Carriage of Plasmid-Mediated Colistin Resistance-1-Positive Escherichia coli in Humans, Animals, and Environment on Farms in Vietnam.

Plasmid-Mediated Colistin Resistance 1 (mcr-1) was first reported in 2015 and is a great concern to human health. In this study, we investigated the prevalence of mcr-1 and mcr-1-positive Escherichia coli (MCRPEC) and the association in infection status among various reservoirs connected to livestock. The study was conducted in 70 poultry and swine farms in a commune in Ha Nam province, northern Vietnam. Samples were collected from farmers, food animals, domestic animals, and farm environments (flies and wastewater) for polymerase chain reaction (PCR) screening for mcr-1 gene and species identification of PCR positive isolates. Among 379 obtained mcr-1 positives isolates, Escherichia coli was the major identified, varying from 50% (2/4) in dog feces to 100% (31/31) in humans feces isolates. The prevalence of MCRPEC was 14.4% (20/139), 49.7% (96/193), 31.3% (25/80), 36.7% (40/109), 26.9% (18/67), and 3.9% (2/51) in humans, chickens, pigs, flies, wastewater, and dogs, respectively. The study identified association between MCRPEC infection status in humans and flies (OR = 3.4), between flies and chickens (OR = 5.3), and between flies and pigs (OR = 9.0). Farmers' age and farm livestock unit were also associated factors of MCRPEC infection status in humans (OR = 5.1 and 1.05, respectively). These findings bring new knowledge on antibiotic resistance in livestock setting and important suggestions on potential role of flies in the transmission of mcr-1 resistance gene.

Fragmented implementation of maternal and child health home-based records in Vietnam: need for integration.

BACKGROUND: Home-based records (HBRs) are globally implemented as the effective tools that encourage pregnant women and mothers to timely and adequately utilise maternal and child health (MCH) services. While availability and utilisation of nationally representative HBRs have been assessed in several earlier studies, the reality of a number of HBRs subnationally implemented in a less coordinated manner has been neither reported nor analysed. OBJECTIVES: This study is aimed at estimating the prevalence of HBRs for MCH and the level of fragmentation of and overlapping between different HBRs for MCH in Vietnam. The study further attempts to identify health workers' and mothers' perceptions towards HBR operations and utilisations. DESIGN: A self-administered questionnaire was sent to the provincial health departments of 28 selected provinces. A copy of each HBR available was collected from them. A total of 20 semi-structured interviews with health workers and mothers were conducted at rural communities in four of 28 selected provinces. RESULTS: Whereas HBRs developed exclusively for maternal health and exclusively for child health were available in four provinces (14%) and in 28 provinces (100%), respectively, those for both maternal health and child health were available in nine provinces (32%). The mean number of HBRs in 28 provinces (=5.75) indicates over-availability of HBRs. All 119 minimum required items for recording found in three different HBRs under nationwide scale-up were also included in the Maternal and Child Health Handbook being piloted for nationwide scaling-up. Implementation of multiple HBRs is likely to confuse not only health workers by requiring them to record the same data on several HBRs but also mothers about which HBR they should refer to and rely on at home. CONCLUSIONS: To enable both health workers and pregnant women to focus on only one type of HBR, province-specific HBRs for maternal and/or child health need to be nationally standardised. Moreover, to ensure a continuum of maternal, newborn, and child health care, the HBRs currently fragmented into different MCH stages (i.e. pregnancy, delivery, child immunisation, child growth, and child development) should be integrated. Standardisation and integration of HBRs will help increase technical efficiency and financial sustainability of HBR operations.

Knowledge, attitude and practices: assessing maternal and child health care handbook intervention in Vietnam.

BACKGROUND: Maternal and Child Health (MCH) Handbook, an integrated MCH home-based record, was piloted in four provinces of Vietnam (Dien Bien, Hoa Binh, Thanh Hoa and An Giang). The study is aimed at assessing the changes in pregnant women's behavior towards the frequencies of their antenatal care service utilizations and their subsequent breastfeeding practices up to six months of age, through the MCH Handbook intervention. This is because the levels of pregnant women's knowledge, attitude and practices (KAP) towards their antenatal care service utilizations and exclusive breastfeeding practices have been previously neither analyzed nor reported in relation to MCH home-based records in the country. METHODS: To compare pre-intervention baseline in 2011, post-intervention data were collected in 2013. Structured interviews were conducted with randomly selected 810 mothers of children 6-18 months of age in the four provinces. A focus group discussion among mothers in each of four provinces was conducted. RESULTS: There was no significant difference in pregnant women's knowledge about the need for ≥3 antenatal care visits between pre- and post-interventions. Yet, the proportion of pregnant women who made ≥3 antenatal care visits in post-intervention was significantly higher than in pre-intervention. Thus, MCH Handbook is likely to have contributed to practicing ≥3 antenatal care visits, by changing their attitude. The proportion of mothers who know the need for exclusive breastfeeding necessary during the initial six months significantly increased between pre- and post-interventions. The proportion of those practicing exclusive breastfeeding significantly increased between pre- and post-interventions, too. Thus, MCH Handbook is likely to have contributed to the increase in both knowledge about and practices of exclusive breastfeeding. CONCLUSION: The results of study imply that MCH Handbook contributed to the increase in pregnant women's practices of ≥3 antenatal care visits and in their knowledge about and practice of exclusive breastfeeding. While there is room for improvement in the level of its data recording, the study confirmed that MCH Handbook plays a catalytic role in ensuring a continuum of maternal, newborn and child care. Note that this study is the first study that attempted to estimate pregnant women's behavioral changes through MCH Handbook intervention in Vietnam.