Thirty years of vaccination in Vietnam: Impact and cost-effectiveness of the national Expanded Programme on Immunization.

INTRODUCTION: Countries like Vietnam transitioning to middle-income status increasingly bear the cost of both existing and new vaccines. However, the impact and cost-effectiveness of the Expanded Programme on Immunization (EPI) as a whole has never been assessed on a country level. METHODS: Data on vaccine-preventable disease incidence and mortality from Vietnam's national surveillance was analysed to estimate the likely impact that vaccination in 1980-2010 may have had. Adjustment for under-reporting was made by examining trends in reported mumps incidence and in case-fatality risks for each disease. The same data were separately analysed using the Lives Saved Tool (LiST) to give an alternative estimate of impact. The financial cost of EPI in 1996-2010 was also estimated from the perspective of service provider. RESULTS: National surveillance data suggests that up to 5.7 million diseases cases and 26,000 deaths may have been prevented by EPI. Analysis using LiST suggests that even more deaths (370,000) may have been prevented by measles and pertussis vaccination alone. The cost-effectiveness of EPI is estimated to be around $1000-$27,000 per death prevented. CONCLUSION: Two separate approaches to assessing EPI impact in Vietnam give different quantitative results but a common conclusion: that EPI has made a substantial impact on mortality and represents good value for money

Guidance toward the implementation of multicriteria decision analysis framework in developing countries

Introduction: Multiple Criteria Decision Analysis (MCDA) is increasingly used in health care mainly because it moves decision-making from ad hoc to an evidence-based and comprehensive process. Developing countries with more restricted financial and human research capacities, however, should consider their own methods of MCDA development and implementation. Areas covered: An MCDA framework to improve procurement decisions of off-patent pharmaceuticals was developed for developing countries and adapted to Indonesia, Kazakhstan and Vietnam during three policy workshops. Based on the experience of these workshops and one joint workshop with international experts and decision makers from multiple developing countries, general recommendations were formulated on how to implement MCDA specifically in developing countries. We provide 17 practical MCDA implementation recommendations in four major areas, including (1) MCDA objectives; (2) technical considerations of MCDA tool; (3) development and customization of MCDA tool and (4) policy implementation of MCDA in decision-making. Expert commentary: These practical MCDA recommendations for developing countries contribute to feasible, transparent, stepwise, iterative and standardized decision-making in health care

Effects of Chronic Comorbidities on the Health-Related Quality of Life among Older Patients after Falls in Vietnamese Hospitals

Although comorbidities are prevalent in older people experiencing falls, there is a lack of studies examining their influence on health-related quality of life (HRQOL) in this population. This study examines the prevalence of comorbidities and associations between comorbidities and HRQOL in older patients after falls in Vietnamese hospitals. A cross-sectional design was employed among 405 older patients admitted to seven hospitals due to fall injuries in Thai Binh province, Vietnam. The EuroQol-5 Dimensions-5 Levels (EQ-5D-5L) was used to measure HRQOL. Socio-demographic characteristics were collected using a structured questionnaire, while comorbidities and other clinical characteristics were examined by physicians and extracted from medical records. Multivariate Tobit regression was used to determine the associations between comorbidities and HRQOL. Among 405 patients, 75.6% had comorbidities, of which hypertension and osteoarthritis were the most common. Lumbar spine/cervical spine diseases (Coefficient (Coef.) = −0.10; 95%CI = −0.18; 0.03) and stroke (Coef. = −0.36; 95%CI = −0.61; −0.10) were found to be associated with a significantly decreased EQ-5D index. Participants with three comorbidities had EQ-5D indexes 0.20 points lower (Coef. = −0.20; 95%CI = −0.31; −0.09) in comparison with those without comorbidities. This study underlined a significantly high proportion of comorbidities in older patients hospitalized due to fall injuries in Vietnam. In addition, the existence of comorbidities was associated with deteriorating HRQOL. Frequent monitoring and screening comorbidities are critical to determining which individuals are most in need of HRQOL enhancement

Fear of Falling among Older Patients Admitted to Hospital after Falls in Vietnam: Prevalence, Associated Factors and Correlation with Impaired Health-Related Quality of Life

Fear of falling (FOF) diminishes older people’s independence in daily activities, as well as causes serious health and economic consequences. This study examined the prevalence of FOF in older patients hospitalized due to fall-injuries, its effect on health-related quality of life (HRQOL), and its associated factors. We conducted a cross-sectional study in seven hospitals in Thai Binh, Vietnam. FOF was assessed using a single close-ended question. HRQOL was evaluated by the EQ-5D-5L instrument. Multilevel logistic regression and Tobit regression models were utilized. The prevalence of FOF in 405 older patients admitted to hospitals after fall injuries was 88.2%, with a mean EQ-5D index and EQ-VAS of 0.34 (SD = 0.38) and 61.6 (SD = 15.2), respectively. Factors associated with FOF included living alone (OR = 0.13, 95%CI = 0.04; 0.50.,), history of eye diseases (OR = 4.12; 95%CI = 1.91; 8.89), and experiencing psychological distress (OR= 3.56, 95% CI = 1.05; 12.00). After adjusting for confounders, the EQ-5D index in the FOF group reduced by 0.15 points (Coef. = −0.15; 95%CI= −0.24; −0.05) compared to that of non-FOF group. Our study shows that FOF had an independent negative relationship with HRQOL of patients. Improving knowledge about fall prevention in patients and caregivers could reduce the burden of falls in older people

Impact of a Smoking Cessation Quitline in Vietnam: Evidence Base and Future Directions

Smoking is considered the most critical modifiable factor with regard to lung cancer and remains a public health concern in many countries, including Vietnam, which is among those countries with the highest tobacco consumption rates in the world. This study has examined the impact of national telephone counselling for smoking cessation and has identified the factors associated with the impact of the quitline among male callers in Vietnam. A randomized cross-sectional survey of 469 smokers who sought smoking cessation services via the national quitline was performed from September 2015 to May 2016. The primary outcomes were measured by a self-reported quit rate at the time of assessment, 7 day point prevalence abstinence (PA), 6 month prolonged PA, service satisfaction, and level of motivation. Among the participants, 31.6% were abstinent, and 5.1% of participants successfully stopped smoking and did not need to seek quitline support. Most of the clients were satisfied with the quality of service (88.5%), felt more confident about quitting (74.3%), and took early action via their first quit attempt (81.7%); 18.3% reported a more than 7 day abstinence period at the time of survey. The primary reasons for smoking relapse were surrounding smoking environments (51.6%) and craving symptoms (44.1%). Future smoking cessation efforts should focus on improving the quality of quitline services, client satisfaction, and developing a tailored program and counseling targeting smokers with specific characteristics, especially ones experiencing chronic diseases

Health-Related Quality of Life Profiles among Patients with Different Road Traffic Injuries in an Urban Setting of Vietnam

Road traffic injuries (RTIs) cause a substantial disease burden in Vietnam. Evaluating health-related quality of life (HRQOL) among patients having a diversity of RTIs informs an integral part of treatment effectiveness. This study aims to examine HRQOL of patients suffering different RTIs in Vietnam’s urban areas. A cross-sectional study was conducted on 408 patients from October to December 2018 in six hospitals in Thai Binh. The EuroQol-5 dimensions-5 levels (EQ-5D-5L) and visual analog scale (VAS) were used to assess the HRQOL of patients. Multivariable Tobit regression was applied to measure the difference of HRQOL among different kinds of injuries. The mean EQ-5D-5L and VAS score was 0.40–0.66, respectively. Mean EQ-5D-5L index was lowest in patients with oral and facial injuries (0.22) and fracture injuries (0.23), while patients having hand injuries had the highest EQ-5D-5L index (0.54). EQ-5D-5L index had a negative association with oral, facial, and fracture injuries. Meanwhile, patients with brain, fracture, and multiple injuries tended to have lower VAS score. Poor HRQOL among patients injured in road traffic were observed. Pain management, early rehabilitation, and mental health counseling services should be considered during treatment time, especially among those having the brain, oral and facial trauma, fracture, and multiple injuries