Strengthening research capacity through regional partners: the HRP Alliance at the World Health Organization.

BACKGROUND: Improvements in health cannot occur without cutting-edge research informing the design and implementation of health programmes and policies, highlighting the need for qualified and capable researchers and institutions in countries where disease burden is high and resources are limited. MAIN BODY: Research capacity strengthening efforts in low- and middle-income countries have included provision of training scholarships for postgraduate degrees, often in high-income countries, internships at research universities/centres, short courses, as well as involvement with research groups for hands-on experience, among others. The HRP Alliance provides opportunities for developing local research capacity in sexual and reproductive health and rights through institutions based in low- and middle-income countries linked with ongoing and past collaborative studies. It is a network of HRP research partner institutions, World Health Organization (WHO) country and regional offices, WHO special programmes and partnerships, and WHO collaborating centres. CONCLUSION: It is through the HRP Alliance that HRP seeks to improve population health by strengthening local research capacity in sexual and reproductive health across the globe, with focus in low- and middle-income countries, in alignment with WHO's quest of promoting healthier populations.

Management of an adult patient with missing one mandibular incisor, severe overjet, and midline discrepancy with asymmetric extraction, lingual appliance, and skeletal anchorage: A case report.

This case report describes the lingual orthodontic treatment of an adult patient with Angle Class I malocclusion, agenesis of mandibular right central incisor, severe overjet and deep overbite, excessive proclination of maxillary and mandibular incisors, and midline discrepancy. Because of unique presentation, symmetric extraction could not be performed in the lower arch of this 34-year-old patient. She was treated with three premolar extractions and absolute anchorage with temporary anchorage devices for maximum retraction of upper anterior teeth. To correct the midline deviation and Bolton tooth-size discrepancy, the mandibular right lateral incisor, canine, and premolars were reshaped to reduce the mesiodistal width. The treatment approach greatly improved the patient's facial and dental appearance and provided a stable occlusion.

Association between Intimate Partner Violence during Pregnancy and Adverse Pregnancy Outcomes in Vietnam: A Prospective Cohort Study.

BACKGROUND: Violence against pregnant women is an increasing public health concern particularly in low- and middle-income countries. The purpose of this study was to measure the association between intimate partner violence (IPV) during pregnancy and the risk of adverse birth outcomes. METHODS: Prospective cohort study of 1276 pregnant women in Dong Anh district, Vietnam. Women with gestational age less than 24 weeks were enrolled and interviewed. Repeated interviews were performed at 30-34 weeks gestation to assess experience of IPV during pregnancy and again 48 hours post-delivery to assess the birth outcome including birth weight and gestational age at delivery. RESULTS: There was a statistically significant association between exposure to physical violence during pregnancy and preterm birth (PTB) or low birth weight (LBW). After adjustment for age, education, occupation, body mass index (BMI), haemoglobin level, previous adverse pregnancy outcomes, the pregnant women who were exposed to physical violence during pregnancy were five times more likely to have PTB (AOR = 5.5; 95%CI: 2.1-14.1) and were nearly six times more likely to give birth to a child of LBW (AOR = 5.7; 95%CI: 2.2-14.9) as compared to those who were not exposed to physical violence. CONCLUSION: Exposure to IPV during pregnancy increases the risk of PTB and LBW. Case-finding for violence in relation to antenatal care may help protect pregnant women and improve pregnancy outcomes.

Early uptake of HIV counseling and testing among pregnant women at different levels of health facilities--experiences from a community-based study in Northern Vietnam.

BACKGROUND: HIV counselling and testing for pregnant women is a key factor for successful prevention of mother to child transmission of HIV. Women's access to testing can be improved by scaling up the distribution of this service at all levels of health facilities. However, this strategy will only be effective if pregnant women are tested early and provided enough counselling. OBJECTIVE: To assess early uptake of HIV testing and the provision of HIV counselling among pregnant women who attend antenatal care at primary and higher level health facilities. METHODS: A community based study was conducted among 1108 nursing mothers. Data was collected during interviews using a structured questionnaire focused on socio-economic background, reproductive history, experience with antenatal HIV counselling and testing as well as types of health facility providing the services. RESULTS: In all 91.0% of the women interviewed had attended antenatal care and 90.3% had been tested for HIV during their most recent pregnancy. Women who had their first antenatal checkup at primary health facilities were significantly more likely to be tested before 34 weeks of gestation (OR = 43.2, CI: 18.9-98.1). The reported HIV counselling provision was also higher at primary health facilities, where women in comparison with women attending higher level health facilities were nearly three or and four times more likely to receive pre-test (OR = 2.7; CI:2.1-3.5) and post-test counseling (OR = 4.0; CI: 2.3-6.8). CONCLUSIONS: The results suggest that antenatal HIV counseling and testing can be scaled up to primary heath facilities and that such scaling up may enhance early uptake of testing and provision of counseling.

Late-term abortion for fetal anomaly: Vietnamese women's experiences.

Screening for fetal anomalies in the second trimester of pregnancy is increasingly becoming a part of antenatal care. As a consequence, more pregnant women are learning that the child they are expecting has an anomaly. This article derives from anthropological research in a hospital in Hanoi, Viet Nam, from 2003-2006 that investigated 30 women's experiences after a fetal anomaly was detected. We followed the women from the ultrasound scan through the process of deciding whether to continue their pregnancy or have an abortion. This article focuses on the 17 women who had an abortion and the support they received from health care providers. Their loss of a wanted pregnancy led to feelings of guilt, pain and sadness and fear and uncertainty about being able to have a healthy baby in the future. Two years after the abortion, most of the women had come to terms with the loss, especially those who had had a healthy child since. We recommend that the Vietnamese health care system seeks to ensure that women receive counselling and support that answers their questions about what happened and why. To do this, health care staff need additional training in fetal medicine and counselling skills and sensitisation to the social and emotional challenges that detection of fetal anomalies and second trimester abortion bring to antenatal care.

Obstetric ultrasound scanning in urban Vietnam: Is it being over used?

The study was conducted at Hanoi Obstetrical and Gynecological Hospital, combining quantitative and qualitative research methods. Results: the study showed that there was a tendency for pregnant women to over-use ultrasound scanning. The reasons for this included women’s perceptions of the usefulness of ultrasound scanning, their serious worries for the fetus, as well as the effects of the market economy on this health service. Over-use of obstetrical ultrasound scanning was not only related to the perception, demands and psychology of pregnant women, but also to socio-economic changes associated with the economic reforms and the liberalization of the health care system.