Can complex programs be sustained? A mixed methods sustainability evaluation of a national infant and young child feeding program in Bangladesh and Vietnam.

BACKGROUND: Poor early-life nutrition is a major barrier to good health and cognitive development, and is a global health priority. Alive & Thrive (A&T) was a multi-pronged initiative to improve infant and young child feeding behaviors. It aimed to achieve at-scale child health and nutrition improvements via a comprehensive approach that included nutrition counseling by health workers, policy change, social mobilization and mass media activities. This study evaluated the sustainability of activities introduced during A&T implementation (2009-2014) in Bangladesh and Vietnam. METHODS: This was a mixed methods study that used a quasi-experimental design. Quantitative data (surveys with 668 health workers, and 269 service observations) were collected in 2017; and analysis compared outcomes (primarily dose and fidelity of activities, and capacity) in former A&T intervention areas versus areas that did not receive the full A&T intervention. Additionally, we conducted interviews and focus groups with 218 stakeholders to explore their impressions about the determinants of sustainability, based on a multi-level conceptual framework. RESULTS: After program conclusion, stakeholders perceive declines in mass media campaigns, policy and advocacy activities, and social mobilization activities - but counseling activities were institutionalized and continued in both countries. Quantitative data show a persisting modest intervention effect: health workers in intervention areas had significantly higher child feeding knowledge, and in Bangladesh greater self-efficacy and job satisfaction, compared to their counterparts who did not receive the full package of A&T activities. While elements of the program were integrated into routine services, stakeholders noted dilution of the program focus due to competing priorities. Qualitative data suggest that some elements, such as training, monitoring, and evaluation, which were seen as essential to A&T's success, have declined in frequency, quality, coverage, or were eliminated altogether. CONCLUSIONS: The inclusion of multiple activities in A&T and efforts to integrate the program into existing institutions were seen as crucial to its success but also made it difficult to sustain, particularly given unstable financial support and human resource constraints. Future complex programs should carefully plan for institutionalization in advance of the program by cultivating champions across the health system, and designing unique and complementary roles for all stakeholders including donors.

Phytochemical constituents from the rhizomes of Kaempferia parviflora Wall. ex Baker and their acetylcholinesterase inhibitory activity.

Phytochemical study on the rhizomes of Kaempferia parviflora led to the isolation of twenty-three compounds including six phenolic glycosides (1-6), thirteen flavones (7-19), and five phenolic compounds (20-23). Of these, the new compounds were determined to be 2,4-dihydroxy-6-methoxyacetophenone-2-ß-D-apiofuranosyl-(1→6)-ß-D-glucopyranoside (1), 2-hydroxy-4-propionyl-phenyl O-ß-D-glucopyranoside (2), and 4-hydroxy-3,5-dimethoxyacetophenone 8-O-α-L-rhamnopyranosyl-(1→6)-ß-D-glucopyranoside (3) and named as kaempanosides A-C, respectively. Their chemical structures were established based on HR-ESI-MS, 1D and 2D NMR spectra. All compounds 1-23 exhibited acetylcholinesterase inhibitory activity with IC50 values ranging from 57.76 to 253.31 µM.

Polypunctosides E-K: seven new steroidal saponins from Polygonatum punctatum Royle ex Kunth and their nitric oxide production inhibitory activities.

Polygonatum punctatum Royle ex Kunth is a high-value medicinal plant found in old natural forests. A phytochemical study on the roots of this plant led to the isolation of seven new steroidal saponins including four furostans (1-4) and three furospirostans (5-7). Their structures were elucidated as (25R)-26-O-(ß-D-glucopyranosyl)-furost-5-ene-3ß,17α,22α,26-tetraol 3-O-α-L-arabinopyranosyl-(1 → 2)-ß-D-glucopyranosyl-(1 → 4)-ß-D-galactopyranoside (1), (25R)-26-O-(ß-D-glucopyranosyl)-furost-5-ene-3ß,14α,17α,22α,26-pentaol 3-O-α-L-arabinopyranosyl-(1 → 2)-ß-D-glucopyranosyl-(1 → 4)-ß-D-galactopyranoside (2), (25R)-26-O-(ß-D-glucopyranosyl)-furost-5-ene-22α-methoxy-3ß,17α,26-triol 3-O-α-L-arabinopyranosyl-(1 → 2)-ß-D-glucopyranosyl-(1 → 4)-ß-D-galactopyranoside (3), (25R)-26-O-(ß-D-glucopyranosyl)-furost-5-ene-22α-methoxy-3ß,17α,26-triol 3-O-[α-L-arabinopyranosyl-(1 → 2)-ß-D-glucopyranosyl-(1 → 4)]-[acetoxy-(→ 6)]-ß-D-galactopyranoside (4), 26-O-(ß-D-glucopyranosyl)-14α,17α-dihydroxynuatigenin 3-O-α-L-arabinopyranosyl-(1 → 2)-ß-D-glucopyranosyl-(1 → 4)-ß-D-galactopyranoside (5), 26-O-(ß-D-glucopyranosyl)-17α-hydroxynuatigenin 3-O-α-L-arabinopyranosyl-(1 → 2)-ß-D-glucopyranosyl-(1 → 4)-ß-D-galactopyranoside (6), and 26-O-(ß-D-glucopyranosyl)-14α-hydroxynuatigenin 3-O-α-L-arabinopyranosyl-(1 → 2)-ß-D-glucopyranosyl-(1 → 4)-ß-D-galactopyranoside (7) by extensive spectroscopic analyses, including infrared, high-resolution electrospray ionization mass spectrometry, and one- and two-dimensional nuclear magnetic resonance spectroscopy. Compounds 1-7 inhibited nitric oxide production in lipopolysaccharide activated RAW264.7 cells with IC50 values ranging from 41.5 ± 3.2 to 62.2 ± 3.7 µM, compared to 33.8 ± 2.6 µM for the positive control compound L-NMMA.

Diagnostic Value in Screening Severe Depression of the Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Beck Depression Inventory Scale, and Zung's Self-Rating Anxiety Scale Among Patients with Recurrent Depression Disorder.

Background: Depression is a widespread and incapacitating mental health disorder that impacts millions of people worldwide, playing a substantial role in the overall global health challenges. Depression has a big impact on a person's quality of life, cognitive and social functioning, risk of suicide, risk of heart disease and other illnesses, as well as death from all causes. Objective: It may be challenging to choose the best tools to screen for severe depression in patients with recurrent depression disorder (PRD) considering the diversity of psychological scales in Vietnam. The aim of this study was to evaluate diagnostic value for detect severe depression of four psychological scales including Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A), Beck Depression Inventory Scale (BECK), and Zung's Self-Rating Anxiety Scale (SAS) by genders and age groups among PRD in Vietnam. Methods: This study was conducted at National Institute of Mental Health, Bach Mai Hospital, Vietnam, from 2020 to 2021. There were 109 PRD evaluated with HAM-D, HAM-A, BECK, and SAS by qualified psychiatrists. By analysing Area Under the Curve (AUC) of Receiver Operating Characteristic (ROC) curve, we determined sensitivity, specificity and cut points of four above scales. Results: Among four scales, the BECK scale had the best diagnostic effect with the most optimal sensitivity and specificity (61.64% and 75%, respectively). We proposed the new cut-off of HAM-D, HAM-A, BECK, and SAS for detecting severe depression among PRD were 20, 34, 30, and 45, respectively. By genders, the cut points for the HAM-D, HAM-A, BECK, and SAS in males were 20, 27, 34, and 44, respectively, while those figure in females were 14, 34, 30, and 46, respectively. By age groups, adults had cut values for four above scales of 20, 34, 27, and 45, respectively, whereas those for the elderly were 16, 17, 35, and 44, respectively. Conclusion: We highly recommended that BECK is the most optimal method to screen severe depression in PRD in Vietnam. It is essential to utilize varied cut values of HAM-D, HAM-A, BECK, and SAS for different genders and age groups.

Establishing a Standardized Surveillance System for Health Care-Associated Infections in Vietnam.

Standardized surveillance for health care-associated infections (HAI) is critical to understand HAI burden and inform prevention strategies at a national level. Due to differing and generally limited resources in Vietnam's health care facilities, implementation of HAI surveillance has been variable and data quality has not been systematically assessed. In 2016, the Vietnam Administration for Medical Services (VAMS) under the Ministry of Health, with the support of partners, began to establish a context-appropriate, standardized HAI surveillance system for bloodstream infections (BSI) and urinary tract infections (UTI) among 6 pilot hospitals in Vietnam. We identified 5 key elements of our HAI surveillance implementation process that have been conducive to ensuring data quality and program sustainability and scalability. These include: (1) engaging stakeholders, (2) designating roles and responsibilities, (3) developing context-sensitive, standardized surveillance protocols, (4) creating a surveillance implementation strategy, and (5) linking HAI surveillance and prevention activities. With the active participation of infection prevention and control staff from the 6 pilot hospitals, standardized HAI surveillance for BSIs and UTIs was expanded to 12 additional hospitals in 2019. Together, VAMS and partners are helping Vietnam fulfill its commitment to safe health care for all patients.

The Stunting Tool for Early Prevention: development and external validation of a novel tool to predict risk of stunting in children at 3 years of age.

INTRODUCTION: Globally, an estimated 151 million children under 5 years of age still suffer from the adverse effects of stunting. We sought to develop and externally validate an early life predictive model that could be applied in infancy to accurately predict risk of stunting in preschool children. METHODS: We conducted two separate prospective cohort studies in Vietnam that intensively monitored children from early pregnancy until 3 years of age. They included 1168 and 475 live-born infants for model development and validation, respectively. Logistic regression on child stunting at 3 years of age was performed for model development, and the predicted probabilities for stunting were used to evaluate the performance of this model in the validation data set. RESULTS: Stunting prevalence was 16.9% (172 of 1015) in the development data set and 16.4% (70 of 426) in the validation data set. Key predictors included in the final model were paternal and maternal height, maternal weekly weight gain during pregnancy, infant sex, gestational age at birth, and infant weight and length at 6 months of age. The area under the receiver operating characteristic curve in the validation data set was 0.85 (95% Confidence Interval, 0.80-0.90). CONCLUSION: This tool applied to infants at 6 months of age provided valid prediction of risk of stunting at 3 years of age using a readily available set of parental and infant measures. Further research is required to examine the impact of preventive measures introduced at 6 months of age on those identified as being at risk of growth faltering at 3 years of age.

Trichoderma asperellumChi42 Genes Encode Chitinase.

Four Trichoderma strains (CH2, SH16, PQ34, and TN42) were isolated from soil samples collected from Quang Tri and Thua Thien Hue provinces in Vietnam. The strains exhibited high chitinolytic secretion. Strain PQ34 formed the largest zone of chitinase-mediated clearance (> 4 cm in diameter) in agar containing 1% (w/v) colloidal chitin. Analysis of the internal transcribed spacer regions of these strains indicated that they were Trichoderma asperellum. The molecular weights of the chitinases were approximately 42 kDa. Chitinase genes (chi42) of T. asperellum strains TN42, CH2, SH16, and PQ34 were 98~99% homologous to the ech42 gene of T. harzianum CB-Pin-01 (accession No. DQ166036). The deduced amino acid sequences of both T. asperellum strains SH16 and TN42 shared 100% similarity.