatic BC state. The downstaging effect of CBE determined the starting probabilities in the no-screening and screening scenarios. The model used a monthly cycle length, with half-cycle correction. Costs and outcomes were discounted at 1.5% annually. RESULTS: Compared with no-screening, the cost-effectiveness ratio (ICER) per quality-adjusted life-year gained for the CBE screening programme was $1801, $2381, and $4179 from three mentioned perspectives, respectively. The finding of cost-effectiveness remained robust to a range of sensitivity analyses. The parameters to which ICERs are most sensitive are average age of cohorts, reduction in proportion of metastatic patients at diagnosis, cost of CBE, and BC detection rate of the programme. CONCLUSION: For HER2-positive patients and compared with no-screening, CBE screening programme in Vietnam is cost-effective from all investigated perspectives. CBE is a 'good value' intervention and should be considered for implementation throughout Vietnam as well as in LMICs where mammography is not feasible.
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Neoplasias da Mama , Humanos , Feminino , Neoplasias da Mama/patologia , Análise Custo-Benefício , Detecção Precoce de Câncer , Mamografia , Programas de RastreamentoRESUMO
Breast cancer is the most frequently diagnosed cancer among Vietnamese women. This qualitative study describes and discusses the mental health challenges of women with breast cancer in Vietnam. Two-rounds of semi-structured in-depth interviews were conducted among thirteen women with breast cancer and four caregivers from northern and southern Vietnam. Participants were recruited using purposive sampling technique. Data was collaboratively analyzed by qualitative content analysis using the Open Code Software version 4.02 and discussed among a team of local and international researchers. Women in the study experienced significant mental health challenges associated with their breast cancer diagnosis. Both psychological and emotional health were adversely affected. Women with breast cancer had profound concerns about how the diagnosis impacted their families. They experienced challenges in spousal relationships as well as facing social stigma and discrimination. Appropriate public health interventions should be implemented to raise society's awareness and help improve the mental health of women with breast cancer.
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Neoplasias da Mama , Saúde Mental , Humanos , Feminino , Vietnã , Neoplasias da Mama/diagnóstico , Pesquisa Qualitativa , Estigma SocialRESUMO
BACKGROUND: Smoking among adolescents in schools is a major global public health concern. There is limited evidence regarding prevalence and associated factors in Vietnam. OBJECTIVE: To compare the prevalence of smoking and associated factors among in-school adolescents aged 13-17 years in Vietnam between 2013 and 2019. METHODS: Data were collected from two rounds of the national representative Vietnam Global School-based Student Health Survey (GSHS) conducted in 2013 (n = 3,331) and 2019 (n = 7,690). Logistic regression was used to identify the factors associated with tobacco and electronic cigarette smoking among in-school adolescents. RESULTS: There was a significant reduction in the prevalence of current smoking (water pipes and cigarettes) from 5.4% (95% CI: 4.0-7.2) in 2013 to 2.8% (95% CI: 2.2-3.6) in 2019. In 2019, 2.6% of the in-school adolescents reported having used electronic cigarette products 30 days prior to the survey. Factors associated with a significantly higher likelihood of current smoking status included gender, loneliness, suicidal ideation, sexual activity, truancy, and alcohol consumption. Similar patterns were observed for e-cigarettes. CONCLUSION: Smoking among in-school adolescents in Vietnam decreased between 2013 and 2019. Follow-up studies are needed to further investigate causal factors so that future policies and communication programmes can be more effectively targeted to reduce smoking in adolescents.
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Fumar Cigarros , Sistemas Eletrônicos de Liberação de Nicotina , Produtos do Tabaco , Adolescente , Fumar Cigarros/epidemiologia , Humanos , Prevalência , Nicotiana , Vietnã/epidemiologiaRESUMO
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.
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Sistemas Eletrônicos de Liberação de Nicotina , Produtos do Tabaco , Vaping , Adolescente , Humanos , Masculino , Fumantes , Vaping/epidemiologia , Vietnã/epidemiologia , Adulto JovemRESUMO
BACKGROUND: Smoking leads to many smoking-attributable diseases. The promotion of quitting tobacco smoking is urgent as it has significant and immediate health benefits and improves the impacts of other tobacco control strategies. Intention to quit smoking is considered the first step before quitting smoking. METHODOLOGY: This paper used data from Vietnam provincial GATS 2020 on 80,166 participants who were 15-year-old or older. Data were collected from 34 provinces and cities throughout Vietnam and managed using REDCap. RESULTS: Among those who were current smokers, 50.3% (95% CI: 49.1%-51.4%) had the intention to quit smoking. Some predictive factors found to be positively associated with the intention to quit smoking were age (from 45-64), education level, received information about harmful effects or encouragement to quit smoking from media channels (from 6 channels), hearing about the Tobacco Control Law and noticing health warnings on the cigarette package. There was no significant difference in intention to quit smoking between current smokers from urban and rural areas or among different age groups to start smoking. CONCLUSIONS: Interventions or health promotion programs on smoking cessation should be focused on current smokers who have low education levels as they have a higher smoking rate and are less motivated to stop smoking. Received information about harmful effects or encouragement to quit smoking from media channels is also associated with stopping smoking in the future. The importance of health warning pictures on tobacco packages should be maintained and promoted as it has a specific effect on one's intention to stop smoking.
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INTRODUCTION: In 2017, aligned with global World Health Organization tetanus guidelines, Vietnam prepared evidence to support a recommendation to introduce the tetanus-diphtheria (Td) vaccine into routine immunization. This study aimed to provide evidence on the costs and budgetary impact of the potential replacement of the tetanus-toxoid (TT) vaccine with the Td vaccine, considering different possible delivery strategies. METHOD: We used an activity-based ingredients costing approach to estimate the 2017 program costs of providing TT vaccination to girls aged 15-16 years and conducting Td campaigns in outbreak areas. We performed a budget impact analysis for 2018-2025 using the cost per dose estimates based on the current delivery of these vaccines. We assumed complete cessation of TT vaccination of girls aged 15-16 years and a transition period where Td outbreak control campaigns would still occur. Td vaccine was assumed to be provided to children aged 7 years using either facility- or school-based delivery or combined facility- and school-based delivery. RESULTS: The delivery cost per dose for current TT vaccination for girls aged 15-16 years was US$1.49 for school-based delivery, US$1.76 for facility-based delivery, and US$3.86 for delivery via outreach. Td vaccination through campaigns was estimated to cost US$3.56/dose. During 2018-2025, replacing the TT vaccine for girls aged 15-16 years with the Td vaccine for children aged 7 years is estimated to save US$4.61 million in immunization delivery costs if a school-based delivery strategy is used or US$1.04 million if facility-based delivery is used. CONCLUSION: Compared to the current plan, delivery of Td routine vaccination via a school-based strategy was the most cost saving. These results were used in late 2019 to support the delivery of Td vaccination using a school-based delivery strategy for children aged 7 years in 30 Northern provinces in Vietnam.
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Difteria , Tétano , Criança , Difteria/epidemiologia , Difteria/prevenção & controle , Vacina contra Difteria e Tétano , Feminino , Humanos , Tétano/epidemiologia , Tétano/prevenção & controle , Toxoide Tetânico , Vacinação , VietnãRESUMO
In many low- and middle-income countries, planning cycles and policy decisions are not always informed by cost evidence, even where relevant and recent cost evidence is available. The Immunization Costing Action Network (ICAN) project was a research and learning community designed to strengthen country capacity to generate immunization cost evidence and to understand and improve the evidence-to-policy linkages for the evidence. We identified key factors that increase the likelihood that health policy makers will use evidence for policy making or planning, which shaped the development of a 6-step evidence to policy and practice (EPP) facilitated process. ICAN used the EPP process in Indonesia, Tanzania, and Vietnam from 2016-2019. The experience resulted in several insights regarding country priorities related to cost evidence and factors that determine uptake. Cost evidence is more likely to be used if it answers a specific policy question prioritized by the immunization program, while the use case is less clear and urgent for routine planning and program management. Nonhealth ministries and subnational stakeholders can provide important perspectives to inform the research and its usability. The use case for evidence should be revisited periodically as divergences from formal planning cycles are common and new policy windows open. Ensuring evidence is available at the right time is critical, even if this requires a sacrifice between rigor and speed. Engaging a small group of stakeholders, rather than an individual, to champion the research may be more effective, and the research has greater legitimacy if it is produced by multidisciplinary country teams. Evidence and messages should be tailored for and packaged targeting different audiences. Going forward, continued support is necessary to bridge the divide between those who generate cost evidence and those who translate evidence for policy and planning decisions.
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Formulação de Políticas , Vacinação , Humanos , Indonésia , Tanzânia , VietnãRESUMO
INTRODUCTION: Many countries have established their own EQ-5D value sets proceeding on the basis that health preferences differ among countries/populations. So far, published studies focused on comparing value set using TTO data. This study aims to compare the health preferences among 11 Asian populations using the DCE data collected in their EQ-5D-5L valuation studies. METHODS: In the EQ-VT protocol, 196 pairs of EQ-5D-5L health states were valued by a general population sample using DCE method for all studies. DCE data were obtained from the study PI. To understand how the health preferences are different/similar with each other, the following analyses were done: (1) the statistical difference between the coefficients; (2) the relative importance of the five EQ-5D dimensions; (3) the relative importance of the response levels. RESULTS: The number of statistically differed coefficients between two studies ranged from 2 to 16 (mean: 9.3), out of 20 main effects coefficients. For the relative importance, there is not a universal preference pattern that fits all studies, but with some common characteristics, e.g. mobility is considered the most important; the relative importance of levels are approximately 20% for level 2, 30% for level 3, 70% for level 4 for all studies. DISCUSSION: Following a standardized study protocol, there are still considerable differences in the modeling and relative importance results in the EQ-5D-5L DCE data among 11 Asian studies. These findings advocate the use of local value set for calculating health state utility.
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Nível de Saúde , Qualidade de Vida , Povo Asiático , Humanos , Qualidade de Vida/psicologia , Projetos de Pesquisa , Inquéritos e QuestionáriosRESUMO
BACKGROUND: There is a paucity of research on the cost of breast cancer (BC) treatment from the patient's perspective in Vietnam. METHODS: Individual-level data about out-of-pocket (OOP) expenditures on use of services were collected from women treated for BC (n = 202) using an online survey and a face-to-face interview at two tertiary hospitals in 2019. Total expenditures on diagnosis and initial BC treatment were presented in terms of the mean, standard deviation, and range for each type of service use. A generalised linear model (GLM) was used to assess the relationship between total cost and socio-demographic characteristics. RESULTS: 19.3% of respondents had stage 0/I BC, 68.8% had stage II, 9.4% had stage III, none had stage IV. The most expensive OOP elements were targeted therapy with mean cost equal to 649.5 million VND ($28,025) and chemotherapy at 36.5 million VND ($1575). Mean total OOP cost related to diagnosis and initial BC treatment (excluding targeted therapy cost) was 61.8 million VND ($2667). The mean OOP costs among patients with stage II and III BC were, respectively, 66 and 148% higher than stage 0/I. CONCLUSIONS: BC patients in Vietnam incur significant OOP costs. The cost of BC treatment was driven by the use of therapies and presentation stage at diagnosis. It is likely that OOP costs of BC patients would be reduced by earlier detection through raised awareness and screening programmes and by providing a higher insurance reimbursement rate for targeted therapy.
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Neoplasias da Mama , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/terapia , Feminino , Gastos em Saúde , Humanos , VietnãRESUMO
PURPOSE: This study compared the health-related quality of life (HRQoL) of breast cancer (BC) patients, survivors, and age-matched women from the general population in Vietnam to address the paucity of HRQoL research and contribute to the robust assessment of BC screening and care in Vietnam. METHODS: The standardised EQ-5D-5L instrument was incorporated in an online survey and a hospital-based face-to-face survey, and together with data from the Vietnam EQ-5D-5L norms study. χ2 tests assessed EQ-5D health profile associations and a Tobit regression model investigated the association between overall health status (EQ-VAS/utility scores) and sociodemographic and clinical characteristics. RESULTS: A total of 309 participants (107 patients undergoing treatment and 202 survivors who had completed treatment) provided usable responses. The dimensions that affected mostly the HRQoL of women with BC were pain/discomfort and anxiety/depression. Current patients and survivors differed significantly regarding HRQoL dimensions of mobility, self-care, usual activities, and anxiety/depression. Their health utilities were 0.74 and 0.84, respectively, compared with 0.91 for age-matched Vietnamese women in the general population (p < 0.001). Treatment status (survivor vs patient), younger age, higher monthly household income, and higher education levels were associated with higher health utility. CONCLUSIONS: The results point to unmet needs in mental health support and well-being and for attention to be given to the development of a biopsychosocial system of cancer diagnosis, treatment, and care. The results will also inform future assessments of the comparative value for money of interventions intended to impact on breast cancer in Vietnam.
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Neoplasias da Mama , Sobreviventes de Câncer , Sobreviventes de Câncer/psicologia , Estudos Transversais , Feminino , Nível de Saúde , Humanos , Qualidade de Vida/psicologia , Inquéritos e Questionários , VietnãRESUMO
INTRODUCTION: Strategies are needed to increase implementation of evidence-based tobacco dependence treatment (TDT) in health care systems in low-and middle-income countries (LMICs). AIMS AND METHODS: We conducted a two-arm cluster randomized controlled trial to compare the effectiveness of two strategies for implementing TDT guidelines in community health centers (n = 26) in Vietnam. Arm 1 included training and a tool kit (eg, reminder system) to promote and support delivery of the 4As (Ask about tobacco use, Advise to quit, Assess readiness, Assist with brief counseling) (Arm 1). Arm 2 included Arm 1 components plus a system to refer smokers to a community health worker (CHW) for more intensive counseling (4As + R). Provider surveys were conducted at baseline, 6 months, and 12 months to assess the hypothesized effect of the strategies on provider and organizational-level factors. The primary outcome was provider adoption of the 4As. RESULTS: Adoption of the 4As increased significantly across both study arms (all p < .001). Perceived organizational priority for TDT, compatibility with current workflow, and provider attitudes, norms, and self-efficacy related to TDT also improved significantly across both arms. In Arm 2 sites, 41% of smokers were referred to a CHW for additional counseling. CONCLUSIONS: The study demonstrated the effectiveness of a multicomponent and multilevel strategy (ie, provider and system) for implementing evidence-based TDT in the Vietnam public health system. Combining provider-delivered brief counseling with opportunities for more in-depth counseling offered by a trained CHW may optimize outcomes and offers a potentially scalable model for increasing access to TDT in health care systems like Vietnam. IMPLICATIONS: Improving implementation of evidence-based TDT guidelines is a necessary step toward reducing the growing burden of noncommunicable diseases and premature death in LMICs. The findings provide new evidence on the effectiveness of multilevel strategies for adapting and implementing TDT into routine care in Vietnam and offer a potentially scalable model for meeting Framework Convention on Tobacco Control Article 14 goals in other LMICs with comparable public health systems. The study also demonstrates that combining provider-delivered brief counseling with referral to a CHW for more in-depth counseling and support can optimize access to evidence-based treatment for tobacco use.Clinical trials number: NCT01967654.
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Tabagismo , Agentes Comunitários de Saúde , Aconselhamento , Humanos , Uso de Tabaco , Tabagismo/terapia , VietnãRESUMO
BACKGROUND: Early detection of autism spectrum disorders (ASDs) is essential given the under-reported cases in low- and middle-income countries. This first national representative survey was conducted to explore the prevalence of ASDs amongst 18 and 30 months in seven provinces in Vietnam. DESIGN AND METHODS: During 2017- 2018, a national cross-sectional and population-based survey for autism spectrum disorder (ASD) amongst 40,243 children aged 18 to 30 months was conducted in 7 provinces representing the socio-economic regions of Vietnam. M-CHAT was used to screen children and then confirmed by diagnostic assessment using DSM-IV criteria. RESULTS: The prevalence of ASDs amongst children aged 18 and 30 months in Vietnam was high (0.758% or 1 in 132 children). Urban setting, male gender, and hereditable genes were associated with ASD prevalence. CONCLUSIONS: ASDs amongst children aged 18 and 30 months in Vietnam tend to be increasing and are similar to this rate in other middle-income countries but lower than that in Western countries. This under-recognized public health problem amongst children should be addressed by early detection and intervention for families with affected children.
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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.