Improving hospital-based quality of care in Vietnam by reducing HIV-related stigma and discrimination

To address HIV-related stigma and discrimination, and improve the quality of care in the healthcare setting in Vietnam, the Institute for Social and Development Studies, the International Center for Research on Women, and the Horizons Program conducted intervention research in four hospitals. The study team conceptualized two fundamental causes of HIV-related stigma: 1) fear of casual transmission; and 2) negative values/social judgments and associations between HIV and certain behaviors and groups, such as sex workers and injecting drug users. Both intervention strategies successfully reduced stigma and discrimination toward HIV-positive patients in these healthcare settings. The findings show that addressing stigma and discrimination in the healthcare setting can contribute to improving the quality of health care for HIV-positive patients. Further, effective approaches to reduce stigma and discrimination in healthcare settings need to address the hospital environment and reach all hospital workers

Second trimester abortions and sex selection of children in Hanoi, Vietnam

Because sex-selective abortions are generally conducted during the second term of the pregnancy, timing of abortion can be used as an indirect way of studying sex-selection by abortion. We examined the likelihood of having a first-trimester vs. second-trimester abortion among a group of 885 married women who had an abortion in an obstetric hospital in Hanoi in 2003. In the absence of sex-selection by abortion, the number and sex of living children should not affect the timing of abortion. Results indicate that women with more children, particularly those with more daughters or without a son, were more likely to undergo a second-term abortion than a first-term abortion. We estimate that, in 2003, 2 per cent of all abortions to women with at least one living child were intended to avoid the birth of a female

Effect of health expenses on household capabilities and resource allocation in a rural commune in Vietnam.

BACKGROUND: Significant health expenses can force households to reduce consumption of items required for daily living and long-term well-being, depriving them of the capability to lead economically stable and healthy lives. Previous studies of out-of-pocket (OOP) and other health expenses have typically characterized them as "catastrophic" in terms of a threshold level or percentage of household income. We aim to re-conceptualize the impact of health expenses on household "flourishing" in terms of "basic capabilities." METHODS AND FINDINGS: We conducted a 2008 survey covering 697 households, on consumption patterns and health treatments for the previous 12 months. We compare consumption patterns between households with and without inpatient treatment, and between households with different levels of outpatient treatment, for the entire study sample as well as among different income quartiles. We find that compared to households without inpatient treatment and with lower levels of outpatient treatment, households with inpatient treatment and higher levels of outpatient treatment reduced investments in basic capabilities, as evidenced by decreased consumption of food, education and production means. The lowest income quartile showed the most significant decrease. No quartile with inpatient or high-level outpatient treatment was immune to reductions. CONCLUSIONS: The effects of health expenses on consumption patterns might well create or exacerbate poverty and poor health, particularly for low income households. We define health expenditures as catastrophic by their reductions of basic capabilities. Health policy should reform the OOP system that causes this economic and social burden

Improving hospital-based quality of care by reducing HIV-related stigma: Evaluation results from Vietnam

Operations Research conducted at four hospitals in Vietnam sought to reduce HIV-related stigma and discrimination among hospital workers. The quasi-experimental study compared effects of focusing on ‘fear-based’ stigma (stemming from lack of knowledge) versus both fear-based and social stigma (stemming from moral judgments). Interventions included staff training (ranging from physicians to ward cleaners), hospital policy development, and supplies provision. At baseline (n = 795), reported stigma was substantial (e.g., about half of hospital workers indicated fear of casually touching PLHIV, and felt HIV was a punishment for bad behavior). By endline, stigma measures had improved significantly for both intervention groups (e.g., proportion reporting signs on beds indicating HIV status decreased from 51 to 24% in Arm 1, and 31 to 7% in Arm 2), with the combined intervention group showing greater effects. This study highlights successful strategies to reduce stigma, and thus, improve quality of care for PLHIV

Les rapports de masculinité à la naissance augmentent-ils au Vietnam?

Une faible fécondité et une préférence pour les garçons sont à l’origine des taux élevés de masculinité à la naissance constatés en Inde, en Corée du Sud et en Chine. Dans cet article, nous nous intéressons aux rapports de masculinité à la naissance calculés à partir des recensements effectués en 1989 et 1999 au Vietnam, des statistiques obtenues auprès d’hôpitaux à Hanoï et à Hô Chi Minh-Ville et de l’enquête sur les niveaux de vie au Vietnam réalisée en 1997-1998. D’une manière générale, les données des recensements ne font apparaître aucune progression des rapports de masculinité à la naissance. En revanche, les données hospitalières de 2001 ventilées par rang de naissance indiquent une augmentation des rapports de masculinité à la naissance selon le rang de naissance, s’agissant des naissances survenues à l’hôpital de Hanoï, ce qui n’est pas le cas à Hô Chi Minh-Ville. Les données fournies par l’enquête de 1997-1998 sur les niveaux de vie au Vietnam indiquent que la proportion de garçons est généralement plus forte chez les enfants de rang de naissance élevé. L’article discute des facteurs susceptibles d’expliquer ces constatations.La investigación existente muestra que la baja fecundidad y la preferencia por hijos varones observada en la India, Corea del Sur y China han resultado en ratios de masculinidad elevados. En este artículo presentamos ratios de masculinidad basados en los censos de población llevados a cabo en Vietnam en 1989 y 1999, en datos de hospitales de Hanoi y de la ciudad de Hô Chi Minh y de la Encuesta de Calidad de Vida de Vietnam 1997-98. Globalmente, los datos censales no muestran un aumento del ratio de masculinidad. Los datos hospitalarios por orden de nacimiento para 2001, sin embargo, sugieren que los ratios aumentan por orden de nacimiento entre los nacimientos registrados en el hospital de Hanoi, pero no en el hospital de la ciudad de Hô Chi Minh. Los datos de la Encuesta de Calidad de Vida de Vietnam 1997-98 indican que los hijos de paridad elevada tienen mayor probabilidad de ser varones. El artículo discute los posibles factores explicativos.Research has identified that low fertility and son preference have led to high sex ratios at birth in India, South Korea and China. In this paper, we present sex ratios at birth from the 1989 and 1999 population censuses of Vietnam, from hospital data for Hanoi and Ho Chi Minh City, and from the 1997-98 Vietnam Living Standards Survey. Overall, census data do not show any increase in the sex ratio at birth. Hospital data by birth order for the year 2001, however, suggest that sex ratios at birth increase by birth order among births recorded in the hospital located in Hanoi, but not in the one located in Ho Chi Minh City. Survey data from the Vietnam Living Standards Survey of 1997-98 indicate that high parity children are more likely to be sons. In the discussion, factors that could explain the findings are reviewed

Results of multivariate regression analyses of inpatient and outpatient treatment and percentage of household allocation categories.

<p><i>Note</i>: Robust standard errors in parentheses. This table depicts estimated regression coefficients from logistic models, after controlling for household size, age, gender, marital status, occupation and education of household head, presence of household member under 18 years or over 65 years old.</p>*<p>Significant at p<0.10.</p>**<p>Significant at p<0.05.</p>***<p>Significant at p<0.01.</p>****<p>Significant at p<0.001.</p

Impact of health expenses on household allocation patterns: a 1% increase in health expenditure is associated with __% change in consumption category.

<p><i>Note</i>: This table depicts multivariate results after controlling for household size; age, gender, marital status, occupation and education of household head; presence of household member under 18 years or over 65 years old. *Significant at <i>p</i><0.10. **Significant at <i>p</i><0.05. ***Significant at <i>p</i><0.01. ****Significant at <i>p</i><0.001.</p