Food safety has emerged as a paramount concern for both Vietnamese consumers and the government. However, limited data are available on food safety management systems in Viet Nam. This study identified significant gaps in good agricultural and hygienic practices along the fresh produce chain (farmers and traditional wholesalers/market sellers) in the region of Da Nang, Viet Nam. This was achieved through a survey on good agricultural and hygienic practices for farmers (n = 100) and sellers (n = 100), which researchers further supplemented by microbiological analysis for E. coli, Salmonella spp., and Listeria monocytogenes on leafy greens, water in contact with produce and contact surfaces (hands). The results indicated that 86.0 % of farmers and 54.0 % of sellers received food safety training in the last 3 years; and women dominated both vegetable cultivation but also trading. Farm-level deficiencies included inadequate handwashing practices, lack of documentation for manure application schedules, improper washing and drying of harvest tools, failure to keep containers elevated off the ground, improper storage of vegetables, and inadequate covering of containers, with respectively 34.0 %, 30.3 %, 12.1 %, 41.7 % and 7.9 % of farmers executing the practice as prescribed by the WHO/FAO \'5 keys of growing safer fruits and vegetables\'. As for sellers, the most dominant gaps (<50.0 % compliance) were the way of handwashing and the practice of keeping containers elevated off the ground before, during, and after harvesting. The microbiological analysis confirmed that, in a total of 36 fresh produce samples including mustard greens, cucumber, lettuce, and crown daisy, the number of samples positive for E. coli, Salmonella spp., and L. monocytogenes were 12, 2, and 10 respectively. Samples of hands and the irrigation water showed high contamination with E. coli. Based on identified gaps, risk communication tools were developed and distributed amongst farmers, sellers, and Da Nang food safety management authority (governmental organisation performing inspections in the traditional food markets). As intervention, two farmers and two sellers were trained in safe agricultural practices for the cultivation of fresh vegetables (managerial intervention) and instructed to use tap water as irrigation water instead of uncontrolled surface water (technological intervention). A post-assessment was conducted, including redoing the survey on good practices and microbiological analysis. The outcome of these interventions showed positive results in terms of good agricultural and hygienic practices resulting in improved hygiene levels and safety of the fresh produce. The findings from this research have the potential to provide a model for the development of a science-based risk management strategy in alternative food chains or geographic areas in emerging countries.

BACKGROUND: In Viet Nam, key populations (KPs) face barriers accessing HIV services. Virtual platforms can be leveraged to increase access for KPs, including for HIV self-testing (HIVST). This study compares reach and effectiveness of a web-based HIVST intervention from pilot to scale-up in Viet Nam.
METHODS: A mixed-methods explanatory sequential design used cross-sectional and thematic analysis. The pilot launched in Can Tho in November 2020, followed by Hanoi and Nghe An in April 2021. Scale-up included Can Tho and Nghe An, with 21 novel provinces from April to December 2022. After risk assessment, participants registered on the website, receiving HIVST (OraQuick®) by courier, peer educator or self-pick-up. Test result reporting and completing satisfaction surveys were encouraged. Intervention reach was measured through numbers accessing the testing, disaggregated by demographics, and proportion of individuals reporting self-testing post-registration. Effectiveness was measured through numbers reporting self-test results, testing positive and linking to care, and testing negative and using HIVST to manage pre-exposure prophylaxis (PrEP) use. Thematic content analysis of free-text responses from the satisfaction survey synthesized quantitative outcomes.
RESULTS: In total, 17,589 participants registered on the HIVST website; 11,332 individuals ordered 13,334 tests. Participants were generally young, aged <25 years (4309/11,332, 38.0%), male (9418/11,332, 83.1%) and men who have sex with men (6437/11,332, 56.8%). Nearly half were first-time testers (5069/11,332, 44.9%). Scale-up participants were two times more likely to be assigned female at birth (scale-up; 1595/8436, 18.9% compared to pilot; 392/3727, 10.5%, p < 0.001). Fewer test results were reported in scale-up compared with pilot (pilot: 3129/4140, 75.6%, scale-up: 5811/9194, 63.2%, p < 0.001). 6.3% of all tests were reactive (pilot: 176/3129, 5.6% reactive compared to scale-up: 385/5811, 6.6% reactive, p = 0.063); of which most linked to care (509/522, 97.5%). One-fifth of participants with a negative test initiated or continued PrEP (pilot; 19.8%, scale-up; 18.5%, p = 0.124). Thematic analysis suggested that community delivery models increased programmatic reach. Live chat may also be a suitable proxy for staff support to increase result reporting.
CONCLUSIONS: Web-based self-testing in Viet Nam reached people at elevated risk of HIV, facilitating uptake of anti-retroviral treatment and direct linkage to PrEP initiations. Further innovations such as the use of social-network testing services and incorporating features powered by artificial intelligence could increase the effectiveness and efficiency of the approach.

BACKGROUND: Hepatitis B virus (HBV) vaccination in Vietnamese adults remains low and unequally distributed. We conducted a study on HBV-naïve adults living in Ho Chi Minh City, Viet Nam, to determine barriers associated with HBV vaccination uptake after removing the financial barrier by providing free coupons for HBV vaccination.
METHODS: After being screened for HBsAg, anti-HBs, and anti-HBc, 284 HBV-naïve study participants aged 18 and over (i.e., negative for HBsAg, anti-HBs, and anti-HBc total) were provided free 3-dose HBV vaccine coupons. Next, study participants\' receipt of 1st, 2nd, and 3rd doses of HBV vaccine was documented at a pre-specified study healthcare facility, where HBV vaccines were distributed at no cost to the participants. Upon study entry, participants answered questionnaires on sociodemographics, knowledge of HBV and HBV vaccination, and related social and behavioral factors. The proportions of three doses of HBV vaccine uptake and their confidence intervals were analyzed. Associations of HBV vaccine initiation with exposures at study entry were evaluated using modified Poisson regression.
RESULTS: 98.9% (281 of 284) of study participants had complete data and were included in the analysis. The proportion of participants obtaining the 1st, 2nd, and 3rd doses of HBV vaccine was 11.7% (95% Confidence Interval [95% CI] 8.0-15.5%), 10.7% (95%CI 7.1-14.3%), and 8.9% (95%CI 5.6-12.2%), respectively. On the other hand, participants were more likely to initiate the 1st dose if they had adequate knowledge of transmission (adjusted relative risk [aRR] = 2.58, 95% CI 1.12-5.92), adequate knowledge of severity (aRR = 6.75, 95%CI 3.38-13.48), and annual health-checking seeking behavior (aRR = 2.04, 95%CI 1.07-3.87).
CONCLUSIONS: We documented a low HBV vaccination uptake despite incentivization. However, increased vaccine initiation was associated with better HBV knowledge and annual health check-up adherence. When considering expanding HBV vaccination to the general adult population, we should appreciate that HBV knowledge is an independent predictor of vaccine uptake.

UNASSIGNED: Translational Study Introduction: The proximal humeral fracture accounts for 4-5% of all fractures1 and traffic accidents are often the main cause of this injury in Vietnam. Shoulder hemiarthroplasty is a suitable option in treating a complex proximal humeral fracture, especially in the elderly, and improves quality of life. This study describes clinical and radiographic characteristics of complex proximal humerus fractures and evaluates the results of shoulder hemiarthroplasty for this type of fracture at Viet Duc University Hospital Materials and methods: A retrospective study of 78 cases with complex proximal humeral fractures underwent shoulder hemiarthroplasty in Viet Duc University Hospital from January 2017 to December 2021.
RESULTS: Traffic accidents (42 cases, 53.8%); daily-life accidents (34 cases, 43.6%), other causes were less common (2 cases, 2.6%). 74.4% of the patients had no pain, 17.4% mild pain, 7.7% moderate pain, and no patients suffered from severe pain that required regular narcotic analgesics. The mean postoperative Constant score was 67.45 ± 13.20.
CONCLUSIONS: In Viet Nam, the most common cause of injury was a traffic accident, primarily occurring in young males with complex proximal humerus fractures, shoulder hemiarthroplasty for complex proximal humerus fractures improves postoperative pain and shoulder function.

UNASSIGNED: To validate a serum biomarker developed in the USA for preterm birth (PTB) risk stratification in Viet Nam.
UNASSIGNED: Women with singleton pregnancies (n = 5000) were recruited between 19+0-23+6 weeks\' gestation at Tu Du Hospital, Ho Chi Minh City. Maternal serum was collected from 19+0-22+6 weeks\' gestation and participants followed to neonatal discharge. Relative insulin-like growth factor binding protein 4 (IGFBP4) and sex hormone binding globulin (SHBG) abundances were measured by mass spectrometry and their ratio compared between PTB cases and term controls. Discrimination (area under the receiver operating characteristic curve, AUC) and calibration for PTB <37 and <34 weeks\' gestation were tested, with model tuning using clinical factors. Measured outcomes included all PTBs (any birth ≤37 weeks\' gestation) and spontaneous PTBs (birth ≤37 weeks\' gestation with clinical signs of initiation of parturition).
UNASSIGNED: Complete data were available for 4984 (99.7%) individuals. The cohort PTB rate was 6.7% (n = 335). We observed an inverse association between the IGFBP4/SHBG ratio and gestational age at birth (p = 0.017; AUC 0.60 [95% CI, 0.53-0.68]). Including previous PTB (for multiparous women) or prior miscarriage (for primiparous women) improved performance (AUC 0.65 and 0.70, respectively, for PTB <37 and <34 weeks\' gestation). Optimal performance (AUC 0.74) was seen within 19-20 weeks\' gestation, for BMI >21 kg/m2 and age 20-35 years.
UNASSIGNED: We have validated a novel serum biomarker for PTB risk stratification in a very different setting to the original study. Further research is required to determine appropriate ratio thresholds based on the prevalence of risk factors and the availability of resources and preventative therapies.

BACKGROUND: In Viet Nam, tuberculosis (TB) represents a devastating life-event with an exorbitant price tag, partly due to lost income from daily directly observed therapy in public sector care. Thus, persons with TB may seek care in the private sector for its flexibility, convenience, and privacy. Our study aimed to measure income changes, costs and catastrophic cost incurrence among TB-affected households in the public and private sector.
METHODS: Between October 2020 and March 2022, we conducted 110 longitudinal patient cost interviews, among 50 patients privately treated for TB and 60 TB patients treated by the National TB Program (NTP) in Ha Noi, Hai Phong and Ho Chi Minh City, Viet Nam. Using a local adaptation of the WHO TB patient cost survey tool, participants were interviewed during the intensive phase, continuation phase and post-treatment. We compared income levels, direct and indirect treatment costs, catastrophic costs using Wilcoxon rank-sum and chi-squared tests and associated risk factors between the two cohorts using multivariate regression.
RESULTS: The pre-treatment median monthly household income was significantly higher in the private sector versus NTP cohort (USD 868 vs USD 578; P = 0.010). However, private sector treatment was also significantly costlier (USD 2075 vs USD 1313; P = 0.005), driven by direct medical costs which were 4.6 times higher than costs reported by NTP participants (USD 754 vs USD 164; P < 0.001). This resulted in no significant difference in catastrophic costs between the two cohorts (Private: 55% vs NTP: 52%; P = 0.675). Factors associated with catastrophic cost included being a single-person household [adjusted odds ratio (aOR = 13.71; 95% confidence interval (CI): 1.36-138.14; P = 0.026], unemployment during treatment (aOR = 10.86; 95% CI: 2.64-44.60; P < 0.001) and experiencing TB-related stigma (aOR = 37.90; 95% CI: 1.72-831.73; P = 0.021).
CONCLUSIONS: Persons with TB in Viet Nam face similarly high risk of catastrophic costs whether treated in the public or private sector. Patient costs could be reduced through expanded insurance reimbursement to minimize direct medical costs in the private sector, use of remote monitoring and multi-week/month dosing strategies to avert economic costs in the public sector and greater access to social protection mechanism in general.

The transport of floating macroplastics (>2.5 cm) can be impacted by variations in hydrometeorological forcing. Several studies have demonstrated that river discharge, wind, and tides can either accelerate or impede the downstream travel path of plastic. However, there remains a substantial gap in our understanding of the impact of river geomorphological complexity on this process. In this context, the role that river bifurcations play in driving plastic dynamics under different hydrometeorological conditions is largely unexplored. Here, we show that specific plastic item categories react differently to the transport drivers, and bifurcation areas can function both as a retention and release site of plastic litter. We found that hard polyolefin appears to be the most responsive plastic to changes in flow discharge (ρ≈0.40, p≈0.01). Absolute wind velocity magnitude does not correlate to plastic transport. We explored correlations of the various plastic items types with wind vector components in all directions. Multilayer plastics correlated highest to the wind vector component that is most effective in driving plastics from an urban area to the river (ρ≈0.57, p≈0.0001). On a monthly scale, the bifurcation area retained up to 50% of the incoming upstream plastic flux. At other times, an additional 30% was released in the same area. Our results demonstrate how bifurcations distribute different plastic items types downstream under varied hydrometeorological conditions. These yields underscore the importance of assessing floating plastic transport in specific plastic item categories and taking river geomorphological complexity into account.

This cross-sectional study is the first to describe the prevalence of violence and poly-victimisation among 310 female sex workers (FSWs) who were cisgender in Haiphong, Viet Nam. An adapted version of the WHO-Multi-Country Study on Violence against Women Survey Instrument was administered to assess physical, sexual, economic and emotional forms of violence perpetrated by an intimate partner, paying partner/client, and/or others (e.g. relatives, police, strangers and other FSWs) during adulthood. The ACE-Q scale was administered to assess adverse childhood experiences (ACEs) before age 18 years. Our findings showed that FSWs are exposed to high rates of multiple forms of violence by multiple perpetrators. For any male client-perpetrated violence (CPV), lifetime prevalence was 70.0%, with 12-month prevalence 61.3%. Lifetime prevalence of male intimate partner violence (IPV) was 62.1%, and the 12-month prevalence was 58.2%. Lifetime and prior 12-month prevalence of physical and/or sexual violence by other perpetrators (OPV) was 18.1% and 14.2%, respectively. Sixty-five percent of FSWs reported at least one type of ACE. Overall, 21.6 percent of FSWs reported having experienced all three forms of violence (IPV, CPV and OPV) in their lifetime. Policy and programme recommendations for screening and prevention of violence are needed in this setting.

Globally, most people with multidrug-resistant tuberculosis (MDR-TB) and their households experience catastrophic costs of illness, diagnosis, and care. However, the factors associated with experiencing catastrophic costs are poorly understood. This study aimed to identify risk factors associated with catastrophic costs incurrence among MDR-TB-affected households in Ho Chi Minh City (HCMC), Viet Nam.
Between October 2020 and April 2022, data were collected using a locally-adapted, longitudinal WHO TB Patient Cost Survey in ten districts of HCMC. Ninety-four people with MDR-TB being treated with a nine-month TB regimen were surveyed at three time points: after two weeks of treatment initiation, completion of the intensive phase and the end of the treatment (approximately five and 10 months post-treatment initiation respectively). The catastrophic costs threshold was defined as total TB-related costs exceeding 20% of annual pre-TB household income. Logistic regression was used to identify variables associated with experiencing catastrophic costs. A sensitivity analysis examined the prevalence of catastrophic costs using alternative thresholds and cost estimation approaches.
Most participants (81/93 [87%]) experienced catastrophic costs despite the majority 86/93 (93%) receiving economic support through existing social protection schemes. Among participant households experiencing and not experiencing catastrophic costs, median household income was similar before MDR-TB treatment. However, by the end of MDR-TB treatment, median household income was lower (258 [IQR: 0-516] USD vs. 656 [IQR: 462-989] USD; p = 0.003), and median income loss was higher (2838 [IQR: 1548-5418] USD vs. 301 [IQR: 0-824] USD; p < 0.001) amongst the participant households who experienced catastrophic costs. Being the household\'s primary income earner before MDR-TB treatment (aOR = 11.2 [95% CI: 1.6-80.5]), having a lower educational level (aOR = 22.3 [95% CI: 1.5-344.1]) and becoming unemployed at the beginning of MDR-TB treatment (aOR = 35.6 [95% CI: 2.7-470.3]) were associated with experiencing catastrophic costs.
Despite good social protection coverage, most people with MDR-TB in HCMC experienced catastrophic costs. Incurrence of catastrophic costs was independently associated with being the household\'s primary income earner or being unemployed. Revision and expansion of strategies to mitigate TB-related catastrophic costs, in particular avoiding unemployment and income loss, are urgently required.

UNASSIGNED: Intestinal stomas are surgical interventions that have an impact on both physical and psychological health, necessitating patient self-care. Insufficient knowledge regarding peristomal skin care, prevention, and treatment of potential problems can lead to an increase in stoma-related complications.
UNASSIGNED: This study aimed to assess patients\' knowledge of self-care for intestinal stomas and examine the relationship between background information and self-care knowledge.
UNASSIGNED: A descriptive cross-sectional study was conducted from December 2021 to December 2022 at the Can Tho University of Medicine and Pharmacy Hospital in Vietnam, involving 74 participants with intestinal stomas. A questionnaire consisting of 24 closed-ended questions was used to evaluate participants\' knowledge of self-care for intestinal stomas. Descriptive statistics, Chi-square, and Fisher\'s exact tests were employed for data analysis.
UNASSIGNED: The findings revealed that 54.1% of participants had good knowledge of general self-care for intestinal stomas. The distribution of good knowledge among participants was as follows: basic knowledge (66.2%), self-care practice (56.8%), recognizing and managing complications (31.1%), and dietary knowledge (64.8%). Significant relationships were observed between participants\' self-care knowledge and their education level (p = 0.002), marital status (p = 0.017), nurses\' education (p = 0.021), and hospitalization (p = 0.001).
UNASSIGNED: The proportion of participants with good knowledge of self-care for intestinal stomas was relatively low, and it was associated with individuals\' education level, marital status, nurses\' education, and hospitalization. This study highlights the need for ongoing development of educational programs on self-care for intestinal stomas. These programs should be tailored to address the specific needs of each patient and aim to improve their self-care knowledge in a meaningful and sustainable manner. By investing in patient education, healthcare professionals, particularly nurses, can assist individuals with intestinal stomas in achieving better outcomes and preventing potential complications.