Community-Based Screening for Cervical Cancer Using Visual Inspection With Acetic Acid: Results and Lessons Learned From a Pilot Study in Vietnam.

CONTEXT: Vietnam still applies the opportunistic cytology-based screening model, which failed to have an impact on the increasing burden of cervical cancer in Vietnam. OBJECTIVES: To pilot a community-based screening model for cervical cancer using visual inspection with acetic acid (VIA) in Vietnam by training midwife and assistant physician working at grassroots level of health care system. DESIGN: The study employed a pre-experimental design. SETTING: Cases from 2 provinces of Vietnam. PARTICIPANTS: The study trained 36 assistant physicians/midwives working at commune health centers to do VIA screening for cervical cancer and provided screening services for 1945 women 30 to 65 years of age. INTERVENTION: The pilot intervention had 2 aims: train health care workers to do VIA screening and assess the quality of screening services provided by the trained staffs by examining the diagnostics value of VIA. RESULTS: All selected health care workers were able to perform VIA screening method after training. Their VIA services had high diagnostic value: positive predicted value of 11.5% and negative predicted value of 99%; for the detection of cervical intraepithelial neoplasia (CIN) 2, the sensitivity of VIA is 100%, specificity of 67.0%, positive predicted value of 5.7%, and negative predicted value of 100%; for the detection of CIN 3, the sensitivity of VIA is 100%, specificity of 66.5%, positive predicted value of 3.8%, and negative predicted value of 100%. The diagnostic value of VIA is comparable with Papanicolaou test but requires far fewer resources and suitable with community-based setting. CONCLUSION: Local midwives and assistant physicians who currently work at commune health centers and district health centers can be trained to do VIA efficiently. Regarding to implications for policy and practice, VIA can offer significant advantages over Papanicolaou test in low-resource settings like Vietnam, particularly in terms of increased screening coverage, improved follow-up care, and overall program quality.

A final-year nursing student survey: rural attitudes, perceived competencies and intention to work across five Asian countries.

BACKGROUND: Shortages and maldistribution of nurses remain significant problems in many countries. Having appropriate intervention strategies to retain nurses in underserved areas, where they are most needed, are crucial for health system strengthening. This study aimed to quantify attitudes to working in rural areas, perceived competencies, and intention to work among final-year nursing students, and to analyze the associations between those factors and their background characteristics across five countries in the Asia-Pacific Network for Health Professional Education Reforms (ANHER), namely Bangladesh, China, India, Thailand, and Vietnam. METHODS: A descriptive comparative cross-sectional survey was conducted between July 2012 and July 2013, using a self-administered questionnaire to assess students' attitudes towards working in rural areas, their perceived competencies, and their intended job choices. A total of 10,169 final-year nursing students in five countries were selected. Bivariate models were constructed to compare students' characteristics. Statistically significant variables were further analyzed using multivariate models. RESULTS: Most nursing students in five countries had rural backgrounds. Students in India (67.1%) and Thailand (65.1%) held more positive attitudes towards working in rural areas. Students in Bangladesh (78.8%) and India (62.6%) believed that their schools prepared them well, and inspired them, to work in rural areas. The 'Lifelong learning' competency was ranked highest by students in all five countries, ranging from 76.2 to 91.7%. Their perceived competencies were significantly related to their background of having graduated from rural high schools and being admitted to study through rural recruitment. Rural upbringing and rural recruitment were significantly associated with more positive attitudes towards rural areas (p-value < 0.5). A majority of students in China (83.8%), Thailand (67.7%) and Vietnam (86.5%) intended to work in the public sector immediately after graduation. CONCLUSIONS: These findings from five Asian countries confirm that nursing students with rural upbringing and recruitment had more positive attitudes toward rural areas and were more likely to choose working in rural areas after graduation. This study provides additional evidence from country implementation to support the value of WHO recommendations of effective strategies to address issues of rural retention by focusing on the recruitment of students with a rural background.

Prevalence of cervical infection with HPV type 16 and 18 in Vietnam: implications for vaccine campaign.

BACKGROUND: The Expanded Program on Immunization currently considers offering Human Papilomavirus vaccine on a routine basis in Vietnam. However, as the current available vaccine can prevent only two types HPV 16 and 18, before implementing a large-scale vaccine campaign we need information about the prevalence of infection with only HPV 16 and 18 in Viet Nam. This study was done in 5 large cities in Vietnam to estimate the prevalence of HPV 16 and/or 18 infections and to explore the distribution of other high risk types of HPV among married women in these provinces. METHODS: The study employed a cross-sectional design with multistage sampling. The sample size included 4500 married women in two rounds (aged ranged from 18-69 years old, median age: 40 year old). Participant were randomly selected, interviewed and given gynaecological examinations. HPV infection status (by real-time PCR kit using TaqMan probe) and HPV genotyping test (by Reverse dot blot) were done for all participants. RESULTS: The prevalence of cervical infection with HPV type 16 and/or 18 among married women in this study ranged from 3.1% to 7.4%. Many positive HPV cases (ranged from 24.5% to 56.8%) were infected with other type of high risk HPV which can lead to cervical cancer and cannot prevented by currently available vaccines. In addition to HPV 16 and/or 18, most common types of high risk HPV were types 58, 52, 35 and 45. Awareness about HPV and HPV vaccines was still low in the study samples. DISCUSSION: While it is relevant to implement an HPV vaccine campaign in Viet Nam, it is important to note that one can be infected with multiple types of HPV. Vaccination does not protected against all type of high risk HPV types. Future vaccine campaigns should openly disclose this information to women receiving vaccines. CONCLUSION: High prevalence of infection with HPV high risk types was observed in this study. As HPV infection has a high correlation with cervical cancer, this study emphasizes the need for both primary prevention of cervical cancer with HPV vaccines as well as secondary prevention with screening.

Neighbourhood ethnic diversity buffers school readiness impact in ESL children.

OBJECTIVES: Contextual factors, as measured by neighbourhood characteristics, shape the experiences children have and affect their "school readiness", i.e., whether they are well or poorly prepared for the transition from home to kindergarten. This study assessed the independent effects of individual and neighbourhood factors on school readiness; specifically, it examined whether and to what degree neighbourhood factors modified children's language ability and thus their school readiness in a population of children in Saskatoon, Saskatchewan. METHOD: The study included all children attending kindergarten in 2001, 2003 and 2005 in Saskatoon. School readiness and child characteristics were measured by the Early Development Instrument (EDI). The EDI measures child development at school commencement in five domains: physical health and well-being, social competence, emotional maturity, cognitive and language development, and communication skills and general knowledge. Data from the 2001 Census were used to characterize Saskatoon's neighbourhoods. Multilevel modeling examined the independent and buffering or exacerbating effects of individual and neighbourhood factors on the relation between English as a Second Language (ESL) status in children and EDI domain scores. RESULTS: ESL children had significantly lower scores on all EDI domains compared with non-ESL children. Certain factors (e.g., younger age, male, Aboriginal status, having special needs) were significantly related to lower readiness in terms of the emotional maturity, and communication skills and general knowledge domains. Importantly, children who lived in neighbourhoods that were highly transient (with a higher proportion of residents who had moved in the previous year) had lower EDI scores on both domains, and those in neighbourhoods with lower rates of employment had lower EDI scores on communication skills and general knowledge. Neighbourhood ethnic diversity mitigated the negative impact of ESL status on school readiness for both domains. ESL children from neighbourhoods with a high degree of ethnic diversity had higher EDI scores than ESL children from neighbourhoods with low ethnic diversity. DISCUSSION: The current study provided insight regarding the impact of contextual factors in addition to individual factors, such as ESL status, on school readiness outcomes. Future research should continue to examine contextual factors related to ESL status and early child developmental outcomes, particularly focusing on the mechanisms of influence.

Neighbourhood effects on hospitalization in early childhood.

OBJECTIVE: To determine whether characteristics of neighbourhoods in which children live, such as socio-economic disadvantage, physical infrastructure, programs and services, social disconnection, smoking prevalence, and overcrowding, are related to hospitalization rates from birth to age six, independent of individual-level factors. METHODS: We studied a population of 8,504 children born in Saskatoon, Canada, over a three-year period (1992-1994). The birth cohort was retrospectively followed until children reached age six. Birth registry records were linked to health care utilization files to create continuous histories of health care utilization for each child. Information on the neighbourhood in which the child's family resided at his or her birth was extracted from Statistics Canada's 1991 Census and numerous local sources. A longitudinal and multilevel design was employed to examine the effect of neighbourhood characteristics and individual-level factors on childhood hospitalization rate. RESULTS: Male children, children born to mothers under 20 years of age, Aboriginal children, children in low-income families, and those with adverse birth outcomes had significantly higher rates of hospitalization. In addition to these individual factors, children living in economically disadvantaged neighbourhoods, neighbourhoods in poor physical condition, and neighbourhoods with higher average household size had significantly higher rates of hospitalization. CONCLUSIONS: The kind of neighbourhood families live in has an impact on their children's risk of hospitalization, above and beyond the family's own characteristics. These findings provide additional support for a 'healthy community' approach that uses community development and healthy public policy to create safe, health-promoting neighbourhoods for all families.

Neighbourhood contexts and low birthweight: social disconnection heightens single parents risks in Saskatoon.

BACKGROUND: The majority of research to date on low birthweight (LBW) has emphasized maternal characteristics, and less so how maternal risk is shaped (via contextual factors). This study aims to understand how neighbourhood characteristics influence LBW, independently and in interaction with individual factors, in the context of community-defined neighbourhoods. METHOD: All singleton births for a 3-year period (1992-1995; n=8504) to mothers resident in Saskatoon comprised the study population. Data included were child and mother's/father's characteristics and six neighbourhood characteristics: socio-economic disadvantage, social disconnection, physical condition, population density, availability and accessibility of local programs and services, and smoking prevalence. Multilevel modeling for a binary outcome (LBW) was employed; odds ratios and 95% confidence intervals for the final model were reported. RESULTS: Newborns in families receiving income assistance, with a mother over 40, and whose mother had previous stillbirths were at greater risk for LBW; however, mothers who had more than one previous live birth were less likely to have a LBW baby. Independent of individual-level risk factors, infants in socio-economically disadvantaged neighbourhoods were at increased risk for LBW (OR 1.34; 95% CI 1.07, 1.68). Most interestingly, the risk of LBW among infants born to single mothers was exacerbated by greater level of neighbourhood social disconnection. Neighbourhoods with low levels of social disconnection have a lower risk of LBW among single mothers (OR=0.89, 95% CI 0.72, 1.17) compared to those with high levels (OR=1.57, 95% CI 1.18, 1.93). CONCLUSION: Neighbourhood contextual factors influence the risk of LBW directly, via independent effects, as well as through moderating the risk of individual factors. Studies that simultaneously examine both individual and contextual effects on LBW could provide a stronger evidentiary base for multiple points of interventions targeting individuals as well as settings.

HIV-related risk behaviors among the general population: a survey using Audio Computer-Assisted Self-Interview in 3 cities in Vietnam.

This study used a confidential survey method-namely, Audio Computer-Assisted Self-Interview (ACASI)-to gather data about HIV-related risk knowledge/behaviors among the general population in Vietnam. The study sample included 1371 people aged 15 to 49 years in 3 cities-Hanoi, Da nang, and Can Tho. Results indicated that 7% of participants had ever had nonconsensual sex, and 3.6% of them had ever had a one-night stand. The percentage of male participants reported to ever have sex with sex workers was 9.6% and to ever inject drugs was 4.3%. The proportion of respondents who had ever tested for HIV was 17.6%. The risk factors and attitudes reported in the survey indicate the importance of analyzing risk behaviors related to HIV infection among the general population. Young people, especially men in more urbanized settings, are engaging in risky behaviors and may act as a "bridge" for the transmission of HIV from high-risk groups to the general population in Vietnam.

Audio computer-assisted self interview compared to traditional interview in an HIV-related behavioral survey in Vietnam.

INTRODUCTION: Globally, population surveys on HIV/AIDS and other sensitive topics have been using audio computer-assisted self interview for many years. This interview technique, however, is still new to Vietnam and little is known about its application and impact in general population surveys. One plausible hypothesis is that residents of Vietnam interviewed using this technique may provide a higher response rate and be more willing to reveal their true behaviors than if interviewed with traditional methods. OBJECTIVE: This study aims to compare audio computer-assisted self interview with traditional face-to-face personal interview and self-administered interview with regard to rates of refusal and affirmative responses to questions on sensitive topics related to HIV/AIDS. METHODS: In June 2010, a randomized study was conducted in three cities (Ha Noi, Da Nan and Can Tho), using a sample of 4049 residents aged 15 to 49 years. Respondents were randomly assigned to one of three interviewing methods: audio computer-assisted self interview, personal face-to-face interview, and self-administered paper interview. Instead of providing answers directly to interviewer questions as with traditional methods, audio computer-assisted self-interview respondents read the questions displayed on a laptop screen, while listening to the questions through audio headphones, then entered responses using a laptop keyboard. A MySQL database was used for data management and SPSS statistical package version 18 used for data analysis with bivariate and multivariate statistical techniques. Rates of high risk behaviors and mean values of continuous variables were compared for the three data collection methods. RESULTS: Audio computer-assisted self interview showed advantages over comparison techniques, achieving lower refusal rates and reporting higher prevalence of some sensitive and risk behaviors (perhaps indication of more truthful answers). Premarital sex was reported by 20.4% in the audio computer-assisted self-interview survey group, versus 11.4% in the face-to-face group and 11.1% in the self-administered paper questionnaire group. The pattern was consistent for both male and female respondents and in both urban and rural settings. Men in the audio computer-assisted self-interview group also reported higher levels of high-risk sexual behavior--such as sex with sex workers and a higher average number of sexual partners--than did women in the same group. Importantly, item refusal rates on sensitive topics tended to be lower with audio computer-assisted self interview than with the other two methods. CONCLUSIONS: Combined with existing data from other countries and previous studies in Vietnam, these findings suggest that researchers should consider using audio computer-assisted self interview for future studies of sensitive and stigmatized topics, especially for men.

Prevalence of cervical human papilloma virus infection among married women in Vietnam, 2011.

The burden of cervical cancer is increasing in Vietnam in the recent years, infection with high risk HPV being the cause. This study aimed to examine the prevalence of HPV and the distribution of HPV specific types among the general population in 5 big cities in Vietnam. Totals of 1500 women in round 1 and 3000 in round 2 were interviewed and underwent gynecological examination. HPV infection status, and HPV genotyping test were performed for all participants. Results indicated that the prevalence of HPV infection in 5 cities ranged from 6.1% to 10.2% with Can Tho having highest prevalence. The most common HPV types in all 5 cities were HPV 16, 18 and 58. Most of the positive cases were infected with high risk HPV, especially in Hanoi and Can Tho where more than 90% positive cases were high risk HPV. Furthermore, in Can Tho more than 60% of women were infected with multiple HPV types. The information from this study can be used to provide updated data for planning preventive activities for cervical cancer in the studied cities.

Cervical human papilloma virus infection among the general female population in Vietnam: a situation analysis.

Human papilloma virus (HPV) is the necessary cause of cervical cancer. This survey used a sample of 1,500 married women aged 15-69 to examine the prevalence of HPV infection and HPV specific types in Vietnam as well as risk factors of HPV infection. Results indicated that the prevalence of HPV infection in Hanoi and HCM was 6.13 and 8.27. The proportion of multiple HPV infection was also higher in HCM than in Hanoi (35.5% vs. 17.4%). Risk factors having significant associations with general HPV infection were early age at first sexual intercourse, number of life time sexual partners and period of use of oral contraceptives. Future implementation of HPV vaccine campaigns in Vietnam should consider the fact that HPV type 58 is common among both Hanoi and HCM populations, which none of the currently available vaccines target.