Publications by authors named "Luu Ngoc Hoat"

29 Publications

  • Page 1 of 1

Multilevel Analysis of 24-Hour Blood Pressure, Heart Rate, and Associated Factors among Police Officers in Hanoi, Vietnam.

Biomed Res Int 2020 16;2020:7494906. Epub 2020 May 16.

Hanoi University of Public Health, 1A Duc Thang, Dong Ngac, Bac Tu Liem District, Hanoi, Vietnam.

Background: Due to long-hour outdoor working environment, policemen have been subjected to tremendous health risks including blood pressure (BP) and heart rate (HR). In tropical countries, the temperature is extremely harsh which may get peak at above 40 Celsius degrees or drops under 8 Celsius degrees. However, the existing data on the effects of weather variation on BP and HR among police task force has been scarce in Vietnam.

Aims: This study aimed to describe the variation of 24-hour BP and HR and identify factors associated with BP and HR for further appropriate interventions in order to reduce health risks from occupational exposure.

Methods: Multilevel regression analysis (MLRA) was applied with two levels of influent factors. 24-hour holter measured systolic blood pressure (SBP), diastolic blood pressure (DBP), and HR values were the first level which should then be nested in the second level (individual). 24-hour temperature and humidity variations were extracted, respectively, from Hanoi Hydrometeorology Department. All individual characteristics and risk behaviours were measured within 24 studying hours.

Results: Temperature and humidity were major factors that influenced (74%-78%) the variation of BP and HR among the policemen population. When each of the Celsius degree temperature or percentage humidity increases, the SBP goes down by 0.44 (0.11-0.77) and by 0.2 (0.33-0.77), respectively, and the DBP goes down by 0.21 (-0.05-0.48) and by 0.12 (0.02-0.22), respectively, and vice versa. Interaction between temperature and humidity was significantly influent to SBP. The farther the time section from the first time section (0-6AM) the more the variation of the BP and HR. Transition from winter to summer made SBP and DBP decrease and vice versa. Individual characteristics including body mass index (BMI), bad life styles, and stress contributed 22% to 26% to the variation of BP and HR. Traffic policemen were at the greatest risks of the outdoor ambient variation in comparison with the firefighters and office-based policemen.

Conclusion: Designing and equipping appropriate uniform and outdoor facilities could help to reduce influence of temperature and humidity variation in the outdoor workplace. Besides, training and educating programs that aimed at controlling BMI, risk behaviours, and stress for police taskforce, especially the traffic policemen, should be implemented.
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http://dx.doi.org/10.1155/2020/7494906DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7255014PMC
March 2021

Factors associated with the duration of hospitalisation among COVID-19 patients in Vietnam: A survival analysis.

Epidemiol Infect 2020 06 10;148:e114. Epub 2020 Jun 10.

Institute of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.

Background: The median duration of hospital stays due to COVID-19 has been reported in several studies on China as 10-13 days. Global studies have indicated that the length of hospitalisation depends on different factors, such as the time elapsed from exposure to symptom onset, and from symptom onset to hospital admission, as well as specificities of the country under study. The goal of this paper is to identify factors associated with the median duration of hospital stays of COVID-19 patients during the second COVID-19 wave that hit Vietnam from 5 March to 8 April 2020.

Method: We used retrospective data on 133 hospitalised patients with COVID-19 recorded over at least two weeks during the study period. The Cox proportional-hazards regression model was applied to determine the potential risk factors associated with length of hospital stay.

Results: There were 65 (48.9%) females, 98 (73.7%) patients 48 years old or younger, 15 (11.3%) persons with comorbidities, 21 (16.0%) severely ill patients and 5 (3.8%) individuals with life-threatening conditions. Eighty-two (61.7%) patients were discharged after testing negative for the SARS-CoV-2 virus, 51 were still in the hospital at the end of the study period and none died. The median duration of stay in a hospital was 21 (IQR: 16-34) days. The multivariable Cox regression model showed that age, residence and sources of contamination were significantly associated with longer duration of hospitalisation.

Conclusion: A close look at how long COVID-19 patients stayed in the hospital could provide an overview of their treatment process in Vietnam, and support the country's National Steering Committee on COVID-19 Prevention and Control in the efficient allocation of resources over the next stages of the COVID-19 prevention period.
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http://dx.doi.org/10.1017/S0950268820001259DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7306545PMC
June 2020

Maternal, neonatal, and child health systems under rapid urbanization: a qualitative study in a suburban district in Vietnam.

BMC Health Serv Res 2020 Feb 5;20(1):90. Epub 2020 Feb 5.

JW LEE Center for Global Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.

Background: Vietnam has been successful in increasing access to maternal, neonatal, and child health (MNCH) services during last decades; however, little is known about whether the primary MNCH service utilization has been properly utilized under the recent rapid urbanization. We aimed to examine current MNCH service utilization patterns at a district level.

Methods: The study was conducted qualitatively in a rural district named Quốc Oai. Women who gave a birth within a year and medical staff at various levels participated through 43 individual in-depth interviews and 3 focus group interviews.

Results: Primary MNCH services were underutilized due to a failure to meet increased quality needs. Most of the mothers preferred private clinics for antenatal care and the district hospital for delivery due to the better service quality of these facilities compared to that of the commune health stations (CHSs). Mothers had few sociocultural barriers to acquiring service information or utilizing services based on their improved standard of living. A financial burden for some services, including caesarian section, still existed for uninsured mothers, while their insured counterparts had relatively few difficulties.

Conclusions: For the improved macro-efficiency of MNCH systems, the government needs to rearrange human resources and/or merge some CHSs to achieve economies of scale and align with service volume distribution across the different levels.
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http://dx.doi.org/10.1186/s12913-019-4874-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7003413PMC
February 2020

Knowledge, Attitude, and Practice Regarding Breast Cancer Early Detection Among Women in a Mountainous Area in Northern Vietnam.

Cancer Control 2019 Jan-Dec;26(1):1073274819863777

1 Institute of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.

Breast cancer is the most common cancer in women all over the world, also in Vietnam. In recent years, the incidence of breast cancer has been increasing in Vietnam, and most cases are diagnosed at late stages, making treatment more difficult. More and better early detection could help more women to survive. The aim of this study was to identify the current knowledge, attitude and practice about early detection of breast cancer as well as potential predictors of breast cancer screening among women aged 20 to 49 year in a mountainous commune in Thanh Hoa Province, Vietnam, in a largely ethnic Muong population. Women aged 20 to 49 years were selected by systematic random sampling to participate in a cross sectional study in October 2017. They were interviewed with a closed questionnaire about their knowledge of breast cancer, its risk factors, and warning signs. A checklist for performance of breast self-examination was also applied. Three hundred six women agreed to participate in the study. More than half had a low level of knowledge, and were weak in attitude and practice about breast self-examination, clinical breast examination, breast ultrasound, and mamography. Among women who had practiced at least 1 screening method, 17.0% mentioned clinical breast examination, and only 13.8% reported practicing breast self-examination. Factors associated with practice included knowledge about breast cancer early detection (BCED), ethnicity, income, the BCED information approach, and the BCED screening programs approach. The finding of a very low proportion of women in the mountainous setting with good awareness and practice on early detection of breast cancer is important evidence to inform the BCED intervention program developers about where and how to target which information, especially to reach more ethnic minority women.
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http://dx.doi.org/10.1177/1073274819863777DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6651667PMC
January 2020

Study Design for the 2016 Baseline Survey of a Health System Strengthening Project in Quoc Oai District, Hanoi, Vietnam.

J Korean Med Sci 2019 Feb 28;34(5):e42. Epub 2019 Jan 28.

Department of Biostatistics and Health Informatics, Hanoi Medical University, Hanoi, Vietnam.

Background: In order to provide essential scientific evidence on the population's health status and social health determinants as well as the current capacity of the health care system in Vietnam to health policy makers and managers, Vietnam Ministry of Health, Hanoi University of Public Health, Hanoi Medical University, and Ho Chi Minh University of Medicine and Pharmacy collaborated with Seoul National University (Korea) and conducted a health system survey in the Quoc Oai district (of Hanoi capital) that represented northern rural Vietnam.

Methods: The study design was a cross-sectional study. The survey covered different topics (more than 200 questions) and was administered in three separate questionnaires: 1) Basic information of all household members; 2) Household characteristics; and 3) Individual characteristics. Socio-demographic characteristics among the households and individuals were collected from 2,400 households sampled by multi-stage cluster sampling method: more than 200 questions.

Results: The household size of Quoc Oai was larger than the national average and there was no significant difference in gender composition. In addition, the proportions of pre-elderly, age 55-64, and elderly group (65 years old and over) were higher than the national population statistics. In this context, demographic transition has begun in Quoc Oai.

Conclusion: This study design description provides the basic information about a baseline survey of a future prospective cohort (as a part of a collaborative project on strengthening the health system in Vietnam) to the prospective data user of this survey.
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http://dx.doi.org/10.3346/jkms.2019.34.e42DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6356029PMC
February 2019

The roles of, activities of, and competencies for, community nursing services in rural Vietnam: Implications for policy decisions.

Int J Health Plann Manage 2018 Oct 9;33(4):e1147-e1159. Epub 2018 Aug 9.

Department of Biostatistics and Medical Informatics, Institute for Preventive Medicine and Public Health, Former Deputy President of Hanoi Medical University, Hanoi, Vietnam.

Community health workforce plays a vital role in providing primary health care services as per the needs of residents; however, few studies have examined how nurses work within commune health centers (CHCs). Using qualitative methods including interviews and focus group discussions with key stakeholders, this study explores the roles, activities, and competencies required of community nursing services in rural districts within Vietnam. Two primary roles were identified: CHC nursing and family nursing. For the latter, in addition to providing people with general health care and health communication, they were expected to also deliver psychological care. CHC nursing fulfilled more roles and required four specific competencies: clinical care, communication, management, and planning/coordination activities. Despite these various roles serving people within a community, few ongoing efforts at either the local or national level are aimed at supporting these nurses. The study highlights the need for policy decisions via either developing a new job position policy or adapting the existing policy by integrating new roles into the existing positions of CHC nurses in Vietnam.
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http://dx.doi.org/10.1002/hpm.2600DOI Listing
October 2018

WHO's Service Availability and Readiness Assessment of primary health care services of commune health centers in a rural district of Northern Vietnam.

Int J Health Plann Manage 2018 Jan 14;33(1):202-211. Epub 2017 Jun 14.

Deputy Head of the Institute for Training Health Management, Hanoi University of Public Health, Hanoi, Vietnam.

The objective of this study was to assess the availability and readiness of the primary health care (PHC) services of commune health centers (CHCs) in Quoc Oai, a rural district of Northern Vietnam based on the World Health Organization's Service Availability and Readiness Assessment (SARA) tool. The study was done in 2 steps. First, the heads of the 21 CHCs of Quoc Oai district were interviewed using SARA, a quantitative survey, and the responses were then validated by direct observations of each facility. The results showed that although the average number of health staffs in each CHC met the national standards (at least 5 staffs per CHC), its allocation within each CHC was not properly met because some CHCs had only 2 health staffs. Several health equipment and facilities were not fully available in many CHCs, and although the majority of the PHC services were available at the CHCs, their readiness remained limited. Several significant correlates between the availability of health care workers and the availability of the facilities and the PHC services were observed, suggesting that they depend upon and affect one another in the health system. Using the SARA-based inventory, the study helps health managers and policy makers to prioritize efforts and allocate resources more appropriately. To be effective, attention should be given to how to make facilities, services, and human resources for health ready for PHC activities-more investment and support from the system (from higher to lower level) and the government.
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http://dx.doi.org/10.1002/hpm.2429DOI Listing
January 2018

Breast cancer services in Vietnam: a scoping review.

Glob Health Action 2018 ;11(1):1435344

a Centre for Public Health , Queen's University , Belfast , UK.

Background: Breast cancer incidence has been increasing consistently in Vietnam. Thus far, there have been no analytical reviews of research produced within this area.

Objectives: We sought to analyse the nature andextent of empirical studies about breast cancer in Vietnam, identifying areas for future research and systemsstrengthening.

Methods: We undertook a scoping study using a five-stage framework to review published and grey literature in English and Vietnamese on breast cancer detection, diagnosis and treatment. We focused specifically on research discussing the health system and service provision.

Results: Our results show that breast cancer screening is limited, with no permanent or integrated national screening activities. There is a lack of information on screening processes and on the integration of screening services with other areas of the health system. Treatment is largely centralised, and across all services there is a lack of evaluation and data collection that would be informative for recommendations seeking to improve accessibility and quality of breast cancer services.

Conclusions: This paper is the first scoping review of breast cancer services in Vietnam. It outlines areas for future focus for policy makers and researchers with the objective of strengthening service provision to women with breast cancer across the country while also providing a methodological example for how to conduct a collaborative scoping review.
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http://dx.doi.org/10.1080/16549716.2018.1435344DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5827719PMC
October 2018

Health Service Utilization Among People With Noncommunicable Diseases in Rural Vietnam.

J Public Health Manag Pract 2018 Mar/Apr;24 Suppl 2:S60-S66

Center for Population Health Sciences (Dr Van Minh and Ms Bao Ngoc) and Health Management Training Institute (Mr Minh Hoang), Hanoi University of Public Health, Hanoi, Vietnam; LEE Jong-wook Center for Global Medicine of Seoul National University College of Medicine, Seoul, Korea (Drs Oh and Lee); Departments of Health Education (Dr Giang), Health Management and Organization (Dr Van Huy), and Biostatistics and Health Informatics (Drs Son and Hoat), Hanoi Medical University, Hanoi, Vietnam; and Department of International Cooperation, Ministry of Health, Hanoi, Vietnam (Dr Giang Huong).

Context: Chronic noncommunicable diseases (NCDs) have been shown to be major causes of morbidity and mortality in hospitals for the whole country.

Objective: This study aims to describe the situation of health service utilization among people with NCDs in a rural area and identify association between the situation of health service utilization among people with chronic diseases and their socioeconomic status.

Design: This was a cross-sectional study.

Setting: A rural district located in the North of Vietnam.

Participants: People 15 years of age and older. Health service utilization was analyzed only among people who reported having NCD.

Main Outcome Measures: Data were collected through a personal household interview conducted by 12 trained field workers. The dependent variable is health care service utilization among people with chronic NCDs. The explanatory variables include both household attributes such as household economic conditions, and so forth, and individual characteristics.

Results: Eighteen percent of the adults and 51% of the elderly respondents reported having at least 1 of the NCDs. The proportions of people with NCDs who used at least 1 outpatient service and used at least 1 inpatient health service during the last 12 months were 68.1% and 10.7%, respectively (the nonutilization rates of 31.9% and 89.3%, respectively). The statistically significant correlates of health care service utilization among people with NCDs were ethnicity (ethnic minority was significantly associated with a lower odds of health care service utilization) and health insurance (no health insurance was significantly associated with lower odds of health care service utilization).

Conclusion: Given the evidence from this study, actions to improve access to health care services among people with NCDs are clearly needed. The capacity of primary health care system for the prevention and control of NCDs should be ranked a top priority.
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http://dx.doi.org/10.1097/PHH.0000000000000696DOI Listing
November 2019

Methodology for the Global Youth Tobacco Use Survey (GYST), Vietnam, 2014.

Asian Pac J Cancer Prev 2016 ;17(S1):11-5

Hanoi Medical University, Viet Nam E-mail :

Viet Nam is a country with the highest rate of adult male smokers in the world. In 2010, the percentage of adult male smokers was 47.4%. Each year in Viet Nam, there are 40,000 lives lost from tobacco-related diseases. The Global Tobacco Youth Survey is an international standardized survey that has been conducted in more than 140 countries. To provide evidence for tobacco control, Viet Nam already conducted two rounds of GYTS in 2003 and 2007. The GYTS in 2014 is the survey's third iteration. This paper aims to document key methodological details and socio-demographic characteristics of the respondents included in the 2014 GYTS in Viet Nam. This survey followed international protocol and was conducted in 13 provinces representative of 6 geographical regions. A total of 3,430 school children, aged 13 to 15 years used a standardized answer sheet to answer 76 questions about seven tobacco-related topics, including prevalence of tobacco use, environmental tobacco smoke, access and availability, media and advertisement, cessation, knowledge and attitudes, tobaccorelated school curriculum. This GYTS provides valid and reliable data for monitoring tobacco use among youth in Vietnam and is recommended to be regularly repeated.
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http://dx.doi.org/10.7314/apjcp.2016.17.s1.11DOI Listing
August 2017

Millennium Development Goals in Vietnam: Taking Multi-sectoral Action to Improve Health and Address the Social Determinants.

Glob Health Action 2016 29;9:31271. Epub 2016 Feb 29.

Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Faculty of Medicine, Umeå University, Umeå, Sweden.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4780116PMC
http://dx.doi.org/10.3402/gha.v9.31271DOI Listing
August 2016

Early sexual initiation and multiple sexual partners among Vietnamese women: analysis from the Multiple Indicator Cluster Survey, 2011.

Glob Health Action 2016 29;9:29575. Epub 2016 Feb 29.

Institute of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.

Introduction: Under current HIV transmission mechanisms operating in Vietnam, women are seen as victims of their male partners. Having multiple sexual partners is one of the well-known risk factors for HIV infection. However, little is known about women's risky sexual behaviour and their vulnerability to HIV in Vietnam. This study aims to explore association between early sexual initiation and the number of lifetime sexual partners in Vietnamese women. Although the Vietnamese culture is socially conservative in this area, identifying women's risky sexual behaviour is important for the protection of women at risk of HIV and other sexually transmitted diseases.

Design: A total of 8,791 women, who reported having had sexual intercourse, were included in this analysis of data from the 2011 Multiple Indicator Cluster Survey in Vietnam. Data were collected using two-stage strata sampling, first at the national level and second across six geographical regions (n=8,791). Multivariable logistic regressions describe association between early initiation of a sexual activity and lifetime multiple sexual partners.

Results: Early sexual intercourse was significantly associated with having lifetime multiple sexual partners. Women who were aged 19 or younger at first sexual intercourse were over five times more likely to have multiple sexual partners, compared with women whose first sexual intercourse was after marriage; aged 10-14 years (OR=5.9; 95% CI=1.9-18.8) at first intercourse; and aged 15-19 years (OR=5.4; 95% CI=4.0-7.2) at first intercourse. There was significant association with having multiple sexual partners for women of lower household wealth and urban residence, but the association with educational attainment was not strong.

Conclusions: The study results call for health and education policies to encourage the postponement of early sexual activity in young Vietnamese women as protection against risky sexual behaviour later in life.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4780093PMC
http://dx.doi.org/10.3402/gha.v9.29575DOI Listing
August 2016

Changes and inequalities in early birth registration and childhood care and education in Vietnam: findings from the Multiple Indicator Cluster Surveys, 2006 and 2011.

Glob Health Action 2016 29;9:29470. Epub 2016 Feb 29.

Center for Population Health Sciences, Hanoi School of Public Health, Hanoi, Vietnam.

Introduction: Early birth registration, childhood care, and education are essential rights for children and are important for their development and education. This study investigates changes and socioeconomic inequalities in early birth registration and indicators of care and education in children aged under 5 years in Vietnam.

Design: The analyses reported here used data from the Vietnam Multiple Indicator Cluster Surveys (MICS) in 2006 and 2011. The sample sizes in 2006 and 2011 were 2,680 and 3,678 for children under 5 years of age. Four indicators of childcare and preschool education were measured: birth registration, possession of books, preschool education attendance, and parental support for early childhood education. The concentration index (CI) was used to measure inequalities in gender, maternal education, geographical area, place of residence, ethnicity, and household wealth.

Results: There were some improvements in birth registration (86.4% in 2006; 93.8% in 2011), preschool education attendance (57.1% in 2006; 71.9% in 2011), and parental support for early childhood education (68.9 and 76.8%, respectively). However, the possession of books was lower (24.7% in 2006; 19.6% in 2011) and became more unequal over time (i.e. CI=0.370 in 2006; CI=0.443 in 2011 in wealth inequality). Inequalities in the care and education of children were still persistent. The largest inequalities were for household wealth and rural versus urban areas.

Conclusion: Although there have been some improvements in this area, inequalities still exist. Policy efforts in Vietnam should be directed towards closing the gap between different socioeconomic groups for the care and education of children under 5 years old.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4780094PMC
http://dx.doi.org/10.3402/gha.v9.29470DOI Listing
August 2016

Multiple vulnerabilities and maternal healthcare in Vietnam: findings from the Multiple Indicator Cluster Surveys, 2000, 2006, and 2011.

Glob Health Action 2016 29;9:29386. Epub 2016 Feb 29.

Department of Biostatistics and Health Informatics, Hanoi Medical University, Hanoi, Vietnam.

Background: Knowledge of the aggregate effects of multiple socioeconomic vulnerabilities is important for shedding light on the determinants of growing health inequalities and inequities in maternal healthcare.

Objective: This paper describes patterns of inequity in maternal healthcare utilization and analyzes associations between inequity and multiple socioeconomic vulnerabilities among women in Vietnam.

Design: This is a repeated cross-sectional study using data from the Vietnam Multiple Indicator Cluster Surveys 2000, 2006, and 2011. Two maternal healthcare indicators were selected: (1) skilled antenatal care and (2) skilled delivery care. Four types of socioeconomic vulnerabilities - low education, ethnic minority, poverty, and rural location - were assessed both as separate explanatory variables and as composite indicators (combinations of three and four vulnerabilities). Pairwise comparisons and adjusted odds ratios were used to assess socioeconomic inequities in maternal healthcare.

Results: In all three surveys, there were increases across the survey years in both the proportions of women who received antenatal care by skilled staff (68.6% in 2000, 90.8% in 2006, and 93.7% in 2011) and the proportions of women who gave birth with assistance from skilled staff (69.9% in 2000, 87.7% in 2006, and 92.9% in 2011). The receipt of antenatal care by skilled staff and birth assistance from skilled health personnel were less common among vulnerable women, especially those with multiple vulnerabilities.

Conclusions: Even though Vietnam has improved its coverage of maternal healthcare on average, policies should target maternal healthcare utilization among women with multiple socioeconomic vulnerabilities. Both multisectoral social policies and health policies are needed to tackle multiple vulnerabilities more effectively by identifying those who are poor, less educated, live in rural areas, and belong to ethnic minority groups.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4780122PMC
http://dx.doi.org/10.3402/gha.v9.29386DOI Listing
August 2016

Secular trends in HIV knowledge and attitudes among Vietnamese women based on the Multiple Indicator Cluster Surveys, 2000, 2006, and 2011: what do we know and what should we do to protect them?

Glob Health Action 2016 29;9:29247. Epub 2016 Feb 29.

Department of Biomedical Statistics and Informatics, Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.

Background: In Vietnam, women are at risk of HIV infection due to many factors. However, there is limited evidence about what women know and how they behave to protect themselves from HIV.

Objective: The objective of this study was to investigate the trends in comprehensive HIV/AIDS knowledge, attitude, and associated factors among Vietnamese women from 2000 to 2011.

Design: Data from three waves of the Vietnam Multiple Indicator Cluster Surveys (years 2000, 2006, and 2011) were used. Logistic regression methods examined factors associated with each of two dependent variables, HIV/AIDS knowledge and attitude toward HIV/AIDS.

Results: Although there was an increasing trend in basic HIV/AIDS knowledge and positive attitude toward the disease, in Vietnamese women in the general population over the survey years, the prevalence of women with basic HIV/AIDS knowledge and positive attitude toward HIV/AIDS was low. Multivariable models indicated that women who had higher levels of education, lived in urban areas, had higher economic status, and knew about places of HIV-related services were more likely to have good HIV/AIDS knowledge (e.g. in 2011, AOR's=3.01; 1.27; 1.88; 2.03, respectively). Women with higher educational attainment, knew about HIV services, and had better HIV knowledge were more likely to report positive attitude toward HIV/AIDS (e.g. in 2011, AOR's=2.50; 1.72; 2.23, respectively).

Conclusions: This study recommends that public health programs for the control of HIV, such as behavioral change communication campaigns or social policies for women, should focus not only in improving the quality of existing HIV/AIDS counseling and testing services but also on expanding coverage to increase accessibility to these services for women in rural areas. In addition, efforts to raise the level of knowledge about HIV/AIDS and improve attitude toward the disease should be undertaken simultaneously. The results of this study can help inform HIV control policies and practices in other developing countries.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4780092PMC
http://dx.doi.org/10.3402/gha.v9.29247DOI Listing
August 2016

Analysis of selected social determinants of health and their relationships with maternal health service coverage and child mortality in Vietnam.

Glob Health Action 2016 4;9:28836. Epub 2016 Feb 4.

Social Determinants of Health (SDH), Public Health, Environmental and Social Determinants of Health Department (PHE), World Health Organization, Geneva, Switzerland.

Introduction: Achieving a fair and equitable distribution of health in the population while progressing toward universal health coverage (UHC) is a key focus of health policy in Vietnam. This paper describes health barriers experienced by women (and children by inference) in Vietnam, and measures how UHC, with reference to maternal health services and child mortality rates, is affected by selected social determinants of health (SDH), termed 'barriers'.

Methods: Our study uses a cross-sectional design with data from the 2011 Vietnam Multiple Indicator Cluster Survey. The study sample includes 11,663 women, aged 15-49 years. Weighted frequency statistics are cross-tabulated with socioeconomic characteristics of the population to describe the extent and distribution of health barriers experienced by disadvantaged women and children in Vietnam. A subset of women who had a live birth in the preceding two years (n=1,383) was studied to assess the impact of barriers to UHC and health. Six multiple logistic regressions were run using three dependent variables in the previous two years: 1) antenatal care, 2) skilled birth attendants, and 3) child death in the previous 15 years. Independent predictor variables were: 1) low education (incomplete secondary education), 2) lack of access to one of four basic amenities. In a second set of regressions, a constructed composite barrier index replaced these variables. Odds ratios (ORs) and 95% confidence intervals (95% CI) were used to report regression results.

Results: In Vietnam, about 54% of women aged 15-49 years in 2011, had low education or lacked access to one of four basic amenities. About 38% of poor rural women from ethnic minorities experienced both barriers, compared with less than 1% of rich urban women from the ethnic majority. Incomplete secondary education or lack of one of four basic amenities was a factor significantly associated with lower access to skilled birth attendants (OR=0.28, 95% CI: 0.14-0.55; OR=0.19, 95% CI: 0.05-0.80) and a higher risk of having had a child death in the previous two years (OR=1.71, 95% CI: 1.28-2.30; OR=1.59, 95% CI: 1.20-2.10).

Conclusions: Our study shows the need for accelerating education and infrastructure investments for ethnic minority communities living in rural areas so as to be able to contribute to equity-oriented progress toward UHC.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4744327PMC
http://dx.doi.org/10.3402/gha.v9.28836DOI Listing
August 2016

Patterns of Health Expenditures and Financial Protections in Vietnam 1992-2012.

J Korean Med Sci 2015 Nov 6;30 Suppl 2:S134-8. Epub 2015 Nov 6.

World Health Organization Office in Vietnam, Vietnam.

Health financing has been considered as an important building block of a health system and has a key role in promoting universal health coverage in the Vietnam. This paper aims to describe the pattern of health expenditure, including total health expenditure and composition of health expenditure, over the last two decades in Vietnam. The paper mainly uses the data from Vietnam National Health Account and Vietnam Living Standards Survey. We also included data from other relevant published literature, reports and statistics about health care expenditure in Vietnam. The per capita health expenditure in Vietnam increased from US$ 14 in 1995 to US$ 86 in 2012. The total health expenditure as a share of GDP also rose from 5.2% in 1995 to 6.9% in 2012. Public health expenditure as percentage of government expenditure rose from 7.4% in 1995 to nearly 10% in 2012. The coverage of health insurance went up from 10% in 1995 to 68.5% in 2012. However, health financing in Vietnam was depending on private expenditures (57.4% in 2012). As a result, the proportion of households with catastrophic expenditure in 2012 was 4.2%. The rate of impoverishment in 2012 was 2.5%. To ensure equity and efficient goal of health system, policy actions for containing the health care out-of-pocket payments and their poverty impacts are urgently needed in Vietnam.
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http://dx.doi.org/10.3346/jkms.2015.30.S2.S134DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4659865PMC
November 2015

Adverse Childhood Experiences and the Health of University Students in Eight Provinces of Vietnam.

Asia Pac J Public Health 2015 Nov 5;27(8 Suppl):26S-32S. Epub 2015 Jun 5.

Hanoi Medical University, Hanoi, Vietnam.

Recent systematic reviews have emphasized the need for more research into the health and social impacts of adverse childhood experiences (ACEs) in the Asia-Pacific region. This cross-sectional study was conducted with 2099 young adult students in 8 medical universities throughout Vietnam. An anonymous, self-report questionnaire included the World Health Organization ACE-International Questionnaire and standardized measures of mental and physical health. Three quarters (76%) of the students reported at least one exposure to ACEs; 21% had 4 or more ACEs. The most commonly reported adversities were emotional abuse, physical abuse, and witnessing a household member being treated violently (42.3%, 39.9%, and 34.6%, respectively). Co-occurrence of ACEs had dose-response relationships with poor mental health, suicidal ideation, and low physical health-related quality of life. This first multisite study of ACEs among Vietnamese university students provided evidence that childhood adversity is common and is significantly linked with impaired health and well-being into the early adult years.
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http://dx.doi.org/10.1177/1010539515589812DOI Listing
November 2015

Climatic-driven seasonality of emerging dengue fever in Hanoi, Vietnam.

BMC Public Health 2014 Oct 16;14:1078. Epub 2014 Oct 16.

Biostatistics and Medical Informatics Department, Institute of Training for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.

Background: Dengue fever (DF) has been emerging in Hanoi over the last decade. Both DF epidemiology and climate in Hanoi are strongly seasonal. This study aims at characterizing the seasonality of DF in Hanoi and its links to climatic variables as DF incidence increases from year to year.

Methods: Clinical suspected cases of DF from the 14 central districts of Hanoi were obtained from the Ministry of Health over a 8-year period (2002-2009). Wavelet decompositions were used to characterize the main periodic cycles of DF and climatic variables as well as the mean phase angles of these cycles. Cross-wavelet spectra between DF and each climatic variables were also computed. DF reproductive ratio was calculated from Soper's formula and smoothed to highlight both its long-term trend and seasonality.

Results: Temperature, rainfall, and vapor pressure show strong seasonality. DF and relative humidity show both strong seasonality and a sub-annual periodicity. DF reproductive ratio is increasing through time and displays two clear peaks per year, reflecting the sub-annual periodicity of DF incidence. Temperature, rainfall and vapor pressure lead DF incidence by a lag of 8-10 weeks, constant through time. Relative humidity leads DF by a constant lag of 18 weeks for the annual cycle and a lag decreasing from 14 to 5 weeks for the sub-annual cycle.

Conclusion: Results are interpreted in terms of mosquito population dynamics and immunological interactions between the different dengue serotypes in the human compartment. Given its important population size, its strong seasonality and its dengue emergence, Hanoi offers an ideal natural experiment to test hypotheses on dengue serotypes interactions, knowledge of prime importance for vaccine development.
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http://dx.doi.org/10.1186/1471-2458-14-1078DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4287517PMC
October 2014

Teaching handwashing with soap for schoolchildren in a multi-ethnic population in northern rural Vietnam.

Glob Health Action 2013 04 24;6:1-12. Epub 2013 Apr 24.

Department of Environmental Health, Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.

Background: In Vietnam, initiatives have been started aimed at increasing the practice of handwashing with soap (HWWS) among primary schoolchildren. However, compliance remains low.

Objective: This study aims to investigate responses to a teacher-centred participatory HWWS intervention in a multi-ethnic population of primary schoolchildren in northern rural Vietnam.

Design: This study was implemented in two phases: a formative research project over 5 months (July-November 2008) and an action research project with a school-based HWWS intervention study in two rural communes during 5 months (May, September-December 2010). Based upon knowledge from the formative research in 2008, schoolteachers from four selected schools in the study communes actively participated in designing and implementing a HWWS intervention. Qualitative data was collected during the intervention to evaluate the responses and reaction to the intervention of teachers, children and parents. This included semi-structured interviews with children (15), and their parents (15), focus group discussions (FGDs) with schoolchildren (32) and school staff (20) and observations during 15 HWWS involving children.

Results: Observations and interview data from children demonstrated that children were visibly excited and pleased with HWWS sessions where teachers applied active teaching methods including rewards, games and HWWS demonstrations. All children, schoolteachers and parents also viewed the HWWS intervention as positive and feasible, irrespective of ethnicity, gender of schoolchildren and background of schoolteachers. However, some important barriers were indicated for sustaining and transferring the HWWS practice to the home setting including limited emphasis on hygiene in the standard curriculum of schools, low priority and lack of time given to practical teaching methods and lack of guidance and reminding HWWS on a regular basis at home, in particular by highland parents, who spend most of their time working away from home in the fields. Access to soap and water at the household level did not seem a barrier for the uptake of HWWS but continuous access to these might be a challenge at schools.

Conclusions: This study demonstrated that it is feasible to engage teachers and implement active teaching methods for behaviour change of HWWS in a group of multi-ethnic primary schoolchildren without the need for major investments in water and hygiene infrastructures. However, in those areas there was limited transfer of practice from school promotion to home. Continuous access to soaps at schools needs to be invested.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3636419PMC
http://dx.doi.org/10.3402/gha.v6i0.20288DOI Listing
April 2013

Handwashing among schoolchildren in an ethnically diverse population in northern rural Vietnam.

Glob Health Action 2013 01 31;6:1-8. Epub 2013 Jan 31.

Department of Environmental Health, Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.

Background: Handwashing with soap (HWWS) is a simple and effective measure to prevent transmission of fecal-oral disease and other infectious diseases in school-age children. To promote the behavior, we need to understand their HWWS compliance. The aim of this article is to describe handwashing behavior and HWWS compliance and to identify associated factors among schoolchildren in the multiethnic rural area of northern Vietnam.

Methods: The study was conducted in six primary and secondary schools and in the homes of four ethnic villages in northern Vietnam. Quantitative methods included face-to-face interviews with, and demonstration of handwashing protocol to, 319 schoolchildren in first, fourth, and seventh grades. Qualitative methods included structured observations at six schools and 20 homes comprising 24 children. The dependent variable was the self-reported HWWS behavior (yes/no). The independent variables included grade, school type, gender, ethnicity group, owning home latrine, and household assets. Logistic regression modelling was performed to examine associations between HWWS behavior and demographic factors.

Results: Among the 319 schoolchildren interviewed, 66% reported HWWS. Through the demonstration protocol, only 10 out of 319 schoolchildren, performed HWWS satisfactorily. The percentage of students who washed their hands at recommended times (30-60 sec) was 58%. This proportion increased by grade (from 34% among grade 1 to 67% among grade 7; p<0.05). Correlates of self-reported HWWS were more common in higher grades [grade 4 vs. grade 1: odds ratio (OR)=4.14 (2.00-8.56), grade 7 vs. grade 1: OR=7.76 (3.67-16.4)] and less common in ethnic minority groups [Xa Phó vs. Kinh-Tay: OR=0.28 (0.11-0.70)]. All 20 homes of schoolchildren visited had soap and water but none of the six schools had soap for handwashing.

Conclusions: This article describes poor compliance of schoolchildren with HWWS in a multiethnic population in Vietnam. Education on handwashing needs to be prioritized among multiethnic children at school.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3562359PMC
http://dx.doi.org/10.3402/gha.v6i0.18869DOI Listing
January 2013

Hot spot detection and spatio-temporal dispersion of dengue fever in Hanoi, Vietnam.

Glob Health Action 2013 Jan 24;6:18632. Epub 2013 Jan 24.

Institute of Training for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.

Introduction: Dengue fever (DF) in Vietnam remains a serious emerging arboviral disease, which generates significant concerns among international health authorities. Incidence rates of DF have increased significantly during the last few years in many provinces and cities, especially Hanoi. The purpose of this study was to detect DF hot spots and identify the disease dynamics dispersion of DF over the period between 2004 and 2009 in Hanoi, Vietnam.

Methods: Daily data on DF cases and population data for each postcode area of Hanoi between January 1998 and December 2009 were obtained from the Hanoi Center for Preventive Health and the General Statistic Office of Vietnam. Moran's I statistic was used to assess the spatial autocorrelation of reported DF. Spatial scan statistics and logistic regression were used to identify space-time clusters and dispersion of DF.

Results: The study revealed a clear trend of geographic expansion of DF transmission in Hanoi through the study periods (OR 1.17, 95% CI 1.02-1.34). The spatial scan statistics showed that 6/14 (42.9%) districts in Hanoi had significant cluster patterns, which lasted 29 days and were limited to a radius of 1,000 m. The study also demonstrated that most DF cases occurred between June and November, during which the rainfall and temperatures are highest.

Conclusions: There is evidence for the existence of statistically significant clusters of DF in Hanoi, and that the geographical distribution of DF has expanded over recent years. This finding provides a foundation for further investigation into the social and environmental factors responsible for changing disease patterns, and provides data to inform program planning for DF control.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3556563PMC
http://dx.doi.org/10.3402/gha.v6i0.18632DOI Listing
January 2013

Sanitation behavior among schoolchildren in a multi-ethnic area of Northern rural Vietnam.

BMC Public Health 2012 Feb 21;12:140. Epub 2012 Feb 21.

Department of Environmental Health, Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.

Background: In Vietnam, efforts are underway to improve latrine use in rural and remote areas with particular focus on increasing coverage of sanitation in schools. However, there is a lack of information on how the school program affects latrine use by schoolchildren and at community level. This paper analyzes sanitation use among schoolchildren in a multi-ethnic area to inform future school-based sanitation promotion programmes.

Methods: A combination of quantitative and qualitative methods was applied during a 5 months period in six primary and secondary schools and in the homes of schoolchildren in four different ethnic villages in Northern rural Vietnam. Using a structured questionnaire, 319 children were interviewed face-to-face to collect quantitative data. Qualitative methods included extensive observations at schools and in the homes of 20 children, a single day's diary writings of 234 children, in-depth interviews with children (20), their parents (20) and school staff (10), and focus group discussions with parents (4) and teachers (6), and picture drawing with children (12).

Results: All surveyed schools had student latrines. However, the observed schoolchildren most commonly urinated and defecated in the open. Main barriers for latrine use included inadequate number of latrines, limited accessibility to latrines, lack of constant water supply in latrines and lack of latrine maintenance by school management. Programs promoting latrine use for children were not conducted in either schools or communities and were not established as a preferred social norm in such settings. Children perceived existing school latrines as unappealing and expressed a wish to have basic, functional, clean, and colorful school latrines with privacy.

Conclusions: The paper shows that the current school based sanitation promotion is insufficient to change sanitation behavior of school children irrespective of their ethnicity. It is important that schools, households and communities work more closely together to increase use and uptake of latrine use among schoolchildren. Also, the contractors of latrine facilities must work more closely with local school management when constructing latrines, including identifying location, design and appropriate systems of water supply. A separate budget needs to be allocated to allow the school to maintain the sanitation infrastructure and keep it hygienic and appealing for users.
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http://dx.doi.org/10.1186/1471-2458-12-140DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3305623PMC
February 2012

Hygiene and sanitation promotion strategies among ethnic minority communities in northern Vietnam: a stakeholder analysis.

Health Policy Plan 2012 Oct 17;27(7):600-12. Epub 2012 Jan 17.

Department of International Health, Immunology and Microbiology, University of Copenhagen, Øster Farimagsgade 5, Bld. 9, DK-1014 Copenhagen, Denmark.

Effective rural hygiene and sanitation promotion (RHSP) is a major challenge for many low-income countries. This paper investigates strategies and stakeholders' roles and responsibilities in RHSP implementation in a multi-ethnic area of northern Vietnam, in order to identify lessons learned for future RHSP. A stakeholder analysis was performed, based on 49 semi-structured individual interviews and one group interview with stakeholders in RHSP in a northern province of Vietnam. Participants came from three sectors (agriculture, health and education), unions supported by the Vietnamese government and from four administrative levels (village, commune, district and province). The study villages represented four ethnic minority groups including lowland and highland communities. Stakeholders' roles, responsibilities and promotion methods were outlined, and implementation constraints and opportunities were identified and analysed using thematic content analysis. Effective RHSP in Vietnam is severely constrained despite supporting policies and a multi-sectorial and multi-level framework. Four main barriers for effective implementation of RHSP were identified: (1) weak inter-sectorial collaborations; (2) constraints faced by frontline promoters; (3) almost exclusive information-based and passive promotion methods applied; and (4) context unadjusted promotion strategies across ethnic groups, including a limited focus on socio-economic differences, language barriers and gender roles in the target groups. Highland communities were identified as least targeted and clearly in need of more intensive and effective RHSP. It is recommended that the Vietnamese government gives priority to increasing capacities of and collaboration among stakeholders implementing RHSP activities. This should focus on frontline promoters to perform effective behaviour change communication. It is also recommended to support more participatory and community-based initiatives, which can address the complex socio-economic and cultural determinants of health in multi-ethnic population groups. These lessons learned can improve future RHSP in Vietnam and are also of relevance for health promotion in other minority population groups in the region and globally.
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http://dx.doi.org/10.1093/heapol/czr082DOI Listing
October 2012

Motivation of university and non-university stakeholders to change medical education in Vietnam.

BMC Med Educ 2009 Jul 24;9:49. Epub 2009 Jul 24.

Biostatistics and Medical Informatics Department, Faculty of Public Health, Hanoi Medical University, Dong Da, Hanoi, Vietnam.

Background: Both university and non-university stakeholders should be involved in the process of curriculum development in medical schools, because all are concerned with the competencies of the graduates. That may be difficult unless appropriate strategies are used to motivate each stakeholder. From 1999 to 2006, eight medical schools in Vietnam worked together to change the curriculum and teaching for general medical students to make it more community oriented. This paper describes the factors that motivated the different stakeholders to participate in curriculum change and teaching in Vietnamese medical schools and the activities to address those factors and have sustainable contributions from all relevant stakeholders.

Methods: Case study analysis of contributions to the change process, using reports, interviews, focus group discussions and surveys and based on Herzberg's Motivation Theory to analyze involvement of different stakeholders.

Results: Different stakeholders were motivated by selected activities, such as providing opportunities for non-university stakeholders to share their opinions, organizing interactions among university stakeholders, stimulating both bottom-up and top-down inputs, focusing on learning from each other, and emphasizing self-motivation factors.

Conclusion: The Herzberg Motivation theory helped to identify suitable approaches to ensure that teaching topics, materials and assessment methods more closely reflected the health care needs of the community. Other medical schools undertaking a reform process may learn from this experience.
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http://dx.doi.org/10.1186/1472-6920-9-49DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2724474PMC
July 2009

Costing of clinical services in rural district hospitals in northern Vietnam.

Int J Health Plann Manage 2010 Jan-Mar;25(1):63-73

Department of Health Economics, Hanoi Medical University, Hanoi, Vietnam.

Objectives: This study aimed to estimate and analyse the "actual" unit cost of providing key clinical services in selected rural district hospitals in the North of Vietnam. It also examined the relationship between actual costs and the levels of cost covered by the corresponding user fees paid by patients.

Methods: This was a facility-based costing study which estimates the costs of health care services from the perspective of the service providers. Three rural district hospitals from three provinces in the North of Vietnam were purposively selected for this study. The "step-down" approach was applied.

Results: There was little difference in the costs of an outpatient visit across the hospitals, but the costs of an operation and an inpatient day varied considerably. In terms of cost structure, personnel costs accounted for the highest share of total cost of the clinical services. The shares of operating cost were considerable while depreciation of buildings/equipments made up a small "proportion". The study results revealed that the user fee levels were much lower than the actual costs of providing the corresponding services. The present study highlights the importance of costing data for hospital planning and management.
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http://dx.doi.org/10.1002/hpm.970DOI Listing
June 2010

Participatory identification of learning objectives in eight medical schools in Vietnam.

Med Teach 2007 Sep;29(7):683-90

Faculty of Public Health, Hanoi Medical University, Hanoi, Vietnam.

The advantages of outcome-based education for medical students have been recognised for several years and in several countries. Until recently in Vietnam, as in many countries, the curriculum for medical doctors was a broad framework that individual teachers filled in according to their own ideas and experience. During the past few years, the main eight medical schools in Vietnam have worked together to develop detailed learning objectives within the framework from the Ministries of Health and of Education and Training. The process was planned in an innovative and participatory way that involved more than one thousand teachers and other experts and resulted in a book listing the expected outcome in the form of the knowledge, attitudes and skills expected of a medical doctor graduating from any medical school in Vietnam. The process of identifying the objectives was followed by revision of the curriculum to be more community-oriented and to include more focus on teaching of skills, and by production of teaching, learning and assessment materials to fit the new curriculum. The process is described as an example of a comprehensive and bottom-up approach to curriculum development that could provide an example for other disciplines and schools in Vietnam or elsewhere.
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http://dx.doi.org/10.1080/01421590701361189DOI Listing
September 2007

Perceptions of graduating students from eight medical schools in Vietnam on acquisition of key skills identified by teachers.

BMC Med Educ 2008 Jan 20;8. Epub 2008 Jan 20.

Biostatistics and Medical Informatics Department, Faculty of Public Health, Hanoi Medical University, Dong Da, Hanoi, Vietnam.

Background: The eight main Vietnamese medical schools recently cooperated to produce a book listing the knowledge, attitudes and skills expected of a graduate, including specification of the required level for each skill. The teaching program should ensure that students can reach that level. The objective of this study was to determine the perception of graduating students on whether they had achieved the level set for a selection of clinical and public health skills as a guide for the schools to adjust either the levels or the teaching.

Methods: From all eight schools, 1136 of the 1528 final year students completed questionnaires just before completed all the requirements for graduation, a response rate of 87% overall (ranging from 74-99% per school). They rated their own competence on a scale of 0-5 for 129 skills selected from the 557 skills listed in the book, and reported where they thought they had learned them. The scores that the students gave themselves were then compared to the levels proposed by the teachers for each skill. The proportions of the self-assessed achievement to the levels expected by the teachers, means self-assessed scores and the coefficients of variation were calculated to make comparisons among disciplines, among schools and among learning sites.

Results: Most students felt they had learned most of the skills for key clinical departments to the required level; this varied little among the schools. Self-assessed skill acquisition in public health and minor clinical disciplines was lower and varied more. Sites outside the classroom were especially important for learning skills. The results revealed key similarities and differences between the teachers and the students in their perception about what could be learned and where

Conclusion: Revising a curriculum for medical schools demands inputs from all stakeholders. Graduating class students can provide valuable feedback on what they have learned in the existing system. Learning objectives should always be checked with students who have followed their study under existing teaching conditions. The information from the graduates helped to identify potential problem areas where either the objectives or the teaching need adjustment.
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http://dx.doi.org/10.1186/1472-6920-8-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2248186PMC
January 2008

Practicing doctors' perceptions on new learning objectives for Vietnamese medical schools.

BMC Med Educ 2007 Jun 28;7:19. Epub 2007 Jun 28.

Biostatistics and Medical Informatics Department, Faculty of Public Health, Hanoi Medical University, Dong Da, Hanoi, Vietnam.

Background: As part of the process to develop more community-oriented medical teaching in Vietnam, eight medical schools prepared a set of standard learning objectives with attention to the needs of a doctor working with the community. Because they were prepared based on government documents and the opinions of the teachers, it was necessary to check them with doctors who had already graduated and were working at different sites in the community.

Methods: Each of the eight medical faculties asked 100 practising recent graduates to complete a questionnaire to check the relevance of the skills that the teachers considered most important. We used mean and standard deviation to summarize the scores rated by the respondents for each skill and percentile at four points: p50, p25, p10 and p5 to describe the variation of scores among the respondents. Correlation coefficient was used to measure the relationship between skill levels set by the teachers and the perception of practicing doctors regarding frequency of using skills and priority for each skill. Additional information was taken from the records of focus group discussions to clarify, explain or expand on the results from the quantitative data.

Results: In many cases the skills considered important by teachers were also rated as highly necessary and/or frequently used by the respondents. There were, however, discrepancies: some skills important to teachers were seldom used and not considered important by the doctors. In focus group discussions the doctors also identified skills that are not taught at all in the medical schools but would be needed by practising doctors.

Conclusion: Although most of the skills and skill levels included in the learning objectives by the teachers were consistent with the opinions of their graduates, the match was not perfect. The experience of the graduates and their additional comments should be included as inputs to the definition of learning objectives for medical students.
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http://dx.doi.org/10.1186/1472-6920-7-19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1925073PMC
June 2007