The Content and Implementation of Policies and Programs on Adolescent Sexual and Reproductive Health in Vietnam: Results and Challenges.

In Vietnam, great efforts have been made in sexual and reproductive health (SRH) information provision, education, communication, as well as service provision for the adolescent and youth (A&Y) over the last 10 years. This paper aimed to examine the content and implementation of SRH policies for A&Y between 2006 and 2017. Case studies were conducted, including interviews and historical documentation. Qualitative data were collected in Hai Duong, Hue, and Dong Thap provinces through 34 in-depth interviews with representatives of central/provincial agencies and 9 focus group discussions with representatives of communal agencies and beneficiaries. SRH policies for A&Y during 2006 to 2017, along with other related national policies, were developed cohesively, however, the gaps in information provision, education, communication as well as service provision remained unresolved. The contents of policies and program implementation did not cover comprehensively, especially regarding disadvantaged groups such as disabled people, migrants, ethnic minorities, and people aged 10 to 14 years. The A&Y SRH policies and program implementation had faced some challenges relating to governance, service delivery, health workforce, health information system, and health financing. The SRH policy for A&Y in the next period needs to be focused on interventions/services for disadvantaged groups. While the human resource is of great importance for the capacity and feasibility to tackle SRH's challenges, strengthening the advocacy to ensure policies/programs should be prioritized and committed for effective implementation. An appropriate financing system to run information provision, education, communication, and support services for A&Y must be considered during policy development and implementation.

Granulocyte-colony stimulating factor GCSF mobilizes hematopoietic stem cells in Kasai patients with biliary atresia in a phase 1 study and improves short term outcome.

AIMS: In RCT of adults with decompensated cirrhosis, GCSF mobilizes hematopoietic stem cells HSC and improves short-term outcome. An FDA-IND for sequential Kasai-GCSF treatment in biliary atresia BA was approved. This phase 1 study examines GCSF safety in Kasai subjects. Preliminary short-term outcome was evaluated. METHODS: GCSF (Neupogen) at 5 or 10 µg/kg (n = 3/group) was given in 3 daily doses starting on day 3 of Kasai surgery (NCT03395028). Serum CD34+ HSC cell counts, and 1-month of GCSF-related adverse events were monitored. The 6-months Phase 1 clinical outcome was compared against 10 subsequent post Phase 1 Kasai patients who did not receive GCSF. RESULTS: With GCSF, WBC and platelet count transiently increased, LFT and serum creatinine remained stable. Reversible splenic enlargement (by 8.5-20%) occurred in 5/6 subjects. HSC count increased 12-fold and 17.5-fold for the 5 µg/kg and10 ug/kg dose respectively; with respective median total bilirubin levels for GCSF vs no-GCSF groups of 55 vs 91 µM at 1 month, p = 0.05; 15 vs 37 µM at 3 months, p = 0.24); and the 6-months cholangitis frequency of 40% vs 90%, p = 0.077. CONCLUSIONS: GCSF safely mobilizes HSC in Kasai infants and may improve short-term biliary drainage and cholangitis. Phase 2 efficacy outcome of GCSF adjunct therapy for sequential Kasai and GCSF is pending.

Capacity of Commune Health Stations in Chi Linh District, Hai Duong Province, for Prevention and Control of Noncommunicable Diseases.

The primary health care system in Vietnam has been playing an important role in prevention and control of diseases. This study aimed to describe the capacity of commune health stations in Chi Linh district, Hai Duong province for prevention and control of noncommunicable diseases (NCDs). A mixed-methods (quantitative and qualitative approaches) approach was applied to collect data in 20 commune health stations. The participants, including health workers, stakeholders, and patients with NCDs, were selected for the study. The findings reported that the main activities of prevention and control of NCDs at commune health stations (CHSs) still focused on information-education-community (IECs), unqualified for providing screening, diagnosis, and treatments of NCDs. The capacity for prevention and control of NCDs in CHSs was inadequate to provide health care services related to prevention and control of NCDs and unmet with the community's demands. In order to ensure the role and implementation of primary care level, there is an urgent need to improve the capacity of CHSs for prevention and control of NCDs, particularly a national budget for NCDs prevention and control, the essential equipment and medicines recommended by the World Health Organization should be provided and available at the CHSs.