Social and behavioral determinants of attitudes towards and practices of hepatitis B vaccine birth dose in Vietnam.

BACKGROUND: Hepatitis B virus (HBV) infection is a significant public health issue in Vietnam. Our goal was to understand the determinants of attitudes towards and practices of hepatitis B vaccine birth dose (HepB-BD) in certain regions of Vietnam. METHOD: A rapid qualitative assessment was conducted in three geographically diverse provinces that reported low coverage (<50%) of HepB-BD. Using purposive sampling of participants, 29 focus group discussions and 20 in-depth interviews were held with caregivers (n = 96), healthcare providers (n = 75), and healthcare administrators (n = 16). Summary notes from these were translated, and inductive coding was used to derive themes. The SAGE Vaccine Hesitancy Determinants Matrix was used as a theoretical framework to organize barriers and facilitators associated with the themes into three levels of influence. RESULTS: At the individual and group level, caregivers who had higher levels of knowledge about HepB-BD sought the vaccine proactively, while others with lower knowledge faced barriers to the vaccine. Some caregivers reported a negative attitude toward health services because of a language barrier or had generalized concerns about HepB-BD due to media reporting of the past adverse events. Distress arising from potential adverse events was equally common among healthcare providers. At the contextual level, the physical environment made it difficult for caregivers to access healthcare facilities and for providers to conduct outreach. Home births posed a challenge for timely administration of HepB-BD, while health facility births facilitated it. Vaccination-specific barriers included misinterpretation of pre-vaccination screening criteria and asking for the consent of caregivers. Inadequate resources for service delivery negatively influenced HepB-BD attitudes and practices. CONCLUSION: Given the diversity of barriers associated with attitudes towards and practices of HepB-BD in the three provinces, tailored interventions will be necessary for both demand- and supply-side factors. Rural areas, often with more home births and geographic barriers, may require focused attention.

Temperature as a risk factor for hospitalisations among young children in the Mekong Delta area, Vietnam.

BACKGROUND: The Mekong Delta is the most vulnerable region to climate change in South-East Asia; however, the association between climate and children's health has rarely been studied in this region. OBJECTIVE: We examined the short-term association between daily temperature and hospital admissions for all causes, gastrointestinal and respiratory infection, among young children in the Mekong Delta area in Vietnam. METHODS: Daily paediatric hospital admissions and meteorological data were obtained from January 2008 to December 2012. A time-series approach was used with a combination of a Poisson regression and constrained distributed lag models to analyse the data. The long-term and seasonal trends, as well as other time-varying covariates, were adjusted using spline functions. Temperature--pediatric admission relationship was evaluated by age-specific (0-2 and 3-5-year-olds) and cause of admission groupings. RESULTS: A 1°C increase in the 2-day moving average temperature was significantly associated with a 3.4% (95% CI 1.2% to 5.5%), 4.6% (95% CI 2.2% to 7.3%), 2.6% (95% CI 0.6% to 4.6%), 4.4% (95% CI 0.6% to 8.2%) and 3.8%(95% CI 0.4% to 7.2%) increase in hospital admissions with 0-2-year-old children, 3-5-year-old children, all causes, gastrointestinal infection and respiratory infection, respectively. The cumulative effects from 1-day to 6-day moving average temperature on hospital admissions were greater for 3-5-year-old children and gastrointestinal infection than for 0-2-year-old children and other causes. CONCLUSIONS: Temperature was found to be significantly associated with hospital admissions in young children with the highest association between temperature and gastrointestinal infection. The government agencies of Mekong Delta should implement measures to protect children from the changing temperature conditions related to climate change.