The cost of delivering COVID-19 vaccines in Vietnam.

BACKGROUND: The COVID-19 pandemic affected hundreds of millions of people and lives, and vaccination was the safest and most effective strategy to prevent and mitigate the burden of this disease. The implementation of COVID-19 vaccination in Vietnam in 2021 was unprecedentedly challenging in scale and complexity, yet economic evidence on the cost of delivery vaccines thought the program was lacking. METHODS: This retrospective costing study utilized a bottom-up, ingredient-based approach to estimate the cost of delivering COVID-19 vaccines in Vietnam in 2021, from a payer perspective. The study included 38 study sites across all administrative and implementation level, including three geographic areas and two delivery strategies, in two provinces, Hanoi and Dak Lak. The study findings were complemented with qualitative interviews with health staff and stakeholders. RESULTS: The economic cost to deliver one COVID-19 vaccine dose was $1.73, mostly comprised of opportunity costs ($1.14 per dose) which were driven by labor costs ($1.12 per dose). The delivery cost in urban areas was the highest ($2.02), followed by peri-urban areas ($1.45) and remote areas ($1.37). Delivery costs were higher at temporary sites ($1.78) when compared to facility-based delivery ($1.63). Comparing low-volume and high-volume periods showed that the delivery cost decreased significantly as volume increased, from $5.24 per dose to $1.65 per dose. CONCLUSIONS: The study estimates the cost of delivering COVID-19 vaccines in Vietnam in 2021. Enabling factors and challenges during the implementation of the program were explored. Study limitations may lead to underestimation of results and reduce generalizability.

Altered skin microbiome, inflammation, and JAK/STAT signaling in Southeast Asian ichthyosis patients.

BACKGROUND: Congenital ichthyosis (CI) is a collective group of rare hereditary skin disorders. Patients present with epidermal scaling, fissuring, chronic inflammation, and increased susceptibility to infections. Recently, there is increased interest in the skin microbiome; therefore, we hypothesized that CI patients likely exhibit an abnormal profile of epidermal microbes because of their various underlying skin barrier defects. Among recruited individuals of Southeast Asian ethnicity, we performed skin meta-genomics (i.e., whole-exome sequencing to capture the entire multi-kingdom profile, including fungi, protists, archaea, bacteria, and viruses), comparing 36 CI patients (representing seven subtypes) with that of 15 CI age-and gender-matched controls who had no family history of CI. RESULTS: This case-control study revealed 20 novel and 31 recurrent pathogenic variants. Microbiome meta-analysis showed distinct microbial populations, decreases in commensal microbiota, and higher colonization by pathogenic species associated with CI; these were correlated with increased production of inflammatory cytokines and Th17- and JAK/STAT-signaling pathways in peripheral blood mononuclear cells. In the wounds of CI patients, we identified specific changes in microbiota and alterations in inflammatory pathways, which are likely responsible for impaired wound healing. CONCLUSIONS: Together, this research enhances our understanding of the microbiological, immunological, and molecular properties of CI and should provide critical information for improving therapeutic management of CI patients.

Heart Rate Variability Measured from Wearable Devices as a Marker of Disease Severity in Tetanus.

Tetanus is a disease associated with significant morbidity and mortality. Heart rate variability (HRV) is an objective clinical marker with potential value in tetanus. This study aimed to investigate the use of wearable devices to collect HRV data and the relationship between HRV and tetanus severity. Data were collected from 110 patients admitted to the intensive care unit in a tertiary hospital in Vietnam. HRV indices were calculated from 5-minute segments of 24-hour electrocardiogram recordings collected using wearable devices. HRV was found to be inversely related to disease severity. The standard deviation of NN intervals and interquartile range of RR intervals (IRRR) were significantly associated with the presence of muscle spasms; low frequency (LF) and high frequency (HF) indices were significantly associated with severe respiratory compromise; and the standard deviation of differences between adjacent NN intervals, root mean square of successive differences between normal heartbeats, LF to HF ratio, total frequency power, and IRRR, were significantly associated with autonomic nervous system dysfunction. The findings support the potential value of HRV as a marker for tetanus severity, identifying specific indices associated with clinical severity thresholds. Data were recorded using wearable devices, demonstrating this approach in resource-limited settings where most tetanus occurs.

Automated pupillometry and optic nerve sheath diameter ultrasound to define tuberculous meningitis disease severity and prognosis.

BACKGROUND: Tuberculous meningitis (TBM) causes high mortality and morbidity, in part due to raised intracranial pressure (ICP). Automated pupillometry (NPi) and optic nerve sheath diameter (ONSD) are both low-cost, easy-to-use and non-invasive techniques that correlate with ICP and neurological status. However, it is uncertain how to apply these techniques in the management of TBM. METHODS: We conducted a pilot study enrolling 20 adults with TBM in the Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam. Our objective was to investigate the relationships between baseline and serial measurements of NPi and ONSD and disease severity and outcome. Serial NPi and ONSD were performed for 30 days, at discharge, and at 3-months, with measurements correlated with clinical progression and outcomes. RESULTS: ONSD and NPi measurements had an inverse relationship. Higher ONSD and lower NPi values were associated with lower Glasgow coma score. Baseline NPi was a strong predictor 3-month outcome (median NPi 4.55, interquartile range 4.35-4.65 for good outcomes versus 2.60, IQR 0.65-3.95 for poor outcomes, p = 0.002). Pupil inequality (NPi ≥0.7) was also strongly associated with poor 3-month outcomes (p = 0.006). Individual participants' serial NPi and ONSD were variable during initial treatment and correlated with clinical condition and outcome. CONCLUSION: Pupillometry and ONSD may be used to predict clinical deterioration and outcome from TBM. Future, larger studies are need explore the optimal timing of measurements and to define how they might be used to optimise treatments and improve outcomes from TBM.

Study protocol for type II hybrid implementation-effectiveness trial of strategies for depression care task-sharing in community health stations in Vietnam: DEP Project.

BACKGROUND: It is not clear what the most effective implementation strategies are for supporting the enactment and sustainment of depression care services in primary care settings. This type-II Hybrid Implementation-Effectiveness study will compare the effectiveness of three system-level strategies for implementing depression care programs at 36 community health stations (CHSs) across 2 provinces in Vietnam. METHODS: In this cluster-randomized controlled trial, CHSs will be randomly assigned to one of three implementation conditions: (1) Usual Implementation (UI), which consists of training workshops and toolkits; (2) Enhanced Supervision (ES), which includes UI combined with bi-weekly/monthly supervision; and (3) Community-Engaged Learning Collaborative (CELC), which includes all components of ES, combined with bi-monthly province-wide learning collaborative meetings, during which cross-site learning and continuous quality improvement (QI) strategies are implemented to achieve better implementation outcomes. The primary outcome will be measured based on the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation quality, and Maintenance) using indicators on implementation, provider, and client factors. The secondary outcome examines factors associated with barriers and facilitators of quality implementation, while the tertiary outcome evaluates the incremental cost-effectiveness ratio of services provided in the ES and CELC conditions, relative to UI condition for depression care. A total of 1,296 clients receiving depression care at CHSs will be surveyed at baseline and 6-month follow-up to assess mental health and psychosocial outcomes (e.g., depression and anxiety severity, health function, quality of life). Additionally, 180 CHS staff and 180 non-CHS staff will complete pre- and post-training evaluation and surveys at baseline, 6, 12, and 24 months. DISCUSSION: We hypothesize that the additional implementation supports will make mental health service implementation superior in the ES and CELC arms compared to the UI arm. The findings of this project could identify effective implementation models and assess the added value of specific QI strategies for implementing depression care in primary care settings in Vietnam, with implications and recommendations for other low- and middle-income settings. More importantly, this study will provide evidence for key stakeholders and policymakers to consider policies that disseminate, scale up, and advance quality mental health care in Vietnam. TRIAL REGISTRATION: NCT04491045 on Clinicaltrials.gov. Registered July 29, 2020.

The case for individualised public health interventions: Smoking prevalence and inequalities in Northern Ireland 1985-2015.

BACKGROUND: While smoking prevalence in high income countries has declined over time, socioeconomic inequalities in smoking have widened. This study is one of the few studies to examine the longitudinal pattern of income-related smoking inequalities and only the second using concentration indices in its analysis. METHOD: Income-related smoking inequalities were measured using concentration indices using the Northern Ireland Continuous Household Survey data. Smoking inequalities were compared quantitatively and visually across three periods: 1985-1995, 1997-2005 and 2007-2015. Joinpoint analysis was used to measure the overall time trend of smoking inequalities. Subgroup analysis was used to examine the nature of change in smoking inequalities across population sub-groups. FINDINGS: Throughout 1985-2015, smoking was more concentrated among the poor (standard concentration index of-0·131, p < 0·001). While prevalence declined sharply across population, income-related inequalities increased sharply in general and within subgroups. Income-related smoking inequalities were significantly larger among high educated group and those who were employed. No structural break was observed with respect to the adoption of any specific policy measures over the period. CONCLUSION: Current approaches to tobacco control may be ill-suited to addressing smoking inequalities and may indeed be counterproductive. More tailored approaches that address the specific needs of population sub-groups or more draconian approaches such as extensions to prohibition may be required to reduce prevalence further while avoiding a widening of inequalities.

Information needs of informal caregivers in caring and rehabilitation for dioxin victims in Vietnam.

BACKGROUND: Health outcomes among Agent Orange/dioxin (dioxin) victims are significant due to many individuals requiring daily assistance, informal care, and rehabilitation support. This study aimed to identify the information needs of informal caregivers of dioxin victims in Vietnam. METHODS: A cross-sectional study was conducted in Quynh Phu district, Thai Binh province - an area with a large number of dioxin victims, from June 2019 to June 2020. Quantitative data were collected from 124 caregivers of victims via structured interviews. Qualitative data were collected using semi-structured interview guides with in-depth interviews (IDI) (n = 36) and two focus group discussions (FGD) (n = 12). RESULTS: The results demonstrated that all caregivers of dioxin victims were family members, predominantly older (71.8%), 61.5 years old on average, living on low incomes (87.9%), and were farmers (80.7%). Almost all participants (96.8%) reported having information needs, particularly concerning dioxin's harms, nutrition, dioxin-related policies and rehabilitation, and psychological support for patients. Caregivers reported that they would like to receive information via health staff counselling (85.0%), television (75.0%), and community loudspeaker (65.8%). Notably, the majority of caregivers reported the need for information regarding psychological support (70.0%). These findings are consistent with qualitative data, which identify an urgent need to provide information, especially through health staff and digital resources. CONCLUSION: Many families with dioxin victims lived with little support and information, highlighting their high demand for information about care and rehabilitation. Thus, the healthcare system should promote information support, policy, and psychological support for caregivers and victims. An online support system for caregivers and victims is also recommended.

Self-reported Communicable Diseases and Associated Socio-demographic Status Among Ethnic Minority Populations in Vietnam.

INTRODUCTION: This study was conducted to identify the self-reported communicable diseases (CDs) rate and associated factors among ethnic minority populations in Vietnam. METHODS: We conducted a cross-sectional study of 6912 ethnic minority participants from 12 provinces located in four socioeconomic regions in Vietnam. A total of 4985 participants were included in the final analysis. We used a structured questionnaire to collect information on self-reported CDs and socio-demographic information. RESULTS: The results showed that the prevalence of self-reported CDs was 5.7% (95% CI: 5.0-6.4%). Ethnicity was shown to have an independently significant correlation to self-reported CDs. The Cham Ninh Thuan, Tay, Dao and Gie Trieng ethnic populations had significantly higher odds of self-reported CDs than those of La Hu ethnicity (OR = 47.1, 6.3, 5.6, and 6.5, respectively). Older people and males had significantly higher odds of having CDs than younger and females. CONCLUSION: Our findings recommend conducting ethnic-specific interventions to diminish the incidence of CDs.

Assessment of the risk factors associated with type 2 diabetes and prediabetes mellitus: A national survey in Vietnam.

This study aims to estimating the prevalence of type 2 diabetes and prediabetes among adult from 30 to 69 years old and assess the association of risk factor with the conditions. A total of 5244 aged 30 to 69 years old were participated in this cross-sectional study, using nationally representative sampling frame. All participants were taking blood sample to measure fasting blood glucose level and 2-hour postload oral glucose tolerance test by National Hospital of Endocrinology, Vietnam. Multinomial logistic regressions with baseline-category logit models were conducted to identify factors associated with diabetes and prediabetes among respondents. The prediabetes prevalence was in 17.9% and diabetes in 7.3%. Patients who were male (reference group vs female OR = 0.79; 95% CI: 0.64, 0.97), in the 50 to 59 years old group (OR = 1.60; 95% CI: 1.28, 2.00), have hypertension and WHR risk have higher prevalence to have prediabetes (OR = 1.31; 95% CI: 1.12, 1.53; OR = 1.37; 95% CI: 1.11, 1.70, respectively). Male patients (reference group vs female OR = 0.62; 95% CI: 0.45, 0.84), patients who were in 40 to 49; 50 to 59; 60 to 69 years old, those who were housewife (OR = 2.17; 95% CI: 1.43, 3.28; OR = 2.85; 95% CI: 1.91, 4.27; OR = 3.12; 95% CI: 2.08, 4.69; OR = 1.71; 95% CI: 1.22, 2.40, respectively). Diabetes have significant associated with participants have hypertension (OR = 1.19; 95% CI: 1.72, 2.70). The common factor directly related to prediabetes and diabetes in both genders is age. Other factors directly associated with prediabetes and diabetes include BMI, WHR, hypertension, educational level, and job.

The relationship between team dynamics with healthcare coordination and clinical work satisfaction among Commune Health Workers: A Bayesian model averaging study.

OBJECTIVE: To determine the relationship between team dynamics with healthcare coordination and clinical job satisfaction of the community health workers (CHWs). METHODS: A cross-sectional study was conducted among 133 health workers (including doctors, nurses, or midwives) at 21 Commune Health Cent in Quoc Oai District, Vietnam, from July 2015 to May 2017. A self-administered questionnaire consisting of 5-Likert items regarding team dynamics and healthcare coordination clinical work satisfaction was utilised. Descriptive statistics and correlation matrix were applied for seven factors of team dynamic, clinical work satisfaction, and patient care coordination queried by primary care providers. Bayesian model averaging (BMA) was used to identify the predictors of the level of team dynamics and healthcare coordination. RESULTS: The mean score of overall team dynamics among the study participants was 4.08. Clinical work satisfaction and patient care coordination scores among resident physicians were higher than those of attending clinicians; however, the differences were not statistically significant. The results of BMA analysis indicated that team dynamics significantly associated with clinical work satisfaction, and it explains 9% of the total variance in clinical work satisfaction. Team dynamics level was also positively associated with patient care coordination. Patient care coordination was not a significant mediator between team dynamics and clinical work satisfaction. CONCLUSION: Team dynamics is a potential contributor to improving patient care coordination and clinical job satisfaction of CHWs. As no significant correlation between patient care coordination and clinical job satisfaction was observed, to improve team performance, providing conditions that facilitate team building and teamwork should be conducted for CHWs in CHCs.

Wearable devices for remote monitoring of hospitalized patients with COVID-19 in Vietnam.

Patients with severe COVID-19 disease require monitoring with pulse oximetry as a minimal requirement. In many low- and middle- income countries, this has been challenging due to lack of staff and equipment. Wearable pulse oximeters potentially offer an attractive means to address this need, due to their low cost, battery operability and capacity for remote monitoring. Between July and October 2021, Ho Chi Minh City experienced its first major wave of SARS-CoV-2 infection, leading to an unprecedented demand for monitoring in hospitalized patients. We assess the feasibility of a continuous remote monitoring system for patients with COVID-19 under these circumstances as we implemented 2 different systems using wearable pulse oximeter devices in a stepwise manner across 4 departments.

Coxsackievirus A16 in Southern Vietnam.

Background: Hand, Foot and Mouth Disease (HFMD) is a major public health concern in the Asia-Pacific region. Most recent HFMD outbreaks have been caused by enterovirus A71 (EV-A71), coxsackievirus A16 (CVA16), CVA10, and CVA6. There has been no report regarding the epidemiology and genetic diversity of CVA16 in Vietnam. Such knowledge is critical to inform the development of intervention strategies. Materials and Methods: From 2011 to 2017, clinical samples were collected from in- and outpatients enrolled in a HFMD research program conducted at three referral hospitals in Ho Chi Minh City (HCMC), Vietnam. Throat or rectal swabs positive for CVA16 with sufficient viral load were selected for whole genome sequencing and evolutionary analysis. Results: Throughout the study period, 320 CVA16 positive samples were collected from 2808 HFMD patients (11.4%). 59.4% of patients were male. The median age was 20.8 months (IQR, 14.96-31.41). Patients resided in HCMC (55.3%), Mekong Delta (22.2%), and South East Vietnam (22.5%). 10% of CVA16 infected patients had moderately severe or severe HFMD. CVA16 positive samples from 153 patients were selected for whole genome sequencing, and 66 complete genomes were obtained. Phylogenetic analysis demonstrated that Vietnamese CVA16 strains belong to a single genogroup B1a that clusters together with isolates from China, Japan, Thailand, Malaysia, France and Australia. The CVA16 strains of the present study were circulating in Vietnam some 4 years prior to its detection in HFMD cases. Conclusion: We report for the first time on the molecular epidemiology of CVA16 in Vietnam. Unlike EV-A71, which showed frequent replacement between subgenogroups B5 and C4 every 2-3 years in Vietnam, CVA16 displays a less pronounced genetic alternation with only subgenogroup B1a circulating in Vietnam since 2011. Our collective findings emphasize the importance of active surveillance for viral circulation in HFMD endemic countries, critical to informing outbreak response and vaccine development.

Covid-19 Preparedness and Response Capability: A Case Study of the Hanoi Primary Healthcare System.

This study examined the coronavirus disease 2019 (COVID-19) preparedness and response of the health system (HS) in Hanoi, Vietnam, and identified enabling factors and barriers. This cross-sectional, mixed-methods study was conducted in 4 urban and peri-urban districts that included some wards with COVID-19-positive cases and some without. The US Centers for Disease Control and Prevention (CDC) analytical frameworks were used. Overall, 10% of health facilities (HFs) failed to fully implement COVID-19 risk determination; 8.8% failed to fully implement stronger community partnerships with local stakeholders to support public health (PH) preparedness; 35% and 2.5% incompletely implemented and did not implement evaluation of PH emergency operations, respectively; 10% did not identify communication channels to issue public information, alerts, warnings, and notifications; 25% incompletely implemented identification, development of guidance, and standards for information; 72.5% had good preventive and treatment collaboration; and 10% did not fully implement procedures for laboratory testing and reporting results. Enablers included sufficient infrastructure and equipment, strong leadership, and good cross-public-sector collaboration with police and military forces. Barriers included workforce constraints, overburdened and inconsistent reporting systems, inappropriate financial mechanisms, ambiguous health governance, and lack of private-sector engagement. Nonetheless, the HS preparedness and response were satisfactory, although further coordinated efforts in evaluation, coordination, communication, and volunteering remain necessary.

Changes in, and predictors of, quality of life among patients with unstable angina after percutaneous coronary intervention.

RATIONALE, AIMS AND OBJECTIVES: Changes in, and predictors of, quality of life (QoL) among unstable angina patients are informative for both clinical and public health practice. However, there is little research on this topic, especially in health care settings with limited resources. This study aims to detect changes in QoL and its associated factors among patients with unstable angina after percutaneous coronary intervention. METHODS: A longitudinal design was conducted with two repeated rounds of measurements, 1 and 3 months after intervention, using the generic SF-36 questionnaire, in 120 patients from Vietnam National Heart Institute. A linear mixed-effects model was used to assess changes in patient QoL over time while adjusting for other covariates. RESULTS: Only two out of eight QoL subscales (social functioning and emotional well-being) declined after 1 month, but these tended to rise again after 3 months, while scores of all other QoL subscales increased. Adjusting for covariates, QoL increased slightly after 1 month of intervention (ß = 0.65, 95%CI = -0.86 to 2.16) but improved by almost six QoL points after 3 months (ß = 5.99, 95%CI = 4.48 to 7.50). Four confounders significantly associated with a decline in QoL were older age, being retired, living in rural areas, and having abnormal troponin level. CONCLUSION: QoL of the patients with unstable angina improves significantly 3 months after intervention, rather than after 1 month. More attention should be given to patients, who are old, retired, live in rural areas and have abnormal troponin level.

Clinical, etiological and epidemiological investigations of hand, foot and mouth disease in southern Vietnam during 2015 - 2018.

Hand, foot and mouth disease (HFMD) continues to challenge Asia with pandemic potential. In Vietnam, there have been two major outbreaks occurring during 2011-2012 (>200,000 hospitalizations and >200 deaths) and more recently in 2018 (>130,000 hospitalizations and 17 deaths). Given the high burden and the complex epidemic dynamics of HFMD, synthesizing its clinical and epidemiological data remains essential to inform the development of appropriate interventions and design public health measures. We report the results of a hospital-based study conducted during 2015-2018, covering the severe HFMD outbreak recently documented in Vietnam in 2018. The study was conducted at three major hospitals responsible for receiving HFMD patients from southern Vietnam with a population of over 40 million. A total of 19 enterovirus serotypes were detected in 1196 HFMD patients enrolled in the clinical study during 2015-2018, with enterovirus A71 (EV-A71), coxsackievirus A6 (CV-A6), CV-A10 and CV-A16 being the major causes. Despite the emergence of coxsackieviruses, EV-A71 remains the leading cause of severe HFMD in Vietnam. EV-A71 was consistently detected at a higher frequency during the second half of the years. The emergence of EV-A71 subgenogroup C4 in late 2018 was preceded by its low activity during 2017-early 2018. Compared with EV-A71 subgenogroup B5, C4 was more likely to be associated with severe HFMD, representing the first report demonstrating the difference in clinical severity between subgenogroup C4 and B5, the two predominant EV-A71 subgenogroups causing HFMD worldwide. Our data have provided significant insights into important aspects of HFMD over four years (2015-2018) in Vietnam, and emphasize active surveillance for pathogen circulation remains essential to inform the local public health authorities in the development of appropriate intervention strategies to reduce the burden of this emerging infections. Multivalent vaccines are urgently needed to control HFMD.

An adaptive model of health system organization and responses helped Vietnam to successfully halt the Covid-19 pandemic: What lessons can be learned from a resource-constrained country.

Coping with the COVID-19 pandemic has been painful and no single model for such a purpose is perfect. However, sharing experiences is the best way for countries to learn real-time lessons and adapt to this rapidly changing pandemic. This commentary shares with the international community how an adaptive model of health system organization and responses helped Vietnam to break transmission of coronavirus. We find that an effective model is adaptive to time and context, and mobilizes and engages the wider society. We identify merging of different health system units into Center for Diseases Controls as a health system organization that saved massive resources. The early establishment of a formal committee responding to the pandemic helped unify every public health strategy. The mobilization of different stakeholders and communities added resources and facilitated a synchronous implementation of response strategies, even where those strategies involved significant personal or financial sacrifice. National training on Covid-19 treatment for healthcare professionals across the entire hospital system was useful to expand the health service availability. Quickly published response guidelines helped to activate every level of the health system and involve every sector of society. A strategy of keeping high alert and preemptive action is also essential for coping with the pandemic.

Neutralizing Antibodies against Enteroviruses in Patients with Hand, Foot and Mouth Disease.

Hand, foot and mouth disease (HFMD) is an emerging infection with pandemic potential. Knowledge of neutralizing antibody responses among its pathogens is essential to inform vaccine development and epidemiologic research. We used 120 paired-plasma samples collected at enrollment and >7 days after the onset of illness from HFMD patients infected with enterovirus A71 (EV-A71), coxsackievirus A (CVA) 6, CVA10, and CVA16 to study cross neutralization. For homotypic viruses, seropositivity increased from <60% at enrollment to 97%-100% at follow-up, corresponding to seroconversion rates of 57%-93%. Seroconversion for heterotypic viruses was recorded in only 3%-23% of patients. All plasma samples from patients infected with EV-A71 subgenogroup B5 could neutralize the emerging EV-A71 subgenogroup C4. Collectively, our results support previous reports about the potential benefit of EV-A71 vaccine but highlight the necessity of multivalent vaccines to control HFMD.

Compliance to dietary guidelines on fruit and vegetable intake and prevalence of hypertension among Vietnamese adults, 2015.

AIMS: The aim of this study was to investigate whether the Western dietary guidelines on fruit and vegetable intake are associated with blood pressure parameters and hypertension among Vietnamese adults. METHODS: Participants included 1384 women and 1049 men aged 18-69 years from the 2015 Vietnam national survey on risk factors of non-communicable diseases. Associations between dietary intake score based on the Dietary Approaches to Stop Hypertension (DASH) guidelines and World Health Organization recommendations on fruit and vegetable consumption and blood pressure parameters and hypertension were evaluated by multivariate regression analyses. RESULTS: Approximately 17.0% and 40.1% of participants met the respective definitions of hypertension according to Joint National Committee 7 (JNC7) and 2017 American College of Cardiology/American Heart Association (ACC/AHA) Hypertension Guideline. Highest tertiles of DASH scores for fruit intake were significantly associated with increased blood pressure parameters, particularly in women. Hypertension was associated with DASH score for fruit intake with odds ratios and 95% confidence intervals for tertiles 2-3 versus tertile 1: 1.31 (0.98, 1.76) and 1.43 (1.05, 1.93) for JNC7; 1.26 (1.01, 1.58) and 1.31 (1.04, 1.66) for 2017 ACC/AHA guideline (all p-trend <0.05). No association with blood pressure parameters and hypertension was observed for DASH score for vegetable intake and meeting World Health Organization recommendations for fruit and vegetable intake. CONCLUSION: We found an unexpected positive association between DASH score for fruit intake and blood pressure parameters and hypertension among Vietnamese adults. More research is needed in this population to understand the relationship between vegetable and fruit intake with hypertension before a firm conclusion and recommendation are made.

Economic Burden Attributed to Children Presenting to Hospitals With Hand, Foot, and Mouth Disease in Vietnam.

BACKGROUND: Hand, foot, and mouth disease (HFMD) has become a major public health concern in the Asia-Pacific region. Knowledge of its economic burden is essential for policy makers in prioritizing the development and implementation of interventions. METHODS: A multi-hospital-based study was prospectively conducted at 3 major hospitals in Ho Chi Minh City, Vietnam, during 2016-2017. Data on direct and productivity costs were collected alongside clinical information and samples and demographic information from study participants. RESULTS: A total of 466 patients were enrolled. Two hundred three of 466 (43.6%) patients lived in Ho Chi Minh City, and 72/466 (15.5%) had severe HFMD. An enterovirus was identified in 74% of 466 patients, with EV-A71, CV-A6, CV-A10, and CV-A16 being the most common viruses identified (236/466, 50.6%). The mean economic burden per case was estimated at US$400.80 (95% confidence interval [CI], $353.80-$448.90), of which the total direct (medical) costs accounted for 69.7%. There were considerable differences in direct medical costs between groups of patients with different clinical severities and pathogens (ie, EV-A71 vs non-EV-A71). In Vietnam, during 2016-2017, the economic burden posed by HFMD was US$90 761 749 (95% CI, $79 033 973-$103 009 756). CONCLUSIONS: Our findings are of public health significance because for the first time we demonstrate that HFMD causes a substantial economic burden in Vietnam, and although multivalent vaccines are required to control HFMD, effective EV-A71 vaccine could substantially reduce the burden posed by severe HFMD. The results will be helpful for health policy makers in prioritizing resources for the development and implementation of intervention strategies to reduce the burden of HFMD.