Dementia and associated factors among the elderly in Vietnam: a cross-sectional study.

BACKGROUND: Dementia poses a serious threat to the wellbeing of the elderly. In the context of the rapidly ageing population of Vietnam however, little is known about the prevalence of symptoms and other related factors. This study aims to detect the prevalence of cognitive symptoms of dementia in the elderly in Vietnam as well as other associated factors. METHODS: A cross-sectional study was conducted over a period of six communes at the Northern, Central and Southern region of Vietnam. Prevalence of cognitive symptoms of dementia was the outcome of interest and assessed by Mini Mental State Evaluation (MMSE) questionnaire and was standardized according to the age structure of Vietnam. A total of 3308 adults aged 60 and above were included. Association between having cognitive symptoms of dementia and other factors was assessed with logistic regression. FINDINGS: Cognitive symptoms of dementia were perceived in 46.4% of the sample group. The symptoms were more common among participants who were older, female, had a lower educational level, were not physically active or have previously had stroke. CONCLUSIONS: Prevalence of cognitive symptoms of dementia in adults aged 60 and above was relatively high in Vietnam. Other modifiable associated factors including physical inactivity and social connectedness should also be considered in designing intervention program to prevent dementia in the future.

Changes in Vietnamese Male Smokers' Reactions Towards New Pictorial Cigarette Pack Warnings Over Time.

Printing of pictorial health warnings (PHWs) on cigarette packages became obligatory by the Vietnam Law on Prevention and Control of Tobacco Harm in May 2013. Literature from high-income countries suggests that PHWs motivate smokers to quit smoking although their long-term effects have been questioned due to reduction of impact over time. This study aimed to assess the salience of PHWs and smokers' reactions towards PHWs over time. In May 2014 and May 2015, a cross-sectional questionnaire-based household survey was administered to respectively 1,462 and 1,509 Vietnamese male smokers aged 18 to 35. The result showed that salience of the PHWs 2 years after the implementation was higher than at the point of 1 year after the implementation. The proportion of respondents who tried to avoid noting the PHWs was reduced from 35% in wave 1 to 23% in wave 2. However, "Tried to avoid looking/thinking about the PHWs" increased 1.5 times the odds of presenting quit intention compared to those respondents who did not try to avoid looking/thinking about the PHWs (OR=1.5; 95%CI: 1.2-2.0). In conclusion, avoidance regarding PHWs may not work as a barrier when aiming at a higher level of quit intention. Salience of the PHWs may increase in the period shortly after their introduction onto packs but can be expected to decrease with time. In other words, it might be advisable to change or renew PHWs after a period of implementation to maintain their beneficial effects.

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.

The utilization of traditional, complementary and alternative medicine for non-communicable diseases and mental disorders in health care patients in Cambodia, Thailand and Vietnam.

BACKGROUND: The purpose of our study was to determine the prevalence of traditional, complementary and alternative medicine (TCAM) use in patients with chronic diseases in lower Mekong countries. METHODS: A cross-sectional study was conducted in a health care setting using a random sample of 4799 adult patients (Mean age: 52.3 years, SD = 22.7) with chronic diseases in Cambodia, Vietnam and Thailand. The measure included the International Questionnaire to measure usage of complementary and alternative medicine (I-CAM). RESULTS: The 1 year prevalence of consulting TCAM providers was 26.0%; 27.0% in Cambodia, 26.3% in Thailand, 23.9% in Vietnam. The most commonly consulted TCAM providers were the herbalist (17.3%), massage therapist (6.0%), and acupuncturist (5.5%). For all different types of TCAM providers more than 80% of participants perceived the consultation as very or somewhat helpful. The own use of herbal medicine was 41.0%, own use of vitamins 26.5% and the own use of other supplements 9.7% in the past 12 months. The most common self-help practices in the past 12 months included praying for your own health (30.1%), meditation (13.9%) and relaxation techniques (9.9%). In multivariate logistic regression analyses, older age, rural residence and having two or more chronic conditions was associated with the use a TCAM provider; being female, urban residence, residing in Vietnam and having two or more chronic conditions was associated with the use of TCAM products; and being female, older age, rural residence, higher formal education, and residing in Cambodia was associated with the use of TCAM self-help practices. CONCLUSIONS: TCAM use is common among chronic disease patients in lower Mekong countries and is associated with several sociodemographic and disease specific factors.

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.

Health policy processes in maternal health: a comparison of Vietnam, India and China.

This article reports on a comparative analysis to assess and explain the strengths and weaknesses of policy processes based on 9 case-studies of maternal health in Vietnam, India and China. Policy processes are often slow, inadequately coordinated and opaque to outsiders. Use of evidence is variable and, in particular, could be more actively used to assess different policy options. Whilst an increasing range of actors are involved, there is scope for further opening up of the policy processes. This is likely, if appropriately managed with due regard to issues such as accountability of advocacy organisations, to lead to stronger policy development and greater subsequent ownership; it may however be a more messy process to co-ordinate. Coordination is critical where policy issues span conventional sectoral boundaries, but is also essential to ensure development of policy considers critical health system and resource issues. This, and other features related to the nature of a specific policy issue, suggests the need both to adapt processes for each particular policy issue and to monitor the progress of the policy processes themselves. The article concludes with specific questions to be considered by actors keen to enhance policy processes.

Human resources for the control of road traffic injury.

The definition of the ideal numbers and distribution of human resources required for control of road traffic injury (RTI) is not as advanced as for other health problems. We can nonetheless identify functions that need to be addressed across the spectrum of injury control: surveillance; road safety (including infrastructure, vehicle design, and behaviour); and trauma care. Many low-cost strategies to improve these functions in low- or middle-income countries can be identified. For all these strategies, there is need for adequate institutional capacity, including funding, legal authority, and human resources. Several categories of human resources need to be developed: epidemiologists who can handle injury data, design surveillance systems, and undertake research; engineers and planners versed in safety aspects of road design, traffic flow, urban planning, and vehicle design; police and lawyers who understand the health impact of traffic law; clinicians who can develop cost-effective improvements in the entire system of trauma treatment; media experts to undertake effective behaviour change and social marketing; and economists to assist with cost-effectiveness evaluations. RTI control can be strengthened by enhancing such training in these disciplines, as well as encouraging retention of those who have the needed skills. Mechanisms to enhance collaboration between these different fields need to be promoted. Finally, the burden of RTI is borne disproportionately by the poor; in addition to technical issues, more profound equity issues must be addressed. This mandates that people from all professional backgrounds who work for RTI control should develop skills in advocacy and politics.

Identifying factors for job motivation of rural health workers in North Viet Nam.

BACKGROUND: In Viet Nam, most of the public health staff (84%) currently works in rural areas, where 80% of the people live. To provide good quality health care services, it is important to develop strategies influencing staff motivation for better performance. METHOD: An exploratory qualitative research was carried out among health workers in two provinces in North Viet Nam so as to identify entry points for developing strategies that improve staff performance in rural areas. The study aimed to determine the major motivating factors and it is the first in Viet Nam that looks at health workers' job perception and motivation. Apart from health workers, managers at national and at provincial level were interviewed as well as some community representatives. RESULTS: The study showed that motivation is influenced by both financial and non-financial incentives. The main motivating factors for health workers were appreciation by managers, colleagues and the community, a stable job and income and training. The main discouraging factors were related to low salaries and difficult working conditions. CONCLUSION: Activities associated with appreciation such as performance management are currently not optimally implemented, as health workers perceive supervision as control, selection for training as unclear and unequal, and performance appraisal as not useful. The kind of non-financial incentives identified should be taken into consideration when developing HRM strategies. Areas for further studies are identified.