Disease Surveillance Networks Initiative Asia: Final Evaluation

The DSN Initiative was launched in 2007 under the new strategy of the Rockefeller Foundation. The initiative intends:[1] To improve human resources for disease surveillance in developing countries, thus bolstering national capacity to monitor, report, and respond to outbreaks;[2] To support regional networks to promote collaboration in disease surveillance and response across countries; and[3] To build bridges between regional and global monitoring effortsThe purpose of the DSN evaluation in the Mekong region was twofold:[1]To inform the work and strategy of the Foundation, its grantees, and the broader field of disease surveillance, based on the experience of DSN investments in the Mekong region. More specifically, the evaluation will inform future directions and strategies for current areas of DSN Initiative work, particularly in Asia, and will highlight potential new areas of work and strategy; and[2] To provide accountability to the Rockefeller Foundation's board, staff, and stakeholders for the DSN funds spent in the Mekong region

Newborn care and knowledge translation - perceptions among primary healthcare staff in northern Vietnam

<p>Abstract</p> <p>Background</p> <p>Nearly four million neonatal deaths occur annually in the world despite existing evidence-based knowledge with the potential to prevent many of these deaths. Effective knowledge translation (KT) could help to bridge this know-do gap in global health. The aim of this study was to explore aspects of KT at the primary healthcare level in a northern province in Vietnam.</p> <p>Methods</p> <p>Six focus-group discussions were conducted with primary healthcare staff members who provided neonatal care in districts that represented three types of geographical areas existing in the province (urban, rural, and mountainous). Recordings were transcribed verbatim, translated into English, and analyzed using content analysis.</p> <p>Results</p> <p>We identified three main categories of importance for KT. Healthcare staff used several channels for acquisition and management of knowledge (1), but none appeared to work well. Participants preferred formal training to reading guideline documents, and they expressed interest in interacting with colleagues at higher levels, which rarely happened. In some geographical areas, traditional medicine (2) seemed to compete with evidence-based practices, whereas in other areas it was a complement. Lack of resources, low frequency of deliveries and, poorly paid staff were observed barriers to keeping skills at an adequate level in the healthcare context (3).</p> <p>Conclusions</p> <p>This study indicates that primary healthcare staff work in a context that to some extent enables them to translate knowledge into practice. However, the established and structured healthcare system in Vietnam does constitute a base where such processes could be expected to work more effectively. To accelerate the development, thorough considerations over the current situation and carefully targeted actions are required.</p

Rapid impact assessments of COVID-19 control measures against the Delta variant and short-term projections of new confirmed cases in Vietnam

vital:17277As of 2020, the cumulative number of COVID-19 cases recorded in Vietnam was less than 1500, proving the success of COVID-19 control in Vietnam [1]. Vietnam has been recognized as one of the few countries that successfully controlled COVID-19 in 2020 [2]. Several recent articles have summarised a set of lessons learned, the so-called “Zero-new-case-approach”. These included (i) a rapid and coordinated public health response with a decentralized health care system [3]; (ii) massive quarantine and targeted lockdown; (iii) third-degree contact tracing; (iv) centralized patient management; (v) early school closures and robust border controls; (vi) mask policies and 5K message (5K refers to use face masks in public places, disinfect regularly, keep distance, stop gathering, and make health declaration); and (vii) innovative mass testing strategies in the resource-constraint system (sample pooling strategy of PCR test with 2-7 swaps) [4], These “Zero-newcase-approach” strategies all focused on the non-pharmaceutical aspect of disease control. They aimed to maintain zero community transmission by establishing a comprehensive public surveillance system and enacted drastic measures with the support of the police and military forces. © 2021 THE AUTHOR(S) JoGH 2021 ISoG

Rapid impact assessments of COVID-19 control measures against the Delta variant and short-term projections of new confirmed cases in Vietnam.

As of 2020, the cumulative number of COVID-19 cases recorded in Vietnam was less than 1500, proving the success of COVID-19 control in Vietnam [1]. Vietnam has been recognized as one of the few countries that successfully controlled COVID-19 in 2020 [2]. Several recent articles have summarised a set of lessons learned, the so-called “Zero-new-case-approach”. These included (i) a rapid and coordinated public health response with a decentralized health care system [3]; (ii) massive quarantine and targeted lockdown; (iii) third-degree contact tracing; (iv) centralized patient management; (v) early school closures and robust border controls; (vi) mask policies and 5K message (5K refers to use face masks in public places, disinfect regularly, keep distance, stop gathering, and make health declaration); and (vii) innovative mass testing strategies in the resource-constraint system (sample pooling strategy of PCR test with 2-7 swaps) [4], These “Zero-newcase-approach” strategies all focused on the non-pharmaceutical aspect of disease control. They aimed to maintain zero community transmission by establishing a comprehensive public surveillance system and enacted drastic measures with the support of the police and military forces. © 2021 THE AUTHOR(S) JoGH 2021 ISoG

Evidence-based practice in neonatal health: knowledge among primary health care staff in northern Viet Nam

<p>Abstract</p> <p>Background</p> <p>An estimated four million deaths occur each year among children in the neonatal period. Current evidence-based interventions could prevent a large proportion of these deaths. However, health care workers involved in neonatal care need to have knowledge regarding such practices before being able to put them into action.</p> <p>The aim of this survey was to assess the knowledge of primary health care practitioners regarding basic, evidence-based procedures in neonatal care in a Vietnamese province. A further aim was to investigate whether differences in level of knowledge were linked to certain characteristics of community health centres, such as access to national guidelines in reproductive health care, number of assisted deliveries and geographical location.</p> <p>Methods</p> <p>This cross-sectional survey was completed within a baseline study preparing for an intervention study on knowledge translation (Implementing knowledge into practice for improved neonatal survival: a community-based trial in Quang Ninh province, Viet Nam, the NeoKIP project, ISRCTN44599712). Sixteen multiple-choice questions from five basic areas of evidence-based practice in neonatal care were distributed to 155 community health centres in 12 districts in a Vietnamese province, reaching 412 primary health care workers.</p> <p>Results</p> <p>All health care workers approached for the survey responded. Overall, they achieved 60% of the maximum score of the questionnaire. Staff level of knowledge on evidence-based practice was linked to the geographical location of the CHC, but not to access to the national guidelines or the number of deliveries at the community level. Two separated geographical areas were identified with differences in staff level of knowledge and concurrent differences in neonatal survival, antenatal care and postnatal home visits.</p> <p>Conclusion</p> <p>We have identified a complex pattern of associations between knowledge, geography, demographic factors and neonatal outcomes. Primary health care staff knowledge regarding neonatal health is scarce. This is a factor that is possible to influence and should be considered in future efforts for improving the neonatal health situation in Viet Nam.</p

Expanding HIV Testing Efforts in Concentrated Epidemic Settings: A Population-Based Survey from Rural Vietnam

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Joint Learning Update

Over the past three years, the Joint Learning Network for Universal Health Coverage (JLN) has become a well-established practitioner-to-practitioner network of countries at the forefront of the global movement toward universal health coverage (UHC) . Now that the JLN has been active for a few years, many involved in the JLN felt that it was an appropriate time to assess what has been achieved to date and develop a roadmap for the future.In December 2012, the Rockefeller Foundation engaged Pact, an independent NGO that specializes in community engagement and networks, to conduct an independent strategic review of the JLN's value proposition, mechanisms for engaging members, and decision-making structures. Pact sampled each stakeholder group in the JLN by administering an online member survey and conducting a series of in-person interviews to gather perspectives from across the community and gain a deeper understanding of how each group contributes to the JLN's goals.One hundred and four JLN members -- a 45 percent response rate -- responded to the member survey and 27 stakeholders participated in semi-structured interviews. The results provided useful information about JLN members and how they are applying knowledge acquired through network activities in their own context

Intensified treatment with high dose Rifampicin and Levofloxacin compared to standard treatment for adult patients with Tuberculous Meningitis (TBM-IT): protocol for a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Tuberculous meningitis is the most severe form of tuberculosis. Mortality for untreated tuberculous meningitis is 100%. Despite the introduction of antibiotic treatment for tuberculosis the mortality rate for tuberculous meningitis remains high; approximately 25% for HIV-negative and 67% for HIV positive patients with most deaths occurring within one month of starting therapy. The high mortality rate in tuberculous meningitis reflects the severity of the condition but also the poor antibacterial activity of current treatment regimes and relatively poor penetration of these drugs into the central nervous system. Improving the antitubercular activity in the central nervous system of current therapy may help improve outcomes. Increasing the dose of rifampicin, a key drug with known poor cerebrospinal fluid penetration may lead to higher drug levels at the site of infection and may improve survival. Of the second generation fluoroquinolones, levofloxacin may have the optimal pharmacological features including cerebrospinal fluid penetration, with a ratio of Area Under the Curve (AUC) in cerebrospinal fluid to AUC in plasma of >75% and strong bactericidal activity against <it>Mycobacterium tuberculosis</it>. We propose a randomized controlled trial to assess the efficacy of an intensified anti-tubercular treatment regimen in tuberculous meningitis patients, comparing current standard tuberculous meningitis treatment regimens with standard treatment intensified with high-dose rifampicin and additional levofloxacin.</p> <p>Methods/Design</p> <p>A randomized, double blind, placebo-controlled trial with two parallel arms, comparing standard Vietnamese national guideline treatment for tuberculous meningitis with standard treatment <it>plus </it>an increased dose of rifampicin (to 15 mg/kg/day total) and additional levofloxacin. The study will include 750 patients (375 per treatment group) including a minimum of 350 HIV-positive patients. The calculation assumes an overall mortality of 40% vs. 30% in the two arms, respectively (corresponding to a target hazard ratio of 0.7), a power of 80% and a two-sided significance level of 5%. Randomization ratio is 1:1. The primary endpoint is overall survival, i.e. time from randomization to death during a follow-up period of 9 months. Secondary endpoints are: neurological disability at 9 months, time to new neurological event or death, time to new or recurrent AIDS-defining illness or death (in HIV-positive patients only), severe adverse events, and rate of treatment interruption for adverse events.</p> <p>Discussion</p> <p>Currently very few options are available for the treatment of TBM and the mortality rate remains unacceptably high with severe disabilities seen in many of the survivors. This trial is based on the hypothesis that current anti-mycobacterial treatment schedules for TBM are not potent enough and that outcomes will be improved by increasing the CSF penetrating power of this regimen by optimising dosage and using additional drugs with better CSF penetration.</p> <p>Trial registration</p> <p>International Standard Randomised Controlled Trial Number <a href="http://www.controlled-trials.com/ISRCTN61649292">ISRCTN61649292</a></p