A Prospective Cohort Study of Gestational Weight Gain, Postpartum Weight Retention, and Maternal Health in Vietnam

The studies presented in this thesis are the first published investigations of physical activity on maternal weight changes, postpartum low back pain and on periconceptional folic acid supplementation in Vietnam. Prenatal and postnatal physical activity are protective factors for excessive gestational weight gain, postpartum weight retention, and low back pain. Folic acid supplementation in the periconceptional period is recommended to prevent neural tube defects, but the rate of correct use in Vietnam is too low

The Relationship between Public Debt, Budget Deficit, and Sustainable Economic Development in Developing Countries: The Role of Corruption Control

This study investigates the effects of public debt and budget deficits on the sustainable economic development of developing countries, taking into account the role of control of corruption. The two-step GMM method was applied for unbalanced panel data of 59 developing countries from 2004 to 2015. The study found that public debt and the budget deficit had negative effects on sustainable development, while the effect of control of corruption was positive. Moreover, using interaction terms between control of corruption and public debt and budget deficit, respectively, empirical results showed that controlling corruption limited these adverse effects. Thus, if the objective is to achieve sustainable economic development, developing countries should not see raising public debt or maintaining budget deficits as a strategy for economic development. The study contributes empirical evidence to the theory of debt overhang, crowded effects, and institutional theory in the context of developing countries. The implications are also discussed in this paper

Indoor PM₀.₁ and PM₂.₅ in Hanoi: Chemical characterization, source identification, and health risk assessment

This study attempted to provide comprehensive insights into the chemical composition, source identification, and health risk assessment of indoor particulate matter (PM) in urban areas of Vietnam. Three hundred and twenty daily samples of PM₀.₁ and PM₂.₅ were collected at three different types of dwellings in Hanoi in two seasons, namely summer and winter. The samples were analyzed for 10 trace elements (TEs), namely Cr, Mn, Co, Cu, Ni, Zn, As, Cd, Sn, and Pb. The daily average concentrations of indoor PM₀.₁ and PM₂.₅ in the city were in the ranges of 7.0–8.9 μg/m³ and 43.3–106 μg/m³, respectively. The average concentrations of TEs bound to indoor PM ranged from 66.2 ng/m³ to 216 ng/m³ for PM₀.₁ and 391 ng/m³ to 2360 ng/m³ for PM₂.₅. Principle component analysis and enrichment factor were applied to identify the possible sources of indoor PM. Results showed that indoor PM₂.₅ was mainly derived from outdoor sources, whereas indoor PM₀.₁ was derived from indoor and outdoor sources. Domestic coal burning, industrial and traffic emissions were observed as outdoor sources, whereas household dust and indoor combustion were found as indoor sources. 80% of PM₂.₅ was deposited in the head airways, whereas 75% of PM₀.₁ was deposited in alveolar region. Monte Carlo simulation indicated that the intake of TEs in PM₂.₅ can lead to high carcinogenic risk for people over 60 years old and unacceptable non-carcinogenic risks for all ages at the roadside house in winter

PRE-ENGINEERED (PACKAGE/AND OR ON-SITE) WASTEWATER TREATMENT PLANTS

Joint Research on Environmental Science and Technology for the Eart

Evaluation of Xpert MTB/RIF and MODS assay for the diagnosis of pediatric tuberculosis

BACKGROUND: Tuberculosis (TB) in children is rarely confirmed due to the lack of effective diagnostic tools; only 10 to 15% of pediatric TB is smear positive due to paucibacillary samples and the difficulty of obtaining high-quality specimens from children. We evaluate here the accuracy of Xpert MTB/RIF in comparison with the Micoroscopic observation drug susceptibility (MODS) assay for diagnosis of TB in children using samples stored during a previously reported evaluation of the MODS assay. METHODS: Ninety-six eligible children presenting with suspected TB were recruited consecutively at Pham Ngoc Thach Hospital in Ho Chi Minh City Viet Nam between May to December 2008 and tested by Ziehl-Neelsen smear, MODS and Mycobacterial growth Indicator (MGIT, Becton Dickinson) culture. All samples sent by the treating clinician for testing were included in the analysis. An aliquot of processed sample deposit was stored at −20°C and tested in the present study by Xpert MTB/RIF test. 183 samples from 73 children were available for analysis by Xpert. Accuracy measures of MODS and Xpert were summarized. RESULTS: The sensitivity (%) in detecting children with a clinical diagnosis of TB for smear, MODS and Xpert were 37.9 [95% CI 25.5; 51.6], 51.7 [38.2; 65.0] and 50.0 [36.6; 63.4], respectively (per patient analysis). Xpert was significantly more sensitive than smear (P=0.046). Testing of additional samples did not increase case detection for MODS while testing of a second sputum sample by Xpert detected only two additional cases. The positive and negative predictive values (%) of Xpert were 100.0 [88.0; 100.0] and 34.1 [20.5; 49.9], respectively, while those of MODS were 96.8 [83.3; 99.9] and 33.3 [19.6; 49.5]. CONCLUSION: MODS culture and Xpert MTB/RIF test have similar sensitivities for the detection of pediatric TB. Xpert MTB RIF is able to detect tuberculosis and rifampicin resistance within two hours. MODS allows isolation of cultures for further drug susceptibility testing but requires approximately one week to become positive. Testing of multiple samples by xpert detected only two additional cases and the benefits must be considered against costs in each setting. Further research is required to evaluate the optimal integration of Xpert into pediatric testing algorithms

Microscopic Observation Drug Susceptibility Assay (MODS) for Early Diagnosis of Tuberculosis in Children

MODS is a novel liquid culture based technique that has been shown to be effective and rapid for early diagnosis of tuberculosis (TB). We evaluated the MODS assay for diagnosis of TB in children in Viet Nam. 217 consecutive samples including sputum (n = 132), gastric fluid (n = 50), CSF (n = 32) and pleural fluid (n = 3) collected from 96 children with suspected TB, were tested by smear, MODS and MGIT. When test results were aggregated by patient, the sensitivity and specificity of smear, MGIT and MODS against “clinical diagnosis” (confirmed and probable groups) as the gold standard were 28.2% and 100%, 42.3% and 100%, 39.7% and 94.4%, respectively. The sensitivity of MGIT and MODS was not significantly different in this analysis (P = 0.5), but MGIT was more sensitive than MODS when analysed on the sample level using a marginal model (P = 0.03). The median time to detection of MODS and MGIT were 8 days and 13 days, respectively, and the time to detection was significantly shorter for MODS in samples where both tests were positive (P<0.001). An analysis of time-dependent sensitivity showed that the detection rates were significantly higher for MODS than for MGIT by day 7 or day 14 (P<0.001 and P = 0.04), respectively. MODS is a rapid and sensitive alternative method for the isolation of M.tuberculosis from children

Host Transcription Profile in Nasal Epithelium and Whole Blood of Hospitalized Children Under 2 Years of Age With Respiratory Syncytial Virus Infection.

BACKGROUND: Most insights into the cascade of immune events after acute respiratory syncytial virus (RSV) infection have been obtained from animal experiments or in vitro models. METHODS: In this study, we investigated host gene expression profiles in nasopharyngeal (NP) swabs and whole blood samples during natural RSV and rhinovirus (hRV) infection (acute versus early recovery phase) in 83 hospitalized patients <2 years old with lower respiratory tract infections. RESULTS: Respiratory syncytial virus infection induced strong and persistent innate immune responses including interferon signaling and pathways related to chemokine/cytokine signaling in both compartments. Interferon-α/β, NOTCH1 signaling pathways and potential biomarkers HIST1H4E, IL7R, ISG15 in NP samples, or BCL6, HIST2H2AC, CCNA1 in blood are leading pathways and hub genes that were associated with both RSV load and severity. The observed RSV-induced gene expression patterns did not differ significantly in NP swab and blood specimens. In contrast, hRV infection did not as strongly induce expression of innate immunity pathways, and significant differences were observed between NP swab and blood specimens. CONCLUSIONS: We conclude that RSV induced strong and persistent innate immune responses and that RSV severity may be related to development of T follicular helper cells and antiviral inflammatory sequelae derived from high activation of BCL6

A Multi-Center Randomised Controlled Trial of Gatifloxacin versus Azithromycin for the Treatment of Uncomplicated Typhoid Fever in Children and Adults in Vietnam

BACKGROUND: Drug resistant typhoid fever is a major clinical problem globally. Many of the first line antibiotics, including the older generation fluoroquinolones, ciprofloxacin and ofloxacin, are failing. OBJECTIVES: We performed a randomised controlled trial to compare the efficacy and safety of gatifloxacin (10 mg/kg/day) versus azithromycin (20 mg/kg/day) as a once daily oral dose for 7 days for the treatment of uncomplicated typhoid fever in children and adults in Vietnam. METHODS: An open-label multi-centre randomised trial with pre-specified per protocol analysis and intention to treat analysis was conducted. The primary outcome was fever clearance time, the secondary outcome was overall treatment failure (clinical or microbiological failure, development of typhoid fever-related complications, relapse or faecal carriage of S. typhi). PRINCIPAL FINDINGS: We enrolled 358 children and adults with suspected typhoid fever. There was no death in the study. 287 patients had blood culture confirmed typhoid fever, 145 patients received gatifloxacin and 142 patients received azithromycin. The median FCT was 106 hours in both treatment arms (95% Confidence Interval [CI]; 94-118 hours for gatifloxacin versus 88-112 hours for azithromycin), (logrank test p = 0.984, HR [95% CI] = 1.0 [0.80-1.26]). Overall treatment failure occurred in 13/145 (9%) patients in the gatifloxacin group and 13/140 (9.3%) patients in the azithromycin group, (logrank test p = 0.854, HR [95% CI] = 0.93 [0.43-2.0]). 96% (254/263) of the Salmonella enterica serovar Typhi isolates were resistant to nalidixic acid and 58% (153/263) were multidrug resistant. CONCLUSIONS: Both antibiotics showed an excellent efficacy and safety profile. Both gatifloxacin and azithromycin can be recommended for the treatment of typhoid fever particularly in regions with high rates of multidrug and nalidixic acid resistance. The cost of a 7-day treatment course of gatifloxacin is approximately one third of the cost of azithromycin in Vietnam. TRIAL REGISTRATION: Controlled-Trials.com ISRCTN67946944

Experience in Using Mobile Laboratory for Monitoring and Diagnostics in the Socialist Republic of Vietnam

The aim was to present the experience of using mobile laboratory for monitoring and diagnostics (MLMD) during the epizootiological monitoring of the northern provinces of Vietnam. MLMD was transferred by Federal Service for Surveillance in the Sphere of Consumers Rights Protection and Human Welfare to the Socialist Republic of Vietnam as part of implementation of cooperation programs on combating infectious diseases. The use of MLMD made it possible to obtain new information on the circulation of pathogens of natural-focal infectious diseases on the territory of Vietnam. It also provided the necessary conditions for conducting research using methods of express diagnostics, bacteriological analysis, performing a full cycle of work – from the receipt of samples to the disinfection and destruction of infected material in compliance with the requirements of biological safety in the field. The effectiveness of using mobile laboratories in response to the emergencies of sanitary and epidemiological nature, both to strengthen stationary laboratory bases and to organize diagnostic studies in remote regions, has been shown. The use of MLMD for the diagnosis of COVID‑19 has been an effective component of countering the new coronavirus infection in Vietnam and significantly increased the volume of testing in the country

Structure of general-population antibody titer distributions to influenza A virus.

Seroepidemiological studies aim to understand population-level exposure and immunity to infectious diseases. Their results are normally presented as binary outcomes describing the presence or absence of pathogen-specific antibody, despite the fact that many assays measure continuous quantities. A population's natural distribution of antibody titers to an endemic infectious disease may include information on multiple serological states - naiveté, recent infection, non-recent infection, childhood infection - depending on the disease in question and the acquisition and waning patterns of immunity. In this study, we investigate 20,152 general-population serum samples from southern Vietnam collected between 2009 and 2013 from which we report antibody titers to the influenza virus HA1 protein using a continuous titer measurement from a protein microarray assay. We describe the distributions of antibody titers to subtypes 2009 H1N1 and H3N2. Using a model selection approach to fit mixture distributions, we show that 2009 H1N1 antibody titers fall into four titer subgroups and that H3N2 titers fall into three subgroups. For H1N1, our interpretation is that the two highest-titer subgroups correspond to recent and historical infection, which is consistent with 2009 pandemic attack rates. Similar interpretations are available for H3N2, but right-censoring of titers makes these interpretations difficult to validate