Reported handwashing practices of Vietnamese people during the COVID-19 pandemic and associated factors: a 2020 online survey.

COVID-19 pandemic currently affects nearly all countries and regions in the world. Washing hands, together with other preventive measures, to be considered one of the most important measures to prevent the disease. This study aimed to characterize reported handwashing practices of Vietnamese people during the COVID-19 pandemic and associated factors. Kobo Toolbox platform was used to design the online survey. There were 837 people participating in this survey. All independent variables were described by calculating frequencies and percentages. Univariate linear regression was used with a significant level of 0.05. Multiple linear regression was conducted to provide a theoretical model with collected predictors. Seventy-nine percent of the respondents used soap as the primary choice when washing their hands. Sixty percent of the participants washed their hands at all essential times, however, only 26.3% practiced washing their hands correctly, and only 28.4% washed their hands for at least 20 seconds. Although 92.1% washed hands after contacting with surfaces at public places (e.g., lifts, knob doors), only 66.3% practiced handwashing after removing masks. Females had better reported handwashing practices than male participants (OR = 1.88; 95% CI: 1.15-3.09). Better knowledge of handwashing contributed to improving reported handwashing practice (OR = 1.30; 95% CI: 1.20-1.41). Poorer handwashing practices were likely due, at least in part, to the COVID-19 pandemic information on the internet, social media, newspapers, and television. Although the number of people reported practicing their handwashing was rather high, only a quarter of them had corrected reported handwashing practices. Communication strategy on handwashing should emphasize on the minimum time required for handwashing as well as the six handwashing steps.

Access to Improved Water Sources and Sanitation in Minority Ethnic People in Vietnam and Some Sociodemographic Associations: A 2019 National Survey.

BACKGROUND: Achieving access to clean water and basic sanitation remains as major challenges in Vietnam, especially for vulnerable groups such as minority people, despite all the progress made by the Millennium Development Goal number 7.C. OBJECTIVES: The study aimed to describe the access to improved water sources and sanitation of the ethnic minority people in Vietnam based on a national survey and to identify associated factors. METHODS: A cross-sectional study was conducted in 2019 with a sample size of 1385 ethnic minority households in 12 provinces in Vietnam. Multivariate logistic regression modeling was performed to examine the probability of having access to improved water sources and sanitation and sociodemographic status at a significance level of P < .05. RESULTS: The access to improved water sources and sanitation was unequal among the ethnic minority people in Vietnam, with the lowest access rate in the northern midland and mountainous and Central Highland areas and the highest access rate in the Mekong Delta region. Some sociodemographic variables that were likely to increase the ethnic minority people's access to improved water sources and/or sanitation included older age, female household heads, household heads with high educational levels, religious households, and households in not poor status. CONCLUSION AND RECOMMENDATIONS: The study suggested more emphasis on religion for improving the ethnic minority's access to improved water sources and sanitation. Besides, persons of poor and near-poor status and with low educational levels should be of focus in future water and sanitation intervention programs.

Vietnam Climate Change and Health Vulnerability and Adaptation Assessment, 2018.

BACKGROUND: The Global Climate Risk Index 2020 ranked Vietnam as the sixth country in the world most affected by climate variability and extreme weather events over the period 1999-2018. Sea level rise and extreme weather events are projected to be more severe in coming decades, which, without additional action, will increase the number of people at risk of climate-sensitive diseases, challenging the health system. This article summaries the results of a health vulnerability and adaptation (V&A) assessment conducted in Vietnam as evidences for development of the National Climate Change Health Adaptation Plan to 2030. METHODS: The assessment followed the first 4 steps outlined in the World Health Organization's Guidelines in conducting "Vulnerability and Adaptation Assessments." A framework and list of indicators were developed for semi-quantitative assessment for the period 2013 to 2017. Three sets of indicators were selected to assess the level of (1) exposure to climate change and extreme weather events, (2) health sensitivity, and (3) adaptation capacity. The indicators were rated and analyzed using a scoring system from 1 to 5. RESULTS: The results showed that climate-sensitive diseases were common, including dengue fever, diarrheal, influenza, etc, with large burdens of disease that are projected to increase. From 2013 to 2017, the level of "exposure" to climate change-related hazards of the health sector was "high" to "very high," with an average score from 3.5 to 4.4 (out of 5.0). For "health sensitivity," the scores decreased from 3.8 in 2013 to 3.5 in 2017, making the overall rating as "high." For "adaptive capacity," the scores were from 4.0 to 4.1, which meant adaptive capacity was "very low." The overall V&A rating in 2013 was "very high risk" (score 4.1) and "high risk" with scores of 3.8 in 2014 and 3.7 in 2015 to 2017. CONCLUSIONS: Adaptation actions of the health sector are urgently needed to reduce the vulnerability to climate change in coming decades. Eight adaptation solutions, among recommendations of V&A assessment, were adopted in the National Health Climate Change Adaptation Plan.

Training need assessment for a master training program in Environmental Health program in Vietnam.

Vietnam is facing a shortage of skilled Environmental health workforce. A Training Needs Assessment was conducted to develop a list of environmental health tasks, a list of core competencies and assess the need for a Master of Environmental Health training program in Vietnam. To answer these questions, a cross-sectional study was conducted in Vietnam in 2017, using both qualitative and quantitative methods. The qualitative study involved a desk review, 29 in-depth interviews, two consultative workshops, and two expert meetings. For the quantitative component, 298 environmental health staff working at different levels completed a structured postal questionnaire. Results showed that different sectors were implementing various environmental health tasks but that there was currently no training program focusing on environmental health in Vietnam. Thirteen core competencies for a Master of Environmental Health were recommended. An urgent need to develop training programs to help building environmental health competencies at the Masters degree level was uniformly expressed. This could be achieved by developing a Master of Public Health with an Environmental Health stream in the short-term and a Master of Environmental Health program in the long-term.

Water Supply, Sanitation, and Medical Waste Treatment and Disposal at Commune Health Centers in Vietnam.

Water hygiene, sanitation, and proper management of health care wastes at health care facilities are important in preventing infections and improving health and the environment. This article describes the access to safe water and sanitation facilities and the disposal of medical wastes at commune health centers (CHCs) in Vietnam. Data was extracted from the 2015 World Bank Vietnam District and Commune Health Facility Survey. Bivariate and multivariate logistic regression was applied to identify associations of CHCs' access to improved water and sanitation and their medical waste management. Overall, 72.76% CHCs had access to both improved water and sanitation facilities, and better access was found in the richest communes. Rural CHCs had higher prevalence of appropriate wastewater treatment. The majority of CHCs combusted medical solid wastes by specialized incinerations, contracted out with sanitation companies, or transported them to district health centers. However, the data was insufficient to give in-depth analysis and conclusion on water and sanitation conditions and the management of medical wastes at CHCs. More information should be collected for further analysis and conclusion.

Exposure to Tobacco Advertising, Promotion Among the Adult Population in Vietnam and Its Implications for Public Health.

INTRODUCTION: The Law on Tobacco Control and the Law on Advertisement prohibit the advertising of any tobacco product in Vietnam. Tobacco promotion and marketing are alsostrictly prohibited. However, the violation of tobacco adverting and promotion is still common in Vietnam. OBJECTIVES: This article aims at describing the exposure to tobacco advertising and promotion among the population aged 15+ years in Vietnam based on the data from the Global Adult Tobacco Survey 2015 from the view of the community, identifying any possible associations between the exposure to tobacco advertising and promotion and other individual factors, and discussing its possible public health implications. METHOD: A cross-sectional study with the nationwide scale. Secondary data from the Global Adult Tobacco Survey 2015 was explored and analyzed. Chi-square test and multivariate logistic regressions were applied in the data analysis. RESULTS: The most common type of adults' exposure to tobacco advertising and promotion was points of sale (8.6%); 9.8% adults exposure to one source of tobacco advertising and 4.0% of them exposed to one source of tobacco promotion. Around 13.3% of Vietnamese adults were exposed to tobacco advertisement, while 2.0% were exposed to tobacco promotion, 5.3% were exposed to both tobacco advertising and promotion, and 16.6% were exposed to tobacco advertising or promotion. Gender, educational level, age, occupation, marital status, socioeconomic status, location (urban, rural), and current smoking status were associated with the exposure to tobacco advertising, tobacco promotion, tobacco advertising and promotion, and tobacco advertising or promotion. CONCLUSION AND RECOMMENDATION: Although there are comprehensive bans on tobacco advertising and promotion in Vietnam, adults aged 15+ years still reported their exposure to tobacco advertising and promotion. There should be a strict enforcement of the ban on tobacco advertising and promotion in Vietnam.

Valine/isoleucine variants drive selective pressure in the VP1 sequence of EV-A71 enteroviruses.

BACKGROUND: In 2011-2012, Northern Vietnam experienced its first large scale hand foot and mouth disease (HFMD) epidemic. In 2011, a major HFMD epidemic was also reported in South Vietnam with fatal cases. This 2011-2012 outbreak was the first one to occur in North Vietnam providing grounds to study the etiology, origin and dynamic of the disease. We report here the analysis of the VP1 gene of strains isolated throughout North Vietnam during the 2011-2012 outbreak and before. METHODS: The VP1 gene of 106 EV-A71 isolates from North Vietnam and 2 from Central Vietnam were sequenced. Sequence alignments were analyzed at the nucleic acid and protein level. Gene polymorphism was also analyzed. A Factorial Correspondence Analysis was performed to correlate amino acid mutations with clinical parameters. RESULTS: The sequences were distributed into four phylogenetic clusters. Three clusters corresponded to the subgenogroup C4 and the last one corresponded to the subgenogroup C5. Each cluster displayed different polymorphism characteristics. Proteins were highly conserved but three sites bearing only Isoleucine (I) or Valine (V) were characterized. The isoleucine/valine variability matched the clusters. Spatiotemporal analysis of the I/V variants showed that all variants which emerged in 2011 and then in 2012 were not the same but were all present in the region prior to the 2011-2012 outbreak. Some correlation was found between certain I/V variants and ethnicity and severity. CONCLUSIONS: The 2011-2012 outbreak was not caused by an exogenous strain coming from South Vietnam or elsewhere but by strains already present and circulating at low level in North Vietnam. However, what triggered the outbreak remains unclear. A selective pressure is applied on I/V variants which matches the genetic clusters. I/V variants were shown on other viruses to correlate with pathogenicity. This should be investigated in EV-A71. I/V variants are an easy and efficient way to survey and identify circulating EV-A71 strains.

Exposure to Tobacco Advertising and Promotion among School Children Aged 13-15 in Vietnam - an Overview from GYTS 2014.

Evidence shows that tobacco advertising and promotion activities may increase tobacco consumption and usage, especially in youth. Despite the regulation on prohibiting advertisement of any tobacco product, tobacco advertisement and promotion activities are still common in Vietnam. This article presents current exposure to tobacco advertising and promotion (TAP) among school children aged 13 to 15 years in Vietnam in 2014 and potential influencing factors. Data from the Global Youth Tobacco Survey 2014 in Vietnam covering 3,430 school aged children were used. Both descriptive and analytical statistics were carried out with Stata 13 statistical software. Binary logistic regression was applied to explain the exposure to TAP among youth and examine relationships with individual factors. A significance level of p<0.05 and sampling weights were used in all of the computations. In the past 30 days, 48.6% of the students experienced exposure to at least 1 type of tobacco advertising or promotion. Wearing or otherwise using products related to tobacco was the most exposure TAP type reported by students (22.3%). The internet (22.1), points of sales (19.2) and social events (11.5) were three places that students aged 13-15 frequently were exposed to TAP. Binary logistic results showed that gender (female vs male) (OR = 0.61, 95%CI: 0.52 - 0.71), susceptibility to smoking (OR = 2.12, 95%CI: 1.53 - 2.92), closest friends' smoked (OR = 1.43, 95%CI: 1.2 - 1.7) and parents smoking status (OR = 2.83, 95%CI: 1.6 - 5.01) were significantly associated with TAP exposure among school-aged children. The research findings should contribute to effective implementation of measures for preventing and controlling tobacco use among students aged 13-15 in Viet Nam.

Violation of Bans on Tobacco Advertising and Promotion at Points of Sale in Viet Nam: Trend from 2009 - 2015.

Comprehensive bans on tobacco advertising and promotion were introduced through tobacco control legislation in Viet Nam, but it has been established that violations of the bans are very common. This study was conducted to explore the trend in violations of bans on tobacco advertising and promotion at points of sale in Viet Nam in the past six years and to explore any differences in the violation situations before and after the Law on Tobacco Control came into effect on 1st May 2013. Quantitative data were collected through observation of violations of the bans on tobacco advertising and promotion at points of sale in 10 provinces throughout Viet Nam in four survey rounds (2009, 2010, 2011, and 2015). Variation in violation prevalence over time was examined by chi-square test using a Bonferini method. Binary logistic regression was employed to identify the factors that may have influences on different types of violation. A level of significance of p<0.05 was used for all tests in this article. The most common form of violation was the display of more than one pack/one carton of a cigarette brand. Violation of bans on tobacco advertising increased while violations on promotion ban and on displaying tobacco decreased through time. Some factors associated with the tobacco advertising and promotion bans included surveyed years, types of points of sale, regions and areas where the points of sale were located. The enforcement of the bans did not improve even after the issuance and the enactment of the Law on Tobacco Control. This suggests that the monitoring and enforcement of bans on tobacco advertising and promotion at points of sale should be strengthened. Penalties should be strictly applied for violators as indicated in the current tobacco control legislation.

Decreasing In-home Smoking of Adults-Results from a School-based Intervention Program in Viet Nam.

It is indicated that children are involuntarily exposed to secondhand smoke from adults, mainly at their home environment. This study aimed at describing the effectiveness of the school-based intervention to decrease the in-home smoking situation of adults so as to decrease children's exposure to secondhand smoke at home during the year 2011-2012 in a rural district in Hanoi, Viet Nam. This school-based intervention program (intervention and control group) involved 804 children aged 8 to 11 years from August 2011 to May 2012 in a rural district of Hanoi, Viet Nam. Children were taught in class about the harmful effects of secondhand smoke and about how to negotiate with fathers not to smoke in-home. Then children applied what they learnt, including staying away from secondhand smoke and persuading fathers not to smoke in-home in order to decrease children's exposure to secondhand smoke. Chi square test, t-test and multinominal logistic regression were applied in data analysis. The results showed that children's reported their father's in-home smoking decreased from 83.0% pre-intervention to 59.8% post-intervention (p < 0.001) in the intervention school while no change happened in the control school. The study found that the better changed smoking location of adult smokers as reported by children associated with the school who received intervention activities (adjusted OR = 2.04; 95% CI: 1.28-3.24). Poorer changed attitudes towards secondhand smoke of children associated with a lower percentage of better change in smoking location of their fathers/other adult smokers (aOR = 0.51, 95% CI: 0.28-0.96). Children's poorer changed knowledge towards secondhand smoke also associated with poorer changed smoking location of adult smokers (aOR = 2.88, 95% CI: 1.07-7.76). It is recommended by this study that similar school based intervention approaches should be applied in primary schools in Viet Nam to increase children's awareness on the adverse health effects of secondhand smoke and to help them to be able to avoid their exposure to secondhand smoke at their home environment.

Longitudinal Household Trends in Access to Improved Water Sources and Sanitation in Chi Linh Town, Hai Duong Province, Viet Nam and Associated Factors.

OBJECTIVE: This study aims to characterize household trends in access to improved water sources and sanitaton in Chi Linh Town, Hai Duong Province, Vietnam, and to identify factors affecting those trends. METHOD: Data were extracted from the Chi Linh Health and Demographic Surveillance System (CHILILAB HDSS) database from 2004-2014, which included household access to improved water sources, household access to improved sanitation, and household demographic data. Descriptive statistical analysis and multinominal logistic regression were used. The results showed that over a 10-year period (2004-2014), the proportion of households with access to improved water and improved sanitation increased by 3.7% and 28.3%, respectively. As such, the 2015 Millennium Development Goal targets for safe drinking water and basic sanitation were met. However, 13.5% of households still had unimproved water and sanitation. People who are retired, work in trade or services, or other occupations were 1.49, 1.97, and 1.34 times more likely to have access to improved water and sanitation facilities than farming households, respectively (p < 0.001). Households living in urban areas were 1.84 times more likely than those living in rural areas to have access to improved water sources and improved sanitation facilities (OR =1.84; 95% CI = 1.73-1.96). Non-poor households were 2.12 times more likely to have access to improved water sources and improved sanitation facilities compared to the poor group (OR = 2.12; 95% CI = 2.00-2.25). More efforts are required to increase household access to both improved water and sanitation in Chi Linh Town, focusing on the 13.5% of households currently without access. Similar to situations observed elsewhere in Vietnam and other low- and middle- income countries, there is a need to address socio-economic factors that are associated with inadequate access to improved water sources and sanitation facilities.

Contribution of SUN1 mutations to the pathomechanism in muscular dystrophies.

Mutations in several genes encoding nuclear envelope (NE) associated proteins cause Emery-Dreifuss muscular dystrophy (EDMD). We analyzed fibroblasts from a patient who had a mutation in the EMD gene (p.L84Pfs*6) leading to loss of Emerin and a heterozygous mutation in SUN1 (p.A203V). The second patient harbored a heterozygous mutation in LAP2alpha (p.P426L) and a further mutation in SUN1 (p.A614V). p.A203V is located in the N-terminal domain of SUN1 facing the nucleoplasm and situated in the vicinity of the Nesprin-2 and Emerin binding site. p.A614V precedes the SUN domain, which interacts with the KASH domain of Nesprins in the periplasmic space and forms the center of the LINC complex. At the cellular level, we observed alterations in the amounts for several components of the NE in patient fibroblasts and further phenotypic characteristics generally attributed to laminopathies such as increased sensitivity to heat stress. The defects were more severe than observed in EDMD cells with mutations in a single gene. In particular, in patient fibroblasts carrying the p.A203V mutation in SUN1, the alterations were aggravated. Moreover, SUN1 of both patient fibroblasts exhibited reduced interaction with Lamin A/C and when expressed ectopically in wild-type fibroblasts, the SUN1 mutant proteins exhibited reduced interactions with Emerin as well.

New ZMPSTE24 (FACE1) mutations in patients affected with restrictive dermopathy or related progeroid syndromes and mutation update.

Restrictive dermopathy (RD) is a rare and extremely severe congenital genodermatosis, characterized by a tight rigid skin with erosions at flexure sites, multiple joint contractures, low bone density and pulmonary insufficiency generally leading to death in the perinatal period. RD is caused in most patients by compound heterozygous or homozygous ZMPSTE24 null mutations. This gene encodes a metalloprotease specifically involved in lamin A post-translational processing. Here, we report a total of 16 families for whom diagnosis and molecular defects were clearly established. Among them, we report seven new ZMPSTE24 mutations, identified in classical RD or Mandibulo-acral dysplasia (MAD) affected patients. We also report nine families with one or two affected children carrying the common, homozygous thymine insertion in exon 9 and demonstrate the lack of a founder effect. In addition, we describe several new ZMPSTE24 variants identified in unaffected controls or in patients affected with non-classical progeroid syndromes. In addition, this mutation update includes a comprehensive search of the literature on previously described ZMPSTE24 mutations and associated phenotypes. Our comprehensive analysis of the molecular pathology supported the general rule: complete loss-of-function of ZMPSTE24 leads to RD, whereas other less severe phenotypes are associated with at least one haploinsufficient allele.