Thuan Thi Nguyen

Background: Despite freely distributed insecticide-treated nets (ITNs) and health information campaigns to increase their use among populations at risk, malaria transmission persists in forested areas in Vietnam, especially among ethnic minority communities. A mixed-methods study was conducted in four villages of Ca Dong and M’nong ethnicity in Central Vietnam between 2009 and 2011 to assess factors limiting the uptake of ITNs. Methods: The mixed-methods research design consisted of a qualitative study to explore the context and barriers to ITN use, and a cross-sectional household survey (n = 141) to quantify factors for limited and appropriate net use. Results: The Ca Dong and M’nong’s livelihood was dependent on swidden farming in the forest. Poverty-related factors, including the lack of beds, blankets, the practice of sleeping around the kitchen fire and deteriorated ITNs due to open housing structures, were reasons for alternative and non-use of ITNs. When household members stayed overnight in plot huts at fields, ITNs were even more unavailable and easily deteriorated. 72.5% of households reported having received one net for every two persons, and 82.2% of participants reported to have used ITNs the night before the survey. However, only 18.4% of participants were estimated to be effectively protected by ITNs after accounting for the availability of torn ITNs and the way ITNs were used, for example as blankets, at both village and fields. Multi-variable logistic regression showed the effect of four significant factors for appropriate ITN use: i) being female (AOR = 8.08; p = 0.009); ii) aware of mosquito bites as the sole cause of malaria (AOR = 7.43; p = 0.008); iii) not sleeping around the kitchen fire (AOR = 24.57; p = 0.001); and iv) having sufficient number of ITNs in the household (AOR = 21.69; p = 0.001). Conclusion: This study showed how social factors rooted in poverty and swidden agriculture limited the effective use of ITNs, despite high coverage, among ethnic minority populations in Central Vietnam. An in-depth understanding of the local context is essential to develop specific indicators for measuring ITN use.

Despite the scale-up of vector control, diagnosis and treatment, and health information campaigns, malaria persists in the forested areas of South-Central Vietnam, home to ethnic minority populations. A mixed-methods study using an exploratory sequential design was conducted in 10 Ra-glai villages in Bac Ai district of Ninh Thuan province to examine which social factors limited the effectiveness of the national malaria elimination strategy in the local setting. Territorial arrangements and mobility were found to directly limit the effectiveness of indoor residual spraying and long-lasting insectidical treated nets (LLINs). Households (n=410) were resettled in the “new villages” by the government, where they received brick houses (87.1%) and sufficient LLINs (97.3%). However, 97.6% of households went back to their “old villages” to continue slash-and-burn agriculture. In the old village, 48.5% of households lived in open-structured plot huts and only 5.7% of them had sufficient LLIN coverage. Household representatives believed malaria could be cured with antimalarials (57.8%), but also perceived non-malarial medicines, rituals, and vitamin supplements to be effective against malaria. Household members (n = 1,957) used public health services for their most recent illness (62.9%), but also reported to buy low-cost medicines from the private sector to treat fevers and discomfort as these were perceived to be the most cost-effective treatment option for slash-and-burn farmers. The study shows the relevance of understanding social factors to improve the uptake of public health interventions and calls for contextually adapted strategies for malaria elimination in ethnic minority populations in Vietnam and similar settings.

Background: Despite free distribution of insecticidal-treated nets (ITNs) and long-lasting insecticidal nets (LLINs) to populations at-risk, malaria transmission persists in forested areas in Vietnam especially amongst ethnic minority communities. A study was conducted between April 2009 and December 2010 in four villages of Ca Dong and M’nong ethnicity located in Central Vietnam with persistent malaria transmission. The objective was to assess the feasibility of bed net use in forest settings with a specific emphasis on contrasting people’s willingness/choice to use nets versus structural limitations to the uptake of the intervention. Methods: The study used an exploratory mixed-method design for complementarity. The qualitative strand included participant observation, informal interviews, in-depth interviews, and group discussions to explore contextual barriers to bednet use. The quantitative strand consisted of a cross sectional household survey (n=141) in a selected village with direct access to bed nets and the health centre. The main outcome was bednet use and related risk factors (using survey logistic regression), and secondary outcomes included the quantification of contextual factors identified during the qualitative strand. Results: Despite self-reported bednet coverage (72.5% of households had sufficient net coverage) and appropriate betnet use the night before the survey (82.2% of HHMs), only 18.4% of HHMs were effectively protected by nets in both the village home and the forest field. The distribution of LLINs and ITNs was not accounted for multiple residency and sleeping places linked to slash-and-burn agriculture, and contextual factors including open-housing structured, high poverty, and animistic beliefs contributing to inappropriate use and shorter lifespan of nets. Health messages promoting bednet use were provided to the population but only 19.8% of respondents considered mosquito bites as the sole cause of malaria. The multi-variable logistic regression showed the effect of four significant factors to appropriate bednet use: being female (AOR=8.08; p=0.009); having knowledge of mosquito bites and malaria link (AOR=7.43; p=0.008); not sleeping in the kitchen (AOR=24.57; p=0.001); and, having sufficient number of bednets in the household (AOR=21.69; p=0.001). Conclusion: This study identified contextual factors that constrains effective bednet use amongst ethnic minority populations living in forested areas of Central Vietnam and calls for multi-sectoral interventions to address the complexity of residual malaria transmission and reach the malaria elimination goal of 2030.

Malaria elimination in the Greater Mekong Sub-Region is challenged by a rising proportion of malaria attributable to P. vivax. Primaquine (PQ) is effective in eliminating the parasite’s dormant liver stages and can prevent relapsing infections, but it induces severe haemolysis in patients with Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency, highlighting the importance of testing enzyme activity prior to treatment. A mixed-method study was conducted in south-central Vietnam to explore the factors that affect acceptability of G6PD testing, treatment-seeking behaviors, and adherence to current regimens. The majority of respondents (75.7%) were unaware of the different parasite species and rather differentiated malaria by perceived severity. People sought a diagnosis if suspected of malaria fever but not if they perceived their fevers as mild. Most respondents agreed to take prescribed medication to treat asymptomatic infection (94.1%) and to continue medication even if they felt better (91.5%). Health professionals did not have G6PD diagnostic tools nor the means to prescribe PQ safely. Adherence to treatment was linked to trust in public providers, who were perceived to make therapeutic decisions in the interest of the patient. Greater focus on providing acceptable ways of assessing G6PD deficiency will be needed to ensure the timely elimination of malaria in Vietnam.

PurposeUnderstanding patients’ attitudes toward novel therapeutic options can help guide providers in personalizing treatment regimens for glaucoma patients. This study aimed to determine factors associated with acceptance of new drug delivery options among glaucoma patients. MethodsA total of 199 patient volunteers participated in an interviewer-administered survey from June to August 2016 at the Glaucoma Service of Massachusetts Eye and Ear. The questionnaire was designed to determine acceptance of 6 drug delivery approaches: (1) triple combination eye drop, (2) microdose eye spray, (3) drug-eluting contact lens, (4) drug-eluting periocular ring insert, (5) injectable subconjunctival drug insert, and (6) injectable anterior chamber implant. Other factors analyzed included self-reported demographics, disease severity, and prior ocular history. ResultsThe average respondent age was 63.2 ± 15.1 years; 48% were female. For approaches 1-6 listed above, overall acceptance rates were, respectively, 85%, 54%, 31%, 43%, 32%, and 30%. Patients with greater disease severity and prior incisional glaucoma surgery were more likely to pursue alternatives to traditional eye drops. ConclusionsThere is limited acceptance of alternatives to traditional eye drop medications among glaucoma patients. Understanding motivating factors and potential barriers to patient acceptance of novel drug delivery approaches is important in how providers will incorporate these glaucoma treatment options into practice.

While climate variability and change affect global patterns of disease, there are few examples of methods that effectively integrate climate into health programming. This study examines a Red Cross Red Crescent pilot project in Kenya, Tanzania, Vietnam, and Indonesia that incorporated climate information and considerations in health operations. Our investigation looks at three elements of programming: baseline community perceptions of climate and health, integration of climate information in operations, and resulting community-level risk reduction behaviour. (1) Through community focus groups, semi-structured interviews, and household surveys, our research reveals that potential health effects of climate variability and change are a key concern at the community level. (2) Project implementors used climate information to design educational materials and health contingency plans to inform when and where disease prevention activities should be concentrated. This climate-based disease anticipation and improved sharing of incidence data aimed to quickly detect and respond to changing disease patterns in a variable climate. (3) Subsequently, community-level risk reduction behaviour significantly increased in project locations. This pilot is evidence that climate information and considerations can be readily integrated into health programming to account for changing risks, using existing disease prevention techniques to address priority concerns of vulnerable communities.