Blinding trachoma in the northern provinces of Vietnam--a cross sectional survey.

INTRODUCTION: A prevalence study was conducted in 2001 as part of the SAFE Trachoma Control initiatives in twelve districts of eight northern provinces of Vietnam. The authors present the magnitude and some risk factors of trachomatous trichiasis (TT), trachomatous scarring (TS) and trachomatous corneal opacity (TCO). METHODS: Ophthalmologists examined 43,677 people of more than 34 years of age, randomly selected. Ophthalmic loupe, torchlight and the trachoma grading card recommended by WHO were used for this examination. RESULTS: The prevalence of TT was 7.31% (95% CI 7.07-7.55) and 382,950 persons with TT were included in the study population. The rate was higher in females (8.92%) than in males (5.35%). The rate was 13.7% in the district of Me Linh in Vinh Phuc province and in the districts of Ha Tay and Khoai Chau in Hung Yen province, while in the districts of Na Ri (Bac Kan province), Cam Xuyen (Ha Tinh province) and Van Yen (Yen Bai province), the prevalence of TT was less than 2%. The TT rate in the plains was 13%, while in mountainous, coastal and delta terrains, the rate fell to 2.4%, 3.5% and 9.4% respectively. The prevalence of TS and TCO was 8.42% (95% CI 8.21-8.61) and 1.1% (95% CI 1.00-1.20) respectively. CONCLUSION: Although the magnitude of TT is high, the problem of TCO seems to be less serious. The goal of eliminating blinding trachoma from the study area by 2010 represents a big challenge. Based on these survey estimates, the national program could plan resources for the 'S' strategy of trachoma control (surgery for those at immediate risk of blindness).

Using lot quality-assurance sampling and area sampling to identify priority areas for trachoma control: Viet Nam.

OBJECTIVE: To report on the use of lot quality-assurance sampling (LQAS) surveys undertaken within an area-sampling framework to identify priority areas for intervention with trachoma control activities in Viet Nam. METHODS: The LQAS survey method for the rapid assessment of the prevalence of active trachoma was adapted for use in Viet Nam with the aim of classifying individual communes by the prevalence of active trachoma among children in primary school. School-based sampling was used; school sites to be sampled were selected using an area-sampling approach. A total of 719 communes in 41 districts in 18 provinces were surveyed. FINDINGS: Survey staff found the LQAS survey method both simple and rapid to use after initial problems with area-sampling methods were identified and remedied. The method yielded a finer spatial resolution of prevalence than had been previously achieved in Viet Nam using semiquantitative rapid assessment surveys and multistage cluster-sampled surveys. CONCLUSION: When used with area-sampling techniques, the LQAS survey method has the potential to form the basis of survey instruments that can be used to efficiently target resources for interventions against active trachoma. With additional work, such methods could provide a generally applicable tool for effective programme planning and for the certification of the elimination of trachoma as a blinding disease.

National environmental health planning in Vietnam: flying some kites.

The link between environment and health has been well established, as has the need to develop strategies to manage the environment to protect health. The response of many governments to the emergence of environment as a leading concern of public health policy has been to fragment environment and health functions across many agencies, without effective coordination or communication systems, resulting in poor planning frameworks. There is a deepening awareness by many in government and international agencies of the need to develop 'national environmental health plans' (NEHAPS) to build and integrate environment and health policy and practice. To date, however, experience in the development of these and similar plans indicates that prescriptive 'top-down' approaches to plan development may yield limited success. This paper describes an ongoing project in Vietnam to develop a process for a national environmental health plan that provides a strong link between policies and practice, and utilizes a learning model for plan development. As environmental health is a new concept in Vietnam, significant attention has been given to the development of both national and local visions. The lessons learnt to date indicate that the use of a learning framework may provide a strong basis for the emergence of environmental health policy and its management. Facilitation of this process has required the use of a variety of change management tools and has placed an emphasis on using them in culturally sensitive ways. It is hoped that the emerging model, which gives environmental health its first expression at both national and provincial levels, will be of value to others undertaking similar policy and planning initiatives.