Adapting and Scaling a Digital Health Intervention to Improve Maternal and Child Health Among Ethnic Minority Women in Vietnam Amid the COVID-19 Context: Protocol for the dMOM Project.

BACKGROUND: Due to interconnected structural determinants including low maternal health knowledge, economic marginalization, and remoteness from low-capacity health centers, ethnic minority women in remote areas of Vietnam face severe maternal, newborn, and child health (MNCH) inequities. As ethnic minorities represent 15% of the Vietnamese population, these disparities are significant. mMOM-a pilot mobile health (mHealth) intervention using SMS text messaging to improve MNCH outcomes among ethnic minority women in northern Vietnam-was implemented from 2013-2016 with promising results. Despite mMOM's findings, exacerbated MNCH inequities, and digital health becoming more salient amid COVID-19, mHealth has not yet been scaled to address MNCH among ethnic minority women in Vietnam. OBJECTIVE: We describe the protocol for adapting, expanding, and exponentially scaling the mMOM intervention qualitatively through adding COVID-19-related MNCH guidance and novel technological components (mobile app and artificial intelligence chatbots) and quantitatively through broadening the geographical area to reach exponentially more participants, within the evolving COVID-19 context. METHODS: dMOM will be conducted in 4 phases. (1) Drawing on a review of international literature and government guidelines on MNCH amid COVID-19, mMOM project components will be updated to respond to COVID-19 and expanded to include a mobile app and artificial intelligence chatbots to more deeply engage participants. (2) Using an intersectionality lens and participatory action research approach, a scoping study and rapid ethnographic fieldwork will explore ethnic minority women's unmet MNCH needs; acceptability and accessibility of digital health; technical capacity of commune health centers; gendered power dynamics and cultural, geographical, and social determinants impacting health outcomes; and multilevel impacts of COVID-19. Findings will be applied to further refine the intervention. (3) dMOM will be implemented and incrementally scaled across 71 project communes. (4) dMOM will be evaluated to assess whether SMS text messaging or mobile app delivery engenders better MNCH outcomes among ethnic minority women. The documentation of lessons learned and dMOM models will be shared with Vietnam's Ministry of Health for adoption and further scaling up. RESULTS: The dMOM study was funded by the International Development Research Centre (IDRC) in November 2021, cofacilitated by the Ministry of Health, and is being coimplemented by provincial health departments in 2 mountainous provinces. Phase 1 was initiated in May 2022, and phase 2 is planned to begin in December 2022. The study is expected to be complete in June 2025. CONCLUSIONS: dMOM research outcomes will generate important empirical evidence on the effectiveness of leveraging digital health to address intractable MNCH inequities among ethnic minority women in low-resource settings in Vietnam and provide critical information on the processes of adapting mHealth interventions to respond to COVID-19 and future pandemics. Finally, dMOM activities, models, and findings will inform a national intervention led by the Ministry of Health. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/44720.

Assessment of cyclic volatile methyl siloxanes (CVMSs) in indoor dust from different micro-environments in northern and central Vietnam.

Comprehensive studies on emerging contaminants like volatile methyl siloxanes in settled dust from different micro-environments are still limited. In this study, concentrations and distribution of cyclic volatile methyl siloxanes (CVMSs) including D3, D4, D5, and D6 were examined in indoor dust samples collected from various micro-environments in northern and central Vietnam. Concentrations of total CVMSs in the dust samples ranged from 86.0 to 5890 (median 755) ng/g and decreased in the order: waste processing workshops (median 1560; range 329-5890) > common houses (650; 115-1680) > university classrooms (480; 86.0-1540) > vehicle repair shops (295; 126-1950) ng/g. This observation suggests that informal waste processing activities are sources of CVMSs. Among the studied CVMSs, D5 was the most predominant compound (41 ± 14%), followed by D6 (26 ± 13%), D4 (23 ± 12%), and D3 (11 ± 11%). Moderate positive correlations between D3/D4, D4/D5, and D5/D6 were found. Median daily intake doses of D3, D4, D5, and D6 through dust ingestion were 0.016, 0.051, 0.11, and 0.054 ng/kg/d, respectively, which were comparable to water consumption and markedly lower than the air inhalation pathway.

Parabens in personal care products and indoor dust from Hanoi, Vietnam: Temporal trends, emission sources, and non-dietary exposure through dust ingestion.

The occurrence of seven typical parabens was investigated in several types of personal care products (PCPs) sold at supermarkets and in indoor dust samples collected from houses, laboratories, and medical stores in Hanoi, Vietnam. Parabens were frequently detected in PCPs regardless of the paraben indication in their ingredient labels. However, concentrations of parabens in labeled products (median 3280; range 1370-5610 µg/g) were much higher than those found in non-labeled products (69.4; not detected - 356 µg/g). Parabens were also measured in indoor dust samples of this study at elevated concentrations, ranging from not detected to 1650 (median 286 ng/g). Levels of parabens in the indoor dust samples collected in 2019 decreased in the order: house > medical store > laboratory dust, however, the difference was not statistically significant. Interestingly, levels of parabens in Vietnamese house dust exhibited an increasing trend over time, for example, mean/median concentrations of parabens in house dust samples collected in 2014, 2017, and 2019 were 245/205, 310/264, and 505/379 ng/g, respectively. Methylparaben was found at the highest frequency and concentrations in both PCPs and indoor dust samples. Mean exposure doses of total parabens through dust ingestion were estimated to be 2.02, 1.61, 0.968, 0.504, and 0.192 ng/kg-bw/d for infants, toddlers, children, teenagers, and adults, respectively. Further studies on the distribution, emission behavior, potential sources, and negative impacts of parabens in different environmental media in Vietnam are needed.

Characterization of triclosan and triclocarban in indoor dust from home micro-environments in Vietnam and relevance of non-dietary exposure.

Contamination status, spatial variability, and exposure risk of triclosan (TCS) and triclocarban (TCC) in indoor dusts from different micro-environments were evaluated for the first time in Vietnam as well as in Southeast Asian region. TCS and TCC were measured in 89 dust samples collected from bedrooms, living rooms, and kitchens of private houses in four northern cities including Hanoi, Bac Ninh, Hung Yen, and Nam Dinh, by means of liquid chromatography-tandem mass spectrometry. Concentrations of TCS and TCC ranged from <5 to 1090 (median 33.2) and from <3 to 531 (median 19.3) ng g-1, respectively. Concentrations of TCS and TCC in the kitchen and bedroom dusts were markedly higher than levels found in the living room samples, probably due to their applications in kitchen utensils, household cleaning reagents, and personal care products. A strong positive correlation between TCS and TCC concentrations was detected in the whole dataset (R2 = 0.810, p < 0.001). For samples in which both TCS and TCC were quantified, TCS/TCC ratios ranged from 0.3 to 12 with a median value of 1.8, and did not show big differences between micro-environments. Human exposures to TCS and TCC through dust ingestion were estimated for various age groups with 95% CI daily intake doses ranging from (0.032-0.070) to (0.340-0.740) and from (0.017-0.033) to (0.175-0.345) ng kg-bw-1 d-1 for adults and infants respectively. Although our derived values were much lower than reference doses, more comprehensive risk assessment considering multiple exposure pathways of TCS and TCC is needed.

Mobile Health Initiatives in Vietnam: Scoping Study.

BACKGROUND: Mobile health (mHealth) offers a promising solution to the multitude of challenges the Vietnamese health system faces, but there is a scarcity of published information on mHealth in Vietnam. OBJECTIVE: The objectives of this scoping study were (1) to summarize the extent, range, and nature of mHealth initiatives in Vietnam and (2) to examine the opportunities and threats of mHealth utilization in the Vietnamese context. METHODS: This scoping study systematically identified and extracted relevant information from 20 past and current mHealth initiatives in Vietnam. The study includes multimodal information sources, including published literature, gray literature (ie, government reports and unpublished literature), conference presentations, Web-based documents, and key informant interviews. RESULTS: We extracted information from 27 records from the electronic search and conducted 14 key informant interviews, allowing us to identify 20 mHealth initiatives in Vietnam. Most of the initiatives were primarily funded by external donors (n=15), while other initiatives were government funded (n=1) or self-funded (n=4). A majority of the initiatives targeted vulnerable and hard-to-reach populations (n=11), aimed to prevent the occurrence of disease (n=12), and used text messaging (short message service, SMS) as part of their intervention (n=14). The study revealed that Vietnamese mHealth implementation has been challenged by factors including features unique to the Vietnamese language (n=4) and sociocultural factors (n=3). CONCLUSIONS: The largest threats to the popularity of mHealth initiatives are the absence of government policy, lack of government interest, heavy dependence on foreign funding, and lack of technological infrastructure. Finally, while current mHealth initiatives have already demonstrated promising opportunities for alternative models of funding, such as social entrepreneurship or private business models, sustainable mHealth initiatives outside of those funded by external donors have not yet been undertaken.