Addressing Unintentional Exclusion of Vulnerable and Mobile Households in Traditional Surveys in Kathmandu, Dhaka, and Hanoi: a Mixed-Methods Feasibility Study.

The methods used in low- and middle-income countries' (LMICs) household surveys have not changed in four decades; however, LMIC societies have changed substantially and now face unprecedented rates of urbanization and urbanization of poverty. This mismatch may result in unintentional exclusion of vulnerable and mobile urban populations. We compare three survey method innovations with standard survey methods in Kathmandu, Dhaka, and Hanoi and summarize feasibility of our innovative methods in terms of time, cost, skill requirements, and experiences. We used descriptive statistics and regression techniques to compare respondent characteristics in samples drawn with innovative versus standard survey designs and household definitions, adjusting for sample probability weights and clustering. Feasibility of innovative methods was evaluated using a thematic framework analysis of focus group discussions with survey field staff, and via survey planner budgets. We found that a common household definition excluded single adults (46.9%) and migrant-headed households (6.7%), as well as non-married (8.5%), unemployed (10.5%), disabled (9.3%), and studying adults (14.3%). Further, standard two-stage sampling resulted in fewer single adult and non-family households than an innovative area-microcensus design; however, two-stage sampling resulted in more tent and shack dwellers. Our survey innovations provided good value for money, and field staff experiences were neutral or positive. Staff recommended streamlining field tools and pairing technical and survey content experts during fieldwork. This evidence of exclusion of vulnerable and mobile urban populations in LMIC household surveys is deeply concerning and underscores the need to modernize survey methods and practices.

Progress on maternal health care in Vietnam: Findings from Vietnam Multiple Indicator Cluster Survey 2000, 2006, 2011, and 2014.

This paper aims to describe a trend in coverage of maternal care services, and provides a detailed analysis of socio-economic correlations to the existing inequities. The paper uses data from the Vietnam Multiple Indicator Cluster Survey 2000, 2006, 2011, and 2014. In the MICS, there were 9,117 women in 2000, 9,473 women in 2006, 11,614 women in 2011, and 9,827 women in 2014 participated in. We found the coverage of antenatal care increase from 68.6% in 2000 to 95.9% in 2014. Similarly, the percentages of women who gave birth with the assistance of skilled staff increased during the studied period ( from 69.9% in 2000, 87.7% to 94.5% in 2014). However, improvements in antenatal care and skilled birth attendance in Vietnam have been uneven across different segments of the population. In all the four surveys, the proportions of women who received ANC by a skilled staff and percentages of women who gave birth with the assistance of a skilled health personnel were much higher among those with higher education, belonged to Kinh majority tribe, had better economic status, and lived in an urban area. The degrees of inequity in both antenatal and delivery care in Vietnam are likely to increase over time.

Ante-, Peri-, and Neonatal Factors Associated with Autism Spectrum Disorders in Vietnam: A Population-Based Cross-Sectional Survey.

Background: Autism Spectrum Disorders (ASDs) are common behavioral syndromes but limited critical evidence in Vietnam. This study aimed to identify ante-, peri- and neonatal factors for ASDs amongst children in Vietnam. Methods: This population-based study applied the cross-sectional design with a multistage sampling in 21 urban and rural districts in seven cities/provinces in Vietnam during 2017-2018. Overall, 42,551 children age 18 to 30 months were enrolled in the study. Two phases of assessment using Modified Checklist for Autism in Toddlers (M-CHAT) for screening and diagnostic assessment using Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria for confirmation. We employed univariate and binary logistic regression to identify. Results: Our study showed a fast-growing trend of ASDs amongst children age 18 and 30 months (75.8 per 10,000 individuals). Nine ante-, peri-, and neonatal factors were associated with ASDs: five factors of antenatal period (history of miscarriage/abortion or stillbirth, children conceived by assisted reproduction technologies, having cold, flu or acquiring virus during pregnancy, having gestational diabetes, toxemia, high blood pressure or pre-eclampsia during pregnancy, and having stress or mental disorders during pregnancy); one factors of perinatal period (mode of delivery); and three factors of neonatal period (jaundice, respiratory distress, and newborn seizures). Conclusion: This first large-scale survey in Vietnam confirms some prenatal, perinatal, and postnatal factors with ASDs amongst children age 18 and 30 months. Future interventions should focus on these factors to early diagnosis and intervention to improve functional outcomes for risky children.

Community engagement in the prevention and control of COVID-19: Insights from Vietnam.

INTRODUCTION: Community engagement (CE) is an effective public health strategy for improving health outcomes. There is limited published knowledge about effective approaches to CE in ensuring effective responses to COVID-19 throughout lockdowns, travel restrictions and social distancing. In this paper, we contribute to bridging this gap by highlighting experience of CE in Vietnam, specifically focusing on migrant workers in Vietnam. METHODS: A cross-sectional qualitative study design was used with qualitative data collection was carried out during August-October 2020. Two districts were purposefully selected from two large industrial zones. Data was collected using in-depth interviews (n = 36) with individuals and households, migrants and owners of dormitories, industrial zone factory representatives, community representatives and health authorities. Data was analyzed using thematic analysis approach. The study received ethics approval from the Hanoi University Institutional Review Board. RESULTS: The government's response to COVID-19 was spearheaded by the multi-sectoral National Steering Committee for the Prevention and Control of COVID-19, chaired by the Vice Prime Minister and comprised different members from 23 ministries. This structure was replicated throughout the province and local levels and all public and private organizations. Different activities were carried out by local communities, following four key principles of infection control: early detection, isolation, quarantine and hospitalization. We found three key determinants of engagement of migrant workers with COVID-19 prevention and control: availability of resources, appropriate capacity strengthening, transparent and continuous communication and a sense of trust in government legitimacy. DISCUSSION AND CONCLUSION: Our results support the current literature on CE in infection control which highlights the importance of context and suggests that future CE should consider five key components: multi-sectoral collaboration with a whole-of-community approach to strengthen governance structures with context-specific partnerships; mobilization of resources and decentralization of decision making to encourage self-reliance and building of local capacity; capacity building through training and supervision to local institutions; transparent and clear communication of health risks and sensitization of local communities to improve compliance and foster trust in the government measures; and understanding the urgent needs ensuring of social security and engaging all parts of the community, specifically the vulnerable groups.

Perceived Barriers to Mental Health Services among the Elderly in the Rural of Vietnam: A Cross Sectional Survey in 2019.

While the burden of neurological and mental disorders has been drastically increased in Vietnam, the current mental healthcare services do not meet the public demand. In order to determine perceived barriers to the use of mental health services, we conducted a cross-sectional study on 376 elderly people from a rural district in Hanoi, Vietnam. We found that depression may be an important indicator of the need for formal and informal community and home care mental health services. Barriers to mental healthcare access were categorized into 7 groups namely stigma, emotional concerns, participation restrictions, service satisfaction, time constraints, geographic and financial conditions, and availability of services. The most significant barriers are the limited availability of and accessibility to health professionals and services in rural areas. Our study highlights the urgent efforts that need to be made in order to enhance availability of mental healthcare services in rural areas of Vietnam.

Early screening and diagnosis of autism spectrum disorders in Vietnam: A population-based cross-sectional survey.

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.

The Utilization of Maternal Healthcare Services Among Ethnic Minority Populations in Vietnam.

BACKGROUND: Previous studies have observed lower utilization of maternal healthcare services by ethnic minority groups in Vietnam compared with the majority Kinh community. This study sought to assess the utilization of maternal healthcare service-associated factors within 12 ethnic minority groups. METHOD: The cross-sectional study enrolled 996 women from 12 ethnic minority groups in Vietnam in 2019. Women had pregnancy outcomes in the last 5 years. The two variables for maternal healthcare utilization were [1] a minimum of four antenatal contacts and [2] health facility-based delivery. We examined the association of individual characteristics of maternal healthcare services using multilevel modeling. Odds ratios (ORs) and 95% confidence intervals (CIs) were reported. RESULTS: This nationally representative study found that 34.1% of women from ethnic minority backgrounds had four or more antenatal contacts during pregnancy, ranging from 8.3% in Mong community to 80.2% in Cham An Giang. Most of the women (94.4%) delivered at health facilities. Factors independently correlated with having fewer than four antenatal contacts included being illiterate, early marriage, unemployment, religious affiliation, household economy, and distance to the nearest health facility. Factors significantly associated with home delivery were living in the most disadvantaged areas and having fewer than four antenatal contacts. CONCLUSION: Substantial inequity exists in antenatal coverage both within ethnic minority groups and between socio-economic groups. The low coverage of having at least four antenatal contacts and its' correlates with facility-based delivery suggests that the government should focus efforts on increasing the number of antenatal contacts for ethnic minority women.

Prevalence and correlates of multimorbidity among adults in border areas of the Central Highland Region of Vietnam, 2017.

INTRODUCTION: The objectives of this study are to estimate the prevalence of multimorbidity (MM) among adults in the Central Highland Region (a poor region) of Vietnam in 2017 and to identify the sociodemographic correlates of these conditions. METHODS: We used data from a cross-sectional study conducted in 2018 on health status among people in four provinces in the Central Highlands Region (Tay Nguyen) of Vietnam. A sample of 1680 adults (aged 15 years and older) were randomly selected for this study. Respondents were asked whether they had been told by a health worker that they had cancer, heart and circulatory conditions, chronic joint problems, chronic pulmonary diseases, chronic kidney problems, chronic digestive problems, psychological illness, diabetes, and/or other chronic conditions. RESULTS: The prevalence of MM among the study participants was 16.4% (95% confidence interval (CI): 14.6%-18.2%). By looking at the 95% CIs, the differences in MM prevalence between the groups classified by gender, age, education, and occupation were not statistically significant. Only the difference in MM prevalence between farmers and government staff was statistically significant. Multivariate logistic analyses show education and occupations were shown to be significant correlates of MM. CONCLUSION: MMs were quite common among the adult populations in the study area, especially among people with lower socioeconomic status. Given the evidence, actions to reduce levels of MM in the setting are clearly urgent. The interventions should address all people in society, with focus on disadvantaged groups, like those with lower education and farmers.

Improving household surveys and use of data to address health inequities in three Asian cities: protocol for the Surveys for Urban Equity (SUE) mixed methods and feasibility study.

INTRODUCTION: As rapid urbanisation transforms the sociodemographic structures within cities, standard survey methods, which have remained unchanged for many years, under-represent the urban poorest. This leads to an overly positive picture of urban health, distorting appropriate allocation of resources between rural and urban and within urban areas. Here, we present a protocol for our study which (i) tests novel methods to improve representation of urban populations in household surveys and measure mental health and injuries, (ii) explores urban poverty and compares measures of poverty and 'slumness' and (iii) works with city authorities to understand, and potentially improve, utilisation of data on urban health for planning more equitable services. METHODS AND ANALYSIS: We will conduct household surveys in Kathmandu, Hanoi and Dhaka to test novel methods: (i) gridded population sampling; (ii) enumeration using open-access online maps and (iii) one-stage versus two-stage cluster sampling. We will test reliability of an observational tool to categorise neighbourhoods as slum areas. Within the survey, we will assess the appropriateness of a short set of questions to measure depression and injuries. Questionnaire data will also be used to compare asset-based, consumption-based and income-based measures of poverty. Participatory methods will identify perceptions of wealth in two communities in each city. The analysis will combine quantitative and qualitative findings to recommend appropriate measures of poverty in urban areas. We will conduct qualitative interviews and establish communities of practice with government staff in each city on use of data for planning. Framework approach will be used to analyse qualitative data allowing comparison across city settings. ETHICS AND DISSEMINATION: Ethical approvals have been granted by ethics committees from the UK, Nepal, Bangladesh and Vietnam. Findings will be disseminated through conference papers, peer-reviewed open access articles and workshops with policy-makers and survey experts in Kathmandu, Hanoi and Dhaka.

Smoking Initiation and Cessation among Youths in Vietnam: A Longitudinal Study Using the Chi Linh Demographic-Epidemiological Surveillance System (CHILILAB DESS).

Study of smoking initiation and cessation is particularly important in adolescent population because smoking prevention and cessation at this time may prevent several health consequences later in life. There is a very limited knowledge about the determinants of smoking initiation and cessation among youths in Vietnam. This limits the development and implementation of appropriately targeted anti-smoking prevention interventions. This study applied pooled data from 3 rounds of a longitudinal survey in the Chi Linh Demographic-Epidemiological Surveillance System (CHILILAB DESS) in a northern province in Vietnam to analyse the determinants of smoking initiation and cessation among youths. The total of youths in the first round, second, and third rounds was 12,406, 10,211, and 7,654, respectively. The random-effects logit model controlling for both time-variant and time-invariant variables was conducted to explore the associated factors with new smokers and quitters. We found an increase trend of new smokers (7.0% to 9.6%) and quitters (27.5% to 31.4%) during 2009-2013. Smoking initiation and cessation are the result of multifactorial influences of demographic and health behaviours and status. Demographic background (older youths, male, unmarried youths, and youths having informal work) and health behaviours and status (youths who had smoking family members and/or smoking close friends, and had harmful drinking) were more likely to initiate smoking and more difficult to quit smoking. Among these variables, youths who had smoking close-friends had the highest likelihood of both initiating smoking and failed quitting. Our results could represent the similar health problems among youths in peri-urban areas in Vietnam. Further, our findings suggested that anti-smoking interventions should involve peer intervention, integrated with the reduction of other unhealthy behaviours such as alcohol consumption, and to focus on adolescents in their very early age (10-14 years old).

Changes in Co-Occurrence of Smoking and Harmful Drinking among Youth: a Study from the Chi Linh Demographic - Epidemiological Surveillance System in Vietnam, 2006-2013.

Smoking and harmful drinking dramatically increase health risks but little is known about their cooccurrence and factors that influence this co-habit, limiting development and implementation of appropriately targeted prevention interventions. This study was conducted among youth aged 10-24 years old in the Chi Linh Demographic - Epidemiological Surveillance System (CHILILAB DESS). The total numbers in the first, second and third rounds in 2006, 2009 and 2013 were 12,406, 10,211, and 7,654, respectively. A random-effects logit model controlling for both time-variant and time-invariant variables was applied to explore factors associated with current smoking, harmful drinking, and occurrence of smoking and harmful drinking together. We found dramatically increasing trends in current smoking, harmful drinking and co-occurrence among youth. Our results indicate similar health problems among youth in peri-urban areas in Vietnam. Demographic characteristics (older age, being male, being unmarried, and having informal work) appeared to be predictors for smoking and drinking behaviour. Besides, peer and family members had significant influence on smoking, whereas having a close-friend who was smoking was the most important variable. The results suggested that smoking and harmful drinking should not be solved with separate, stand-alone interventions but rather with integrated efforts.

Potential Impact of Graphic Health Warnings on Cigarette Packages in Reducing Cigarette Demand and Smoking-Related Deaths in Vietnam.

Two years after implementation of the graphic health warning intervention in Vietnam, it is very important to evaluate the intervention's potential impact. The objective of this paper was to predict effects of graphic health warnings on cigarette packages, particularly in reducing cigarette demand and smoking-associated deaths in Vietnam. In this study, a discrete choice experiment (DCE) method was used to evaluate the potential impact of graphic tobacco health warnings on smoking demand. To predict the impact of GHWs on reducing premature deaths associated with smoking, we constructed different static models. We adapted the method developed by University of Toronto, Canada and found that GHWs had statistically significant impact on reducing cigarette demand (up to 10.1% through images of lung damage), resulting in an overall decrease of smoking prevalence in Vietnam. We also found that between 428,417- 646,098 premature deaths would be prevented as a result of the GHW intervention. The potential impact of the GHW labels on reducing premature smoking-associated deaths in Vietnam were shown to be stronger among lower socio-economic groups.