Social and behavioral determinants of attitudes towards and practices of hepatitis B vaccine birth dose in Vietnam.

BACKGROUND: Hepatitis B virus (HBV) infection is a significant public health issue in Vietnam. Our goal was to understand the determinants of attitudes towards and practices of hepatitis B vaccine birth dose (HepB-BD) in certain regions of Vietnam. METHOD: A rapid qualitative assessment was conducted in three geographically diverse provinces that reported low coverage (<50%) of HepB-BD. Using purposive sampling of participants, 29 focus group discussions and 20 in-depth interviews were held with caregivers (n = 96), healthcare providers (n = 75), and healthcare administrators (n = 16). Summary notes from these were translated, and inductive coding was used to derive themes. The SAGE Vaccine Hesitancy Determinants Matrix was used as a theoretical framework to organize barriers and facilitators associated with the themes into three levels of influence. RESULTS: At the individual and group level, caregivers who had higher levels of knowledge about HepB-BD sought the vaccine proactively, while others with lower knowledge faced barriers to the vaccine. Some caregivers reported a negative attitude toward health services because of a language barrier or had generalized concerns about HepB-BD due to media reporting of the past adverse events. Distress arising from potential adverse events was equally common among healthcare providers. At the contextual level, the physical environment made it difficult for caregivers to access healthcare facilities and for providers to conduct outreach. Home births posed a challenge for timely administration of HepB-BD, while health facility births facilitated it. Vaccination-specific barriers included misinterpretation of pre-vaccination screening criteria and asking for the consent of caregivers. Inadequate resources for service delivery negatively influenced HepB-BD attitudes and practices. CONCLUSION: Given the diversity of barriers associated with attitudes towards and practices of HepB-BD in the three provinces, tailored interventions will be necessary for both demand- and supply-side factors. Rural areas, often with more home births and geographic barriers, may require focused attention.

Prevalence and pregnancy outcomes of gestational diabetes mellitus by different international diagnostic criteria: a prospective cohort study in Vietnam.

Background: Several diagnostic criteria for gestational diabetes mellitus (GDM) have been developed and used internationally. This study estimated the prevalence of GDM and pregnancy outcomes among Vietnamese women.Methods: A prospective cohort study of 2030 women was undertaken in Vietnam between 2015 and 2016. Baseline interview and a single-step 75-g oral glucose tolerance test (OGTT) were conducted at 24-28 weeks of gestation. GDM was defined by five international diagnostic criteria: America Diabetes Association (ADA), European Association for the Study of Diabetes (EASD), International Association of the Diabetes and Pregnancy study groups (IADPSG), National Institute of Health and Clinical Excellence (NICE), and World Health Organization (WHO). Maternal and neonatal outcomes were assessed using medical records. Besides descriptive statistics and univariate analyses, logistic regressions were performed to ascertain the associations between GDM and maternal and neonatal outcomes.Results: The prevalence of GDM varied considerably by the diagnostic criteria: 6.4% (ADA), 7.9% (EASD), 22.8% (IADPSG/WHO), and 24.2% (NICE). Women with GDM according to EASD were more likely to have macrosomic infants (adjusted odds ratio (OR) 4.35, 95% confidence interval [CI]: 1.49-12.72), despite no apparent increase in risk under other criteria. Babies born to mothers with GDM appeared to be large-for-gestational age (LGA) by ADA criteria (adjusted OR 2.10, 95% CI: 1.10-4.02) or EASD criteria (adjusted OR 2.15, 95% CI: 1.16-3.98), when compared to their counterparts in the normal group. No significant differences in maternal and other neonatal outcomes were found between the normal and GDM groups.Conclusions: A global guideline is needed for the diagnosis, prevention and management of GDM.