Effectiveness of Community Intervention Program on Knowledge and Practice of HPV Prevention Among Married Females in Vietnam Rural Areas.

Human papillomavirus (HPV) is identified as the leading cause of cervical cancer which is the second most common cancer of females in the world. This study aimed to evaluate the effects of a community-based intervention on knowledge and practice of HPV prevention among married females aged 15 to 49 in rural areas, Vietnam. This study used a quasi-experimental design with serial cross-sectional surveys at one intervention commune (Chi Linh, Hai Duong) and one control commune at other province (Thanh Thuy, Phu Tho). Number of participants in these surveys were respectively 317 and 320 in Chi Linh and 334 and 335 in Thanh Thuy at pre- and postintervention period. The time of intervention was 15 months from April 2015 to June 2016. The study used behavior models to build up a logical framework for identifying related factors of knowledge and practice among females and developing intervention strategies. A difference-in-differences analysis approach was used to evaluate the effects of this intervention program. The study identified that the intervention had a significant change of knowledge of HPV prevention among married females after the intervention (odds ratio = 3.16, 95% confidence interval: 1.3-7.66) after adjusting for other confounders but no any significant change of practice of HPV prevention (eg, condom use, numbers of sexual partner, HPV vaccination, and screening test for cervical cancer). This might be caused by a short intervention program that did not lead to changes of practice but only change of knowledge.

Guidance toward the implementation of multicriteria decision analysis framework in developing countries.

INTRODUCTION: Multiple Criteria Decision Analysis (MCDA) is increasingly used in health care mainly because it moves decision-making from ad hoc to an evidence-based and comprehensive process. Developing countries with more restricted financial and human research capacities, however, should consider their own methods of MCDA development and implementation. Areas covered: An MCDA framework to improve procurement decisions of off-patent pharmaceuticals was developed for developing countries and adapted to Indonesia, Kazakhstan and Vietnam during three policy workshops. Based on the experience of these workshops and one joint workshop with international experts and decision makers from multiple developing countries, general recommendations were formulated on how to implement MCDA specifically in developing countries. We provide 17 practical MCDA implementation recommendations in four major areas, including (1) MCDA objectives; (2) technical considerations of MCDA tool; (3) development and customization of MCDA tool and (4) policy implementation of MCDA in decision-making. Expert commentary: These practical MCDA recommendations for developing countries contribute to feasible, transparent, stepwise, iterative and standardized decision-making in health care.

Punching above their weight: a network to understand broader determinants of increasing life expectancy.

BACKGROUND: Life expectancy initially improves rapidly with economic development but then tails off. Yet, at any level of economic development, some countries do better, and some worse, than expected - they either punch above or below their weight. Why this is the case has been previously researched but no full explanation of the complexity of this phenomenon is available. NEW RESEARCH NETWORK: In order to advance understanding, the newly formed Punching Above Their Weight Research Network has developed a model to frame future research. It provides for consideration of the following influences within a country: political and institutional context and history; economic and social policies; scope for democratic participation; extent of health promoting policies affecting socio-economic inequities; gender roles and power dynamics; the extent of civil society activity and disease burdens. CONCLUSION: Further research using this framework has considerable potential to advance effective policies to advance health and equity.

Early marriage and intimate partner violence among adolescents and young adults in Viet Nam.

Research about the association between early marriage and intimate partner violence (IPV) in low-income countries has yielded conflicting evidence. The aim of this study was to describe the prevalence of and associations between early marriage, and IPV among adolescents and young adults in Viet Nam. Secondary analysis of data from the national Survey Assessment of Viet Namese Youth-Round II (SAVY-II) conducted in 2009-2010, which assessed a representative cohort of people aged 14 to 25 years recruited via a systematic household survey was undertaken. Prevalence was established using descriptive statistics. The association between early marriage and IPV was examined using multiple logistic regressions, adjusting for potential risk factors. Of 10,044 participants, 1,701 had ever married and were included in analyses. Early marriage (before age 18), and experiences of verbal, physical, or sexual IPV were more common among females than males. More young married men than women reported experiences of controlling behaviors by their partners. Early marriage, being illiterate, and exposure to sexual abuse were associated with experience of IPV among young females, but not among young males. Poverty and exposure to family violence was associated with IPV in both sexes. Addressing early marriage, low educational opportunities for girls, childhood sexual abuse, family violence, and poverty should be considered in strategies to reduce IPV in Viet Nam.

Policy approaches to address the social and environmental determinants of health inequity in Asia-pacific.

Asia Pacific is home to over 60% of the world's population and the fastest growing economies. Many of the leadership in the Asia Pacific region is becoming increasingly aware that improving the conditions for health would go a long way to sustaining economic prosperity in the region, as well as improving global and local health equity. There is no biological reason why males born in Cambodia can expect to live 23 years less than males born in Japan, or why females born in Tuvalu live 23 years shorter than females in New Zealand or why non-Indigenous Australian males live 12 years longer than Indigenous men. The nature and drivers of health inequities vary greatly among different social, cultural and geo-political contexts and effective solutions must take this into account. This paper utilizes the CSDH global recommendations as a basis for looking at the actions that are taking place to address the structural drivers and conditions of daily living that affect health inequities in the Asia Pacific context. While there are signs of action and hope, substantial challenges remain for health equity in Asia Pacific. The gains that have been made to date are not equally distributed and may be unsustainable as the world encounters new economic, social and environmental challenges. Tackling health inequities is a political imperative that requires leadership, political courage, social action, a sound evidence base and progressive public policy.