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OBJECTIVES: The novel dual-target triazaacenaphthylene, gepotidacin, recently showed promising results in its Phase III randomized controlled trial for the treatment of gonorrhoea. We investigated alterations in the gepotidacin GyrA and ParC targets in gonococci by in silico mining of publicly available global genomes (nâ=â33â213) and determined gepotidacin MICs in isolates with GyrA A92 alterations combined with other GyrA and/or ParC alterations. METHODS: We examined gonococcal gyrA and parC alleles available at the European Nucleotide Archive. MICs were determined using the agar dilution method (gepotidacin) or Etest (four antimicrobials). Models of DNA gyrase and topoisomerase IV were obtained from AlphaFold and used to model gepotidacin in the binding site. RESULTS: GyrA A92 alterations were identified in 0.24% of genomes: GyrA A92P/S/Vâ+âS91Fâ+âD95Y/A/N (0.208%), A92Pâ+âS91F (0.024%) and A92P (0.003%), but no A92T (previously associated with gepotidacin resistance) was found. ParC D86 alterations were found in 10.6% of genomes: ParC D86N/G (10.5%), D86Nâ+âS87I (0.051%), D86Nâ+âS88P (0.012%) and D86Gâ+âE91G (0.003%). One isolate had GyrA A92Pâ+âParC D86N alterations, but remained susceptible to gepotidacin (MICâ=â0.125 mg/L). No GyrA plus ParC alterations resulted in a gepotidacin MICâ>â4 mg/L. Modelling of gepotidacin binding to GyrA A92/A92T/A92P suggested that gepotidacin resistance due to GyrA A92T might be linked to the formation of a new polar contact with DNA. CONCLUSIONS: In silico mining of 33â213 global gonococcal genomes (isolates from 1928 to 2023) showed that A92 is highly conserved in GyrA, while alterations in D86 of ParC are common. No GyrA plus ParC alterations caused gepotidacin resistance. MIC determination and genomic surveillance of potential antimicrobial resistance determinants are imperative.
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OBJECTIVES: MDR and XDR Neisseria gonorrhoeae strains remain major public health concerns internationally, and quality-assured global gonococcal antimicrobial resistance (AMR) surveillance is imperative. The WHO global Gonococcal Antimicrobial Surveillance Programme (GASP) and WHO Enhanced GASP (EGASP), including metadata and WGS, are expanding internationally. We present the phenotypic, genetic and reference genome characteristics of the 2024 WHO gonococcal reference strains (nâ=â15) for quality assurance worldwide. All superseded WHO gonococcal reference strains (nâ=â14) were identically characterized. MATERIAL AND METHODS: The 2024 WHO reference strains include 11 of the 2016 WHO reference strains, which were further characterized, and four novel strains. The superseded WHO reference strains include 11 WHO reference strains previously unpublished. All strains were characterized phenotypically and genomically (single-molecule PacBio or Oxford Nanopore and Illumina sequencing). RESULTS: The 2024 WHO reference strains represent all available susceptible and resistant phenotypes and genotypes for antimicrobials currently and previously used (nâ=â22), or considered for future use (nâ=â3) in gonorrhoea treatment. The novel WHO strains include internationally spreading ceftriaxone resistance, ceftriaxone resistance due to new penA mutations, ceftriaxone plus high-level azithromycin resistance and azithromycin resistance due to mosaic MtrRCDE efflux pump. AMR, serogroup, prolyliminopeptidase, genetic AMR determinants, plasmid types, molecular epidemiological types and reference genome characteristics are presented for all strains. CONCLUSIONS: The 2024 WHO gonococcal reference strains are recommended for internal and external quality assurance in laboratory examinations, especially in the WHO GASP, EGASP and other GASPs, but also in phenotypic and molecular diagnostics, AMR prediction, pharmacodynamics, epidemiology, research and as complete reference genomes in WGS analysis.
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Antibacterianos , Genoma Bacteriano , Gonorreia , Testes de Sensibilidade Microbiana , Neisseria gonorrhoeae , Fenótipo , Neisseria gonorrhoeae/genética , Neisseria gonorrhoeae/efeitos dos fármacos , Humanos , Antibacterianos/farmacologia , Gonorreia/microbiologia , Testes de Sensibilidade Microbiana/normas , Organização Mundial da Saúde , Sequenciamento Completo do Genoma , Genótipo , Farmacorresistência Bacteriana/genética , Garantia da Qualidade dos Cuidados de Saúde , Padrões de ReferênciaRESUMO
OBJECTIVES: Antimicrobial resistance (AMR) in Neisseria gonorrhoeae is a global threat and novel treatment alternatives are imperative. Herein, susceptibility to the novel antimicrobial zoliflodacin, currently in a global Phase 3 randomized controlled clinical trial for gonorrhoea treatment, was investigated by screening for zoliflodacin GyrB target mutations in publicly available gonococcal genomes and, where feasible, determination of the associated zoliflodacin MIC. METHODS: The European Nucleotide Archive was queried using the search term 'Taxon: 485'. DNA sequences from 27â151 gonococcal isolates were analysed and gyrB, gyrA, parC and parE alleles characterized. RESULTS: GyrB amino acid alterations were rare (97.0% of isolates had a wild-type GyrB sequence). GyrB V470L (2.7% of isolates) was the most prevalent alteration, followed by S467N (0.12%), N. meningitidis GyrB (0.092%), V470I (0.059%), Q468R/P (0.015%), A466T (0.0074%), L425Iâ+âL465I (0.0037%), L465I (0.0037%), G482S (0.0037%) and D429V (0.0037%). Only one isolate (0.0037%) carried a substitution in a resistance-associated GyrB codon (D429V), resulting in a zoliflodacin MIC of 8â mg/L. None of the other detected gyrB, gyrA, parC or parE mutations caused a zoliflodacin MIC outside the wild-type MIC distribution. CONCLUSIONS: The zoliflodacin target GyrB was highly conserved among 27â151 global gonococcal isolates cultured in 1928-2021. The single zoliflodacin-resistant clinical isolate (0.0037%) was cultured from a male patient in Japan in 2000. Evidently, this strain has not clonally expanded nor has the gyrB zoliflodacin-resistance mutation disseminated through horizontal gene transfer to other strains. Phenotypic and genomic surveillance, including gyrB mutations, of zoliflodacin susceptibility are imperative.
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Anti-Infecciosos , Gonorreia , Masculino , Humanos , Antibacterianos/farmacologia , DNA Girase/genética , DNA Topoisomerase IV/genética , Anti-Infecciosos/farmacologia , Neisseria gonorrhoeae/genética , Mutação , Testes de Sensibilidade Microbiana , Farmacorresistência Bacteriana/genéticaRESUMO
OBJECTIVES: Antimicrobial resistance (AMR) in Neisseria gonorrhoeae, compromising gonorrhoea treatment, is a threat to reproductive health globally. South-East and East Asia have been major sources of emergence and subsequent international spread of AMR gonococcal strains during recent decades. We investigated gonococcal isolates from 2011 and 2015-16 in Vietnam using AMR testing, WGS and detection of AMR determinants. METHODS: Two hundred and twenty-nine gonococcal isolates cultured in 2015-16 (n = 121) and 2011 (n = 108) in Vietnam were examined. AMR testing was performed using Etest and WGS with Illumina MiSeq. RESULTS: Resistance among the 2015-16 isolates was as follows: ciprofloxacin, 100%; tetracycline, 79%; benzylpenicillin, 50%; cefixime, 15%; ceftriaxone, 1%; spectinomycin, 0%; and 5% were non-WT to azithromycin. Eighteen (15%) isolates were MDR. The MIC range for gentamicin was 2-8 mg/L. Among the 2015-16 isolates, 27% (n = 33) contained a mosaic penA allele, while no isolates had a mosaic penA allele in 2011. Phylogenomic analysis revealed introduction after 2011 of two mosaic penA-containing clones (penA-10.001 and penA-34.001), which were related to cefixime-resistant strains spreading in Japan and Europe, and a minor clade (eight isolates) relatively similar to the XDR strain WHO Q. CONCLUSIONS: From 2011 to 2015-16, resistance in gonococci from Vietnam increased to all currently and previously used antimicrobials except ceftriaxone, spectinomycin and tetracycline. Two mosaic penA-containing clones were introduced after 2011, explaining the increased cefixime resistance. Significantly increased AMR surveillance, antimicrobial stewardship and use of WGS for molecular epidemiology and AMR prediction for gonococcal isolates in Vietnam and other Asian countries are crucial.
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Gonorreia , Neisseria gonorrhoeae , Antibacterianos/farmacologia , Ásia , Ceftriaxona/farmacologia , Farmacorresistência Bacteriana , Europa (Continente) , Genômica , Gonorreia/epidemiologia , Humanos , Japão , Testes de Sensibilidade Microbiana , Neisseria gonorrhoeae/genética , Vietnã/epidemiologiaRESUMO
We interviewed 1,805 women in a rural setting in Vietnam with the aim of investigating women's knowledge regarding reproductive tract infections (RTIs) and their health-seeking behavior. We found that women's overall knowledge was poor. Furthermore, only one-third of the symptomatic women sought health care. RTIs affect millions of women globally each year. Most vulnerable are women in low- and middle-income countries where poverty and gender inequities affect their access to health care services. Findings from our study can be used in similar rural settings worldwide to understand and manage the widespread problem of RTIs.
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Conhecimentos, Atitudes e Prática em Saúde/etnologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Infecções do Sistema Genital/etnologia , Adolescente , Adulto , Estudos Transversais , Feminino , Comportamentos Relacionados com a Saúde , Serviços de Saúde , Acessibilidade aos Serviços de Saúde , Humanos , Entrevistas como Assunto , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Pobreza , Prevalência , Pesquisa Qualitativa , População Rural/estatística & dados numéricos , Fatores Socioeconômicos , Vietnã/epidemiologia , Serviços de Saúde da Mulher/estatística & dados numéricosRESUMO
BACKGROUND: Healthcare providers (HCPs) play a critical role in controlling the spread of sexually transmitted infections (STI) through early and accurate diagnosis, appropriate treatment and prevention counselling. This study aimed to assess the effectiveness of an educational intervention about STI on knowledge and reported practice among HCPs and to explore which determinants may influence the intervention's effects. METHODS: A cluster randomized controlled educational intervention was carried out in a rural district, Vietnam. 32 communes of the district were randomized into two arms, with 160 HCPs in an STI intervention arm and 144 in a control arm. The STI intervention comprised interactive training with basic STI knowledge, case scenarios, and poster distribution. Questionnaires to evaluate knowledge and reported practice were completed three times: before, during and after the intervention. Correct answer was scored as 1; "do not know", incorrect answer was scored as 0. Univariate and multilevel multivariate analyses were applied. RESULTS: Of the maximum 56 points, the mean knowledge score increased significantly in the STI intervention arm and in the control arm post-intervention (37.2 to 48.4, and 32.7 to 41.7, respectively). In multivariate regression analysis, knowledge improvement in the intervention arm was significantly higher than that in the control arm (regression coefficient = 2.97, p = 0.008). Other factors which positively influenced the increase in knowledge were being between 35 and 50 years old, having intermediate professional training, being a pharmacist or working at a village level (regression coefficient: 2.81, 4.43, 5.53 and 7.91, respectively). Post-intervention, the mean reported practice score increased significantly in the STI intervention arm (from 17.6 to 21.8) and insignificantly in the control arm (maximum 36 points). Factors which positively influenced the increase in reported practice were being between 35 and 50 years old, having intermediate professional training, or working at a pharmacy/drugstore (regression coefficient: 2.15, 3.33 and 3.22, respectively). CONCLUSIONS: This study indicates that an educational intervention including interactive training and multi-faceted interventions may be effective in improving STI knowledge and reported practice of HCPs at grassroots level, particularly among pharmacists, HCPs who work in villages or pharmacies/drugstores, and who initially have low STI knowledge.
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Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde , Infecções Sexualmente Transmissíveis/prevenção & controle , Adulto , Idoso , Análise por Conglomerados , Feminino , Pessoal de Saúde/educação , Pessoal de Saúde/normas , Humanos , Masculino , Pessoa de Meia-Idade , População Rural , Comportamento Sexual , Inquéritos e Questionários , Resultado do Tratamento , Vietnã , Adulto JovemRESUMO
In this study, CoCr layered double hydroxide material (CoCr-LDH) was prepared and used as an effective catalyst for peroxymonosulfate (PMS) activation to degrade organics in water. The prepared CoCr-LDH material had a crystalline structure and relatively porous structure, as determined by various surface analyses. In Rhodamine B (RhB) removal, the most outstanding PMS activation ability belongs to the material with a Co:Cr molar ratio of 2:1. The removal of RhB follows pseudo-first-order kinetics (R2 > 0.99) with an activation energy of 38.23 kJ/mol and efficiency of 98% after 7 min of treatment, and the total organic carbon of the solution reduced 47.2% after 10 min. The activation and oxidation mechanisms were proposed and the RhB degradation pathways were suggested with the key contribution of O2â¢- and 1O2. Notably, CoCr-LDH can activate PMS over a wide pH range of 4 - 9, and apply to a wide range of organic pollutants and aqueous environments. The material has high stability and good recovery, which can be reused for 5 cycles with a stable efficiency of above 88%, suggesting a high potential for practical recalcitrant water treatment via PMS activation by heterogeneous catalysts.
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Peróxidos , Poluentes Químicos da Água , Purificação da Água , Poluentes Químicos da Água/química , Peróxidos/química , Purificação da Água/métodos , Rodaminas/química , Cinética , Oxirredução , CatáliseRESUMO
In the present study, the biosynthesis of stable silver nanoparticles (BioAgNPs) was accomplished successfully for the first time by using an aqueous extract derived from the buds of Syzygium nervosum (SN) as both a reducing and a stabilizing agent. Transmission electron microscopy (TEM) and high-resolution transmission electron microscopy (HR-TEM) investigations revealed that the biosynthesized BioAgNPs were predominantly spherical with an average size of 10-30 nm. It was found that the outstanding stability of the BioAgNPs colloidal solution was assigned to the additive effect of the surrounding protective organic layer and the highly negatively charged surface of the nanoparticles. Consequently, good antibacterial activity was demonstrated by the colloidal BioAgNPs solution against four distinct bacterial strains, including Gram-positive S. aureus and B. subtilis as well as Gram-negative E. coli and S. typhi. Interestingly, the biosynthesized BioAgNPs displayed greater antibacterial activity even when tested at low doses against Gram-negative S. typhi. In addition, the biogenic AgNPs demonstrated a significant level of catalytic activity in the process of converting 2-NP, 3-NP, and 4-NP into aminophenols within 15 min, with reaction rate constants of 9.0 × 10-4, 10 × 10-4, and 9.0 × 10-4 s-1, respectively. BioAgNPs formulations were assessed against anthracnose disease in tea plants and were found to be as effective as the positive control at a dose of 20-fold dilution, but less effective at a dose of 30-fold dilution. Both doses of BioAgNPs formulations significantly suppressed Colletotrichum camelliae (anthracnose disease) without affecting the growth of the tea plants.
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This study delves into the advanced integration of a ternary heterogeneous Z-scheme photocatalyst, TiO2/CuInS2/OCN (OCN: O-g-C3N4), with carbon quantum dot (CQD) to improve the degradation efficiency of reactive yellow 145 (RY145) dye in water. Through a systematic examination, we elucidated the photocatalytic mechanisms and the role of radicals, electrons, and holes in the treatment process. Our findings revealed that this novel catalyst integration significantly boosted RY145 degradation efficiency, achieving 98.2%, which is markedly higher than the efficiencies which could be achieved using TiO2/CuInS2/OCN alone. Moreover, the TiO2/CuInS2/OCN/CQD photocatalyst demonstrated superior rate performance over its components. Comprehensive evaluations, including photoelectrochemical and radical tests, further confirmed the efficiency of the integrated system, adhering to Z-scheme principles. The catalyst showcased remarkable stability, with over 94% reusability after five reaction cycles. These findings pave the way for the potential use of the TiO2/CuInS2/OCN/CQD photocatalyst as an innovative solution for water pollutant treatment via photocatalytic technology.
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OBJECTIVE: This study aimed to explore Vietnamese midwives' experiences of working in maternity care. METHODS: A descriptive qualitative study was undertaken, which involved four focus group discussions with midwives (n = 25) working at three different hospitals in urban, semi-urban and rural parts of Hanoi region, Vietnam. Data were analysed using qualitative content analysis. RESULTS: The overall theme, "Practising midwifery requires commitment" showed that Vietnamese midwives' dedication to their work and to women's reproductive health helped them to cope with stress, pressure and negative aspects of their work environment. In the first category "Being the central link in the web of care", midwives described themselves as having a key role in maternity care although collaborations with other health professions were important. In the second category "Rewarding role but also vulnerable position", positive aspects of midwifery were expressed although the great pressure of the work midwives do was prominent. High workload, patients' demands, and being negatively exposed and vulnerable, when adverse events occurred, were reported. In the third category "Morally challenging tasks", ultrasound examinations to reveal fetal sex and working with abortion services were described as emotionally stressful. CONCLUSIONS: Although participating Vietnamese midwives experienced midwifery as essentially positive, they felt exposed to significant workload pressure, ethically highly demanding work and being blamed when adverse obstetric events occurred. Public health interventions to inform Vietnamese citizens about reproductive issues, as well as specific antenatal education measures may increase the understanding of evidence-based maternity care and complications that can occur during pregnancy and birth.
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Serviços de Saúde Materna , Tocologia , Enfermeiros Obstétricos , Obstetrícia , Povo Asiático , Feminino , Humanos , Tocologia/educação , Enfermeiros Obstétricos/psicologia , Gravidez , Pesquisa QualitativaRESUMO
BACKGROUND/AIM: Cervical cancer is the second most common malignancy among women in Vietnam, but the country is yet to introduce a national human papillomavirus (HPV) vaccine programme targeted at adolescents. We determined HPV prevalence and HPV vaccine knowledge among female university students in Vietnam. PATIENTS AND METHODS: We surveyed and screened 1,491 female university students in Hanoi, Hue, and Ho Chi Minh City for their sexual behaviours, HPV knowledge and low- and high-risk HPV infection. RESULTS: The prevalence of any HPV infection and any high-risk HPV infection were 4.2% (95%CI=3.3%-5.4%) and 3.4% (95%CI=2.5%-4.4%), respectively. Being sexually active [adjusted prevalence ratio (aPR): 6.22; 95%CI=3.4-11.37] and having ever been pregnant (aPR: 4.82; 95%CI=1.93-12.04) were positively associated with high-risk HPV infection. Whilst 60% of participants had heard of HPV vaccine, only 4.6% had received the vaccine. CONCLUSION: The low HPV prevalence found in university students in Vietnam indicates that they can benefit from HPV vaccination, along with a well-designed HPV health promotion programme.
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Alphapapillomavirus , Infecções por Papillomavirus , Vacinas contra Papillomavirus , Neoplasias do Colo do Útero , Adolescente , Estudos Transversais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Papillomaviridae/genética , Infecções por Papillomavirus/epidemiologia , Prevalência , Estudantes , Universidades , Neoplasias do Colo do Útero/epidemiologia , Vietnã/epidemiologiaRESUMO
OBJECTIVE: To explore Vietnamese midwives' experiences and views on the role of obstetric ultrasound in relation to clinical management, including ethical aspects. METHODS: Using a qualitative design, content analysis of focus group discussions with midwives (N = 25) working at Departments of Obstetrics and Gynecology at three hospitals in urban, semi-urban and rural parts of Hanoi were performed. RESULTS: Obstetric ultrasound was reported as being a highly valuable tool, although replacing ordinary antenatal care surveillance with ultrasound examinations and misuse of ultrasound without medical indication was perceived as troubling. Participants generally viewed the fetus as a human being already at an early stage of pregnancy. However, when complications occurred, the pregnant woman's health was mostly prioritised. CONCLUSION: Although the use of ultrasound has many benefits during pregnancy, replacing ordinary antenatal care surveillance with ultrasound examinations and misuse of ultrasound without medical indication is concerning and needs to be addressed. There is also a need to communicate the benefits of adequate antenatal care to pregnant women and caution about the non-beneficial use of repeated ultrasound examinations without medical indication. Additionally, non-medical ultrasounds consume limited healthcare resources and its use needs to be better regulated in Vietnam.
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Atitude do Pessoal de Saúde , Mau Uso de Serviços de Saúde/prevenção & controle , Serviços de Saúde Materna/normas , Tocologia , Cuidado Pré-Natal/normas , Ultrassonografia Pré-Natal/psicologia , Adulto , Feminino , Grupos Focais , Humanos , Gravidez , Pesquisa Qualitativa , VietnãRESUMO
OBJECTIVES: To assess knowledge and reported practice regarding sexually transmitted infections (STI) among healthcare providers in rural Vietnam and to examine background characteristics possibly associated with knowledge and practice. METHODS: A cross-sectional study using a self-completed questionnaire was carried out in 2006 among 465 healthcare providers in rural Vietnam. The questionnaire included questions on providers' characteristics, STI knowledge, and case scenarios of 4 common STI syndromes. Correct answer was scored 1, "do not know" or incorrect answer was scored 0. Linear and logistic regressions were applied. RESULTS: Diseases considered as STI were gonorrhea and syphilis by 83% of the respondents, 70% believed partner treatment necessary for bacterial vaginosis or candidiasis cases. Sharing clothes/food or kissing was commonly mentioned as transmission routes (60%). Median scores of knowledge and reported practice were 29 (range: 0-50) and 2 (range: 0-20), respectively. Among the respondents, 34% had a knowledge score of less than 25 and 78% had a practice score of less than 10. Characteristics predicting higher level of knowledge were being a medical doctor, assistant medical doctor, midwife, or serving STI patients. Characteristics predicting higher level of practice were serving STI patients, being a midwife or female provider, and having participated in STI or reproductive tract infection training courses. Respondents who reported treating STI patients had a higher level of knowledge and reported practice than the others.
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Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde , População Rural , Infecções Sexualmente Transmissíveis , Adulto , Idoso , Atitude do Pessoal de Saúde , Atitude Frente a Saúde , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Sexualmente Transmissíveis/fisiopatologia , Infecções Sexualmente Transmissíveis/prevenção & controle , Infecções Sexualmente Transmissíveis/transmissão , Inquéritos e Questionários , Vietnã , Adulto JovemRESUMO
BACKGROUND: The serious long-term complications of sexually transmitted infections (STI) in women and newborns are well-documented. Particularly, STI imply considerable social consequences for women. Low STI knowledge has been shown to be associated with unsafe sex. In Vietnam, misconceptions regarding STI exist, and rural women delay seeking care for STI. The aim of the study was to investigate knowledge of STI among women aged 15 to 49 years in a rural district of Vietnam and to evaluate possible associations between socioeconomic factors and STI knowledge. METHODS: A cross-sectional population-based study using face-to-face interviews was carried out between March and May 2006 in a demographic surveillance site in rural Vietnam. In total, 1805 women aged 15-49 years were randomly selected to participate in the study. The interviews were based on a structured questionnaire including questions on sociodemographic characteristics of the women and their knowledge about STI. Each correct answer was scored 1, incorrect or do not know answer was scored 0. Multivariate analyses were applied to examine associations between socio-economic conditions and STI knowledge. Intra-cluster correlation was calculated to examine similarities of STI knowledge within clusters. RESULTS: Of the 1,805 respondents, 78% (73% married vs. 93% unmarried, p < 0.001) did not know any symptoms of STI, 50% could not identify any cause of STI, 59% (54% married vs. 76% unmarried, p < 0.001) did not know that STI can be prevented. Only 31% of the respondents (36% married vs. 14% unmarried, p < 0.001) answered that condom use could protect against STI, and 56% considered partner treatment necessary. Of 40 possible correct answers, the mean knowledge score was 6.5 (range 0-26, median 6). Young, unmarried women and women who lived in the highlands or mountainous areas demonstrated very low levels of STI knowledge (regression coefficients -1.3 and -2.5, respectively, p < 0.001). Experience of an induced abortion was significantly associated with a higher level of knowledge. CONCLUSION: The low levels of STI knowledge found among women of reproductive age in a rural district of Vietnam indicate an urgent need of health education interventions, of which, young and unmarried women should be specifically targeted.
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Conhecimentos, Atitudes e Prática em Saúde , População Rural , Infecções Sexualmente Transmissíveis/epidemiologia , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Pessoa de Meia-Idade , Análise Multivariada , Fatores Socioeconômicos , Inquéritos e Questionários , Vietnã/epidemiologia , Saúde da Mulher , Adulto JovemRESUMO
OBJECTIVES: Obstetric ultrasound is an important part of antenatal care in Vietnam, although there are great differences in access to antenatal care and ultrasound services across the country. The aim of this study was to explore Vietnamese health professionals' experiences and views of obstetric ultrasound in relation to clinical management, resources and skills. DESIGN: A cross-sectional questionnaire study was performed as part of the CROss Country UltraSound study. SETTING: Health facilities (n=29) in urban, semiurban and rural areas of Hanoi region in Vietnam. PARTICIPANTS: Participants were 289 obstetricians/gynaecologists and 535 midwives. RESULTS: A majority (88%) of participants agreed that 'every woman should undergo ultrasound examination' during pregnancy to determine gestational age. Participants reported an average of six ultrasound examinations as medically indicated during an uncomplicated pregnancy. Access to ultrasound at participants' workplaces was reported as always available regardless of health facility level. Most participants performing ultrasound reported high-level skills for fetal heart rate examination (70%), whereas few (23%) reported being skilled in examination of the anatomy of the fetal heart. Insufficient ultrasound training leading to suboptimal pregnancy management was reported by 37% of all participants. 'Better quality of ultrasound machines', 'more physicians trained in ultrasound' and 'more training for health professionals currently performing ultrasound' were reported as ways to improve the utilisation of ultrasound. CONCLUSIONS: Obstetric ultrasound is used as an integral part of antenatal care at all selected health facility levels in the region of Hanoi, and access was reported as high. However, reports of insufficient ultrasound training resulting in suboptimal pregnancy management indicate a need for additional training of ultrasound operators to improve utilisation of ultrasound.
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Acessibilidade aos Serviços de Saúde/normas , Enfermeiros Obstétricos , Médicos , Cuidado Pré-Natal , Ultrassonografia Pré-Natal , Adulto , Atitude do Pessoal de Saúde , Competência Clínica , Estudos Transversais , Feminino , Grupos Focais , Necessidades e Demandas de Serviços de Saúde , Humanos , Obstetrícia/métodos , Gravidez , Cuidado Pré-Natal/métodos , Cuidado Pré-Natal/normas , Utilização de Procedimentos e Técnicas/normas , Desenvolvimento de Pessoal , Ultrassonografia Pré-Natal/métodos , Ultrassonografia Pré-Natal/estatística & dados numéricos , VietnãRESUMO
OBJECTIVE: To explore perceptions, attitudes and health-seeking patterns for reproductive tract infections including sexually transmitted infections (RTI/STI) among men and women in rural Vietnam. METHOD: Ten focus group discussions (FGDs) were conducted with 46 women and 27 men aged 15-49 in Bavi district, northern Vietnam. A pre-designed discussion guide was used during the discussions. Content analysis was applied for data analysis. Each sentence/paragraph was coded. Similar codes were clustered and collapsed into sub-categories and categories. Two main themes 'community perceptions of RTI/STI' and 'attitudes towards RTI/STI' were created, based on the relationship between categories. FINDINGS: Complex terminology with many different terms was used by participants to describe and discuss RTI/STI. "Inflammation" [RTI], Gonorrhoea, Syphilis was described as three stages of STI. Health-seeking patterns for RTI/STI were reported to differ between men and women: self-medication was mentioned as a common practice among women, while men were more likely to seek health care from private providers. Complaints were voiced about clinicians' negative attitudes towards RTI/STI patients. CONCLUSION: Rural dwellers in a district of Vietnam expressed a variety of misconceptions regarding RTI/STI. Designing health education strategies to provide comprehensive RTI/STI information to the community and improving communication between RTI/STI patients and clinicians are urgently needed.
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Conhecimentos, Atitudes e Prática em Saúde , Medicina Reprodutiva , População Rural , Infecções Sexualmente Transmissíveis , Adolescente , Adulto , Feminino , Grupos Focais , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , VietnãRESUMO
Adequate infection control plays a key role in preventing healthcare-associated infections (HAIs). This study aimed to explore staff perceptions of hospital infection control in a rural and an urban hospital in Vietnam. Individual interviews were conducted with hospital managers, and focus group discussions were conducted with doctors, nurses and cleaning workers separately. Content analysis was applied. An interview guide including discussion points on HAIs, hand hygiene and healthcare waste management was used. Generally, the staff were knowledgeable of hospital infection control, but they were not aware of the situation in their own hospital, and infection control practices in the hospitals remained poor. Reported difficulties in infection control included lack of resources, poor awareness and patient overload. A main theme emerged: 'Making data on HAIs available for health workers can improve their awareness and motivate them to put their existing knowledge into practice, thus decreasing the know-do gap in infection control'. This could be a feasible intervention to improve infection control practice in the hospitals with limited resources, high workload and patient overload.
Assuntos
Atitude do Pessoal de Saúde , Infecção Hospitalar/prevenção & controle , Controle de Infecções/métodos , Recursos Humanos em Hospital/psicologia , Adulto , Feminino , Grupos Focais , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , População Rural , População Urbana , VietnãRESUMO
OBJECTIVES: Implementation of ultrasound in antenatal care (ANC) in low-income countries has been shown to increase pregnant women's compliance with ANC visits, and facilitate detection of high-risk pregnancies. In Rwanda, as in other low-income countries, access to ultrasound has increased significantly, but lack of training is often a barrier to its use. The aim of this study was to investigate Rwandan health professionals' experiences and views of obstetric ultrasound in relation to clinical management, resources and skills. METHODS: A cross-sectional questionnaire study was undertaken between November 2016 and March 2017, as part of the CROss Country UltraSound Study (CROCUS). Data were collected at 108 health facilities located in both rural and urban areas of Rwanda, including provincial, referral, district and private hospitals as well as health centres. Participants were obstetricians (n = 29), other physicians (n = 222), midwives (n = 269) and nurses (n = 387). RESULTS: Obstetricians/gynecologists/other physicians commonly performed ultrasound examinations but their self-rated skill levels implied insufficient training. Access to ultrasound when needed was reported as common in hospitals, but available to a very limited extent in health centres. The vast majority of participants, independent of health profession, agreed that maternity care would improve if midwives learned to perform basic ultrasound examinations. CONCLUSIONS: Barriers to provision of high quality ultrasound services include variable access to ultrasound depending on health facility level and insufficient skills of ultrasound operators. Physicians in general need more training to perform ultrasound examinations. Implementation of a general dating ultrasound examination seems to be a relevant goal as most health professionals agree that pregnant woman would benefit from this service. To further improve maternity care services, the possibility of educating midwives to perform ultrasound examinations should be further explored.
Assuntos
Obstetrícia/métodos , Ultrassonografia Pré-Natal/métodos , Estudos Transversais , Feminino , Pessoal de Saúde , Humanos , Tocologia , Enfermeiros Obstétricos , Médicos , Gravidez , Cuidado Pré-Natal , Ruanda , Inquéritos e QuestionáriosRESUMO
Staff practice, driven by knowledge, plays a decisive role in hospital infection control. This study aimed to assess and compare knowledge and self-reported practices of infection control among various occupational groups in a rural and an urban hospital in Vietnam. Questionnaires consisting of items on knowledge and practices were collected from 339 hospital staff with varying occupations. For analysis, total knowledge or practice score ranged from 0-15. Mood's median test was performed to compare median scores. Post-hoc analysis of ordinal logistic regression models was applied to test differences in scores among occupational groups. The majority of hospital staff had good or adequate knowledge (median score: rural = 11.8; urban = 12), but the score range was wide (1.4-14.5). Self-reported practices in the urban hospital were likely to be better than in the rural one (p = 0.003). Self-reported practices yet not completely satisfactory, indicating the need for continuing professional development in both settings. Overall, cleaners had lower scores than both physicians and nurses, highlighting the need for tailored education in this topic. Future infection control strategies within the hospitals might want to assess the difference between the staff's self-reported practice and their actual real practice. These findings can be of value in many other similar settings.