Improving hospital death certification in Vietnam: results of a pilot study of injury-related fatalities.

BACKGROUND: Vietnam has prioritised the establishment of a civil registration system for deaths but as yet is unable to report accurate national statistics for the population of 93.5 million people due to inadequate mortality data. Verbal autopsy data suggest that injury is a third leading cause of death (by International Statistical Classification of Diseases and Related Health Problems 10th Revision chapters) in Vietnam, with road traffic injuries in particular a significant and increasing challenge. The study aims to present a more accurate profile of the number and probable causes of these deaths based on data collected hospitals using a version of the WHO death certificate modified for the Vietnamese context. METHODS: Death data collected from Viet Duc Surgical and Trauma Hospital in Vietnam between 1 March 2013 to 31 March 2015 was analysed to explore the number and probable causes of deaths for deaths resulting from an injury. RESULTS: A total of 1616 deaths were recorded for Viet Duc Hospital, of which 73% (1181/1616) were associated with an injury. Most (83%; n=871/1049) injury-related deaths for which immediate cause of death was documented were as a result of head/brain injuries. Injury-related deaths were most commonly caused by from traffic accidents (72%, 853/1181). The majority of patients suffering injury-related deaths were discharged home to die (93%, 1097/1181). CONCLUSION: The study confirms some findings from previous studies about deaths from injuries, while disagreeing with others, highlighting the challenge for Vietnam in collecting these data. Gathering detailed death data provides essential evidence on which to base decisions about allocation of government funding and policy for injury prevention and treatment.

Predictors of Weight Change in Male HIV-Positive Injection Drug Users Initiating Antiretroviral Therapy in Hanoi, Vietnam.

We examined clinical and nutritional predictors of weight change over two consecutive 6-month intervals among 99 HIV-positive male injection drug users initiating antiretroviral therapy (ART) in Hanoi, Vietnam. The average weight gain was 3.1 ± 4.8 kg in the first six months after ART and 0.8 ± 3.0 kg in the following six months. Predictors of weight change differed by interval. In the first interval, CD4 < 200 cells/µL, excellent/very good adherence to ART, bothersome nausea, and liquid supplement use were all associated with positive weight changes. Moderate to heavy alcohol use and tobacco smoking were associated with negative weight changes. In the second interval, having a CD4 count <200 cells/µL at the beginning of the interval and tobacco smoking were the only significant predictors and both were associated with negative weight changes. We identified several potential areas for interventions to promote weight gain immediately after starting ART in this population. Studies are needed to determine whether improving weight prior to, or at, ART initiation will result in improved outcomes on ART.