Perspectives on child diarrhoea management and health service use among ethnic minority caregivers in Vietnam

<p>Abstract</p> <p>Background</p> <p>In Vietnam, primary government health services are now accessible for the whole population including ethnic minority groups (EMGs) living in rural and mountainous areas. However, little is known about EMGs' own perspectives on illness treatment and use of health services. This study investigates treatment seeking strategies for child diarrhoea among ethnic minority caregivers in Northern Vietnam in order to suggest improvements to health services for EMGs and other vulnerable groups.</p> <p>Methods</p> <p>The study obtained qualitative data from eight months of field work among four EMGs in lowland and highland villages in the Northern Lao Cai province. Triangulation of methods included in-depth interviews with 43 caregivers of pre-school children (six years and below) who had a case of diarrhoea during the past month, three focus group discussions (FGDs) with men, and two weeks of observations at two Communal Health Stations (CHGs). Data was content-analyzed by ordering data into empirically and theoretically inspired themes and sub-categories assisted by the software NVivo8.</p> <p>Results</p> <p>This study identified several obstacles for EMG caregivers seeking health services, including: gender roles, long travelling distances for highland villagers, concerns about the indirect costs of treatment and a reluctance to use government health facilities due to feelings of being treated disrespectfully by health staff. However, ethnic minority caregivers all recognized the danger signs of child diarrhoea and actively sought simultaneous treatment in different health care systems and home-based care. Treatments were selected by matching the perceived cause and severity of the disease with the 'compatibility' of different treatments to the child.</p> <p>Conclusions</p> <p>In order to improve EMGs' use of government health services it is necessary to improve the communication skills of health staff and to acknowledge both EMGs' explanatory disease models and the significant socio-economic constraints they experience. Broader health promotion programs should address the significant gender roles preventing highland mothers from seeking health services and include family elders and fathers in future health promotion programs. Encouraging existing child health care practices, including continued breastfeeding during illness and the use of home-made rehydration solutions, also present important opportunities for future child health promotion.</p

The use of reproductive healthcare at commune health stations in a changing health system in Vietnam

Background: With health sector reform in Vietnam moving towards greater pluralism, commune health stations (CHSs) have been subject to growing competition from private health services and increasing numbers of patients bypassing CHSs for higher-level health facilities. This study describes the pattern of reproductive health (RH) and family planning (FP) service utilization among women at CHSs and other health facilities, and explores socio demographic determinants of RH service utilization at the CHS level

Novel patterns of the Epstein-Barr nuclear antigen (EBNA-1) V-Val subtype in EBV-associated nasopharyngeal carcinoma from Vietnam

The Epstein-Barr nuclear antigen 1 (EBNA-1) gene, plays a key role in viral infection, immortalization, viral genome replication, transcription and maintenance, and is the frequently detected gene, protein in both latent and lytic stage of Epstein-Barr virus (EBV). Based on the amino acid at position 487, EBNA-1 was classified into five subtypes, including P-Ala, P-Thr, V-Val, V-Pro and V-Leu. In Vietnam, an Asian country with a high incidence, mortality rates of nasopharyngeal carcinoma (NPC), had limited research on the EBNA-1 variation. Therefore, the aim of the current study was to identify the pattern of the EBNA-1 V-Val subtype in Vietnamese NPC patients, for its value further applied in NPC patients. Fifty-eight NPC biopsy samples were collected from local patients, analyzed by nested-polymerase chain reaction (nested-PCR), sequencing and compared to a previous B95-8 prototype sequence. Four EBNA-1 subtypes, including V-Val (35/44, 79.55%), P-Ala (2/44, 4.55%), P-Thr (5/44, 11.36%), and V-Leu (2/44, 4.55%), were observed in 44/58 samples. The sequences of the V-Val subtype were compared to the B95-8 prototype, resulting in five patterns, contained seven consensus changes, including five amino acid changes at positions 487, 499, 502, 524, 594, and two silent changes at residues 520 and 553. Of these, four of five, patterns were identified as novel patterns of the V-Val subtype, showing the different changes of amino acids at positions 492, 528, 529, 553, 585 and 588, by comparison with previous studies of V-Val EBNA-1. Those data suggested the profile of variation patterns of the EBNA-1 gene, related to geographic distribution, in Vietnamese NPC patients

A randomized comparison of chloroquine versus dihydroartemisinin-piperaquine for the treatment of Plasmodium vivax infection in Vietnam

A total of 128 Vietnamese patients with symptomatic Plasmodium vivax mono-infections were enrolled in a prospective, open-label, randomized trial to receive either chloroquine or dihydroartemisinin-piperaquine (DHA-PPQ). The proportions of patients with adequate clinical and parasitological responses were 47% in the chloroquine arm (31 of 65 patients) and 66% in the DHA-PPQ arm (42 of 63 patients) in the Kaplan-Meier intention-to-treat analysis (absolute difference 19%, 95% confidence interval = 0-37%), thus establishing non-inferiority of DHA-PPQ. Fever clearance time (median 24 versus 12 hours, P = 0.02), parasite clearance time (median 36 versus 18 hours, P &lt; 0.001), and parasite clearance half-life (mean 3.98 versus 1.80 hours, P &lt; 0.001) were all significantly shorter in the DHA-PPQ arm. All cases of recurrent parasitemia in the chloroquine arm occurred from day 33 onward, with corresponding whole blood chloroquine concentration lower than 100 ng/mL in all patients. Chloroquine thus remains efficacious for the treatment of P. vivax malaria in southern Vietnam, but DHA-PPQ provides more rapid symptomatic and parasitological recovery