Understanding the barriers to integrating maternal and mental health at primary health care in Vietnam.

The prevalence of common perinatal mental disorders in Vietnam ranges from 16.9% to 39.9%, and substantial treatment gaps have been identified at all levels. This paper explores constraints to the integration of maternal and mental health services at the primary healthcare level and the implications for the health system's responsiveness to the needs and expectations of pregnant women with mental health conditions in Vietnam. As part of the RESPONSE project, a three-phase realist evaluation study, we present Phase 1 findings, which employed systematic and scoping literature reviews and qualitative data collection (focus groups and interviews) with key health system actors in Bac Giang province, Vietnam, to understand the barriers to maternal mental healthcare provision, utilization and integration strategies. A four-level framing of the barriers to integrating perinatal mental health services in Vietnam was used in reporting findings, which comprised individual, sociocultural, organizational and structural levels. At the sociocultural and structural levels, these barriers included cultural beliefs about the holistic notion of physical and mental health, stigma towards mental health, biomedical approach to healthcare services, absence of comprehensive mental health policy and a lack of mental health workforce. At the organizational level, there was an absence of clinical guidelines on the integration of mental health in routine antenatal visits, a shortage of staff and poor health facilities. Finally, at the provider level, a lack of knowledge and training on mental health was identified. The integration of mental health into routine antenatal visits at the primary care level has the potential help to reduce stigma towards mental health and improve health system responsiveness by providing services closer to the local level, offering prompt attention, better choice of services and better communication while ensuring privacy and confidentiality of services. This can improve the demand for mental health services and help reduce the delay of care-seeking.

Realist evaluation to improve health systems responsiveness to neglected health needs of vulnerable groups in Ghana and Vietnam: Study protocol.

BACKGROUND: Socio-economic growth in many low and middle-income countries has resulted in more available, though not equitably accessible, healthcare. Such growth has also increased demands from citizens for their health systems to be more responsive to their needs. This paper shares a protocol for the RESPONSE study which aims to understand, co-produce, implement and evaluate context-sensitive interventions to improve health systems responsiveness to health needs of vulnerable groups in Ghana and Vietnam. METHODS: We will use a realist mixed-methods theory-driven case study design, combining quantitative (household survey, secondary analysis of facility data) and qualitative (in-depth interviews, focus groups, observations and document and literature review) methods. Data will be analysed retroductively. The study will comprise three Phases. In Phase 1, we will understand actors' expectations of responsive health systems, identify key priorities for interventions, and using evidence from a realist synthesis we will develop an initial theory and generate a baseline data. In Phase 2, we will co-produce jointly with key actors, the context-sensitive interventions to improve health systems responsiveness. The interventions will seek to improve internal (i.e. intra-system) and external (i.e. people-systems) interactions through participatory workshops. In Phase 3, we will implement and evaluate the interventions by testing and refining our initial theory through comparing the intended design to the interventions' actual performance. DISCUSSION: The study's key outcomes will be: (1) improved health systems responsiveness, contributing to improved health services and ultimately health outcomes in Ghana and Vietnam and (2) an empirically-grounded and theoretically-informed model of complex contexts-mechanisms-outcomes relations, together with transferable best practices for scalability and generalisability. Decision-makers across different levels will be engaged throughout. Capacity strengthening will be underpinned by in-depth understanding of capacity needs and assets of each partner team, and will aim to strengthen individual, organisational and system level capacities.

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.

Is obesity associated with decreased health-related quality of life in school-age children?-Results from a survey in Vietnam.

BACKGROUND: Overweight and obesity have short-term and long-term effects on children's physical and mental health. These conditions currently have a tendency to increase among Vietnamese school children. AIMS: This study aimed to assess the quality of life among 8-10 year-old children in Vietnam. METHODS: This cross-sectional study was conducted with a sample of 264 children aged 8-10 years (including 88 obese children and 176 normal-weight ones) at two primary schools in Hanoi, Vietnam, in 2018 and their mothers or fathers participated in this study. The Vietnamese version of the Pediatric Quality of Life Inventory (PedsQL) 4.0 generic score scales were used to collect information from children and their parents about the children's quality-of-life. Mean and standard deviation of PedsQL scores were calculated. Independent t-test was used to compare mean scores between normal-weight and obese children. RESULTS: Both child self reports and parent-proxy reports revealed that obese children had significantly lower scores for the total scales compared to normal weight children (80.7 versus 84.0; p < 0.05 for proxy reports and 77.6 vs 84.6; p < 0.001 for self reports). Total scale and subscale scores reported by parents were lower compared to those reported by children. Besides, 79% of normal weight children reported having PedsQL total scores in the highest quartile (≥75%), compared to 56.8 % of obese children (p = 0.01). Similarly, these proportions for parent-proxy reports were 79.5% and 65.9%, respectively (p < 0.05). Emotional scores were both found the lowest among the four subscales (71.6 for child self reports and 73.1 for parent-proxy reports). RECOMMENDATIONS: Interventions aimed to improve quality of life of overweight and obese children in Vietnam should not focus only on diet adjustment and physical exercise but need to address all dimensions of health-related quality of life, especially emotional, social and school functioning.