Patterns of food consumption in Vietnam: effects on socioeconomic groups during an era of economic growth.

OBJECTIVE: To identify if the nutritional status and improvements in Vietnam during the 1990s applied equally to the key vulnerable population groups (poor, rural, and ethnic minority) as it did to the nonpoor-largely in the urban areas. DESIGN: This study used cross-sectional analyses in the context of inequalities occurring in the diets of the poor and nonpoor that accompanied economic improvements during the Vietnam Doi Moi period. SETTING: During the Doi Moi period in Vietnam. SUBJECTS: A cross-sectional analysis was conducted on data using 23,839 individuals (4800 households) from the Vietnam Living Standard Survey (VLSS) in 1992-1993 and 28,509 individuals (6,002 households) from the Vietnam Living Standard Survey in 1997-1998. Analysis for changes in food consumption was conducted on 17,763 individuals (4,305 households) that were included in both surveys. INTERVENTION: None. RESULTS: After initiation of Doi Moi in 1986, the average Vietnamese person reached the dietary adequacy of 2,100 kcal per day per capita in the early 1990s, but this did not improve during the next decade. The structure of diet shifted to less starchy staples while proteins and lipids (meat, fish, other protein-rich higher fat foods) increased significantly. Although the gap in nutrient intake between the poor and the nonpoor decreased, the proportion of calories from protein- and lipid-rich food for the poor is lower than for the nonpoor. The VLSS data showed that the increase of protein and lipid foods in total energy structure over the 5 y between the VLSS studies for poor households was 0.43% (CI=0.33, 0.53) and 0.47% (CI=0.41, 0.54) lower, respectively, than for nonpoor households (P<0.0001). Inequalities compared to the nonpoor were also found in both quantity and quality of food consumption. For example, poor households consumed (quantity) 127 kcal/day (CI=119, 135) less from meat, and 32 kcal/day (CI=27, 38) less from fats than nonpoor households (P<0.0001), and the proportion of calories consumed (quality) by poor households was 5.8% (CI=5.4, 6.1) less from meat and 0.96% (CI=1.2, 0.7) less from fats than by nonpoor households (P<0.0001). CONCLUSIONS: Although the key vulnerable groups-rural, poor, and minority populations-showed improvements in diet, there still remains an inequity between these groups and the nonpoor of the population. In particular, the vulnerable groups consumed less of their daily consumption from the desirable high-quality proteins of animal foods and fats, and more from cereals and other starches-lagging the better-off populations in desired composition.

Child malnutrition in Vietnam and its transition in an era of economic growth.

OBJECTIVE: In the past decade, Vietnam has achieved an impressive rate of socioeconomic development paralleled by broad improvements in the health sector--but child malnutrition still lags far behind that of most other health indicators. The purpose of this study is to discover inequality in the near-present situation (1997-98; hereafter referred to as the present situation), changes of child malnutrition over the period from 1992-93 to 1997-98, and factors that might affect the inability to rapidly reduce child malnutrition among the poor, rural, and minority populations. DESIGN: Data from two nationally representative surveys--the 1992-93 and 1997-98 Vietnam Living Standards Measurement Surveys (LSMS)--of Vietnamese households were utilized in this study. Descriptive and logistic procedures were used for the analyses. The focus was on the variables related to household poverty status, total expenditure levels, rural residence, and minority status with controls for other key economic and demographic measures. SUBJECTS: A cross-sectional analysis was conducted on data using 4305 households and 4367 children (2-11 years of age in 1992-93) that were included in both surveys of the Vietnam Living Standard Survey (VLSS) in 1992-93 and 1997-98, conducted under the framework of the LSMS. RESULTS: Children of rural households, poor households, and ethnic minority backgrounds are significantly more likely to be malnourished than urban residents, children of nonpoor households, and the majority Kinh population. Additionally, avenues to escape malnourishment are limited in the former categories. These results suggest that economic improvements in Vietnam have, for the most part, bypassed the rural poor and minorities, and targeting economic resources towards these groups will be most critical to reduce malnutrition in Vietnam.

Detection of nanocolloids with flow-field flow fractionation and laser-induced breakdown detection.

A new nanosize colloid detection method comprised of flow-field flow fractionation (FFFF) with laser-induced breakdown detection (LIBD) is presented, which is capable of characterizing the colloid size distribution as well as determining the number density of each size fraction in very low concentrations. The method facilitates the detection of aquatic colloids particularly in the lower range of nanometer size (< 50 nm) with the sensitivity much higher than a laser light-scattering method (LLS), i.e., the lower ppb range. The method is tested with a mixture of polystyrene colloids in three different nominal sizes, 19, 50, and 102 nm, and the results are compared with those of the LLS method. For colloids of 19-nm diameter, the present method demonstrates the detection sensitivity over 3 orders of magnitude better than that of the LLS method. The limitation of the detection sensitivity arises from the surface bleeding of a ceramic frit overlying the separation channel of the used FFFF instrument.

Early childhood survivorship in Vietnam.

The effects on early childhood mortality of birth order, age of the mother at the time of the child's birth, mother's education, as well as infant mortality risk in the province, urban/rural residence, the presence of schools and other facilities and health care services, were examined using data from the 1988 Vietnam Demographic and Health Survey and the 1990 Study of Accessibility of Contraceptives in Vietnam. A total of 4137 urban and rural children born between 1983 and 1988 to the 4172 women interviewed in the Demographic and Health Survey were included in the hazard model analysis of maternal and child characteristics. However, since the Accessibility of Contraceptives Study included only rural respondents, the hazard model analysis of community development characteristics and health services effects on early childhood mortality was based on a subsample of 3314 rural children. Rural children in birth orders five and higher had the greatest risk of early childhood death, birth order one an intermediate risk and orders 2-4 the lowest risk of early childhood death. Rural children residing in communes with fewer than 10,000 inhabitants were at significantly greater risk of early childhood death than children from larger communes. Neither age nor education of the mother nor gender of the child, had a significant impact on early childhood survivorship independent of other variables. Risk of infant mortality in the child's province was of borderline significance.

PIP: The authors examined the effects of the following factors upon early childhood mortality: birth order, mother's age at the time of the child's birth, mother's education, infant mortality risk in the province, urban/rural residence, and the presence of schools and other facilities and health care services. Data were used in a hazard model analysis of maternal and child characteristics for 4137 urban and rural children born between 1983 and 1988 whose 4172 mothers were interviewed in the 1988 Vietnam Demographic and Health Survey. Data were also used for a subsample of 3314 rural children from the 1990 Study of Accessibility of Contraceptives in Vietnam. Analysis found that rural children of birth orders five and higher had the greatest risk of early childhood death. Birth order one held an intermediate risk, while orders 2-4 held the lowest risk. Rural children residing in communes with less than 10,000 inhabitants were at significantly greater risk of early childhood death than children from larger communes. Neither mother's age nor education, nor gender of the child, had a significant impact upon early childhood survivorship independent of other variables. The risk of infant mortality in the child's province was of marginal significance.

Vietnamese infant and childhood mortality in relation to the Vietnam War.

OBJECTIVES: There is obvious potential for war to adversely affect infant and childhood mortality through direct trauma and disruption of the societal infrastructure. This study examined trends in Vietnam through the period of the war. METHODS: The 1988 Vietnam Demographic and Health Survey collected data on reproductive history and family planning from 4172 women aged 15 through 49 years in 12 selected provinces of Vietnam. The 13,137 births and 737 deaths to children younger than age 6 reported by the respondents were analyzed. RESULTS: For the country as a whole, infant and childhood mortality dropped by 30% to 80% from the prewar period to the wartime period and was stable thereafter. In provinces in which the war was most intense, mortality did not decline from the prewar period to the wartime period but declined after the war, consistent with an adverse effect during the wartime period. CONCLUSIONS: The data are limited by assignment of birth location on the basis of mother's current residence and by inadequate information on areas of war activity. Nonetheless, the data do not indicate a widespread, sizable adverse effect of the war on national infant and childhood mortality in Vietnam but suggest detrimental effects in selected provinces.

Individual and community characteristics influencing breastfeeding duration in Vietnam.

This analysis of selected community and maternal characteristics influencing duration of breastfeeding in Vietnam utilized data from the 1988 Demographic and Health Survey and 1990 Accessibility of Contraceptives Survey available for the 4434 children born to 2769 women having their last birth between 1983-88. Explanatory variables included as covariates in the hazards model were mother's education, age of the mother at the time of the child's birth, birth order, and gender of the child, urban versus rural residence, infant mortality risk in the child's province, locality (mountains and highlands compared to delta and coastal), and region of the country (north, south). Indicators of development in the child's village included availability of electricity and public transportation. Breastfeeding duration was longer among the more highly educated women and among those women living in provinces with higher infant mortality. However, there were no significant differences in the duration of breastfeeding with variations among certain development characteristics of the village. Although there were regional differences in the duration of breastfeeding for the rural population, there were no regional differences for the overall population. There were no significant variations in the duration of breastfeeding by age of the mother, birth order or gender of the child. Although there were significant variations in duration of breastfeeding by some maternal and community characteristics, between 80-90 per cent of all women breastfeed for at least the first year of the child's life.

Determinants of birth intervals in Vietnam: a hazard model analysis.

There was absence of any regional differences in parity progressions and length of birth intervals, although urban-rural differences persisted at most birth orders, suggesting that, as in other studies, the urban-rural differentials are the primary source of variations in fertility between different areas of a country. The significantly higher probability of a subsequent birth after birth order 2 in areas with high infant mortality compared to those with low infant mortality suggests that women in the high-risk provinces may be more likely to advance beyond parity 2 and continue on into the advanced parities. The provinces identified as having high infant mortality had also been identified in other studies as the provinces with the highest crude birth rates and population growth rates, the least available family planning services, and highest crude death rates. Mothers' education was consistently related to the likelihood of another birth at each birth order, with the most-educated women experiencing a significantly lower probability of having a subsequent birth at every birth order. This concurs with results in other studies, suggesting that the woman's education is a prime determinant of fertility and that increasing the educational attainment of women is one of the most beneficial measures to reduce fertility. The significant relationship between the previous birth interval of the index child and the probability that the index child would be followed by a subsequent birth conforms with other studies of birth interval dynamics that suggest that pregnancy-spacing for a given woman remains constant throughout her reproductive career.(ABSTRACT TRUNCATED AT 250 WORDS)

Factors related to the utilization of prenatal care in Vietnam.

Data from the 1988 Vietnam Demographic and Health Survey and 1990 Vietnam Accessibility of Contraceptives Survey were used in this analysis of the influence of selected individual and community characteristics on the utilization of prenatal care in Vietnam. Specific analysis of the impact of availability of health services and other development characteristics of the community on utilization of prenatal care was done in a rural subsample. The woman's educational level and total number of living children were the most significant predictors of prenatal care utilization. Age independent of parity did not significantly affect the use of prenatal care. Rural women and women living in provinces with the highest infant mortality rates were significantly less likely to use prenatal services than their counterparts in the urban areas and provinces with low infant mortality rates. Non-physician health care providers were the main sources of prenatal care for women in both rural and urban areas.

PIP: Researchers analyzed data from the 1988 Vietnam Demographic and Health Survey and the 1990 Vietnam Accessibility of Contraceptives Survey to determine the influence of individual and community characteristics on use of prenatal care. Most pregnant women received prenatal care services from midwives or assistant physicians (34.8-51.2%). Less than 5% received prenatal care from a physician. Level of education and utilization of prenatal care were positively associated (p = .0001). Higher parity women were less likely to use prenatal care (47.1% vs. 68.8%), perhaps reflecting that they were more confident about pregnancy and felt less need for prenatal care. Maternal age did not affect utilization of prenatal care, regardless of parity. Urban women were more likely to use prenatal care than rural women and those living in the provinces where infant mortality was higher than 40/1000 live births. The lack of transport in rural areas was likely responsible for this difference in prenatal care utilization. Absence of prenatal care services in provinces with high infant mortality rates probably explained the difference in prenatal care use. Among rural women, the factor having the most influence on prenatal care utilization was education. These findings emphasized the need for promotion of prenatal care services among women with limited education and expansion of the accessibility and availability of prenatal services. They also indicted the importance of improving women's education which in turn improves utilization of prenatal care services.