The association between food environment, diet quality and malnutrition in low‐ and middle‐income adult populations across the rural—Urban gradient in Vietnam

Background: Economic reforms and trade liberalisation in Vaietnm have transformed the food environment, influencing dietary patterns and malnutrition status. The present study focuses on the relationship between food environments (proximity and density of food outlets) and malnutrition (underweight, overweight, obesity) through diet quality in adult populations across urban, periurban and rural areas of Vietnam. Methods: We evaluated food environment by geospatial mapping of food outlets through a transect walk across the “food ecosystem” from rural to urban areas. Diet quality was assessed using the Diet Quality Index – Vietnamese (DQI‐V) comprising Variety, Adequacy, Moderation and Balance components. Malnutrition status was determined using body mass index. We performed a mediation analysis utilising mixed effect models to control for neighbourhood clustering effects. Confounders included age, education, income and nutrition knowledge score. Results: Analysis of data from 595 adult participants (mean ± SD age: 31.2 ± 6.4 years; 50% female) found that longer distance to the nearest food outlet was associated with higher overall DQI‐V (β = 2.0; 95% confidence interval = 0.2–3.8; p = 0.036) and the Moderation component (β = 2.6; 95% confidence interval = 1.2–4.0; p = 0.001). Outlet density shows a negative association with the odds of underweight among women (odds ratio = 0.62; 95% confidence interval = 0.37–0.96). However, we did not observe statistically significant relationships between diet quality and malnutrition. Education and nutrition knowledge scores were positively associated with diet diversity, while income was negatively associated with diet moderation. Conclusions: The findings of the present study have important implications for nutrition and dietetics practice in Vietnam and globally. It emphasises the need to consider various dimensions of sustainable diets, including economic, health and socio‐cultural/political factors. Longer distances to food outlets are associated with higher diet quality, whereas lower food outlet density increases the odds of underweight among women. This poses challenges in balancing modernisation and its adverse effects on sustainable food systems. Socio‐economic status consistently correlated with diet quality and malnutrition, necessitating further research to promote healthy diets across socio‐economic strata

Diet Quality Index and food choice motives in Vietnam: The roles of sensory appeal, mood, convenience, and familiarity

Food choices that shape human diets and health are influenced by various socio-economic factors. Vietnam struggles to meet many nutrition targets where links between food choice and diet have not been widely explored. This study assesses the food choice motives, based on a 28-item food choice questionnaire (FCQ), and the diet quality of 603 adults in three sites (urban, peri-urban, and rural) in northern Vietnam. We assess diet quality using the Diet Quality Index–Vietnam (DQI-V) which consists of variety, adequacy, moderation, and balance components. Using factor analysis, we grouped FCQ items into five factors: health focus, sensory appeal, mood ethics, convenience, and familiarity. The structural equation modeling indicates that food choice motives significantly impact the DQI-V and its components but in different directions. The results show that sensory appeal has a positive association with the overall DQI-V score, while having a negative impact on the variety component. Findings present a potential trade-off issue for interventions and policies related to food products. Nutrition knowledge is positively associated with all elements of diet quality across all three study sites. Vietnamese agrobiodiversity could be better utilized to increase dietary diversity. Differentiated policies are necessary to address the poor dietary diversity and adequacy in northern Vietnam

Partial food systems baseline assessment at the Vietnam benchmark sites

Using data collected from a cross-sectional study in Moc Chau, Dong Anh and Cau Giay districts in Vietnam, this report aims to elucidate specific components of local Vietnamese food systems along a rural to urban transect focusing specifically on (i) diets, (ii) nutrition status (anthropometry), (iii) consumer behavior, (iv) food environment, and (v) food flows

Awareness and preparedness of healthcare workers against the first wave of the COVID-19 pandemic: A cross-sectional survey across 57 countries.

BACKGROUND: Since the COVID-19 pandemic began, there have been concerns related to the preparedness of healthcare workers (HCWs). This study aimed to describe the level of awareness and preparedness of hospital HCWs at the time of the first wave. METHODS: This multinational, multicenter, cross-sectional survey was conducted among hospital HCWs from February to May 2020. We used a hierarchical logistic regression multivariate analysis to adjust the influence of variables based on awareness and preparedness. We then used association rule mining to identify relationships between HCW confidence in handling suspected COVID-19 patients and prior COVID-19 case-management training. RESULTS: We surveyed 24,653 HCWs from 371 hospitals across 57 countries and received 17,302 responses from 70.2% HCWs overall. The median COVID-19 preparedness score was 11.0 (interquartile range [IQR] = 6.0-14.0) and the median awareness score was 29.6 (IQR = 26.6-32.6). HCWs at COVID-19 designated facilities with previous outbreak experience, or HCWs who were trained for dealing with the SARS-CoV-2 outbreak, had significantly higher levels of preparedness and awareness (p<0.001). Association rule mining suggests that nurses and doctors who had a 'great-extent-of-confidence' in handling suspected COVID-19 patients had participated in COVID-19 training courses. Male participants (mean difference = 0.34; 95% CI = 0.22, 0.46; p<0.001) and nurses (mean difference = 0.67; 95% CI = 0.53, 0.81; p<0.001) had higher preparedness scores compared to women participants and doctors. INTERPRETATION: There was an unsurprising high level of awareness and preparedness among HCWs who participated in COVID-19 training courses. However, disparity existed along the lines of gender and type of HCW. It is unknown whether the difference in COVID-19 preparedness that we detected early in the pandemic may have translated into disproportionate SARS-CoV-2 burden of disease by gender or HCW type

Safety and efficacy of fluoxetine on functional outcome after acute stroke (AFFINITY): a randomised, double-blind, placebo-controlled trial

Background Trials of fluoxetine for recovery after stroke report conflicting results. The Assessment oF FluoxetINe In sTroke recoverY (AFFINITY) trial aimed to show if daily oral fluoxetine for 6 months after stroke improves functional outcome in an ethnically diverse population. Methods AFFINITY was a randomised, parallel-group, double-blind, placebo-controlled trial done in 43 hospital stroke units in Australia (n=29), New Zealand (four), and Vietnam (ten). Eligible patients were adults (aged ≥18 years) with a clinical diagnosis of acute stroke in the previous 2–15 days, brain imaging consistent with ischaemic or haemorrhagic stroke, and a persisting neurological deficit that produced a modified Rankin Scale (mRS) score of 1 or more. Patients were randomly assigned 1:1 via a web-based system using a minimisation algorithm to once daily, oral fluoxetine 20 mg capsules or matching placebo for 6 months. Patients, carers, investigators, and outcome assessors were masked to the treatment allocation. The primary outcome was functional status, measured by the mRS, at 6 months. The primary analysis was an ordinal logistic regression of the mRS at 6 months, adjusted for minimisation variables. Primary and safety analyses were done according to the patient's treatment allocation. The trial is registered with the Australian New Zealand Clinical Trials Registry, ACTRN12611000774921. Findings Between Jan 11, 2013, and June 30, 2019, 1280 patients were recruited in Australia (n=532), New Zealand (n=42), and Vietnam (n=706), of whom 642 were randomly assigned to fluoxetine and 638 were randomly assigned to placebo. Mean duration of trial treatment was 167 days (SD 48·1). At 6 months, mRS data were available in 624 (97%) patients in the fluoxetine group and 632 (99%) in the placebo group. The distribution of mRS categories was similar in the fluoxetine and placebo groups (adjusted common odds ratio 0·94, 95% CI 0·76–1·15; p=0·53). Compared with patients in the placebo group, patients in the fluoxetine group had more falls (20 [3%] vs seven [1%]; p=0·018), bone fractures (19 [3%] vs six [1%]; p=0·014), and epileptic seizures (ten [2%] vs two [<1%]; p=0·038) at 6 months. Interpretation Oral fluoxetine 20 mg daily for 6 months after acute stroke did not improve functional outcome and increased the risk of falls, bone fractures, and epileptic seizures. These results do not support the use of fluoxetine to improve functional outcome after stroke

Diet quality and food sources in Vietnam: first evidence using compositional data analysis

International audienceFood environments have been evolving rapidly in lower-middle-income countries. Nevertheless, little is known about the impact of these changes on diet quality. Thanks to the availability of detailed data on Vietnamese household consumption, this chapter presents a set of first results on the association between food sources and diet quality. These results highlight the contrasts between three Vietnamese districts located on an urban to rural gradient. We used recent advances in compositional data analysis to take into account the compositional nature of the share data describing the different food sources: principal balances as a tool for summarizing information carried by share data and techniques to deal with observed zero-valued shares

Factors associated with food safety compliance among street food vendors in Can Tho city, Vietnam: Implications for intervention activity design and implementation

Background Street food plays a valuable role in several Asian countries including Vietnam. Improving the safety of street food is an important responsibility for many local food authorities. This study aims to characterize the business profile of fixed and mobile street food vendors, and to compare their compliance with the food safety criteria. Methods A cross-sectional study was conducted using a questionnaire and observational checklist to assess the ten Vietnamese food safety criteria prescribed under Decision No. 3199/2000/QD-BYT for street food vendors in Can Tho city. A total of 400 street food vendors, composed of fixed and mobile vendors, in urban areas of the city were randomly selected for the survey. Results The study showed significant differences between the two types of street food vendors in educational level (p = 0.017); business profile, including types of foods vended, area in use, number of employees, training in food safety, and business registration paperwork; and the status of compliance with the ten-food hygiene and safety criteria (p < 0.01). Poisson regression analysis found that education attainment (IRR = 1.228, p = 0.015), food safety training (IRR = 4.855, p < 0.01), total business capital (IRR = 1.004, p = 0.031) and total area in use (IRR = 1.007, p = 0.001) appeared to be significantly positively associated with food safety and hygiene compliance. In contrast, mobile vending type was negatively associated with the likelihood of adhering to the ten criteria (IRR = 0.547, p = 0.005). Conclusions These findings emphasize the need for training and education programs to improve food safety knowledge and practice among street food vendors. Basic infrastructure and services, especially clean water, proper sanitation, and waste disposal facilities, should be provided to help street food vendors better practice food safety and hygiene regulations

Diets, Food Choices and Environmental Impacts across an Urban-Rural Interface in Northern Vietnam

Human diets and their associated environmental impacts differ across segments of the population. There is evidence that consumer choices of food intake can also affect the overall environmental impacts of a food system. This paper analyzes the environmental impact of diets and food choices across a rural–urban transect in Northern Vietnam by using mixed survey data from 619 adult respondents. The average greenhouse gas emissions (GHGE) resulting from producing the daily food intake of adults in the urban and peri-urban districts were similar, while the average in the rural district was lower. Although starchy staples contributed the most to energy intake, pork and beef were the largest contributors to GHGE. Metrics of blue water use were higher for diets of males than those of females in all three districts. Interestingly, the difference in mean diet diversity score between urban and rural households was significant, and females’ diets were more diverse than those of males. As expected, urban households were more likely to buy food, while rural households often produced their own foods. Urban households reported prioritizing personal health and the natural content of food and would increase seafood and fruits if their income were to increase. In rural regions, interventions aimed at reducing undernutrition should address improving diet quality without significant increases to diet-related environmental impacts